Dr. Bray Links

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

Better Prevention and Treatment of Tick-borne Diseases Needed

The incidence of tick-borne disease in the United States is increasing at an alarming rate, officials from the National Institute of Allergy and Infectious Diseases say. They call on public health and biomedical researchers to double down on efforts to better understand the pathogenesis of tick-borne illnesses and to develop improved strategies for prevention and management.

Citing a report released earlier this year from the Centers for Disease Control and Prevention (CDC) indicating that the number of tick-borne diseases reported in the United States has more than doubled in the last 13 years, Catharine I. Paules, MD, from the Office of the Director, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, and colleagues suggest this is a conservative estimate.

"The public health burden of tickborne pathogens is considerably underestimated," the authors write in a perspective article published online July 25 in the New England Journal of Medicine. "For example, the CDC reports approximately 30,000 cases of Lyme disease per year but estimates that the true incidence is 10 times that number." The authors attribute this discrepancy to limitations in surveillance and reporting systems, as well as constraints imposed by diagnostics that rely heavily on serologic assays.

https://www.medscape.com/viewarticle/900249

Low Acetyl-L-Carnitine a New Biomarker for Major Depression?

"In rodent experiments led by Dr Nasca, both here at Rockefeller and elsewhere previously, a deficiency of acetyl-L-carnitine was associated with depression-like behavior," McEwen said in the press release.

"They also showed that [LAC] is one of the vital connecting biomarkers in developing depression as a reaction to stress," Rasgon added in speaking to Medscape Medical News.

Interestingly, LAC supplementation administered intravenously or orally to the rats who had depression-like traits led to "rapid and lasting antidepressant-like effects."

https://www.medscape.com/viewarticle/900130

Saturday, August 4, 2018

The classic EDCs, phthalate esters and organochlorines, in relation to abnormal sperm quality: a systematic review with meta-analysis

Nonetheless, our systematic review with meta-analysis, together with the review of possible mechanisms, provides a better explanation of the impact of classic EDCs on sperm quality. However, future research is needed to examine the following: (1) the biomarker of testis function and human fertility should be well defined in an epidemiology study, and the analysis of sperm quality parameters need to be normalized; (2) the size of adequate samples, occupational exposure to specific EDCs, longitudinal instead of cross-sectional studies, and multi-center studies need to be conducted; (3) due to potential interactions between different EDCs on sperm quality, co-exposure to mixtures of EDCs, as well as their interactions or combined effects should be investigated; (4) for a better understanding of classic EDC-induced abnormal sperm quality, mechanism studies should be focused on low-dose, long-term, and co-exposure; and (5) both human studies and animal experiments are needed on transgenerational effects (e.g. DNA methylation) of EDCs because epigenetic effects as a result of EDC exposure can subsequently change the sperm quality of future generations.

https://www.nature.com/articles/srep19982

Fullerenes as Anti-Aging Antioxidants. - PubMed - NCBI

Here we review fullerenes biological effects focusing on their antioxidant and anti-ageing action. A scope of various poisonous and healing properties reported in literature for fullerene and its derivatives is analyzed. The review begins with the history of fullerenes discovery and their main properties. Then we focus on the longevity and antioxidant action, including the confrontation of available experimental data and theoretical modeling of buckminsterfullerene C60. Special attention is given to our hypothesis concerning the possibility of fullerenes to act as mitochondria protonophore and various simulations of the transport of C60 and its hydroxylated and other derivatives through lipid bilayer membranes, which can account for scavenging capacity of fullerenes for reactive oxygen species and their acting as mild mitochondrial respiration uncouplers. Extension of the theoretical modeling to the mitochondria membranes and implications on the real biological systems is analyzed. Finally, we focus on the toxicity evaluation and current therapeutic usage of fullerenes. The review contains a comprehensive discussion of both papers published by 2016 and our own research results.


https://www.ncbi.nlm.nih.gov/pubmed/27659261

Saturday, July 7, 2018

Alpha-Gal Allergy: Symptoms, Treatment, Causes, and More

Galactose-alpha-1,3-galactose (alpha-gal) is a carbohydrate found in the cells of many mammals that humans eat, such as cows, sheep, and pigs. Poultry that has been injected with natural flavoring containing beef or other mammal cells may also have alpha-gal. As a result of autoimmune responses, some people become allergic to alpha-gal.

People with this allergy may experience mild discomfort after eating meat, or they may have a dangerous reaction that leaves them unable to breathe. The spectrum of reactions to alpha-gal varies. Most instances of this allergy are triggered by tick bites.

https://www.healthline.com/health/allergies/alpha-gal

Tuesday, June 26, 2018

Why petroleum jelly may not be the best thing to heal cuts - BBC News

Prof Ariens said: "We did laboratory and animal studies which showed this film could be a barrier against microbial infection for at least 12 hours, and this gives the immune system time to get white blood cells to the wound to counteract any infection."

Adding petroleum jelly perforated the protective film.

Prof Ariens said: "If you get a scrape or a cut it is best to let it clot for half an hour to let the film form. Do clean it of course if it needs it, but the clot will make its own perfect plaster. After that, it might not be so bad to add petroleum jelly, but before then, from our findings, it appears to damage this film."

Independent wound care advisor Jacqui Fletcher, who is also the clinical editor of the journal Wound UK, said: "You do see it used in sports. Boxing is a good example. If the fighter gets a cut they can use it to stop the blood running down the their face so that they can continue the fight. 

https://www.bbc.com/news/health-44600618

Monday, June 25, 2018

The effects of micronutrient deficiencies on bacterial species from the human gut microbiota

Vitamin and mineral (micronutrient) deficiencies afflict 2 billion people. Although the impact of these imbalances on host biology has been studied extensively, much less is known about their effects on the gut microbiota of developing or adult humans. Therefore, we established a community of cultured, sequenced human gut-derived bacterial species in gnotobiotic mice and fed the animals a defined micronutrient-sufficient diet, followed by a derivative diet devoid of vitamin A, folate, iron, or zinc, followed by return to the sufficient diet. Acute vitamin A deficiency had the largest effect on bacterial community structure and metatranscriptome, with Bacteroides vulgatus, a prominent responder, increasing its abundance in the absence of vitamin A. Applying retinol selection to a library of 30,300 B. vulgatus transposon mutants revealed that disruption of acrR abrogated retinol sensitivity. Genetic complementation studies, microbial RNA sequencing, and transcription factor-binding assays disclosed that AcrR is a repressor of an adjacent AcrAB-TolC efflux system. Retinol efflux measurements in wild-type and acrR-mutant strains plus treatment with a pharmacologic inhibitor of the efflux system revealed that AcrAB-TolC is a determinant of retinol and bile acid sensitivity in B. vulgatus Acute vitamin A deficiency was associated with altered bile acid metabolism in vivo, raising the possibility that retinol, bile acid metabolites, and AcrAB-TolC interact to influence the fitness of B. vulgatus and perhaps other microbiota members. This type of preclinical model can help to develop mechanistic insights about the effects of, and more effective treatment strategies for micronutrient deficiencies.

Combo antibiotic found inferior for MDR bloodstream infections | CIDRAP

The results of a large, international randomized trial indicate that the use of a combination therapy being investigated as a potential alternative to carbapenem antibiotics should be avoided in patients with certain multidrug-resistant bloodstream infections (BSIs), because of increased risk of mortality.

The findings of the MERINO Trial, presented this week at the 28th annual European Congress of Clinical Microbiology and Infectious Disease (ECCMID), showed that the combination antibiotic piperacillin/tazobactam is inferior to meropenem for treating BSIs caused by third-generation cephalosporin-resistant Escherichia coli or Klebsiella pneumoniae. The number of patients on piperacillin/tazobactam who died at the 30-day mark was more than three times the number who died in the meropenem arm.

http://www.cidrap.umn.edu/news-perspective/2018/04/combo-antibiotic-found-inferior-mdr-bloodstream-infections

Saturday, May 26, 2018

Atopic Dermatitis severity reduced by topical microbiome treatment

Roseomonas mucosa bacteria obtained from healthy volunteers without atopic dermatitis reduced the severity of the disorder in a small, early-phase study of 10 adults and 5 children with atopic dermatitis. Also today, a new device could detect osteoarthritis with sound and motion, seven days of antibiotics is enough for gram-negative bacteremias, and canagliflozen is linked to lower HbA1c levels in younger patients. 


https://www.mdedge.com/oncologypractice/article/166415/mixed-topics/mdedge-daily-news-atopic-dermatitis-severity-reduced

Thursday, May 10, 2018

Very Low-Carbohydrate Diet Beneficial in Type 1 Diabetes

The study included 316 individuals, of whom 54% were adult patients and 42% were parents of children with type 1 diabetes. All were part of an international Facebook group for people with type 1 diabetes who follow Bernstein's recommended VLCD diet.

The approach includes a weight-based carbohydrate prescription of no more than 30 grams/day, derived from fibrous vegetables and nuts with a low glycemic index. High-protein foods are substituted for carbohydrates, and insulin doses adjusted empirically by postprandial and fasting glucose levels.  

Most of the participants were from the United States, Canada, Europe, or Australia, the majority (88%) were white, and 84% were college graduates. Mean age at diabetes diagnosis was 16 years, diabetes duration was 11 years, and time following the VLCD diet was 2.2 years.

Confirmatory data were obtained from diabetes care providers and medical records, including a multi-tiered investigation to ensure all participants had type 1 diabetes — not type 2 diabetes or a genetic variant. However, not all data points were available for all respondents.  

Participants reported consuming an average of 36 grams/day of carbohydrate. The mean reported HbA1c was 5.67%, a drop of 1.45 percentage points following adoption of the VLCD (P < .001). Average blood glucose level was 104 mg/dL in the 137 patients who had continuous glucose monitoring data.

In a regression analysis, carbohydrate intake goal was the only significant predictor of variation in HbA1c (P = .001), with an increase in HbA1c of 0.1% per 10 g of carbohydrate consumed. The mean daily insulin dose was 0.40 U/kg/day.

https://www.medscape.com/viewarticle/896288

Tuesday, May 1, 2018

Tick and Mosquito Infections Spreading Rapidly, C.D.C. Finds - The New York Times

The real case numbers were undoubtedly far larger, Dr. Petersen said. For example, the C.D.C. estimates that about 300,000 Americans get Lyme disease each year, but only about 35,000 diagnoses are reported.

The study did not delve into the reasons for the increase, but Dr. Petersen said it was probably caused by many factors, including two related to weather: ticks thriving in regions previously too cold for them, and hot spells triggering outbreaks of mosquito-borne diseases.

Other factors, he said, include expanded human travel, suburban reforestation and a dearth of new vaccines to stop outbreaks.

More jet travel from the tropics means that previously obscure viruses like dengue and Zika are moving long distances rapidly in human blood. (By contrast, malaria and yellow fever are thought to have reached the Americas on slave ships three centuries ago.)

A good example, Dr. Petersen said, was chikungunya, which causes joint pain so severe that it is called "bending-up disease."

In late 2013, a Southeast Asian strain arrived on the Dutch Caribbean island of St. Maarten, its first appearance in this hemisphere. Within one year, local transmission had occurred everywhere in the Americas except Canada, Chile, Peru and Bolivia.

Tickborne diseases, the report found, are rising steadily in the Northeast, the Upper Midwest and California. Ticks spread Lyme disease, anaplasmosis, babesiosis, Rocky Mountain spotted fever, rabbit fever, Powassan virus and other ills, some of them only recently discovered.

Ticks need deer or rodents as their main blood hosts, and those have increased as forests in suburbs have gotten thicker, deer hunting has waned, and rodent predators like foxes have disappeared.

https://mobile.nytimes.com/2018/05/01/health/ticks-mosquitoes-diseases.html

Saturday, April 7, 2018

Intestinal microbiota as a tetrahydrobiopterin exogenous source

We further confirmed that at least two PTPS-2-producing species, Aldercreutzia equolifaciens and Microbacterium schleiferi, generate BH4 and are present in hph-1 fecal material. In conclusion, intestinal Actinobacteria generate BH4. This finding has important translational significance, since manipulation of the intestinal flora in individuals with congenital biopterin deficiency may allow for an increase in total body BH4 content.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227711/#!po=1.16279

Friday, March 30, 2018

Federal Agency Courted Alcohol Industry to Fund Study on Benefits of Moderate Drinking

It was going to be a study that could change the American diet, a huge clinical trial that might well deliver all the medical evidence needed to recommend a daily alcoholic drink as part of a healthy lifestyle.

That was how two prominent scientists and a senior federal health official pitched the project during a presentation at the luxurious Breakers Hotel in Palm Beach, Fla., in 2014. And the audience members who were being asked to help pay for the $100 million study seemed receptive: They were all liquor company executives.

The 10-year government trial is now underway, and Anheuser Busch InBev, Heineken and other alcohol companies are picking up most of the tab, through donations to a private foundation that raises money for the National Institutes of Health.

The N.I.H., a federal agency, is considered one of the world’s foremost medical research centers, investing over $30 billion of taxpayer money in biomedical research each year. The vast majority of the funding goes to scientists outside the N.I.H., which manages the grants and provides oversight.

The alcohol study is overseen by the National Institute on Alcohol Abuse and Alcoholism, one of 27 centers under the N.I.H. The lead investigator and N.I.H. officials have said repeatedly that they never discussed the planning of the study with the industry. But a different picture emerges from emails and travel vouchers obtained by The New York Times under the Freedom of Information Act, as well as from interviews with former federal officials.
...

https://www.nytimes.com/2018/03/17/health/nih-alcohol-study-liquor-industry.html

Sunday, March 25, 2018

Sodium bisulfite

Sodium bisulfite is also added to leafy green vegetables in salad bars and elsewhere, to preserve apparent freshness, under names like LeafGreen. The concentration is sometimes high enough to cause severe allergic reactions.[12]


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

Saturday, March 17, 2018

Physical Fitness Tied to a Nearly 90% Reduction in Dementia Risk

A high level of cardiovascular physical fitness in middle-aged women is associated with close to a 90% reduction in dementia risk in later life, results of a longitudinal study show.

https://www.medscape.com/viewarticle/894032

Thursday, March 15, 2018

'Reinventing Healthcare' Without the People Who Care for Patients

Unfortunately, too many of those who seek to disrupt healthcare have dollar signs in their eyes, making it impossible for them to see and acknowledge their ignorance—their lack of any real insight in the daily practice of healthcare. Those with the practical experience to help shape a better system that integrates the potential efficiencies of telemedicine, machine learning, and big data with current practice patterns in order to provide efficient and high-quality care are too often relegated to the sidelines; changes are imposed upon them from above by people with no understanding of the potential unintended consequences of their unilateral decisions.

I believe the US healthcare system is poised for significant change in the coming years. This may be rudderless navigation directed overwhelmingly by profiteering individuals from a business and technology background, merely seeking a short-term exit strategy to maximize their wealth rather than a true transformation of healthcare in a meaningful, beneficial way. But there are new entrants in the healthcare arena who may have the more noble goal of creating a US healthcare system that truly works, rather than being dragged down by colossal inefficiencies and the deliberate foot-dragging of the incumbent stakeholders who benefit from this. The recently announced collaboration among Amazon, Berkshire Hathaway, and JP Morgan to create and demonstrate a path to efficient medical care in America[1] may have the needed power and, possibly, the long-term vision to execute on this promise.

To do so, it will be critical to welcome the participation not only of the medical dilettantes who consider themselves experts because they technically still see a few stray patients as a small fraction of their workweek, but the vast majority of working doctors who unfortunately remain an afterthought of far too many who expect to redefine how healthcare is delivered. At the same time, physicians who fit that bill and care for patients day to day should strive to play a more active role in these initiatives. We only have the right to not be shepherded around by those outside healthcare if we, as practicing physicians, are not complacent enough to act like sheep.

https://www.medscape.com/viewarticle/893790

Arsenic, Lead Found in Popular Protein Supplements - Consumer Reports

Whether for weight loss, muscle building, or simply as a convenient quick meal on the go, many Americans turn to protein powders and drinks.

But a new study shows that many of the top-selling powders and drinks may contain concerning levels of heavy metals such as arsenic, cadmium, mercury, and lead, and toxins like bisphenol A (BPA), a chemical found in some plastic containers and food can liners.

These substances have been linked to cancer, brain damage, and reproductive issues.

https://www.consumerreports.org/dietary-supplements/heavy-metals-in-protein-supplements/

Thursday, March 8, 2018

America's Love/Hate Relationship With Doctors

The truth of the matter is that a large degree of America's love/hate relationship with doctors is fueled primarily by our idealized notion of what a doctor should be. When asked to describe their vision of an ideal doctor, patients often use such words as "empathetic," "wise," "confident," "attentive," "brilliant," "dedicated," and "altruistic." But they want trust, friendliness, respect, honesty, timeliness, and sincerity, too.

That's an awfully high pedestal. And these expectations extend to physicians' lives and behavior outside the office as well.

How did we get here? Once upon a time, long ago (before third parties inserted themselves into medicine), we had the doctor and the patient. Alone. In one room. Many times, in a bedroom during a house call. The relationship between doctor and patient was undisturbed by layers of bureaucracy, faxes, and phone trees, uncorrupted by superbills and CPT codes.

This fairy-tale physician—our savior in a white coat—who will come to our aid any time of day or night lives in our collective consciousness. Doctors yearn to be heroes, and suffering patients seek a savior. We fulfill each other's core needs. After all, without patients, doctors couldn't exist.

https://www.medscape.com/viewarticle/888837

Wednesday, March 7, 2018

Male urinary biomarkers of antimicrobial exposure and bi-directional associations with semen quality parameters

Abstract

Antimicrobials including parabens, triclosan, and triclocarban have endocrine disrupting properties. Among 501 male partners of couples planning to become pregnant, preconception urinary biomarkers of parabens, triclosan and triclocarban exposure were quantified in spot urine samples. Men also provided two fresh semen samples collected approximately one month to undergo 24-h semen quality analysis. Linear mixed-effects models, adjusted for creatinine, race, age and body mass index, were utilized to assess the relationship between log transformed chemical concentrations rescaled by their standard deviations and semen parameters. Methyl, ethyl and butyl parabens, were associated with diminished sperm count and several sperm motility parameters. Hydroxylated paraben metabolites and triclosan were significantly positively associated with select semen quality parameters. Overall, our findings suggest that specific urinary parabens found in consumer goods (methyl, ethyl and butyl parabens) may adversely impact sperm quality parameters among reproductive-age male partners of couples trying for pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/29474822

Tuesday, March 6, 2018

HbA1c Below 8% in Diabetes for 'Most' Says ACP, But Others Disagree

"ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7% or less, compared with targets of about 8%, did not reduce deaths or macrovascular complications, such as heart attack or stroke, but did result in substantial harms," said Jack Ende, MD, ACP president, in a statement.

"For most people with type 2 diabetes, achieving an HbA1c between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs," he added.

https://www.medscape.com/viewarticle/893421

For all their risks, opioids had no pain-relieving advantage in a yearlong clinical trial

By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone — though the differences weren't large enough to be considered statistically significant. Patients in both groups saw similar improvements in their quality of life.


http://www.latimes.com/science/sciencenow/la-sci-sn-opioid-painkillers-no-better-20180306-story.html

Sunday, March 4, 2018

Diabetes is actually five separate diseases, research suggests - BBC News

The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.

    Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
    Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
    Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
    Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
    Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder

http://www.bbc.com/news/health-43246261

Saturday, March 3, 2018

Calcium Supplements Up Risk for Precancerous Serrated Polyps



Calcium supplementation alone more than doubled the risk for serrated sessile adenomas or polyps (SSA/Ps), and when combined with vitamin D, it almost quadrupled the risk, according to the results of a large randomized chemoprevention trial published online today in Gut.

https://www.medscape.com/viewarticle/893319

Wednesday, February 28, 2018

Urinary Phthalate Metabolites Are Associated With Decreased Serum Testosterone in Men, Women, and Children

Results:

Multiple phthalates were associated with significantly reduced T in both sexes and in differing age groups. In females, the strongest and most consistent inverse relationships were found among women ages 40–60 years. In boys 6–12 years old, an interquartile range increase in metabolites of di-2-ethylhexyl phthalate was associated with a 29% (95% confidence interval, 6, 47) reduction in T. In adult men, the only significant or suggestive inverse associations between phthalates (metabolites of di-2-ethylhexyl phthalate and dibutyl phthalate) and T were observed among men ages 40–60 years.

https://academic.oup.com/jcem/article/99/11/4346/2836774

Sunday, February 25, 2018

E-cigarettes leak toxic metals, study finds

In a previous study, Rule and colleagues identified a series of toxic metals — cadmium, chromium, lead, manganese, and nickel — in e-cigarette liquids.

The new research took these findings and went further, testing the e-cigarettes of actual users in order to try to understand how exposed people were to these toxic substances, and under what circumstances.

Rule and team worked with 56 participants who used e-cigarettes on a daily basis. The researchers tested the participants' e-cigarettes, verifying the presence of 15 metals in the refilling dispensers, the vaping liquids "loaded" into the e-cigarettes, and the vapors that resulted from the liquids' heating.


https://www.medicalnewstoday.com/articles/321006.php

Saturday, February 24, 2018

Nixtamalization

Nixtamalization /nɪʃtəməlaɪˈzeɪʃən/ typically refers to a process for the preparation of maize (corn), or other grain, in which the corn is soaked and cooked in an alkaline solution, usually limewater (but sometimes wood ash lye[1]) washed, and then hulled. This process, originating in Mexico, is known to remove up to 97–100% of aflatoxins from mycotoxin-contaminated corn.[2] The term can also refer to the removal via an alkali process of the pericarp from other grains such as sorghum.

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

Impact of Cleaning Products on Women's Lungs as Damaging as 20-a-Day Cigarette Habit: Study

Regular use of cleaning sprays can have as much of an impact on health as smoking a pack of cigarettes a day, according to a new study.

Scientists at Norway's University of Bergen tracked 6,000 people, with an average age of 34 at the time of enrollment in the study, who used the cleaning products over a period of two decades, according to the research published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

They found that lung function decline in women who regularly used the products, such as those who worked as cleaners, was equivalent over the period to those with a 20-cigarette daily smoking habit.

"While the short-term effects of cleaning chemicals on asthma are becoming increasingly well documented, we lack knowledge of the long-term impact," said Dr. Cecile Svanes, a professor at the University of Bergen in Norway and  senior author of the study. 

http://www.newsweek.com/impact-cleaning-products-lung-health-bad-20-day-cigarette-habit-study-810277

Newly invented eyedrops could replace glasses altogether

 A revolutionary eyedrop invention from a team of Israeli ophthalmologists has been found to heal damaged corneas and improve the vision of pigs. Clinical trials for humans are expected to begin later this year.

The recently patented 'nanodrops' developed by a team at Shaare Zedek Medical Center and Bar-Ilan University's Institute of Nanotechnology and Advanced Materials improved both short-sightedness and long-sightedness in tests on pigs.

https://www.rt.com/news/419711-eyedrops-invention-israel-glasses/

EHR Time Exceeds Patient Face Time in Family Practice Visits

Primary care physicians spend less time interacting face-to-face with their patients than they do working on electronic health records (EHR), according to a cross-sectional study published in the February issue of Family Medicine.

"The majority of family physicians worked through lunch, stayed late at clinic, or took their work home to complete the day's EHR work," write Richard A. Young, MD, from the JPS Family Medicine Residency Program in Fort Worth, Texas, and colleagues.

"Significant predictors of visit length included the number of reasons for the visit, new patients to the practice, the number of medications prescribed, whether the physician was Hispanic, whether a resident physician presented the patient to an attending physician, whether the patient had one or multiple physicians caring for him or her, and a few other factors," the authors explain.

https://www.medscape.com/viewarticle/893038

Friday, February 23, 2018

Health care’s fundamental problem: Your doctor doesn’t work for you | TheHill

Once the backbone of America's health care system, primary care physicians have been overtaken by medical middlemen that drive up costs and get between doctors and our patients. Every step of the way, the patient's interests are subordinated to another customer. Doctors answer to their hospital employers. The hospitals are eager to please the insurance companies that decide whether to pay medical claims.


Throughout its history, the health insurance industry has paid lip service to controlling costs while actually driving them higher. At any time, your doctor's years of training and knowledge of your unique condition can be vetoed by your insurance company. By overriding a doctor's recommendation, a patient's condition can deteriorate and lead to more costly procedures. 

http://thehill.com/opinion/healthcare/375348-health-cares-fundamental-problem-your-doctor-doesnt-work-for-you

CMS Wants in on Direct Primary Care (Healthcare Blog) | Medpage Today

Just as the direct primary care movement to take insurers and government intermediaries out of medicine gains traction, the Centers for Medicare and Medicaid Services is getting involved, one proponent writes for The Healthcare Blog.

There are 770 direct primary care clinics in the country, Niran Al-Agba, MD, writes. But as the movement grows, CMS is edged out. Now, the agency is holding focus groups in four cities, asking how it can get involved.

At best, Al-Agba said, that's patronizing.

"The DPC movement offers the first successful and innovative alternative healthcare approach to emerge in years," he writes. "Make no mistake, CMS is the enemy of independent physicians everywhere and our best defense is to have a good offense – leading with transparency to our patients and the public. "

https://www.medpagetoday.com/practicemanagement/practicemanagement/71252

Wednesday, February 21, 2018

The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds

Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume.

But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.

https://mobile.nytimes.com/2018/02/20/well/eat/counting-calories-weight-loss-diet-dieting-low-carb-low-fat.html

Monday, February 19, 2018

Advanced glycation endproducts, dityrosine and arginine transporter dysfunction in autism



Changes in plasma AGEs were likely indicative of dysfunctional metabolism of dicarbonyl metabolite precursors of AGEs, glyoxal and 3-deoxyglucosone. DT is formed enzymatically by dual oxidase (DUOX); selective increase of DT as an oxidative damage marker implicates increased DUOX activity in ASD possibly linked to impaired gut mucosal immunity. Decreased renal clearance of arginine and CMA in ASD is indicative of increased arginine transporter activity which may be a surrogate marker of disturbance of neuronal availability of amino acids. Data driven combination of these biomarkers perturbed by proteotoxic stress, plasma protein AGEs and DT, gave diagnostic algorithms of high sensitivity and specificity for ASD.

https://molecularautism.biomedcentral.com/articles/10.1186/s13229-017-0183-3

Acetaminophen Use Alters Sex Hormones, May Cause Birth Defects?



"The surprising thing that we observed in people who were taking acetaminophen (paracetamol) was that all of them had a peculiar profile in hormone metabolites," senior author Amalio Telenti, MD, from J Craig Venter  Institute, in La Jolla, California, explained to Medscape Medical News.

The researchers speculated that they might find liver dysfunction with large doses of acetaminophen, "because that is normal toxicity," but surprisingly they found that acetaminophen was associated with changes in certain hormonal metabolites.

For example, the effect of taking acetaminophen on pregnen-diol disulfate was roughly equivalent to the effect of 35 years of aging, or the normal decrease in levels seen in menopause.

https://www.medscape.com/viewarticle/892824

New C difficile Guidelines Refine Diagnosis, Add FMT

The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have updated the 2010 clinical practice guidelines on Clostridium difficile infection (CDI) in adults.

The update adds recommendations for children, refines combinations and sequences of diagnostic tests, and changes antibiotic choices. It also, for the first time, includes guidance for implementing fecal microbiota transplantation (FMT). The guidelines are published in Clinical Infectious Diseases.

https://www.medscape.com/viewarticle/892813

Ketogenic Drinks Improve Glycemia and Insulin Sensitivity

A ketone supplement, taken as a so-called 'keto drink' half an hour prior to consuming glucose, reduces glycemic response and improves markers of insulin sensitivity without affecting insulin secretion, show data from a small randomized cross-over study in healthy volunteers.

According to the authors, led by Étienne Myette-Côté, PhD candidate, from the University of British Columbia Okanagan, Kelowna, Canada, "ketone monoester supplements could have therapeutic potential in the management and prevention of metabolic disease." The article was published online February 15 in the Journal of Physiology.

https://www.medscape.com/viewarticle/892829

Friday, February 16, 2018

Adult endothelial stem cells can make fully functional blood vessels

"Our findings show that CD157-positive vascular endothelial stem cells give rise to a hierarchy of cell types that can repair vascular injury and maintain the normal blood vessel architecture," Takakura says. "We believe these findings represent an entirely new way of thinking about how blood vessels are formed and, ultimately, how stem cells can be used to treat disorders related to blood vessel malfunction."

https://www.sciencedaily.com/releases/2018/02/180215105734.htm

Thursday, February 15, 2018

Ultra-processed foods 'linked to cancer' - BBC News

What counts as ultra-processed

    Mass-produced packaged breads and buns
    Sweet or savoury packaged snacks including crisps
    Chocolate bars and sweets
    Sodas and sweetened drinks
    Meatballs, poultry and fish nuggets
    Instant noodles and soups
    Frozen or shelf-life ready meals
    Foods made mostly or entirely from sugar, oils and fats

http://www.bbc.com/news/health-43064290

Wednesday, February 14, 2018

Chemicals in packaging, carpets and non-stick pans 'may contribute to obesity'

Chemicals used to make non-stick pots and pans, stain-resistant carpets, and food packaging may contribute to high levels of obesity by disrupting the body's ability to burn calories, scientists say.

Researchers at Harvard University examined the effects of compounds called perfluoroalkyl substances (PFASs), which have already raised concerns among some health experts after animal experiments and other studies linked them to cancer, high cholesterol and immune problems.

In the latest work, Qi Sun, a nutritionist who specialises in the risk factors for diabetes, obesity, and cardiovascular disease, analysed records for 621 overweight and obese people who spent six months dieting. All were part of a clinical trial run in the 2000s to test the effectiveness of different types of diets.


https://www.theguardian.com/science/2018/feb/13/chemicals-in-packaging-carpets-and-non-stick-pans-may-contribute-to-obesity