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Image result for chlamydia wikipediaThe annual Sexually Transmitted Disease Surveillance Report was released today by the US Centers for Disease Control and Prevention (CDC) and the news wasn't good. More than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016 - the highest number ever. But the CDC acknowledges that the actual numbers are far higher - that most cases of STDs are not reported to the CDC. The CDC estimates that there are actually 20 million new STDs in the U.S. each year, including other sexually transmitted diseases such as genital herpes and human papillomavirus, and half of these are among young people ages 15 to 24 years.

The report discusses the four STDs (sexually transmitted diseases) that are reported to the CDC. The 4th one is chancroid, but there were only 7 cases reported last year. Most of the new cases of STDs involved chlamydia, a bacterial infection that affects both men and women - about 1.6 million cases were reported to the CDC. Gonorrhea also increased among men and women last year, but the steepest rise was among men, especially among men who have sex with men (MSM). The CDC is especially concerned about the threat of gonorrhea becoming resistant to all treatments. Untreated STDs have serious health consequences (e.g. infertility, still-birth in infants)

This report stresses the need for STD screening and treatment, especially among pregnant women (make it part of prenatal care). There is also a need for STD education, and greater use of condoms to reduce risk of STDs. The CDC has a page on STD prevention (practice abstinence, use condoms, have fewer sexual partners and exclusive relationships, get the HPV vaccine, and talk with your partner about safe sex).  Excerpts from CDC:

STDs at record high, indicating urgent need for prevention

More than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016, the highest number ever, according to the annual Sexually Transmitted Disease Surveillance Report released today by the Centers for Disease Control and Prevention (CDC).

The majority of these new diagnoses (1.6 million) were cases of chlamydia. There were also 470,000 gonorrhea cases and almost 28,000 cases of primary and secondary syphilis – the most infectious stages of the disease. While all three of these STDs can be cured with antibiotics, if left undiagnosed and untreated, they can have serious health consequences, including infertility, life-threatening ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission.

While young women continue to bear the greatest burden of chlamydia (nearly half of all diagnosed infections), surges in syphilis and gonorrhea are increasingly affecting new populations.

Syphilis rates increased by nearly 18 percent overall from 2015 to 2016. The majority of these cases occur among men – especially gay, bisexual and other men who have sex with men (MSM) – however, there was a 36 percent increase in rates of syphilis among women, and a 28 percent increase in syphilis among newborns (congenital syphilis) during this period. More than 600 cases of congenital syphilis were reported in 2016, which has resulted in more than 40 deaths and severe health complications among newborns. The disease is preventable through routine screening and timely treatment for syphilis among pregnant women.

While gonorrhea increased among men and women in 2016, the steepest increases were seen among men (22 percent). Research suggests that a large share of new gonorrhea cases are occurring among MSM. These trends are particularly alarming in light of the growing threat of drug resistance to the last remaining recommended gonorrhea treatment.

Image result for chlamydia wikipedia Chlamydia trachomatis (chlamydia) - in brown. Credit: Wikipedia

This is part 2 of posts about tiny particles of plastic (microfibers) in our water - which is a form of water pollution. These plastic fibers are smaller than 5 mm, and are found in water (drinking water, rivers, oceans) throughout the world. An investigative study by Orb Media (done by research scientists) took numerous drinking water samples from more than a dozen nations and analyzed them. They found that 83% of drinking water samples worldwide, and 94% of drinking water samples taken in the US (which included tap water from Congressional buildings, the US Environmental Protection Agency’s headquarters, Trump Tower in New York, and bottled waters) contained plastic microfibers.

The last post discussed  research finding plastic microfibers in rivers, and how they are now found in fish and shellfish - and so eventually in us (we eat fish and shellfish, don't we?). The plastic microfibers are in our food chain, and there is tremendous concern over what that is doing to wildlife and to us, especially as the microfibers accumulate. Well, we also now know that the plastic microfibers are found in drinking water, are in the air, and can be found in foods tested (even beer).

So what are these plastic microfibers doing to us? And how can we reduce the number of microfibers being released into the air? The Orb Media site discusses sources of plastic microfibers in the environment (from clothes being washed, tire dust, paint dust, etc.) to how we personally can generate fewer plastic microfibers (try not to use plastic bags or straws, etc.). Excerpts from The Guardian:

Plastic fibres found in tap water around the world, study reveals

Microplastic contamination has been found in tap water in countries around the world, leading to calls from scientists for urgent research on the implications for health. Scores of tap water samples from more than a dozen nations were analysed by scientists for an investigation by Orb Media, who shared the findings with the Guardian. Overall, 83% of the samples were contaminated with plastic fibres.

The US had the highest contamination rate, at 94%, with plastic fibres found in tap water sampled at sites including Congress buildings, the US Environmental Protection Agency’s headquarters, and Trump Tower in New York. Lebanon and India had the next highest rates. European nations including the UK, Germany and France had the lowest contamination rate, but this was still 72%. The average number of fibres found in each 500ml sample ranged from 4.8 in the US to 1.9 in Europe.

The new analyses indicate the ubiquitous extent of microplastic contamination in the global environment. Previous work has been largely focused on plastic pollution in the oceans, which suggests people are eating microplastics via contaminated seafood. “We have enough data from looking at wildlife, and the impacts that it’s having on wildlife, to be concerned,” said Dr Sherri Mason, a microplastic expert at the State University of New York in Fredonia, who supervised the analyses for Orb. “If it’s impacting [wildlife], then how do we think that it’s not going to somehow impact us?”

Mahon said there were two principal concerns: very small plastic particles and the chemicals or pathogens that microplastics can harbour. “If the fibres are there, it is possible that the nanoparticles are there too that we can’t measure,” she said. “Once they are in the nanometre range they can really penetrate a cell and that means they can penetrate organs, and that would be worrying.” The Orb analyses caught particles of more than 2.5 microns in size, 2,500 times bigger than a nanometre. [NOTE: This means they were not able to test for smaller sizes.]

The scale of global microplastic contamination is only starting to become clear, with studies in Germany finding fibres and fragments in all of the 24 beer brands they tested, as well as in honey and sugar. In Paris in 2015, researchers discovered microplastic falling from the air, which they estimated deposits three to 10 tonnes of fibres on the city each year, and that it was also present in the air in people’s homes.

How microplastics end up in drinking water is for now a mystery, but the atmosphere is one obvious source, with fibres shed by the everyday wear and tear of clothes and carpets. Tumble dryers are another potential source, with almost 80% of US households having dryers that usually vent to the open air. “We really think that the lakes [and other water bodies] can be contaminated by cumulative atmospheric inputs,” said Johnny Gasperi, at the University Paris-Est Créteil, who did the Paris studies. “What we observed in Paris tends to demonstrate that a huge amount of fibres are present in atmospheric fallout.”.... Plastic fibres may also be flushed into water systems, with a recent study finding that each cycle of a washing machine could release 700,000 fibres into the environment. Rains could also sweep up microplastic pollution, which could explain why the household wells used in Indonesia were found to be contaminated. 

Microfibers found in the Hudson River. Credit: PBS News Hour, Sara Cathey, Adventure Scientists

You may not think of your clothes as pollutants, but tiny plastic fibers from synthetic textiles (microfibers) are big contributors to water pollution. Clothes and fabrics made with synthetic fibers are using plastic fibers (e.g. polyester, nylon, acrylic, fleece and athletic clothing). When they are washed, they break apart in the washing machine, and so get into the wastewater system, and eventually into our rivers and oceans.

These microplastic particles are smaller than 5 mm. One 2011 study found that "Experiments sampling wastewater from domestic washing machines demonstrated that a single garment can produce greater than 1900 fibers per wash" (which then goes directly into wastewater). And while a 2017 study didn't examine sources of microfibers (air, rain, water treatment plants, etc) found in numerous Hudson River water samples, the researchers estimate that the entire Hudson River dumps 300 million human-made fibers into the Atlantic Ocean each day. Wow.

In the past few weeks a number of articles and studies have been published about these small plastic pieces (microfibers) that are found in our water - yes, in our drinking water, as well as our rivers, seas, and oceans. Which eventually get into birds, fish and shellfish - and so eventually into us. So the microfibers are in our food chain. There is tremendous concern over what that is doing to wildlife and to us, especially as the microfibers accumulate. We all use plastics every day and most of us wear clothing made of plastic fibers (synthetic fibers), and we're not about to stop. (NOTE: No matter what fabrics we wear, our clothing also sheds fibers into the air, so we leave a trail of fibers behind us, including at crime scenes. Synthetic and natural materials - such as cotton and wool, both shed.)

The big questions: Can anything be done to stop this water pollution? And what is it doing to us and wildlife? Today I am posting links to these stories because it is of concern to all of us and to future generations, and we need to think about and address this issue.

Excerpts from PBS News Hour: This New York river dumps millions of fabric microfibers into the ocean daily

The faded, “distressed look” of a favorite pair of blue jeans, may come with a hidden price for the residents of New York. The Hudson River dumps 300 million clothing fibers into the Atlantic Ocean each day, according to a recent study in the Marine Pollution Bulletin. Many of the fibers come from aging clothes, rinsed out with the laundry and into the environment. Approximately half of the fibers were plastic, while the remainder were spun from natural materials like cotton or wool. Invisible to the naked eye, these fibers can cause health problems for animals and humans.

Barrows, who has been studying microfiber pollution in oceans for more than five years, wanted to learn more about what’s happening upstream in freshwater. So last year, Barrows and a team of scientists and volunteers measured microfiber pollution across all 13,300 miles of the Hudson river..... The team found about one microfiber per liter of water, which seems small until you consider the sheer volume of the Hudson River. An average-sized, above-ground swimming pool filled with this water would contain about 10,800 microfibers, and the entire Hudson River dumps 300 million human-made fibers into the Atlantic Ocean each day. [Original Hudson River study.]

If wastewater treatment facilities are not the major culprit, people may want to look their everyday clothes. Fabrics cast off tiny threads at every stage of their life. Even crime scene investigators count on perpetrators leaving behind bits of clothing. “We are just not conscious of it,” Carr said. “It’s invisible, but everywhere you go and everywhere I go, we are leaving a trail of fibers in our wake.”

Pollutants and other fine particles can hang in the air and travel great distances, said George Thurston, who studies the health effects of air pollution at New York School of Medicine. These airborne fibers can also be toxic. During the industrial revolution, byssinosis or brown lung disease, befell textile plant workers due to cotton or other fibers in the factory’s air. But Thurston said more research is needed to ascertain how microfibers get around.

Microfibers found in the Hudson River. Credit: PBS News Hour, Sara Cathey, Adventure Scientists

 

 

An interesting article that describes the difficulty of capturing tiny plastic microfibers at sewage and water treatment plants in Minnesota. From MPR News: Microplastics could pose big treatment challenges

So-called microplastics are tiny — less than 5 millimeters across. They can come from litter or plastic bags that break down over time. ...."These small little threads, they find their way into the wastewater treatment system and then, into our aquatic environment."

Austin Baldwin, a hydrologist with the U.S. Geological Survey, studied the St. Croix, Namekagon and Mississippi rivers in 2015. The results were published earlier this year in a brief issued by the National Park Service. Baldwin's team found microplastics in all of the samples they took of water, sediment, fish and mussels. The level of concentration was surprising: They found as many as 111 microscopic pieces of plastic in a single fish. Scientists worry that microplastics might clog the digestive systems of fish and make them feel full, so they end up starving. Baldwin said there need to be more study of the biological impacts.

Microplastic fibers in the wastewater are so small they slip through filters and screens designed to capture larger particles. Hoellin's team sampled Chicago rivers and found higher concentrations of microplastics downstream of sewer plants. "What I've seen is that some wastewater treatment plants are really effective at retaining 99 percent of the microplastic that comes in as raw sewage," Hoellin said. "But even that 1 percent, when it's added up on a daily, yearly basis, is amounting to a lot of plastic pollution." Hoellin noted there's no legal requirement for wastewater plants to treat for microplastics. "

By the time the treated wastewater is discharged into the Mississippi River, Rogacki [Larry Rogacki, assistant general manager of the Metropolitan Wastewater Treatment Plant in St. Paul, MN] estimates that 96-98 percent of all microplastics have been removed. Retrofitting the plant to eliminate 100 percent of microplastics would require installing sand filters that could capture smaller particles, he said. It would be costly — close to $1 billion. ....What scientists say might be more effective — and less expensive — is to figure out how to keep plastic out of the wastewater stream in the first place.

Tattoos are very popular these days, with about 29% of Americans having one or more. But there also is concern because so little is known about tattoo inks and any health effects on the body, and because adverse effects (e.g. inflammatory reactions) can occur months or years later. One study of 300 people in New York City with tattoos found that 10.3% reported experiencing an adverse tattoo reaction, of which 6% reported suffering from a chronic reaction from a specific color (especially red and black ink) that lasted for more than 4 months.

Now a new study in the journal Scientific Reports reports that microscopic particles from tattoo inks can migrate into the body and wind up in the lymph nodes of the immune system. Most tattoo inks contain particles of varying sizes - with some being very small nanoparticles. The researchers analyzed the skin and lymph nodes of 4 tattooed corpses and 2 corpses with no tattoos. They found the presence of several toxic elements such as nickel, chromium, cadmium, aluminum from the colorful tattoo inks. They found tattoo pigment particles in the skin, and that smaller ink nanoparticles had traveled to the lymph nodes - which leads to chronic enlargement of those lymph nodes, as well as lifelong exposure. From Science Daily:

Nanoparticles from tattoos travel inside the body, scientists find

The elements that make up the ink in tattoos travel inside the body in micro and nanoparticle forms and reach the lymph nodes according to a study published in Scientific Reports on 12 September by scientists from Germany and the ESRF, the European Synchrotron, Grenoble (France). 

The reality is that little is known about the potential impurities in the colour mixture applied to the skin. Most tattoo inks contain organic pigments, but also include preservatives and contaminants like nickel, chromium, manganese or cobalt. Besides carbon black, the second most common ingredient used in tattoo inks is titanium dioxide (TiO2), a white pigment usually applied to create certain shades when mixed with colorants. TiO2 is also commonly used in food additives, sun screens, paints. Delayed healing, along with skin elevation and itching, are often associated with white tattoos, and by consequence with the use of TiO2. 

"We already knew that pigments from tattoos would travel to the lymph nodes because of visual evidence: the lymph nodes become tinted with the colour of the tattoo. It is the response of the body to clean the site of entrance of the tattoo. What we didn't know is that they do it in a nano form, which implies that they may not have the same behaviour as the particles at a micro level. And that is the problem: we don't know how nanoparticles react," explains Bernhard Hesse, one of the two first authors of the study and ESRF visiting scientist.

X-ray fluorescence measurements on ID21 allowed the team to locate titanium dioxide at the micro and nano range in the skin and the lymphatic environment. They found a broad range of particles with up to several micrometres in size in human skin but only smaller (nano) particles transported to the lymph nodes. This may lead to the chronic enlargement of the lymph node and lifelong exposure [Original study.]

Image result for thunderstorm wikipediaThunderstorm asthma? This is an asthma attack triggered by a thunderstorm - it is still relatively rare, but predicted to increase with the coming climate changes. During thunderstorms there are downdrafts of cold air which sweep up particles of pollens and mold spores into the clouds. There they absorb moisture and rupture into small, fragments (into a size easily inhaled into the lungs), which then are dispersed by rain and wind. When inhaled they  can enter the lungs and trigger an asthma attack - thunderstorm asthma. [Note that normally larger pollen grains are usually filtered by hairs in the nose - so they don't make it to the lungs.] It seems that people with "hayfever" and allergies to grass pollen are at highest risk - at least in Australia. From Medscape:

Thunderstorm Asthma on the Rise

For seasonal allergy sufferers, rain is usually thought of as a friend—it washes the pollen out of the air. However, there are circumstances in which a particular type of wet weather event can make things much worse: thunderstorms. Asthma epidemics have occurred under such circumstances and have affected patients who have never exhibited asthmatic symptoms before. The most recent severe episode occurred in Melbourne, Australia, in 2016, with 8500 emergency asthma visits and nine deaths.[1]

Recently in the Journal of Allergy and Clinical Immunology, Dr Gennaro D'Amato and colleagues[1] explored the nature of this phenomenon and implications for the future. The authors point out that although rare, these events are expected to occur more often with anticipated climate change. According to the authors, the evidence for this so far is limited to pollen and outdoor mold seasons—but even in the northeastern United States, that is about three quarters of the year.

Pollen grains are large (up to 35 µm in diameter)[2] and usually do not make their way down to the bronchial tree. During a thunderstorm, however, these grains are swept up by a dry updraft, ruptured by high humidity at the cloud base, then forced down by cold air. These smaller grains contains allergens of the just the right size (< 3 µm) to reach the bronchial tree, resulting in asthma symptoms in patients with allergic rhinitis who perhaps have never exhibited asthma before.

The first reported case of thunderstorm asthma was in the United Kingdom in 1983. Since then it has happened in Australia, Canada, the United Kingdom (Alternaria species), the United States, and Italy (olive and Parietaria pollens). Evidence for the role of the Parietaria pollen in the outbreak in Naples, Italy, was supported by high levels of the pollen grains as opposed to low levels of measured particulates and pollutants, including ozone and nitric oxide.

Certainly, people who are sensitized to the relevant allergens are at risk. Beyond that, we can presume that patients who already have poorly controlled asthma or more bronchial hyperresponsiveness would be at risk, as would patients who have other concurrent risk factors for allergic asthma (such as rhinovirus infection).

Image result for psoriasis wikipediaCould probiotics have a role to play in the treatment of psoriasis? A recent analysis and review of studies suggests that they might. Psoriasis is a non-contagious, chronic disease affecting about 2 to 4% of the population, and which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly, and can cover small areas to covering the entire body. There is no cure for psoriasis, but various treatments can help control the symptoms, such as steroid creams, vitamin D3 cream, ultraviolet light, and immune system suppressing medications. 

What did the researchers find? They said that "new evidence suggests that the microbiome may play a pathogenic role in psoriatic disease" - meaning the community of microbes (microbiome) may be involved in this disease. There is dysbiosis of the skin microbiome (microbial community is out of whack) in areas of skin lesions or patches. Areas of skin lesions had a different microbiome ("lesional psoriatic microbiome") compared to healthy skin - and in these skin lesions or patches some microbial species increase which leads to a decrease or elimination of others. Not just differences in bacteria, but also in fungi and viruses.

in psoriasis the microbial community of the gut is also out of whack (dysbiosis of the gut microbiome). And the gut microbiome is different in those with psoriasis limited to just skin patches, and those with complications of psoriasis (e.g., psoriatic arthritis) - and several studies found that these shifts in the gut microbiome occurred before the psoriatic complications became evident. That suggests that probiotics might help. But which ones?

The researchers state: "Other changes observed in gut microbiome studies include a decrease in Actinobacteria. This may suggest a protective role of Actinobacteria, a phylum which includes Bifidobacterium species that have been shown to reduce intestinal inflammation, suppress autoimmunity, and induce Tregs." They go on to state that one 2013 study by Groeger et al demonstrated that eating Bifidobacteria infantis 35,624 for 6–8 weeks in a randomized, double-blind, placebo-controlled clinical trial reduced inflammatory markers (plasma CRP and TNF-a) in psoriasis patients. Bifidobacterium species, including B. infantis, are commonly found in many multi-strain supplements. So I wonder, what happens if people with psoriasis take them over an extended period? Will the skin psoriasis skin patches improve? This is currently unknown. But...If you've had success with probiotics as a  psoriasis treatment - please let me know. What microbes? And for what symptoms of psoriasis?

From Current Dermatology Reports : The Role of the Skin and Gut Microbiome in Psoriatic Disease

Our review of studies pertaining to the cutaneous microbiome showed a trend towards an increased relative abundance of Streptococcus and a decreased level of Propionibacterium in psoriasis patients compared to controls. In the gut microbiome, the ratio of Firmicutes and Bacteroidetes was perturbed in psoriatic individuals compared to healthy controls. Actinobacteria was also relatively underrepresented in psoriasis patients relative to healthy individuals.

Summary: Although the field of the psoriatic microbiome is relatively new, these first studies reveal interesting differences in microbiome composition that may be associated with the development of psoriatic comorbidities and serve as novel therapeutic targets.

Image result for psoriasis medscape  Psoriasis.  Credit: Medscape

  Finally some good news regarding ticks and the diseases they can transmit to humans. Currently ticks in the US are known to transmit at least 14 diseases, including Lyme disease. But a recent study done in the Netherlands found that the presence of predators such as foxes resulted in mice and voles having fewer ticks on them. A really big reduction in both tick numbers and the percentage of ticks infected with a disease. The researchers  thought that this was due to the mice and voles being less active when predators were nearby, and also that mice and voles that did venture further were preyed upon and eaten by the predators. So be happy if you see foxes in your neighborhood - they're beneficial. Excerpts from the NY Times:

Lyme Disease’s Worst Enemy? It Might Be Foxes

It is August, the month when a new generation of black-legged ticks that transmit Lyme disease and other viruses are hatching. On forest floors, suburban estates and urban parks, they are looking for their first blood meal. And very often, in the large swaths of North America and Europe where tick-borne disease is on the rise, they are feeding on the ubiquitous white-footed mice and other small mammals notorious for harboring pathogens that sicken humans.

But it doesn’t have to be that way. A new study suggests that the rise in tick-borne disease may be tied to a dearth of traditional mouse predators, whose presence might otherwise send mice scurrying into their burrows. If mice were scarcer, larval ticks, which are always born uninfected, might feed on other mammals and bird species that do not carry germs harmful to humans. Or they could simply fail to find that first meal. Ticks need three meals to reproduce; humans are at risk of contracting diseases only from ticks that have previously fed on infected hosts.

For the study, Tim R. Hofmeester, then a graduate student at Wageningen University in the Netherlands and the lead researcher of the study, placed cameras in 20 plots across the Dutch countryside to measure the activity of foxes and stone martens, key predators of mice. Some were in protected areas, others were in places where foxes are heavily hunted. Over two years, he also trapped hundreds of mice — and voles, another small mammal — in the same plots, counted how many ticks were on them, and tested the ticks for infection with Lyme and two other disease-causing bacteria. To capture additional ticks, he dragged a blanket across the ground.

In the plots where predator activity was higher, he found only 5 to 10 percent as many newly hatched ticks on the mice as in areas where predators were scarcer. Thus, there would be fewer ticks to pass along pathogens to the next generation of mice. In the study, the density of infected “nymphs,” as the adolescent ticks are called, was reduced to 6 percent of previous levels in areas where foxes were more active.“The predators appear to break the cycle of infection,’’ said Dr. Hofmeester, who earned his Ph.D. after the study.

Interestingly, the predator activity in Dr. Hofmeester’s plots did not decrease the density of the mouse population itself, as some ecologists had theorized it might. Instead, the lower rates of infected ticks, Dr. Hofmeester suggested in the paper, published in Proceedings of the Royal Society B, may be the result of small mammals curtailing their own movement when predators are around. [Original study.]

  Two more studies found that higher levels of vitamin D in the blood are associated with better health outcomes - one study found a lower risk of breast cancer, especially among postmenopausal women, and in the other - better outcomes after a metastatic melanoma diagnosis.

The breast cancer study suggested that a fairly high blood level of vitamin D (25(OH)D serum level>38.0 ng/mL) was associated with a lower risk of breast cancer. But overall they found that women supplementing with vitamin D (more than 4 times a week) at any dose had a lower risk of breast cancer over a 5 year period than those not supplementing with vitamin D. From Environmental Health Perspectives:

Serum Vitamin D and Risk of Breast Cancer within Five Years

Vitamin D is an environmental and dietary agent with known anticarcinogenic effects, but protection against breast cancer has not been established. We evaluated the association between baseline serum 25-hydroxyvitamin D [25(OH)D] levels, supplemental vitamin D use, and breast cancer incidence over the subsequent 5 y of follow-up. From 2003-2009, the Sister Study enrolled 50,884 U.S. women 35-74 y old who had a sister with breast cancer but had never had breast cancer themselves. Using liquid chromatography-mass spectrometry, we measured 25(OH)D in serum samples from 1,611 women who later developed breast cancer and from 1,843 randomly selected cohort participants.

We found that 25(OH)D levels were associated with a 21% lower breast cancer hazard (highest versus lowest quartile). Analysis of the first 5 y of follow-up for all 50,884 Sister Study participants showed that self-reported vitamin D supplementation was associated with an 11% lower hazard. These associations were particularly strong among postmenopausal women.

In this cohort of women with elevated risk, high serum 25(OH)D levels and regular vitamin D supplement use were associated with lower rates of incident, postmenopausal breast cancer over 5 y of follow-up. These results may help to establish clinical benchmarks for 25(OH)D levels; in addition, they support the hypothesis that vitamin D supplementation is useful in breast cancer prevention.

The first sentence in the melanoma study lays out what is widely known: "Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma." Studies show that the relationship between vitamin D, sunlight exposure, and melanoma is complicated in a number of ways, including: sun exposure may be associated with increased survival in patients with melanoma. which may mean that vitamin D has a protective role in patients with melanoma. Several studies suggest that vitamin D may delay melanoma recurrence and improve overall prognosis. The study also found that metastatic melanoma patients with vitamin D deficiency who are unable to or don't raise their vitamin D blood levels (25(OH)D3) have a worse outcome compared to those who are are able to markedly increase (by greater than >20 ng/mL) their 25(OH)D3 levels. From Oncotarget:

Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma

Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma. A retrospective, single-center study of individuals diagnosed with melanoma from January 2007 through June 2013 who had a vitamin D (25(OH)D3) level measured within one year of diagnosis was performed to determine whether vitamin D deficiency and repletion are associated with melanoma outcome.

A total of 409 individuals diagnosed with histopathology-confirmed melanoma who had an ever measured serum 25(OH)D3 level were identified. 252 individuals with a 25(OH)D3 level recorded within one year after diagnosis were included in the study .... A worse melanoma prognosis was associated with vitamin D deficiency, higher stage, ulceration, and higher mitotic rate. In patients with stage IV metastatic melanoma, vitamin D deficiency was associated with significantly worse melanoma-specific mortality. Patients with metastatic melanoma who were initially vitamin D deficient and subsequently had a decrease or ≤20 ng/mL increase in their 25(OH)D3 concentration had significantly worse outcomes compared to non-deficient patients who had a >20 ng/mL increase. Our results suggest that initial vitamin D deficiency and insufficient repletion is associated with a worse prognosis in patients with metastatic melanoma.

Image result for human sperm, wikipedia The last post discussed the steep ongoing decline in sperm counts and sperm concentration in men from North America, Europe, Australia, and New Zealand. It mentioned a number of environmental causes that could be contributing to this, including the huge increase of chemicals, especially endocrine disruptors (chemicals that disrupt our hormones) over the past few decades.

But another study was also just published that showed (in mice) that effects of chronic exposure to endocrine disrupting chemicals are amplified over 3 generations - and each generation has even lower sperm counts, sperm concentration, and reproductive abnormalities. So each generation gets progressively worse with continued exposure.

As the researchers state: "Our findings suggest that neonatal estrogenic exposure can affect both the reproductive tract and sperm production in exposed males, and exposure effects are exacerbated by exposure spanning multiple generations. Because estrogenic chemicals have become both increasingly common and ubiquitous environmental contaminants in developed countries, the implications for humans are serious. Indeed, it is possible effects are already apparent, with population-based studies from the U.S., Europe, Japan, and China reporting reductions in sperm counts/quality and male fertility within a span of several decades." Yikes...

The World Health Organization (WHO) considers an impairment in ability to fertilize an egg at 40 million sperm per milliliter or below, and the level where WHO considers fertilization unlikely is 15 million sperm per milliliter. This is why the sperm count study discussed in the last post is so frightening: North American, Canadian, Australian, and New Zealand men  whose partners are not yet pregnant nor do they have children (i.e., they are not confirmed fertile men) have experienced a drop in average sperm count of about 50 percent over four decades, to 47 million sperm per milliliter. Niels Skakkebæk, a Danish pediatrician and researcher working on this topic said: "Here in Denmark, there is an epidemic of infertility."and "Most worryingly [in Denmark] is that semen quality is in general so poor that an average young Danish man has much fewer sperm than men had a couple of generations ago, and more than 90 percent of their sperm are abnormal." Uh-oh...What will it take for governments to address this serious issue?

In the meantime, see the last post for some tips on how to reduce your own exposure to endocrine disrupting chemicals. Just note that you can reduce exposure, but you can't totally eliminate exposure. Excerpts from Environmental Health News:

Science: Are we in a male fertility death spiral?

Margaret Atwood's 1985 book, The Handmaid's Tale, played out in a world with declining human births because pollution and sexually transmitted disease were causing sterility. Does fiction anticipate reality? Two new research papers add scientific weight to the possibility that pollution, especially endocrine disrupting chemicals (EDCs), are undermining male fertility.

The first, published Tuesday, is the strongest confirmation yet obtained that human sperm concentration and count are in a long-term decline: more than 50 percent from 1973 to 2013, with no sign that the decline is slowing. "The study is a wakeup that we are in a death spiral of infertility in men," said Frederick vom Saal, Curators’ Distinguished Professor Emeritus of Biological Sciences at the University of Missouri and an expert on endocrine disruption who was not part of either study.

The second study, published last week by different authors, offers a possible explanation. It found that early life exposure of male mouse pups to a model environmental estrogen, ethinyl estradiol, causes mistakes in development in the reproductive tract that will lead to lower sperm counts. According to vom Saal, the second study "provides a mechanistic explanation for a progressive decrease in sperm count over generations." What makes this study unique is that it examined what happened when three successive generations of males were exposed—instead of just looking only at the first. Hunt, in an email, said "we asked a simple question with real-world relevance that had simply never been addressed."

In the real world, since World War II, successive generations of people have been exposed to a growing number and quantity of environmental estrogens—chemicals that behave like the human hormone estrogen. Thousands of papers published in the scientific literature (reviewed here) tie these to a wide array of adverse consequences, including infertility and sperm count decline. This phenomenon—exposure of multiple generations of mammals to endocrine disrupting compounds—had never been studied experimentally, even though that's how humans have experienced EDC exposures for at least the last 70 years. That's almost three generations of human males. Men moving into the age of fatherhood are ground zero for this serial exposure.

So Horan, Hunt and their colleagues at WSU set out to mimic, for the first time, this real-world reality. They discovered that the effects are amplified in successive generations. They observed adverse effects starting in the first generation of mouse lineages where each generation was exposed for a brief period shortly after birth. The impacts worsened in the second generation compared to the first, and by the third generation the scientists were finding animals that could not produce sperm at all. This latter condition was not seen in the first two generations exposed. Details of the experimental results actually suggested that multiple generations of exposure may have increased male sensitivity to the chemical[Original study.]

Once again a study (this time a review and meta-analysis of other studies) found an alarming and steep decline in sperm counts in men from Western countries over a 40 year period. This steep decline for both sperm concentration (SC) and total sperm count (TSC) is for men in North America, Europe, Australia, and New Zealand. The sperm count and sperm concentration declined 50 to 60% in the period between 1973 to 2011 - with a downward slope showing a decline of -1.4% to -1.6% per year. On the other hand, men from South America, Asia and Africa did not show a decline.

The authors of the study were very concerned over the results showing this decline in Western countries, with no evidence of the decline leveling off. As these declines continue, more and more men will have sperm counts below the point at which they can reproduce. Instead they will be infertile or "sub-fertile" (with a decreased probability of conceiving a child). The threshold level associated with a "decreased monthly probability of conception" is considered to be 40 million/ml. Shockingly - this study found that in 1973 when Western men who were not selected for fertility, and didn't know their fertility status (e.g., college students, men screened for the military) - the average sperm concentration was 99 million/ml, but by 2011 it was 47.1 million/ml. These men were called "unselected" and are likely to be representative of men in the general population. Men known to be fertile (e.g., had fathered a child) were at 83.8 million/ml in 1976, but were down to 62.0 million/ml in 2011. Both groups had consistent declines year after year.

What about the men from South America, Asia, and Africa? There, studies showed that the "unselected" men (not selected for fertility and who didn't know their fertility status) started out at 72.7 million/ml in 1983, and were at 62.6 million/ml in 2011, while men known to be fertile started out on average at 66.4 million/ml in 1978 and were at 75.7 million/ml in 2011. They did not show the decline of the North American, European, Australian, and New Zealand group of men.

What does this mean? And what is going on? These results go beyond fertility and reproduction. The decline is consistent with other male reproductive health indicators over the last few decades: higher incidence of testicular cancer, higher rates of cryptorchidism, earlier onset of male puberty, and decline in average testosterone levels. Instead, it appears that sperm counts of men are "the canary in the mine" for male health - evidence of harm to men from environmental and lifestyle influences. These Western developed countries are awash in chemicals and plastics, also with endocrine disruptors (hormone disruptors) in our foods, our personal care products, etc - and so studies find these chemicals in all of us (in varying degrees). Same with flame retardants, pesticides, "scented" products. Exposure to all sorts of environmental pollutants - whether in air, water, soil, our food - such as high levels of aluminum. All of these can have an effect on sperm counts and reproductive health. And note that chemicals that can depress sperm counts  are also linked to many health problems, including chronic diseases.

What can I do?  You can lower your exposure to many chemicals (e.g., pesticides), plastics, and endocrine disruptors, but you can't avoid them totally. Yes, it'll mean reading labels and ingredient lists on foods, personal care products (such as soaps, shampoo, lotion), and products used in the home. TRY TO AVOID OR LOWER EXPOSURE TO: phthalates, parabens, BPA, BPS, and even BPA-free labeled products (all use similar chemicals), flame-retardants (e.g., in upholstered furniture and rugs), stain-resistant, dirt-resistant, waterproof coatings, Scotchgard, non-stick cookware coatings, dryer sheets, scented products (including scented candles and air fresheners), fragrances, pesticides in the yard and home, and "odor-free", antibacterial, antimicrobial, anti-mildew products. Don't microwave foods in plastic containers (including microwave popcorn bags). 

INSTEAD: Try to eat more organic foods, look for organic or least-toxic Integrated Pest Management (IPM) alternatives for the home and garden. Store foods as much as possible in glass, ceramic, or stainless steel containers. Buy foods, if possible, that are in glass bottles - not cans (all lined with endocrine disrupting chemicals) and not plastic bottles or containers (plastics leach). Some people use water filters because there are so many contaminants in our water, even if they meet federal guidelines on "allowable levels" in the water. Avoid cigarette smoke or smoking. Try to lose weight if overweight. Open windows now and then in your residence to lower indoor air pollution. The list is long - yes, a lifestyle change! (see posts on ENDOCRINE DISRUPTORS, FLAME RETARDANTS, and PESTICIDES)

From Medical Xpress: Study shows a significant ongoing decline in sperm counts of Western men

In the first systematic review and meta-analysis of trends in sperm count, researchers from the Hebrew University-Hadassah Braun School of Public Health and Community Medicine and the Icahn School of Medicine at Mount Sinai report a significant decline in sperm concentration and total sperm count among men from Western countries.

By screening 7,500 studies and conducting a meta-regression analysis on 185 studies between 1973 and 2011, the researchers found a 52.4 percent decline in sperm concentration, and a 59.3 percent decline in total sperm count, among men from North America, Europe, Australia and New Zealand who were not selected based on their fertility status. In contrast, no significant decline was seen in South America, Asia and Africa, where far fewer studies have been conducted. The study also indicates the rate of decline among Western men is not decreasing: the slope was steep and significant even when analysis was restricted to studies with sample collection between 1996 and 2011.

The findings have important public health implications. First, these data demonstrate that the proportion of men with sperm counts below the threshold for subfertility or infertility is increasing. Moreover, given the findings from recent studies that reduced sperm count is related to increased morbidity and mortality, the ongoing decline points to serious risks to male fertility and health.

"Decreasing sperm count has been of great concern since it was first reported twenty-five years ago. This definitive study shows, for the first time, that this decline is strong and continuing. The fact that the decline is seen in Western countries strongly suggests that chemicals in commerce are playing a causal role in this trend," Dr. Shanna H Swan, a professor in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, New York.

While the current study did not examine causes of the observed declines, sperm count has previously been plausibly associated with environmental and lifestyle influences, including prenatal chemical exposure, adult pesticide exposure, smoking, stress and obesity. Therefore, sperm count may sensitively reflect the impact of the modern environment on male health across the lifespan and serve as a "canary in the coal mine" signaling broader risks to male health. [Original study.]

  Human sperm. Credit: Wikipedia