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Author: Sima

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Finding an increased risk of dementia and Alzheimer's with so many common over-the-counter medications such as Benadryl and  Chlortrimeton (the first generation allergy drug that so many people took for years) was an unpleasant surprise. Note: they found the link with high doses or heavy use (3 or more years). Some examples of common anticholinergics (from Wikipedia) are: atropine, benztropine (Cogentin), chlorpheniramine (Chlor-Trimeton), dimenhydrinate (Dramamine), diphenhydramine (Benadryl, Sominex, Advil PM, etc.), doxylamine (Unisom), hydroxyzine (Atarax, Vistaril), ipratropium (Atrovent), oxybutynin (Ditropan, Driptane, Lyrinel XL), tolterodine (Detrol, Detrusitol), tiotropium (Spiriva), and bupropion (Zyban, Wellbutrin). The message here: only take medications when absolutely needed and for as little a time as necessary. The study was done on older adults, so now the question is: what about children or young adults who take these drugs for years? Is there a similar increased risk later in life? From Medical Daily:

Common Over-The-Counter Anticholinergic Drugs Like Benadryl May Increase Your Risk Of Alzheimer's

Anticholinergic medications span a range of common drugs and include antihistamines, sleep aids, antidepressants, cardiovascular meds, gastrointestinal drugs (for diarrhea, incontinence, diverticulitis, and ulcers), and muscle relaxants. Now, a new study confirms the link between these everyday medications and dementia. Taking anticholinergic drugs at high doses or for a long time may significantly increase your risk for developing Alzheimer's disease and other dementias, say researchers from University of Washington School of Pharmacy.

“If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient, they should use the lowest effective dose, monitor the therapy regularly to ensure it's working, and stop the therapy if it's ineffective,” Dr. Shelly Gray, a professor and director of the geriatric pharmacy program at the UW School of Pharmacy said in a release.

On average, older people take four or five prescription drugs and two over-the-counter drugs each day. Clearly, drugs are an important part of medical care for older people; however, older people are more sensitive to the effects of many pills, including anticholinergics, which block the neurotransmitter acetylcholine and so effect the nervous system. While the drugs are too numerous to mention, those with anticholinergic effects — and these effects are sometimes dependent on the dose — include Benadryl, Sominex, Xanax, Ativan, Valium, Luminal, Skelaxin, Limbitrol, and Tavist.

For the current study, the researchers investigated a previously reported link between anticholinergics, both prescription strength and over-the-counter, and dementia by employing more rigorous methods than in the past. Specifically, the researchers conducted a longer follow-up of more than seven years and more accurate use assessment via pharmacy records, which included nonprescription choices. The team tracked nearly 3,500 seniors participating in a long-running study, the Adult Changes in Thought (ACT), a joint project of UW and the National Institute on Aging.

The most commonly used medications in the study, the researchers discovered, were tricyclic antidepressants like doxepin (Sinequan), antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). People taking at least 10 mg/day of doxepin, 4 mg/day of diphenhydramine, or 5 mg/day of oxybutynin for more than three years, the researchers estimated, would be at greater risk for developing dementia. Importantly, substitutes are available for some of these drugs.  

While this study is the first to show a dose response — meaning, the more you use anticholinergic medications the greater your risk of developing Alzheimer’s — it also is the first to suggest this higher risk may persist, and may not be reversible, even years after you stop taking these drugs. 

Source: Gray S, Crane P, Dublin S, et al. Cumulative Use of Strong Anticholinergic Medications and Incident Dementia. JAMA Internal Medicine. 2015.

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Evidence is growing that "mini-fasts" (when food is not eaten) for as little as a 12 hour time period every day is good for the body and may help with weight control. For example, eat supper and then nothing more (but water is OK) till the next day's breakfast - instant 12 hour fast! The second study posted liked a 16 hour mini-fast. From the NY Times:

A 12-Hour Window for a Healthy Weight

Scientists, like mothers, have long suspected that midnight snacking is inadvisable. But until a few years ago, there was little in the way of science behind those suspicions. Now, a new study shows that mice prevented from eating at all hours avoided obesity and metabolic problems — even if their diet was sometimes unhealthful.

Researchers at the Salk Institute for Biological Studies in San Diego and elsewhere began experimenting with the eating patterns of laboratory mice in a previous study. On that occasion, some mice consumed high-fat food whenever they wanted; others had the same diet but could eat only during an eight-hour window. None exercised. The mice that ate at all hours soon grew chubby and unwell, with symptoms of diabetes. But the mice on the eight-hour schedule gained little weight and developed no metabolic problems. Those results were published in 2012.

For the new study, which appeared in the journal Cell Metabolism in December, Salk scientists fed groups of adult males one of four diets: high-fat, high-fructose, high-fat and high-sucrose, and regular mouse kibble. Some of the mice in each dietary group were allowed to eat whenever they wanted throughout their waking hours; others were restricted to feeding periods of nine, 12 or 15 hours. The caloric intake for all the mice was the same.

By the end, the mice eating at all hours were generally obese and metabolically ill, reproducing the results of the earlier study. But those mice that ate within a nine- or 12-hour window remained sleek and healthy, even if they cheated occasionally on weekends. What’s more, mice that were switched out of an eat-anytime schedule lost some of the weight they had gained.

“Time-restricted eating didn’t just prevent but also reversed obesity,” says Satchidananda Panda, an associate professor at the Salk Institute who oversaw the studies. “That was exciting to see.” Mice that consumed regular kibble in fixed time periods also had less body fat than those that ate the same food whenever they chose.

Precisely how a time-based eating pattern staved off weight gain and illness is not fully understood, but Dr. Panda and his colleagues believe that the time at which food is eaten influences a body’s internal clock. “Meal times have more effect on circadian rhythm than dark and light cycles,” Dr. Panda says. And circadian rhythm in turn affects the function of many genes in the body that are known to involve metabolism.

To date, Dr. Panda’s studies have been conducted with only mice, but he says the results seem likely to apply to humans. The upshot: Contain your eating to 12 hours a day or less. And pay attention to when you begin. The clock starts, Dr. Panda says, with “that first cup of coffee with cream and sugar in the morning.”

Another article also liked an "energy restriction period" (mini-fast), but they liked a 16 hour non-eating period.Here is the complete abstract (summary) of the article in Proceedings of the National Academy of Sciences USA,Nov. 25, 2014:

Meal frequency and timing in health and disease.

Although major research efforts have focused on how specific components of foodstuffs affect health, relatively little is known about a more fundamental aspect of diet, the frequency and circadian timing of meals, and potential benefits of intermittent periods with no or very low energy intakes. The most common eating pattern in modern societies, three meals plus snacks every day, is abnormal from an evolutionary perspective. Emerging findings from studies of animal models and human subjects suggest that intermittent energy restriction periods of as little as 16 h can improve health indicators and counteract disease processes. The mechanisms involve a metabolic shift to fat metabolism and ketone production, and stimulation of adaptive cellular stress responses that prevent and repair molecular damage. As data on the optimal frequency and timing of meals crystalizes, it will be critical to develop strategies to incorporate those eating patterns into health care policy and practice, and the lifestyles of the population.

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The evidence keeps growing of health effects with BPA exposure, especially during pregnancy and childhood. To minimize BPA exposure try to use glass instead of plastic. Try to drink from and store liquids in glass containers, and do not microwave food in plastic dishes. From Medical Daily:

BPA Disrupts Sperm Production In Mice, Could Be Linked To Decreased Fertility In Men

BPA, or bisphenol A, is a chemical component of plastic that is often found in plastic food containers, plastic bottles, and thermal receipts. Now, a new study shows a direct link between this chemical and disrupted sperm production in mice. BPA disrupts the delicate DNA interactions needed to create sperm, say the Washington State University researchers.

Sperm counts have declined over the past few decades worldwide, scientists warn. In Denmark, more than 40 percent of young men have sperm counts in the infertility or decreased fertility range. Reports from other European countries, Japan, and the United States all tell the same story. Sperm counts, though, may be only the tip of the iceberg. Studies also document an increase in abnormalities of male reproductive organs, including undescended testicles, hypospadias (when the urethra opening is misplaced on the penis), and increased incidence of testicular cancer — a constellation of male disorders referred to as testicular dysgenesis syndrome. This syndrome is thought to result from exposure, during early development, to estrogens. BPA is an endocrine disrupting chemical with estrogenic activity. Could descending sperm counts and testicular dysgenesis syndrome be linked to early exposures to this chemical?

Hunt and her colleagues gave newborn male mice oral doses of BPA. They also exposed another group of mice to the synthetic estrogen, ethinyl estradiol, which is used in many formulations of hormonal contraceptives (such as birth control pills). They also exposed another group of mice to a placebo. ..The team discovered that the sperm of BPA exposed mice did a poorer job of meiosis, the process by which cells combine the genetic information of their parents. As a result, more sperm died."We have a window of just a few days and we permanently change the way that the testis makes sperm in the adult," says Hunt.Hunt worries that sperm counts will continue to go down with each exposed generation. 

Same study, but this write-up has more background. From Environmental Health News:

BPA exposure linked to changes in stem cells, lower sperm production

The study, published online today in PLoS Genetics, is the first to suggest that low, brief exposures to bisphenol-A, or other estrogens such as those used in birth control but found as water contaminants, early in life can alter the stem cells responsible for producing sperm later in life...These exposures – comparable to human exposures to the compounds -- caused “permanent alterations” to the stem cells responsible for sperm production, the authors wrote.

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Good news for those people who enjoy drinking a glass of orange juice each day. From NPR News:

What's More Nutritious, Orange Juice Or An Orange? It's Complicated

We all could probably eat more fruits and vegetables. But if forced to choose between whole fruit or a glass of juice, which one seems more healthful? The general advice is to opt for the fruit, since juices are stripped of the fiber – which most us don't get enough of — in whole fruit. And let's face it: Most juice contains a lot of sugar, which most of us consume too much of.

So our interest was piqued when we spotted a study suggesting that, when it comes to oranges, juice might actually unlock more carotenoids and flavonoids – both beneficial phytonutrients — than an equivalent amount of fruit.

To figure that out, German and Saudi researchers started with a big batch of fresh navel oranges. They analyzed the fruit in three forms: peeled segments, a mashed-up puree and as juice, both fresh-squeezed and pasteurized. They found that levels of vitamin C and carotenoids were basically the same in the juice and the unprocessed fruit, while levels of flavonoids were significantly lower.

But then the scientists threw their orange test foods into in a test tube model designed to mimic digestion, and that's when things got interesting: Much more of the carotenoids and flavonoids were released from the orange juice than from the fruit slices or mush. The differences were striking: Carotenoid release went up from nearly 11 percent in the fruit to 28 percent in the fresh juice, and up to 39.5 percent in the pasteurized juice. Meanwhile, flavonoids were boosted nearly five-fold in juice compared to fruit.

The findings, which appear in the Journal of Agricultural and Food Chemistry, are scientifically intriguing. For example, the researchers suspect heat may have something to do with the extra carotenoids released in pasteurized juice....That said, the new study "is in line with other studies that have found that nutrients in some fruits and vegetables are more bioavailable when the produce is chopped, mashed, juiced or prepared with oils," Blumberg notes in an email to The Salt.

Indeed, there's a whole avenue of research that is challenging our understanding of how to unleash the nutrition fixed inside fruits and veggies. For instance, as we've reported, we get more beta-carotene from tomatoes when we add a little fat like olive oil, and gently cooking carrots can coax them to release more nutrients. And while cooking broccoli for too long can destroy its antioxidants, chopping it is ideal.

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Exercise has health benefits at all ages! From Medical Xpress:

Study indicates exercise sharpens the young adult brain

Regular physical activity improves brain function even in young adults considered in their prime and at the height of cognitive ability, according to a new University of Otago study.

They took 52 tertiary students, aged from 18 to 30, and put them through a series of cognitive tests on a computer while measuring oxygen availability in the frontal lobe of their brains, as well as their self-reported exercise frequency. Dr Machado says their "surprising" findings, just published online in the journal Psychophysiology, show that both blood supply to the brain and cognitive functioning appear to benefit from regular exercise in young adults.

"This provides compelling evidence that regular exercise, at least 5 days per week, is a way to sharpen our cognitive ability as young adults – challenging the assumption that living a sedentary lifestyle leads to problems only later in life," she says... "The exercise could involve brisk walking or more vigorous activity, and could be made up of a few 10 minute bouts of exercise, rather than one single block of exercise," she says.

The researchers also found that body mass index was not a key factor in how well the brain functioned, indicating that regular engagement in physical activity may be more important than body weight.

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Over the past year I have seen a number of studies looking at alcohol consumption and health effects. Overall it seems that the effects of alcohol are complex and frequently result in a J-curve: abstainers have a higher mortality rate or problems, light or moderate drinkers do the best, and then heavier drinkers have the most problems and higher mortality rates. The following two studies support this. From Science Daily:

Drinking moderate amounts of alcohol is linked to reduced risk of heart failure, large study finds

Evidence already exists for the beneficial effects of drinking moderate amounts of alcohol on the risk of developing a number of heart conditions; however, the role it plays in the risk of developing heart failure has been under-researched with conflicting results. Now, a large study of nearly 15,000 men and women shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.

They defined a drink as one that contains 14g of alcohol, equivalent to approximately one small (125ml) glass of wine, just over half a pint or a third of a litre of beer, and less than one shot of liquor such as whisky or vodka. The study participants were divided into six categories: abstainers (people who recorded having drunk no alcohol at every visit by the researchers), former drinkers, people who drank up to seven drinks a week, or between 7-14 drinks, 14-21 drinks, or 21 or more drinks a week.

From Science Daily:

If you're over 60, drink up: Alcohol associated with better memory

For people 60 and older who do not have dementia, light alcohol consumption during late life is associated with higher episodic memory -- the ability to recall memories of events -- researchers report.

Moderate alcohol consumption was also linked with a larger volume in the hippocampus, a brain region critical for episodic memory. The relationship between light alcohol consumption and episodic memory goes away if hippocampal volume is factored in, providing new evidence that hippocampal functioning is the critical factor in these improvements.

Findings from animal studies suggest that moderate alcohol consumption may contribute to preserved hippocampal volume by promoting generation of new nerve cells in the hippocampus. In addition, exposing the brain to moderate amounts of alcohol may increase the release of brain chemicals involved with cognitive, or information processing, functions.

Although the potential benefits of light to moderate alcohol consumption to cognitive learning and memory later in life have been consistently reported, extended periods of abusing alcohol, often defined as having five or more alcoholic beverages during a single drinking occasion is known to be harmful to the brain.

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Even though the researchers said this was a "preliminary study"(looking only at non-Hispanic whites), what was good was that results are based on a very large sample size. Coffee drinkers can definitely feel that they are doing something beneficial for their health. From Medical Xpress:

Coffee may be associated with a lower risk of malignant melanoma

Both epidemiological and pre-clinical studies have suggested that coffee consumption has a protective effect against non-melanoma skin cancers. However the protective effect for cutaneous melanoma (malignant and in situ) is less clear, according to a study published January 20 in the Journal of the National Cancer Institute.

To determine if there is an association between coffee consumption and risk of cutaneous melanoma, Erikka Loftfield, M.P.H., of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, and colleagues used data from the NIH-AARP Diet and Health Study. Information on coffee consumption was obtained from 447,357 non-Hispanic white subjects with a self-administered food-frequency questionnaire in 1995/1996, with a median follow-up of 10 years. 

Overall, the highest coffee intake was inversely associated with a risk of malignant melanoma, with a 20% lower risk for those who consumed 4 cups per day or more. There was also a trend toward more protection with higher intake, with the protective effect increasing from 1 or fewer cups to 4 or more. However, the effect was statistically significant for caffeinated but not decaffeinated coffee and only for protection against malignant melanoma but not melanoma in-situ, which may have a different etiology.

The researchers point out that the results are preliminary and may not be applicable to other populations, and therefore additional investigations of coffee intake are needed. 

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This is very exciting research if it holds up. Basically a bacterial cause for urologic chronic pelvic pain syndrome (UCPPS), also known as non-bacterial chronic prostatitis, means that it is really a urinary tract infection. Bacteria were found that can only be found with state of the art genome sequencing, and NOT with ordinary cultures. From American Microbiome Institute:

Bacteria may be responsible for chronic prostatitis

Some people suffer from an enigmatic diagnosis known as ), also known as non-bacterial chronic prostatitis.  UCPPS’s symptoms are rather similar to urinary tract infections (UTI’s), with a conspicuous lack of a bacterial cause.  In order to diagnose UCPPS doctors must do a bacterial culture of the urine, and if no bacteria grow then the UCPPS diagnosis may be given. 

While many believe that this disease may be caused by stress or hormone imbalances, a team of researchers from across the U.S. and Canada investigated if there was a bacterial cause.  As we know, much of the microbiome is unculturable, and can only be identified through genome sequencing.  These researchers hypothesized that bacteria are the true cause of UCPPS, and that UCPPS is similar to UTI, only the bacteria are unculturable, and so basic hospital screens for the bacteria fail to identify them.  The scientists recently published the results of their study in The Journal of Urology.

The researchers did genome analyses on 110 urine samples from male patients suffering from UCPPS and 115 urine samples from normal males with no UCPPS diagnosis.  The results showed that both the groups had approximately 75 bacteria in their urine, all of which would unlikely have cultured in normal hospital assays.  When they compared the types of bacteria between the groups they noticed that Burkholderia cenocepacia was highly abundant in patients with UCPPS but not the control group.  Interestingly, this species had been previously identified as a possible urologic pathogen.

The study had a number of limitations, and the authors admit as much.  For example, it is unclear their sampling procedures would adequately identify any bacteria causing biofilms, and they limited the study to bacteria so fungi and viruses went untested.  Still, it is compelling evidence for a bacterial cause to a disease that had previously been thought to not have a bacterial origin.  These findings really speak to what prominent microbiome scientist, and member of the AMI’s scientific advisory board, Rob Knight recently said in an interview with NPR:  “When you consider the number of diseases where, just over the last five years, it went from being crazy to think the microbes were involved to now being crazy to think the microbes aren't involved, it's amazing how rapidly the evidence has been accumulating.”

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I feel like I'm posting the same thing over and over as study after study finds the same or similar results. Bottom line: sitting much is bad for health, so get up and move (walks are good). The more you move or exercise, the better for health.

From Science Daily: Sitting for long periods increases risk of disease and early death, regardless of exercise

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study.

"More than one half of an average person's day is spent being sedentary -- sitting, watching television, or working at a computer," said Dr. David Alter, Senior Scientist, Toronto Rehab, University Health Network (UHN), and Institute for Clinical Evaluative Sciences. "Our study finds that despite the health-enhancing benefits of physical activity, this alone may not be enough to reduce the risk for disease." The meta-analysis study reviewed studies focused on sedentary behaviour.

The authors found the negative effects of sitting time on health, however, are more pronounced among those who do little or no exercise than among those who participate in higher amounts of exercise."The findings suggest that the health risk of sitting too much is less pronounced when physical activity is increased," said Biswas. 

In the interim, Dr. Alter underlines strategies people can use to reduce sitting time. The target is to decrease sedentary time by two to three hours in a 12-hour day...For example, at work, stand up or move for one to three minutes every half hour; and when watching television, stand or exercise during commercials."

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After my January 9, 2015 post I was asked more about the microbial differences in babies who had been born by cesarean vs vaginal deliveries. What could be done about this? Should this be of concern when C-section rates in some places are approaching 50% of all births?

Well, some researchers are concerned, including Dr. Dominguez-Bello, who is doing ground-breaking research in this area. She is doing a long-term study in which babies born by cesarean section are immediately swabbed with a gauze cloth laced with the mother's vaginal fluids and resident microbes. Several (but not all) articles that I looked at said that the gauze is a "saline-soaked gauze".

Summary of the method:1) Incubate gauze in mother's vagina for 1 hour 2) Extract gauze before C-section  3) Expose newborn to the vaginal gauze (Mouth first, then face, then rest of body). If for some medical reason they don’t (and there is a C-section), then this is a restoring intervention.

Note that Dr. Dominguez-Bello always first checks to make sure the mother is HIV-negative and strep-B negative, and showing no signs of a STD. The basic premise is that babies should have crossed the mother's birth canal to be "seeded" with the mother's microbes, but if for some medical reason they don’t (and there is a C-section), then this is a (somewhat) restoring intervention.

From Feb. 2014 New York Academy of Sciences: Hats Off to Bacteria!

Why are bacteria in the body? What do we, and the bacteria, gain from this arrangement? And who's in charge? "There is a dialogue," Dominguez-Bello said, "sometimes a fight, sometimes a good dialogue. We have evolved with them. The first form of life on Earth was bacteria. Whatever came after had to deal with bacteria, cope with bacteria, associate with bacteria ...  ...continue reading "Can Missing Birth Canal Bacteria Be Restored to Cesarean Birth Babies?"