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Published on Leave a comment on Acetaminophen Is A Common Cause Of Liver Injury and Liver Failure

A recent article discussed the large assortment of medications (both prescription and non-prescription) that are linked to liver injury, commonly known as "Drug-induced liver injury" (DILI). While it occurs rarely (fewer than 10 in 10,000 persons who take the drug in question), many medications can result in liver injury - especially if taken in too large doses and for too long. The scary part is that 46% of people with acute liver failure in the U.S have the liver damage from acetaminophen. Acetaminophen is the main cause of drug induced liver injury and liver failure in the U.S. Acetaminophen is found not just in Tylenol, but in many non-prescription drugs - thus it is easy to take too large a dose. The liver helps remove toxins - thus we need to take good care of it. From Science Daily:

Acetaminophen, supplements and other medications may trigger drug-induced liver injury

More than 1,000 medications, with acetaminophen being the most common, have been associated with drug-induced liver injury (DILI). Diagnosis can be challenging due to the multitude of contributing factors, and timely recognition and clinical response may mean the difference between recovery and acute liver failure or even death. DILI affects an estimated fewer than 10 people in every 10,000 exposed persons. The condition is dose-dependent or an adverse reaction to a medication, dietary supplement or other substance. 

"The liver helps remove toxins, which makes it especially vulnerable to injury from either short-term intake above recommended levels or long-term usage that allows toxins to build up," Collins-Yoder said. "Recognizing the clinical signs and symptoms is crucial to prompt treatment and effective patient care." Depending on the contributing factors and the level of damage to the liver, patients with mild and moderate signs and symptoms may recover normal liver function after the triggering substance is identified and use is discontinued. Other patients may experience more severe damage, progressing to acute liver failure.

About 46 percent of persons with acute liver failure in the United States have liver damage associated with acetaminophen, making it the most common cause of DILI. Since acetaminophen is often an ingredient in over-the-counter and prescription pain medications, patients may take higher doses than needed. A more infrequent type of DILI is triggered by an adverse reaction to prescription medications, herbal dietary supplements or other substances, including: nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen and others; antibiotics and antiviral agencies, such as amoxicillin-clavulanate, sulfamethoxazole-trimethoprim and nitrofurantoin; antileptic agents, such as volproic acid and carbamazepine; statins; novel anticoagulants; proton pump inhibitors; methotrexate; azathioprine; sulfasalazine; herbal and dietary supplements.

Published on Leave a comment on Is Autism Spectrum Disorder Linked To Pregnancy Flu Shots or The Flu?

A big concern nowadays is why some children develop autism, specifically autism spectrum disorder (ASD). Autism spectrum disorder is considered a life-long neurodevelopmental disorder that is thought to affect 1 out of 68 American children. While the causes of ASD are unknown in most cases, some studies report an association (higher risk) between a pregnant woman's infections and fever during pregnancy and risk of ASD in the baby, while other studies don't find such an association. Some studies also looked at the timing of infections during pregnancy, but again results have been mixed. A viral infection during the first trimester is associated with increased risk in some studies, while other studies report an increased risk with a second- or third-trimester bacterial infection.  So it has been unclear whether a flu (influenza) infection or flu vaccination during pregnancy is linked to autism spectrum disorder or not. Is there a link or not?

Why are pregnant women encouraged to get a flu shot (flu vaccine)? This is because pregnant women have an increased risk of complications from the flu infection. Studies also show that getting a flu vaccine during pregnancy reduces the risk of a preterm birth, a small-for gestational-age child, and a low-birth-weight child, and prevents influenza infection in newborns for up to 6 months.

The researchers of a large study done in California found no association between autism spectrum disorder (ASD) risk and flu (influenza) infection during pregnancy or flu (influenza) vaccination during the second to third trimester of pregnancy. However, there was a suggestion of increased ASD risk among children whose mothers received flu vaccinations during the first trimester (though the researchers say the association was perhaps due to "chance". Bottom line: the study results were reassuring for pregnant women, but if one wanted to be ultra-cautious, then delay getting a flu shot until the second trimester of pregnancy. From Science Daily:

No association between mother's flu in pregnancy, increased child autism risk

A study of more than 196,000 children found no association between a mother having an influenza infection anytime during pregnancy and an increased risk of autism spectrum disorders (ASDs) in children, according to a new study published online by JAMA Pediatrics. The study by Ousseny Zerbo, Ph.D., of Kaiser Permanente Northern California, Oakland, and coauthors included 196,929 children born in the health system from 2000 through 2010 at a gestational age of at least 24 weeks.

Within the group, there were 1,400 mothers (0.7 percent) diagnosed with influenza and 45,231 mothers (23 percent) who received an influenza vaccination during pregnancy. There were 3,101 children (1.6 percent) diagnosed with ASD. The authors report no association between increased risk of ASD and influenza vaccination during the second and third trimesters of pregnancy. There was a suggestion of increased risk of ASD with maternal vaccination in the first trimester but the authors explain the finding was likely due to chance because it was not statistically significant after adjusting for multiple comparisons. The study cannot establish causality and has several limitations, including ASD status determined by diagnoses on medical records and not validated by standardized clinical assessment for all cases. [Original study.]

Published on Leave a comment on Poor Diets May Lead To Vitamin C Deficiency

  It turns out that scurvy and vitamin C deficiency is still around these days. Scurvy is a disease resulting from a lack of vitamin C. Most animals can synthesize vitamin C, but not humans. We must eat foods containing vitamin C to get the vitamin.

Vitamin C deficiency results in defective formation of collagen and connective tissues (in our bones, skin, tendons, muscles), and symptoms may include weakness, feeling tired, curly hair, sore arms and legs, bruising, bleeding gums, and impaired wound healing.

A recent small Australian study looked at diabetic persons with chronic foot wounds (foot ulcers that didn't heal after several months). Their vitamin C levels were tested and if found to be low, then they were given vitamin C supplements of 500 or 1000 mg daily, and the result was that within 2 to 3 weeks the wounds were healed. The one person with a zinc deficiency was given 50 mg daily of zinc supplement and that wound also promptly healed.

Treatment of scurvy is by taking vitamin C supplements (the Mayo Clinic recommends taking 400 to 1000 milligrams of vitamin C  daily for one week). Vitamin C deficiency can be easily prevented by a diet that includes fruits and vegetables. The recommended daily intake for adult women is 75 milligrams and for adult men it is 90 milligrams, which can be easily met by eating fruits and vegetables, especially if they are fresh (uncooked).

Good sources of vitamin C include: oranges, lemons, kiwi fruit, black currants, papaya, guava, pineapple, mango, strawberries, and vegetables such as bell peppers (red, yellow, green), tomatoes, potatoes, kale, brussels sprouts, and broccoli. It is possible to be vitamin C deficient even if the person is of normal weight or overweight - it all comes down to the diet and whether fruits and vegetables are eaten. Bottom line: Eat some daily!

From Medical Xpress: Poor diet sees scurvy reappear in Australia

Scurvy, a disease historically associated with old-world sailors on long voyages, is making a surprise comeback in Australia, with health officials Tuesday revealing a rare spate of cases. Caused by vitamin C deficiency, the condition used to be a common—and often fatal—curse among seafarers who went months without fresh fruit and vegetables.  ...continue reading "Poor Diets May Lead To Vitamin C Deficiency"

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Published on 12 Comments on Is Garlic The Source Of Beneficial Lactobacillus Sakei in Kimchi?

As you may have noticed, I write about the beneficial bacteria Lactobacillus sakei a lot. This is because it has turned out to be a great treatment for both chronic and acute sinusitis for my family and others (see post The One Probiotic That Treats Sinusitis). We originally found it in kimchi (it occurs in the kimchi during normal fermentation), but not all kimchi brands. Kimchi is a mix of vegetables (including typically cabbage) and seasonings, which is then fermented for days or weeks before it is eaten.

Why is L. sakei found in some kimchi, but not all? Which vegetable or spice is needed or important for encouraging L. sakei growth? It turns out it is not the cabbage - which is why L. sakei is not normally found in sauerkraut.

A recent study looking at several kimchi samples found that garlic seems to be important for the development of various Lactobacillus bacteria, of which L. sakei is one. The results mean that raw garlic has very low levels of L. sakei, and it multiplies during kimchi fermentation. Note that as fermentation progresses, the bacterial species composition in the kimchi changes (this is called ecological succession).

Korean studies (here and here) have consistently found L. sakei in many brands of kimchi (especially from about day 14 to about 2 or 2 1/2 months of fermentation), but not all kimchi brands or recipes. L.sakei, of which there are many strains, is so beneficial because it "outcompetes other spoilage- or disease-causing microorganisms" and so prevents them from growing (see post).

Excerpts are from the blog site Microbial Menagerie: MICROBES AT WORK IN YOUR KIMCHI

Cabbage is chopped up into large pieces and soaked in salt water allowing the water to draw out from the cabbage. Other seasonings such as spices, herbs and aromatics are prepared. Ginger, onion, garlic, and chili pepper are commonly used. The seasonings and cabbage are mixed together. Now the kimchi is ready to ferment. The mixture is packed down in a glass container and covered with the brining liquid if needed. The kimchi sits at room temperature for 1-2 days for fermentation to take place....Kimchi does not use a starter culture, but is still able to ferment. Then where do the fermentation microbes come from?

Phylogenetic analysis based on 16S rRNA sequencing indicates that the kimchi microbiome is dominated by lactic acid bacteria (LAB) of the genus Leuconostoc, Lactobacillus, and Weissella. Kimchi relies on the native microbes of the ingredients. That is, the microbes naturally found on the ingredients. Because of this, there may be wide variations in the taste and texture of the final kimchi product depending on the source of the ingredients. In fact, a research group from Chung-Ang University acquired the same ingredients from different markets and sampled the bacterial communities within each of the ingredients. The group found a wide variability in the same ingredient when it was bought from different markets. Surprisingly, the cabbage was not the primary source of LAB. Instead, Lactic acid bacteria was found in high abundance in the garlic samples. 

Note that Lactobacillus sakei is an example of a lactic acid bacteria. More study details from  the Journal of Food Science: Source Tracking and Succession of Kimchi Lactic Acid Bacteria during Fermentation.

This study aimed at evaluating raw materials as potential lactic acid bacteria (LAB) sources for kimchi fermentation and investigating LAB successions during fermentation. The bacterial abundances and communities of five different sets of raw materials were investigated using plate-counting and pyrosequencing. LAB were found to be highly abundant in all garlic samples, suggesting that garlic may be a major LAB source for kimchi fermentation. LAB were observed in three and two out of five ginger and leek samples, respectively, indicating that they can also be potential important LAB sources. LAB were identified in only one cabbage sample with low abundance, suggesting that cabbage may not be an important LAB source.

Bacterial successions during fermentation in the five kimchi samples were investigated by community analysis using pyrosequencing. LAB communities in initial kimchi were similar to the combined LAB communities of individual raw materials, suggesting that kimchi LAB were derived from their raw materials. LAB community analyses showed that species in the genera Leuconostoc, Lactobacillus, and Weissella were key players in kimchi fermentation, but their successions during fermentation varied with the species, indicating that members of the key genera may have different acid tolerance or growth competitiveness depending on their respective species.

Although W. koreensis, Leu. mesenteroides, and Lb. sakei were not detected in the raw materials of kimchi samples D and E (indicating their very low abundances in raw materials), they were found to be predominant during the late fermentation period. Several previous studies have also reported that W. koreensis, Leu. mesenteroides, and L. sakei are the predominant kimchi LAB during fermentation (Jeong and others 2013a, 2013b; Jung and others 2011, 2012, 2013a, 2014). 

Published on Leave a comment on High Fiber Diet Protects The Colon’s Mucus Layer

An interesting study that showed that when gut microbes are deprived of dietary fiber (their food) they start to eat the natural layer of mucus that lines the colon. (The colon is part of the large intestine). This is important because the colon's mucus layer normally acts as a barrier to pathogenic microbes. Yes, it was done in mice, but the researchers feel that this study accurately models what also happens in humans. Their conclusion: when the microbes in the gut don't get enough dietary fiber from plants (such as whole grains, fruits, vegetables, seeds, nuts), then the microbes feed on the colon's mucus layer, which results in inflammation and makes the colon more vulnerable to pathogenic (disease causing) microbes. This is what some people refer to as "leaky gut".

Research shows that changes in the diet (high fiber vs low fiber) quickly results in changes in the gut microbes in humans and rodents - so it's important to consistently eat a lot of a variety of plant fiber. Currently the recommended daily fiber intake for adults is for 28 to 35 grams (chart of some high fiber foods). They found that some bacteria strains flourished the best in low or no fiber conditions and it was these bacteria that were involved in breaking down the mucus layer. The research also showed that what are called "prebiotics" (purified forms of soluble fiber similar to what some processed foods and supplements contain) also resulted in thinning of the colon's mucus layer - they did not properly feed the gut microbes. From Medical Xpress:

High-fiber diet keeps gut microbes from eating colon's lining, protects against infection

It sounds like the plot of a 1950s science fiction movie: normal, helpful bacteria that begin to eat their host from within, because they don't get what they want. But new research shows that's exactly what happens when microbes inside the digestive system don't get the natural fiber that they rely on for food. Starved, they begin to munch on the natural layer of mucus that lines the gut, eroding it to the point where dangerous invading bacteria can infect the colon wall. In a new paper in Cell, an international team of researchers show the impact of fiber deprivation on the guts of specially raised mice. The mice were born and raised with no gut microbes of their own, then received a transplant of 14 bacteria that normally grow in the human gut. 

The findings have implications for understanding not only the role of fiber in a normal diet, but also the potential of using fiber to counter the effects of digestive tract disorders. "The lesson we're learning from studying the interaction of fiber, gut microbes and the intestinal barrier system is that if you don't feed them, they can eat you," says Eric Martens, Ph.D., an associate professor of microbiology at the University of Michigan Medical School....Using U-M's special gnotobiotic, or germ-free, mouse facility, and advanced genetic techniques that allowed them to determine which bacteria were present and active under different conditions, they studied the impact of diets with different fiber content - and those with no fiber. They also infected some of the mice with a bacterial strain that does to mice what certain strains of Escherichia coli can do to humans - cause gut infections that lead to irritation, inflammation, diarrhea and more.

The result: the mucus layer stayed thick, and the infection didn't take full hold, in mice that received a diet that was about 15 percent fiber from minimally processed grains and plants. But when the researchers substituted a diet with no fiber in it, even for a few days, some of the microbes in their guts began to munch on the mucus.They also tried a diet that was rich in prebiotic fiber - purified forms of soluble fiber similar to what some processed foods and supplements currently contain. This diet resulted in the same erosion of the mucus layer as observed in the lack of fiber.

The researchers also saw that the mix of bacteria changed depending on what the mice were being fed, even day by day. Some species of bacteria in the transplanted microbiome were more common - meaning they had reproduced more - in low-fiber conditions, others in high-fiber conditions. And the four bacteria strains that flourished most in low-fiber and no-fiber conditions were the only ones that make enzymes that are capable of breaking down the long molecules called glycoproteins that make up the mucus layer....  Just like the mix of bacteria, the mix of enzymes changed depending on what the mice were being fed, with even occasional fiber deprivation leading to more production of mucus-degrading enzymes.

Images of the mucus layer, and the "goblet" cells of the colon wall that produce the mucus constantly, showed the layer was thinner the less fiber the mice received. While mucus is constantly being produced and degraded in a normal gut, the change in bacteria activity under the lowest-fiber conditions meant that the pace of eating was faster than the pace of production - almost like an overzealous harvesting of trees outpacing the planting of new ones. 

When the researchers infected the mice with Citrobacter rodentium - the E. coli-like bacteria - they observed that these dangerous bacteria flourished more in the guts of mice fed a fiber-free diet. Many of those mice began to show signs of illness and lost weight. When the scientists looked at samples of their gut tissue, they saw not only a much thinner or even patchy mucus later - they also saw inflammation across a wide area. Mice that had received a fiber-rich diet before being infected also had some inflammation but across a much smaller area. [Original study]

A thick mucus layer (green), generated by the cells of the colon's wall, provides protection against invading bacteria and other pathogens. This image of a mouse's colon shows the mucus (green) acting as a barrier for the "goblet" cells (blue) that produce it. Credit: University of Michigan

Published on Leave a comment on Vitamin D and Autism Spectrum Disorder?

This study found impressive results - improvement in autistic behaviors in children diagnosed with autism spectrum disorder (ASD) with four months of daily vitamin D supplementation. Children in the placebo group did not show improvement. A nice aspect of the study was that the children were randomly assigned  to a placebo or a vitamin D group (so that the groups were not self-selected) and it was double-blinded (so no one knew who was getting the vitamins - again to prevent bias). This was a preliminary study - meaning more studies are needed, but it would be amazing if these results hold up... From Science Daily:

Vitamin D supplements may benefit children with autism spectrum disorder

Studies have shown an association between the risk of autism spectrum disorder and vitamin D insufficiency. In this latest study, 109 children with autism spectrum disorder were randomized to receive four months of vitamin D3 supplementation or a placebo."Autism symptoms -- such as hyperactivity, social withdrawal, and others -- improved significantly following vitamin D3 supplementation but not after receiving placebo," said Dr. Khaled Saad, lead author of the Journal of Child Psychology and Psychiatry study.

Excerpts from the original study from  The Journal of Child Psychology and Psychiatry: Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder

Autism spectrum disorder (ASD) is a frequent developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of interests and activities. It has been previously reported that there is vitamin D deficiency in autistic children; however, there is a lack of randomized controlled trials of vitamin D supplementation in ASD children.

This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3–10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. ASD patients were randomized to receive vitamin D3 or placebo for 4 months. The serum levels of 25-hydroxycholecalciferol (25 (OH)D) were measured at the beginning and at the end of the study. The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale (CARS), .... 
Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD.   

Recently, Wang et al. (2016) performed a systematic review and meta-analysis of all studies on serum concentration of 25 (OH)D in ASD (Wang et al., 2016). Eleven studies were included, accounting for a total of 870 ASD patients and 782 healthy controls. Serum levels of 25 (OH)D in participants with ASD were significantly lower than those in controls. They concluded that low vitamin D might serve as a risk factor for autism spectrum disorder (Wang et al., 2016). 

In a recent survey, our research group measured 25 (OH)D in 122 ASD children (3–9 years old) and 100 healthy children as controls (Saad, Abdel-Rahman, et al., 2015). The ASD group showed a significantly lower level of serum 25 (OH)D compared with the control group (p < .0001). The study found highly significant inverse correlations between serum 25 (OH)D levels and autism rating scales. In the second part of the previous study (Saad, AbdelRahman, et al., 2015), an open-label trial of 83 subjects who completed a 3-month therapy with high daily doses of vitamin D (300 IU/kg/day) was performed. Collectively, 80.7% of the children with ASD had significantly improved outcome, which was mainly in the sections of the CARS and ABC subscales that measure behavior, stereotypy, eye contact, and attention span (Saad, Abdel-Rahman, et al., 2015). 

Published on Leave a comment on Preventing Food Allergies In Children

Guidelines for how to prevent food allergies in children are changing. Until very recently, it was avoid, avoid, avoid exposing babies or young children to any potential allergens. Remember parents being advised that if an allergy to X (whether pets or food) runs in the family, then absolutely avoid exposing the child to the potential allergen? Well, recent research (here, here, and here) found that the opposite is true - that in the first year of life the baby should be exposed to potential allergens (whether animals or food) which stimulates the child's developing immune system in beneficial ways.

Physicians at a recent conference of allergists said that evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life. The new 2017 medical guidelines will recommend introducing small amounts of peanuts (mixed in with other foods), when children are 4 to 6 months of age..

About two years ago a landmark study (LEAP study) found that when infants at a high risk of developing peanut allergy consumed peanuts on a regular basis, their risk of peanut allergy was dramatically reduced. And the opposite was also true: peanut avoidance in the first year of life was associated with a greater frequency of peanut allergy. Which made doctors start to rethink their strategies of how to avoid food allergies. From Medscape:

Allergenic Foods Should Be Introduced to Infants Early

Although the evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life, guidelines are lagging behind, said an allergist speaking here at the American College of Allergy, Asthma & Immunology (ACAAI) 2016 Annual Scientific Meeting. Official guidelines to be issued early in 2017 will address only peanuts, recommending introduction when children are 4 to 6 months of age.

"There is now a large body of observation and trial data for other foods, including egg, that show that delaying the introduction of allergenic solids increases the risk of those particular food allergies," said Katrina Allen, MBBS, PhD, from the Murdoch Childrens Research Institute in Melbourne, Australia. Policy changes are needed to help guide parents' decisions, she said. In fact, there is evidence showing that changes to policy — namely, infant-feeding guidelines — mirror the rise in the incidence of food allergies.

Not everyone agrees on exposure amount and timing in the case of egg allergy. In a recent trial, researchers looked at the early introduction of allergenic foods in breast-fed children (N Engl J Med. 2016;374:1733-1743). The prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group, as was the prevalence of peanut allergy and egg allergy. And a study Dr Allen was involved in, which introduced cooked egg in small amounts, showed that early introduction reduced allergy (J Allergy Clin Immunol. 2010;126:807-813).

However, in a German study, where greater amounts of egg were introduced at 4 to 6 months, early exposure increased the risk for life-threatening allergic reactions (J Allergy Clin Immunol. Published online August 12, 2016). And in the STEP study, there was no change in the number of food allergies in 1-year-old children when egg was introduced early (J Allergy Clin Immunol. Published online August 20, 2016). However, that did not take into account high-risk infants, particularly those with eczema, who are known to have a higher incidence of egg allergy and are likely to see a much greater benefit from the early introduction of egg.

The new peanut guidelines — coauthored by Amal Assa'ad, MD, from the Cincinnati Children's Hospital, who is chair of the ACAAI food allergy committee — will recommend that children with no eczema or egg allergy can be introduced to peanut-containing foods at home, according to the family's preference. And for children with mild to moderate eczema who have already started solid foods, the guidelines say that peanut-containing foods can be introduced at home at around 6 months of age, without the need for an evaluation. However, the guidelines caution, peanut-containing foods should not be the first solid food an infant tries, and an introduction should be made only when the child is healthy. The first feeding should not happen when the child has a cold, is vomiting, or has diarrhea or another illness.

For eggs, there is no official recommendation as of yet....The early introduction of allergenic foods is not the only policy that needs to be changed to lower the incidence of food allergies, Dr Allen told Medscape Medical News. Other factors, particularly environmental factors — mostly written up in observational studies — are contributing to an increasing intolerance to allergenic foods. Policies advocating that kids "get down and dirty," have more exposure to dogs, and bathe less are also warranted....Dr Allen and Dr Assa'ad agree that delaying the introduction of foods such cow's milk and egg until after 12 months is harmful. Guidelines should encourage families to introduce these foods in the first year of life, once solids have commenced at around 6 months, but not before 4 months.

Published on Leave a comment on Air Pollution Linked To Strokes

Study after study finds negative health effects from air pollution, such as heart disease (here, here, and here). Now two more studies found that living in areas with high air pollution is linked to a higher stroke risk. One study (done in Japan) found an increase of ischemic stroke on the same day as exposure to high levels of air pollution, while the other (done in London, UK) found a higher risk of death after stroke (especially ischemic strokes) in patients who live in areas of high air pollution. This was especially pronounced with exposure to smaller or fine particulate matter (PM2.5)- which is found in high quantities in vehicle exhaust fumes.

It is thought that the fine particles in the air (PM2.5) contribute to the development of potentially fatal diseases various ways - by causing chronic inflammation, and also because they slip past the body's defenses and can be absorbed deep into the lungs and bloodstream. They are not sneezed or coughed out the way larger natural particles, like airborne soil and sand, are removed from the body's airways. What can be done? Other studies have found that when air pollution is reduced, than the risk of death is reduced. So yes, pollution controls on vehicles such as trucks and buses are good. And just think how much air pollution will be reduced when electric vehicles replace current gas powered cars and trucks. From Medscape:

Air Pollution Linked to Higher Stroke Mortality

More evidence showing that living in areas with high levels of air pollution is linked to a higher stroke risk has come from two new studies. Both studies are published online in the journal Stroke. The first, from the United Kingdom, shows a higher risk for death after a stroke in patients who live in areas of high air pollution, and the other, a Japanese study, suggests a higher risk for a new stroke the same day as exposure to high levels of air pollution.

"We have shown a significantly increased risk of death after stroke in patients who had long-term exposure to high levels air pollution before their stroke occurred," senior author of the UK study, Charles Wolfe, MD.... "This was particularly pronounced for high exposure to smaller particulate matter — particles below 2.5 μm in diameter (PM2.5) — which are found in high quantities in exhaust fumes." For the study, Professor Wolfe and colleagues analyzed data from the South London Stroke Register, a population-based register covering an urban, multiethnic population.....Results showed an increased risk for death up to 5 years after stroke in patients living in areas of high air pollution.

"While this study adds to the evidence linking air pollution to cardiovascular disease, it cannot prove causality as it has an observational design," Professor Wolfe commented...."So it is difficult to say for certain that it is the air pollution that is responsible but there are many studies now that have shown similar associations," he said. He noted that the smaller particles (PM2.5) were associated with a worse effect on mortality and this correlated with biological studies that have shown a greater inflammatory effect of small particulate matter vs larger particulate matter on the vessel wall. "Our study suggests that people who have previously had an ischemic stroke, but not a hemorrhagic stroke, may be more vulnerable and at a higher risk of death to chronic, long-term exposure of PM," they conclude.

The Japanese study, by lead author Ryu Matsuo, MD, PhD, Department of Health Care Administration and Management Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and colleagues, looked at acute exposure to air pollution and shows a small increase in the risk of having a stroke within a day of high exposure to pollution. For the study, the researchers analyzed data on 6885 ischemic stroke patients from a multicenter hospital-based stroke registry in Japan who were previously independent and hospitalized within 24 hours of stroke onset.

Professor Wolfe said his group have conducted a similar study looking at exposure of air pollution in the year before stroke, which showed a 23% increase in stroke risk in those exposed to higher levels of PM2.5. 

Published on Leave a comment on Popular Heartburn Drugs May Increase Stroke Risk

Uh oh - once again a drug taken for a common problem (heartburn) is linked to an unexpected negative health effect (higher risk of strokes). Millions of Americans take proton pump inhibitors  (PPIs) to treat acid reflux and heartburn. They are among the most prescribed drugs in the United States, are frequently taken for long periods of time, and are available over the counter. But according to preliminary research presented at a 2016 American Heart Association conference, these medications may also increase the risk of ischemic stroke. Ischemic strokes, which are the most common type of stroke, occur when a blood clot cuts off blood flow to the brain.

Earlier research has linked proton pump inhibitors to increased risk of dementia in older patients, disruption of gut microbes, increased risk of C. difficile infections, and kidney disease. Stomach acid seems to play a role in the normal balance of microbes in the digestive system. When someone takes PPIs it lowers their amount of stomach acid, and so disrupts the gut microbial community (and these changes last for at least a month after discontinuing the drug).

The research was conducted in Denmark among a quarter-million patients who suffered from stomach pain and indigestion, and were taking one of four PPIs: Prilosec, Protonix, Prevacid or Nexium. Overall, they found that ischemic stroke risk increased by 21% among patients who were taking a PPI. The researchers found either no increased risk or minimal increased risk of stroke when taking low doses of PPIs. But at the highest doses of PPIs, they found that stroke risk increased from 30% (Prevaacid) to a high of 94% (Protonix). Another group of medications used to treat heartburn - called H2 blockers - were not linked to increased stroke risk.

Hey, what this research suggests is that not everything should be treated with pills. Medical professionals agree: the safest and best way to reduce heartburn is by making some lifestyle changes. Eat smaller meals (and not right before bedtime), lose weight if needed, don't eat very fatty meals, drink less alcohol, and don't smoke. From EurekAlert:

Popular heartburn medication may increase ischemic stroke risk

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of ischemic stroke, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016.

"PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia," said Thomas Sehested, M.D., study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. "We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population." Ischemic stroke, the most common type of stroke, is caused by clots blocking blood flow to or in the brain.

Researchers analyzed the records of 244,679 Danish patients, average age 57, who had an endoscopy -- a procedure used to identify the causes of stomach pain and indigestion. During nearly six years of follow up, 9,489 patients had an ischemic stroke for the first time in their lives. Researchers determined if the stroke occurred while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).

For ischemic stroke, researchers found:Overall stroke risk increased by 21 percent when patients were taking a PPI. At the lowest doses of the PPIs, there was slight or no increased stroke risk. At the highest dose for these 4 PPI's, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix). There was no increased risk of stroke associated with another group of acid-reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

Authors believe that their findings, along with previous studies, should encourage more cautious use of PPIs. Sehested noted that most PPIs in the United States are now available over the counter. Doctors prescribing PPIs, should carefully consider whether their use is warranted and for how long: "We know that from prior studies that a lot of individuals are using PPIs for a much longer time than indicated, which is especially true for elderly patients."

Published on Leave a comment on The FDA Has Already Stopped Testing For These Pesticides In Foods

An article points out what we should all be concerned with, but is being ignored - pesticide residues of glyphosate (found in Monsanto's Roundup) and 2,4-D in foods. Glyphosate is the most used pesticide in the world, and both glyphosate and 2,4-D pesticide residues in food are set to really increase with the introduction of genetically modified crops resistant to both pesticides (The farmers can spray the pesticides against weeds repeatedly and the crops won't die - they're resistant to the pesticides, so the crops and foods will contain pesticide residues.). Both pesticides are linked to a variety of health problems.

The FDA, under pressure, started analyzing some foods this year for glyphosate residues, but has already stopped due to "problems". When and if they resume is unknown. It is important to know that pesticide residues at varying levels have been found in many foods (here, here, and here). What this chronic low level exposure does to humans is unknown. The only way to avoid or minimize pesticide exposures is to eat organic foods (here, here, and here).

When reading the following excerpts, note that there are no standards for glyphosate residues in honey in the United States. Research by a FDA chemist and a chemist at the University of Iowa found residues of glyphosate at varying levels with a high of 653 parts per billion in one sample (in honey from Iowa) - which is more than 10 times the limit of 50 ppb allowed in the European Union. Other honey samples tested detected glyphosate residues from under 16 ppb to over 123 parts per billion ppb (in honey from Louisiana). I mention this because pesticide residues are an important issue - because we don't know what chronic exposure to mixtures of low levels of pesticides in foods does to us. To babies and children, to pregnant women, to the elderly, to all of us. The following article excerpts are by journalist Carey Gillam, from The Huffington Post:

FDA Suspends Testing for Glyphosate Residues in Food

Government testing for residues of an herbicide that has been linked to cancer has been put on hold, slowing the Food and Drug Administration’s first-ever endeavor to get a handle on just how much of the controversial chemical is making its way into U.S. foods. The FDA, the nation’s chief food safety regulator, launched what it calls a “special assignment” earlier this year to analyze certain foods for residues of the weed killer called glyphosate after the agency was criticized by the U.S. Government Accountability Office for failing to include glyphosate in annual testing programs that look for many less-used pesticides. Glyphosate is the most widely used herbicide in the world, and is the key ingredient in Monsanto Co.’s branded Roundup herbicide line.

Glyphosate is under particular scrutiny now after the World Health Organization’s cancer experts last year declared the chemical a probable human carcinogen. Several private groups and nonprofits have been doing their own testing, and have been finding glyphosate residues in varying levels in a range of foods, raising consumer concerns about the pesticide’s presence in the American diet.

The FDA’s residue testing for glyphosate was combined with a broader herbicides analysis program the FDA set in motion in February of this year. But the glyphosate testing has been particularly challenging for the FDA. The agency was finally forced to put the glyphosate residue testing part of the work plan on hold amid confusion, disagreement and difficulties ....FDA spokeswoman Megan McSeveney confirmed the testing suspension and said the agency is not sure when it will resume.....Alongside the testing for glyphosate, the FDA laboratories have also been analyzing foods for 2,4-D and other “acid herbicides,” documents obtained from the FDA show. The category of acid herbicides includes five of the top 10 active ingredients used in homes and gardens. Usage of 2,4-D is expected to triple in the coming year, according to the FDA.

McSeveney said glyphosate residues were only being analyzed in soy, corn, milk and eggs and the popcorn samples, while the other foods are being tested for residues of other herbicides. Earlier this year, one of the agency’s senior chemists also analyzed glyphosate residues in honey and oatmeal and reported his results to the agency. Some honey samples contained residue levels well over the limit allowed in the European Union. The United States has no legal tolerance for glyphosate in honey, though the Environmental Protection Agency (EPA) said recently it may set one because of the FDA findings. 

With the testing on hold, it is not clear when the agency might have final results on the glyphosate residue analysis. McSeveney said preliminary results showed no violations of legal tolerance levels allowed for glyphosate in the foods tested. She did not provide details on what, if any, levels of residue were found. Tolerance levels are set by the EPA for a variety of pesticides expected to be found in foods. When residue levels are detected above the tolerance levels, enforcement action can be taken against the food producers.

Though FDA annually tests domestic and imported foods for residues of other pesticides, it never tested for glyphosate before. It has not routinely tested for 2,4-D either, a fact also criticized by the GAO. The FDA testing for 2,4-D residues comes as the use of 2,4-D with food crops is expected to start rising due to the commercialization of new formulated herbicide products that combine glyphosate and 2,4-D. Safety questions have been raised about the combination. But the EPA gave a green light on Nov. 1 to a Dow AgroSciences’ herbicide combination of glyphosate and 2,4-D. The new products are intended to counter widespread weed resistance to glyphosate, and be used with new types of genetically engineered herbicide-tolerant crops.