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Mediterranean Diet is Healthy Eating – A Good Option for Seniors Another study finding health benefits of a fiber rich diet, which means lots of fruits, vegetables, whole grains, legumes (beans), nuts, and seeds. This time, researchers doing an a analysis of 2 studies lasting over a number of years found that there was an association with more fiber in the diet and less risk of developing knee osteoarthritis pain and of knee osteoarthritis symptoms worsening. The highest fiber group reported eating a median (middle number) 25.5 grams of fiber per day, while the lowest fiber group had a median of about 9 grams of fiber per day. They found a dose dependent relationship - the more fiber, the less osteoarthritis knee pain, and vice versa (the less daily fiber, the more they reported knee pain worsening) - this is called a "dose-dependent inverse relationship". The average fiber intake for Americans is about 15 grams per day.

The researchers also found that the more fiber in the diet, the lower their Body Mass Index (less weight) - but they say they took that into account in the analyses, and found that the amount of fiber intake was the most important thing regarding knee osteoarthritis pain. Interestingly, they did not find an association of fiber intake and x-ray evidence of osteoarthritis.  Note that this was an observational study - it observed that certain things go hand in hand, but it doesn't prove causation.

Osteoarthritis (OA) is common among adults aged 60 years and older, and is sometimes called "wear and tear" arthritis because it affects the joints. It causes pain and limits a person's physical functioning. There is a strong association between obesity, inflammation, and knee osteoarthritis. Obesity causes both inflammation and puts extra weight on the knees, and inflammation results in more joint pain. On the other hand, a high fiber diet reduces inflammation. The researchers point out that the data shows "a consistent protective association" between fiber in the diet and symptoms of knee osteoarthritis (no matter if you're overweight or not). IN SUMMARY: Eat lots of fruits, vegetables, legumes, whole grains, and nuts! From Science Daily:

Fiber-rich diet linked to lowered risk of painful knee osteoarthritis

A fibre-rich diet is linked to a lowered risk of painful knee osteoarthritis, finds the first study of its kind, published online in the Annals of the Rheumatic Diseases. The findings, which draw on two different long term studies, are broadly in line with the other reported health benefits of a fibre-rich diet. These include reductions in blood pressure, weight, and systemic inflammation, and improved blood glucose control.

The researchers mined data from two US studies in a bid to find out if dietary fibre might have any bearing on the risks of x-ray evidence of knee osteoarthritis, symptomatic knee osteoarthritis (x-ray evidence and symptoms, such as pain and stiffness), and worsening knee pain. The first of these studies was the Osteoarthritis Initiative (OAI). This has been tracking the health of nearly 5000 US men and women with, or at risk of, osteoarthritis since 2004-6 (average age 61), to pinpoint potential risk factors for the condition.  The second was part of the Framingham Offspring cohort study, which has been tracking the health of more than 1200 adult children of the original Framingham Heart Study and their partners since 1971.

Analysis of the data showed that eating more fibre was associated with a lower risk of painful knee osteoarthritis. Compared with the lowest intake (bottom 25 per cent of participants), the highest intake (top 25 per cent) was associated with a 30 per cent lower risk in the OAI and a 61 per cent lower risk in the Framingham study. But it was not associated with x-ray evidence of knee osteoarthritis. Additionally, among the OAI participants, eating more fibre in general, and a high cereal fibre intake, were associated with a significantly lower risk of worsening knee pain.

This is an observational study, so no firm conclusions can be drawn about cause and effect. Nevertheless, the researchers say: "These data demonstrate a consistent protective association between total fibre intake and symptom-related knee [osteoarthritis] in two study populations with careful adjustment for potential confounders." [Original study.]

Image result for stethoscope We spend so much on health care, but the USA really lags behind other developed countries in quality of health care. The United States is ranked number 35 on the just released ranking of healthcare quality in 195 countries list. It is called the Healthcare Access and Quality Index, and is a highly regarded and much anticipated analysis, which was just published in the journal Lancet.

How did such health care rankings start? In the late 1970s, some researchers first talked about the idea of “unnecessary, untimely deaths”, and they proposed a list of causes from which death should not occur if the person received "timely and effective medical care". This approach has been modified and extended over time, and now there is a list of 32 medical conditions looked at in 195 countries. The researchers looked at the death rate in each country for the diseases that can be avoided or can be effectively treated with proper medical care. Some of the diseases: diabetes, hypertension, some cancers, appendicitis, etc.

Virtually all the high ranking countries (the top 20) have universal health care, and yet they spend less on medical costs per person. Remember, when one can't afford the costs of medicines or treatments, and consequently dies - then that is the same as a "death panel" or "death sentence". So....is medical care a right for all or a privilege for some? From Medical Xpress:

Which countries have the best healthcare?

Neither Canada nor Japan cracked the top 10, and the United States finished a dismal 35th, according to a much anticipated ranking of healthcare quality in 195 countries, released Friday. Among nations with more than a million souls, top honours for 2015 went to Switzerland, followed by Sweden and Norway, though the healthcare gold standard remains tiny Andorra, a postage stamp of a country nestled between Spain (No. 8) and France (No. 15).

Iceland (No. 2), Australia (No. 6), Finland (No. 7), the Netherlands (No. 9) and financial and banking centre Luxembourg rounded out the first 10 finishers, according to a comprehensive study published in the medical journal The Lancet. Of the 20 countries heading up the list, all but Australia and Japan (No. 11) are in western Europe, where virtually every nation boasts some form of universal health coverage. The United States—where a Republican Congress wants to peel back reforms that gave millions of people access to health insurance for the first time—ranked below Britain, which placed 30th.

The Healthcare Access and Quality Index, based on death rates for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each nation compared to the benchmark year of 1990. Virtually all countries improved over that period, but many—especially in Africa and Oceania—fell further behind others in providing basic care for their citizens. With the exceptions of Afghanistan, Haiti and Yemen, the 30 countries at the bottom of the ranking were all in sub-Saharan Africa, with the Central African Republic suffering the worst standards of all.

Furthermore, he added in a statement, the standard of primary care was lower in many nations than expected given levels of wealth and development.....Among rich nations, the worst offender in this category [underachievers] was the United States, which tops the world in per capita healthcare expenditure by some measures. Within Europe, Britain ranked well below expected levels.

The gap between actual and expected rating widened over the last quarter century in 62 of the 195 nations examined. "Overall, our results are a warning sign that heightened healthcare access and quality is not an inevitable product of increased development," Murray said.... The 32 diseases for which death rates were tracked included tuberculosis and other respiratory infections; illnesses that can be prevented with vaccines (diphtheria, whooping cough, tetanus and measles); several forms of treatable cancer and heart disease; and maternal or neonatal disorders. [Original study.]

Image result for gout in toe Gout is something that is not discussed that much, but it has been increasing in recent years and now afflicts about  3.9% of adults in the US. Gout is a form of inflammatory arthritis, characterized by recurrent attacks of pain, tenderness, and swelling of a joint, frequently the joint of the big toe. It is caused by elevated levels of uric acid in the blood (known as hyperuricaemia).

Gout occurs more commonly in men ages 40 and older, who eat a lot of meat and seafood, drink a lot of alcohol (especially beer) or sweetened drinks, have high blood pressure, metabolic syndrome, or are overweight.  Gout used to be known as "the disease of kings" or "rich man's disease". [On the other hand, past research has shown that consumption of coffee, cherries, vitamin C foods, and dairy products, losing weight and physical fitness seems to decrease the risk.]

Recent research showed that the DASH diet reduces blood pressure and reduces uric acid in the blood, which is why a research team (study in The BMJ) now looked at  whether it lowers the risk of gout. The Dietary Approaches to Stop Hypertension or DASH diet is high in fruit, vegetables, whole grains, legumes, nuts, and low-fat dairy, and low in red and processed meats, salt, and sugary drinks. On the other hand, the typical Western diet has higher intakes of red and processed meats, sweetened beverages, sweets, desserts, French fries, and refined grains. The researchers analysed data on a total of 44,444 male health professionals, who had no history of gout at the start of the study. During the 26 years of the observational study, they documented 1731 cases of gout.

The researchers found that eating a more DASH type diet - a diet rich in fruits, vegetables, legumes, nuts, whole grains, and low in salt, sugary drinks, and red and processed meats, is associated with a lower risk of gout. On the other hand, a more 'Western' diet is associated with a higher risk of gout. They found that the effects are dose dependent - the more DASH-type diet, the lower the risk of gout. Bottom line: Once again, eating lots of fruits, vegetables, nuts, legumes, and whole grains is linked to health benefits. From Science Daily:

Diet rich in fruit, vegetables and whole grains may lower risk of gout

A diet rich in fruit and vegetables, nuts and whole grains and low in salt, sugary drinks, and red and processed meats, is associated with a lower risk of gout, whereas a typical 'Western' diet is associated with a higher risk of gout, finds a study published by The BMJ.

Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older and is caused by excess uric acid in the blood (known as hyperuricaemia) which leads to uric acid crystals collecting around the joints. The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and is recommended to prevent heart disease. It has also been found to lower uric acid levels in the blood. Therefore, the DASH diet may lower the risk of gout.

To investigate this further, a team of US and Canada based researchers examined the relationship between the DASH and Western dietary patterns and the risk of gout. They analysed data on over 44,000 men aged 40 to 75 years with no history of gout who completed detailed food questionnaires in 1986 that was updated every four years through to 2012.

Each participant was assigned a DASH score (reflecting high intake of fruits, vegetables, nuts and legumes, such as peas, beans and lentils, low-fat dairy products and whole grains, and low intake of salt, sweetened beverages, and red and processed meats) and a Western pattern score (reflecting higher intake of red and processed meats, French fries, refined grains, sweets and desserts). During 26 years of follow-up, a higher DASH score was associated with a lower risk for gout, while a higher Western pattern was associated with an increased risk for gout.

Image result for gout NHS Credit: Both photos of gout on this page are from NHS.UK

 Great article about the importance of both dirt (it's alive!) and exposure to nature. Main points: It’s estimated that children now spend less time outside than the average prisoner, and that that the average American adult now spends 93 percent of their life indoors (in our homes, workplaces, cars, etc.). It is now thought that human beings need to be exposed to lots of microbes when young for proper immune system development - and this means exposure to the microbes in dirt (for example, young children benefit from playing in the dirt!). There is much harm on many levels from monocultures (whether huge fields of only one crop or "perfect" lawns) sustained by large amounts of chemicals (pesticides and fertilizers). In contrast, a lawn with diversity (clover, flowering "weeds", etc) avoids the use of dangerous chemicals, has benefits to wildlife and humans, and is also a "bee habitat".

Also, what is rarely discussed, but very important to the health of our environment: An estimated quarter of a million acres are paved or repaved in the United States each year - so that “asphalt is the land’s last crop". Paving over the land is "soil sealing", because this cuts off air and water, and kills the microorganisms and insects that live there. This results in dirt being killed off forever. Yikes! Why isn't this discussed more? Excerpts from National Geographic:

WHY YOU NEED MORE DIRT IN YOUR LIFE

It’s estimated that children now spend less time outside than the average prisoner. This could have devastating effects: Kids need to be exposed to the microbes in the soil to build up their defences against diseases that may attack them later. But it’s not just children, Paul Bogard explains in his new book, The Ground Beneath Us. The EPA estimates that the average American adult now spends 93 percent of their life indoors. As we retreat indoors, more and more of the earth is disappearing, with an estimated quarter of a million acres paved or repaved in the United States each year

When National Geographic caught up with Bogard by phone at his home in Minnesota, the author explained why Iowa is the most transformed state in the U.S., how soil is alive but we’re killing it, and how places where terrible things happened can become sacred ground.

You write, “We are only just now beginning to understand the vast life in the soil, what it does, and how our activities on the surface may affect it.” Talk us through some highlights of the new science—and how you became so passionate about dirt.

It began with this statistic: that those of us in the Western world now spend about 90-95 percent of our time inside, in our houses, workplaces, in our cars. We’re living our lives separated from the natural world. When we walk outside, many of us walk on pavement. There’s this literal separation from the natural ground, from the soil, the dirt. It made me think, what are the costs of this separation? And it struck me as symbolic of our separation of these many different kinds of grounds that sustain us. Our food, water, energy, even our spirits come from these different grounds.

One of the first scientific discoveries I found was the hypothesis that human beings need to be exposed to the biota in the dirt, on the ground, especially when they’re kids, as a way of inoculating us to diseases that appear later in life. Kids these days are not being exposed to dirt because they’re not allowed to play outside. Their parents think dirt is dirty. But both the newest science and the oldest traditions tell us the same thing, which is that the ground is alive. The ground gives us life. And in the book, I tried to touch on both of those things.

One expert you quote says, “asphalt is the land’s last crop.” Talk about “soil sealing” and how roads and suburbs are literally eating away at the ground beneath our feet.

Soil sealing is one of the most shocking things I learned about. When we pave over the natural ground, we cut it off from the air and water that the life in the ground needs to stay alive. We essentially kill that ground. There is an argument that, if we pulled up the pavement and worked hard to rejuvenate that ground, we could bring it back. But the scientists I talked to said, when you pave it over, it’s the last crop, the last thing that’s going to grow there. We’re not moving in the direction of pulling pavement up. We’re moving in the opposite direction where we’re paving some of our most fertile ground, the ground that we’re going to need to feed a growing population.

You also had childhood affection for Iowa. But when you went back to research your book, you changed your mind. Why?

As a child, I was enamoured with the beauty of the green corn stalks, the black dirt, and what I thought was the natural topography. Coming back older and with a new understanding of the ground, it made me uncomfortable because Iowa is the most transformed state in the union. Some 97 percent of the natural ground has been altered, changed, or transformed. As one biologist said, “it’s an open air monoculture owned by monopolies.” So, instead of my romantic, childhood view of miles of corn stalks, the beauty of life growing, and the colour green, I saw it as this monoculture where another life isn’t allowed to grow.

Americans love their lawns and spend billions of dollars keeping them green and weed free. But we are also paying a high price for this perfect turf, aren’t we?

Oh my! We really are, certainly ecologically, paying a high price. America’s greatest crop, the thing we grow the most of, is our turf grass lawns. And the amounts of pesticides and chemical fertilisers we dump onto these lawns, and the amount of water that we use to grow them, is enormous. As a result, we have problems with runoff draining into our rivers and the lawns themselves tend to become monocultures, where nothing else grows but the turf grass. What a massive opportunity is being lost! We could have lawns that are more biologically diverse and pollinator-friendly. There’s also evidence that a number of illnesses are associated with coming into contact with these chemical fertilisers and pesticides.

 This is a thought-provoking study that looked at environmental quality and cancer incidence in counties throughout the US. The researchers found that the more polluted the county, the higher the cancer incidence. An increase in cancer rates was associated with poorer air quality and the "built environment" (such as major highways). They correctly point out that many things together can contribute to cancer occurring - and this is why looking at how polluted the air, water, etc. together is important.

They looked at the most common causes of cancer death in both men (lung, prostate, and colorectal cancer), and women (lung, breast, and colorectal cancer). They found that prostate and breast cancer demonstrated the strongest associations with poor environmental quality. [Original study.]

The researchers point out that about half of cancers are thought to have a genetic component, but therefore the other half have environmental causes. Other studies already find that environmental exposures (e.g., pesticides, diesel exhaust) are linked to various cancers. But this study was an attempt to look at interactions of various things in the environment with rates of cancer - because we all are exposed to a number of things simultaneously wherever we live, not just to exposures to one thing. Thus this study looked at associations in rates of cancer. 

Of course there is also a lifestyle contribution to many cancers that wasn't looked at here (nutrition, alcohol use, exercise). They also pointed out that many counties in the US are large and encompass both very polluted and non-polluted areas - and that those counties should be broken up into smaller geographic areas when studied. [More air pollution studies.] From Science Daily:

Poor overall environmental quality linked to elevated cancer rates

Nationwide, counties with the poorest quality across five domains -- air, water, land, the built environment and sociodemographic -- had the highest incidence of cancer, according to a new study published in the journal Cancer. Poor air quality and factors of the built environment -- such as the presence of major highways and the availability of public transit and housing -- -- were the most strongly associated with high cancer rates, while water quality and land pollution had no measurable effect.

Previous research has shown that genetics can be blamed for only about half of all cancers, suggesting that exposure to environmental toxins or socioeconomic factors may also play a role. "Most research has focused on single environmental factors like air pollution or toxins in water," said Jyotsna Jagai, research assistant professor of environmental and occupational health in the University of Illinois at Chicago School of Public Health and lead author of the study. "But these single factors don't paint a comprehensive picture of what a person is exposed to in their environment -- and may not be as helpful in predicting cancer risk, which is impacted by multiple factors including the air you breathe, the water you drink, the neighborhood you live in, and your exposure to myriad toxins, chemicals and pollutants."

To investigate the effects of overall environmental quality, the researchers looked at hundreds of variables, including air and water pollution, pesticide and radon levels, neighborhood safety, access to health services and healthy food, presence of heavily-trafficked highways and roads, and sociodemographic factors, such as poverty. Jagai and her colleagues used the U.S. EPA's Environmental Quality Index, a county-level measure incorporating more than 200 of these environmental variables and obtained cancer incidence rates from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program State Cancer Profiles. Cancer data were available for 85 percent of the 3,142 U.S. counties.

The average age-adjusted rate for all types of cancer was 451 cases per 100,000 people. Counties with poor environmental quality had higher incidence of cancer -- on average, 39 more cases per 100,000 people -- than counties with high environmental quality. Increased rates were seen for both males and females, and prostate and breast cancer demonstrated the strongest association with poor environmental quality.

The researchers found that high levels of air pollution, poor quality in the built environment and high levels of sociodemographic risk factors were most strongly associated with increased cancer rates in men and women. The strongest associations were seen in urban areas, especially for the air and built environment domains. Breast and prostate cancer were most strongly associated with poor air quality.

 The research finding of so many baby foods with elevated arsenic levels (above the legal limit) in the European Union made me wonder about arsenic standards in baby cereals in the US. It turns out that the US has "parallel" standards to the European Union. The EU has "maximum 0.1 milligrams of arsenic per kilogram of rice" (this standard has been in place since January 2016), and in  2016 the US the FDA proposed a "maximum allowed standard of 100 ppb (parts per billion)" in infant rice cereal.

Why is there so much arsenic in baby cereal? It's in the rice - rice plants absorb arsenic from the soil (it may be naturally occurring in the soil or in the soil because of arsenic pesticides that were used for years). And why should we be concerned about arsenic in food? The health effects of regularly consuming infant rice cereal — and other rice-based products —containing traces of arsenic are currently unclear. But...the researchers stated that early-life exposure to arsenic, even at low concentrations, is of particular concern because infants and young children are especially vulnerable to the adverse health effects of arsenic. Arsenic is a carcinogen (causes cancer), and can have "neurological, cardiovascular, respiratory and metabolic" effects.

A Harvard Health Publication (Harvard Medical School) publication in 2016 stated: "In high doses it is lethal, but even small amounts can damage the brain, nerves, blood vessels, or skin — and increase the risk of birth defects and cancer." The FDA found that inorganic arsenic exposure in infants and pregnant women can result in a child’s decreased performance on certain developmental tests that measure learning, based on epidemiological evidence including dietary exposures.

So what should parents do? The American Academy of Pediatricians (AAP) encourages that babies and toddlers eat a variety of foods, and that this will decrease a child's exposure to arsenic from rice. They also encourage other options as first foods (rather than just rice cereal), such as oat, barley, and multigrain cereals - all of which have lower arsenic levels than rice cereal. From Science Daily:

New research shows illegal levels of arsenic found in baby foods

In January 2016, the EU imposed a maximum limit of inorganic arsenic on manufacturers in a bid to mitigate associated health risks. Researchers at the Institute for Global Food Security at Queen's have found that little has changed since this law was passed and that 50 per cent of baby rice food products still contain an illegal level of inorganic arsenic. Professor Meharg, lead author of the study and Professor of Plant and Soil Sciences at Queen's, said: "....Babies are particularly vulnerable to the damaging effects of arsenic that can prevent the healthy development of a baby's growth, IQ and immune system to name but a few."

Rice has, typically, ten times more inorganic arsenic than other foods and chronic exposure can cause a range of health problems including developmental problems, heart disease, diabetes and nervous system damage. As babies are rapidly growing they are at a sensitive stage of development and are known to be more susceptible to the damaging effects of arsenic, which can inhibit their development and cause long-term health problems. Babies and young children under the age of five also eat around three times more food on a body weight basis than adults, which means that, relatively, they have three times greater exposures to inorganic arsenic from the same food item.

The research findings, published in the PLOS ONE journal today, compared the level of arsenic in urine samples among infants who were breast-fed or formula-fed before and after weaning. A higher concentration of arsenic was found in formula-fed infants, particularly among those who were fed non-dairy formulas which includes rice-fortified formulas favoured for infants with dietary requirements such as wheat or dairy intolerance. The weaning process further increased infants' exposure to arsenic, with babies five times more exposed to arsenic after the weaning process, highlighting the clear link between rice-based baby products and exposure to arsenic.

In this new study, researchers at Queen's also compared baby food products containing rice before and after the law was passed and discovered that higher levels of arsenic were in fact found in the products since the new regulations were implemented. Nearly 75 per cent of the rice-based products specifically marketed for infants and young children contained more than the standard level of arsenic stipulated by the EU law.[Original study.]

A 2016 study done in New Hampshire also showed that babies eating rice cereals and other rice-based snacks had higher amounts of arsenic in their urine compared to infants who did not eat rice foods. From JAMA Pediatrics: Association of Rice and Rice-Product Consumption With Arsenic Exposure Early in Life

Image result for stethoscope Dr. John Mandrola (physician and medical writer) has once again written thought provoking posts about medicine and the need for people to question tests, procedures, screening, and to look at the harms and benefits. Because YES - all of the above have harms and benefits, even something as "minor" as taking an antibiotic for a week or two (for example, effects on the gut microbes).

Excerpts from his April 20 post at drjohnm.orgTrust and Medical Science

I first addressed the lack of skepticism among my colleagues. I argue that doctors have become a rapturous audience for medical news. We too easily accept flawed evidence. Our embrace of a flawed dissolving coronary stent and a left atrial appendage closure device serve as good examples of misplaced optimism.

In the second section of the essay, I explore the problem with overselling science. Here’s an except: Science does not do itself. Humans—bent on having a successful academic career—do science. This means positive results can become the goal rather than the pursuit of scientific truth.

I spent three paragraphs on evangelism over screening healthy people. It crushes the public trust to say “screening saves lives” when the evidence doesn’t support the claim. This is not a typo. I cite numerous studies that show common screening tests, mammography, PSA tests, colonoscopy, when put to the test of a randomized controlled trial, do not lower overall death rates.

The obfuscation comes when screening advocates tout lower disease-specific death rates. Viz, mammography may (slightly) lower the chance of dying from breast cancer but it has no significant effect on all-cause death. Through a colleague [Dr. B. Mazer] on Twitter, I found a wonderful quote on the folly of trying to reduce your risk of dying from one sort of disease. “If you are a patient contemplating some screening test, and the result of that test or treatment is no measurable reduction in the rate of death at some clinically relevant later point in time, then why have the test or treatment—unless the patient, for some reason, has a desire to die from condition A instead of condition B.”

And excerpts from his commentary on this topic at Medscape: Want More Trust in Medical Science? Embrace Uncertainty and Cut the Hype

I see a lot of overconfidence in medical science. At the bedside, clinicians—myself included—underestimate harms and overestimate benefits of medical intervention. These inaccuracies have many causes. One is a lack of skepticism. It was 10 years into practice before I learned that most of a study's bias comes in its planning, in the questions it asks.

Rarely do I hear a practicing colleague or speaker at a medical meeting cite Dr John Ioannidis's famous 2005 paper "Why most published research findings are false." Ioannidis, a Stanford epidemiologist, argues that small sample sizes, tiny treatment effects, "flexible" study designs (which can transform "negative" into "positive" results), prestudy biases, and conflicts of interest are the root causes of false research findings. Research findings, he argues, may simply be an accurate measure of the prevailing bias.....Richard Horton, the editor of the Lancet, agrees with Ioannidis. In 2015, he wrote that "much of the scientific literature, perhaps half, may simply be untrue." One of the (many) reasons for this crisis, Horton adds, is that "in their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world." 

Another group of academics that threaten the public trust are screening evangelists. Screening is precarious because it puts doctors close to breaking the golden rule—first, do no harm. Doing things to people-without-complaints and promoting the slogan "screening saves lives" should require clearing the highest bar of evidence. The truth, though, is that the evidence does not support such zealous advocacy.

A systematic review of meta-analyses and randomized clinical trials that studied screening of asymptomatic adults for 19 diseases (39 tests, including mammography) found reductions in disease-specific mortality were uncommon and reductions in all-cause mortality were very rare or nonexistent. Prasad and colleagues explain how screening advocates conflate disease-specific death rates with overall mortality. "Using disease-specific mortality as a proxy for overall mortality," they wrote in the BMJ, "deprives people of information about their chief concern: reducing the risk of dying."

Another good Dr. John Mandrola post: Four Crucial Questions To Ask Your Doctor

Mediterranean Diet is Healthy Eating – A Good Option for Seniors An article was just published in a research journal to discuss the fact that humans - in part due to lifestyles which include less dietary fiber (due to eating fewer varieties and amounts of plants) and due to medical practices (such as frequent use of antibiotics) has resulted in gut "bacterial extinctions". In other words, humans (especially those living an urban industrialized Western lifestyle) have fewer gut bacterial species than those living a more traditional lifestyle, and this loss of bacterial species is linked to various diseases. Humans can increase the number of certain bacterial species, but the loss of some bacterial species is forever. 

The researchers discuss that humans have the "lowest level of gut bacterial diversity"  of any hominid and primate. They stated that the shrinking of the variety of microbial species in the human gut (the gut microbiome) began early in human evolution (as humans started eating more meat), but that it has accelerated dramatically within industrialized societies. And that evidence is accumulating that this gut bacterial "depauperation" - the loss of a variety of bacterial species - may predispose humans to a range of diseases.  Some of it is due to evolution (as humans ate more meat), and some to lifestyle changes. A term is used throughout this paper: depauperate - which means lacking in numbers or variety of species in the gut microbiome (the microbial community or ecosystem).

Other research has also shown that eating a highly processed Western diet results in gut microbial changes that are linked to various diseases (here, here, here) - that is, the microbes being fed are those associated with diseases. Also, certain diets encourage certain microbial species to flourish (here, here).  Bottom line: studies find health benefits from higher levels of dietary fiber - from fruits, vegetables, seeds, nuts, whole grains, and legumes (beans). From Current Opinion In Microbiology:

The shrinking human gut microbiome

Highlights: Humans harbor the lowest levels of gut bacterial diversity of any hominid. Humans in industrialized nations harbor fewer gut bacterial taxa than any primate. Medical practices and lack of dietary fiber may drive gut bacterial extinctions. Depauperate microbiotas may predispose entire human populations to certain diseases.

Mammals harbor complex assemblages of gut bacteria that are deeply integrated with their hosts’ digestive, immune, and neuroendocrine systems. Recent work has revealed that there has been a substantial loss of gut bacterial diversity from humans since the divergence of humans and chimpanzees. This bacterial depauperation began in humanity’s ancient evolutionary past and has accelerated in recent years with the advent of modern lifestyles. Today, humans living in industrialized societies harbor the lowest levels of gut bacterial diversity of any primate for which metagenomic data are available, a condition that may increase risk of infections, autoimmune disorders, and metabolic syndrome. Some missing gut bacteria may remain within under-sampled human populations, whereas others may be globally extinct and unrecoverable.

A typical human harbors on the order of 1013 bacterial cells in the large intestine. This gut microbiota, which can contain over a thousand species, is deeply integrated with virtually every tissue and organ system in the body. Gut bacteria process difficult to digest components of the diet, promote angiogenesis in the intestine, train the immune system, regulate metabolism, and even influence moods and behaviors.

In contrast to hunter–gatherer to agricultural transitions, adoptions of industrial and post-industrial lifestyles have led to massive reductions in bacterial richness within human gut microbiotas. Individuals living in urban centers in the United States harbor fewer gut bacterial species on average than do individuals living more traditional lifestyles in Malawi , Venezuela, Peru, and Papua New Guinea.....Industrialized and traditional lifestyles differ in many respects, confounding the identification of the specific practices that have led to decreases in gut bacterial diversity within industrialized societies. One potential cause is the rise of food processing and the corresponding reductions in the intake of dietary fiber in favor of simple sugars. Recently, studies in model systems have indicated that long-term reductions in dietary fiber can lead to the extirpation of gut bacterial taxa from host lineages. 

Other potential causes of reduced gut bacterial diversity within industrialized human populations include certain modern medical practices. For example, longitudinal studies in humans have shown that levels of gut bacterial diversity decrease drastically after antibiotic use. Although bacterial richness may recover after treatment is completed, the timeline and extent of the restoration is highly subject-dependent. The consequences of antibiotic use on gut bacterial diversity may be most severe when treatment is administered during the early years of life, before the adult microbiota has fully formed .

 This post is more on the theme of nanoparticles and human health. My last post was about a study that examined how inhaled nanoparticles  (for example, from air pollution) travel from the lungs to the bloodstream. Well, today's post is about a pretty shocking 2016 air pollution nanoparticle study which examined the brains (brain tissue) of 45 dead people  (ages 3 to 92) who had lived for a long time in two places with heavy  particulate air pollution - Mexico City and Manchester, England. Some of the British people also had Alzheimer's disease or dementia.

The researchers found evidence that minute nano-sized particles of magnetite from air pollution can find their way into the brain. There are 2 forms of magnetite (which is an iron ore) - one naturally occurring (jagged edges in appearance), and one found commonly in air pollution (smooth and rounded - from being created in the high temperatures of vehicle engines or braking systems). The researchers are concerned that the air pollution nanoparticles may increase the risk for brain diseases such as Alzheimer's.

One of the researchers (Prof Barbara Maher) has previously identified magnetite particles in samples of air gathered beside a busy road in Lancaster, England and outside a power station. She suspected that similar particles may be found in the brain samples, and that is what happened. "It's dreadfully shocking. When you study the tissue you see the particles distributed between the cells and when you do a magnetic extraction there are millions of particles, millions in a single gram of brain tissue - that's a million opportunities to do damage."..."It's a whole new area to investigate to understand if these magnetite particles are causing or accelerating neurodegenerative disease." However, it must be stressed that at this time there is no proven link between these magnetite particles and any neurodegenerative diseases. They're just wondering.... they call finding these pollution nanoparticles "suggestive observations".

From Medical Xpress: Toxic air pollution nanoparticles discovered in the human brain

Tiny magnetic particles from air pollution have for the first time been discovered to be lodged in human brains – and researchers think they could be a possible cause of Alzheimer's disease. Researchers at Lancaster University found abundant magnetite nanoparticles in the brain tissue from 37 individuals aged three to 92-years-old who lived in Mexico City and Manchester. This strongly magnetic mineral is toxic and has been implicated in the production of reactive oxygen species (free radicals) in the human brain, which are associated with neurodegenerative diseases including Alzheimer's disease.

Professor Barbara Maher, from Lancaster Environment Centre, and colleagues (from Oxford, Glasgow, Manchester and Mexico City) used spectroscopic analysis to identify the particles as magnetite. Unlike angular magnetite particles that are believed to form naturally within the brain, most of the observed particles were spherical, with diameters up to 150 nm, some with fused surfaces, all characteristic of high-temperature formation – such as from vehicle (particularly diesel) engines or open fires. The spherical particles are often accompanied by nanoparticles containing other metals, such as platinum, nickel, and cobalt.

Professor Maher said: "The particles we found are strikingly similar to the magnetite nanospheres that are abundant in the airborne pollution found in urban settings, especially next to busy roads, and which are formed by combustion or frictional heating from vehicle engines or brakes."

Other sources of magnetite nanoparticles include open fires and poorly sealed stoves within homes. Particles smaller than 200 nm are small enough to enter the brain directly through the olfactory nerve after breathing air pollution through the nose.....The results have been published in the paper 'Magnetite pollution nanoparticles in the human brain' by the Proceedings of the National Academy of Sciences.

A good discussion of the study in The Scientist: Environmental Magnetite in the Human Brain

Fig. S11. Image of magnetite nanoparticles from the exhaust plume of a diesel engine. Credit: Maher et al study, 2016.

09_05_magnetic_01  A microscopic image shows magnetic nanoparticles in the human brain. Credit: Barbara Maher et al study, 2016.

Image result for earth wikipedia On this Earth Day I want to say: Support science. Support the work of scientists. Science is the pursuit of knowledge. Science is about facts and evidence - not opinions. Medicine is applied science - scientific discoveries are turned into real-world medical treatments. Yes, scientific theories and what we know in science and medicine can change over time as more evidence is found. But science is not political, or it shouldn't be political. This is because we all benefit from science and scientific knowledge.

Sometimes there is bias in science (as when scientists receiving money from a corporation or working for a corporation then do research with results desired by that corporation), but that is why it is important to have transparency in research studies and results, and why good research involves peer review (other scientists review the research) and open discussion, and the importance of others having similar research results in an area. This is also why government funding of basic research is important.

Science is a process of understanding how the world works - it is curiosity driven and uses empirical evidence, particularly information acquired by observation and experimentation. Data is recorded and analyzed by scientists and is part of the scientific method. Basic science results in discoveries that may lead to incredible uses down the road and to amazing benefits to society. An example is the discovery of penicillin, which eventually changed medicine. Government funding has supported basic science for years - for example, NASA, National Oceanic and Atmospheric Administration, National Institutes of Health, and the National Science Foundation. Without government support, most basic scientific research will never happen.

Basically every post I've ever done is science based. Even the ones on sinusitis, Lactobacillus sakei, and the results of self-experimentation. And yes, self-experimentation in science and medicine has a long and honorable history. A very famous example was when the Australian physician Barry Marshall drank a petri dish containing Helicobacter pylori bacteria (from a patient) and soon developed the symptoms of peptic ulcer - this led to his eventually being awarded the Nobel Prize in 2005.

Similarly, through self-experimentation - my four family members, as well as many people writing to me, have reported amazing results within days of using a L. sakei product without changing anything else in their lives. These self-experiments were based on scientific evidence presented in the original Abreu et al study (2012) on sinusitis and the sinus microbiome. This is science at its most basic: doing "A" to a person with condition "B" and seeing the result "C" (which can be a positive effect, no effect, or negative effect).

So take a moment and appreciate all the different fields of science and how they have changed our lives: oceanography, chemistry, physics, earth science, ecology, geology, meteorology, astronomy, zoology, human biology (includes microbiology, anatomy, neurology, immunology, genetics, physiology, pathology, and ophthalmology), botany, anthropology, archaeology, criminology, psychology, sociology, computer science, statistics, mathematics, etc. Some areas of applied science are: engineering, computer science, and medicine. Wow....So please...Support science and the pursuit of knowledge. It's not political. It's not opinions or wishful thinking. Don't deny science.