Smile! Good Oral Hygiene Contributes To Heart Health

For over twenty years, studies have shown a link between poor oral health and coronary heart disease. One such study showed a 25% increased risk of heart disease in individuals with periodontitis (gum disease) (DeStefano et. al, 1993). Recent studies have shown additional risks: one study showed participants with greater amounts of plaque on their teeth correlated with a 4.43-fold increased occurrence of infective endocarditis, an inflammation of the inner layer of the heart (Lockhart et. al, 2009).

But how is it that brushing and flossing decrease chances of heart problems?

No one is quite sure yet, but there are two leading theories.

Firstly, experts know that bacteria in the mouth can enter the bloodstream through the gums. This occurs when tiny cuts, caused by eating, brushing and flossing allow the bacteria to get into the bloodstream. Bacteria from the mouth travel through the circulatory system and stick to fatty plaques in the bloodstream, contributes to blockages. Large numbers of bacteria have been found clumped in artery plaques (Griffin, 2000). Bacteria may also be able to travel directly to the heart and infect the inner layer (Lockhart et. al, 2009).

The other theory focuses on the body’s defense mechanism against the bacteria. Inflammation is one of the primary responses of the body’s immune system. When bacteria from the mouth enter the bloodstream, arteries and blood cells become inflamed. The swelling causes the blood vessels to narrow, increasing the risk of clots (Griffin, 2000). In the case of gum disease, the inflammation would become chronic, increasing the risk of heart attack and stroke (Is Flossing Good For Your Heart?, 2000).

One of the issues in identifying the connection between periodontitis and heart disease is that individuals commonly affected by one disease also have the other – but the two illnesses may be unrelated. The most common group affected often had other contributing factors to heart disease including diabetes, high blood pressure, high cholesterol, and smoking (Is Flossing Good For Your Heart?, 2000). The difference between causation and correlation becomes apparent in these studies.

Regardless, doctors still advocate for maintaining good oral hygiene. Routine brushing and flossing decreases damage done to the gums by the bristles of the toothbrush and material of the floss. It also decreases the number of bacteria in the mouth. “It’s fairly easy to do,” says Gordon Douglass, DDS, “and why not get rid of a potential risk factor for heart disease?” (Griffin, 2000)

References:

DeStefano, F., Anda, R.F., Kahn, H.S., Williamson, D.F., Russell, C.M. (1993). Dental disease and risk of coronary heart disease and mortality. British Medical Journal, 306(6879), 688-91.

Griffin, R.M. & Chang, L. (Ed.) (2000). Gum disease and heart health: Brushing and flossing may actually save your life. Web MD. Retrieved from: http://www.webmd.com/heart-disease/features/periodontal-disease-heart-health

Is flossing good for your heart? (10 September, 2000). Web MD. Retrieved from: http://www.webmd.com/heart/news/20000919/is-flossing-good-for-your-heart

Lockhart, P.B., Brennan, M.T., Thornhill, M., Michalowicz, B.S., Noll, J., Bahrani-Mougoet, F.K., Sasser, H.C. (2009). Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. Journal of the American Dental Association, 140(10), 1238-44.

Are unvaccinated kids a health threat?

According to the Associated Press in eight states, more than 1 in 20 public school kindergarteners aren’t getting all the vaccines required for attendance. Why is this?

While the safety of vaccines has been proven in many studies, parents may doubt the safety of vaccines. Many parents have noticed a temporal correlation between the first signs of autism and the routine childhood vaccination schedule but the correlation has been proven to be unfounded. A review study by Doja and Roberts (2006) shows there is no causal association between the MMR vaccine or the vaccine preservative thimerosal and autism.

Could lack of education or resources play a role in the decision to not vaccinate a child? The profile of a parent that decides not to vaccinate is middle-class, college educated and web savvy according to Dr. Nancy Snyderman, the Chief Medical Editor for NBC in an article by MSNBC, indicating that lack of education and resources do not play a role in the decision to not vaccinate.

Dr. Nancy Snyderman implies it is rather the fact that these new parents do not have any memory of measles, mumps, polio or whooping cough outbreaks; therefore they do not see the necessity of vaccinating their children for these diseases. While the prevalence of these diseases are decreased they still are a risk with 24 children dying of whooping cough last year in California.

This decision to not vaccinate not only affects the unvaccinated children but puts others at risk as well. Unvaccinated children could potentially infect infants too young for vaccines and people with compromised immune systems such as the elderly or chemotherapy patients.

It is a personal choice as to raise a child and what to expose them to but with the pros outweighing the cons in this situation, is the right decision to vaccinate or to not vaccinate?

Asif Doja and Wendy Roberts. (2006). Immunizations and Autism: A Review of the Literature. The Canadian Journal of Neurological Sciences, 33:341-346

http://moms.today.msnbc.msn.com/_news/2011/11/29/9090395-are-opt-out-parents-and-unvaxxed-kids-a-health-threat

Beryllium Sensitization and Chronic Beryllium Disease

During my time at National Jewish Health in the Department of Environmental and Occupational Health Sciences I was able to learn a great deal on beryllium sensitization (BeS) and chronic beryllium disease (CBD).

Beryllium is an element that is used in the airplane, automobile and aerospace industry, nuclear receptors, computers, phones, and dental fillings, crown and implants. The individuals that work in these industries can be exposed to beryllium and are at an increased risk for health effects associated with beryllium. Exposure to beryllium particles in the workplace can come from inhaling small beryllium particles produced by drilling, sanding or grinding a part with beryllium in it or from skin contact with these particles or contaminated surfaces.

Beryllium sensitization is an allergy to beryllium and causes no symptoms. Individuals are tested for beryllium sensitization using a beryllium lymphocyte proliferation test (BeLPT). The BeLPT tests the patient’s lymphocytic reaction to differing concentrations and incubation times with beryllium. If the patient’s lymphocytes proliferate when exposed to beryllium it is considered abnormal and indicates the possibility of beryllium sensitization. Individuals with beryllium sensitization are at an increased risk for developing chronic beryllium disease.

The symptoms of chronic beryllium disease include: shortness of breath, cough, sweating at night and fatigue. As these symptoms are vague, chronic beryllium disease can often be misdiagnosed if a BeLPT is not performed. The symptoms of chronic beryllium disease are generally caused by granulomas in the lung tissue causing scar tissue to thicken the walls of the alveoli making it difficult for gas exchange to occur.

Unfortunately there is no cure for beryllium sensitization or chronic beryllium disease. The treatment of beryllium sensitization and chronic beryllium disease depend on the symptoms. As beryllium sensitization and mild cases of chronic beryllium disease have no symptoms there is no treatment. For more severe symptoms of chronic beryllium disease the use of inhaled bronchodilators, prednisone or other steroids and inhaled oxygen are used.

Which would you like injected into your face, Toxic A or Toxic B?

Clostridium botulinum is a endospore forming bacteria found in the soil. It can also commonly be found in canned foods and other foods that have not been cooked properly. The bacterium itself is not dangerous, but the spores it produces are the cause of worry. Toxins from Clostridium botulinum is the most dangerous of all chemicals known and one gram could devastate entire populations of people. Toxins from C. botulinum is much more dangerous than anthrax. It is so dangerous because Botulinum toxin is a neuromodulator. It is a neurotoxin, which inhibits the release of neurotransmitters. Without the release of acetylcholine muscles do not receive signals and become paralyzed. Paralysis will first occur in the face and quickly spread to the limbs and core. Without immediate treatment the infected person will suffocate due to the diaphragm not contracting to allow inhalation.

When people go into surgery for cosmetic procedures for face lifts many do not know that they are injecting toxins from bacteria into themselves. Botox is a cosmetic procedure, which the doctor takes a small dosage of toxins from the bacterium Clostridium botulinum and injects it straight into the skin. The injections are superficial and are in small dosages, which do not affect the rest of the body. The toxins reduce wrinkles by not allowing the facial muscles to contract.

Currently the most commonly used is Botox, onabotulinumtoxinA, but another form currently being investigated for cosmetic use is abobotulinumtoxinA, called Dysport. Botox is better known and has been used much longer, but Dysport shows better improvements in decreasing crow’s feet. They are both toxins from Clostridium botulinum, but different compounds. There were no significant differences between the faces of the patients with Dysport and Botox, besides the reduced appearance of crow’s feet. In a study of 90 volunteers, 67% preferred Dysport rather than Botox.

Although many people use Botox for cosmetic procedures, there are some negative side effects. The toxin is poisonous and can spread to other parts of the body, causing blurry vision, difficulty breathing, slurring of speech, and swallowing difficulties. This is a serious problem and people should seek immediate help if symptoms occur after Botox injections. With negative side effects occurring with Botox, what worries would arise from Dysport? And should this cosmetic procedure be allowable although the toxin is one of the most dangerous toxins known and could paralyze and kill a person in a matter of hours.

Egg and Sperm Synthesis

I have been working at a fertility clinic for the last 4 months, and have encountered many different reasons as to why couples are incapable of reproducing (infertility affects 1 in 6 couples). Most patients generally resort to in vitro fertilization, and for that reason I am always interested in finding new techniques that can cure infertility. Recently, I read a study in which a research team in Japan injected stem cells into the testes of infertile mice, which then went on to produce sperm. They were then able to use the synthesized sperm to fertilize eggs, and ultimately produce normal, healthy offspring. (http://www.christianpost.com/news/embryonic-stem-cells-used-to-cure-infertile-mice-53540/)

A team at Stanford was also able to take stem cells, treat them with proteins known to stimulate germ cell formation, and develop both sperm and eggs in the lab. Because most birth defects occur as a result of errors in the development of eggs and sperm, this technique will enable us to study the effects of environmental toxins on germ cell differentiation. This could potentially be monumental towards limiting the number of birth defects. (http://www.sciencedaily.com/releases/2009/10/091028142225.htm)

Creating eggs and sperm could be the answer to people left infertile by chemotherapy. Also the risk of down syndrome, caused by trisomy 21, is known to increase exponentially with the age of the mother. This is because eggs are left dormant in metaphase 1, and it is believed that eggs left in this stage for a longer period of time are more likely to have chromosomal abnormalities upon ovulation. (http://www.biomed.emory.edu/PROGRAM_SITES/PBEE/pdf/sherman1.pdf) So doesn't it seem logical that creating eggs in lab would eliminate the age factor of an egg, and drastically decrease the number of chromosomal abnormalities?

Would there be major ethical issues that arise as a result of this research? Could male stem cells produce eggs? Could those eggs be the answer to gay couples having kids of their own? If person A's stem cells were injected into person B's testes to produce sperm, whose sperm would it be?

Ultimately though, I believe this research will be beneficial towards the problem of infertility, and will provide opportunities to people that may not have had them.

Troublemaker? Stupid? Bored? Or is it ADHD?

Many children who are disruptive in class, impulsive and just can’t sit still are mistaken as troublemakers, but they may have attention deficit hypersensitivity disorder. More boys are diagnosed with ADHD than girls, but it affects 3-5% of school-aged children. ADHD begins early, at the start of brain development. The symptoms are inattention, impulsiveness and hyperactivity. The symptoms can all occur at the same time or the person may just have one of the symptoms. Since there are no physical signs or symptoms to diagnose the child, the child’s behavior is the only method of diagnosis. With this method it can be mistaken for depression or other psychological disorders. ADHD can be managed using medication such as Ritalin and Adderall and antidepressants. There are theories that ADHD is hereditary, but the true cause is unknown.

As stated above, diagnosing ADHD is difficult because it can be mistaken for other problems such as depression, other psychological disorders, or the child may simply be bored. Misdiagnosing children to have ADHD can be harmful due to the medications being prescribed. The medications are meant for children who suffer from ADHD and if they are misdiagnosed could cause more problems when the child may have simply bored in class. Diagnosing children with ADHD has been difficult due to lack of screening methods until recently. It has been discovered that children with ADHD process visual information differently from those that do not have the disorder. Researchers are trying to find specific brain pattern activity in children with ADHD. Researchers watched brain activity in children between the ages of 9 to 15 years old with and without ADHD to see the differences between brain pattern activity. Functional MRI scans are used to observe the different brain patterns. While the children are being observed they are also taking a series of tests. The children are tested for their concentration, visualization, and memory. Children with ADHD were found to have less activity in the region of the brain where other children would have more activity, the regions of the brain where visual attention and working memory are located. Although the research has shown to have some significance between children with and without ADHD, it needs to be confirmed that the brain pattern activity is not due to other psychological disorders. Another setback is that MRI scanning is costly, starting at $3,000 to $5,000 dollars.

There is still much research to be done, but with a more precise method of screening for ADHD it will be much easier to diagnose and treat children. Thus reducing if not eliminating the misdiagnoses of children with other psychological problems and giving them the right treatment and medications.

Radiological Society of North America 97th Scientific Assembly and Annual Meeting, Chicago, Nov. 27-Dec. 2, 2011.

Xiaobo Li, PhD, assistant professor, radiology, Albert Einstein College of Medicine, New York City.

Zombies are real. Yes, REAL

I'm currently taking a psychopharmacology course and we recently learned that there is actually a way to turn a living, breathing person into a living, breathing zombie. This practice is mainly seen in Haiti, and elicits great amounts of fear due to the workings of witch doctors who practice voodoo. Haitian voodoo was brought from Africa to Haiti in the 16th century by slaves. It is a religion based mainly on a belief in the spirit world. A main aspect of Haitian voodoo is a belief that an outside spirit or other individual can take over another individual's body and control it. So in the case of zombies, and the unlucky few who are forced to undergo this terrifying transformation, the experience is far from enjoyable, but more importantly, far from the victim's memory when it is all said and done.

The victim is first sent to a witch doctor to have a large wound or skin infection treated. This is when the victim is then administered a large dose of TTX, or tetrodotoxin, to the open would. This toxin blocks Na channels along the axons of motor neurons in the periphery, but has no effect on the sensory neurons in the periphery. (If the individual is given to much TTX, they will die, usually dues to respiratory failure, unable to breath because their muscles can no longer receive stimulus signals to do so). The victim is then watched until their heart rate slows significantly, and can no longer speak or move, so that they are considered dead (but the victim has almost all sensory ability still intact at this point, so they know what is happening to them, but lack the ability to do anything about it). They are then subsequently buried alive for a brief amount of time. These people, if they are able to survive the burial, are dug up and immediately administered a anticholinergic drug of some sort, which will inhibit ACh binding in the periphery and CNS, but just enough to calm a person who has just been dug up out of their grave. This shocks the person enough so even though they can again move, they can not gather themselves to run away. This anticholinergic causes the individual to lose their desire to be an individual, and causes retrograde amnesia due to the this drugs' ability to disrupt processes in the CNS, interrupting working memory and causing other memory disturbances. Immediately following this administration, the victim is baptized and given a new name. The victim then acts as if they have a form of PTSD that is not specific to any trigger, rather they seem sensitive to everything around them without the ability to understand why. They are usually held as slaves for as long as these symptoms will last, unwilling to care about who they really are, and unable to make decisions for themselves....

This was the most informative video I found on this topic that did not explain the scientific aspects of this process as much, but rather spoke about the practice from the viewpoint of Haitian people, except for the last couple minutes.

http://www.youtube.com/watch?v=RpcUnf5k8g4

Reversing the Irreversible - Stem cells used to cure heart failure

A few recent studies involving heart attack victims have found that regenerative potential exists within the heart itself. In the past, heart failure as a result of heart attack has been inevitable and unavoidable. One doctor said that it's only a matter of time before the heart fails. However, that could be changing within our lifetime. Stem cells derived from the heart itself have the potential to regenerate heart muscle and blood vessel tissue, and reverse the damage of a heart attack.

So far, the studies have shown that after administration of the stem cells, heart function is gradually restored above the "Left Ventricle Ejection Fraction" of 40% that is indicative of heart failure. Scar tissue retreats in addition to new tissue formation after the treatment. Even though further studies are necessary before the treatment becomes standard, several studies thus far paint a promising picture for our ever-growing population of heart attack and heart disease patients.

In addition to the exciting results of the studies, I found it very interesting that treatments including a mixture of stem cells and other types of cells extracted from a patient's heart have been more effective than nearly pure stem cell administrations. Similarly, some data suggests that treatment with bone marrow-derived stem cells yields the greatest results when administered within a few days of a heart attack, rather than a few weeks or months post-heart attack. Though no explanation is offered in the article, perhaps this is because the heart would be at its peak of trying to repair damage from the heart attack shortly after, and the stem cells boost this repair even further. That idea brings up further questions, though, as to why the heart doesn't automatically repair itself before the heart attack even happens then, if these cells already exist in the heart. Is it because the number of these cells is too low, and they must be multiplied in the lab to be effective? Or because they are not active in the heart without some sort of action to activate them?

All of this data seems exciting and likely to become a promising treatment, but I have concerns about the social impact of the treatment. In many ways, our society is working to eat healthier and be more active to reduce the current obesity epidemic and ultimately decrease the incidence of heart conditions. If this treatment becomes standard, will it deter people from the current healthy movement since they have the option to reverse the damage they could do by eating less healthfully and not maintaining an active lifestyle? If the repercussions of a less healthy lifestyle are potentially removed, perhaps people will not put as much effort into taking care of their bodies. Or is this worry an overreaction to something that could greatly benefit a society that isn't turning away from unhealthy lifestyles quickly enough? Either way, the physiology behind the heart and its newly-discovered repair mechanisms is interesting and a step in the right direction of understanding the intricacies of the human body.

http://www.cnn.com/2011/11/14/health/stem-cells-heart-damage-reverse/index.html?hpt=he_c2

Music to your ears: is it a good thing?

I know from experience hunting without ear plugs is hard on your ears, but I wondered how bad headphones were. Hearing loss is more common than ever before. About 16% of American adults have an impaired ability to hear speech, and more than 30% of Americans over age 20 — an estimated 55 million people — have lost some high-frequency hearing, according to a study published in the Archives of Internal Medicine. There is huge variation in how people are affected by loud sound, however, and this is an area where a number of researchers are conducting studies. Certainly a huge part of this is underlying genetics.

We know how much sound causes how much hearing loss based on studies that were conducted in the late '60s and early '70s, before employers were required to protect workers' hearing in noisy work environments. What was found is that when people are exposed to a certain level of noise every day for a certain duration, they're going to have a certain degree of hearing loss on average. “The outer hair cells in the cochlea, when exposed to loud noise, initially experience transient damage that causes a temporary threshold shift in the hearing; if the person is exposed long enough, the damage becomes permanent” (Kenna). But the amount of hearing loss might differ by as much as 30 dB between people who had the toughest ears and those with the most tender ones — a huge variation.

Another interesting thing I learned was how much bacteria built up in your ears when you shared headphones or used them for long periods of time. I found a comparative analysis of bacterial growth with earphone use. In the study they took 50 males and split them up into two groups. Group A rarely or infrequently used earphones and group B used earphones very frequently. Not surprisingly, both groups had an increase after using headphones, but group B had a lot more growth. Their study found “Frequent and constant use of earphones increases the bacterial growth in the ear and sharing of earphones might be a potential vector of commensals. It is therefore, always better not to share or else to clean the earphones before sharing” (Mukhopadhyay).

Reference:

Blue, Laura. "How Bad Are IPods for Your Hearing? - TIME." Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com. 28 July 2008. Web. 25 Nov. 2011. .

Kenna, Margaret A. "Music to Your Ears: Is It a Good Thing?" Acta Paediatrica 97.2 (2008): 151-52. Print.

Mukhopadhyay C, Basak S, Gupta S, Chawla K, Bairy I. A comparative analysis of bacterial growth with earphone use. Online J Health Allied Scs. 2008;7(2):4

Fruits and Vegetables vs. Snack Foods

In class we discussed metabolism and how it involves energy production, energy release, and growth (2). We also discussed metabolic rates and the average caloric consumption for average males and females. We also talked about if you consume too many calories, you run the risk of gaining weight and if you continually consume more calories than you burn, you can gain so much weight that you are overweight. I came upon this paper discussing obesity.
Many studies are being conducted to determine the main causes of obesity, but there are few studies that look at regions in the United States. According to the 2005 dietary guidelines, this paper contrasted fruit/vegetable consumption, physical activity, and foods that our bodies cannot digest, termed discretionary calories in Los Angeles County and Souther Louisiana (1).
They "conducted a cross-sectional survery in 228 urban census tracts in Los Angeles County (LAC) and Souther Louisiana (SL) and estimated calories in the past 24 hours from fruit, vegetables, cookies, candy, salty snacks, sweetened soda, and alcohol among 2,767 people" (1). Ther results of the paper calculated the average intake of those calories to be 438 in LAC and 617 calories in SL (1). According to this paper, the average discretionary calories should not exceed 267 and the mean consumption for fruit and vegetables fell 10% short in LAC and 20% in SL (1).
In class we discussed chemorecptors found on the tongue and how they are responsible for taste (3). From this article, it appears that some of the population finds that these foods are more favorful and better tasting. Since taste is often associated with smell, it appears that the smell of vegetables is correlated to their taste and maybe people find the smell and taste less desirable than snack foods (3). This same topic was discussed last night on 20/20 and they interview chemists and manufactures that are responsible for making such food addicting. The chemists and manufactures said that they try to create a product that heightens your sense of smell and taste and they try to make it so you keep craving it and you keep purchasing it.
However, fruits and vegetables are essential to our diet. Vitamin absorption occurs in the small intestine and fat-soluble vitamins (A, D, E, and K) are carried by micelles (4). Vitamin A is in fruits and vegetables such as mangos and broccoli. Vitamin D is found in mushrooms and vitamin E is found in cranberries and parsnips. Vitamin K is also found in blueberries, plums, adn okra.
"In contrast, campaigns, addressing obesity have encouraged people to consume more fruit, vegetables, and low-fat foods in lieu of recommending abstinence from any specific food " (1). Even though Americans have increased their consumption of fruits and vegetables, they have also increased their consumption of foods high in carbohydrates. As we learned in physiology, these carbohydrates are broken down into a more usable form called glucose, but if we consume excess carbohydrates, they are stored as glycogen and fatty acids.
Obesity is an issue that will continue to exist. Emphasis should be placed on making fruits and vegetables addictive versus snack foods and daily intake of calories should be lower or not exceed daily output.

References:
1. Cohen, Deborah A.; Sturm, Roland; Scott, Molly; Farley, Thomas A.; Bluthenthal, Ricky. Not Enough Fruit and Vegetables, or Too Many Cookies, Candies, Salty Snacks, and Soft Drinks? Public Health Rep. Jan-Feb 2010; 125: 1-8
2. Metabolism Lecture
3. Sensory Transduction Lecture
4. Digestive System: Organization and Function/ Nutrient Digestion and Absorption

The good, the bad, and the salty

Very often scientific research studies produce findings that contradict one another. This leads to significant confusion especially when the findings influence policy and national health campaigns. This post will consider the current attention dietary salt intake has received in the media due to recently published studies.

Federal health officials recommend daily sodium intake of ~2,300mg for normotensives and

1,500mgs for vulnerable populations (2). Yet, the average American consumes >3,000mgs of sodium daily (2). High salt intake has long been considered a major contributor to cardiovascular (CV) conditions including hypertension, congestive heart failure, stroke, and heart disease. (Photo: dailyfitnessmagz.com)

However, a recent Huffington Post article explored interesting findings by a group of researchers who reported no ties to the food or salt industries. Graudal et al. (2011) analyzed 167 studies that assessed low to high sodium diets on at least one of these parameters:

-systolic and diastolic blood pressure

-plasma or serum levels of several hormones and proteins

Data for normotensive and hypertensive individuals of Caucasian, Black, and Asian backgrounds were analyzed. Notably they found that sodium reduction resulted in significant increase in plasma renin, 2.5% increase in cholesterol, and 7% increase in triglyceride (4). These researchers identified an inverse relationship between decreasing sodium intake and increasing total cholesterol, and considered the potential CV risks that occur as a result.

Approximately two weeks later Health.com posted an article that highlighted a recent study that confirms the high sodium high-risk relationship that dominates discourse and research on this issue. O’Donnell et al. (2011) set out to clarify the optimal daily intake amount as it pertains to patients at risk for CV disease. Their study population included 28, 880 individuals with high CV risk from two pharmaceutical sponsored clinical studies for heart disease drugs. They measured sodium and potassium intake indirectly by estimating excretion levels (5). While the study by O’Donnell et al. demonstrated a J curve relationship indicating risk at both ends of the salt intake spectrum, they emphasized the high sodium high cardiovascular risk dynamic as significant and underplayed the low sodium high-risk relationship (5).

While study designs, methodology, populations, and location can all contribute to the discrepancies in findings, Folkow (2011) argues that another significant player is bias. In a recent editorial review, he highlights room for conflict of interest and proposes three alternative potential contributors to the salt-cholesterol relationship as opposed to what we consume (3):

-mental stateà mental stress can elevate plasma cholesterol levels more than eating eight eggs would

-influence of exerciseà effects metabolism, organ structure and function, “mental state, sympathetic activity, [and] immune functions”

-placebo effectsà participants “are aware of whether they are targets or controls”

Failure to fully disclose data, especially that which contradicts the original hypothesis, also contributes to bias.

Most data suggests that for normotensive individuals maintaining moderate sodium intake is optimal. However, more research needs to be conducted on larger sample populations to clarify the effects of low-sodium intake on individuals at risk for CV conditions to ensure that while trying to solve one problem we aren’t creating another one.

(1) “Study Confirms Sodium-Related Heart Risks” Online article, 11/23/11

http://news.health.com/2011/11/23/sodium-heart-risks/ Accessed 11/25/11

(2) “Low-Salt Diet Benefits Questions in New Study” Online article, 11/9/11

http://www.huffingtonpost.com/2011/11/09/low-salt-diet-cholesterol-study_n_1084611.html?ref=healthy-living-health-news Accessed 11/25/11

(3) Folkow, B. On bias in medical research; reflections on present salt-cholesterol controversies. Scandinavian Cardiovascular Journal, 2011; 45: 194-197

(4) Graudal N.A., Hubeck-Graudal T., Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub3.

O’Donnell, M.J., Yusuf, S., Mente, A., Gao, P., Mann, J.F., Teo, K., McQueen, M., Sleight, P., Sharma, A.M., Dans, A., Probstfield, J., Schmieder, R.E. Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events. JAMA. 2011; 306 (20): 2229-2238

Don't Take Too Much: Accidental Tylenol Overdose

Acetaminophen, commonly dispersed as Tylenol, is a well-known pain reliever. Regular Strength Tylenol is the most widely used painkiller in the US. It is well known that overdoses cause liver damage, renal failure, coma, and death, usually resulting from liver failure (Chan, 2011). Liver injury occurs when acetaminophen’s toxic metabolite, NAPQI, accumulates in the liver. Too much acetaminophen also depletes the liver’s detoxifying material, glutathione, causing damage to be maximized (Lee, ND). In the US, 10% of poisoning admissions involve acetaminophen. 40% of those admissions are a result of intentional overdose, but 60% are accidental (Dargan & Jones, 2002).

That’s right – it’s possible to accidently overdose on Tylenol. And as of now, the statistics regarding accidental overdoses are increasing.

Researchers from the University of Edinburg in Scotland found that “staggered overdoses”, or those that result from taking a little bit more than the recommended daily dose over several days, can be even more dangerous than a single, large overdose (Chan, 2011). Massive intentional overdose, taken as a suicide attempt, is treated with NAC, an antidote for the poisoning, or by pumping the stomach to remove excess acetaminophen. This prevents as much liver damage as possible. These dangers, however, present fewer immediate symptoms in patients with staggered overdoses. Repetitive use of slightly increased acetaminophen levels result in acute liver failure and hepatotoxicity (Dargan & Jones, 2002). In the study from Edinburg, compared with people who’d taken a single overdose of acetaminophen, those with a staggered overdose were more likely to have liver and brain problems, require dialysis or help with breathing, and were at greater risk of dying (Chan, 2011).

Staggered overdoses have been on the rise in the US for several reasons. The diverse cultures unique to the United States have caused a language barrier – misunderstandings and inability to communicate proper drug administration techniques results in an increase of accidental overdoses (Dargan & Jones, 2002). But the scarier reason is simple: people do not realize the risk of taking too much medication. In July of 2011, Johnson & Johnson, the manufacturer of Tylenol, reduced the maximum daily dose of the drug – from 4,000 miligrams per day (8 pills) to 3,000 (6 pills) - to lower the risk of accidental overdose (Johnson, 2011).

Tylenol is not a prescription drug; most of us use it frequently. Where does personal responsibility come in? Have you ever taken an extra pill, trying to get rid of that headache?

References:

Chan, Amanda. (27 November, 2011). Taking just a little bit to much Tylenol a day can lead to overdose, study finds. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2011/11/27/tylenol-overdose-staggered-health-risk_n_1110802.html?1322411285&ref=health-news

Dargan, P.I. & Jones, A.L. (2002). Acetaminophen poisoning: An update for the intensivist. Crit Care, 6(2): 108–110. Retrieved on 27 November, 2011 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137288/?tool=pubmed

Johnson, L.A. (2011). Maximum Tylenol dose lowered to prevent overdoses. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2011/07/28/tylenol-maximum-dose-lowered_n_912629.html

Lee, D. & Marks, J.W. (ed). (No date). Tylenol liver damage: How does an overdose of acetaminophen cause liver injury? Retrieved from: http://www.medicinenet.com/tylenol_liver_damage/page3.htm#tocg

Gluten-Free: Fad or Requirement?

The exact cause of celiac disease, a genetic autoimmune disorder, is unknown. But the symptoms are - and this has become apparent due to the recent rise in gluten-free products lining the shelves of neighborhood grocery stores. Celiac disease causes damage to the lining of the small intestine along with an inability to absorb certain nutrients. However, this digestive condition is only triggered when people with this disease consume gluten, a protein found in foods containing wheat, barley, or rye. There is no treatment for this disease so the only way to effectively manage it is a change in diet. If no change in diet occurs then the immune system reacts to the consumption of gluten by damaging the villi in the small intestine. This leads to malnourishment no matter how much food the individual is actually consuming. Thus, a change in diet is necessary for a patient to lead a normal healthy life.

If the many gluten-free products that are becoming available to Americans now are due to this disease then why the sudden market increase? Where is this large consumer population coming from?

Gluten-free food products were practically impossible to find in the 1990s because doctors believed that celiac disease wasn’t a problem in this country. As Dr. Stefano Guandilini observed, a medical textbook published in 1999 labeled celiac disease as a mostly European disease and quoted a prevalence of 1 in 10,000 in the U.S. for having the disease. But neither Dr. Guandilini nor Dr. Alessio Fasano believed this, especially since the genes were somewhere present in America due to our large European ancestry. In Italy, Dr. Fasano regularly saw celiac disease and questioned its absence in the States. He later founded the University of Maryland Center for Celiac Research and set out to do a more comprehensive study in 2003 on the presence of the disease in America. His study had stunning results – 1 in every 133 people had celiac disease and since it’s a genetic disorder, among those related to celiac patients the rate was as high as 1 in 22. This caused people to finally give attention to the disease. As Dr.Fasano says “the history of celiac disease as a public health problem in the United States started in 2003.”

As awareness of celiac disease spread so too did the diagnoses increase. The requests for celiac blood tests jumped 25 percent since 2009. Not only have Americans become better at diagnosing it but the disease has also become more common. Young people today are five times as likely to have celiac disease for unknown reasons. The disease has been on the rise in other previously untouched countries as well, such as Mexico and India.

Because of this dramatic increase in the affected population gluten-free products are in high demand and so far they appear to be recession-proof as well. The industry is rapidly growing and major corporations have been moving into the market. General Mills is a prime example of this. Employees once made statements such as the following, ‘we love gluten’ and ‘we are the very best of gluten’. This once gluten-rich company is now making a complete roundabout by reformulating their Rice Chex along with other cake, brownie, and cookie recipes to be made without gluten.

Celiacs aren’t the only ones consuming these products. Among the consumers are professional athletes who claim that a gluten-free diet has enhanced their athletic performance, a statement which many doctors and scientists scoff at. Rather than being a sign of the benefits of a gluten-free diet this exemplifies that gluten-free has in reality become a fad. Despite these fad consumers more than 80 percent of the market is driven by those who are medically required to. The rising awareness is seen especially in the occurrence of events such as the Gluten Free Expo in Sandy, Utah, which drew nearly 6,000 by the end of the day. After all, everyone needs to eat.



References:

http://www.nytimes.com/2011/11/27/magazine/Should-We-All-Go-Gluten-Free.html?pagewanted=1&_r=1&ref=health

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/

http://www.ncbi.nlm.nih.gov/pubmed/22060243

Induced Hypothermia: Just Chill Out!

Doctors are advocating a new technique where patients are purposefully chilled – lowering their body temperatures to nearly 50° F – in order to slow the metabolism of the brain and other organs.

Therapeutic hypothermia technique is a new treatment trauma surgeons have begun using on patients with uncontrollable blood loss. By drastically lowering the patient’s body temperature, the risk of brain damage following a period of massive blood loss resulting in cardiac arrest is greatly reduced. When a heart stops beating, oxygen does not sufficiently move to the brain. If revival occurs at normal body temperature (98.6° F) oxygen molecules form free radicals, which can cause damage and death to brain cells. Therapeutic hypothermia prevents this brain damage. Ice-cold fluids are flushed into the inferior vena cava, which spreads through the heart, brain, and rest of the body. The result is a large, but slow, drop in core temperature. Therapeutic hypothermia causes metabolic rates of the brain and heart to dramatically decrease, so less oxygen is necessary. When the patient is revived, their core temperature is gradually increased. The brain cells, having needed less oxygen, are able to withstand the reintroduction of oxygen molecules after resuscitation.

Studies have shown that induced hypothermia doubles the chances of survival in individuals with life-threatening traumatic injuries. With such promising results, as many as a quarter to a third of hospitals have added therapeutic hypothermia to their treatments for cardiac arrest.

There are, of course, risks associated with the treatment. Hypothermia inhibits blood clotting and may cause destruction to tissues.

The other complications of therapeutic hypothermia are ethical. Bioethicists are concerned because patient consent for those needing therapeutic hypothermia would be extremely difficult to attain, as a person bleeding to death is likely going to be unable to agree to the procedure. Instead, the research team, in collaboration with the FDA, will place signs, host informational meetings, and advertise online campaigns to inform residents in the area of the treatment. Residents worried about potential risks will be able to sign a list “opting out” in the case they were ever a potential candidate. Bioethicists, however, still worry that the “informed community” model cannot effectively cover the hazards.

Regardless of the possible risks, therapeutic hypothermia is becoming a mainstream treatment. In Colorado, it is protocol in Colorado Springs at Memorial Health. Is therapeutic hypothermia beneficial? Ethical? Or is it simply the “cool” new treatment?

References:

Clumpner M, Mobley J. Raising the dead: Prehospital hypothermia for cardiac arrest patients may improve neurological outcome and survival to discharge. EMS 37(9): 52-60, Sep 2008.

Holzer, Michael. “Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine. (2002) Vol. 346, No. 8.

Neergaard, Lauren. (14 November 2011). Hypothermia to save lives? Doctors to try deep-chilling trauma patients. Retrieved from: http://www.huffingtonpost.com/2011/11/14/deep-chilling-trauma-patients_n_1093546.html?ref=healthy-living-health-news

Screening for Heart Disease in Teen Athletes - Safe or Sorry?

Recent studies have shown that physicians who perform pre-season physical examinations on teenage athletes often do not sufficiently screen for potentially detrimental heart issues. This negligence endangers athletes who may be at risk for sudden cardiac death. According to this article, about one in 30,000 teen athletes suddenly dies each year. This figure doesn't seem alarming until you consider that this translates 175-233 deaths occur each year - needless and fully preventable deaths.

Our society is caught up in keeping kids and teens busy with sports, activities, homework, and other extracurriculars. In general, allowing kids to experience a variety of activities is beneficial to creating good time-management skills and developing well-rounded individuals. However, I think this desire to let all kids have a fair chance at the activity they want to participate in might be clouding judgment on actually screening kids before allowing them to participate in physical activities.

From my own perspective, I was not aware of any major medical issues I might have had. However, any time I had a pre-season examination done, it was a 10-minute-long, superficial process. The physicians assumed I was healthy enough to safely participate in intense physical activity. Fortunately, I was healthy enough - but many kids are not, and they slip through the cracks when physicians blanket all teens as young and healthy.

During my senior year of high school, a fellow classmate and star varsity basketball player passed out during practice and hit his head as he fell. He was in a coma for nearly two weeks before he died in the hospital. His family was aware of his congenital heart disease, but doctors and trainers allowed him to play anyway. According to this article, most doctors that participated in the study do not even ask about an athlete's family history or if the athlete has chest pain, etc. Clearly stricter guidelines are necessary to prevent such terrible, avoidable tragedies.

Obviously, it would be difficult to tell a child that he or she cannot play a sport or participate in an activity because of a potential risk that may or may not amount to something significant. But wouldn't it be better to be safe than sorry?

http://vitals.msnbc.msn.com/_news/2011/11/13/8759048-teen-athletes-often-not-screened-for-heart-risks-study-finds

Synaptic Pruning by Microglia is Necessary for Normal Brain Development

Like in all of our organ systems, there are specialized cells that have specific roles. For example, microglia are non-neuronal cells found in the CNS. They are tissue macrophages that play a role in the innate immune system. Normally their job is to be on the look out for damaged neurons or infectious agents and engulf them. They can also secrete cytokines ,including hydrogen peroxide and nitrous oxide, which will can lead directly to cell death.

I recently read an article in Science discussing the importance of microglia in the undamaged brain. The purpose of this paper was to investigate whether microglia monitor synaptic function and if they are involved in synaptic maturation and elimination. First they went about using fluorescent labels to tag excitatory postsynaptic density and another fluorescent label to tag microglia processes. Their results showed an overlapping or colocalization of the fluorescent markers which indicates microglia engulfment of post synaptic activity.

These researchers then took this study a step further by knocking out a chemokine receptor usually present on microglia. Without this chemokine receptor, the microglia will not be able to become activated and fulfill their roles in the CNS. Their studies showed that KO mice for this chemokine receptor had a greater incidence of LTD (long term depression), an increase in postsynaptic material as well as a higher susceptibility to drug induced seizures.

This paper showed the important role microglia play in an undamaged or uninfected CNS. Microglia engulf and eliminate post-synaptic activity during development. Synaptic pruning is important because it is a way of weeding out inefficient synapses. If microglia are nonfunctional or cannot become activated than the CNS system will have efficient as well as inefficient synapses. These inefficient synapses can lead to a number of problems including LTD and an overall less developed brain.

The paper brings up an important point, that genetic variation in the chemokine receptor involved in activating microglia, may contribute to susceptibility of developmental disorders associated with altered synapses number. If researchers are able to understand this chemokine receptor gene, we may be able to provide therapies and treatments for debilitating neurological diseases.

References:

http://www.sciencemag.org.dml.regis.edu/content/333/6048/1456.full.pdf?sid=f519e898-8935-4cc5-9587-ad8be1fcd9d5

Sweet delicious honey, perfect for tea, cake..and festering wounds?

Deep in the center of the hive, surrounded by the pervasive hum of thousands of honey bees, golden honey from the nectar of millions of flowers collected from up to 55,000 miles of travel sits within its comb. The honey is composed of both plant and bee components. Consisting primarily of the carbohydrates fructose and glucose, as well as water. Other then the carbohydrates, honey consists of many enzymes such as diastase (amylase), invertase (α-glucosi-dase) and glucose oxidase. Other enzymes present in smaller amounts are catalase and acid phosphatase. Phytochemicals also exist within honey, a source of antioxidants, as well as organic acids that hold honey at a pH of 3.9.

For thousands of years honey has been used for medicinal and nutritional purposes, revered by the ancient Egyptians, and even found buried within their tombs, the only item to remain preserved, unspoiled and still useful. Thousands of years unspoiled? Still usable? On op of that used as a revered medicine? Science has recently begun to take on these claims, and is beginning to find that honey is indeed a form of liquid gold, at least in its medicinal properties.
One of honeys most well known attributes, one that would assist in wound healing and in it's ability to remain unscathed for thousands of years within a tomb, is that it contains antibacterial activity. Most of the antibacterial activity of the honeys occurs due to hydrogen peroxide generation. Other researchers have identified the flavonoids in honey, particularly caffeic acid and ferulic acid, as the most likely contributors. For millennium honey has been used to treat wounds, and recently science is showing why it is being viewed as a viable and potent wound salve.
Bacteria, especially those associated with external wounds are found in a polysacchride biofilm which protects them from their host's immune system, antibiotics, and wound washing and drying. Therefore a topical agent, is needed to most effectively treat persistent biofilm wound infections. The only issue is that many topical antibiotics don't penetrate well, and in fact can be quite useless against resistant bacteria. Honey however, has been shown to be effective against MRSA, MRSE, Klebsiella, pseudomonas, and E. Coli, even those that are known to be antibiotic resistant. It has also been shown to encourage skin regrowth, B and T cell immune activation, as well as anti-inflammatory(through an anti-oxidant pathway). It has been used successfully on venous ulcers, chronic diabetic wounds, and burns.
Honey's glucose oxidase produces hydrogen peroxide and gluconic acid both which help to break down bacteria. It's low water content has been shown to prohibited microorganism growth, and the high osmolarity has been shown to help draw out tissue lymph and continue to bathe and help the healing process. Flavanoids and benzoic acid have also been identified as contributors.
There are also other non-peroxide antimicrobial components that have not yet been identified. Overall honey has been shown to be broad spectrum and effective antibiotic and wound ointment.

With so many naturally occurring medicinal products, and research showing expansive plausible uses, that delicious jar in your cupboard could come in handy for more then just your tea...

http://www.honey.com/nhb/about-honey/
http://www.ncbi.nlm.nih.gov/pubmed/22095907
"An overview of honey: Therapeutic properties and contribution in nutrition and human health" Christy E. Manyi-Loh1, Anna M. Clarke1 and Roland N. Ndip

Video Games: Good or Evil?

My sister is a video game fanatic, literally. Ever since we were kids, she has turned a shoulder on reality to escape to the fantasies created within these games. She has hundreds of games, and from what I can tell, every gaming device there is known to man. I’m only partial to Nintendo 64 (do they even make those anymore?) but she has x-box, Wii, PlayStations, game cube, etc. and her collection of games ranges far and wide as well.

She can also walk into a room for no longer than 10 seconds and tell you exactly where everything was placed, the colors of the paintings on the wall, how many outlets there are and if there were tiny cracks or cobwebs unseen to most.

Video games have long been attributed to a continuum of behaviors we see in society today. One end of the spectrum includes anger, violence, social isolation and hostility, while the other encompasses improvements in fine motor and spatial skills, multi-tasking, and quick thinking. It’s hard to judge and pinpoint how a video game will affect an individual, since all games are different as are people, but for better or worse, I like to believe that playing video games has made my sister increasingly more aware of her surrounding environment.

A short review article in the Review of Optometry journal stated that research shows individuals who play video games can reorganize the brains cortical network, which can help them perform complex visuomotor tasks. The study placed subjects in an fMRI machine while playing video games and measured which areas of the brain were activated during the duration of the game. Experienced gamers had more activity in the prefrontal cortex while non-gamers had more activity in their parietal cortex, and it was therefore concluded that there is a correlation between video games and reorganization of the cortical network.

Another study from the Department of Brain and Cognitive Science at the University of Rochester showed that playing video games increases the speed of processing surrounding stimuli. The researchers studied effects of games on hand-eye coordination, visual processing in the periphery, and visuospatial memory, and their results concluded that there was a significant increase in these three parameters among individuals who regularly played video games compared to individuals who do not. This research is where I want to contribute my sisters’ impressive photographic memory to her passion of nonstop gaming. Although I am aware that playing video games did not suddenly bless her with the ability to distribute her visual attention across space, I believe it certainly enhanced her abilities to be incredibly visual.

Obviously there are valid arguments that playing video games can be detrimental, regardless if they are violent or not. Gaming consistently promotes laziness, and absence of social interaction can create complications in communication. However, as mentioned above there are benefits of playing video games including being more aware of your visual surroundings, increase hand-eye coordination, fine tune visuomotor skills, etc. Video games challenge your brain to pay more attention to detail, patterns, and other stimuli which can be very beneficial in other areas of your life. I have seen these aspects in my sister when she plays. She absorbs everything that’s happening on the tv screen, every move she makes is done with precision and awareness, conscious that something bad could happen at any moment. I’m lucky enough if I can keep Mario and his little cart straight on the road, let alone thinking about those evil green and red shells that are out to destroy me (you know what I’m talking about if you every played Mario Cart on the ’64).

Finally, there are more and more computer based games being produced that are specifically targeted to either helping children learn (games that incorporate math, language, science, to make the learning experience fun) or targeted to improve cognition in Alzheimer’s patients. In the Journal of Neurology, Neurosurgery, and Psychiatry, a program called Smartbrain provides stimulation to cognitive facilities including attention and memory among individuals with Alzheimer’s, enhancing those areas of memory, which is great news!

What are your thoughts on video games and do you think they can significantly alter brain patterns?

References:

Video Games Stimulate Visual Brain Function. (2010). Review of Optometry, 147(10), 8.

Dye, M. G., Green, C., & Bavelier, D. (2009). Increasing Speed of Processing With Action Video Games. Current Directions In Psychological Science (Wiley-Blackwell), 18(6), 321-326. doi:10.1111/j.1467-8721.2009.01660.x

Balcells, J., et al. "A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer's disease." Journal of Neurology, Neurosurgery and Psychiatry 77.10 (2006): 1116+. Academic OneFile. Web. 26 Nov. 2011.