Dr. Bray Links

Monday, December 10, 2018

Even When Not In Rome, Eat A Mediterranean Diet To Cut Heart Disease Risk | Kaiser Health News

Once again, your mother was right. You really do need to eat your vegetables. And while you are at it, put down the bacon and pick up the olive oil, because new research supports the contention that switching to a Mediterranean diet could significantly decrease the risk of heart disease.

According to a study published Friday in JAMA Network Open, people who followed this type of diet had 25 percent less risk of developing cardiovascular disease over the course of 12 years.

https://khn.org/news/even-when-not-in-rome-eat-a-mediterranean-diet-to-cut-heart-disease-risk/

Saturday, December 8, 2018

Association of Frequency of Organic Food Consumption With Cancer Risk

Results  Among 68 946 participants (78.0% female; mean [SD] age at baseline, 44.2 [14.5] years), 1340 first incident cancer cases were identified during follow-up, with the most prevalent being 459 breast cancers, 180 prostate cancers, 135 skin cancers, 99 colorectal cancers, 47 non-Hodgkin lymphomas, and 15 other lymphomas. High organic food scores were inversely associated with the overall risk of cancer (hazard ratio for quartile 4 vs quartile 1, 0.75; 95% CI, 0.63-0.88; P for trend = .001; absolute risk reduction, 0.6%; hazard ratio for a 5-point increase, 0.92; 95% CI, 0.88-0.96).

Conclusions and Relevance  A higher frequency of organic food consumption was associated with a reduced risk of cancer. If these findings are confirmed, further research is necessary to determine the underlying factors involved in this association.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2707948

Ultraviolet and Vitamin D

Reptiles need UVB for biosynthesis of vitamin D, and other metabolic processes. Specifically cholecalciferol (vitamin D3), which is needed to for basic cellular / neural functioning as well as the utilization calcium for bone and egg production. The UVA wavelength is also visible to many reptiles and might play a signifiant role in their ability survive in the wild as well as visual communication between individuals. Therefore, in a typical reptile enclosure, a fluorescent UV a/b source (at the proper strength / spectrum for the species), must be available for many captive species to survive. Simple supplementation with cholecalciferol (Vitamin D3) will not be enough as there's a complete biosynthetic pathway that is "leapfrogged" (risks of possible overdoses), the intermediate molecules and metabolites also place important functions in the animals health. Natural sunlight in the right levels is always going to be superior to artificial sources, but this might be possible for keepers in different parts of the world. 

https://en.m.wikipedia.org/wiki/Ultraviolet

Tuesday, December 4, 2018

The acute and chronic effects of hot water immersion on inflammation and metabolism in sedentary, overweight adults

Regular exercise-induced acute inflammatory responses are suggested to improve the inflammatory profile and insulin sensitivity. As body temperature elevations partly mediate this response, passive heating might be a viable tool to improve the inflammatory profile. This study investigated the acute, and chronic effects of hot water immersion on inflammatory and metabolic markers. Ten sedentary, overweight males (BMI: 31.0±4.2 kg/m2) were immersed in water set at 39°C for 1 h (HWI) or rested for 1 h at ambient temperature (AMB). Venous blood was obtained prior to, immediately post and 2 h post-session for assessment of monocyte intracellular heat shock protein 72 (iHsp72) and plasma concentrations of extracelullar heat shock protein 72 (eHsp72), interleukin-6 (IL-6), fasting glucose, insulin and nitrite. Thereafter, participants underwent a 2-week intervention period, consisting of 10 hot water immersion sessions (INT). Eight BMI-matched participants (BMI: 30.0±2.5 kg/m2) were included as control (CON). Plasma IL-6 and nitrite concentrations were higher immediately following HWI compared to AMB (IL-6 p<0.001, HWI: 1.37±0.94 to 2.51±1.49 pg/ml; nitrite p=0.04, HWI: 271±52 to 391±72 nM), while iHsp72 expression was unchanged (p=0.57). In contrast to resting iHsp72 expression (p=0.59), fasting glucose (p=0.04, INT: 4.44±0.93 to 3.98±0.98 mmol/l), insulin (p=0.04, INT: 68.1±44.6 to 55.0±29.9 pmol/l) and eHsp72 (p=0.03, INT: 17±41% reduction) concentrations were lowered after INT compared to CON. HWI induced an acute inflammatory response and increased nitric oxide bioavailability. The reductions in fasting glucose and insulin concentrations following the chronic intervention suggest that hot water immersion may serve as a tool to improve glucose metabolism.

https://www.physiology.org/doi/abs/10.1152/japplphysiol.00407.2018

Sunday, December 2, 2018

Patients Often Withhold Information From Providers

The most common situations in which information was withheld were not agreeing with the clinician's recommendation (MTurk, 45.7%; SSI, 31.4%) and not understanding the clinician's instructions (MTurk, 31.8%; SSI, 24.3%).

The five reasons most commonly indicated for participants not disclosing information were not wanting to be judged or lectured (MTurk, 81.8%; SSI, 64.1%), not wanting to hear how harmful their behavior is (MTurk, 75.7%; SSI, 61.1%), embarrassment (MTurk, 60.9%; SSI, 49.9%), not wanting the clinician to think they were difficult patients (MTurk, 50.8%; SSI, 38.1%), and not wanting to take up more of the clinician's time (MTurk, 45.2%; SSI, 35.9%).

"If patients are withholding information from clinicians as frequently as this research suggests, then clinicians are routinely not receiving the information that they need to provide high quality care to patients, especially sicker patients," the researchers conclude. They note that sicker patients were more likely to withhold information.

https://www.medscape.com/viewarticle/905825

Saturday, December 1, 2018

A novel hypothesis for atherosclerosis as a cholesterol sulfate deficiency syndrome

Worldwide geographical data show an inverse relationship between cardiovascular disease and annual sunlight availability [18]. In a study conducted in the British Isles, 49 % of the variance in mortality from coronary heart disease was accounted for by mean annual sunshine hours as measured by the Meteorological Office [19]. However, placebo-controlled trials failed to show any benefit from vitamin D3 supplementation [20]. We propose that the benefit comes from Ch-S synthesis instead. In [16], it was proposed that the protein endothelial nitric oxide synthase (eNOS), along with sunlight, catalyzes sulfate production in erythrocytes, endothelial cells, platelets and keratinocytes in the skin. Thus, eNOS is a dual-purpose enzyme, producing sulfate when it is membrane–bound and producing nitric oxide when it is free in the cytoplasm. We hypothesize that the overuse of sunscreen has played a dual damaging role not only because sunlight catalysis is suppressed but also because the aluminum found in high-SPF sunscreens as an emulsifier actively disrupts eNOS' function [21]. eNOS is an orphan cytochrome P450 (CYP) enzyme [22], and aluminum is a known disruptor of CYP enzyme function through its displacement of the iron in the heme group [23]. Many other environmental toxicants also disrupt CYP enzymes, including mercury [24, 25], arsenic [26], cadmium [24], glyphosate [27, 28], and lead [25, 29].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456713/

Wednesday, November 28, 2018

Can Diet Reverse Type 2 Diabetes?

Unlike in DiRECT, patients were allowed to take insulin at study onset (30% in the low-carbohydrate group and 46% in the usual care group). After 1 year, patients in the usual care group had no significant changes in study biomarkers.

Conversely, 60% of those in the low-carbohydrate group achieved an A1c level < 6.5 while taking no diabetes medications or metformin only. There was also a 12% weight loss, 24% reduction in triglyceride level, 18% increase in high-density lipoprotein cholesterol level, and 39% reduction in C-reactive protein level.

According to Sarah Hallberg, DO, the study's principal investigator and medical director of Virta Health and Indiana University Arnett's Medically Supervised Weight Loss Program, the 94% rate of reduction or outright cessation of insulin in this group is particularly noteworthy.

https://www.medscape.com/viewarticle/905409

Sunday, November 25, 2018

Report: Toxic herbicide found in many Texans' drinking water | The Texas Tribune


Nearly 500 water utilities across the state tested positive for atrazine — a weed killer — which can lead to harmful health effects, according to a new report. The Environmental Working Group also found that utilities are testing water during times when the herbicide isn't being used as much — and that they may be lowballing the results.


https://www.texastribune.org/2018/11/15/report-toxic-herbicide-found-many-texans-drinking-water/

The Real Scoop on the Latest Low-Carb Diet Study

Those in the low-carb-diet group had significantly higher total energy expenditure than those in the other groups. They were burning about 209 calories per day more than the high-carb group.

https://www.medscape.com/viewarticle/904963

Tuesday, November 20, 2018

This Inventor May Have Cured Motion Sickness Without Drugs. And That Could Mean a Lot to the US Military - Defense One

The vibrations emanating from the OtoTech gently target two of the four fibers that carry data about body motion to the brain via a system of inner ear sensors called the vestibulocochlear nerve. "Two [of the four vestibulocochlear nerve fibers] go to the brain, two go to your reflexes," Owen said. The trick is to affect the former and not the latter.

"The working hypothesis is that [the vibration] causes a chaotic and noninformative stimulus to go to the brain. Somewhere, probably the cerebellum, there's a filtering mechanism that filters out noninformative sensed information. It's the reason you don't notice the shirt on your back right now," he said.

https://www.defenseone.com/technology/2018/11/inventor-may-have-cured-motion-sickness-without-drugs-and-could-mean-lot-us-military/152960/

Sunday, November 18, 2018

Death of HHS official Daniel Best is ruled a suicide

The Nov. 1 death of Daniel Best, a pharmaceutical executive from Bay Village who led U.S. Department of Health and Human Services efforts to lower prescription drug prices, has been ruled a suicide, officials in Washington, D.C., said Thursday.

Police say Best was found "unresponsive" near the garage door exit of an apartment building in Washington, D.C.'s Navy Yard neighborhood at 5:25 a.m. on Nov. 1, and was pronounced dead by medical personnel who responded to the scene.

The city's Office of the Chief Medical Examiner on Thursday said Best died from "multiple blunt force injuries" and it ruled his death a suicide. It would not release further information.

http://12160.info/m/discussion?id=2649739%3ATopic%3A1847383

Eating More Organic Food Tied to Lower Cancer Risk

A higher frequency of eating organic food was associated with a reduced risk for cancer, according to results from a large population-based observational study published online October 22 in JAMA Internal Medicine.

"Promoting organic food consumption in the general population could be a promising preventive strategy against cancer," conclude the authors, led by Julia Baudry, PhD, of the Center of Research in Epidemiology and Statistics Sorbonne Paris Cité.


https://www.medscape.com/viewarticle/903742

The High Cost of Pesticides: Human and Animal Diseases | OMICS International

A significant degradation in the health of wild animals in Montana has been recorded over the past two decades. We surmise that the health issues are related to pesticide exposure. We present some of the evidence of the deterioration of the health in wildlife, which we used to inspire investigations on human health in the US population. While the animals' exposure is through food, water and air, we believe that human exposure is predominantly through food, as the majority of the population does not reside near agricultural fields and forests. We have obtained US government data on pesticide usage and on human disease patterns over time from the 1998-2010 hospital discharge data. Since glyphosate is by far the most widely used herbicide, we believe it to be a major source of contamination for humans. Correlations between glyphosate usage and specific health issues, along with the known toxicology profile of glyphosate obtained from the literature, reflect a plausible causal relationship. Because much of the wildlife data is from deer fawns, most of the human data presented here involve newborn infants, but we also present some data for children 0-15 years old and for the full population (except newborn). We found many diseases and conditions whose hospital discharge rates match remarkably well with the rate of glyphosate usage on corn, soy, and wheat crops. These include head and face anomalies (R=0.95), newborn eye disorders, newborn blood disorders (R=0.92), newborn skin disorders (R=0.96), lymph disorders in children 0-15 (R=0.86) and in the general population except newborn (R=0.89), congenital heart conditions in newborns (R= 0.98), enlarged right ventricle in all age groups except newborn (R=0.96), newborn lung problems (R=0.95), pulmonary bleeding and edema for all age groups except newborn (R=0.97), liver cancer for all age groups except newborn (R=0.93), newborn metabolic disorders (R=0.95) and newborn genitourinary disorders (R=0.96).

https://www.omicsonline.org/open-access/the-high-cost-of-pesticides-human-and-animal-diseases-2375-446X-1000132.php?aid=56471

Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT: Cell


Murine gut mucosal probiotic colonization is only mildly enhanced by antibiotics
Human gut mucosal probiotic colonization is significantly enhanced by antibiotics
Post antibiotics, probiotics delay gut microbiome and transcriptome reconstitution
In contrast, aFMT restores mucosal microbiome and gut transcriptome reconstitution

https://www.cell.com/cell/fulltext/S0092-8674%2818%2931108-5?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867418311085%3Fshowall%3Dtrue

Saturday, November 17, 2018

EMA Curtails Use of Fluoroquinolone, Quinolone Antibiotics

Fluoroquinolones "should be used with special caution in the elderly, patients with kidney disease and those who have had an organ transplantation because these patients are at a higher risk of tendon injury. Since the use of a corticosteroid with a fluoroquinolone also increases this risk, combined use of these medicines should be avoided," the EMA advised.

On the basis of available evidence, the EMA concluded that fluoroquinolones are associated with prolonged (up to months or years), serious, disabling, and potentially irreversible drug reactions affecting more than one and sometimes multiple systems, organ classes, and senses.

The adverse effects include tendonitis, tendon rupture, arthralgia, pain in the extremities, gait disturbance, neuropathies associated with paraesthesia, depression, fatigue, memory impairment, sleep disorders, and impaired hearing, vision, taste, and smell.

Tendon damage (especially to the Achilles tendon but also other tendons) can occur within 48 hours of starting a fluoroquinolone, but the damage may be delayed several months after stopping treatment, the EMA said.

https://www.medscape.com/viewarticle/905023

Worse than opioids: Alcohol deaths soar among the middle-aged, women

From 2007 to 2017, the number of deaths attributable to alcohol increased 35 percent, according to a new analysis by the Institute for Health Metrics and Evaluation at the University of Washington. The death rate rose 24 percent.

One alarming statistic: Deaths among women rose 67 percent. Women once drank far less than men, and their more moderate drinking helped prevent heart disease, offsetting some of the harm.

https://www.usatoday.com/story/news/health/2018/11/16/alcohol-deaths-emergency-room-increase-middle-aged-women-addiction-opioids/1593347002/

Thursday, November 15, 2018

Novel Agent Lowers Lp(a), Meets All End Points in Phase 2

A novel antisense agent is relatively safe and highly effective in lowering levels of lipoprotein(a) in patients with both elevated Lp(a) and established cardiovascular disease (CVD), new research suggests.

In a dose-finding phase 2b trial that examined five regimens in more than 200 patients with CVD and Lp(a) levels of 60 mg/dL or higher. Treatment with the subcutaneous injectable drug known as AKCEA-APO(a)-LRX (Akcea Therapeutics/Ionis Pharmaceuticals) was associated with a dose-dependent effect on these levels from baseline to week 25 to 27, meeting the primary end point.

In addition, for the patients receiving the highest active dose evaluated, 20 mg/week, there was a mean 80% reduction in Lp(a) from baseline.

Lead author Sotirios Tsimikas, MD, vice president of Global Cardiovascular Development at Ionis Pharmaceuticals and professor of medicine at the University of California, San Diego, noted that this is especially dramatic compared with currently available treatments, including proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors.

"Looking at current therapies, PCSK-9 inhibitors lower Lp[a] by about 15% to 25% and niacin can lower it by 20% to 30%. So this is two to three times more potent than what's currently available to lower Lp(a)," Tsimikas told theheart.org | Medscape Cardiology.

Results also showed that 98% of the participants "got to goal," defined as Lp(a) less than 50 mg/dL. "This means almost everybody who got on the drug got to a level that we think has very low risk," Tsimikas said.

In addition, the 20 mg/week dose met all secondary outcomes, including mean change from baseline in low-density-lipoprotein cholesterol (LDL-C), ApoB, and oxidized phospholipids on apoB particles (OxPL-apoB and OxPl-apo[a]).

https://www.medscape.com/viewarticle/904891

Low-Carbohydrate Diets May Increase Energy Expenditure

 Lowering dietary carbohydrate intake could help in maintaining weight loss, new research suggests. However, some experts say the trial methodology makes drawing conclusions difficult.

Findings from a randomized trial comparing the metabolic effects of diets of varying carbohydrate-to-fat ratio were presented November 14 here at Obesity Week 2018 by David S. Ludwig, MD, and Cara B. Ebbeling, MD, both of the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts. The findings were simultaneously published in BMJ.

The study found that lowering dietary carbohydrate increased energy expenditure during weight loss maintenance, especially among those with high insulin secretion. However, the investigators' use of doubly labeled water to measure energy expenditure was called into question during the Obesity Week symposium by Kevin Hall, PhD, a senior investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

The bottom line, symposium chair and Obesity Society president Caroline M. Apovian, MD, told Medscape Medical News, is, "We need to do more studies to show that this is actually the case. There's controversy...This may mean that we haven't yet figured out how to find out what each individual person needs to eat for better health."

https://www.medscape.com/viewarticle/904956

Wednesday, November 14, 2018

Effect of Amla fruit (Emblica officinalis Gaertn.) on blood glucose and lipid profile of normal subjects and type 2 diabetic patients

Overall, the results of the present study suggest that Amla fruit (E. officinalis, Gaertn.) has both anti-hyperglycemic and lipid-lowering properties and might be used as an ideal plant food supplement in developing successful alternative therapies in the prevention and treatment of diabetes, dyslipidemia, obesity and cancers in general population. 

https://www.tandfonline.com/doi/full/10.3109/09637486.2011.560565?scroll=top&needAccess=true

Efficacy and safety of Amla (Phyllanthus emblica L.) in non-erosive reflux disease: a double-blind, randomized, placebo-controlled clinical trial. - PubMed - NCBI

BACKGROUND:

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal complaints. GERD, caused by the reflux of stomach contents into the esophagus, leads to troublesome symptoms such as heartburn and regurgitation. It is classified into two types: erosive esophagitis, characterized by visible esophageal mucosa erosion in endoscopy, and non-erosive reflux disease (NERD). GERD is a chronic and recurrent disease that impairs the quality of life and imposes socioeconomic and therapeutic burdens to both patients and society.
OBJECTIVE:

Due to the failure of the conventional treatments for GERD and to the traditional use of Amla (Phyllanthus emblica L.), in addition to beneficial effects shown in recent studies, we evaluated the safety and efficacy of Amla tablet for improvement of symptoms of patients with NERD.
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS:

We designed a double-arm, randomized, double-blind, placebo-controlled clinical trial. Sixty-eight patients who had classic symptoms of GERD (heartburn, regurgitation and epigastralgia) for at least three months before the start of the trial were randomized in two parallel groups. Patients in the Amla group received two 500 mg Amla tablets twice a day, after meals, for 4 weeks. In the control group, patients received placebo tablets similar to the Amla prescription.
MAIN OUTCOME MEASURES:

The patients were visited at baseline, and at the end of the 2nd and 4th weeks of intervention; their symptoms were measured on a frequency and severity scale for the symptoms of NERD, according to the quality of life in reflux-associated disease questionnaire.
RESULTS:

Frequencies of heartburn and regurgitation in both groups of the study were significantly reduced after intervention (P < 0.001). Repeated measures logistic regression analysis showed that, in the Amla group, there was a more significant reduction in regurgitation frequency, heartburn frequency, regurgitation severity and heartburn severity during the study period, compared with the placebo group (P < 0.001).
CONCLUSION:

This randomized double-blind, placebo-controlled clinical trial demonstrated that Amla could reduce frequencies of heartburn and regurgitation and improve heartburn and regurgitation severity in patients with NERD.

https://www.ncbi.nlm.nih.gov/pubmed/2952623

AHA.18: Nonstatin therapies, CAC testing claim larger role in cholesterol guidelines

New cholesterol guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) recommend adding ezetimibe and/or PCSK9 inhibitors to statin therapy for select high-risk patients, and also propose using coronary artery calcium scoring as "a tiebreaker" to guide statin decisions for those at intermediate risk of atherosclerotic cardiovascular disease (ASCVD).

"How we treat and how we prevent (CVD) can vary from patient to patient," said ACC vice president Richard Kovacs, MD. "This guideline gives clinicians the tools that we need to have those conversations with patients about the most appropriate treatment for high cholesterol."

The 121-page guideline, which was presented Nov. 10 at the AHA's Scientific Sessions in Chicago, was also published online in Circulation and the Journal of the American College of Cardiology.

https://www.cardiovascularbusiness.com/topics/lipids-metabolic/nonstatin-therapies-cac-screening-headline-new-cholesterol-guidelines

AHA.18: VITAL, REDUCE-IT deliver mixed results for fish oil products

VITAL and REDUCE-IT—both highly anticipated trials revolving around the cardiovascular benefits of fish oil products—delivered mixed results at this year's AHA Scientific Sessions in Chicago, with one trial observing few heart benefits from omega-3s while the other saw a 25 percent reduction in major cardiovascular events with a purified eicosapentaenoic acid (EPA) product.


https://www.cardiovascularbusiness.com/topics/lipids-metabolic/vital-reduce-it-deliver-mixed-results

AHA.18: US government updates physical activity guidelines for first time since 2008

As for adults, experts still recommend anywhere between 150 and 300 minutes of moderately intense aerobic activity, like power walking or dancing, each week in addition to two days of strength training. As a whole, recommendations for seniors also stayed the same.

The new guidelines expanded on recommendations for preschoolers aged 3 through 5, who Giroir and colleagues said should be active throughout the day to enhance growth and development. They recommend at least three hours of activity a day, ideally in a variety of settings.

A breadth of new evidence

According to Giroir, new data allowed the guideline committee to take into account a series of unique health considerations. We're now more aware of the extensive health benefits that come with physical activity, as well as the risks associated with being sedentary.

Sedentary behavior, in particular, was a major talking point for this year's guidelines. The first key recommendation for adults is to "move more and sit less"—a tip based in evidence that increased sedentary behavior leads to more heart disease, high blood pressure and all-cause death. Giroir also underlined the fact that evidence now suggests exercise has immediate health benefits, including reducing anxiety and blood pressure, improving sleep quality and increasing insulin sensitivity.

The new guidelines also account for unique patient populations, like pregnant women and those with chronic health conditions or disabilities. Those groups are advised to aim for 150 minutes of physical activity a week and should consult with their specialists before beginning any kind of training program.


https://www.cardiovascularbusiness.com/topics/practice-management/government-updates-physical-activity-guidelines

Patient engagement falls short as ‘blockbuster drug’ physicians are seeking

Medical organizations across the country are trending toward patient-centered care, incorporating meaningful patient activation and engagement (PAE) into their clinical routines. But, despite a push for more personalized medicine, the majority of physicians and assistants still fail to fully understand what PAE means, and much less how to incorporate it into practice.

It's widely accepted that patients and families who are actively engaged in their care see more favorable health outcomes, first author Manish K. Mishra, of the Geisel School of Medicine at Dartmouth, and colleagues wrote in BMJ Open. Techniques like goal-setting, motivational interviewing and shared decision-making are all regarded as successful approaches to PAE.

"If patient engagement is the new 'blockbuster drug,' why are we not seeing spectacular effects?" Mishra et al. wrote. "Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organizations (ACOs). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown."

https://www.cardiovascularbusiness.com/topics/practice-management/patient-engagement-falls-short-physicians

Even ‘intermittent’ exposure to Western lifestyle leads to BP increases

A study of two neighboring communities living in the remote Venezuelan rainforest is poking holes in the idea that blood pressure inevitably increases with age.  

Residents of one community, the Yanomami, demonstrated a flat BP throughout the life course, as indicated by age-BP intercepts and slopes derived from blood pressure measurements in 72 participants aged 1 to 60. On the other hand, Yekwana participants showed average annual increases of 0.25 mm Hg for systolic BP and 0.18 for diastolic BP, based on measurements from 83 participants. Overall, the average blood pressures for the Yanomami and Yekwana, respectively, were 95.4/62.9 mm Hg and 104/66.1 mm Hg.

Both communities are inaccessible by land, but the Yekwana village is near a small airstrip, which has allowed for missionaries to visit as well as intermittent exposure to "aspects of Western lifestyle" like salt, medicine and processed foods. The Yanomami, however, "are among the least acculturated peoples in the world" and have the lowest known BP measurements of any adults, Noel T. Mueller, PhD, MPH, and colleagues wrote in JAMA Cardiology.

https://www.cardiovascularbusiness.com/topics/hypertension/even-intermittent-exposure-western-lifestyle-leads-bp-increases

Tuesday, November 13, 2018

Pricey Precision Medicine Often Financially Toxic For Cancer Patients | Kaiser Health News

Insurers say costs aren't their only concern. Evidence is lacking that the precision medicine approach will work consistently, they argue.

America's Health Insurance Plans, an industry group, said genetic sequencing remains unproven.

Cathryn Donaldson, the group's spokeswoman, described recent scientific advances as "remarkable and noteworthy." But she said insurers "need a more definitive answer" about whether the tests help the average patient live longer.

The South Dakota State Employee Health Plan — which runs Kilmer's insurance plan — said it bases its coverage decisions on science and reviews "published, randomized data about the safety and efficacy of the requested drugs."

Although genetic testing has become the standard of care for melanoma and a common type of lung cancer, no one knows if genomic sequencing will extend the lives of people with other types of cancer, said Dr. Carolyn Presley, an assistant professor at the Ohio State University Comprehensive Cancer Center.

https://khn.org/news/pricey-precision-medicine-often-financially-toxic-for-cancer-patients/

Brain Inflammation Seen for First Time in Fibromyalgia

Researchers have reported for the first time that they have found inflammation in the brains of patients with fibromyalgia.

Daniel S. Albrecht, PhD, a postdoctoral fellow with the Department of Radiology at Massachusetts General Hospital, and Harvard Medical School, Boston, and colleagues, joined with a research team led by Anton Forsberg, PhD, of the Department of Clinical Neuroscience at the Karolinska Institute in Stockholm, Sweden, to broaden generalizability and boost statistical power of the study.

The researchers write that although there has been mounting evidence that brain inflammation plays some role in fibromyalgia, this research is the first to show direct evidence of brain glial activation in the poorly understood and difficult-to-treat chronic condition.

The findings were published online September 14 in Brain, Behavior, and Immunity.

https://www.medscape.com/viewarticle/904827

Wednesday, November 7, 2018

Multiple metal exposures and metabolic syndrome: A cross-sectional analysis of the National Health and Nutrition Examination Survey 2011-2014

Epidemiologic studies suggest toxic metals are linked with diabetes and cardiovascular disease, while experimental studies indicate nutritionally essential metals are involved in the metabolism of macronutrients and defense against oxidative stress.
OBJECTIVES:

We sought to evaluate how essential and toxic metals are cross-sectionally related to metabolic syndrome, a clustering of cardiometabolic conditions.
METHODS:

Using data from the 2011-2014 National Health and Nutrition Examination Survey (n = 1088), we characterized metal concentrations as measured in spot urine (arsenic, cadmium, and inorganic/elemental mercury), whole blood (manganese, lead, methylmercury, and selenium), and serum (copper and zinc) samples. Principal component analysis was performed to derive patterns of exposures. Metabolic syndrome was defined according to the 2009 Joint Scientific Statement as the presence of ≥ 3 of the following conditions: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, and abdominal obesity.
RESULTS:

After adjustment for potential confounders, prevalence ratios for metabolic syndrome comparing the highest to the lowest quartiles were 1.41 (95% CI: 1.18-1.67) for the arsenic-inorganic/elemental mercury pattern, 0.95 (0.78-1.16) for the methylmercury-manganese pattern, 0.73 (0.57-0.94) for the cadmium-lead pattern, 0.91 (0.76-1.10) for the copper pattern, and 1.36 (1.13-1.63) for the selenium-zinc pattern. The positive associations observed for the arsenic-inorganic/elemental mercury pattern were due to an elevated prevalence of high blood pressure, low HDL cholesterol, and high triglycerides among those with greater exposures. Associations for the selenium-zinc pattern were driven by a positive relationship with high triglycerides. Greater lead-cadmium co-exposures were related to a lower prevalence of dyslipidemia and abdominal obesity.
CONCLUSIONS:

These cross-sectional findings suggest both toxic and essential metal exposures may contribute to cardiometabolic health, but need to be confirmed with prospective data.

https://www.ncbi.nlm.nih.gov/pubmed/30388496

Quercetin, but Not Epicatechin, Decreases Plasma Concentrations of Methylglyoxal in Adults

Methylglyoxal (MGO) is the most potent precursor of advanced glycation end products (AGEs). MGO and AGEs have been associated with diabetes, its complications, and other age-related diseases. Experimental studies have shown that the flavonoids quercetin and epicatechin are able to scavenge MGO and lower AGE formation.
Objective:

Data on the effects of these flavonoids on MGO and AGE concentrations in humans are not yet available. We therefore investigated the effect of quercetin and epicatechin on the concentrations of MGO and AGEs in a post hoc analysis.
Methods:

Thirty-seven apparently healthy, nonsmoking adults with a systolic blood pressure between 125 and 160 mm Hg at screening were included in a randomized, double-blind, placebo-controlled crossover trial. Participants ingested (-)-epicatechin (100 mg/d), quercetin 3-glucoside (160 mg/d), or placebo capsules for periods of 4 wk separated by 4-wk washout periods. Fasting blood samples were collected at the start and end of each intervention period. Liquid chromatography-tandem mass spectrometry was used to determine plasma concentrations of the dicarbonyl compounds MGO, glyoxal (GO), and 3-deoxyglucosone (3-DG) and free and protein-bound AGEs. Gene expression of glyoxalase 1 (GLO1), the enzyme involved in the degradation of MGO, was determined by either microarray or quantitative reverse transcriptase-polymerase chain reaction.
Results:

The treatment effect (Δtreatment - Δplacebo) of quercetin on MGO was -40.2 nmol/L (95% CI: -73.6, -6.8 nmol/L; P = 0.019), a decrease of 11% from baseline values, whereas GO, 3-DG, and free and protein-bound AGEs did not change significantly. Epicatechin did not affect the concentrations of dicarbonyls and free and protein-bound AGEs. We did not find a significant change in expression of GLO1.
Conclusions:

In apparently healthy (pre)hypertensive men and women, quercetin but not epicatechin decreased plasma MGO concentrations. Quercetin may potentially form a new treatment strategy for diseases in which MGO plays a pivotal role. This study was registered at clinicaltrials.gov as NCT01691404.

https://www.ncbi.nlm.nih.gov/pubmed/30398646

Human drugs flowing into the animal kingdom - Times Union

Modern medicines are moving through sewage treatment systems and into aquatic insects and the animals that eat them, according to an environmental study in Australia that involved a Hudson Valley researcher.

Tests of six Australian streams near the city of Melbourne found animals there contained high doses of painkillers, antidepressants and other drugs that had gotten into the water after passing through municipal sewer systems that are unequipped to remove them.

https://m.timesunion.com/7dayarchive/article/Human-drugs-flowing-into-the-animal-kingdom-13367091.php#photo-16458812

Sunday, November 4, 2018

Cancer Fears Over Cell Phones, Again, but FDA Disagrees

Scientists from the National Toxicology Program (NTP), part of the National Institute of Environmental Health Sciences within the National Institutes of Health, issued a report on November 1 in which they said that their study clearly showed that male rats exposed to high levels of RFR developed heart schwannomas, a form of cancer that is very rare in humans.

They also said that there was some evidence to suggest that exposed male rats were at increased risk of developing tumors in the brain and adrenal glands.

John Bucher, PhD, senior scientist at the NTP, said in a release: "We believe that the link between radio frequency radiation and tumors in male rats is real, and the external experts agreed."

https://www.medscape.com/viewarticle/904317

Wednesday, October 31, 2018

Common Household Chemicals Tied to Language Delays in Kids

Early prenatal exposure to phthalates — the synthetic chemicals commonly found in household items and personal care products — has been tied to language delays in children, new research shows.

In the first study of its kind, the collaboration between investigators from the Icahn School of Medicine at Mount Sinai, New York City, and Karlstad University, Sweden, showed that the risk for language delay was as much as 30% greater in children whose mothers were exposed to twice the levels of dibutyl phthalate and butyl benzyl phthalate, two chemicals commonly found in such everyday items as cosmetics, plastic toys, and food.

"The bottom line here is that the phthalates that a mother is exposed to in early pregnancy can affect the development of the brain in her children, particularly in this area of language development," principal investigator Shanna Swan, PhD, professor of environmental and public health at the Icahn School of Medicine at Mount Sinai, told Medscape Medical News.

"Unfortunately, these results point to different phthalates than we've found to be bad actors in the past. We've previously observed negative associations with di-ethylhexyl phthalate, which is more commonly found in food. Now we have more phthalates to worry about," said Swan.

The study was published online October 29 in JAMA Pediatrics.


https://www.medscape.com/viewarticle/904083

Common Household Chemicals Tied to Language Delays in Kids

Saturday, October 27, 2018

Plant-Based Diet to Lower Type 2 Diabetes Risk: Is It All or Nothing?

A Plant-Based Dietary Index

We embedded these analyses in the Rotterdam study, a large population-based cohort in the Netherlands, where almost 15,000 people were followed over time. We measured their diets at baseline.

For each participant, we scored how much they consumed of plant-based foods—such as vegetables, nuts, and legumes—and of animal-based foods, such as meat, dairy, eggs, and fish. We computed an overall score, with higher scores reflecting more plant-based and less animal-based foods.

When we analyzed this plant-based diet score in relation to incident diabetes and insulin resistance—controlling for body mass index, physical activity, smoking, and several other factors—we consistently found that higher scores on the plant-based dietary index were related to lower diabetes risk and lower levels of insulin resistance in the general population.

Overall, these findings strengthen current dietary recommendations that support the adoption of a more plant-based diet for lowering the risk of developing type 2 diabetes.

https://www.medscape.com/viewarticle/903699

Thursday, October 18, 2018

Vitamin C cocktail for sepsis: randomized trials to test efficacy - PulmCCM

Since Marik et al announced exceptional survival rates among patients with septic shock given a cocktail of vitamin C, thiamine, and hydrocortisone, physicians taking care of septic patients have expressed both enthusiasm and skepticism about the cocktail's reported lifesaving effects.

Soon, more rigorous testing from randomized, double-blind placebo-controlled trials should provide harder data about the sepsis cocktail's efficacy.

Jonathan Sevransky, MD of Emory University announced plans for a clinical trial enrolling between 500 and 2,000 patients at multiple centers over about 18 months, completing by the end of 2019. Patients with septic shock would get either the cocktail, or placebo. Mortality will be tested, as well as days free of vasopressors or a ventilator. The study will be funded by a private foundation.

Michael Donnino, MD of Harvard's Beth Israel plans to enroll 200 patients at multiple centers, also testing the cocktail vs. placebo in patients with septic shock. Organ failure, mortality, and other outcomes will be compared. Major funding will come from the Open Philanthropy Project. The study should be completed in the autumn of 2019.


https://pulmccm.org/infectious-disease-sepsis-review/vitamin-c-cocktail-for-sepsis-randomized-trials-to-test-efficacy/

Saturday, October 13, 2018

High-Quality Diet Linked to Better Outcomes in Bipolar Disorder

A high-quality diet was one that included an abundance of fruits and vegetables, whereas poorer-quality diets included more saturated fat, refined carbohydrates, and alcohol.

https://www.medscape.com/viewarticle/903342

Sunday, October 7, 2018

FDA Bans Use of 7 Synthetic Food Additives

Ever heard of these food additives? Synthetically-derived benzophenone, ethyl acrylate, methyl eugenol, myrcene, pulegone, or pyridine?

These compounds can help mimic natural flavors and are used to infuse foods with mint, cinnamon and other flavors.

https://www.npr.org/sections/thesalt/2018/10/06/655135633/fda-bans-use-of-7-synthetic-food-additives-after-environmental-groups-sue

Friday, October 5, 2018

Patient Advocacy Groups Take In Millions From Drugmakers. Is There A Payback? | Kaiser Health News

It spotlights donations pharma companies made to patient groups large and small. The recipients include well-known disease groups, like the American Diabetes Association, with revenues of hundreds of millions of dollars; high-profile foundations like Susan G. Komen, a patient group focused on breast cancer; and smaller, lesser-known groups, like the Caring Ambassadors Program, which focuses on lung cancer and hepatitis C.

The data show that 15 patient groups — with annual revenues as large as $3.6 million — relied on the pharmaceutical companies for at least 20 percent of their revenue, and some relied on them for more than half of their revenue. The database explores only a slice of the pharmaceutical industry's giving overall and will be expanded with more companies and groups over time.

https://khn.org/news/patient-advocacy-groups-take-in-millions-from-drugmakers-is-there-a-payback/

US woman develops salmonella in breast implant after trip to Cancun | Fox News

An American woman who traveled to Mexico five months after undergoing breast augmentation surgery had to have one of the implants removed because she developed salmonella in her right breast. The 34-year-old patient, who was not named in the JPRAS Open case report, was otherwise healthy before vacationing in Cancun and is believed to be the first documented case of breast implant infection following a case of traveler's diarrhea. 

https://www.foxnews.com/health/us-woman-develops-salmonella-in-breast-implant-after-trip-to-cancun

Tuesday, October 2, 2018

Is Kombucha Actually Good For You? - Eater

Perhaps the only kombucha study that meets today's scientific standards came out in the September 2000 issue of Nutrition. A team of researchers from the University of Alaska Fairbanks department of psychology gave kombucha to a group of lab mice. Male mice that drank kombucha lived 5 percent longer than males that didn't drink kombucha; for females, kombucha extended life by 2 percent. Kombucha also inhibited weight gain, even though kombucha-drinking mice ate and drank more than those that didn't drink it. The authors speculated that this could be due to the free xanthines — naturally occurring chemical compounds with the same base as caffeine — in the kombucha stimulating the metabolism. The tea leaves are likely the source of the xanthines, as xanthines are found in green, black, and oolong tea. These results were in line with anecdotal health claims, but that's not all the study found. The mice that were treated with kombucha also developed smaller brains and larger livers and spleens, which are all associated with poor health in humans. 

https://www.eater.com/2018/5/23/17208400/kombucha-health-benefits-studies-history

Kombucha Isn't Making You Any Healthier - Tonic

But if it's a probiotic boost you're seeking, Hallen-Adams recommends yogurt or kefir instead—it boasts more good bugs, has been more solidly linked to health benefits (including a reduced risk of type 2 diabetes, abnormal cholesterol levels, and obesity) and fewer risks. As Murad points out, it delivers other nutrients like protein, calcium, and vitamin D.

Besides, you don't necessarily need to ingest more bacteria, even the beneficial types. "You have good seeds, you just need to take care of them. You don't need to keep planting in poor conditions," Li says. In other words, you're better off nurturing the flora already growing in your gut with high-quality soil and fertilizer, aka a healthy diet full of vegetables, fruits, and bacteria-feeding fiber. "If you really want to grow the garden with rich variety, take good care of it by eating right." 

https://tonic.vice.com/en_us/article/7xx9bz/kombucha-isnt-making-you-any-healthier

Thursday, September 27, 2018

Signs point to growing abuse of gabapentinoids in the U.S. | Internal Medicine News

Three states have now added gabapentin to their list of Schedule V controlled substances: Kentucky in 2017, West Virginia this May, and Tennessee in July.

Ohio, Minnesota, Virginia, and Massachusetts have taken a different tack to controlling dispensing. In those states, all pharmacies, prescribers, and wholesalers must report all dispensing and sales of gabapentin to their prescription monitoring databases.

https://www.mdedge.com/internalmedicinenews/article/175585/addiction-medicine/signs-point-growing-abuse-gabapentinoids-us

Caffeine Linked to Lower Mortality in CKD

A large observational study found a significant inverse relationship between consuming caffeine and all-cause mortality among US patients with chronic kidney disease (CKD). The research was published online September 12 in Nephrology Dialysis Transplantation.

https://www.medscape.com/viewarticle/902567

Friday, September 21, 2018

Physician Foundation 2018

The Physicians Foundation's 2018 survey, now in its sixth edition, reveals some startling findings about the impact of several factors driving physicians to reassess their careers. The survey of nearly 9,000 U.S. physicians across the country examines the impact of poverty on healthcare outcomes, practice patterns, career plans, how physicians are responding to the opioid crisis and perspectives of today's physicians.

https://physiciansfoundation.org/research-insights/the-physicians-foundation-2018-physician-survey/

Wednesday, September 19, 2018

Turmeric behind woman's liver problems? | Fox News

It's known that in about 10 to 15 percent of people with autoimmune hepatitis, the condition is triggered by drugs or supplements, the report said. In these cases, the condition is called drug-induced autoimmune hepatitis. It's unclear how drugs or supplements trigger drug-induced autoimmune hepatitis, but it's thought that in some cases, the breakdown of drugs may lead to the formation of molecules that trigger an immune reaction, according to the NIH .

When the authors of the new report reviewed 35 previous studies of turmeric supplements in people, they found that about 5 percent of participants in those studies experienced liver problems tied to the supplements. It may be that some patients, such as older adults or those who consume alcohol, are more prone to these problems tied to supplements.

Still, the authors said that it's unclear whether turmeric compounds were indeed responsible for the liver problems in the woman's case. A sample of the product was not available to test, but it could be that contaminants in the product, rather than the turmeric itself, triggered the condition, the report said. Or, it may be that the combination of turmeric and other medicines and supplements that the woman was taking led to the condition.

http://www.foxnews.com/health/2018/09/18/turmeric-behind-womans-liver-problems.html

Syphilis cases up 44 percent in California county | Fox News

Health officials are attempting to combat a record number of syphilis cases in San Joaquin County after the area saw a 44 percent increase from 2016 to 2017, making it the second highest in the state.

"We're just trying to inform the public as much as possible that this is a public health concern in the county," Dr. Kismet Baldwin, a health officer with the county's health services, told Fox 40.

"If you're not treated you move onto the secondary stage and in the secondary stage you could have multiple sores like that but it could be in the mouth."

http://www.foxnews.com/health/2018/09/18/syphilis-cases-up-44-percent-in-california-county.html

Mediterranean Diet Linked to Improved Sleep Quality

Adherence to the Mediterranean diet (MeDi) may improve quality of sleep in older adults, new research suggests.

Investigators analyzed sleep duration and quality, as well as adherence to the MeDi, in more than 1600 adults. Results showed that in individuals aged 65 to 75 years, sleep quality was better for those who adhered to the MeDi than for those who did not, even after adjusting for possible confounding factors, including cognitive status.

https://www.medscape.com/viewarticle/902107

Air pollution affects thyroid development in fetuses, research finds

Soot and dust alters thyroid development in fetuses before they are born in smoggy cities, raising concern about health impacts later in life, new USC research shows.

It means before a doctor cuts the umbilical cord or a parent hugs a baby or a sibling gazes at the newest member of the family, the caress of air pollution already reached the womb's inner sanctum. The timing couldn't be worse, as the researchers found that no matter when they checked, thyroid impacts were evident until the final month of gestation.

https://m.medicalxpress.com/news/2018-09-air-pollution-affects-thyroid-fetuses.html

Tuesday, September 18, 2018

Healthcare Bluebook, your free health care guide to fair pricing for health care services

 Did you know that the cost for a single procedure could vary 400% or more at a different in-network facility just down the street? Or that the higher cost procedure could be performed by a provider with a much lower quality rating? Healthcare Bluebook levels the playing field with reliable cost and quality information that makes shopping for healthcare simple and straightforward. 

https://www.healthcarebluebook.com/
Ultimately, however, Myles envisions a day when consumer skin products are tested for their effects on the microbiome before they end up on store shelves. Topical products like soaps and shampoos, he believes, are among the "biggest offenders" behind the explosion of eczema in industrialized nations since the 1980s. In his recent study, some common preservatives, such as parabens and quaternium 15, inhibited the growth of R mucosa more than S aureus or inhibited healthy strains of R mucosa more than unhealthy ones. These preservatives can be found in skin products like baby shampoo, bubble baths, and even some lotions marketed as treatments for eczema, he said.


What should I do about insomnia?

Friday, September 14, 2018

Nutrition Training for Young Doctors Lacks Bite

The survey of the 133 US medical schools with 4-year MD programs in 2012 showed that medical students received a median of 16 hours of nutritional education that year—roughly the same as in 2000, 2004, and 2008.[1] Meanwhile, the percentage of US medical schools that do not require medical students to receive any instruction about nutrition increased from 5% in 2000 to 10% in 2012. Only around 1 in 4 medical schools have a required nutrition course.

Typically, in the first 2 years of med school, students learn about the molecular structures of vitamins and metabolites, Dr Kohlmeier said. However, teaching students about "the structure of Krebs-cycle metabolites," for example, "doesn't teach them anything about diabetes."

"Fewer than one half of all US medical schools offer any kind of clinical focus on nutrition—no rounds, no clinics—which reflects the reality in a lot of these teaching hospitals," Dr Kohlmeier observed. "Even in those that offer something, the average is in the range of 5 hours at most, which is not enough."

Students are not getting practice in "making patient assessments or understanding which patients are at risk from malnutrition before or after surgery," nor are they learning how to help motivate patients to lose weight.


https://www.medscape.com/viewarticle/886722

Wednesday, September 12, 2018

Healthy Midlife Diet May Preserve Memory, Prevent Mental Illness

A healthy diet, as reflected by AHEI-2010 score, is rich in vegetables, fruits, whole grains, nuts, legumes, omega-3 fats, and polyunsaturated fatty acids, and is light on sugar-sweetened drinks, red and processed meat, trans fat, and sodium-rich products. It is also characterized by low alcohol intake. In the current study, low alcohol intake was a "key component" associated with larger hippocampus volume, the researchers say.

"Our findings lend support for the hypothesis that overall diet may affect brain structures with a specific impact on hippocampus volume," the researchers conclude. "Accounting for the importance of hippocampus with long-term, declarative, episodic memory, as well as for flexible cognition network, our findings reaffirm the need to recognize diet and nutrition as potential determinants of cognition, mental health and social behavior."

https://www.medscape.com/viewarticle/901867

Estrogen Matters – Science-Based Medicine

Once considered a veritable fountain of youth, estrogen replacement got a bad rap with the Women's Health Initiative study. This book is an exhaustively researched and meticulously reasoned vindication of hormone replacement therapy. Estrogen matters: it's the most effective treatment for hot flashes and other symptoms of menopause, and when started early and used continuously, it has important health benefits and can actually prevent some of the adverse events it was thought to cause. Bluming and Tavris tell estrogen's story in a way that is both accessible to the general public and appropriate for professionals. What's more, they provide valuable insights into understanding research and how even the best randomized controlled studies can lead to unjustified public fears and injudicious clinical recommendations. Very enlightening!

https://sciencebasedmedicine.org/estrogen-matters/

Tuesday, September 11, 2018

Report: Pharma exec says he had 'moral requirement' to raise drug price 400% - CNN

Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, commented in a story Tuesday about the decision to raise the price of an antibiotic mixture called nitrofurantoin from about $500 per bottle to more than $2,300. The drug is listed by the World Health Organization as an "essential" medicine for lower urinary tract infections.

"I think it is a moral requirement to make money when you can," Mulye told the Financial Times, "to sell the product for the highest price."

The Financial Times said Mulye compared his decision to increase the price to that of an art dealer who sells "a painting for half a billion dollars" and said he was in "this business to make money." 

https://amp.cnn.com/cnn/2018/09/11/health/drug-price-hike-moral-requirement-bn/index.html

Friday, September 7, 2018

Flavorings in Tobacco Products Induce Endothelial Cell Dysfunction | Arteriosclerosis, Thrombosis, and Vascular Biology

Use of alternative tobacco products including electronic cigarettes is rapidly rising. The wide variety of flavored tobacco products available is of great appeal to smokers and youth. The flavorings added to tobacco products have been deemed safe for ingestion, but the cardiovascular health effects are unknown. The purpose of this study was to examine the effect of 9 flavors on vascular endothelial cell function.
Approach and Results—

Freshly isolated endothelial cells from participants who use nonmenthol- or menthol-flavored tobacco cigarettes showed impaired A23187-stimulated nitric oxide production compared with endothelial cells from nonsmoking participants. Treatment of endothelial cells isolated from nonsmoking participants with either menthol (0.01 mmol/L) or eugenol (0.01 mmol/L) decreased A23187-stimulated nitric oxide production. To further evaluate the effects of flavoring compounds on endothelial cell phenotype, commercially available human aortic endothelial cells were incubated with vanillin, menthol, cinnamaldehyde, eugenol, dimethylpyrazine, diacetyl, isoamyl acetate, eucalyptol, and acetylpyrazine (0.1–100 mmol/L) for 90 minutes. Cell death, reactive oxygen species production, expression of the proinflammatory marker IL-6 (interleukin-6), and nitric oxide production were measured. Cell death and reactive oxygen species production were induced only at high concentrations unlikely to be achieved in vivo. Lower concentrations of selected flavors (vanillin, menthol, cinnamaldehyde, eugenol, and acetylpyridine) induced both inflammation and impaired A23187-stimulated nitric oxide production consistent with endothelial dysfunction.
Conclusions—

Our data suggest that short-term exposure of endothelial cells to flavoring compounds used in tobacco products have adverse effects on endothelial cell phenotype that may have relevance to cardiovascular toxicity.

https://www.ahajournals.org/doi/abs/10.1161/ATVBAHA.118.311156

Thursday, September 6, 2018

More Bad News About Benzos

Benzodiazepines are in the news again—this time, not for the increased risk for falls and fractures that can come with their use.

A case-control study was conducted in Finland among community-dwelling adults who had been diagnosed with Alzheimer disease. Benzodiazepines and related Z drug use was associated with a modestly increased risk for Alzheimer disease. No real differences were seen for the drug subcategories. This included short-, medium-, and long-acting benzodiazepines, as well as zolpidem, zaleplon, and eszopiclone.

The analysis showed that 5.7% of dementia cases among adults using benzodiazepines were due to the drugs. Even this small increased risk could be significant because they are widely prescribed to elderly adults, often long term. The drugs are given to treat prodromal and neuropsychiatric symptoms of dementia like insomnia and anxiety.

The authors concluded that benzodiazepines and Z drugs should be avoided when possible, given their adverse-event profile. For patients who you would like to wean off benzodiazepines, deprescribing can be tough and take a long time. Guidelines are now available to help you with the process.

https://www.medscape.com/viewarticle/901271

There aren’t enough doctors to go around | TheHill

And then, there's economics. In 1997, the Balanced Budget Act capped federal funding of medical residency programs; in 2016, for example, the government spent about $10 billion, the overwhelming majority of it coming from Medicare. Most experts predicted that the cap would soon be lifted; more than 20 years later, it's still in place.

As a result, what we have now is a classic bottleneck condition: More and more people want to practice medicine while less and less funding is available to help create residency programs that meet the demand.

http://thehill.com/opinion/healthcare/405231-there-arent-enough-doctors-to-go-around

Sunday, September 2, 2018

Time-Restricted Feeding Prevents Obesity and Metabolic Syndrome in Mice Lacking a Circadian Clock

Increased susceptibility of circadian clock mutant mice to metabolic diseases has led to the idea that a molecular clock is necessary for metabolic homeostasis. However, these mice often lack a normal feeding-fasting cycle. We tested whether time-restricted feeding (TRF) could prevent obesity and metabolic syndrome in whole-body Cry1;Cry2 and in liver-specific Bmal1 and Rev-erbα/β knockout mice. When provided access to food ad libitum, these mice rapidly gained weight and showed genotype-specific metabolic defects. However, when fed the same diet under TRF (food access restricted to 10 hr during the dark phase) they were protected from excessive weight gain and metabolic diseases. Transcriptome and metabolome analyses showed that TRF reduced the accumulation of hepatic lipids and enhanced cellular defenses against metabolic stress. These results suggest that the circadian clock maintains metabolic homeostasis by sustaining daily rhythms in feeding and fasting and by maintaining balance between nutrient and cellular stress responses.

https://www.sciencedirect.com/science/article/pii/S1550413118305059?via%3Dihub

Making Doctors Dumber Won't Make Our Health Care System Smarter

We need more early intervention and prevention, not more late-stage expensive patches. Smoking cessation counseling isn't sexy the way humming machines and newly approved biologics are, but it's effective, inexpensive and what our country really needs. Unfortunately, the way the house of medicine is carved now, it's not the specialists who are providing it.

The balance between primary care and specialty services is a delicate one, and some would argue that health care is already too specialized ― why does one patient need an entire Rolodex of "-ologists" — a cardiologist, a nephrologist, an endocrinologist, a pulmonologist and a dermatologist? 

Patients are not sliced into the "organ systems" we divide specialty lines across. And there is no better example of this than the patients we see in the emergency room, confused by their multiple canisters of co-interacting meds, sent to see us by one of their specialists who, after expensive tests on the organ of expertise, couldn't figure out what was going on and sent the patient to the ER. Ophthalmologists refer patients to the ER for high blood pressure found in the clinic. Orthopedists send patients to the ER when they find incidental elevated blood sugar prior to an operation. 

Yes, some referrals are appropriate, but some are plainly wasteful. The ER, designed to be full of "resuscitation-ists" — providers trained to take care of life-threatening events like heart attacks, strokes and gunshot wounds — has quickly become a catch-all of "available-ists" — providers who happen to be available 24/7/365. In between the heart attacks and car accidents, I also counsel patients on smoking and drug cessation, advise them on the importance of seat belts, teach them to use their glucometers and adjust their daily meds. 

Why? Because not only are these patients unable to get in to see all of their specialists in a timely manner, but many don't even have a primary care doctor.

We can't force medical students to become primary care physicians, nor should we. But education reform isn't necessarily going to fix our health care system, either.

https://m.huffpost.com/us/entry/us_5b89b277e4b0cf7b0035e624/amp

Thursday, August 30, 2018

Colorectal Cancer Screening Should Begin at Age 45: Coalition

Earlier this year, the American Cancer Society (ACS) updated its guidelines for colorectal cancer (CRC) screening, and recommended that screening begin at age 45 for those at average risk for the disease. The update of the ACS guidelines was prompted by recent data showing increased rates of CRC in young and middle-aged populations.

Now a coalition of 22 public health and patient advocacy groups has joined the ACS and submitted a letter to the US Preventive Services Task Force (USPSTF) asking that the task force reconsider its 2016 guidance, in which it recommends that CRC screening begin at age 50 years and continue until age 75 years. This recommendation is scheduled for review in 2021, but the coalition is asking for earlier action.

https://www.medscape.com/viewarticle/901376

Wednesday, August 29, 2018

Curcumin Reverse Methicillin Resistance in Staphylococcus aureus

Curcumin has a significant effect on the protein level of PBP2a. The TEM images of MRSA showed damage of the cell wall, disruption of the cytoplasmic contents, broken cell membrane and cell lysis after the treatment of curcumin. These data indicate a remarkable antibacterial effect of curcumin, with membrane permeability enhancers and ATPase inhibitors, and curcumin did not directly bind to PGN on the cell wall. Further, the antimicrobial action of curcumin involved in the PBP2a-mediated resistance mechanism was investigated. 

http://www.mdpi.com/1420-3049/19/11/18283

STDs hit all-time highs in US for fourth straight year, CDC reports | Fox News

Sexually-transmitted diseases continue to hit all-time highs in the U.S. with the Centers for Disease Control and Prevention (CDC) reporting a 10 percent spike for chlamydia, gonorrhea and syphilis in 2017. The federal health agency said in a report released Tuesday that the numbers, which include nearly 2.3 million new cases of the aforementioned diseases, reflect a "steep, sustained increase" in STDs since 2013.

"We're sliding backward," Jonathan Mermin, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said. "It is evident the systems that identify, treat and ultimately prevent STDs are strained to near-breaking point."

The data, which was presented at the 2018 STD Prevention Conference, found a 67 percent increase in gonorrhea diagnoses, which officials sounded alarm over due to the growing threat of untreatable strains.

http://www.foxnews.com/health/2018/08/28/stds-hit-all-time-highs-in-us-for-fourth-straight-year-cdc-reports.html

Monday, August 27, 2018

Why saturated fat cannot raise cholesterol levels (LDL levels) | Dr. Malcolm Kendrick

'When the US government introduced "Dietary Goals for the United States", they did not have unanimous support. The guidelines, which urged the public to cut saturated fat from their diet, were challenged by a number of scientists in a Congressional hearing. The findings were not based on sufficient evidence, they argued.

They were ignored. Dr. Robert Olson recounts an exchange he had with Senator George McGovern, in which he said: "I plead in my report and will plead again orally here for more research on the problem before we make announcements to the American public." McGovern replied: "Senators don't have the luxury that the research scientist does of waiting until every last shred of evidence is in.'1

Senator McGovern might as well have said. 'Listen son, we know that saturated fat raises cholesterol and causes heart disease, we don't need any damned evidence.' Of course, they didn't have any evidence at all. None. But they still managed to find saturated fat and cholesterol guilty. Some people would call this proper leadership. Make a decision and go with it.

I would call it monumental stupidity.

As you can see I am stepping back in this blog to look at saturated fat – again. Because I am going to share some thinking with you, which I have not really shared before. Some of you will know that I am a 'first principles' kind of guy. I take very little at face value, and I am certainly highly critical of accepted wisdom: I usually translate it, in my mind, into accepted stupidity.

So, I am going to try and explain to you that saturated fat cannot raise blood cholesterol levels. By which I mean low density lipoprotein levels (LDLs) as this is the substance which someone or another ended up calling 'bad' cholesterol. It is the lipoprotein that is thought to cause CVD.

However, LDL is not cholesterol, it never was. We do not have a blood cholesterol level – but we are seemingly stuck with this hopelessly inaccurate terminology for all time.


https://drmalcolmkendrick.org/2018/07/03/why-saturated-fat-cannot-raise-cholesterol-levels-ldl-levels/

Warnings About Benzodiazepine Use in the Elderly Go Unheeded

Despite years of warnings about the hazards of prescribing benzodiazepines for the elderly, these drugs continue to be used at a higher rate than what is considered appropriate in older Americans — particularly older women, new data show.

A recent report released by Athena Health shows that individuals older than 65 years are prescribed benzodiazepines — including alprazolam (multiple brands), lorazepam (multiple brands), diazepam (multiple brands), and clonazepam (Klonapin, Roche) — more than other age groups are.

In 2017, 8.4% of individuals aged 65 and older were prescribed one of the drugs, a drop from 8.7% the previous year. Just over 8% of 50- to 64-year-olds were prescribed a benzodiazepine in 2017, compared to 7.5% of those aged 40 to 49 and 6.6% of those aged 30 to 39.

Ten percent of women older than 65 were prescribed a benzodiazepine, compared to just under 6% of men.

The data come from a sample of 3 million patients treated by primary care providers who are part of the Athena Health data network.

The data "are consistent with earlier research that suggests significant benzodiazepine overuse, especially among older adults," Mark Olfson, MD, MPH, professor of psychiatry and epidemiology, Columbia University, New York City, told Medscape Medical News.

https://www.medscape.com/viewarticle/901169

Sunday, August 26, 2018

Five-Year SCOT-HEART Update Indicates CTA Screening Reduces Heart Attack Deaths | MD Magazine

The five-year rate of heart disease death or nonfatal myocardial infarction was lower in patients initially provided CTA imaging (n= 48 [2.3%]) than in patients given standard evaluation (n= 81 [3.9%]), providing investigators a hazard ratio of 0.59 (95% CI; 0.41-0.84; P = .004).

Patients provided CTAs reported similar rates of invasive coronary angiography to standard-care patients (491 vs 502; HR 1.00; 95% CI; 0.88-1.13), as well as in coronary revascularization (279 vs 267; HR 1.07; 95% CI; 0.91-1.27). Investigators noted this difference is improved from earlier follow-up analyses, when patients provided CTAs reported notably greater rates in both procedures.

That said, preventive therapies were more frequently initiated in patients provided CTAs (OR 1.40; 95% CI; 1.19-1.65), as were antianginal therapies (OR 1.27; 95% CI; 1.05-1.54). Newby noted that there's often a "big to-do" in the idea of providing a patient preventive aspirin therapy on top of statins. He advocated against it, but noted it has its place in coronary treatment.

https://www.mdmag.com/medical-news/fiveyear-scotheart-update-indicates-cta-screening-reduces-heart-attack-deaths

Top Infectious Disease News of the Week-August 19, 2018

Health officials across the United States are investigating an increase in Cyclospora cases reported in a multistate outbreak which has been linked back to salads sold at McDonald's locations throughout the country.

The most recent case counts reveal that there have been 476 confirmed cases of cyclosporiasis related to this outbreak spanning 15 states; the majority of cases, or 246, have been reported in Illinois.
 
As of August 16, 2018, the US Centers for Disease Control and Prevention (CDC) reported that all illnesses associated with the Cyclospora outbreak started on or after May 20, with the median illness onset date of June 29. The cases have been confirmed in individuals between the ages of 14 and 91; the median age of those infected is 53. Additionally, the CDC reports that 66% of those affected in the outbreak are female. There have been 21 hospitalizations, but no deaths have been reported at this time. Illnesses that began after July 5, 2018, may not be reported or confirmed yet. 

https://www.contagionlive.com/news/top-infectious-disease-news-of-the-week-august-19-2018?p=3

Aspirin disappoints for avoiding first heart attack, stroke | Fox Business

Taking a low-dose aspirin every day has long been known to cut the chances of another heart attack, stroke or other heart problem in people who already have had one, but the risks don't outweigh the benefits for most other folks, major new research finds.

Although it's been used for more than a century, aspirin's value in many situations is still unclear. The latest studies are some of the largest and longest to test this pennies-a-day blood thinner in people who don't yet have heart disease or a blood vessel-related problem.

One found that aspirin did not help prevent first strokes or heart attacks in people at moderate risk for one because they had several health threats such as smoking, high blood pressure or high cholesterol.

Another tested aspirin in people with diabetes, who are more likely to develop or die from heart problems, and found that the modest benefit it gave was offset by a greater risk of serious bleeding.

Aspirin did not help prevent cancer as had been hoped.

And fish oil supplements, also tested in the study of people with diabetes, failed to help.

"There's been a lot of uncertainty among doctors around the world about prescribing aspirin" beyond those for whom it's now recommended, said one study leader, Dr. Jane Armitage of the University of Oxford in England. "If you're healthy, it's probably not worth taking it."

https://www.foxbusiness.com/healthcare/aspirin-disappoints-for-avoiding-first-heart-attack-stroke

No level of alcohol consumption is healthy, scientists say | Fox News

When it comes to drinking alcohol, the healthiest thing to do is abstain entirely, according to a large, wide-ranging report published by scientists.

Alcohol led to 2.8 million premature deaths in 2016; it was the leading risk factor for premature mortality and disability in the 15 to 49 age group, accounting for 20 percent of deaths, according to the researchers at the Institute for Health Metrics and Evaluation, who carried out the study.

Globally, 27.1 percent of cancer deaths in women and 18.9 percent in men over age 50 were linked to the their drinking habits, according to the study's findings, which were published in the Lancet medical journal.

Researchers investigated the health effects of alcohol consumption in 195 countries between 1990 and 2016—using data from 694 studies to find out how common drinking was and from 592 studies to determine health risks.

The study, which received funding from the Bill & Melinda Gates Foundation, also analyzed whether moderate levels of drinking could have health benefits—which previous studies have indicated.


http://www.foxnews.com/science/2018/08/26/no-level-alcohol-consumption-is-healthy-scientists-say.html

Saturday, August 25, 2018

Eyelid dermatitis: Experience in 203 cases

Cocamidopropyl betaine (CAPB) was found more often than expected, because it is often a shampoo ingredient. However, it is now in many products including Dove soap, so adults have ample opportunity for exposure. CAPB in eye makeup remover or eye cosmetics22 or in contact lens solution23 can cause contact dermatitis of the eyelids. Apparently, it may also be hand-transferred, because it was seemingly a factor for several patients in this series who ostensibly were exposed to it in a shampoo.

https://www.sciencedirect.com/science/article/pii/S0190962202001585?via%3Dihub

Saturday, August 18, 2018

Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics | The BMJ

Mortality in midlife in the US has increased across racial-ethnic populations for a variety of conditions, especially in recent years, offsetting years of progress in lowering mortality rates. This reversal carries added consequences for racial groups with high baseline mortality rates, such as for NH blacks and NH American Indians and Alaskan Natives. That death rates are increasing throughout the US population for dozens of conditions signals a systemic cause and warrants prompt action by policy makers to tackle the factors responsible for declining health in the US.

https://www.bmj.com/content/362/bmj.k3096

Report Finds Traces of a Controversial Herbicide in Cheerios and Quaker Oats - The New York Times

An environmental research and advocacy group has found traces of a controversial herbicide in Cheerios, Quaker Oats and other breakfast foods that it says could increase cancer risk for children.

The report comes amid longstanding debate about the safety of the chemical glyphosate, which federal regulators maintain is not likely to cause cancer.

In its report, released Wednesday, the Environmental Working Group said that it tested 45 samples of breakfast foods made from oats grown in fields sprayed with herbicides. Then, using a strict standard the group developed, it found elevated levels of glyphosate in 31 of them.

"There are levels above what we could consider safe in very popular breakfast foods," said Alexis Temkin, the group's toxicologist who helped with the analysis in the report.


https://www.nytimes.com/2018/08/15/health/herbicide-glyphosate-cereal-oatmeal-children.html

Full-Fat Milk Could Cut Risk of Stroke, Heart Attack, Study Says

Consuming dairy products such as milk and cheese could cut the risk of heart disease and stroke, according to a study that challenged the commonly held belief that dairy is harmful. 

Marcia Otto, lead author of the study and assistant professor of epidemiology, human genetics and environmental sciences at UTHealth School of Public Health, said in a statement: "Our findings not only support, but also significantly strengthen, the growing body of evidence which suggests that dairy fat, contrary to popular belief, does not increase risk of heart disease or overall mortality in older adults."

One fatty acid present in dairy was actually found to potentially lower the risk of death from cardiovascular disease, particularly stroke, she said.

Popular baby foods contain 'worrisome levels' of heavy metals, study finds | Fox News

Still, of the brands and samples studied, "15 of the foods would pose potential health risks to a child regularly eating just one serving or less per day."

Those 15 food items include: Earth's Best Organic Chicken & Brown Rice; Earth's Best Turkey, Red Beans and Brown Rice; Gerber Chicken & Rice; Gerber Turkey & Rice; Sprout Organic Baby Food Garden Vegetables Brown Rice with Turkey; Gerber Lil' Meals White Turkey Stew with Rice & Vegetables; Gerber Carrot, Pear & Blackberry; Gerber Carrots Peas & Corn with Lil' Bits; Plum Organics Just Sweet Potato Organic Baby Food; Beech-Nut Classics Sweet Potatoes; Earth's Best Organic Sweet Potatoes, 1st Stage; Earth's Best Organic Whole Grain Rice Cereal; Earth's Best Organic Sunny Days Snack Bars, Strawberry; Happy Bab Organics Superfood Puffs, Apple & Broccoli; and Happy Baby Organics Superfood Puffs, Purple Carrot & Blueberry.

Researchers also determined baby and toddler foods labeled as "organic" did not mean these products were safer or contained less heavy metals than non-organic foods.

The effects from these heavy metals are long-term, not short-term, according to the Consumer Reports study. The long-term effects can result in serious complications, such as different types of cancer, type 2 diabetes and cognitive issues, among other potential side effects.

http://www.foxnews.com/health/2018/08/17/popular-baby-foods-contain-worrisome-levels-heavy-metals-study-finds.html

First Biomarker Evidence Autism Is Linked to DDT

"This study provides the first evidence, using a marker of an insecticide in the blood, that a pregnant mother's exposure to this organic pollutant is related to an increased risk of autism in her offspring. Previous studies were based, for example, on proximity to sites that were contaminated with these pollutants," lead investigator Alan S. Brown, MD, MPH, professor of epidemiology at Columbia University's Mailman School of Public Health and of psychiatry at Columbia University Medical Center in New York City, told Medscape Medical News.

"The study," he said, "offers potential implications for understanding a pathway regarding how autism might develop from a prenatal exposure and could have policy implications for public health regarding testing for, and minimizing exposure to, environmental pollutants."

The study was published online August 16 in the American Journal of Psychiatry.

https://www.medscape.com/viewarticle/900776

New Warning About Benzodiazepine Use and Dementia Risk

Yet another study has linked benzodiazepine use to an increased risk for Alzheimer's disease (AD).

"Even though the association between benzodiazepine use and Alzheimer's disease was small in this study, the threshold for prescribing these drugs should be high enough due to their overall adverse effect profile, including higher risk of falls and hip fractures," lead author Vesa Tapiainen, MD, PhD, a student in the School of Pharmacy, University of Eastern Finland, Kuopio, told Medscape Medical News.

These drugs are often used to treat sleep problems, but their efficacy for this indication diminishes over time, whereas the risks for adverse events remain, she added.

"Physicians should consider the risks and benefits, as well as appropriate duration of treatment, before prescribing these drugs," said Tapiainen.

Although other studies have linked benzodiazepines with AD risk, Tapiainen believes this one is the largest to date.

The study was published in the August issue of Acta Psychiatrica Scandinavica.

https://www.medscape.com/viewarticle/900813

Monday, August 13, 2018

White House called toxins contamination 'PR nightmare'

 Lauren Woeher wonders if her 16-month-old daughter has been harmed by tap water contaminated with toxic industrial compounds used in products like nonstick cookware, carpets, firefighting foam and fast-food wrappers. Henry Betz, at 76, rattles around his house alone at night, thinking about the water his family unknowingly drank for years that was tainted by the same contaminants, and the pancreatic cancers that killed wife Betty Jean and two others in his household.

Tim Hagey, manager of a local water utility, recalls how he used to assure people that the local public water was safe. That was before testing showed it had some of the highest levels of the toxic compounds of any public water system in the U.S.

"You all made me out to be a liar," Hagey, general water and sewer manager in the eastern Pennsylvania town of Warminster, told Environmental Protection Agency officials at a hearing last month. The meeting drew residents and officials from Horsham and other affected towns in eastern Pennsylvania, and officials from some of the other dozens of states dealing with the same contaminants.

https://apnews.com/2ca497384f01401394f4fbdd7e9aeb1d/Toxins-turning-up-in-dozens-of-public-water-systems

Monday, August 6, 2018

More Evidence for Gut-Brain Link in Alzheimer's Disease

First, lower serum concentrations of primary bile acids synthesized in the liver from cholesterol were significantly associated with worse cognitive function, decreased hippocampal volume, and decreased brain glucose metabolism.

Second, higher serum concentrations of secondary bile acids produced in the gut by bacteria were significantly associated with higher CSF phosphorylated tau and CSF total tau levels, as well as larger brain structural atrophy and decreased brain glucose metabolism.

Third, higher serum concentrations of ratios of bacterially produced secondary bile acids to primary bile acids were significantly associated with lower CSF Aβ1-42 values, larger brain structural atrophy, and decreased brain glucose metabolism.

https://www.medscape.com/viewarticle/899956