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Published on Leave a comment on Yoga For Chronic Back Pain?

Image result for yoga wikipedia A recent study found that yoga is as good as physical therapy in reducing chronic back pain in a diverse group of low-income patients. In those sticking with the program and attending the most yoga classes, yoga was better in the long-term than physical therapy and much better than just receiving educational advice about back pain. Both physical therapy and yoga reduced pain medication use by 20% at 12 weeks. These findings are supported by other research finding that yoga improves pain, function, reduces medication use, and practicing yoga long-term results in positive brain changes (such as more gray matter in the brain). From Medscape:

Yoga as Good as Physical Therapy for Back Pain

Yoga is as good as physical therapy (PT) in reducing chronic low back pain, the most common pain problem in the United States, new research shows. "Our study showed that yoga was noninferior to physical therapy for a diverse group of low-income patients," said Robert B. Saper, MD, director of integrative medicine, Boston Medical Center, Massachusetts. "Its effectiveness was most obvious in the most adherent patients." Dr Saper presented his study at the American Academy of Pain Management (AAPM) 2016 Annual Meeting. 

Previous research has shown that yoga improves pain and function and reduces medication use. For example, a 2013 meta-analysis demonstrated small to medium effect sizes for yoga in short-term and long-term back pain–related disability. Research also shows that PT is effective in treating patients with back pain. PT is considered a conventional therapy and is the most common nonpharmacologic referral by physicians for chronic low back pain, Dr Saper said. 

For this new study, researchers enrolled 320 adult patients from Boston-area community health centers who had chronic back pain with no obvious anatomic cause, such as spinal stenosis. The patients were predominantly nonwhite and low income, with a relatively low education level. The patients had "quite high" pain scores (average of 7 out of 10 on a pain scale) and were "quite disabled" in terms of their back pain, said Dr Saper. Almost three quarters were using pain medication, with about 20% taking opioids....Patients were randomly assigned to one of three groups: yoga, PT, or education.

To develop the structured yoga protocol, Dr Saper and his colleagues organized an expert panel, which reviewed the literature on the topic. The final product was a 75-minute weekly class with a very low student-to-teacher ratio. The classes began with short segment on yoga philosophy (nonviolence, moderation, self-acceptance). Participants were then given mats on which to do the simple yoga poses. They received a DVD to practice these at home. The PT group had 15 one-on-one 60-minute sessions that included aerobic exercise. PT personnel were trained to help coach patients on fear avoidance. The education group got a comprehensive book on back pain.

Both the PT and yoga sessions continued for 12 weeks, after which patients were followed to 52 weeks. During this postintervention period, patients in both the yoga and PT groups were randomly assigned to maintenance (drop in yoga classes or more PT sessions) or just at-home practice. Overall adherence was not great. The mean number of yoga classes and PT sessions attended during the initial phase was 7.

The primary question being addressed was whether yoga is not inferior to PT at 12 weeks. The study showed that for function (score on the Roland-Morris Disability Questionnaire), yoga and PT "are exactly the same, ie noninferior," said Dr Saper, adding that, "they are not terribly different from education at 12 weeks...."What that means is that for every two patients who go to yoga, about 50% of them are going to have a clinical response."....comparing the various interventions, "yoga is actually superior" to PT and is "quite a bit" superior to education, said Dr Saper. At baseline, about 70% of participants were using medication. At 12 weeks, such use was down by about 20% in both the yoga and PT groups, and hadn't changed in the education group. A similar number of yoga and PT subjects reported being "very improved" and "very satisfied," said Dr Saper.

Yoga proved to be safe, with only mild, usually transient exacerbations of back pain.....Larger studies are needed to develop better strategies to enhance adherence, he said. The new study "adds to our knowledge in suggesting that a) yoga is as good as the standard of care, non pharmacologic therapy, and b) it can be done in a diverse population, including a low income, non-English speaking population in Boston. So it takes away some of those barriers to recommending it."

There's also evidence that yoga has a positive impact on the brain. According to M. Catherine Bushnell, PhD, National Center for Complementary and Integrative Health, National Institutes of Health, long-time yoga practitioners have more gray matter than matched physically active controls. "Gray matter goes down with age, but yoga practitioners have a flat line; you don't see this age-related decrease in gray matter that you see in other healthy people,".... And there seems to be "quite a robust" relationship between how long a person has done yoga and positive brain changes, she said. "The number of years a person has practiced yoga, the more gray matter at multiple sites in the brain." Yoga influences areas of the brain that are important for pain modulation, said Dr Bushnell. It is a "complex activity" that involves not only exercise but also breath control and meditation.

Published on Leave a comment on Drinking Coffee Linked To A Reduced Risk of Dementia?

More great news about drinking coffee daily - for women. Older women (between ages of 65 to 80 at the start of the study) reporting drinking higher amounts of caffeinated beverages (about 261 mg which is about 2 to 3 cups of coffee per day) had a lower incidence of dementia and cognitive impairment over a 10 year period (as compared to the low caffeine group). The low caffeine group averaged 64 mg of caffeine per day.  Other studies also found a reduction in "cognitive decline" in older people with coffee consumption. This study, among others, is more evidence of caffeine being "neuroprotective". NOTE: an 8-ounce cup of brewed coffee contains about 95 mg of caffeine, 8-ounces of brewed black tea contains about 47 mg, a 12-ounce can of carbonated cola contains 33 mg, and 8-ounces of decaffeinated coffee has about 5 mg of caffeine. Science Daily:

For women, caffeine could be ally in warding off dementia

Among a group of older women, self-reported caffeine consumption of more than 261 mg per day was associated with a 36 percent reduction in the risk of incident dementia over 10 years of follow-up. This level is equivalent to two to three 8-oz cups of coffee per day, five to six 8-oz cups of black tea, or seven to eight 12-ounce cans of cola.

"The mounting evidence of caffeine consumption as a potentially protective factor against cognitive impairment is exciting given that caffeine is also an easily modifiable dietary factor with very few contraindications," said Ira Driscoll, PhD, the study's lead author and a professor of psychology at the University of Wisconsin-Milwaukee. "What is unique about this study is that we had an unprecedented opportunity to examine the relationships between caffeine intake and dementia incidence in a large and well-defined, prospectively-studied cohort of women."

The findings come from participants in the Women's Health Initiative Memory Study, which is funded by the National Heart, Lung, and Blood Institute. Driscoll and her research colleagues used data from 6,467 community-dwelling, postmenopausal women aged 65 and older who reported some level of caffeine consumption. Intake was estimated from questions about coffee, tea, and cola beverage intake, including frequency and serving size.

In 10 years or less of follow-up with annual assessments of cognitive function, 388 of these women received a diagnosis of probable dementia or some form of global cognitive impairment. Those who consumed above the median amount of caffeine for this group (with an average intake of 261 mg per day) were diagnosed at a lower rate than those who fell below the median (with an average intake of 64 mg per day). The researchers adjusted for risk factors such as hormone therapy, age, race, education, body mass index, sleep quality, depression, hypertension, prior cardiovascular disease, diabetes, smoking, and alcohol consumption. (The original study in the Journal of Gerontology.)

Published on Leave a comment on Endocrine Disruptors In Fast Food

Recent research examined levels of endocrine disruptors called phthalates in people eating fast food. Researchers found evidence of a dose–response relationship between fast food intake and exposure to phthalates - the more one eats fast food, the more phthalates (actually metabolites of the phthalates) can be measured in the person's urine. Fast food consumers had higher urinary levels of the phthalates DEHP, DiNP, and BPA than those not consuming fast food (even though the differences in levels of BPA among groups were "non-significant"). This is of concern because these endocrine disruptors are linked to a number of health problems. (Earlier discussion of this research.)

DEHP, DiNP, and BPA are detected in over 90% of the population in the US, but since there are many health concerns - it is better to have lower levels than higher levels. (Zero levels would be best). Note that phthalates and BPA are quickly metabolized and excreted in urine, with elimination half-lives of less than 24 hr - which is why the study looked at what had been eaten in the last 24 hours. But this also shows that one can quickly reduce their levels in the body.

Some possible sources of phthalate contamination in fast food are: PVC tubing, vinyl gloves used for food handling, and food packaging, including beverage cans - the chemicals leach or migrate out into the food and then are ingested. (More on chemicals migrating from containers to food), Fast food was defined as food obtained from restaurants without waiter service and from pizza restaurants, as well as all carry-out and delivery food. Another excellent reason to cut back on fast food (like we don't have enough reasons already!). The following news report discusses the research. From Environmental Health Perspectives:

Phthalates in Fast Food: A Potential Dietary Source of Exposure

Many research studies have surveyed nutritional habits, but fewer have studied how food processing and packaging might introduce unwanted chemicals into foods. In this issue of EHP, researchers report that fast food consumption appears to be one source of exposure to the chemicals di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DiNP).1

The authors used data from the National Health and Nutrition Examination Survey (NHANES) to estimate the percentage of individuals’ calories that came from fast food, fat intake attributable to fast food consumption, and fast food intake by food group. During NHANES interviews, respondents had reported their diet from the preceding 24 hours. Fast food was defined as food obtained from restaurants without waiter service and from pizza restaurants, as well as all carryout and delivery food.2 ....The final study population included nearly 9,000 people aged 6 years or older. Approximately one-third of people surveyed had eaten fast food in the preceding 24 hours. Study participants who ate fast food were more likely to be male, under age 40, and non-Hispanic black, and to have higher total calorie and total fat intake from fast food, compared with the general population.1

Fast food consumers had higher urinary levels of DEHP, DiNP, and BPA than non-consumers, although the differences in average urinary levels were small and for BPA were non-significant. When fast food intake was categorized by food group, DEHP metabolites were associated with intake of grains and “other” (a category that included vegetables, condiments, potato items, beverages, and more). DiNP metabolites were associated with intake of meat and grains.1

The authors also found that the associations between phthalates and fast food were not uniform across the population.1They speculate that the pronounced association they saw between fast food consumption and DEHP in black consumers could reflect higher overall consumption of fast food and/or different food choices among this population. Prior research suggests that predominately black neighborhoods in urban areas have a greater density of fast food restaurants than white neighborhoods.3

The authors point to PVC tubing, vinyl gloves used for food handling, and food packaging as possible sources of phthalate contamination in fast food. DEHP is a ubiquitous high-molecular-weight phthalate that has been removed from some products due to concerns about potential adverse health effects.5 In some cases it is being replaced with DiNP.2

The related Environmental Health Perspectives research article:  Recent Fast Food Consumption and Bisphenol A and Phthalates Exposures among the U.S. Population in NHANES, 2003–2010

Experimental animal studies demonstrate that DEHP and DiNP have endocrine-disrupting properties because of their anti-androgenic effects on the male reproductive system (National Research Council 2008). Human exposure to DEHP has been associated with adverse reproductive, neurobehavioral, and respiratory outcomes in children (Braun et al. 2013; Ejaredar et al. 2015) and metabolic disease risk factors such as insulin resistance in adolescents and adults (James-Todd et al. 2012; Attina and Trasande 2015). Though epidemiologic evidence of DiNP is less complete, recent studies report associations between exposure and similar health outcomes including adverse respiratory and metabolic outcomes in children (Bertelsen et al. 2013; Attina and Trasande 2015). BPA is also a suspected endocrine disrupter, and experimental and human evidence suggest that BPA is a reproductive toxicant (Peretz et al. 2014). In addition, prenatal BPA exposure has also been associated with adverse neurobehavioral outcomes in children (Mustieles et al. 2015).

Given the concern over chemical toxicity, it is important to identify modifiable sources of exposure that may be targeted for exposure reduction strategies. Simulated exposure modeling, observational epidemiologic studies, and intervention studies all suggest that diet is an important exposure pathway for both high-molecular-weight phthalates and BPA.....Phthalates have been shown to leach into food from PVC in materials like tubing used in the milking process, lid gaskets, food preparation gloves, conveyor belts and food packaging materials (Cao 2010;Serrano et al. 2014). In fact, an intervention study reported that urinary BPA and DEHP were reduced by 66% and 53–56%, respectively, when participants’ diets were restricted to food with limited packaging (Rudel et al. 2011). Foods high in fat, such as dairy and meat, may be more contaminated by high-molecular-weight phthalates that are more lipophilic such as DEHP (Serrano et al. 2014). Fast food may be an important source of exposure to phthalates and BPA because it is highly processed, packaged, and handled.

Published on Leave a comment on Dental Fillings and Mercury Levels

Many of us grew up having silver colored dental fillings (called dental amalgam) in our teeth. Dental amalgam has been used for over 150 years for the treatment of dental cavities (caries) because it is durable, easy to use, and affordable. But it is composed of about 50% elemental mercury (Hg) and so it may release a certain amount of mercury both during the time the cavity is filled and afterward with normal wear. Mercury can cause adverse health effects, such as effects on the central nervous system, kidneys, and immune system. Human mercury exposure also occurs through the consumption of mercury (MeHg) contaminated seafood.

Recently many dentists switched to the use of the composite resins, which are mercury-free alternative materials. However, these can release can release small quantities of bisphenol A (BPA) when applied and as they degrade in the mouth. BPA is an endocrine disruptor, has been found to cause various adverse health effects, including reproductive effects, and can be measured in urine. Which raised the question, do persons with composite resin fillings have elevated BPA in their bodies?

This study examined 14,703 subjects who were divided into three groups based on the number of dental surface restorations (DSR): 0, 1–8, or greater than 8. Dental surface restorations applies to fillings, and not crowns. Note that a tooth's surface can have 5 surfaces (in molars and pre-molars), so 8 filled surfaces can be fewer than 8 teeth with fillings. (It's not the number of fillings, but the surface area they occupy - so the Science Daily article title is misleading.)

They found that the more dental surface restorations a person has, the higher the levels of mercury in the blood. But they found no association between dental surface restorations and urinary BPA. These results are reassuring for those with fillings made of composite resins, but not for people with fillings of dental amalgam. Note: DSR are Dental Surface Restorations, THg is blood total mercury, IHG is inorganic mercury, and MeHg is methyl mercury (typically from seafood). From Science Daily:

Have more than eight dental fillings? It could increase the mercury levels in your blood

Dental surface restorations composed of dental amalgam, a mixture of mercury, silver, tin and other metals, significantly contribute to prolonged mercury levels in the body, according to new research from the University of Georgia's department of environmental health science in the College of Public Health.This research, which analyzed data from nearly 15,000 individuals, is the first to demonstrate a relationship between dental fillings and mercury exposure in a nationally representative population.  ...continue reading "Dental Fillings and Mercury Levels"

Published on Leave a comment on Read Food Labels To Find Hidden MSG

Monosodium glutamate is an additive used as a "flavor enhancer" that has long been used in foods (processed and packaged foods, as well as fast food and restaurant meals) - and it has also been controversial for decades. Even four decades ago some people complained of headaches after having foods with added monosodium glutamate, and since then health complaints have just increased. Since so much is still unknown about the health effects of additives commonly added to foods, then many people just want to avoid them. But it's tricky because manufacturers sneak monosodium glutamate into foods using various other name such as hydrolyzed vegetable protein, autolyzed yeast, glutamic acid, and yeast extract.

The FDA points out on its web-site that monosodium glutamate (MSG) is the "sodium salt of the common amino acid glutamic acid" - in other words, it is a form of glutamic acid. Glutamic acid is an amino acid naturally present in our bodies, and found naturally in many foods, such as tomatoes, cheeses, meat, seaweed, and mushrooms. The FDA views MSG as "generally recognized as safe". But even if a form of something may occur naturally in foods, that does NOT mean that we want to eat foods with added forms of it, or that we should be eating food with added additives, including MSG.

Sometimes the term "natural flavor" is used by the food industry for glutamic acid (which is chemically similar to MSG). So read ingredient lists carefully. And note that "natural flavor" can mean many things, that they are produced in a lab, and that the Food and Drug Administration (FDA) does not require disclosure of components and amounts of "natural flavor". From Tech Insider:

Here’s how food companies sneak MSG into foods

That savory, meaty, salty taste you get after taking a bite of Chinese beef and broccoli or after a crunch into a Doritos nacho cheese chip is unmistakable. It hits your tongue, makes it water, and leaves you craving more. MSG, which stands for monosodium glutamate — a naturally-occurring food additive — is largely responsible for that irresistible taste. Chemists have been infusing it into everything from broths, frozen pizzas, flavored potato chips, salad dressings, deli meats, and hot dogs, for more than a century to make them taste addictively delicious.

MSG is a naturally occurring amino acid that makes up proteins in our bodies. But the compound's safety has been debated for years. While it is generally recognized as safe by the Food and Drug Administration, some claim that it can cause adverse reactions in sensitive people, including chest pain, flushing, and sweating. It's also reportedly caused numbness or burning near the mouth and facial pressure or swelling. While there haven't been any studies to back up this claim, it would be helpful for sensitive or MSG-wary people to know which processed foods contain the ingredient. But because the additive can go by many different names, it can be difficult to tell which foods contain it.

Take this Doritos label, for instance. You can easily tell that there's MSG in it, because it's listed simply by its full name, "Monosodium Glutamate."....But check out this nutrition label for Nissin Chicken Garden Vegetable Flavor Soup. While it does reveal that it indeed contains monosodium glutamate, it also contains many other forms of glutamates that are often considered slight variations on MSG. Hydrolyzed protein, for example, is just proteins that are broken down into their animo acid components – one of which is glutamic acid, another name for MSG. Autolyzed yeast is a similar example, yeast cells are allowed to die and pop open, which releases their innards, which then break down into individual amino acids — including glutamic acid.

MSG can go by these and many other synonymous names as well, including monosodium salt, monohydrate, monosodium glutamate, monosodium glutamate monohydrate, monosodium L-glutamate monohydrate, MSG monohydrate, sodium glutamate monohydrate, UNII-W81N5U6R6U, L-Glutamic acid, monosodium salt, and monohydrate. Foods that contain these ingredients, of course, aren't necessarily bad for you. Glutamate is a naturally occuring chemical in cheeses, tomatoes, mushrooms, broccoli, peas, and walnuts. Japanese biochemist Kikunae Ikeda first isolated MSG from seaweed in 1908.

Published on Leave a comment on FDA Finds Weed Killer Residues in Oatmeal

New research shows that the most applied pesticide in the world - glyphosate - is being detected in more and more foods (such as honey, wheat). Glyphosate is a herbicide (weed killer) found in the product Roundup. Its use is increasing annually due to its use on crops genetically engineered to tolerate applications of the herbicide ("Roundup Ready" corn, soybeans, canola).

The latest news is that glyphosate residues are found in oat products, including baby cereals. The FDA (Food and Drug Administration) only started testing this year for glyphosate residues in foods (see post), but they may already be slowing down testing - because they are already talking about shutting down one of the testing labs (tested honey). There are various health concerns about glyphosate and its residues in foods, including that it is a probable carcinogen and a biocide that may disrupt the bacteria of the human gut. What are the long-term health implications of constantly (daily) eating foods with pesticide residues such as glyphosate? No one knows, but it is concerning. Yes, individual foods have low levels, but we're ingesting the pesticide residue in many foods every day - thus chronic exposure. And yes, studies show that it is found in our urine (one European study found it in 100% of people tested)

Note that Monsanto (producer of the glyphosate product Roundup) also encourages farmers to apply Roundup right before harvest as a "preharvest dessicant" to non-genetically modified crops, which also increases the odds that residues will be found in food. (Look at the preharvest application guide from Monsanto for oats and some other crops). What can one do? Buy organic foods - because glyphosate is not allowed to be used in organic farming. From the investigative journalist Carey Gillam's article for Huffington Post:

FDA Tests Confirm Oatmeal, Baby Foods Contain Residues of Monsanto Weed Killer

The U.S. Food and Drug Administration, which is quietly starting to test certain foods for residues of a weed killing chemical linked to cancer, has found the residues in a variety of oat products, including plain and flavored oat cereals for babies.

Data compiled by an FDA chemist and presented to other chemists at a meeting in Florida showed residues of the pesticide known as glyphosate in several types of infant oat cereal, including banana strawberry- and banana-flavored varieties. Glyphosate was also detected in “cinnamon spice” instant oatmeal; “maple brown sugar” instant oatmeal and “peach and cream” instant oatmeal products, as well as others. In the sample results shared, the levels ranged from nothing detected in several different organic oat products to 1.67 parts per million, according to the presentation.

Glyphosate, which is the key ingredient in Monsanto Co.’s Roundup herbicide, is the most widely used weed killer in the world, and concerns about glyphosate residues in food spiked after the World Health Organization in 2015 said a team of international cancer experts determined glyphosate is a probable human carcinogen. Other scientists have raised concerns about how heavy use of glyphosate is impacting human health and the environment.

The EPA maintains that the chemical is “not likely” to cause cancer, and has established tolerance levels for glyphosate residues in oats and many other foods. The levels found by the FDA in oats fall within those allowed tolerances, which for oats is set by the EPA at 30 ppm. The United States typically allows far more glyphosate residue in food than other countries allow. In the European Union, the tolerance for glyphosate in oats is 20 ppm.

Monsanto, which derives close to a third of its $15 billion in annual revenues from glyphosate-based products, has helped guide the EPA in setting tolerance levels for glyphosate in food, and in 2013 requested and received higher tolerances for many foods. The company has developed genetically engineered crops designed to be sprayed directly with glyphosate. Corn, soybeans, canola and sugar beets are all genetically engineered to withstand being sprayed with glyphosate.

Oats are not genetically engineered. But Monsanto has encouraged farmers to spray oats and other non-genetically modified crops with its glyphosate-based Roundup herbicides shortly before harvest. The practice can help dry down and even out the maturity of the crop. “A preharvest weed control application is an excellent management strategy to not only control perennial weeds, but to facilitate harvest management and get a head start on next year’s crop ” according to a Monsanto “pre-harvest staging guide.”  Glyphosate is also used on wheat shortly before harvest in this way, as well as on other crops. A division of the U.S. Department of Agriculture....has been testing wheat for glyphosate residues for years for export purposes and have detected the residues in more than 40 percent of hundreds of wheat samples examined in fiscal 2009, 2010, 2011 and 2012.

Even though the FDA annually examines foods for residues of many other types of pesticides, it has skipped testing for glyphosate residues for decades. It was only in February of this year that the agency said it would start some glyphosate residue analysis. That came after many independent researchers started conducting their own testing and found glyphosate in an array of food products, including flour, cereal, and oatmeal. Monsanto and U.S. regulators have said glyphosate levels in food are too low to translate to any health problems in humans. But critics say such assurances are meaningless unless the government actually routinely measures those levels as it does with other pesticides. And some do not believe any level of glyphosate is safe in food. 

In addition to oats, the FDA also earlier this year tested samples of U.S. honey for glyphosate residues and found all of the samples contained glyphosate residues, including some with residue levels double the limit allowed in the European Union, according to documents obtained through a Freedom of Information Act request. The EPA has not set a tolerance level for glyphosate in honey, so any amount is problematic legally....the FDA did not notify the honey companies involved that their products were found to be contaminated with glyphosate residues, nor did it notify the public. The FDA has also tested corn, soy, eggs and milk in recent months, and has not found any levels that exceed legal tolerance, though analysis is ongoing.

Published on Leave a comment on Sexual Intercourse Helps Pass Kidney Stones?

Yesterday's post on the possibility of riding "medium intensity" (think old fashioned) roller coasters to dislodge and pass kidney stones was amusing, but now I've read of another interesting way to facilitate passing of kidney stones. One study of Turkish men found that having sex 3 to 4 times a week promoted passage of kidney stones under 6 mm in size. Kidney stones are small, hard mineral deposits that form inside the kidneys, affecting up to 15 percent of people in developed countries.

All the men in the 3 groups (Sexual intercourse group, Tamsulosin group, and Control group) were also told to drink 2 liters of water a day to help expel kidney stones. Note that tamsulosin (also called Flomax) is a drug used to improve urination and to help with the passage of kidney stones. They found that after 2 weeks: 83.9% of the Sexual Intercourse group, 47.6% of the Tamsulosin group, and 34.8% of the Control group had successfully passed kidney stones, and after 4 weeks: 93.5% of the Sexual Intercourse group,  81% of the Tamsulosin group, and 78.3% of the Control group had done so. Frequent sex appeared to work, especially in speeding up the process! From the journal Urology:

Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study.

OBJECTIVE: To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones.

The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant.

The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001).

Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.

Published on Leave a comment on Ride A Roller Coaster To Pass Kidney Stones?

Image result for roller coaster wikipedia The most amusing study that I've read in a while, but hey, if it works - why not? Bottom line: Riding certain types of roller coasters (such as Big Thunder Mountain at Disney World) enables some people to pass kidney stones. Kidney stones are small, hard mineral deposits that form inside the kidneys, affecting up to 15 percent of people in developed countries.

The researchers made a model kidney (and used actual kidney stones and urine) and brought it on the roller coaster ride multiple times - and found that what they were hearing from patients was true. Riding the medium intensity roller coaster dislodged the kidney stones in many cases so that they can be passed. Can you imagine a prescription for kidney stones that says "Go ride a roller coaster"?  Note that "the ideal coaster is rough and quick with some twists and turns, but no upside down or inverted movements." From Futurity:

Roller coasters can jostle out kidney stones

Riding a roller coaster helps patients pass kidney stones with nearly a 70 percent success rate, research shows. David Wartinger, a professor emeritus in the department of osteopathic surgical specialties at Michigan State University, led both a pilot study and an expanded study to assess whether the stories he was hearing from patients were true. “Basically, I had patients telling me that after riding a particular roller coaster at Walt Disney World, they were able to pass their kidney stone,” Wartinger says. “I even had one patient say he passed three different stones after riding multiple times.” 

This resulted in Wartinger going out and testing the theory. Using a validated, synthetic 3D model of a hollow kidney complete with three kidney stones no larger than 4 millimeters inserted into the replica, he took the model in a backpack on Big Thunder Mountain at the theme park 20 times. His initial results verified patient reports. “In the pilot study, sitting in the last car of the roller coaster showed about a 64 percent passage rate, while sitting in the first few cars only had a 16 percent success rate,” Wartinger says.

The expanded study, conducted with Mark Mitchell, a Michigan State University resident at the time, included riding the same roller coaster with multiple kidney models attached to the researchers. They discovered even better results while sitting in the back of the coaster, with a passage rate of nearly 70 percent. They also found that both studies showed a 100 percent passage rate if the stones were located in the upper chamber of the kidney.

“In all, we used 174 kidney stones of varying shapes, sizes and weights to see if each model worked on the same ride and on two other roller coasters,” Wartinger says. “Big Thunder Mountain was the only one that worked. We tried Space Mountain and Aerosmith’s Rock ‘n’ Roller Coaster and both failed.” Wartinger went on to explain that these other rides are too fast and too violent with a G-force that pins the stone into the kidney and doesn’t allow it to pass. “The ideal coaster is rough and quick with some twists and turns, but no upside down or inverted movements,” he says.

Lithotripsy, which breaks apart kidney stones that are too large to pass, is a common treatment for the problem. Wartinger says the procedure is usually used in cases where the kidney stone is larger than 5 millimeters. “The problem though is lithotripsy can leave remnants in the kidney which can result in another stone,” Wartinger says. “The best way to potentially eliminate this from happening is to try going on a roller coaster after a treatment when the remnants are still small.” He adds that patients could even try going on a coaster once a year as maintenance, lessening the chances of future issues and minimizing health care costs. 

The original pilot study from the Journal of the American Osteopathic Association: Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster

Published on Leave a comment on Eating Foods With Turmeric May Be Good For You

The spice turmeric is very popular these days, especially because studies link it to various health benefits. But is this true? Is it better to eat turmeric in foods or take it in pill form as a supplement? Today's post is about a study that was done by the BBC teaming up with researchers at Newcastle University (in the UK) where they looked at whether modest doses of turmeric had health benefits when ingested daily for 6 weeks. Specifically, they looked at what turmeric does to various blood markers thought to be associated with inflammation and changes that could eventually lead to the onset of cancer. It is currently thought that many or turmeric's supposed health benefits come from the compound curcumin found in it.

The researchers took blood samples of 100 volunteers, who were then split up into 3 groups (turmeric powder, a turmeric pill, or a placebo pill daily). Only the group that ingested turmeric in powder form (1 teaspoon mixed in food) showed changes after 6 weeks, and they were exciting beneficial changes in the methylation of DNA. This is because "methylation of the DNA can ‘go wrong’ and this can cause cells to become cancerous".

It's still early days in this research, and more has to be done, but it is exciting. In the meantime, don't take turmeric in pill form, but eat it in foods. It seems that more of the turmeric gets absorbed when eaten with foods, especially foods with fat, and also with a little black pepper. Excerpts from the article written by Michael Mosley, one of the presenters of the broadcast show "Trust Me, I'm A Doctor", from the BBC News:

Could turmeric really boost your health?

Turmeric is a spice which in its raw form looks a bit like ginger root, but when it's ground down you get a distinctive yellowy orange powder that's very popular in South Asian cuisine.....So we tracked down leading researchers from across the country and with their help recruited nearly 100 volunteers from the North East to do a novel experiment. Few of our volunteers ate foods containing turmeric on a regular basis.

Then we divided them into three groups. We asked one group to consume a teaspoon of turmeric every day for six weeks, ideally mixed in with their food. Another group were asked to swallow a supplement containing the same amount of turmeric, and a third group were given a placebo, or dummy pill. The volunteers who were asked to consume a teaspoon of turmeric a day were ingenious about what they added it to, mixing it with warm milk or adding it to yoghurt. Not everyone was enthusiastic about the taste, with comments ranging from "awful" to "very strong and lingering".

But what effect was eating turmeric having on them? We decided to try and find out using a novel test developed at University College, London, by Prof Martin Widschwendter and his team....There are at least 200 different compounds in turmeric, but there's one that scientists are particularly interested in. It gives this spice its colour. It's called curcumin. Thousands of scientific papers have been published looking at turmeric and curcumin in the laboratory - some with promising results. But they've mainly been done in mice, using unrealistically high doses. There have been few experiments done in the real world, on humans.

Prof Widschwendter is not particularly interested in turmeric but he is interested in how cancers start. His team have been comparing tissue samples taken from women with breast cancer and from women without it and they've found a change that happens to the DNA of cells well before they become cancerous. The change is in the "packaging" of the genes. It's called DNA methylation. It's a bit like a dimmer switch that can turn the activity of the gene up or down. The exciting thing is that if it is detected in time this change can, potentially, be reversed, before the cell turns cancerous.

So we asked Prof Widschwendter whether testing the DNA methylation patterns of our volunteers' blood cells at the start and end of the experiment would reveal any change in their risk of cancer and other diseases, like allergies. It was something that had not been done before. Fortunately he was very enthusiastic. "We were delighted," he said, "to be involved in this study, because it is a proof of principle study that opens entirely new windows of opportunity to really look into how we can predict preventive measures, particularly for cancer."

So what, if anything, happened? When I asked him that, he pulled out his laptop and slowly began to speak."We didn't find any changes in the group taking the placebo," he told me. That was not surprising. "The supplement group also didn't also show any difference," he went on. That was surprising and somewhat disappointing.

"But the group who mixed turmeric powder into their food," he continued, "there we saw quite substantial changes. It was really exciting, to be honest. We found one particular gene which showed the biggest difference. And what's interesting is that we know this particular gene is involved in three specific diseases: depression, asthma and eczema, and cancer. This is a really striking finding."

It certainly is. But why did we see changes only in those eating turmeric, not in those taking the same amount as a supplement? Dr Kirsten Brandt, who is a senior lecturer at Newcastle University and who helped run the experiment, thinks it may have something to do with the way the turmeric was consumed. "It could be," she told me, "that adding fat or heating it up makes the active ingredients more soluble, which would make it easier for us to absorb the turmeric.....She also told me, because our volunteers all tried consuming their turmeric in different ways, that we can be confident it was the turmeric that was making the difference and not some other ingredient used to make, say, chicken tikka masala. There is a lot more research that needs to be done, including repeating the experiment to see if these findings can be confirmed.

More information about the study and results from BBC News: Does turmeric really help protect us from cancer?

Published on Leave a comment on Time For Doctors To Prescribe Exercise

We all know that exercise is beneficial for health. Research suggests that exercising out in nature is best for several varied reasons -  including that it lowers markers of inflammation, and that it's good for our gut microbiome (community of gut microbes). The following excerpts are written by Dr. John La Puma encouraging other doctors to prescribe exercise for their patients and why.

An important message of his is that exercise is more important than a drug prescription for a number of conditions, including diabetes prevention, reducing the risk of recurrence of several cancers (he mentions breast cancer, but it also holds for prostate cancer). While exercising and walking out in nature may be best, any exercise anywhere is better than no exercise. (Other posts on exercise as prescription medicine are here and here; and check the category exercise for all exercise research posts).

From Medscape: Rx: Exercise Daily -- Outdoors. Doctor's Orders

With dazzling Olympic feats on display all summer, too many of my patients are still literally immobilized. Medically, sitting too long shuts off the enzyme lipoprotein lipase. In people who are sedentary, the enzyme doesn't break down fat to create energy, like it should. But medical prescription for exercise has lagged even the slowest runner. Why? Some reasons are time, training, and money. Time especially is a scarce commodity: The average clinician visit lasts just 20 minutes. Fitness is a shamefully small part of medical training. And as doctors, we don't get paid for discussing exercise, let alone monitoring a prescription and assessing the response. 

Finally, there are practical reasons. Clinicians find it difficult to persuade patients that exercise is more effective than medication for any number of conditions, including stroke recovery, diabetes prevention, and treatment of low back pain. Regular exercise reduces the risk for recurrent breast cancer by approximately 50%. Given all these reasons, it's easy to see why fitness prescriptions are seldom more than an afterthought. Yet even without formally prescribing the frequency, intensity, time, and type of exercise, clinicians can speak with patients and families about fitness in inspiring, life-changing ways.

Because clinicians have a secret weapon to use that most people don't even know about—location. Exercising in nature (in sight of and preferably near water or greenery, whether a deserted beach or an urban park) is better. Walking city streets and the office itself can be harder on your health than you think. In both environments, your attention is demanded and directed—sometimes by digital interruptions, sometimes by vehicles, toxins, or duties. In nature, your attention is drawn, not pushed, to a variety of often unexpected but not unpleasant sounds, colors, aromas, textures, and forms.

A recent Stanford study of nature therapy showed significantly reduced rumination after a 90-minute walk in nature, compared with a 90-minute walk through an urban environment. On MRI, "nature walkers" showed lower activity in an area of the brain linked to risk for mental illness, the subgenual prefrontal cortex, compared with "urban walkers." In other words, nature offers a sense of something bigger than ourselves on which to focus. MRIs show the way the brain changes when that sense occurs to us.

Exercising in nature may improve a person's immune system by enriching the diversity in the microbiota. Microbiota buffer the immune system against chronic stress-related disease. They appear to act as a hormone-producing organ, not simply a collection of beneficial bacteria. Microbiota are sensitive and responsive to physical environmental changes as well as dietary ones. So, exercise in nature may favorably boost microbiota.

And finally, exercise in nature is clinically preferred and calming. A Norwegian study showed that exercise in nature and in view of nature improves both mood and diastolic blood pressure vs exercise without nature. A Chinese study showed higher energy levels, and lower levels of interleukin-6 and tumor necrosis factor (both markers of inflammation), in a forest walking group compared with an urban exercising group. A British study showed significantly improved mood and self-esteem with "green" exercise, with the largest benefits from 5-minute engagements. Five minutes!

Of course, there are areas in our country and world in which it is dangerous to walk, never mind exercise. It may not be as easy to generate sweat and intensity with outdoor exercise as it is with indoor exercise. It may be stormy, or baking hot, or otherwise harsh outside, and the cool recesses of one's own bedroom or the gym may be just perfect for you today. And with the 2013 total cost of inactivity estimated at $24.7 billion for the United States, and with the public sector bearing almost one half of that expense, any exercise anywhere is better than none.  Yet physicians have a therapeutic tool few others in our culture wield—a prescription pad—and we have every patient's attention, at least for a few minutes. Patients try harder when doctors advise them about fitness.