Dr. Bray Links

Monday, May 29, 2017

Evidence Accumulates Outside of Randomized Controlled Trials

Observational trials and large datasets are increasingly being used to answer research questions that randomized controlled trials cannot, according to experts at the Big Data in Biomedicine 2017 Conference in Stanford, California.

Certain issues are not appropriate for randomized controlled trials, such as the value of breast-feeding and the optimum weight for good health, said Mark Cullen, MD, director of the Center for Population Health Sciences at Stanford University.

Observational studies can be faster, less expensive, and better able than large clinical trials to deliver on the promise of precision medicine, he noted.

Each type of study has its place, said Allison Kurian, MD, associate professor of medicine and of health research and policy at Stanford University.

There is "nothing like a randomized controlled trial" for the assessment of novel therapies, "but there are important questions for which observational studies may do as well, or better," she told Medscape Medical News.


Thursday, May 25, 2017

Meditation Not All Sweetness and Light

Individuals who practice meditation may have unexpected, challenging, distressing, and even functionally impairing experiences, new research shows.

The challenging aspects of Buddhist-derived meditation practices are well described in Buddhist tradition but are less so in Western scientific literature, the researchers note.

"Certainly, we are not trying to detract from the fact that there are a lot of benefits of meditation, and that's been pretty well documented, but just because something is beneficial doesn't mean that we should remain unaware of the full range of possibilities," Jared Lindahl, PhD, visiting assistant professor, Brown University Cogut Center for the Humanities, in Providence, Rhode Island, told Medscape Medical News.


Wanted: Top doctor to care for 7 billion people - BBC News

Dr Tedros Adhanom Ghebreyesus

"I was born into a poor family. When I was seven, I lost my younger brother, probably to measles. I survived by chance, but it could have been me.

"For me, this position is about standing up for the rights of the poor.

"If I became director general, I would be very vocal on the issue of universal healthcare.

"We complain about emergencies or epidemics, worried it may come to our country. But if we ensure universal health coverage, we can resolve all of those issues.

"Inequity is a central challenge. The world has all the resources to save every life, as long as we believe every life is important.

"Those who have, do not care for the have-nots, and unless we confront that reality honestly, I don't think we will make progress."

Dr Sania Nishtar

"I was born and brought up in Peshawar on the Afghan border in Pakistan. I was raised in a progressive family. My father encouraged us to swim in the summer and play golf. I was a local golf champion by the time I was 16.

"When I was 15, my father passed away silently in his sleep - I think that was a turning point in my life.

"I trained as a cardiologist and I became very disillusioned with the disparity of care between the rich and the poor.

"My vision for this role centres on regaining the WHO's primacy, and ensuring that it has the world's trust as its lead health agency.

"Since the Ebola outbreak, the WHO has come under heavy criticism for its inability to... exercise stewardship during health emergencies.

"I want to make the organisation more accountable and transparent.

"I want it to focus on its core roles, rather than doing everything under the sun, in a half-baked way. I would lead the WHO very differently."

Dr David Nabarro

"My parents are both doctors, and probably because of their influence, I started working outside the UK.

"It was when I was working in Nepal in 1989, that I found how malnutrition and disease were most likely to come from households that faced particularly difficult circumstances in terms of income, the status of women and their access to sanitation and water.

"It seemed to me blindingly obvious that I had to work on the underlying determinants of health.

"My first priority if I become director general of the WHO, is to focus on universal health coverage - everybody being able to access healthcare when and where they need it.

"My second priority is to make sure people can be defended against outbreaks of disease.

"Thirdly, we are seeing increasing levels of diabetes, heart disease and mental ill-health. These kinds of non-communicable conditions could be prevented by better work across governments and society." 


'Half a glass of wine every day' increases breast cancer risk

What does this report say?

It says there are ways women can lower their risk of breast cancer by focusing on factors they can control, like diet, weight and exercise.

After analysing more than 100 studies that examined the medical history of 12 million women, the report backs up current advice to be aware of alcohol consumption.

The report found evidence that drinking an extra small glass of wine every day (10g of alcohol) increases a woman's risk of breast cancer after the menopause by 9%.
What does that really mean?

It means that in a group of 100 women, around 13 would be likely to develop breast cancer anyway.

And if they all drank an additional small glass of wine every day, one extra case might develop among the original group. 


They Went to Manchester Arena as Homeless Men. They Left as Heroes. - NYTimes.com

Mr. Parker, 33, was panhandling when the bomb exploded, according to local news reports. The force of the blast knocked him to the floor, but he was unfazed.

Rather than running for safety, he went to the aid of victims, comforting a girl who had lost her legs, wrapping her in a T-shirt, and cradling a dying woman in his arms.

Mr. Jones, 35, says he pulled nails out of children's arms and faces.

"Just because I am homeless doesn't mean I haven't got a heart, or I'm not human still," he told ITV News. "I'd like to think someone would come and help me if I needed the help," he said, adding that he had been overcome by an "instinct" to pitch in.


Two drug counselors overdosed at addiction facility

"If anybody is wondering how bad the opioid epidemic has become, this case is a frightening example," Chester County District Attorney Tom Hogan said. "The staff members in charge of supervising recovering addicts succumbed to their own addiction and died of opioid overdoses. Opioids are a monster that is slowly consuming our population." Authorities haven't released the counselors' names. 


Saturday, May 20, 2017

Diarrhea outbreaks linked to swimming pools on the rise in US | Fox News

Before you dive into the pool this summer, consider this: Health officials are warning that outbreaks of diarrhea caused by swallowing pool water containing parasites have doubled in the last few years.

The parasite, named Cryptosporidium or Crypto, is difficult to kill and caused at least 32 outbreaks in swimming pools or water parks in 2016 compared with just 16 in 2014. It's the most common cause of diarrhea outbreaks linked with swimming facilities because it can survive up to 10 days in chlorinated water, Reuters reported. An infected person can battle symptoms including stomach cramps, watery diarrhea, nausea or vomiting for up to three weeks.


Friday, May 19, 2017

John Mackey of Whole Foods Market Debates on Nutritional Science

At a Junto meeting in New York City in March 2015, Co-Founder and Co-CEO Whole Foods Market, John Mackey, and the author of "The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet," Nina Teicholz, held a debate. The proposition: "An animal foods/low-carb diet is unhealthy compared with a 90+% plant diet that excludes sugar and refined grain products." Mackey spoke in favor of the proposition and Teicholz against. View the entire debate here. 


The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs

The preponderance of scientific evidence shows that NSAIDs damage articular cartilage. Various scientific papers and consensus groups have stated that there is no convincing data to show that the widely used NSAIDs and recommended selective COX-2 inhibitors have favorable effects on cartilage.129-131 Even the main consensus paper from the International Cartilage Repair Society and Osteoarthritis Research Society International stated that NSAID use has to be limited to the short term. Specifically the recommendation was as follows: In patients with symptomatic hip or knee osteoarthritis, non-steroidal anti-inflammatory drugs (NSAIDs) should be used at the lowest effective dose but their long-term use should be avoided if possible.132 They also noted that NSAIDs should not be first-line therapy for joint OA. Other groups have raised similar sentiments. The committees of the International League Against Rheumatism and the World Health Organization came up with guidelines for the testing of new drugs in osteoarthritis. The consensus from these meetings resulted in recommendations by The European Group for the Respect of Ethics and Excellence in Science (GREES) for governmental registration and approval of new drugs used in the treatment of OA and have added the requirement that the drug not have a deleterious effect on the diseased and non-diseased contra lateral joint; i.e., no deleterious effect on osteoarthritic or normal cartilage.133 If this latter recommendation were followed, the vast majority, if not all NSAIDs, would be immediately taken off the market and no new ones would get approved.

While it is admirable for the various consensus and rheumatology organizations to educate doctors and the lay public about the necessity to limit NSAID use in OA, this author (RH) feels the warnings are not enough. Within the last year, for instance, the FDA has again implemented new rules requiring stronger and more extensive label warnings (in addition to the heart disease risks) regarding the risk of liver damage and stomach bleeding for people taking common over-the-counter pain relievers. As for NSAIDs, the new regulations require front labels to instruct users to see new warnings that say, "This product contains a nonsteroidal anti-inflammatory drug (NSAID), which may cause severe stomach bleeding. The chance is higher if you are age 60 or older, have had stomach ulcers or bleeding problems, take a blood thinning or steroid drug, take other drugs containing prescription or nonprescription NSAIDs, have three or more alcoholic drinks every day using this product, take more or for a longer time than directed."134

The lay public for whom NSAIDs are prescribed and recommended by both health care professionals and drug manufacturers should be aware that long-term NSAID use is detrimental to articular cartilage. Specifically, be informed that NSAIDs will likely worsen the OA disease for which it is prescribed. Physicians, allied health care professionals, and drug manufacturers should be required to inform the lay public that NSAID use can accelerate OA articular cartilage degeneration. A strict warning label on these medications should read as follows:

Enzyme Supplement Protects Gluten-sensitive Patients

CHICAGO — The prolyl endoprotease enzyme derived from Aspergillus niger might help people with a gluten sensitivity who unintentionally consume wheat or other grains avoid troublesome gastrointestinal symptoms, a small study suggests.

The enzyme, known as AN-PEP and marketed as Tolerase G by DSM in the United States, "actually works," said lead investigator Julia König, PhD, from Örebro University in Sweden. "There are a lot of enzymes on the market, but this functions in the stomach where the pH is acidic. Often enzymes don't work in this environment."

Perturbing Status of Vitamin B12 in Indian Infants and Their Mothers

Vitamin B12 deficiency in early life can adversely affect the growth of developing brain with myriad of neurodevelopmental manifestations. At this age, the deficiency is usually the result of low maternal levels.

To assess the vitamin B12 status of healthy exclusively breast-fed Indian infants aged 1 to 6 months and their mothers.

One hundred term exclusively breast-fed infants aged 1 to 6 months attending pediatric outpatient department were recruited. Hemogram, serum B12, folate, and ferritin levels were obtained from each infant-mother pair.

The prevalence of B12 deficiency in infants was found to be 57%. Forty-six percent of mothers were deficient. There was a positive correlation ( r = .23) between the B12 levels of the infants and their mothers.

There is a high prevalence of vitamin B12 deficiency in Indian infants and their mothers. There is an urgent need to supplement our population with vitamin B12, and the best time to do this would be antenatal.


Thursday, May 18, 2017

New Guidelines for Deprescribing Proton Pump Inhibitors

A new practice guideline aims to help clinicians make decisions about when and how to safely deprescribe proton pump inhibitors (PPIs).

The evidence-based recommendations incorporate data from key clinical studies and focus on outcomes that are important to patients, including the harms and benefits of PPI dose reduction.

Barbara Farrell, PharmD, ACPR, FCSHP, from the University of Ottawa in Ontario, Canada, and colleagues published the evidence-based guideline in the May issue of Canadian Family Physician.

"A PPI deprescribing guideline works in conjunction with current treatment guidelines because it offers clinicians recommendations and clinical considerations to help them deprescribe PPIs in patients after an appropriate treatment duration or if long-term therapy is being reevaluated," the authors write.

Concern about the overuse of PPIs has been rising as data accumulate regarding potential adverse effects, including increased risk for kidney disease, Clostridium difficile infection, and hip fractures. Chronic PPI use is also common, with some studies showing a lack of ongoing indication for PPI treatment in as many as 40% to 65% of hospitalized patients who receive the drugs.


Tuesday, May 16, 2017

Steroid Injections Increased Cartilage Loss in Knee Arthritis

Quarterly corticosteroid injections for knee osteoarthritis increased cartilage loss over the course of 2 years without providing any clinical benefit, according to a randomized controlled trial published in the May 16 issue of JAMA.

"Although the cartilage loss was not associated with worsening of symptom outcomes, rates of cartilage loss have been associated with higher rates of arthroplasty, raising the possibility of potential for longer-term adverse consequences on the health of the joint," write Timothy E. McAlindon, MD, MPH, from Tufts Medical Center in Boston, Massachusetts, and colleagues.

The researchers compared outcomes between two groups of 70 patients, average age 58 years, with symptomatic knee osteoarthritis with synovitis, identified through ultrasonography. From February 2013 to January 2015, patients in one group received 40 mg triamcinolone in intra-articular injections, and those in the other group received placebo saline injections every 12 weeks for 2 years.


Saturday, May 13, 2017

The labels said ‘organic.’ But these massive imports of corn and soybeans weren’t

A shipment of 36 million pounds of soybeans sailed late last year from Ukraine to Turkey to California. Along the way, it underwent a remarkable transformation.

The cargo began as ordinary soybeans, according to documents obtained by The Washington Post. Like ordinary soybeans, they were fumigated with a pesticide. They were priced like ordinary soybeans, too.

But by the time the 600-foot cargo ship carrying them to Stockton, Calif., arrived in December, the soybeans had been labeled “organic,” according to receipts, invoices and other shipping records. That switch — the addition of the “USDA Organic” designation — boosted their value by approximately $4 million, creating a windfall for at least one company in the supply chain.

After being contacted by The Post, the broker for the soybeans, Annapolis-based Global Natural, emailed a statement saying it may have been “provided with false certification documents” regarding some grain shipments from Eastern Europe. About 21 million pounds of the soybeans have already been distributed to customers.

The multimillion-dollar metamorphosis of the soybeans, as well as two other similar grain shipments in the past year examined by The Post, demonstrate weaknesses in the way that the United States ensures that what is sold as “USDA Organic” is really organic.

The three shipments, each involving millions of pounds of “organic” corn or soybeans, were large enough to constitute a meaningful proportion of the U.S. supply of those commodities. All three were presented as organic, despite evidence to the contrary. And all three hailed from Turkey, now one of the largest exporters of organic products to the United States, according to Foreign Agricultural Service statistics.

Agriculture Department officials said that they are investigating fraudulent organic grain shipments. But the agency declined to identify any of the firms or shipments involved.

“We are continuing the investigation based on the evidence received,” it said in a statement.


Wednesday, May 10, 2017

All NSAIDs Linked to Increased MI Risk

Use of nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen, considered by some as one of the safest drugs in this class, is associated with a significantly increased risk for myocardial infarction (MI), results of a new patient-level meta-analysis show.

The analysis showed the heightened MI risk occurred as early as the first week of use and the risk was greater with higher doses.

"This new research on NSAIDs reinforces what physicians know already, that patients should use the smallest possible dose for the shortest possible time," Michèle Bally, PhD, an epidemiologist in the Department of Pharmacy and Research Center, Centre hospitalier de l'Université de Montréal, Quebec, Canada, told Medscape Medical News.

Even though the research suggests the increased MI risk lessened over time, "the findings were not conclusive enough about longer duration," said Dr Bally.

But for most patients, the risk is very small, she noted. "If you average people with different baseline heart risks, the risk specifically due to an NSAID is only about 1% per year, so out of 100 people treated continuously for a year, there will be one extra heart attack."

The research was published online May 3 in BMJ.


Tuesday, May 9, 2017

Chelation for Coronary Heart Disease | NCCIH

Overall, TACT showed that infusions of disodium EDTA chelation therapy produced a modest reduction in cardiovascular events. However, further examination of the data showed that chelation therapy benefitted only the patients with diabetes.
Patients with diabetes, who made up approximately one-third of the 1,708 TACT participants, had a 41 percent overall reduction in the risk of any cardiovascular event; a 40 percent reduction in the risk of death from heart disease, nonfatal stroke, or nonfatal heart attack; a 52 percent reduction in recurrent heart attacks; and a 43 percent reduction in death from any cause. In contrast, there was no significant benefit of EDTA treatment in participants who didn't have diabetes.
The TACT study team also looked at the impact of taking high-dose vitamins and minerals in addition to chelation therapy. They found that chelation plus high-dose vitamins and minerals produced the greatest reduction in risk of cardiovascular events versus placebo.


Serum levels of lead, mercury and cadmium in relation to coronary artery disease in the elderly: A cross-sectional study


There is a continuing attempt to identify novel factors that can predict the risk of cardiovascular disease beyond the established coronary risk factors. It has been suggested that serum levels of lead, mercury and cadmium are associated with the risk of coronary artery disease (CAD). In the present study, we aimed to evaluate serum concentrations of lead (s-Pb), mercury (s-Hg) and cadmium (s-Cd) in patients with CAD in comparison with those of healthy individuals. The correlation between serum levels of these heavy metals and lipid profile parameters was also investigated.

In this case-control study, we included 65 patients (35 females) aged 50-70 years with angiographically-documented CAD and 65 healthy controls (43 female) matched for sex, age and place of residence. Serum concentrations of heavy metals were determined using graphite furnace atomic absorption (GFAA). Serum lipids were measured using routine enzymatic methods.

It was observed that the mean concentration of s-Pb (12.54 ± 8.41 vs. 5.89 ± 4.44 μg/L, p < 0.05) and s-Cd (0.938 ± 0.72 vs. 0.448 ± 0.30, p < 0.05; CI: 95%) and s-Hg (10.14 ± 5.06 vs. 6.11 ± 5.66, p < 0.05) were significantly higher in CAD patients compared with control subjects. The same result was also obtained after adjustment for cardiovascular risk factors including age, dyslipidemia, diabetes mellitus and hypertension (p < 0.05). The mean concentration of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and TC:HDL-C ratio were significantly higher in CAD patients (p < 0.05). There was no significant association between serum metal concentrations with TC, HDL-C and TC:HDL-C ratio (p > 0.05).

The present results showed that serum levels of heavy metals are associated with the presence of CAD. Long-term exposure to trace levels of Pb, Cd and Hg may play a role in the development of coronary atherosclerotic plaques.


Consumption of seafood and its estimated heavy metals are associated with lipid profile and oxidative lipid damage on healthy adults

The association between the consumption of seafood and its benefits on cardiovascular (CVD) risk can be challenged by its heavy metal (HM) content. This study aimed to explore the association of seafood consumption and its estimated HM contents with the lipid profile and lipid oxidation biomarkers in adults from a Spanish Mediterranean area who do not present risk factors for CVD. In this cross-sectional study, the clinical history, three-day dietary record, lipid profile (LDLc, HDLc, APOB/A, and triglyceride levels), plasma oxidised LDL (oxLDL) and 8-isoprostane levels of 81 adults without risk factors for CVD [43% men, with a mean age of 43.6 years (95%CI: 40.1-47.1)] were assessed. The HM [arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb)] contents of seafood were estimated according to data from analyses of marine species in the same Mediterranean area. Moderate adherence to the Mediterranean diet (score: 4.6 of 9) with a mean seafood consumption of 74.9g/day (95%CI: 59.9-89.9), including 22.7g of shellfish per day (95%CI: 13.5-31.9), was observed. The estimated HM contents were lower than the provisional tolerable weekly intakes (PTWIs): 21.12µg/kg/week As, 0.57µg/kg/week InAs, 0.15µg/kg/week Cd, 1.11µg/kg/week Hg and 0.28µg/kg/week Pb. After adjusting by confounder variables, an increase in shellfish consumption was associated with increases in the levels of LDLc (P=0.013), non-HDLc (P=0.015), APOB/A (P=0.02) and plasma oxLDL (P=0.002). Moreover, an increase in the estimated As and Hg levels in shellfish was associated with an increase in LDLc (P=0.015 and P=0.018, respectively), non-HDLc (P<0.008 and P<0.008, respectively), APOB/A ratio (P=0.008 and P=0.009, respectively), and oxLDL (P≤0.001 and P≤0.001, respectively) levels. In conclusion, in adults without risk factors for CVD, increasing shellfish consumption, even by a moderate amount, could favour a pro-atherogenic lipid profile and a higher level of oxidised LDL. These associations are likely influenced by the estimated exposure to As and Hg from shellfish despite these values are lower than the PTWIs.


Sunday, May 7, 2017

Compositional differences in soybeans on the market: Glyphosate accumulates in Roundup Ready GM soybeans

This article describes the nutrient and elemental composition, including residues of herbicides and pesticides, of 31 soybean batches from Iowa, USA. The soy samples were grouped into three different categories: (i) genetically modified, glyphosate-tolerant soy (GM-soy); (ii) unmodified soy cultivated using a conventional "chemical" cultivation regime; and (iii) unmodified soy cultivated using an organic cultivation regime. Organic soybeans showed the healthiest nutritional profile with more sugars, such as glucose, fructose, sucrose and maltose, significantly more total protein, zinc and less fibre than both conventional and GM-soy. Organic soybeans also contained less total saturated fat and total omega-6 fatty acids than both conventional and GM-soy. GM-soy contained high residues of glyphosate and AMPA (mean 3.3 and 5.7 mg/kg, respectively). Conventional and organic soybean batches contained none of these agrochemicals. Using 35 different nutritional and elemental variables to characterise each soy sample, we were able to discriminate GM, conventional and organic soybeans without exception, demonstrating "substantial non-equivalence" in compositional characteristics for 'ready-to-market' soybeans.


The U.S. Government Wants You to Know that GMOs are Safe

The Food and Drug Administration will fund a campaign to promote genetically modified organisms in food under a bipartisan agreement to keep the government funded through the end of September.

The deal to avert a government shutdown allocates $3 million to "consumer outreach and education regarding agricultural biotechnology," which includes genetic engineering of food and commodity crops. The money is to be used to tout "the environmental, nutritional, food safety, economic, and humanitarian impacts" of biotech crops and their derivative food products.

More than 50 agriculture and food industry groups had signed on to an April 18 letter urging the funding to counter "a tremendous amount of misinformation about agricultural biotechnology in the public domain." But some environmental groups and House Democrats have derided the provision as a government-sponsored public relations tour for the GMO industry.

"It is not the responsibility of the FDA to mount a government-controlled propaganda campaign to convince the American public that genetically modified foods are safe," said Rep. Nita M. Lowey (D-N.Y.), who attempted to get the measure struck from the bill last month. "The FDA has to regulate the safety of our food supply and medical devices. They are not, nor should they be, in the pro-industry advertising business," Lowey said during a congressional hearing

It's unclear what the FDA campaign will look like, or when it will launch. The $3 million allocated is little more than a speck in the FDA's total allocated budget of $2.8 billion.


Embattled by Sea Lice, Salmon Farmers Dump Pesticides in Our Waters

Every day, salmon farmers across the world walk into steel cages – in the seas off Scotland or Norway or Iceland – and throw in food. Lots of food; they must feed tens of thousands of fish before the day is over. They must also check if there are problems, and there is one particular problem they are coming across more and more often. Six months ago, I met one of these salmon farmers, on the Isle of Skye. He looked at me and held out a palm – in it was a small, ugly-looking creature, all articulated shell and tentacles: a sea louse. He could crush it between his fingers, but said he was impressed that this parasite, which lives by attaching itself to a fish and eating its blood and skin, was threatening not just his own job, but could potentially wipe out a global multibillion-dollar industry that feeds millions of people.

"For a wee creature, it is impressive. But what can we do?" he asks. "Sometimes it seems nature is against us and we are fighting a losing battle. They are everywhere now, and just a few can kill a fish. When I started in fish farming 30 years ago, there were barely any. Now they are causing great problems."

Lepeophtheirus salmonis, or the common salmon louse, now infests nearly half of Scotland's salmon farms. Last year lice killed thousands of tonnes of farmed fish, caused skin lesions and secondary infections in millions more, and cost the Scottish industry alone around £300m in trying to control them.

Scotland has some of the worst lice infestations in the world, and last year saw production fall for the first time in years. But in the past few weeks it has become clear that the lice problem is growing worldwide and is far more resistant than the industry thought. Norway produced 60,000 tonnes less than expected last yearbecause of lice, and Canada and a dozen other countries were all hit badly. Together, it is estimated that companies across the world must spend more than £1bn a year on trying to eradicate lice, and the viruses and diseases they bring.

As a result of the lice infestations, the global price of salmon has soared, and world production fallen. Earlier this year freedom of information [FoI] requests of the Scottish government showed that 45 lochs had been badly polluted by the antibiotics and pesticides used to control lice – and that more and more toxic chemicals were being used.


Does Too Much Turmeric Have Side Effects?

Turmeric and curcumin supplements do not seem to have any serious side effects.

However, some people may be prone to mild discomfort, such as headaches or diarrhea, at high doses.

Keep in mind that low-quality turmeric may be adulterated with cheap fillers, such as wheat starch, which will cause adverse symptoms in people with gluten intolerance. 


Saturday, May 6, 2017

Gaining weight in middle age? It's this molecule's fault, scientists say

Chung and his colleagues looked for molecular changes that occurred in animals during middle age and found that an enzyme called DNA-dependent protein kinase, or DNA-PK, increases in activity with age.

Their research showed that this enzyme is involved in  metabolism (such as the conversion of nutrients to fat) and in the production of mitochondria, or the "powerhouses" in cells that turn nutrients into energy. It's known that as people age, they see a drop in the number of mitochondria.

In the study, the researchers found that giving mice that were on a high-fat diet a drug that inhibits DNA-PK led to a weight gain in those mice that was 40 percent less, compared to mice that were also on this diet but didn't receive the drug.

In addition, mice that received the drug saw an increase in the number of mitochondria in their skeletal muscle cells, and experienced increased aerobic fitness.

"Our studies indicate that DNA-PK is one of the drivers of the metabolic and fitness decline that occurs during aging, which makes staying lean and physically fit difficult" in older age, Chung said. 

However, the researchers noted that the findings don't mean people should abandon diet and exercise as they get older, since these are still the primary tools for fighting obesity. Middle-age adults should continue with these practices, even if it takes a while to see results, they said.

The study was published in the May issue of the journal Cell Metabolism.


The Evolution of Primary Care | May 2017 Functional Forum

For our May show, the Evolution of Medicine is thrilled to be heading to Minnesota, MN for the first time, the site of the largest Functional Forum Meetup to date. So far in 2017, we have focused each episode on medical specialties, where the functional medicine operating system could be beneficial in going upstream and solving the root causes of those disease categories.

Primary Care, however, is where we believe is the rightful place for functional medicine not only for the best clinical outcomes, but also for the positive economic impact for payers and patients alike. During the episode we will not only be looking at the clinical models, but also evolved delivery models including micropractices, membership models and episodes of care.

Furthermore, the Evolution of Primary Care is about all different professions coming together to serve patients on the front lines, helping people create and maintain health. To this end, we'll be featuring a variety of guests from across the professions set to this evolution.

Featured in this episode are leaders in the space who are already bringing functional medicine to the masses. First we welcome, Dr. Thomas Sult who brings decades of experience treating tough cases. He's on the faculty at the Institute for Functional Medicine and will be sharing insight from his clinic "Third Opinion".

We are thrilled to welcome Dr. Kristi Hughes for her Functional Forum debut. Dr. Hughes is one of the most popular educators with the Institute for Functional Medicine and has a successful functional medicine practice. She be sharing a mix of clinical and practical pearls about operating a functional medicine practice on the front lines.

We're also very excited to welcome Dr. Sachin Patel of the Living Proof Institute as our other keynote speaker. Dr. Patel is running of one of the most innovative functional medicine practices in North America. His Living Proof Institute is expanding rapidly. Dr. Patel has been innovating the group structure, marketing, and patient acquisition. We're very excited to share his vision of the future of primary care.

Also, joining this group of practitioners is journalist, Pilar Gerasimo, founding editor of Experience Life magazine who has been covering the emergence of functional medicine for more than a decade.


Wednesday, May 3, 2017

Ketogenic Diet And Lowered Seizure Incidence Due to Tryptophan

The recently released study by P. Maciejak et al. (2016) examined whether the interaction between fatty acids from the ketogenic diet and the amino acid tryptophan was responsible for the decreased seizure risk in epileptics, with an emphasis of the interaction pathway in children.  The study allegedly found that the efficacy of the ketogenic diet in reducing seizures seems to be due primarily to an increased presence of the ketones known as "acetoacetic acid", "acetone" and "β-hydroxybutyric acid" in hepatic (liver) cells. The authors previously published work which found that an anti-epileptic drug mimicking the structure of a medium-chain triglyceride (MCT) led to an increase in the metabolism of tryptophan 3. The previous study also noted that the increased levels of trytophan passed into the central nervous system (CNS), which were then converted into kynurenic acid, potentially explaining the role of tryptophan in the CNS to control seizures. Other studies have also confirmed that tryptophan leads to an increase in levels of kynurenic acid in the CNS 4.  Kynurenic acid itself is believed to play a role in seizure incidence.

So, through an elaborate pathway, it seems that tryptophan may indirectly regulate and lower the incidence of seizures when its metabolism is increased in the presence of fatty acids. The new study found that increased levels of fatty acids led to a significant increase in the amount of current required to induce typical seizure symptoms such as "after discharges" (ADs), or rather an increase in the seizure threshold level. The mechanism was examined extensively within rat hippocampal cells and it was concluded to most likely be due to increased tryptophan metabolism, confirming the hypothesis from the prior study.

To conclude, these findings show that the primary benefits of a ketogenic diet in the treatment of epileptic seizures are most likely due to higher levels of tryptophan crossing into the CNS. Despite these findings, there are numerous older studies which have failed to show that tryptophan supplemented directly reduces seizure incidence or intensity 5.  This could mean that the pathway with which tryptophan enters the CNS to increase seizure threshold cannot be activated by consuming the amino acid directly, but rather requires indirect activation through MCTs. This study does seem to confirm that a ketogenic diet, under appropriate medical advise and supervision, may be used in the management of epilepsy, and furthermore demonstrates why this is so.


Mercury in Fish Tied to a Higher ALS Risk

Mercury in fish and seafood has been linked to an increased risk for amyotrophic lateral sclerosis (ALS), new research shows.

Findings from a preliminary study showed that among persons who ate fish and seafood regularly, those in the top 25th percentile for an estimated annual mercury intake had a more than two-fold increased risk for ALS compared with those with lower levels.

"For most people, eating fish is part of a healthy diet. But questions remain about the possible impact of mercury in fish," study investigator Elijah Stommel, MD, PhD, said in a press release.

The findings were presented here at the American Academy of Neurology 2017 Annual Meeting (AAN) by coinvestigator Angeline S. Andrew, PhD.

Tuesday, May 2, 2017

JAMA Takes Sweeping Aim at Conflicts of Interest in Medicine

In a wide-ranging multifaceted review, the current edition of JAMA, published online May 2, explores the complex landscape of physician conflicts of interest (COIs) and suggests remedial solutions.

As healthcare expenditure, transparency, patient-centered medicine, and physician–patient trust take center stage, the 44-page, 23-essay review offers opinions and strategies from medical specialists as well as ethicists, public policy advocates, health economists, and experts in decision-making behavior.

"This issue has been an important one in medicine for well over a decade," said JAMA Editor-in-Chief Howard C. Bauchner, MD, a professor of pediatrics at Boston University School of Medicine in Massachusetts, in an interview with Medscape Medical News. "[COI] is critical to the health and well-being of the medical profession because the profession relies on trust. We have to get this right."