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Month: August 2016

Published on Leave a comment on Farm Animal Exposure and Asthma In Children

Earlier posts discussed research that showed that farm and animal (pets such as dogs) exposures in the first year of life is protective against allergies and asthma (lowers the risk of developing them). New research examined this further by looking at Amish and Hutterite groups - looking at not just "farm life", but whether children had much exposure to farm animals. The Amish have close exposure to farm animals (traditional farming methods), but the Hutterites don't (communal highly industrialized farming). Both groups studied had similar lifestyles (drank raw milk, breastfeeding, little exposure to smoking), but both groups did not have indoor pets ("taboos against indoor pets"). Thus farming methods were important for exposures to animals and their microbes.

The researchers said: "The importance of environmental exposures in the development of asthma is most exquisitely illustrated by epidemiologic studies conducted in Central Europe that show significant protection from asthma and allergic disease in children raised on traditional dairy farms. In particular, children’s contact with farm animals and the associated high microbial exposures4,5have been related to the reduced risk." Traditional farming exposed the children to an environment rich in microbes, and these children had very low rates of asthma and "distinct immune profiles that suggest profound effects on innate immunity." Once again, note the importance of microbes in the development of the immune system. From Science Daily:

Growing up on an Amish farm protects children against asthma by reprogramming immune cells

By probing the differences between two farming communities -- the Amish of Indiana and the Hutterites of South Dakota -- an interdisciplinary team of researchers found that specific aspects of the Amish environment are associated with changes to immune cells that appear to protect children from developing asthma. In the Aug. 4, 2016, issue of The New England Journal of Medicine, the researchers showed that substances in the house dust from Amish, but not Hutterite, homes were able to engage and shape the innate immune system (the body's front-line response to most microbes) in young Amish children in ways that may suppress pathologic responses leading to allergic asthma.

The Amish and Hutterite farming communities in the United States, founded by immigrants from Central Europe in the 18th and 19th centuries, respectively, provide textbook opportunities for such comparative studies. The Amish and the Hutterites have similar genetic ancestry. They share similar lifestyles and customs, such as no television and a Germanic farming diet. They have large families, get childhood vaccinations, breastfeed their children, drink raw milk and don't allow indoor pets.

The communities, however, are distinct in two important ways. Although both groups depend on agriculture, their farming practices differ. The Amish have retained traditional methods. They live on single-family dairy farms and rely on horses for fieldwork and transportation. In contrast, the Hutterites live on large communal farms. They use modern, industrialized farm machinery. This distances young Hutterite children from the constant daily exposure to farm animals. The other striking difference is what Ober calls a "whopping disparity in asthma." About 5 percent of Amish schoolchildren aged 6 to 14 have asthma. This is about half of the U.S. average (10.3%) for children aged 5 to 14, and one-fourth of the prevalence (21.3%) among Hutterite children.

To understand this disparity, the researchers studied 30 Amish children 7 to 14 years old, and 30 age-matched Hutterite children. They scrutinized the children's genetic profiles, which confirmed the remarkable similarities between Amish and Hutterite children. They compared the types of immune cells in the children's blood, collected airborne dust from Amish and Hutterite homes and measured the microbial load in homes in both communities.

The first gee-whiz moment came from the blood studies. These revealed startling differences between the innate immune response from the Amish and Hutterites. "The Amish had more and younger neutrophils, blood cells crucial to fight infections, and fewer eosinophils, blood cells that promote allergic inflammation," said study co-author, immunologist Anne Sperling, PhD, associate professor of medicine at the University of Chicago. Gene expression profiles in blood cells also revealed enhanced activation of key innate immunity genes in Amish children.

The second eureka moment came from experiments using mice. When study co-author, immunologist Donata Vercelli, MD, professor of cellular and molecular medicine and associate director of the Asthma and Airway Disease Research Center at the University of Arizona, exposed mice to house-dust extracts, she found the airways of mice that received Amish dust were protected from asthma-like responses to allergens. In contrast, mice exposed to Hutterite house dust were not protected.

What was different? Dust collected from Amish homes was "much richer in microbial products," the authors note, than dust from Hutterite homes. "Neither the Amish nor the Hutterites have dirty homes," Ober explained. "Both are tidy. The Amish barns, however, are much closer to their homes. Their children run in and out of them, often barefoot, all day long. There's no obvious dirt in the Amish homes, no lapse of cleanliness. It's just in the air, and in the dust."

To better understand how asthma protection was achieved, the researchers used mice that lack MyD88 and Trif, genes crucial for innate immune responses. In these mice, the protective effect of the Amish dust was completely lost. "The results of the mouse experiments conclusively prove that products from the Amish environment are sufficient to confer protection from asthma, and highlight the novel, central role that innate immunity plays in directing this process," Vercelli said.

Published on Leave a comment on Exercise Can Lead To Misdiagnosis of Heart Disease

 The last post pointed out that the importance of high levels of physical activity or exercise in reducing the risk of 5 diseases. Now a study points out that all this exercise (starting at about 3 to 5 hours of exercise per week) can result in the heart becoming enlarged from all this exercise ("athlete's heart"), and that this is totally normal and healthy. The researchers also stressed that doctors should be aware that athlete's heart or "exercise-related cardiac remodeling" can occur not only in professional athletes, but also in those engaging in moderate levels of exercise, and that it not be misdiagnosed as heart disease. From Science Daily:

Regular exercise can lead to heart disease misdiagnosis

Scientists have shown that people who exercise for even a few hours each week can enlarge their hearts. This is a normal and beneficial response to exercise, but until now has only been recognised in athletes. The researchers say that doctors should now consider an individual's activity level before diagnosing common heart conditions.

"It's well known that the hearts of endurance athletes adapt in response to exercise, a phenomenon called 'athlete's heart'. This study is the first to show that healthy adults who do regular exercise may also develop enlarged hearts. As a result, there's a risk that some active adults could be misdiagnosed with heart disease," says Declan O'Regan, of the MRC Clinical Sciences Centre, based at Imperial College London, and one of the lead scientists on the research. The findings were published today in Circulation: Cardiovascular Imaging.

Scientists have not previously known the extent to which the hearts of healthy people adapt to the demands of moderate exercise. Over 1000 people took part in this study, making it one of the largest of its kind. Participants selected one of four possible categories that best represented their activity level over the past year, according to how many hours of exercise they did each week. Around one third of participants reported doing three to five hours of exercise, and the scientists found that one in five of these people had developed an enlarged heart as a result. Similar adaptations were seen in almost half of those who reported doing more than five hours of exercise.

The findings suggest that above a threshold of three hours, the more exercise you do, the more your heart is likely to adapt, and the more the exercise, the more pronounced the changes. "Going to the gym frequently increases the thickness of your heart muscle and the volume of your heart chambers, particularly the right ventricle. It's a completely normal, healthy response. It shouldn't be misdiagnosed as being heart disease," says O'Regan. These adaptations allow the heart to pump more blood, which helps to supply exercising muscles with the oxygen and nutrients they need. Changes to the heart's thickness and volume happen in tandem, and this distinguishes them from the changes seen in disease, which occur in isolation.

Today, doctors across the world use a standard of set values to see if the thickness and volume of a person's heart fall into the healthy or abnormal range. This helps to ensure consistency between different hospitals. According to O'Regan, the data that underpins these ranges comes from a relatively small study with people who were mainly sedentary. He says, "In this latest study, we looked at a much larger and broader group of people. We found that more people reported being active than had done in previous studies. Our recommendations reflect this growing participation in exercise.".....And this interesting research shows that even moderate physical activity is associated with changes in the heart's size and shape, which are visible on a cardiac MRI.

Published on Leave a comment on Really Increase Activity Level to Reduce Risk of 5 Diseases

Get active, really active, to reduce your risk for 5 diseases: breast cancer, colon cancer, heart disease, and ischemic stroke. Instead of the 150 minutes of brisk walking or 75 minutes per week of running (which is equal to the 600 metabolic equivalent (MET) minutes now recommended by the World Health Organization), this study found that much more exercise is needed for best health results.

This study (which was a review and analysis of 174 studies) found that there is a dose-response effect, with the most reduction in the risk of the 5 conditions by getting 3000 to 4000 MET minutes per week. This sounds like a lot, but the researchers  point out that this can be achieved by incorporating exercise into your daily routines. The researchers write: "A person can achieve 3000 MET minutes/week by incorporating different types of physical activity into the daily routine—for example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or cycling for transportation 25 minutes on a daily basis would together achieve about 3000 MET minutes a week."

So start thinking creatively about how to increase exercise or activity into your daily life, especially moderate or vigorous intensity activity. For example, park your car far from the store door, or better yet, bicycle or walk to the store from home. From Medscape:

Get Moving: High Physical-Activity Level Reduces Risk of 5 Diseases

High levels of physical activity can reduce the risk for five major diseases, including type 2 diabetes, new research shows. Findings from the systematic review and meta-analysis were published online ....The data, from a total 174 studies comprising 149,184,285 total person-years of follow-up, suggest that the more total regular daily physical activity one engages in — including recreation, transportation, occupational activity, and/or daily chores — the lower the risks for breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke.

However, significant reductions in those conditions were seen only with total activity levels considerably higher than the minimum 600 metabolic equivalent (MET) minutes per week recommended by the World Health Organization for health benefits. That 600 METs equates to about 150 minutes/week of brisk walking or 75 minutes/week of running. (A MET is defined as the ratio of the metabolic rate during that activity to the metabolic rate when resting.) Risks of the five conditions dropped significantly with an increase in MET minutes per week from 600 to 3000 to 4000, with less additive benefit seen above that level.

For reference, the authors say, "a person can achieve 3000 MET minutes/week by incorporating different types of physical activity into the daily routine — for example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or cycling for transportation 25 minutes on a daily basis would together achieve about 3000 MET minutes a week." "This amount might seem a bit large, but this is about total activity across all domains of life.…For people who currently don't exercise, clinicians could encourage them to incorporate physical activity into their daily routines, [such as] turning household chores into exercise. 

Another recent meta-analysis of trials involving more than one million individuals indicated that an hour of moderate-intensity activity, such as brisk walking or cycling, offsets the health risks of 8 hours of sitting. The message that physical inactivity is a killer — leading to 5.3 million premature deaths annually worldwide, which is as many as caused by smoking and twice as many as associated with obesity, has been emerging over the past few years, with warnings that "sitting is the new smoking."

This new research is the first meta-analysis to quantify the dose-response association between total physical activity across all domains and the risk of five chronic diseases. The 174 prospective cohort studies included 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke. (Some included more than one end point.)....Higher levels of total physical activity were associated with lower risks of all five outcomes.

With the development of diabetes, for example, compared with no physical activity, those with 600 MET minutes per week (the minimum recommended level of activity) had a 2% lower risk. That risk reduction jumped by an additional 19% with an increase from 600 to 3600 METs/week. Gains were smaller above that, with the increase of total activity from 9000 to 12,000 MET minutes/week yielding only an additional 0.6% diabetes reduction.

Overall, compared with insufficiently active individuals (total activity < 600 MET minutes/week), the risk reduction for those in the highly active category (≥ 8000 MET minutes/week) was 14% for breast cancer; 21% for colon cancer; 28% for diabetes; 25% for ischemic heart disease; and 26% for ischemic stroke. 

Credit: Medscape

Published on Leave a comment on Similar Fertility Decline In Both Dogs and Men

Take note: what is happening to dogs is also happening to men. Specifically, for many decades - year by year - there has been a decrease in male dog fertility. And yes, this is also happening with human male fertility - a decline in male semen quality (including sperm), along with an increase in the incidence of testicular cancer, the birth defect hypospadias, and undescended testes. This cluster of problems is called testicular dysgenesis syndrome (TGS), and it has an negative impact on male fertility.

Dr Richard Lea, who led the research said: "This is the first time that such a decline in male fertility has been reported in the dog and we believe this is due to environmental contaminants..." and "While further research is needed to conclusively demonstrate a link, the dog may indeed be a sentinel for humans -- it shares the same environment, exhibits the same range of diseases, many with the same frequency, and responds in a similar way to therapies."

What chemicals were detected that affect male fertilty? Why, the same chemicals that appear again and again in studies and are linked to a number of health problems: endocrine disruptors. Yes, they are all around us - in our food, our homes, our everyday products, our environment. From Science Daily:

Study demonstrates rapid decline in male dog fertility, with potential link to environmental contaminants

A study led by researchers at The University of Nottingham has discovered that the fertility of dogs may have suffered a sharp decline over the past three decades. The research, published in the academic journal Scientific Reports, found that sperm quality in a population of stud dogs studied over  a 26-year period had fallen significantly.The work has highlighted a potential link to environmental contaminants, after they were able to demonstrate that chemicals found in the sperm and testes of adult dogs -- and in some commercially available pet foods -- had a detrimental effect on sperm function at the concentrations detected.

 The study centered on samples taken from stud dogs at an assistance dogs breeding center over the course of 26 years. Professor Gary England.... said: "The strength of the study is that all samples were processed and analysed by the same laboratory using the same protocols during that time and consequently the data generated is robust." The work centred on five specific breeds of dogs -- Labrador retriever, golden retriever, curly coat retriever, border collie and German shepherd -- with between 42 and 97 dogs studied every year. Semen was collected from the dogs and analysed to assess the percentage of sperm that showed a normal forward progressive pattern of motility and that appeared normal under a microscope (morphology).

Over the 26 years of the study, they found a striking decrease in the percentage of normal motile sperm. Between 1988 and 1998, sperm motility declined by 2.5 per cent per year and following a short period when stud dogs of compromised fertility were retired from the study, sperm motility from 2002 to 2014 continued to decline at a rate of 1.2% per year. In addition, the team discovered that the male pups generated from the stud dogs with declining semen quality, had an increased incidence of cryptorchidism, a condition in which the testes of pups fail to correctly descend into the scrotum.

Sperm collected from the same breeding population of dogs, and testes recovered from dogs undergoing routine castration, were found to contain environmental contaminants at concentrations able to disrupt sperm motility and viability when tested. The same chemicals that disrupted sperm quality, were also discovered in a range of commercially available dog foods -- including brands specifically marketed for puppies. Dr Lea added: "We looked at other factors which may also play a part, for example, some genetic conditions do have an impact on fertility. However, we discounted that because 26 years is simply too rapid a decline to be associated with a genetic problem."

Over the past 70 years, studies have suggested a significant decline in human semen quality and a cluster of issues called 'testicular dysgenesis syndrome' that impact on male fertility which also include increased incidence of testicular cancer, the birth defect hypospadias and undescended testes.

However, declining human semen quality remains a controversial issue -- many have criticised the variability of the data of the studies on the basis of changes in laboratory methods, training of laboratory personnel and improved quality control over the years. Dr Lea added: "The Nottingham study presents a unique set of reliable data from a controlled population which is free from these factors. This raises the tantalising prospect that the decline in canine semen quality has an environmental cause and begs the question whether a similar effect could also be observed in human male fertility."

Excerpts from the original study in Scientific Reports: Environmental chemicals impact dog semen quality in vitro and may be associated with a temporal decline in sperm motility and increased cryptorchidism

A significant decline in human semen quality over the last 70 years has been widely reported1,2. The first meta-analysis reporting this phenomenon included 61 studies selected over a 50 year period (1938–1991)1 and such a trend was confirmed by re-analysis with an additional 47 studies included2.....Nevertheless, reports of declining sperm counts linked with epidemiological data on increased incidences of testicular cancer and genital tract abnormalities, is indicative of an adverse environmental effect on male reproduction6,7,8. Since these reproductive problems, termed by some as “testicular dysgenesis syndrome” (TDS), cluster in geographical areas9 they are thought to have a common aetiology and have been associated with endocrine perturbations in early life10. Exposure of developing males to environmental chemicals, particularly those with endocrine disrupting activity, is thought to be the initiator11. Although periods of development particularly sensitive to exposure encompass both pre-natal and pre-pubertal periods, environmental chemicals also perturb adult testis function e.g. gene expression and meiosis12. 

As ‘man’s best friend’ and closest animal companion, the dog shares the same environment, exhibits the same range of diseases, many with the same frequency, and responds in a similar way to therapeutic treatments. There is evidence that over the last 40 years, the incidence rate of canine testicular cancer has increased in parallel with changes seen in humans17,18. In addition, histological signs which characterise human TDS have recently been described in the dog19. These include seminiferous tubule abnormalities and testicular germ cell neoplasia in situ (GCNIS) cells which are known precursors of seminomas in the human20. Since human TDS includes a reduction in sperm count21 and an increased incidence of cryptorchidism, we hypothesised that the dog may exhibit similar manifestations of TDS and that this may be associated with exposure to endocrine disrupting chemicals.  

The dog is probably man’s closest companion and by sharing the same habitat, is likely to be exposed to similar environmental conditions including environmental chemicals. This was especially true in the current study since the dogs lived in homes with their handlers. Twelve chemicals detected in adult dog testes (DEHP, 7 PCB congeners, 4 PBDE congeners) were also detected in the 15 commercially available dog foods analysed. 

Published on Leave a comment on Strong Evidence That Alcohol Causes Seven Cancers

A medical article in the journal Addiction states that there is strong evidence that alcohol causes 7 cancers, that there is evidence that it probably causes more, the effects are dose related, and if one also smokes the risks are greatly increased. The 7 cancers are: oropharynx (mouth and pharynx), larynx, esophagus, liver, colon, rectum, and female breast.

An earlier post reported on conflicting results from some studies (e.g. that low to moderate alcohol consumption is beneficial), as well as the finding that effects are dose-related (the more alcohol a person drinks, the higher the risk of cancer). NOTE: One standard drink contains 14 grams of alcohol, and is equivalent to one ordinary beer, a glass of wine (5 oz), or a nip of spirits (1.5 oz or 44 ml). The article excerpts below state that the strongest effects are from consuming 50 grams or more of alcohol per day (compared to those who don't drink at all).

From Medscape: No Confusion: Alcohol Causes Seven Cancers

There is "strong evidence" that alcohol causes seven cancers, and other evidence indicates that it "probably" causes more, according to a new literature review published online July 21 in Addiction. Epidemiologic evidence supports a causal association of alcohol consumption and cancers of the oropharynx, larynx, esophagus, liver, colon, rectum, and female breast, says Jennie Connor, MB, ChB, MPH, from the Department of Preventive and Social Medicine, University of Otago, in Dunegin, New Zealand.

In short, alcohol causes cancer. This is not news, says Dr Connor. The International Agency for Research on Cancer (IARC) and other agencies have long identified alcohol consumption as being causally associated with these seven cancers. So why did Dr Connor, who is an epidemiologist and physician, write a new review? Because she wants to "clarify the strength of the evidence" in an "accessible way." 

The newly published review "reinforces the need for the public to be made aware of the causal link between alcohol and cancer," said Colin Shevills, from the Alcohol Health Alliance UK, in a press statement....The lack of clarity about alcohol causing cancer, Dr Connor believes, is related to alcohol industry propaganda as well as the fact that the "epidemiological basis for causal inference is an iterative process that is never completed fully."

Dr Connor writes that the strength of the association of alcohol as a cause of cancer varies by bodily site. The evidence is "particularly strong" for cancer of the mouth, pharynx, and esophagus (relative risk, ~4-7 for ≥50 g/day of alcohol compared with no drinking) but is less so for colorectal cancer and liver and breast cancer (relative risk, ~1.5 for ≥50 g/day). "For cancers of the mouth, pharynx, larynx and oesophagus there is a well-recognized interaction of alcohol with smoking, resulting a multiplicative effect on risk," adds Dr Connor.

Other cancers are also likely caused by alcohol. Dr Connor writes that there is "accumulating research" supporting a causal contribution of alcohol to cancer of the pancreas, prostate, and skin (melanoma). One British expert had an opinion about alcohol's carcinogenicity. In a statement about the new review, Prof Dorothy Bennett, director of the Molecular and Clinical Sciences Research Institute at St. George's, University of London, said: "Alcohol enters cells very easily, and is then converted into acetaldehyde, which can damage DNA and is a known carcinogen."

In the new review, Dr Connor describes various hallmarks of causality that have been found in epidemiologic studies of alcohol and these seven cancers, such as a dose-response relationship and the fact that the risk for some of these cancers (esophageal, head and neck, and liver) attenuates when drinking ceases. Current estimates suggest that alcohol-attributable cancers at the seven cancer sites make up 5.8% of all cancer deaths worldwide, she states. The alcohol industry has a lot at stake, she says, which in turn leads to "misinformation" that "undermines research findings and contradicts evidence-based public health messages."

But there is no safe level of drinking with respect to cancer, says Dr Connor, citing research about low to moderate levels of alcohol, which has been covered by Medscape Medical News. This was also the conclusion of the 2014 World Cancer Report, issued by the World Health Organization's IARC.

Published on Leave a comment on Tart Cherry Juice May Aid Recovery After Intense Exercise

Image result for cherries wikipedia Another study reporting health benefits of drinking tart cherry juice, specifically in speeding recovery following prolonged, repeat sprint activity (think soccer and rugby). The researchers found that after a prolonged, intermittent sprint activity, the cherry juice significantly lowered levels of Interleukin-6, a marker for inflammation and that there was a decrease in muscle soreness.  The study participants drank the cherry juice (1 oz cherry juice concentrate mixed with 100 ml water) for several days before and several days after the sprint activity. Montmorency tart cherry juice is a polyphenol rich food that is already used by many professional sports teams to aid recovery. From Medical Xpress:

New study: Montmorency tart cherry juice found to aid recovery of soccer players

Montmorency tart cherry juice may be a promising new recovery aid for soccer players following a game or intense practice. A new study published in Nutrients found Montmorency tart cherry juice concentrate aided recovery among eight semi-professional male soccer players following a test that simulated the physical and metabolic demands of a soccer game .The U.K. research team, led by Glyn Howatson at Northumbria University, conducted this double-blind, placebo-controlled study to identify the effects of Montmorency tart cherry juice on recovery among a new population of athletes following prolonged, intermittent exercise..... many teams in professional and international soccer and rugby already use Montmorency tart cherry juice to aid recovery."

The study involved 16 semi-professional male soccer players aged 21 to 29 who were randomly assigned to either a Montmorency tart cherry concentrate group or a placebo control group. Montmorency group participants consumed about 1 ounce (30 ml) of a commercially available Montmorency tart cherry juice concentrate mixed with 100 ml of water twice per day (8 a.m. and 6 p.m.) for seven consecutive days—for four days prior to the simulated trial and for three days after the trial. Following the same schedule, placebo group participants consumed a calorie-matched fruit cordial with less than 5 percent fruit mixed with water and maltodextrin. The 30 ml dosage of Montmorency tart cherry juice concentrate contained a total anthocyanin content of 73.5 mg, or the equivalent of about 90 whole Montmorency tart cherries.

Montmorency tart cherry juice, compared to a placebo, was found to maintain greater functional performance, impact a key marker of inflammation and decrease self-reported muscle soreness among study participants following prolonged activity that mirrors the demands of field-based sports. While additional research is needed, the authors suggest the dampening of the post-exercise inflammatory processes may be responsible.

Across every performance measure, including maximal voluntary isometric contraction, countermovement jump height, 20 m sprint time, knee extensors, 5-0-5 agility, the Montmorency group showed better performance than the placebo group. Additionally, the Montmorency group showed significantly lower levels of Interleukin-6, a marker for inflammation, particularly immediately post-trial. Ratings for muscle soreness (DOMS) were significantly lower in the Montmorency group across the 72-hour post-trial period. No significant effects in muscle damage or oxidative stress were observed in either the Montmorency group or the placebo group. These data support previous research showing similar results for athletes performing marathon running, high-intensity strength training, cycling, and metabolic exercise. 

Published on Leave a comment on Does Saline Nasal Irrigation Treat Sinusitis Symptoms?

A recent study compared saline nasal irrigation vs steam inhalation vs doing both saline irrigation and steam inhalation vs doing neither (the control group) for chronic or recurring sinusitis symptoms. In the study, people with a history of chronic or recurring sinusitis symptoms were randomly assigned to one of the 4 groups, and then studied 3 months and 6 months later. The results were: a modest (slight improvement) in the saline irrigation group in symptom and quality-of-life scores, but no improvement for the steam inhalation group. However, the researchers noted that the control group also had slight improvements at 3 and 6 months. Most of the improvement in the saline irrigation group was in the group that also did steam inhalation - thus perhaps some benefit to combining both.

In addition, patients in the nasal irrigation group reported fewer headaches, fewer of them used over-the-counter medications, and said they were less likely to consult with a physician about their nasal problems in the future when compared with patients in the steam inhalation group.

Most people with chronic or recurring sinusitis will probably agree with the findings. Yes, effects are modest with saline irrigation, but it definitely does improve nasal stuffiness (experiences of family members and readers). But it does NOT treat the sinusitis. The sinus microbial community continues to stay out of whack (dysbiosis). Which explains the researchers' finding that saline irrigation and steam inhalation did not result in differences in antibiotic use or physician visits after 6 months.

From Science Daily: Nasal irrigation may prevent chronic sinus ailments

Advising patient with chronic sinus congestion to use nasal irrigation -- a popular nonpharmacologic treatment -- improved their symptoms, but steam inhalation did not, according to a randomized controlled trial published in CMAJ(Canadian Medical Association Journal). More than 25 million people in the United States and about 2.5 million Canadians suffer from chronic rhinosinusitis, or sinus infection, and experience compromised quality of life. To alleviate symptoms, steam inhalation and nasal irrigation are widely suggested as an alternative to common treatment with antibiotics, which are often not effective and contribute to antibiotic resistance.

Researchers from the United Kingdom conducted a randomized controlled trial on the effectiveness of advice from primary care physicians to use nasal irrigation and/or steam inhalation for chronic sinusitis. The study involved 871 patients from 72 primary care practices in England who were randomly assigned to 1 of 4 advice strategies: usual care, daily nasal and saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions.

Patients who were instructed to use nasal irrigation showed improvement at 3 and 6 months, as measured by the Rhinosinusitis Disability Index. Steam inhalation did not appear to alleviate symptoms of sinusitis.

"We found potentially important changes in other outcomes; in particular, fewer participants in the nasal irrigation group than in the no-irrigation group had headaches, used over-the-counter medications and intended to consult a doctor in future episodes," write the authors. "Although there was no significant difference in either physician visits or antibiotic use, as might be expected over only a 6-month follow-up period, our findings concerning consultations are important in the longer term, given antibiotic use increases the risk of antimicrobial resistance."

The Abstract (summary) of the study, which is from the Canadian Medical Association Journal (CMAJ): Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial

ABSTRACT  Background: Systematic reviews support nasal saline irrigation for chronic or recurrent sinus symptoms, but trials have been small and few in primary care settings. Steam inhalation has also been proposed, but supporting evidence is lacking. We investigated whether brief pragmatic interventions to encourage use of nasal irrigation or steam inhalation would be effective in relieving sinus symptoms.

Methods: We conducted a pragmatic randomized controlled trial involving adults (age 18–65 yr) from 72 primary care practices in the United Kingdom who had a history of chronic or recurrent sinusitis and reported a “moderate to severe” impact of sinus symptoms on their quality of life. Participants were recruited between Feb. 11, 2009, and June 30, 2014, and randomly assigned to 1 of 4 advice strategies: usual care, daily nasal saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions. The primary outcome measure was the Rhinosinusitis Disability Index (RSDI). Patients were followed up at 3 and 6 months. We imputed missing data using multiple imputation methods.

Results: Of the 961 patients who consented, 871 returned baseline questionnaires (210 usual care, 219 nasal irrigation, 232 steam inhalation and 210 combined treatment). A total of 671 (77.0%) of the 871 participants reported RSDI scores at 3 months. Patients’ RSDI scores improved more with nasal irrigation than without nasal irrigation by 3 months (crude change −7.42 v. −5.23; estimated adjusted mean difference between groups −2.51, 95% confidence interval −4.65 to −0.37). By 6 months, significantly more patients maintained a 10-point clinically important improvement in the RSDI score with nasal irrigation (44.1% v. 36.6%); fewer used over-the-counter medications (59.4% v. 68.0%) or intended to consult a doctor in future episodes. Steam inhalation reduced headache but had no significant effect on other outcomes. The proportion of participants who had adverse effects was the same in both intervention groups.

Interpretation: Advice to use steam inhalation for chronic or recurrent sinus symptoms in primary care was not effective. A similar strategy to use nasal irrigation was less effective than prior evidence suggested, but it provided some symptomatic benefit.

Published on Leave a comment on Twin Study Finds Being Overweight Not Linked To Early Death or Heart Attack

Another interesting study looking at whether being overweight is linked to premature death, heart attacks, and diabetes. This study looked at sets of twins, in which one is heavier than the other, and followed them long-term (average 12.4 years) and found that NO - being overweight or obese (as measured by Body Mass Index or BMI) is NOT associated with premature death or heart attack (myocardial infarction), but it is associated with higher rates of type 2 diabetes. These results are in contrast with what a large study recently found. From Science Daily:

Higher BMI not associated with increased risk of heart attack or early death, twin study shows

A study of 4,046 genetically identical twin pairs with different amounts of body fat shows that twin siblings with a higher Body Mass Index, as a measure of obesity, do not have an increased risk of heart attack or mortality. The study, conducted by researchers at Umeå University in Sweden, also shows that a higher BMI is associated with an increased risk of type 2 diabetes...."The results suggest that lifestyle changes that reduce levels of obesity do not have an effect on the risk of death and heart attack, which contradicts conventional understandings of obesity-related health risks," says Peter Nordström, researcher at the Department of Community Medicine and Rehabilitation at Umeå University.

In the cohort study, Peter Nordström and research colleagues at Umeå University compared health data from 4,046 monozygotic twin pairs. All twins in the study had different levels of body fat, as measured in BMI....During a follow-up period of on average 12.4 years, differences between the twins were compared when it comes to incidents of mortality, heart attack and type 2 diabetes. The results clearly showed that twin siblings with a higher BMI did not have an increased risk of mortality or heart attack compared to their thinner counterparts. However, twins with a higher BMI did have an increased risk of developing type 2 diabetes.

The results showed that: - Among twin siblings with a higher BMI (mean value 25.1), there were 203 heart attacks (5 %) and 550 deaths (13.6 %) during the follow-up period. - Among twin siblings with a lower BMI (mean value 23.9), there were 209 heart attacks (5.2 %) and 633 deaths (15.6 %) during the same period. - Among the 65 twin pairs in the study who had a BMI difference of 7 or higher, and where the larger twin siblings had a BMI of 30 or higher, there were still no noticeably increased risk of mortality or heart attack associated with a higher BMI.

The study, described in the article Risks of Myocardinal Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Index, is based on the Swedish Twin Registry, the largest of its kind in the world. The median age of the twins in the study was 57.5 and participants' ages ranged from 42-92. The cohort study was conducted between 1998 and 2003, with follow-ups regarding incident of mortality, heart attack and diabetes during a 10 year period until 2013. One study limitation was that weight and length (used to calculate BMI) was self-reported.