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 The following article supported what I have been reading over the past few years: that medical tests and treatments also have downsides, that it is possible to "know too much", that more harm than benefits can occur from certain tests, procedures, and medicines, and lifestyle changes (eat a less processed more plant-based diet, move more, and don't smoke) can be better than some medicines or certain procedures. The doctor mentioned in this article (Dr. H. Gilbert Welch) recently published a book aimed at the general public which I just read and highly recommend: Less Medicine, More Health. Dr. Welch is an academic physician, a professor at Dartmouth Medical School, and a nationally recognized expert on the effects of medical testing. In 2012 he published the well regarded and more technical and in-depth book on this issue: Overdiagnosed: Making People Sick in the Pursuit of Health. From The Atlantic:

The Downside of Medical Screening

If you had a disease, and you could find out sooner rather than later, why wouldn’t you?Medicine has long focused on early detection of diseases as part of a move toward preventive care. But imperfect tests, false positives, and overdiagnosis mean that sometimes the tests do more harm than good, and in recent years, there have been more recommendations to reduce some kinds of screening, including pap smears, colonoscopies, mammograms, and even annual pelvic exams.

“This is something we all need to understand, the two sides of early detection. It does help people, but it’s almost guaranteed to harm others,” said H. Gilbert Welch, a professor of medicine, public policy, and business administration at Dartmouth College, and author of the book Should I Be Tested for Cancer? (He reveals his answer in the book’s subtitle: “Maybe not.”)

The more you look for disease, the more you find it. And in the case of cancer, it’s hard for doctors to know if what they find is dangerous and needs to be addressed, or if it’s just a small tumor that won’t grow and poses no threat. “We can’t be sure which is which, so we treat everybody,” Welch explained at the Aspen Ideas Festival’s Spotlight Health session. “That means we’re treating people who will never experience problems from their disease.”

But they may experience problems from the treatment.The panel gave the example of prostate cancer, which is very common in men—one in seven American men will be diagnosed with it in their lifetimes. “But it turns out a lot of these cancers are very indolent,” said Jessica Herzstein, a preventive-medicine consultant and member of the U.S. Preventive Services Task Force. Around 30 to 40 percent of men who’ve been treated for prostate cancer likely had “slow-growing tumors that would never have become a threat to the man’s lifespan or health,” according to the Prostate Cancer Foundation.

In other words, “you’re going to die with them, not of them,” Herzstein said, “and the treatments are very very harmful.” Radiation therapy, for example, can cause incontinence and erectile dysfunction, and hormone therapy can cause osteoporosis and depression.

The possibility of a false positive is another downside. Not only could it lead to more invasive follow-up tests or treatments that aren’t needed, but it can also give patients unnecessary anxiety.“If we resolve the test by saying ‘The test was wrong, you’re fine!’, that’s one thing,” Welch said. “But most false alarms aren’t resolved that way. [It’s more like] ‘You don’t have cancer, but you have some abnormality that possibly puts you at a higher risk for cancer, but we’re not going to do anything about it. I think that’s where there can be [mental] harm.”

Ultimately, it comes down to a weighing of the benefits and the harms, and, in the absence of clear evidence, the preferences of the patient. The U.S. Preventive Services Task Force helps identify which tests are beneficial by evaluating and grading them. It gives tests an A if there’s a high certainty of substantial benefit, a B if there’s moderate certainty of substantial benefit, a C if there’s moderate certainty of a small benefit, a D if there’s moderate or high certainty of no benefit, and an I if the evidence is just too insufficient to say.

The task force gave prostate cancer screening a D. HIV screening got an A. For breast cancer screening, an always-controversial topic, the results vary. Breast self-exams got a D. Mammograms got a B, but only for women between 50 and 74 years old. For women in their 40s, the grade is a C, meaning the task force recommends patients and physicians discuss and decide together.

Before getting a screening test, patients should think about what would happen if they get a positive result, and if they’d be ready for it, Welch advised. “If I were to go through this, and have this diagnosis, would I want to have this surgery?” Herzstein asked, posing a hypothetical. Would you want to undergo the biopsy, the chemo, whatever treatments come next? “Maybe you don’t even want to go there if there is no treatment for the disease,” she added. Welch gives an example. “With Alzheimer’s disease that’s a fundamental question: What are you going to do with a positive result?” he asked. 

Huh - all that talk and research for years about the first born being the smartest and most responsible. Yes...but according to this large study comparing 377,00 high school students from different families, the differences are so small as to be meaningless (1 IQ point!). Researchers looking within-families (studying siblings within families) say that the effects are larger. Depends on who you want to believe. And this study did not look at the siblings later in life - at achievements, etc. From Medical Xpress:

Birth order has no meaningful effect on personality or IQ, massive study reports

For those who believe that birth order influences traits like personality and intelligence, a study of 377,000 high school students offers some good news: Yes, the study found, first-borns do have higher IQs and consistently different personality traits than those born later in the family chronology. However, researchers say, the differences between first-borns and "later-borns" are so small that they have no practical relevance to people's lives. The analysis found - as a previous large-scale study did - that first-borns enjoy a one-IQ-point advantage over later-borns, Damian said. The difference is statistically significant but meaningless, she said.

The analysis also revealed consistent differences in personality traits between first-borns and later-borns - first-borns tended to be more extroverted, agreeable and conscientious, and had less anxiety than later-borns, for example - but those differences were "infinitesimally small," amounting to a correlation of 0.02, Roberts said. "But in terms of personality traits and how you rate them, a 0.02 correlation doesn't get you anything of note. You are not going to be able to see it with the naked eye. You're not going to be able to sit two people down next to each other and see the differences between them.."

The study controlled for potentially confounding factors - such as a family's economic status, the number of children and the relative age of the siblings at the time of the analysis - that might skew the results, Damian said. For example, wealthier families tend to have fewer children than other families, and so have a higher proportion of first-borns who also have access to more resources that may influence their IQ or personality, she said.

Many previous studies of birth order suffered from small sample sizes, Damian said. Many compared children with their siblings - a "within-family" design that some assert is better than comparing children from different families, as the new analysis did.

The team also evaluated a subset of the children in the study - those with exactly two siblings and living with two parents. This allowed the researchers to look for specific differences between first- and second-borns, or second- and third-borns. The findings confirmed those seen in the larger study, with specific differences between the oldest and a second child, and between second and third children. But the magnitude of the differences was, again, "minuscule," Roberts said.

There used to be alternative medicine, but it has evolved to what is now called integrative medicine. There are integrative centers even at some if the most prestigious medical institutions in the USA (Harvard, Mayo Clinic,etc). Integrative medicine is part of the medical establishment, so there is an emphasis on treatments that can be scientifically investigated, and conventional medical treatments are also used as needed. But there is a concern with wellness, with looking at the whole body, at prevention and treating chronic diseases (such as heart disease and diabetes) that take years to develop and are tied to the ways people think, feel, and live their everyday lives (so they look at stress, diet, lifestyles).

What I especially like is the quote taught in medical schools: “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half.” That alone is a good reason for a person to take responsibility for living the most healthy lifestyle that they can (to focus on wellness and prevention), rather than depending on medicines for "treatments" and "cures". Excerpts from The Atlantic:

The Evolution of Alternative Medicine

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking.... That was the decade when doctors started to realize just how many Americans were using alternative medicine, starting with a 1993 paper published in The New England Journal of Medicine. The paper reported that one in three Americans were using some kind of “unconventional therapy.” Only 28 percent of them were telling their primary-care doctors about it.

Enough Americans had similar interests that, in the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine (NCCAM), with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing.Some thought the NCCAM’s work was too far outside the mainstream....

In an email, Briggs confirmed that her center’s mission has shifted over the years...”That change became more pronounced a few months ago, when Congress removed the word “alternative” from the NCCAM’s name, redubbing it the National Center for Complementary and Integrative Health (NCCIH). 

The idea of alternative medicine—an outsider movement challenging the medical status quo—has fallen out of favor since my youth. Plenty of people still identify strongly with the label, but these days, they’re often the most extreme advocates, the ones who believe in using homeopathy instead of vaccines, “liver flushes” instead of HIV drugs, and garlic instead of chemotherapy. In contrast, integrative doctors see themselves as part of the medical establishment. “I don’t like the term ‘alternative medicine,’” says Mimi Guarneri, a longtime cardiologist and researcher who founded the Academy of Integrative Health and Medicine as well as the integrative center at Scripps. 

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine. There are 50 institutions around the country that have integrative in their name, at places like Harvard, Stanford, Duke, and the Mayo Clinic. Most of them offer treatments like acupuncture, massage, and nutrition counseling, along with conventional drugs and surgery.

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

It’s hard to talk about integrative health without using abstract terms like wellness, vitality, and healing...For a long time, though, the medical profession was so busy treating acute illness that it didn’t put as much attention on preventing heart disease, diabetes, or cancer...The bigger problem, says Hyman, is that most doctors aren’t well equipped to treat chronic disease. “We have an acute-disease system for a chronic-disease population,” he told me. “The whole approach is to suppress and inhibit the manifestations of disease.” 

The question is how integrative doctors try to restore balance—and the answer varies. Many of them focus on diet to a degree that goes far beyond the usual guidelines about avoiding salt or trans fat. They’ll look for undiagnosed food sensitivities or hormonal imbalances, with the idea that these problems account for many chronic health complaints and cause even more serious breakdowns over time. There’s a lot of emphasis on intestinal bacteria. “We now know that so many separate things are linked to what’s going on in the gut,” Hyman told me, alluding to a growing body of literature linking the microbiome to everything from cancer to mood disorders. Guarneri, the cardiologist who founded the integrative center at Scripps, told me integrative health is highly personalized

Integrative doctors tend to favor treatments that are—as Briggs, the NCCIH director, put it—“amenable to scientific investigation.” Several of the doctors I interviewed told me they don’t prescribe homeopathic remedies, for instance, because there’s no evidence to support them....When integrative doctors do employ alternative-seeming treatments, it’s usually to manage pain or reduce stress. 

Aside from these variations, there’s another reason it’s hard to define integrative health: It doesn’t exist in a vacuum. Its practitioners are part of the same medical establishment as other doctors, going to the same conferences and publishing in the same journals. They’ve influenced and been influenced by major trends in medicine—for instance, the movement toward patient-centered medicine, or the backlash against the overuse of drugs and surgery that the New Yorker writer Atul Gawande calls “the epidemic of unnecessary care.”

Data: CDC Report on Multiple Chronic Conditions Among Adults; Chart: Lauren Giordano / The Atlantic

When Blackwelder teaches family medicine at East Tennessee University, he says he reminds his students to stay open to treatments that once seemed esoteric, as long as they show some promise. “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half,” he says. “We find things out by remaining inquisitive, being open to exploring new ideas when a question is asked. We should never just say we’ve got it all figured out, because we rarely do.”At a time when one in two American adults has at least one chronic disease, it’s safe to say there are a lot of things medicine still hasn’t figured out. 

Elderly people (average age was 77 years) who have been married a long time (average length of marriage was 44 years, but one couple was married 76 years!) give advice on marriage and love. The gerontologist  Karl Pillemer details the finding of the Cornell Marriage Advice Project in his book, "30 Lessons for Loving: Advice from the Wisest Americans on Love, Relationships, and Marriage."  From Science Daily:

Love, factually: Gerontologist finds the formula to a happy marriage

A gerontologist has uncovered common advice for couples walking down the aisle or decades into marriage. To capture the voice of lived experience, the study included a random national survey of nearly 400 Americans age 65 and older, asking how to find a compatible partner and other advice on love and relationships. In subsequent in-person interviews with more than 300 long-wedded individuals -- those in unions of 30, 40, 50, or more years -- the study captured more insights for overcoming common marriage troubles. The team of researchers interviewed divorced individuals, too, asking how others might avoid marital breakups.

Pillemer uncovered common advice for couples walking down the aisle or decades into marriage. The top five lessons from the elders..:

Learn to communicate: "For a good marriage, the elders overwhelmingly tell us to 'talk, talk, talk.' They believe most marital problems can be solved through open communication, and conversely many whose marriages dissolved blamed lack of communication."

Get to know your partner very well before marrying: "Many of the elders I surveyed married very young; despite that fact, they recommend the opposite.

Treat marriage as an unbreakable, lifelong commitment

Learn to work as a team: ...Concretely, this viewpoint involves seeing problems as collective to the couple, rather than the domain of one partner. Any difficulty, illness, or setback experienced by one member of the couple is the other partner's responsibility."

Chose a partner who is very similar to you: "Marriage is difficult at times for everyone, the elders assert, but it's much easier with someone who shares your interests, background and orientation. The most critical need for similarity is in core values regarding potentially contentious issues like child-rearing, how money should be spent and religion."

There is growing evidence that women around a lot of endocrine disrupting chemicals at home or in jobs such as cleaners, hairdressers and laboratory workers during pregnancy are more likely to have baby boys with a genital defect called hypospadias (a condition where the opening of the urethra is on the underside of the penis rather than at the tip). From Environmental Health News:

Genital defect in baby boys linked to moms’ chemical exposure

Mothers around a lot of endocrine disrupting chemicals at home or in jobs such as cleaners, hairdressers and laboratory workers during pregnancy are more likely to have baby boys with a genital defect, according to a new study in the south of France.The study adds to mounting evidence that fetal exposure to chemicals that mimic people’s natural hormones may cause hypospadias, a condition where the opening of the urethra is on the underside of the penis rather than at the tip.

French researchers examined more than 600 children in the south of France and found that babies exposed to endocrine disrupting chemicals while their genitals were developing were more likely to suffer from hypospadias. Half the boys had hypospadias and half did not. The risk for those exposed was 68 percent higher than the unexposed boys. The researchers ruled out baby boys with known genetic risks for such defects.

The defect, which can be minor or quite severe depending on how far the opening is from the tip, can lead to problems with urination and, later in life, sexual difficulty....It is one of the most common genital defects in baby boys, and most cases require surgery, often done before they reach two years old. In the United States, an estimated five out of 1,000 boys are born annually with hypospadias, while Europe’s rate is slightly less than two out of 1,000.

The researchers estimated the unborn babies’ exposure by looking at their parents’ jobs and where they lived. Working with hormone disrupting chemicals and living in homes near heavy polluters were both linked to more baby boys having the defect. However, the researchers did say a limit of the study was attempting to estimate fetal exposure to such chemicals.Mothers were most likely to have boys with hypospadias if they worked as a cleaner, hairdresser or beautician.  

Some of the endocrine disrupting chemicals linked to the professions involved in the study were bisphenol-A (BPA), phthalates, polychlorinated compounds, alkylphenolic compounds and organic solvents. Most exposures—78 percent—occurred in the window of development when babies’ genitals are forming.... but detergents, pesticides, and cosmetics accounted for 75 percent of the cases,” the authors wrote in the study published in the European Urology journal this month.

Other possible causes of the birth defect include older, obese mothers, and fertility or hormone treatments during pregnancy, according to the U.S. Centers for Disease Control and Prevention.

This wasn’t the first time scientists have found a link between certain chemicals and hypospadias. Mothers in southeast England who were heavily exposed to endocrine disrupting phthalates on the job were about three times as likely to have a baby boy with hypospadias. Phthalates are used in some cosmetics, fragrances, food packaging and PVC plastics.

Looks like another procedure is found not to be beneficial and possibly harmful - this time arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones). The researchers also found that "exercise therapy" had more benefits. From Medical Xpress:

Benefit of knee surgery for middle aged or older patients 'inconsequential', say experts

The benefit of surgery for middle aged or older patients with persistent knee pain is inconsequential and such surgery is potentially harmful, say researchers in a study published in The BMJ this week.Their findings do not support arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones).

The article is part of The BMJ's Too Much Medicine campaign - to highlight the threat to human health and the waste of resources caused by unnecessary care. Over 700,000 knee arthroscopies (a type of keyhole surgery) are carried out in the USA and 150,000 in the UK each year on middle aged and older adults with persistent knee pain. Yet the evidence for arthroscopic surgery is known to be weak, with all but one published trials showing no added benefit for surgery over control treatment.Despite this, many specialists are convinced of the benefits of surgery.

So researchers based in Denmark and Sweden reviewed the results of 18 studies on the benefits and harms of arthroscopic surgery compared with a variety of control treatments (ranging from placebo surgery to exercise) for middle aged and older people with persistent knee pain.s.

Overall, surgery was associated with a small but significant effect on pain at three and six months (but no longer) compared with control treatments. No significant benefit on physical function was found. A further nine studies reporting on harms found that, although rare, deep vein thrombosis (DVT) was the most frequently reported adverse event, followed by infection, pulmonary embolism (a blockage of the main artery of the lung), and death.

"Interventions that include arthroscopy are associated with a small benefit and with harms," say the authors, and the benefit is "markedly smaller than that seen from exercise therapy." These findings "do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis," they conclude.

"It is difficult to support or justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo," argues Professor Andy Carr from Oxford University in an accompanying editorial.

 

A wonderful commentary by Dr. Mandrola about recent research of almost 500,000 UK citizens. Researchers found that just asking the patient several basic questions was a better predictor of 5 year mortality than all sorts of blood tests, measurements, and analyses. The best basic questions were: Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions were the best predictors of staying alive in the next 5 years. These excerpts are from Medscape:

Health Is Not Complicated—Just Ask the Patient

It turns out predicting health is not so complicated. Nor is it digital at all. For persons of middle age (40 to 70 years), self-reported overall health and walking speed were the best predictors of death in the next 5 years, according to a study published this week in the Lancet.[1]

In an analysis of nearly 500,000 UK citizens followed for 5 years, these two simple questions outperformed 655 measurements of demographics, health, and lifestyle. Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions, inquiries that hardly require a digital device, were the best predictors of staying alive in the next 5 years.

Pause for a moment here and ponder the beauty of that top-line result. Half a million people followed for 5 years; 655 measures of health, including heart rate, blood pressure, and lab tests, and the best predictors were that simple.

In the 5 years of follow-up, 8532 (1.7%) subjects died. Overall, cancer was the most common cause of death (53% in men; 69% in women). The most common cancer-related cause of death was lung cancer in men (n=546) and breast cancer in women (n=489). Cardiovascular disease was the second leading cause of death (26% in men; 33% in women).

 

There were gender differences in predictors of death. Self-reported health was the strongest predictor of death in men (C index 0.74). In women, a previous cancer diagnosis was the strongest predictor (C index 0.73).Self-reported walking pace was a strong predictor of death in both men and women (C index 0.72 and 0.69, respectively.) For example, a man aged 40 to 52 years who reported a slow walking pace was 3.7 times more likely to die than a similarly aged man who reported a steady walking pace. In a large subset of subjects with no reported health conditions, smoking was the best predictor of mortality.

 

The final, and perhaps niftiest, aspect of this study was that researchers developed an 11 to 13 question risk prediction score, which they then put on an interactive website. Anyone can answer these simple questions and get their health-related age relative to the UK population. The researchers call this age the UK Longevity Explorer (UbbLE) age.

I am drawn to these findings because they emphasize something that is increasingly lost on both doctors and patients. True health is not complicated. And the big picture is still useful.Any experienced clinician will testify that patients know when they are well and when they are not. The finding that self-reported health predicts death urges clinicians, generalists and specialists alike, to ask our patients how they feel about their health.

Then there is the matter of self-reported walking pace. How easy it is to be distracted by digital data. We walk into the exam room to see our patient. He is still. We look at him. We poke and listen to his body. We assess his ECG and other measures. Soon we will review his smartphone metrics and DNA data. Yet we tend to forget the obvious: to move is to be healthy. Drs Ganna and Ingelsson teach us that to move briskly may be healthier.

Stop drinking soda every day! Research finds that a daily sugar-sweetened beverage habit may increase the risk for non-alcoholic fatty liver disease (NAFLD). Earlier research has already linked daily sugar-sweetened beverages (typically soda) to type 2 diabetes and cardiovascular disease. And try to avoid high-fructose corn syrup in general (found in many highly processed foods) . From Medical Xpress:

Daily sugar-sweetened beverage habit linked to non-alcoholic fatty liver disease

A daily sugar-sweetened beverage habit may increase the risk for non-alcoholic fatty liver disease (NAFLD), researchers from the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HRNCA) at Tufts University report today in the Journal of Hepatology.

The researchers analyzed 2,634 self-reported dietary questionnaires from mostly Caucasian middle-aged men and women enrolled in the National Heart Lunch and Blood Institute (NHLBI) Framingham Heart Study's Offspring and Third Generation cohorts....The participants underwent a computed tomography (CT) scan to measure the amount of fat in the liver and the authors of the current study used a previously defined cut-point to identify NAFLD. They saw a higher prevalence of NAFLD among people who reported drinking more than one sugar-sweetened beverage per day compared to people who said they drank no sugar-sweetened beverages.

The relationships between sugar-sweetened beverages and NAFLD persisted after the authors accounted for age, sex, body mass index (BMI), and dietary and lifestyle factors such as calorie intake, alcohol, and smoking. In contrast, after accounting for these factors the authors found no association between diet cola and NAFLD.

NAFLD is characterized by an accumulation of fat in the liver cells that is unrelated to alcohol consumption. NAFLD is diagnosed by ultrasounds, CT, MRI, or biopsy, and many of the approximately 25% of Americans with the disease don't experience any symptoms. Being obese or overweight increases the risk for NAFLD and people with NAFLD are at greater risk of developing cardiovascular disease and type 2 diabetes.Sugar-sweetened beverages are a major dietary source of fructose, the sugar that is suspected of increasing risk of NAFLD because of how our bodies process it.

Textbooks will have to be rewritten with the recent discovery of a system of lymphatic vessels that are a direct link from the immune system to the brain. Amazing that after centuries of studying people, that only now was this system detected (but they are very small and they follow a major blood vessel down into the sinuses). After extensive research,  the researchers determined that these vessels carry both fluid and immune cells from the cerobrospinal fluid, and that they exist in humans. The discovery reinforces findings that immune cells are present even within healthy brains, a notion that was doubted until recently.From Medical Daily:

Discovery Of 'Missing Link' Between Brain And Immune System Could Change How Disease Is Studied

The recent discovery of a "missing link" between the brain and the immune system may lead to a complete revision of biology textbooks. The link, vessels of the lymphatic system that run through the sinuses, were previously unidentified and thought not to exist. However, the true significance of the discovery lies in the potential effects this finding could have on both the study and treatment of neurological diseases such as Alzheimer’s disease and multiple sclerosis.  

The newly discovered "central nervous system lymphatic system vessels" follow a major blood vessel down into the sinuses, an area that has been traditionally difficult to obtain images of. Their presence is causing a stir in the medical world, as the researchers responsible believe the vessels may help to explain current medical mysteries, such as why patients with Alzheimer’s disease have accumulations of large protein plaques in the brain.

The fascinating discovery was made by researchers at the University of Virginia School of Medicine, and a study on the finding is currently available in the online journal Nature....Using a recently developed method, the team mounted the meninges, the membranes covering the brain, on a single slide so that they could be better observed. Only after doing this were they able to notice the brain’s elusive lymphatic vessels.   "It's so close to the blood vessel, you just miss it," Kipnis said. "If you don't know what you're after, you just miss it."

The team believes that the “missing link” between the brain and the immune system could explain why some diseases like Alzheimer’s can cause plaque buildup in the brain. Kipnis believes this plaque may be the result of the meningeal lymphatic vessels not efficiently removing buildup before it reaches the brain. Although scientists are currently not sure what causes cell death and tissue loss in the brains of those with Alzheimer’s, this plaque buildup is believed to play a role.

It’s not just the presence of plaque in the brain that the researchers hope this discovery can shed light on. According to Kipnis, this discovery could completely change the way we perceive the neuro-immune interaction.“We believe that for every neurological disease that has an immune component to it, these vessels may play a major role,” Kipnis said. “Hard to imagine that these vessels would not be involved in a [neurological] disease with an immune component.”The vessels also appear to look different with age, which has lead the researchers to suggest that they may play a role in the aging process.

 

Maps of the lymphatic system: old (left) and updated to reflect UVA's discovery.   Credit: University of Virginia Health System

Low levels of vitamin D are associated with low levels of testosterone in healthy middle-aged men. Note that hypovitaminosis D means low levels of vitamin D in the blood, defined by a lab test as "25-hydroxyvitamin D level below 30.0 ng/LInterestingly, being overweight also seems to lower the testosterone level, and losing weight raises the level, and supplementing with vitamin D may raise the testosterone level in those with low levels (the German study mentioned in the article). And research with mice suggests that there is something about testosterone synthesis that needs vitamin D. From Medscape:

Low Vitamin D Tied to Testosterone Dip in Healthy Men

Low levels of vitamin D are significantly and independently associated with low levels of testosterone in otherwise healthy middle-aged men, according to a study presented at the American Urological Association 2015 Annual Meeting in New Orleans. 

In this new analysis of data from of the World Trade Center CHEST program, blood samples from 824 men were analyzed for various parameters, such as 25-hydroxyvitamin D and total testosterone. Hypovitaminosis D was defined as a 25-hydroxyvitamin D level below 30.0 ng/L.

Level of 25-hydroxyvitamin D were insufficient in 68% of the samples....Total testosterone was higher in men with normal levels of 25-hydroxyvitamin D than in men with lower levels...."subjects with hypovitaminosis D still had significantly lower total testosterone than those with normal total testosterone (P = .019)," Dr McLaughlin and her colleagues report. When levels of 25-hydroxyvitamin D were lower, body mass index was higher than when levels were normal (30.8 vs 29.12 kg/m²; P < .001), waist circumference was greater (41.3 vs 39.8 inches; P < .001), and lipid profiles were less favorable.

In previous studies, testosterone levels were shown to be lower in mice who had the vitamin D receptor genetically deleted, said Dr McLaughlin."This suggests that there is something about testosterone synthesis that needs vitamin D," she explained.

In a small German study of healthy overweight men with a low baseline level of 25-hydroxyvitamin D and testosterone levels at the lower end of the reference range, there was a significant increase in total testosterone levels after 12 months of vitamin D 3000 IU daily (Horm Metab Res. 2011;43:223-225)...the German study was primarily a weight-loss study, and weight loss in and of itself causes increases in testosterone."We see that in patients who undergo bariatric surgery to remove visceral fat," he explained. "Once the weight loss has taken place, their testosterone levels normalize independent of anything else."