Improving health and longevity Archives

Adult HPV Vaccine Age, Guidelines

“The HPV vaccine is having a significant effect of decreasing cervical cancer. More recently HPV is associated with oral cancer and anal cancer.

HPV goes through latex And many of other sexually transmitted diseases do not. Many adults don’t know that the “safe sex” procedures they use may not work with HPV.

This recent review of this CDC information says that the vaccine has a low side effect rate in adults. The CDC data is established up to age 26. The CDC cannot recommend the vaccines for older adults. Adults older than 26 years who are sexually active should examine this data and balance that with their HPV risks.

Gardasil 9 has the broadest range of efficacy. The Prevents infection by 9 different types of HPV virus. These 9 types account for 90% of cervical cancers.” Bill Chesnut M.D.

Return to New Health News, https://billchesnutmd.com/new-health-news/

· Why Adults Should Get the HPV Vaccine
· When Should Adults Get the HPV Vaccine?
· Are There Any Adults Who Should Not Receive the HPV Vaccine?
· What Are the HPV Vaccine Ingredients?
· What Are the Risks and Side Effects of the HPV Vaccine?
Human papillomavirus (HPV) is the virus that causes cervical cancer in women and genital warts in men and women. The HPV vaccine effectively prevents infection with the HPV types responsible for most cervical cancers and can also prevent genital warts. HPV vaccination is most effective during childhood or adolescence, but adults can also benefit from the HPV vaccine.

Why Adults Should Get the HPV Vaccine

HPV infection is extremely common; most sexually active people will be infected with HPV at some point in life. HPV infection usually causes no symptoms, but can cause genital warts and anal cancer in both women and men. HPV can also cause throat cancer.

In women, HPV infection can cause cells in the cervix to grow abnormally. In a small fraction of women, these HPV-induced changes will develop into cervical cancer. About 12,000 women are diagnosed with cervical cancer each year and about 4,000 women die from the condition.

The HPV vaccine prevents infection by the HPV types responsible for most cervical cancers. There are three available forms of the HPV vaccine:

Cervarix: Prevents infection by HPV-16 and HPV-18. These two HPV types cause 70% of all cervical cancers. It is used for the prevention of cervical cancer and precancers.
Gardasil: Prevents infection by HPV-16, HPV-18, and also HPV-6 and HPV-11, the two HPV types that cause 90% of genital warts. It is used to prevent cancers and precancers of the cervix, vulva, vagina, anus, penis, and throat.
Gardasil 9: Prevents infection by the same HPV types as Gardasil, plus HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58. Collectively, these types are implicated in 90% of cervical cancers.
All HPV vaccines are extremely effective at preventing infection by the HPV types they cover. Getting the HPV vaccine reduces a woman’s risk of cervical cancer and precancerous growths substantially. Men cannot develop cervical cancer, but the HPV vaccine may prevent genital warts, anal cancer, and the spread of HPV to sexual partners. Gardasiland, Gardasil 9 are approved for males ages 9 through 26.

The HPV vaccine does not treat or cure an HPV infection in women or men who are already infected by one of these HPV types.

When Should Adults Get the HPV Vaccine?

The CDC recommends that all women ages 26 years and younger receive three doses of the HPV vaccine. The CDC recommends that all men ages 21 years and younger receive three doses of the HPV vaccine. It is an option for all men, but is recommended for men who have sex with men or who have a compromised immune system (including HIV) who are ages 26 and younger.

CDC guidelines recommend the three doses of the HPV vaccine should be given as follows:

First dose: ideally at ages 11 or 12
Second dose: one to two months after the first dose
Third dose: six months after the first dose
Some adults may have received doses of the HPV vaccine in childhood or adolescence. All three doses should be given to get the most protection from HPV infection. Re-vaccination in adulthood is recommended if the vaccination schedule was not completed.

Are There Any Adults Who Should Not Receive the HPV Vaccine?

Certain people should not get the HPV vaccine or should wait before getting it:

Anyone who has had a life-threatening allergic reaction to a previous dose of the HPV vaccine
Anyone who has had a previous life-threatening allergic reaction to an ingredient in the HPV vaccine
Pregnant women
Anyone with a moderate or severe illness; people who feel mildly ill may still receive the HPV vaccine.
The HPV vaccine is not known to be harmful to pregnant women or their babies. However, until more information is known, pregnant women are advised not to receive the HPV vaccine. Women who are breastfeeding can safely receive the HPV vaccine.

The HPV vaccine’s safety and effectiveness have not yet been studied in adults older than age 26. Until that information is available, the HPV vaccine is not recommended for adults older than age 26.

What Are the HPV Vaccine Ingredients?

The HPV vaccine contains no viruses and is not made from human papillomavirus. The active ingredients in the HPV vaccine are proteins that are similar to those found in the human papillomavirus. Genetically modified bacteria produce the proteins, which are then purified and mixed into a sterile, water-based solution.

What Are the Risks and Side Effects of the HPV Vaccine?

In clinical trials and in real-world use, the HPV vaccine appears to be very safe. More than 40 million doses of the vaccine — mostly Gardasil, which was approved in 2006 — have been given in the U.S. Cervarix was approved in 2009 and Gardasil 9 was approved in 2014.

From 2006 to 2014, there were about 25,000 reports to the government of HPV vaccine side effects. Over 90% of these were classified as nonserious. The most common side effects of the HPV vaccine are minor:

About one in 10 people will have a mild fever after the injection.
About one person in 30 will get itching at the injection site.
About one in 60 people will experience a moderate fever.
These symptoms go away quickly without treatment. Other mild-to-moderate side effects resulting from the HPV vaccine include:

Nausea
Fainting
Headache
Arm pain

Severe side effects, or adverse events, are uncommonly reported and have included:

Blood clots
Seizures
Guillain-Barre syndrome
Chronic inflammatory demyelinating polyneuropathy
Systemic exertion intolerance disease (formerly called chronic fatigue syndrome)
Death
Government, academic, and other public health investigators could not identify the HPV vaccine as the cause of any severe adverse event. There were 117 deaths as of September 2015, none of which could be directly tied to the HPV vaccine. The conclusion of public health investigators was that the HPV vaccine was unlikely to be the cause of these events. Such events occur at a certain rate in any group of tens of millions of people. The vaccination before each adverse event seemed to be a simple coincidence.

PPIs prematurely age cells that line the inside of blood vessels.

“The side effects of long term Omeprazole, Nexium and its related drugs, called PPIs, is alarming. On May 10 a report described PPI drugs being associated with central nervous system dysfunction. Avoid PPI drugs and use Zantac and its class of medications.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)

PPIs prematurely age cells that line the inside of blood vessels, study suggests. AMA Wire __May 11, 2016.

The Houston Chronicle (5/10, Hawryluk) reports that research suggests “proton pump inhibitors prematurely age the cells that line the inside of blood vessels, making them less resistant to blockages that can cause heart attacks and strokes.” The findings were published in Circulation Research.

HealthDay (5/10, Thompson) reports that the findings, from “lab tests,” may “explain why other studies have shown increased risk of heart disease in people who use” PPIs, “said study senior author Dr. John Cooke.”

________________________________________________________________

CIRCULATION RESEARCH_American Heart Association.

Proton Pump Inhibitors Accelerate Endothelial Senescence

Abstract
Rationale: Proton pump inhibitors (PPIs) are popular drugs for gastroesophageal reflux, now available for long-term use without medical supervision. Recent reports suggest that PPI use is associated with cardiovascular, renal and neurological morbidity.

Objective: To study the long-term effect of PPIs on endothelial dysfunction and senescence and investigate the mechanism involved in PPI induced vascular dysfunction.

Methods and Results: Chronic exposure to PPIs impaired endothelial function and accelerated human endothelial senescence by reducing telomere length.

Conclusions: Our data may provide a unifying mechanism for the association of PPI use with increased risk of cardiovascular, renal and neurological morbidity and mortality.

Silent heart attacks make up 45% of all heart attacks.

“The Wake Forest School of Medicine studied > 9,000 people. The paper is Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. The important finding is not about sex and race differences but that 45% of heart attacks (myocardial infarction) are not clinically documented meaning not causing enough symptoms to cause medical attention. The silent myocardial infarction (SMI) incidence was surprising. The SMI was detected by EKG changes in people who had no symptoms of ever having a heart attack. The study was over eight years. The combined total of heart attacks was 7.4% of the studied group. A heart healthy life style is even more important with this information.” Bill Chesnut, MD
(Return to New Health News, https://billchesnutmd.com/new-health-news/)
Silent heart attacks make up 45% of all heart attacks, study suggests

TIME (5/16, Alter) reports that research suggests “silent heart attacks, which have no symptoms but still involve a loss of blood flow to the heart, make up 45% of all heart attacks and triple the chances of dying from heart disease.” The findings were published in Circulation.

NBC News (5/16, Fox, Powers) reports on its website that investigators “looked at the medical records of 9,500 middle-aged men and women taking part in a heart disease risk study.” The researchers found that “nine years into the study, 317 of the volunteers had ‘silent’ heart attacks and 386 had heart attacks that were noticed right away.”

On its website, CBS News (5/16, Marcus) reports that the researchers also found that “found that silent heart attacks were more common in men – but more likely to cause death in women.”

CNN (5/16, Kounang) reports that the study indicated “having a silent heart attack increased the chances of dying from heart disease threefold and increased chances of dying from any cause by 34%.”

The serious side effects associated with fluoroquinolone antibacterial drugs.

“The FDA issues advisory regarding treatment with fluoroquinolone antibacterial drugs. The tendon side effects include tendon ruptures. I was not aware of the central nervous system side effects. I posted a list of the brand names below for your information. The best known antibiotic in this class is Cipro.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)

The U.S. Food and Drug Administration (FDA) is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options. An agency safety review has shown that, when used systematically, fluoroquinolones are associated with disabling and potentially permanent serious side effects that can occur together. Side effects can involve the tendons, muscles, joints, nerves, and central nervous system. As a result, FDA is requiring the drug labels and medication guides for all fluoroquinolone antibacterial drugs to be updated to reflect this new safety information. The agency states that healthcare professionals should stop systemic fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.

First-generation[edit]

cinoxacin(Cinobac)
nalidixic acid(NegGram, Wintomylon)^[77]
oxolinic acid(Uroxin)
piromidic acid(Panacid)
pipemidic acid(Dolcol)
rosoxacin(Eradacil)

Second-generation[edit]

The second-generation class is sometimes subdivided into “Class 1” and “Class 2”.^[78]

ciprofloxacin(Cipro)^[77]^[79]
enoxacin(Enroxil, Penetrex)^[77]
fleroxacin(Megalone, Roquinol)
lomefloxacin(Maxaquin)^[77]
nadifloxacin(Acuatim, Nadoxin, Nadixa)
norfloxacin(Lexinor, Noroxin, Quinabic, Janacin)^[77]^[80]
ofloxacin(Floxin, Oxaldin, Tarivid)^[77]
pefloxacin(Peflacine)
rufloxacin(Uroflox)

Third-generation[edit]

Unlike the first- and second-generations, the third-generation is active against streptococci.^[78]

balofloxacin(Baloxin)
grepafloxacin(Raxar) (removed from clinical use)
levofloxacin(Leflox, Cravit, Levaquin, Tavanic)
pazufloxacin(Pasil, Pazucross)
sparfloxacin(Zagam)
temafloxacin(Omniflox) (removed from clinical use)^[81]
tosufloxacin(Ozex, Tosacin)

Fourth-generation[edit]

Fourth-generation fluoroquinolones act at DNA gyrase and topoisomerase IV.^[82] This dual action slows development of resistance.

clinafloxacin ^[79]
gatifloxacin(Zigat, Tequin) (Zymar -opth.) (Tequin removed from clinical use)^[83]
gemifloxacin(Factive)
moxifloxacin(Acflox Woodward, Avelox,Vigamox)^[77]
sitafloxacin(Gracevit)
trovafloxacin(Trovan) (removed from clinical use)^[77]^[79]
prulifloxacin(Quisnon)

In development[edit]

delafloxacin— an anionic fluoroquinoline in clinical trials
JNJ-Q2— completed Phase II for MRSA
nemonoxacin

Take care of your teeth to reduce your risk of stroke.

“Here is another reason to put in the effort for the best gum health possible. Orthopedic surgeons tell patients that dental infections are a leading cause of infections in the blood stream getting into a total joint implant causing it to fail. Here is a report about an increased risk of stroke.

I love the Panasonic water irrigator. http://www.amazon.com/Panasonic-Dental-Flosser-Pressure-Settings/dp/B0027LSEPS/ref=sr_1_1_a_it/189-9774289-5118830?ie=UTF8&qid=1461892248&sr=8-1&keywords=panasonic+water+irrigator . It cleans my teeth and gums better than a water pik, the more common irrigator.

Try this trick to motivate yourself. I timed how long it took me to use the irrigator thoroughly inside and outside of the teeth. It takes 2.5 minutes, 150 seconds. I always find the 150 seconds to keep my teeth healthy. “ Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)

March 22, 2016 Cleveland Clinic Wellness Newsletter

Take care of your pearly whites! It may reduce your risk of stroke.

Raise your hand if you received a reminder card from your dentist and tossed it in the recycling bin. Now use that hand to grab the phone and call for an appointment! New research underscores the links between your oral health and your overall health, and calls attention to the importance of seeing your dental professional every six months. Multiple studies indicate a link between periodontal disease and heart disease — and, on the “good news” front, treating periodontal disease has been shown to lower your risk of heart attack. Now a new study sheds light on how the presence of Streptococcus mutans, a cavity-causing bacteria, may increase your risk of hemorrhagic stroke. Professional cleanings can reduce not only bacteria but also harmful inflammation, which may also contribute to heart disease. Brush and floss daily, and see your dental pro twice a year for cleaning and evaluation. If you find yourself slacking, remind yourself that, when it comes your health, everything is connected, so that good health anywhere in the body improves the likelihood of good health everywhere.

Surgical options correct the cause of reflux

“The treatment options for sufferers of GERD are increasing. The surgery to correct refractory cases is becoming less major with a faster recovery. Also the incidences of side effects of the Proton Pump Inhibitor medications is increasing, now including central nervous system problems. I included this here because the improvements in treatments is not widely known.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)

Surgical options correct the cause of reflux

The surgical options attack the actual cause of the problem – the dysfunction of the lower esophageal sphincter (LES). Each attempts to correct the problem rather than covering it up with PPIs. I will summarize every available alternative and encourage further investigation of each.

Nissen fundoplication

Considered the “gold standard” of surgical antireflux therapy is the laparoscopic Nissen Fundoplication. This procedure restores the function of the LES by wrapping a portion of the upper stomach loosely around the lower esophagus. It is performed under general anesthesia using minimally invasive techniques. Five 1/2-1 inch incisions are required and it necessitates a one-day hospital stay. A “soft food” diet is typically suggested initially with gradual resumption to a normal diet taking 6-12 weeks. Although this is not a difficult procedure, it has its nuances and must be performed by a surgeon experienced in this procedure for optimal results. This operation stops the reflux in approximately 80-85% of patients, returning the pH test to normal.

This procedure eliminates the need for PPIs in most patients with the most well performed studies showing approximately 90% of surgical patients do not require those medications. Approximately the same number indicate that they are satisfied with the procedure in the 5-10 year time frame.

Even though the satisfaction rate is great, there are side effects with this procedure including swallowing difficulty (2-5% of patients), bloating and diarrhea to various degrees (10-20% of patients), and the inability to belch and vomit (30% of patients). These side effects seem to vary with the experience of the surgeon. In good hands, this is a proven, effective alternative to PPI therapy. Susan should also understand that a Nissen procedure can repair even the largest of hiatal hernias.

LINX Reflux Management System

Last year, the FDA approved a new procedure called the LINX Reflux Management System. This procedure places a magnetic bracelet around the lower esophagus to “augment” the failed LES. This is a minimally invasive technique and is typically completed in about 30 minutes. A regular diet and full activity is immediately resumed and the reflux is stopped approximately 70% of the time without the typical side effects associated with a Nissen procedure, except that a small number of recipients have difficulty swallowing.

The latest study of 100 patients showed 85% have eliminated PPIs after 3-5 years and 94% would recommend the procedure to a friend. Only 2% had swallowing difficulty, which was corrected with a simple non-surgical dilation (gentle stretching of the esophagus.) This procedure is available at a limited number of select locations in the US.

Incisionless procedures

Two procedures are available that are performed orally and do not require incisions. The TIF procedure, also know as the Esophyx procedure, and the Stretta procedure are both performed through the mouth. Since no incision is required, many individuals find this an attractive feature for both procedures. These two procedures do not have a predictable effect on eliminating reflux and studies have conflicted on the ability of patients to eliminate their PPI use. Many recipients report an improved “quality of life” although there is a concern that the elimination of reflux is not predictable and PPIs may be required long-term for some. In the only 10-year study on Stretta available, only 23% remained off PPIs at 10 years. As is the case with Nissen procedures, the skill set of the surgeon is an important factor is successful outcomes. Also, according to several surgeons, patient selection is an important variable as well.

Weigh your options

As discussed, there are alternatives to long-term PPI use to GERD. These treatment alternatives are becoming more attractive and receiving more interest today as consumers become more aware of the potential for negative long-term side affects from PPIs. For Susan, the best non-medical procedure seems to be the laparoscopic Nissen fundoplication since she describes a hiatal hernia. If it is greater than 3 cm in size, Nissen is the only recommended choice. If the hernia is less than 3cm, all of these procedures are options.

Exercise linked to reduced risk of several cancers

“I love any article that says I can do something to decrease the risk of cancer. The researchers pooled data from 12 prospective US and European cohorts (baseline 1987-2004). They used self-reported exercise level in Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)
Exercise linked to reduced risk of several cancers

ABC World News Tonight (5/16, story 11, 0:25, Muir) reported, “The National Cancer Institute confirms that moderate exercise, all the way up to intense exercise, lowers the risk of” cancer “in many forms.”

The Los Angeles Times (5/16, Healy) reports that the research, published in JAMA Internal Medicine, suggests “exercise is a powerful cancer-preventive.” Investigators found that “physical activity worked to drive down rates of a broad array of cancers even among smokers, former smokers, and the overweight and obese.”

US News & World Report (5/16, Esposito) reports that investigators “analyzed data from participants in 12 US and European study groups who self-reported their physical activity between 1987 and 2004.” The researchers “looked at the incidence of 26 kinds of cancer occurring in the study follow-up period, which lasted 11 years on average.” The data indicated that “overall, a higher level of activity was tied to a 7 percent lower risk of developing any type of cancer.”

TIME (5/16, Park) reports that “the reduced risk was especially striking for 13 types of cancers.” Individuals “who were more active had on average a 20% lower risk of cancers of the esophagus, lung, kidney, stomach, endometrium and others compared with people who were less active.” Meanwhile, “the reduction was slightly lower for colon, bladder, and breast cancers.”

AMA News 5.17.16

Acupuncture may help with chronic pain and high blood pressure.

“Acupuncture in my practice experience continues to improve with some results that are astonishing. I have patients who find acupuncture relieves their sinus obstructions during their allergy seasons when nothing else works.” Bill Chesnut, MD

May 9, 2016 Cleveland Clinic Wellness Newsletter

Get stuck, in a good way! Acupuncture may help with chronic pain and high blood pressure.

Sometimes needles are used to deliver treatment, and other times they are the treatment. Acupuncture, the use of very thin needles to stimulate points on the body, has been practiced for more than 3,500 years as part of Chinese medicine. “It draws on the belief that energy, or qi (pronounced “chee”), circulates throughout our body, from the tops of our heads to the soles of our feet,” notes Cleveland Clinic Medical Director Daniel Neides, M.D. In an exciting new study, nine weekly acupuncture sessions were shown to ease symptoms and improve quality of life in people with fibromyalgia, a hard-to-treat condition characterized by chronic pain. The best part: the positive effects persisted a year later! The study was unusual in that subjects received individualized acupuncture treatments (the way it’s often practiced in the real world) rather than a uniform, one-size-fits-all treatment. Acupuncture has been shown to help a number of chronic pain conditions, from headaches to back pain to arthritis, and a preliminary study suggests it may be helpful for mild to moderate high blood pressure, perhaps in part by lowering levels of norepinephrine, a stress hormone. If you’re dealing with these or other chronic conditions, ask your physician about trying acupuncture as a complementary treatment. As research continues, the day may come when you hear, “Take two needles and call me in the morning!”

Hormone replacement therapy, HRT, in early menopause may slow progression of cardiovascular disease.

“Hormone Replacement therapy in early menopause is important to decrease the bone loss following menopause. I have posted several articles on this website related to osteoporosis. Post-menopausal women not taking hormone replacement lose 60% of their total bone mass between menopause and 60 years of age.

Now another benefit is reported. The study below shows slowing of atherosclerosis by taking hormone replacement.

It is important to know what replacement is most safe. Also know the safety advantages of vaginal or topical HRT versus oral hormone placement. The metabolism is different when taking a medical orally than transcutaneous. Vaginal HRT with estriol elevates estriol a little and transiently if it elevates blood levels at all.

Testosterone is another hormone loss in menopause. Its involvement in bone loss and atherosclerosis has not been as extensively tested. The research available that I found does not report a significant risk of testosterone replacement to keep the normal pre-menopausal blood level.

This finding is so important in my view that I posted the abstract of the original article just below the announcement in the popular press.

If you know women in the age group to be peri-menopausal please tell them the news.” Bill Chesnut, MD

To go back to New Health News: https://billchesnutmd.com/new-health-news

Starting HRT in early menopause may slow progression of cardiovascular disease, study indicates

The Wall Street Journal (3/30, Beck, Subscription Publication) reports the findings of a 643-patient study published in the New England Journal of Medicine study add to the evidence that beginning hormone replacement therapy (HRT) in early menopause may be protective against cardiovascular disease.

The NPR (3/30, Bichell) “Shots” blog reports that in the study, investigators “directly tested the effect of starting hormone therapy within the first six years after menopause, versus the effect of starting 10 years or more after menopause.” After five years, researchers found that “women who started hormones within six years of menopause had artery walls that thickened a little more slowly than the women on the placebo, whereas the extra estrogen did not seem to slow thickening in the group that started the hormone therapy later.”

ORIGINAL ARTICLE

Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol

Howard N. Hodis, M.D., Wendy J. Mack, Ph.D., Victor W. Henderson, M.D., Donna Shoupe, M.D., Matthew J. Budoff, M.D., Juliana Hwang-Levine, Pharm.D., Yanjie Li, M.D., Mei Feng, M.D., Laurie Dustin, M.S., Naoko Kono, M.P.H., Frank Z. Stanczyk, Ph.D., Robert H. Selzer, M.S., and Stanley P. Azen, Ph.D., for the ELITE Research Group*

N Engl J Med 2016; 374:1221-1231March 31, 2016DOI: 10.1056/NEJMoa1505241

BACKGROUND

Data suggest that estrogen-containing hormone therapy is associated with beneficial effects with regard to cardiovascular disease when the therapy is initiated temporally close to menopause but not when it is initiated later. However, the hypothesis that the cardiovascular effects of postmenopausal hormone therapy vary with the timing of therapy initiation (the hormone-timing hypothesis) has not been tested.

METHODS

A total of 643 healthy postmenopausal women were stratified according to time since menopause (<6 years [early postmenopause] or ≥10 years [late postmenopause]) and were randomly assigned to receive either oral 17β-estradiol (1 mg per day, plus progesterone [45 mg] vaginal gel administered sequentially [i.e., once daily for 10 days of each 30-day cycle] for women with a uterus) or placebo (plus sequential placebo vaginal gel for women with a uterus). The primary outcome was the rate of change in carotid-artery intima–media thickness (CIMT), which was measured every 6 months. Secondary outcomes included an assessment of coronary atherosclerosis by cardiac computed tomography (CT), which was performed when participants completed the randomly assigned regimen.

RESULTS

After a median of 5 years, the effect of estradiol, with or without progesterone, on CIMT progression differed between the early and late postmenopause strata (P=0.007 for the interaction). Among women who were less than 6 years past menopause at the time of randomization, the mean CIMT increased by 0.0078 mm per year in the placebo group versus 0.0044 mm per year in the estradiol group (P=0.008). Among women who were 10 or more years past menopause at the time of randomization, the rates of CIMT progression in the placebo and estradiol groups were similar (0.0088 and 0.0100 mm per year, respectively; P=0.29). CT measures of coronary-artery calcium, total stenosis, and plaque did not differ significantly between the placebo group and the estradiol group in either postmenopause stratum.

CONCLUSIONS

Oral estradiol therapy was associated with less progression of subclinical atherosclerosis (measured as CIMT) than was placebo when therapy was initiated within 6 years after menopause but not when it was initiated 10 or more years after menopause. Estradiol had no significant effect on cardiac CT measures of atherosclerosis in either postmenopause stratum. (Funded by the National Institute on Aging, National Institutes of Health; ELITE ClinicalTrials.gov number, NCT00114517.)

Specific genes associated with marijuana addiction

“A genetic factor in cannabis dependence severity is important for the public to know. Look into the paragraph of Design, Setting, and Participants to appreciate the quality of this research. A 90% association of this genetic factor with another psychiatric condition or addiction is stunning.

The first paragraph is an announcement in the popular media. I looked up the original article and publish that article’s abstract below the horizontal line.” Bill Chesnut, MD

To go back to New Health News: https://billchesnutmd.com/new-health-news

Researchers identify specific genes associated with marijuana addiction

TIME (3/30, Szalavitz) reports that “specific genes associated with marijuana addiction have been identified – and some of them are also linked to increased risk for depression and schizophrenia.” Researchers arrived at this conclusion after studying “the genes of nearly 15,000 people from three different groups.” The study’s findings may “help explain why 90% of people with marijuana addictions also suffer from another psychiatric condition or addiction.” The study was published online in JAMA Psychiatry.

Below is the abstract of that original research publication March 30, 2016.

Online First >

Original Investigation | March 30, 2016

Genome-wide Association Study of Cannabis Dependence Severity, Novel Risk Variants, and Shared Genetic Risks ONLINE FIRST

Richard Sherva, PhD¹; Qian Wang, MS²; Henry Kranzler, MD^3,4; Hongyu Zhao, PhD^2,5,6,7; Ryan Koesterer, MS¹; Aryeh Herman, PsyD⁸; Lindsay A. Farrer, PhD^1,9,10,11,12; Joel Gelernter, MD^7,8,13,14

JAMA Psychiatry. Published online March 30, 2016. doi:10.1001/jamapsychiatry.2016.0036

ABSTRACT

Importance Cannabis dependence (CAD) is a serious problem worldwide and is of growing importance in the United States because cannabis is increasingly available legally. Although genetic factors contribute substantially to CAD risk, at present no well-established specific genetic risk factors for CAD have been elucidated.

Objective To report findings for DSM-IV CAD criteria from association analyses performed in large cohorts of African American and European American participants from 3 studies of substance use disorder genetics.

Design, Setting, and Participants This genome-wide association study for DSM-IV CAD criterion count was performed in 3 independent substance dependence cohorts (the Yale-Penn Study, Study of Addiction: Genetics and Environment [SAGE], and International Consortium on the Genetics of Heroin Dependence [ICGHD]). A referral sample and volunteers recruited in the community and from substance abuse treatment centers included 6000 African American and 8754 European American participants, including some from small families. Participants from the Yale-Penn Study were recruited from 2000 to 2013. Data were collected for the SAGE trial from 1990 to 2007 and for the ICGHD from 2004 to 2009. Data were analyzed from January 2, 2013, to November 9, 2015.

Main Outcomes and Measures Criterion count for DSM-IV CAD.

Results Among the 14 754 participants, 7879 were male, 6875 were female, and the mean (SD) age was 39.2 (10.2) years. Three independent regions with genome-wide significant single-nucleotide polymorphism associations were identified, considering the largest possible sample. These included rs143244591 (β = 0.54,P = 4.32 × 10⁻¹⁰ for the meta-analysis) in novel antisense transcript RP11-206M11.7;rs146091982 (β = 0.54,P = 1.33 × 10⁻⁹ for the meta-analysis) in the solute carrier family 35 member G1 gene (SLC35G1); andrs77378271 (β = 0.29, P = 2.13 × 10⁻⁸ for the meta-analysis) in the CUB and Sushi multiple domains 1 gene (CSMD1). Also noted was evidence of genome-level pleiotropy between CAD and major depressive disorder and for an association with single-nucleotide polymorphisms in genes associated with schizophrenia risk. Several of the genes identified have functions related to neuronal calcium homeostasis or central nervous system development.

Conclusions and Relevance These results are the first, to our knowledge, to identify specific CAD risk alleles and potential genetic factors contributing to the comorbidity of CAD with major depression and schizophrenia.

People who consume full-fat dairy may weigh less

“This finding supports recent thinking that cultured daily products, cottage cheese, yogurt, etc., are better for health using regular milk, no low or no fat milk. They are a stable in my daily food.” Bill Chesnut, MD.

To go back to New Health News: https://billchesnutmd.com/new-health-news

People who consume full-fat dairy may weigh less, may be less likely to develop diabetes than those who eat low-fat dairy products

The Atlanta Journal-Constitution (4/6, Foreman) reports that “people who consume full-fat dairy weigh less and are less likely to develop diabetes than those who eat low-fat dairy products,” the findings of a 3,333-adult, 15-year study published in the journal Circulation suggest. The study revealed that “people with higher levels of three different byproducts of full-fat dairy had, on average, a 46 percent lower risk of getting diabetes than those with lower levels.”

The CBS News (4/6, Marcus) website points out that another study involving “more than 18,000 middle-age women who were part of the Women’s Health Study – and [of] normal weight, free of cardiovascular disease, cancer, and diabetes at the start of the research – found that those who ate more high-fat dairy had an 8 percent lower chance of going on to become obese over time compared to those who ate less.” No such link was seen “with low-fat dairy product intake,” however.

Transplants of insulin-producing pancreas cells may help the most seriously ill patients with diabetes

“This research has been maturing as our tools improve. The first published report of the procedure in the Islet Cell Transplant database is 1999 according to the National Library of Medicine. I expect there will be more improvements.” Bill Chesnut, MD.

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Transplants of insulin-producing pancreas cells may help the most seriously ill patients with diabetes. Ama Wire, April 19, 2016.

The AP (4/19, Neergaard) reports that “transplants of insulin-producing pancreas cells” may help “protect the most seriously ill patients” with diabetes “from a life-threatening complication of the disease,” severe hypoglycemia, the findings of a study published online April 18 in Diabetes Care suggest. For the study, “the National Institutes of Health targeted…highest-risk patients, funding a study that gave 48 people at eight medical centers at least one islet cell transplant.” Just one year after transplant, “88 percent were free of severe hypoglycemia events, had their awareness of blood sugar dips restored, and harbored glucose levels in near-normal ranges,” and “two years later, 71 percent of participants still were faring that well,” the study found. The study team now “plans to seek a Food and Drug Administration license for” cell-based diabetes therapy.

Anticholinergic medications may be linked to increased dementia risk

“Avoiding anticholinergic medications over the counter is a smart choice with this information. The list of common anticholinergic drugs is listed here in Wikipedia. https://en.wikipedia.org/wiki/Anticholinergic . It surprised me.” Bill Chesnut, MD

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Anticholinergic medications may be linked to increased dementia risk

ABC World News Tonight (4/18, story 10, 0:20, Muir) reported that “certain medications may increase the risk of dementia,” a new study warns. Medicines, “including tablets for cold and flu, allergies and heartburn,” appear to be linked to “memory problems.”

According to CNN (4/18, Tinker), the study “offers the most definite proof yet of what scientists have known for at least a decade: that anticholinergic” medications are associated with “cognitive impairment and an increased risk of dementia.” Such medicines “are sold over the counter and by prescription as sleep aids and for chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease.”

TIME (4/18, Oaklander) points out that researchers “analyzed already existing data from 451 people around ages 70-75 who had normal brains,” then “examined the results of memory tests, MRI brain scans and other neuroimaging data – all while paying particular attention to people who said they took anticholinergic” medications. Seniors “who regularly took at least one anticholinergic drug showed poorer cognition, lower brain volumes and less glucose metabolism in the whole brain and the temporal lobe” than seniors who did not. The study was published online in JAMA Neurology.

Change your brain pathways for the better pathways. Be Better.

“The advances in functional MRI and SPECT scans of the brain are leading to better correlations between personality, mood and mental disorders with anatomic sections fo the brain. The SPECT scan shows hypoperfusion and hyperperfusion of areas of the brain. Depression, bipolar disorder and similar dysfunctions are associated with hypoperfusion is brain areas. The Cleveland Clinic advice has more science behind it now than ten years ago. The proof is in the pudding. Try it and you will see that your brain assumptions and reflex reactions change.” Bill Chesnut, MD

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April 26, 2016 Cleveland Clinic Wellness Newsletter http://www.clevelandclinicwellness.com/

Harness the power of positive thinking…for your health!

Pollyanna gets a bad rap. What if it turns out that her relentless optimism wasn’t naiveté, but wisdom? Considering that negative thinking contributes to chronic stress and a host of health problems, Polly may have known exactly what she was doing. Advances in neuropsychology have shown that returning to the same thought over and over creates a real neural pathway in the brain, just like taking the same path through a field day after day creates a visible trail. Once the “thought pathway” is there, you’re more likely to follow it. Take these three steps to set yourself up for good health by increasing positive thinking and interrupting negative thinking before it gets entrenched. Happy trails!

Get perspective. If you notice that you’re having a negative thought, step outside yourself (figuratively!) and take stock. This probably isn’t the worst day ever, and everyone is not, in fact, out to get you. Your brain is just in a mental rut. Really. It’s that simple.

Sit and be still. A regular meditation practice can help steer you away from negative thought pathways and lead to lasting, beneficial changes in your brain. Sitting quietly, paying attention to your breath, and noticing your thoughts and emotions without judging them (all hallmarks of meditation) will help you to cultivate a more positive frame of mind.

Revel in the good stuff. Reinforce positive pathways by basking in enjoyable experiences, like the scent of fresh lilacs, a laughing fit with your best friend, or the natural high you feel after a bike ride. Keep a “joy journal” or a “gratitude register” to record the high points. And if people start calling you Polly, take it as a compliment!

Reversible Stomach Tube May Be an Alternative to Bariatric Surgery

“You have got to read this. Using a stomach feeding tube to treat obesity? How about that.The treatments for medical conditions in severe obesity are not ideal. The surgery is complicated. This website explains the details of the types of gastrointestinal operations developed to try to reverse obesity safely. https://asmbs.org/resources/story-of-obesity-surgery This simple idea of inserting a tube to drain the stomach appears to produce excellent results with minimal complications. The report of a new procedure was April 11, 2016 at a conference of Interventional Radiologists. It is not FDA approved yet. Expect it will be approved and cost effective. This is great news for obese patients with severe degeneration in their backs, hips, knees and feet.” Bill Chesnut, MD

To go back to New Health News: https://billchesnutmd.com/new-health-news

Reversible Gastrostomy Tube May Be an Alternative to Bariatric Surgery: Presented at SIR

Created 04/11/2016 – 16:21

By Lorraine L. Janeczko

VANCOUVER — April 11, 2016 — A tube running from the stomach directly out the body through the abdomen may be an alternative to bariatric surgery for obese patients, according to research presented here at the 41st Annual Scientific Meeting of the Society of Interventional Radiology (SIR).

“This is a safe, easy, relatively low-risk procedure that can be removed when desired and can result in high weight loss,” said Shelby Sullivan, MD, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri. “Right now, very few patients are optimally treated for obesity, and we need to be able to treat more patients with additional tools like this device that have lower risk than bariatric surgery but that achieves higher weight loss than lifestyle therapy alone.”

The AspireAssist Aspiration Therapy System consists of a percutaneous gastrostomy tube with one end placed inside the stomach and the other end connected to a port outside the abdomen, as well as a removable siphon that facilitates aspiration. The device allowed each patient to expel roughly 30% of their most recent meal before it was digested. Although the study was planned to run for 1 year, 12 patients chose to remain implanted for 3 years.

To evaluate the weight-loss efficacy and safety of the endoscopically placed device, lead author Stephen Solomon, MD, Department of Radiology, Cornell University, New York, New York, and colleagues enrolled 25 obese patients with a mean body mass index (BMI) of 39.8 kg/m2 in a pilot study at Blekinge County Hospital, Karlskrona, Sweden, between July and September 2012.

Of these, 22 patients completed 1 year, 15 completed 2 years, and 12 completed 3 years. For the 12 who completed 3 years, the mean weight loss was 26 kg with a mean excess weight loss of 58%. The mean weight loss at the end of years 1, 2, and 3 was 48% (19 kg), 46% (18 kg), and 45% excess weight loss (19 kg), respectively, on an intent-to-treat basis using the last observation carried forward method.

“The misconception is that you can eat anything and then aspirate it,” explained Dr. Sullivan. “In reality, patients must eat less than before. The food particles have to be smaller than 5 mm in size to fit through the tube. To get good aspiration, patients have to chew their food until it disintegrates in their mouth.”

“People not only get tired of chewing and stop eating earlier in the meal than before, they eat more slowly, can sense feeling full and push away from the meal,” he said. “The patients also need to drink a lot of water with their meal to create a slurry that can be aspirated. This reduces the amount of food they can fit into their stomach.”

The device is available on a limited basis in Europe and select additional regions. It is not approved by the US Food and Drug Administration (FDA) yet.

One-third of advanced-melanoma patients given nivolumab in study are alive five years after starting treatment

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Reversible Gastrostomy Tube May Be an Alternative to Bariatric Surgery: Presented at SIR

Created 04/11/2016 – 16:21

By Lorraine L. Janeczko

The device is available on a limited basis in Europe and select additional regions. It is not approved by the US Food and Drug Administration (FDA) yet.

Where the Health Care Dollars Go

“US Healthcare is in flux and looking for a better way to take care of our sick. This graph shows the exact percentages of spending. Physician’s services are 15.9 % of the healthcare dollar. A pie chart showing the size of the slices is a part of this particle. It can’t be produced here. Please use the link to the AMA below for the graphics and complete information.

Please notice in the sixth paragraph that physician service cost rose 4.1% annually in total between 2004 and 2014. The AMA did not calculate this figure to account for the increase in physicians, PA, Nurse practitioners between 2004 and 2014. I don’t have that figure. Common sense implies the amount of the tax care dollar spent for services by individual providers has decreased a lot.” Bill Chesnut, MD.

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Where the health care dollars go AMA News_3/4/2016 Visit the AMA’s spending in health care Web page for further insight. http://www.ama-assn.org/ama/pub/advocacy/topics/spending-health-care.page

With all the talk about rising health care costs, you may be wondering how those vital dollars are being spent. A new analysis answers this question.

A close look at national health expenditures can offer physicians a clearer vision of the total costs and funding that are required each year to keep the health care system functioning. A new analysis (log in) from the AMA sheds light on health care spending.

In 2014, the last year for which data are available, U.S. health expenditures were more than $3.0 trillion—which breaks down to $9,523 per person. This reflects a growth rate of 5.3 percent over 2013. “In comparison,” the analysis said, “spending grew by 2.9 percent in 2013 and by an average of 4.0 percent per year” from 2007 to 2012.

“Despite the uptick,” the analysis said, “the 5.3 percent growth rate is still low by historical standards.”

“Important factors behind the acceleration in growth include the coverage expansions of the Affordable Care Act (ACA) as well as the introduction of new drug treatments for hepatitis C, cancer and multiple sclerosis,” the analysis said.

Out of that $3.0 trillion, only 15.9 percent went to physician services. Furthermore, physician spending grew by an average of only 4.1 percent per year between 2004 and 2014, which is 1.5 percentage points lower than the average annual growth rate for hospital spending and a full 2 percentage points lower than that for clinical spending, showing physician spending is not the main driver behind rising health care costs.

On the other hand, prescription drug spending rose 12.2 percent in 2014 (9.8%), marking an abrupt departure from growth rates of recent years. “There hadn’t been double-digit growth in this category since 2003,” the analysis said, “and post-2006 growth rates had remained well below 6 percent.” More than one-third of the new drug spending was from new treatments for hepatitis C.

Investigating a longer window of spending

The analysis also investigates the changes in health care spending over both 25 year and 50-year windows to present the patterns that allow analysts to look at short-term changes in a broader context.

The ACA Medicaid expansion’s effect on spending is evident in 2014. Medicaid spending increased by 11 percent—the largest single-year increase since 2001—and its share of spending increased from 15.5 percent to 16.4 percent.

The most dramatic change over the past ten years was in the share of spending paid for by Medicare, which increased from 16.4 percent of spending to 20.4 percent of spending between 2004 and 2014. Changes in the share of spending paid for by Medicare and Medicaid are tied to changes in program expansion and payment policy as well as cyclical economic factors for Medicaid.

Private health insurance has historically been the largest source of funds for health care spending since the 1970s. It continued this trend in 2014 with a 32.7 percent share of the pie, followed by Medicare and Medicaid—these three sources account for the majority of payments in the health care system. The smallest source of funds was out of pocket spending, whose share has continued to trickle downward over the past 50 years from a high of over 40 percent to only 10.9 percent in 2014.

Visit the AMA’s spending in health care Web page for further insight. http://www.ama-assn.org/ama/pub/advocacy/topics/spending-health-care.page

The Accidental Deadly Drug Prescription

“There are many publications the medical world about opioid medications. Managing chronic pain without risking accidental death is hard. This article looks at anther much less known risk of opioid medications. The grave risk for some is combining an opioid with a benzodiazepine drug such as Xanax. This is a commentary in the Wall Street Journal. Dr. Wen shows you the difficulty in practicing the best medicine, being effective and keeps risks as low as possible. If you friends who take pain pills, tell them about the benzodiazepine class of drugs, all of their brand names. ” Bill Chesnut, MD

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The Accidental Deadly Drug Prescription. Many doctors are unaware that a drug like Valium or Xanax, taken with an opioid, could be fatal. By LEANA S. WEN,MD_______March 30, 2016

My patient was a college student brought into the emergency room after a minor car accident. Although CT scans showed no spinal fractures, he had severe neck pain and spasms. Instinctively, I prescribed Percocet for pain and Valium for muscle spasms. But I didn’t know then what I know now: These two drugs, when taken together, could interact and cost him his life.

Opioids—including prescriptions such as Percocet and OxyContin, as well as the illicit form, heroin—are under increased scrutiny. The number of Americans dying from an opioid overdose has quadrupled over the past decade, according to the Centers for Disease Control and Prevention. This week President Obama joined health officials and advocates to raise awareness of this growing epidemic. Clinicians and the public, however, are often unaware of the threat posed by opioid interaction with another frequently prescribed drug.

Benzodiazepines, known to most Americans as Xanax or Valium, typically treat anxiety or insomnia. But when combined with opioids, as they often are, they can suppress the instinct to breathe, increase sleepiness and cause death. In 2010, one in three unintentional overdose deaths in the U.S. from prescription opioids also involved benzodiazepines, according to the National Vital Statistics System. Maryland Department of Health data show more than 70% of deaths in the state associated with benzodiazepines also involved prescription opioids.

Despite this danger, doctors prescribe both drugs at increasing rates. The CDC reported that in 2012 there were over 259 million prescriptions of opioids in the U.S.—more than one for every adult. That year there were nearly 40 benzodiazepine prescriptions for every 100 Americans. Hospital admissions for patients with combined addiction to opioids and benzodiazepines have increased by 569% over 10 years, according to anotherfederal study.

Why do doctors continue to prescribe this deadly combination? In part, because that is what they are taught. When I was in medical school in the early 2000s, I learned to treat muscle pain and spasms with both opioids and benzodiazepines, so I routinely prescribed them together. A 2015 study published in the journal Pain Medicine found that one in three patients with chronic pain on opioids was also on benzodiazepines. Just as I acted on instinct with my ER patient, doctors prescribe medications based on habit.

Most overdose-education campaigns focus exclusively on the opioid epidemic, in part because there is an easy-to-use antidote available, naloxone. In Baltimore, we have increased its availability by allowing all 620,000 residents to obtain a naloxone prescription—no questions asked. Last year, we conducted over 8,000 targeted trainings, going to high-risk areas like jails, bus shelters and public markets to demonstrate use of this lifesaving medication.

Likewise, education for physicians has focused on increasing monitoring of opioid prescriptions, rather than on decreasing their use with benzodiazepines. But with mounting scientific and epidemiological evidence about this deadly combination, doctors must adjust their patterns. Shouldn’t they already know that combining these drugs is dangerous? Unfortunately, the figures suggest they don’t.

Last month, I co-led a coalition of over 40 city health-commissioners and state health-directors who sent a petition urging the Food and Drug Administration to require a “black-box warning”—the FDA’s strongest risk communication—any time that opioids and benzodiazepines are prescribed together. Such a warning would sound the alarm about the danger of taking these drugs at the same time. Thousands of health officials, academics, researchers, physicians and citizens signed our petition.

Studies show that black-box warnings change how physicians prescribe potentially dangerous medications. In the mid-2000s, a black-box warning was issued for an antidepressant associated with suicide in youth. This resulted in a 22% drop in prescriptions, according to a study in the American Journal of Psychiatry. Physicians listened to the warning and changed their practices.

The FDA recently proposed a black-box warning on opioids. It is a welcome move: 44 Americans die every day from prescription opioid overdose. Yet, while one-third of those deaths were associated with an unintentional combination with benzodiazepines, the FDA’s new warning doesn’t mention the dangers of combining the drugs.

When I look back at my practice, I wonder how many deaths my colleagues and I might have caused inadvertently—and how many we could have prevented if we had known the potential dangers sooner. It’s a harrowing thought that should spur physicians to change their prescribing practices and patients to look inside their medicine cabinets.

Dr. Wen is an emergency physician and the health commissioner for the city of Baltimore.

Breast Cancer Reoperation Rate Is Nearly Halved When MRI Findings Are

“Using bilateral MRI when planning surgery of breast cancer improves results in 1,926 patients.” Bill Chesnut, MD

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Reoperation Rate Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment DG News_March 8, 2016 By Jenny Powers

VIENNA, Austria — March 8, 2016 — A comparison between two cohorts of patients who did and did not receive magnetic resonance imaging (MRI) in addition to mammography or ultrasound before breast cancer surgery revealed that MRI detected additional contralateral lesions and provided information that significantly altered surgical plans, researchers reported here on March 3 at the 2016 Annual European Congress of Radiology (ECR).

The study included women with newly-diagnosed breast cancer who were not candidates for neoadjuvant therapy. Surgical treatment was pre-planned for all women in the study based on mammography and or ultrasound, but one cohort received an MRI prior to surgery and one group did not.

To date 4,295 women have been enrolled in the ongoing study. The current analysis included data from 1,926 women aged 18 to 80 years, of whom 972 received MRI and 954 did not.

“The cohorts were not homogenous and significant differences in age and breast density were seen in the groups,” noted Giovanni Di Leo, MD, Radiology Unit, IRCCS Policlinico, Milan, Italy.

Patient age was 56 years in the MRI group versus 61 years in the non-MRI group and ACR breast density was 12% versus 18%, respectively (P < .001 for both).

The mastectomy rate was significantly higher in patients having MRI in addition to mammography or ultrasound (20.1% vs 14.0%; P < .001).

Pre-planned breast conserving surgery based upon MRI results was unchanged in 74% of women in the MRI cohort, altered to less extensive surgical treatment in 13%, and to a broader surgical treatment in 13% of women.

The rate of MRI-detected new contralateral cancers was (2%).

Importantly, the number of subsequent surgeries was significantly reduced in patients receiving MRI. The reoperation rate for positive margins was 7% in the MRI group compared with 13% in the non-MRI group (P < .001).

“The order for an MRI was made by a radiologist in 67% of the cases and by a surgeon in 40% of cases,” said Dr. Di Leo. “More mastectomies had already been planned on the basis of mammography or ultrasound in patients receiving MRI; this higher rate is due to a selection bias. One could say MRI is a confirmation tool for mastectomy.”

The European Congress of Radiology is sponsored by the European Society for Radiology.

Prolonged Nightly Fasting and Breast Cancer Prognosis

“This study in JAMA Oncology is a sophisticated look at the research of 2413 women studied for 12 years. The finding is that fasting over 13 hours while sleeping reduces the risk of recurrence in women with breast cancer. There will be more study of this first look at fasting affecting our health positively. There isn’t anything harmful about fasting for 13 hours a day. It is a matter of eating your dinner earlier and not snacking later. Clever idea.” Bill Chesnut, MD

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Prolonged Nightly Fasting and Breast Cancer Prognosis Catherine R. Marinac, BA^1,2,3; Sandahl H. Nelson, MS^1,2; Caitlin I. Breen, BS, BA¹; Sheri J. Hartman, PhD^1,3; Loki Natarajan, PhD^1,3; John P. Pierce, PhD^1,3; Shirley W. Flatt, MS¹; Dorothy D. Sears, PhD^1,3,4; Ruth E. Patterson, PhD^1,3

JAMA Oncol. Published online March 31, 2016.

Importance Rodent studies demonstrate that prolonged fasting during the sleep phase positively influences carcinogenesis and metabolic processes that are putatively associated with risk and prognosis of breast cancer. To our knowledge, no studies in humans have examined nightly fasting duration and cancer outcomes.

Objective: To investigate whether duration of nightly fasting predicted recurrence and mortality among women with early-stage breast cancer and, if so, whether it was associated with risk factors for poor outcomes, including glucoregulation (hemoglobin A_1c), chronic inflammation (C-reactive protein), obesity, and sleep.

Design, Setting, and Participants Data were collected from 2413 women with breast cancer but without diabetes mellitus who were aged 27 to 70 years at diagnosis and participated in the prospective Women’s Healthy Eating and Living study between March 1, 1995, and May 3, 2007. Data analysis was conducted from May 18 to October 5, 2015.

Exposures Nightly fasting duration was estimated from 24-hour dietary recalls collected at baseline, year 1, and year 4. Main Outcomes and Measures Clinical outcomes were invasive breast cancer recurrence and new primary breast tumors during a mean of 7.3 years of study follow-up as well as death from breast cancer or any cause during a mean of 11.4 years of surveillance. Baseline sleep duration was self-reported, and archived blood samples were used to assess concentrations of hemoglobin A_1c and C-reactive protein.

Results The cohort of 2413 women (mean [SD] age, 52.4 [8.9] years) reported a mean (SD) fasting duration of 12.5 (1.7) hours per night. In repeated-measures Cox proportional hazards regression models, fasting less than 13 hours per night was associated with an increase in the risk of breast cancer recurrence compared with fasting 13 or more hours per night (hazard ratio, 1.36; 95% CI, 1.05-1.76).

Nightly fasting less than 13 hours was not associated with a statistically significant higher risk of breast cancer mortality (hazard ratio, 1.21; 95% CI, 0.91-1.60) or a statistically significant higher risk of all-cause mortality (hazard ratio, 1.22; 95% CI, 0.95-1.56). In multivariable linear regression models, each 2-hour increase in the nightly fasting duration was associated with significantly lower hemoglobin A_1c levels (β = –0.37; 95% CI, –0.72 to –0.01) and a longer duration of nighttime sleep (β = 0.20; 95% CI, 0.14-0.26).

Conclusions and Relevance Prolonging the length of the nightly fasting interval may be a simple, nonpharmacologic strategy for reducing the risk of breast cancer recurrence. Improvements in glucoregulation and sleep may be mechanisms linking nightly fasting with breast cancer prognosis.

Insufficient maternal D3 during pregnancy may increase the risk of MS in offspring.

“Know your Vitamin D3 total blood test level! Don’t assume it is normal only because you live a normal life. My view is that every adult should have one “screening” blood test of their Vitamin D3. Its easy, cheap and risk free to correct. The Mayo Clinic in their wellness division thinks there patients do best if there Vit D3 test (250hydroxy Vitmain D3 total) is around 5- ng/dl. I have seen many orthopedic problems resolve when correcting a Vitamin D deficiency.” Bill Chesnut, MD.

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JAMA NEUROLOGY

Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort _ Original Investigation | March 07, 2016 Kassandra L. Munger, ScD¹; Julia Åivo, MD²; Kira Hongell, MD²; Merja Soilu-Hänninen, MD²; Heljä-Marja Surcel, PhD³; Alberto Ascherio, MD, DrPH^1,4

Importance Vitamin D has been associated with a decreased risk of multiple sclerosis (MS) in adulthood; however, some, but not all, previous studies have suggested that in utero vitamin D exposure may be a risk factor for MS later in life.

Objective To examine whether serum 25-hydroxyvitamin D (25[OH]D) levels in early pregnancy are associated with risk of MS in offspring.

Design, Setting, and Participants Prospective, nested case-control study in the Finnish Maternity Cohort conducted in May 2011. We identified 193 individuals with a diagnosis of MS before December 31, 2009, whose mothers are in the Finnish Maternity Cohort and had an available serum sample from the pregnancy with the affected child. We matched 176 cases with 326 controls on region of birth in Finland, date of maternal serum sample collection, date of mother’s birth, and date of child’s birth.

Main Outcomes and Measures Maternal serum 25(OH)D levels were measured using a chemiluminescence assay. The risk of MS among offspring and association with maternal 25(OH)D levels were the main outcomes. Conditional logistic regression was used and further adjusted for sex of the child, gestational age at the time of sample collection, and season of sample collection to estimate the relative risks and 95% CIs.

Results Of the 193 cases in the study, 163 were female. Of the 331 controls in the study, 218 were female. Seventy percent of serum samples were collected during the first trimester of pregnancy. The mean (SD) maternal vitamin D levels were in the insufficient vitamin D range, but higher in maternal control than case samples (15.02 [6.41] ng/mL vs 13.86 [5.49] ng/mL [to convert to nanomoles per liter, multiply by 2.496]). Maternal vitamin D deficiency (25[OH]D levels <12.02 ng/mL) during early pregnancy was associated with a nearly 2-fold increased risk of MS in the offspring (relative risk, 1.90; 95% CI, 1.20-3.01; P = .006) compared with women who did not have deficient 25(OH)D levels. There was no statistically significant association between the risk of MS and increasing serum 25(OH)D levels (P = .12).

Conclusions and Relevance Insufficient maternal 25(OH)D during pregnancy may increase the risk of MS in offspring.

PPIs may be linked to an increased risk of CKD, study reveals AMA Morning Rounds, April 15, 2016.

Harness the power of positive thinking…for your health!