All posts by yellowbeak

Niacin seems to be very unhelpful as a supplement for low HDL!

Niacin fails to improve coronary health
Niacin fails to improve coronary health
  • If you have been taking niacin to help your HDL, there is more and more evidence that it may be hurting you! Besides the red flushing it can cause if taken in large amounts that is needed to help increase HDL levels, it also can cause liver damage.
  • In the AIM-HIGH study in 2011, no benefits were found from Niacin supplementation, and in fact there were increased side effects, including bleeding risks.
  • In the HSP2-Thrive study, Niacin supplementation had no effect on major vascular events. There were bad side effects including a 32% increase in new-onset diabetes, and  a 55% worsened glucose control in diabetics taking the supplement. In fact, mortality risk increased by 9%
  • I think it’s time to throw out the Niacin supplements and not worry so much about an isolated HDL problem. Low HDL is probably a symptom of another lipid and metabolic problem.

Toenail problems? New solutions for fungal nails!

Onychomycosis
Onychomycosis – yellowed, thickened nails
  • Onychomycosis – refers to nail infections by fungus, including yeasts and molds.  Toenail onychomycosis is most commonly due to dermatophytes, a type of fungus (i.e. Trichophyton rubrum and T. mentagrophytes)
  • Risk factors for the problem include swimming,   athlete’s foot, diabetes, genetics, and living with family members who have the disease.
  • Besides being unsightly, the nails can be difficult to cut and also can increase the risk of bacterial infection. Pain can be an issue as well, as nails can become sensitive to pressure.
  • Yeasts, like Candida Albicans, can also cause some cases of nail fungus, especially on the hands. People who immerse their hands in water a lot are at risk.
  • Some fungal infections can discolor the nail black –  (dematiaceous fungi  – pigment-producing molds)
  • As a result of these infections, the nails get thickened, discolored,  with crazy shapes and debris under the nail.
  • Two recent approved topical therapies that appear to have excellent effectiveness have come to the market.
  • Kerydin (Tavaborole) topical solution can be applied to the nail daily for 48 weeks. No nail removal is required and the solution is not absorbed to any degree by the body. About a third had significant improvement without adverse reactions to any large degree. It is expensive (~400$)
  • Efinaconazole (Jublia) topical solution is another new arrival to treat the standard nail infections caused by T. Rubrum/T. Mentagrophytes. It is a topical triazole that blocks the fungus from producing it’s cell membrane. Applied at a drop a day to the affected nail for 52 weeks,  40% had mycological cure with minimal side effects, but at a cost of $450 a month.
  • Oral treatments that are mainstay include  Terbinafine (Lamisil) daily for 12 weeks and itraconazole daily for three months. Their effectiveness is about 30%-40% with more side effects.
  • Alternative therapies with some possible efficacy include applying Vicks Vapor rub (a mixture of menthol, eucalyptus oil, camphor, and thymol) to the nails every day for up to a year. This has worked well for quite a few people.
  • Tea tree oil is another alternative topical therapy with unproven results.
  • Still, oral therapies are still the best options as of yet. Oral Lamisil (terbinafine) cures 40% to 60% of patients…compared to less than 9% for Penlac (ciclopirox) and 11% for clotrimazole 1% topical solutions (less effective topical agents also on the market).
  • Key preventative measures include wearing flip-flops around a shared shower or pool, wash and dry feet thoroughly every day , do not clip your nails too low to the base, and avoid nail polish.

Diet and Heart attack prevention

 

 

 

 

The Mediterranean diet has scientific evidence of its efficacy in preventing heart attacks. There are several foods that play a large role in decreasing the inflammation in the body that leads to plaque build-up.

  1. Insane medicine - olive oil
    Olive Oil

    Extra Virgin Olive Oil (EVOO) is produced from olives and is rich in polyphenols that have anti-oxidant and anti inflammatory effects. It also has omega-3s and flavenoids, which are cardioprotective. It has a high content of monounsaturated fatty acids, which can decrease your LDL levels (bad cholesterol), and this is cardioprotective as well. EVOO can be cooked up to a temperature of 410 degrees F, so it can be used in most recipes. For higher temperatures, use regular olive oil. There are about 120 calories per teaspoon, so be careful how much is used! Compounds in EVOO include polyphenols (hydroxytyrosol, tyrosol, oleupein) and monounsaturated fats.

  2. Salmon and fatty fish such as halibut and sardines contain heart-healthy omega-3 fats. These lower triglycerides in your blood and stabilize plaques. The Omega-3 fatty acids are EPA (eicosapentanoic acid) and DHA (decosahexanoic acid).
    Insane medicine - Salmon
    Salmon –

     

  3. Red wine – is loaded with flavenoids and the antioxidant resveratrol. A glass of wine a day keeps the doctor away!
  4. Lentils and legumes – including beans and peas, have an abundance of minerals and vitamins and fiber, which lowers cholesterol. You can use soymilk to supply your daily dose of legumes in place of cow’s milk. Present in legumes are flavenoids (quercetin, anthocyanins) and isoflavones (genistein and daidzein), fiber, and phenolic acids (ferulic acid), all of which prevent artery plaque build up and inflammation.
    Insane medicine -Lentils
    Lentils

     

  5. Walnuts and flaxseeds – have a lot of alpha linoleic acid, a vegetarian omega 3 fat and fiber as well. Flaxseeds can be added to baked goods and pancakes to increase their fiber content and flavor.
    Insane medicine - flaxseeds
    Flaxseeds

     

  6. Greens and vegetables – including spinach, a very nutrient- dense vegetable, and red-purple colored vegetables such as radicchio, eggplant, and red beets all contain pigments that increase glutathione in our system, a natural antioxidant.You want to mix many different colored vegetables into your diet every day.
  7. Dark Chocolate and green tea – lowers blood pressure and cholesterol. Green tea is rich in antioxidants, especially polyphenols.
  8. Figs and fruits – dried fruits, pureed fruits – all are healthy, aim for three servings a day. They are high in polyphenol flavenoids and vitamins.
  9. Oatmeal and other whole grains – Oats are filled with soluble fiber ( a beta-glucan) that soaks up cholesterol. They are also high in antioxidants.

Alzheimer’s Disease – new screening tests in the near future?

 

 

Alzheimers disease brain tissue

Insane Medicine -Alzheimers disease
Alzheimer’s disease – neurons affected by plaques.
  • 5 million people are affected by Alzheimer’s Disease (A.D.) in the U.S., with a 1% incidence in the age group of 60-70 and 6-8% in the 85 year old category.
  • It is a progressive disease leading to eventual functional incapacity. There is a resulting loss of retention of recent memories at first with a progression to loss of remote memories in later stages. Language, abstract reasoning, and executive or decision making functions are impaired. Patients become household and work impaired. Some become delusional or psychotic.
  • This disease is the result of hyperphosphorylated Tau proteins that form neurofibrillary tangles inside the neurons. Also there are plaques of beta-amyloid that deposit in the brain, disrupting neuronal function.
  • Family history plays a role in the disease, with an individual having twice the average risk of disease if a first degree relative has Alzheimer’s.
  • Genetic changes, such as the presence of Apolipoprotein E4 mutation, increases the risk of A.D. by 2-5 times average risk by the age of 60-80.
  • Other causes of dementia must be ruled out before Alzheimer’s Disease is diagnosed. Reversible causes especially must be looked for, such as B12 deficiency, infections such as syphilis, thyroid disorders, autoimmune disorders, medication side effects, and drug abuse, especially alcohol.
  • A.D. results in difficulty in performing sequential tasks with poor decision-making skills eventually. This results in an at-risk population of elders, who are easy prey for con-artists looking to make money off impaired individuals.
  • Neuropsychiatric testing can help determine a person’s capabilities.
  • Cedar-Sinai Medical Center is developing a retinal imaging device that may identify A.D. 15-20 years earlier than other tests, such as PET scanning. Using curcumin, a compound found in the spice Tumeric, researchers discovered that the curcumin bound the Alzheimer’s plaques and could be seen in the retina. This resulted in 100% detection of the disease. Some people without the disease, however, tested positive with this testing.
  • Another retinal test is being evaluated by the Banner Alzheimer’s Institute using Fluorescent Ligand Eye Scanning (FLES). Researchers could detect beta-amyloid in the retinas of A.D. patient 85 % of the time.
  • Such retinal scans will allow for earlier detection of A.D.
  • There is no specific treatment for Alzheimer’s Disease, so there are a lot of ethical considerations that need to be evaluated in performing such tests. However, earlier detection may allow an individual to protect their financial and personal well-being from poor decision-making by allowing  specified power-of-attorneys to help make decisions when executive functioning starts to fail.
  • Other A.D. findings: Recently, a new protein, TDP-43, also seen in Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) ,has been associated with A.D. Additionally, A.D. patient can be screened for impairment through an inability of smell detection as well, using a 40-item smell detection test, called the University of Pennsylvania Smell identification Test.

Ebola Virus

Ebola Virus Infection

Ebola virus_virion
Ebola virus_virion magnified under electron microscope
  • Ebola has continued to spread in West Africa, infecting over 4500 people through September 2014, with 2300 deaths. The average mortality rate has been 70% with this infection.
  • This epidemic is the Zaire Ebola virus. There are several other sub-types of Ebola. It is an RNA virus of the filovirus family. It’s reservoir is the fruit bat and is spread among humans by direct contact with body fluid or the consumption of infected food or plants contaminated with bat droppings.
  • This epidemic started in Guinea in march.
  • Humans, apes, certain mammals, and potentially rodents can get Ebola.
  • There is no specific treatment as of yet, various interventions have been tried, but the main treatment is isolation of the individual, intravenous fluids, hydration, management of electrolyte issues, and prevent co-infection from bacteria.
  • Ebola life cycle
    Ebola life cycle

    According to a CDC prediction tool recently released, if current conditions persist, the cases will double every 20 days up to 20,000 infected by early November. This can be prevented by isolating at least 70% of the infected patients in specialty Ebola units. The more delay there is in obtaining this critical isolation and treatment number, the more likely infection rates will increase.

  • The CDC still predicts that the epidemic will end even if counter-measures are delayed, it will just result in more deaths.
  • Ebola virus infection isolation and treatment is needed to decrease spread.
    Ebola virus infection isolation and treatment is needed to decrease spread.

     

  • Many health care providers have lost their lives in Africa treating the sick, including researchers, nurses, and doctors. Fear of the disease and customary burial practices have increased the transmission rate and death rates. There are fewer and fewer doctors and nurses available to help stem the infection.

 



Exercising, even a small amount, benefits older adults!

Exercising and stretching are important to maintain mobility
Exercising and stretching are important to maintain mobility

 

  • Many studies have recognized the importance of exercising, especially in older individuals. Some physical activity is better than none in decreasing mobility issues in the elderly (Journal of American Medical Association – May 2014).
  • Flexibility and balance training, combined with walking, with a goal of 30 minutes at least for a total of 150 minutes a week reduced major health complications from poor mobility.
  • Walking, strength, and balance training decreased muscle loss in the elderly, and a structured physical activity routine is probably a great way to reduce disability in the elderly.
  • You may have wondered why some older people end up never walking again after a brief illness. They are doomed to a bed-bound existence because they suffer from sarcopenia, or muscle loss. That muscle does not come back, hence the need to preserve and maintain the strength one has before illness strikes so they do not lose mobility.
  • You should consult with your doctor before starting an exercise program. Local senior centers or health clubs may have exercise programs for older adults. It is best to have a training partner to give you more motivation to work out.
  • As one ages, it is very important to stay active and maintain what muscle mass that you have.
  • Tai Chi helps maintain balance and muscle strength.
    Tai Chi helps maintain balance and muscle strength.

     

  • Tai chi is a proven method of helping with balance and strength maintenance. It is low-impact, using slow, gentle bodily exercises and can alleviate a variety of physical and mental disorders.
  • Tai chi is effective in pain reduction, since physical inactivity results in increased pain and muscle mass loss. It is important to maintain flexibility and balance, both of which Tai Chi provides. Studies have shown that Tai Chi reduces the amount of falling in Parkinson’s disease.
  • Tai Chi allows you to manage your stress more effectively.
  • There are a variety of DVD’s available which demonstrate how to practice Tai Chi. Likewise, local resources in your community may offer Tai Chi classes.

Phosphorus in our diet: A problem or a marker for a bad diet?

  • Phosphorus is found in a wide variety of foods, both processed and unprocessedPhosphorus
  • It is found in meats, nuts, seeds,, whole grains, seafood, and poultry.
  • Additives in the form of phosphates are another form of phosphorus that we ingest. The inorganic form like this is readily absorbed. They are used as leavening agents, stabilizers, flavor enhancers, emulsifiers, and moisture binders in many food products.
  • Sodas, in particular, Colas are sources of phosphates.
  • Basically any processed food is generally filled with extra phosphorus.
  • We need Phosphorus for energy metabolism, regulating calcium, genetic information, and cell maintenance.
  • Too much phosphorus can increase the risk of cardiovascular events, bone loss, and kidney failure.
  • The RDA is 700 mg a day. Amounts over 1400 mg a day are associated with increased risk of mortality even in healthy people.
  • The type of food and it’s phosphorus load may play a role in the extent of problems. Phosphorus in an inorganic form is absorbed quickly and is present in processed food . This along with phosphorus present in meat products seems to pose an increased risk. In milk and dairy products, which have calcium and phosphorus in large amounts, there is not as much danger. In fact, dairy products lower high blood pressure.
  • Colas contain a lot of phosphorus, and this may result in displacement of calcium in the body, resulting in low bone density and fractures.
  • High phosphorus intake may increase risk for osteoporosis.
  • A hormone, FGF-23 may be increased in patient who consume a lot of phosphorus. This hormone  may cause cardiovascular problems such as calcification of the arteries and stiffening of the arteries.
  • Excess phosphorus may be associated with cancer and type 2 diabetes risk.
  • In short, decrease your processed food intake, cola consumption, and consider following the DASH diet (Dietary Approaches to Stop Hypertension)
Dash Diet Pyramid
Dash Diet Pyramid

Cefaly: A new Migraine Prevention tool!

Cefaly: The new Transcutaneous electrical nerve stimulator to prevent Migraines
Cefaly: The first transcutaneous electrical nerve stimulator to prevent Migraines

 

  • The FDA has approved of the use of Cefaly  (Cefaly technologies)to prevent episodic migraines in patients over 18 years old. Another device, the SpringTMS (eNeura)  is approved for migraine prevention and treatment in patients that have migraines with auras. The SpringTMS devise is a transcranial magnetic stimulation device, different from the Cefaly.
  • Simply attach a sticky electrode to your forehead and lower the headband, which has a pulse generator in it, and you are ready for your treatment.
  • It stimulates the trigeminal nerve in the face and produces a tingling sensation. Each treatment lasts 20 minutes once a day and is relatively pain-free.
  • There was a significant decrease in the  number of migraine days per month by 50% (PREMICE trial).
  • The more migraine headaches you have per month (especially if more than 6), the better the results for this treatment. In effect, you use less anti-migraine medications, but your headaches, when they do occur, are just as severe, but fewer in number per month.
  • The device cannot be used if you have a pacemaker or implanted defibrillator or metallic devices in your head.
  • Some patients complained of insomnia.
  • This treatment seems to work well in half of all patients who tried it.
  • Any personal experience with this device? Please comment!! See the link below for the product page:

http://www.cefaly.ca/

Enterovirus EV-D68 Marches on!

  • As more states report clusters of severe cold-like illnesses, some of which have been linked to EV-D68, it seems apparent that cases and locations of the illness will keep mounting.
  • There is no vaccination or antibiotic to treat a virus, and just because you have a cough, nasal congestion, or signs of an upper respiratory illness, it does not mean that you have the EV-D68. Don’t get in a panic, even if you do.
  • Treatment plans if you get cold-like symptoms : see your doctor/ER if you feel short of breath or have severe symptoms. Avoid close contact and wash your hands frequently. Take in plenty of liquids. Tylenol and ibuprofen for fevers and aches.
  • Doctors will basically assess you in the Emergency Department for possible other diseases such as pneumonia, bronchitis, or worsening asthma. Bacteria are treatable, but most viral infections require only supportive care. Doctors will assure your hydration status, administer nebulizers for bronchospasm, and use imaging such as a chest xray to look for pneumonia.
  • Severe symptoms such as dehydration and persistent vomiting, low oxygen saturation in your blood stream requiring oxygen, or another severe diagnosis may necessitate admission to a hospital.
  • As many children have never had exposure to this infection, immunity will be low, hence, more severe presentations.
  • Don’t forget to get your Flu vaccine this year!

I have a cold

Enterovirus D68

Enterovirus Virions
Enterovirus under high magnification.

What is this Enterovirus D68 (EV-D68)?

  • It was first found in California in 1962, but has never really been associated with mass outbreaks of infection
  • Enteroviruses are related to polioviruses. There are many flavors of Enteroviruses, which generally cause rash, mouth sores, conjunctivitis, and sometimes more severe infections.
  • Since doctors generally don’t test for viruses in their patients, it is hard to tell how common the EV-D68 infection is. Some people may be very sick while other show no symptoms. There are a broad range of presentations.
  • This EV-D68 infection is acting like a common cold with a twist. It mostly causes runny nose, fever, muscle aches, and cough. However, occasionally it has led to severe respiratory failure.
  • As of September 15, states which have had the illness present included Colorado, Illinois, Iowa, Kansas, Kentucky, and Missouri. It may be coming to a town near you soon.
  • The National Enterovirus Surveillance System through the CDC tracks such viral infections, but the disease is not reportable, so it will be difficult to assess it’s true impact and presence.
  • Since EV-D68 is acting like a common cold, the usual precautions should be taken among family members and coworkers with any respiratory illness: Don’t share utensils, avoid close contact, and wash your hands frequently. Stay away from sick people, especially if they have cancer, emphysema, or a transplant. Pregnant women and small infants should stay away from people with respiratory illnesses.
  • In all, this infection will pass through the communities in the East and Mid-West as schools have started and people are in close contact.  This will not result in any large scale catastrophes, but occasionally some patients, primarily in the 6 month to 16 year old range, will demonstrate more severe symptoms.
  • There is no vaccine available and no specific treatment other than measures to deal with associated conditions, such as wheezing or worsening asthma and fever. Antibiotics do not help. Good hygiene is important to prevent spread of the virus.

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