Posted by: Chris Maloney | February 4, 2016

Has Zika Virus Always Been An STD (Sexually Transmitted Disease)?

Since the confirmed case of Zika Virus passing through sex in Texas, the CDC has issued a warning to pregnant mothers to avoid unprotected sex. They include every possibility, including oral transmission of the virus. But despite that warning, it may not be enough. If Zika Virus can be transmitted in the saliva as well as the blood (and it is found in both fluids) then unprotected sex is only one route of possible transmission.

Previously, I wrote that Zika Virus had been confirmed transmitted sexually, so it is nice to see that reconfirmed again. I’m never sure why it has to be reconfirmed inside the United States before we issue warnings.

With the new confirmation, the old maps of Zika Virus transmission in Africa take on new meaning. Think about the transmission as coming from mosquitoes or humans. Those mosquitoes needed to do a lot of traveling to make those leaps, but humans move from location to location. Since we’ve known that Zika Virus is found in the blood and saliva of humans for years now, it seems clear human transmission has been going on all along.

I think the reality we must face is that a disease like the Zika Virus doesn’t really enter our consciousness in the U.S. until it arrives in the U.S. It’s like we imagine we have a border that resists viral infection as well as immigration. How many other viruses are ravaging other countries now that we’re not being told about because they haven’t yet shown up in the U.S.?

Figure2

Posted by: Chris Maloney | January 29, 2016

What Is Zika Virus And What Does It Do To Babies?

If you get bitten by the wrong mosquito, you could get Zika virus. It normally causes mild illness in adults: fever, rash, joint pain, and conjunctivitis (red eyes).

But the biggest problem is that it may cause birth defects in unborn babies. It may cause the babies to be born with very small heads (microcephaly). But this scare is based on 35 babies within Brazil, and was not yet confirmed by other studies. Previous reports have shown that mothers pass the virus on to their unborn children. No previous reports talk about microcephaly, and the CDC still considers it confirmed.

Before May of 2015 Zika virus was confined to areas of Africa, Southeast Asia, and the Pacific Islands. In May of 2015 it was reported in Brazil. Now we’re getting reports of it spreading far more widely. Here’s the CDC’s map:

zik-world-map_active_01-26-2016_web_2

The map doesn’t give you a true sense of the problem. The Brazilian ministry of health estimates that at least half a million people in Brazil have come down with the Zika virus this year.

The U.S. should be concerned since the virus seems to be growing very rapidly. One journal reports that the first case of Zika virus has been confirmed in Texas. Two years ago an imported case was confirmed in Germany.

Given the rapid transmission this year, we should be looking at other forms of transmission beyond mosquito bites. Zika virus has been found in both the blood and saliva of those infected. A man in Tahiti developed symptoms that resolved and then returned eight weeks later. Two weeks after the second bout resolved he noticed blood in his semen at the same time that his wife developed symptoms of Zika infection.

First isolated in Uganda in 1947, Zika virus has two major strains: Asian and African. During the past decade, ZIKV has caused 2 large epidemics in Micronesia and French Polynesia. “Since January 2012, the Pacific is experiencing a high burden of mosquito-borne disease due to concurrent epidemics of dengue, chikungunya and Zika virus infections. So far over 120,000 people have been reported to be affected… this epidemic wave of mosquito-borne viruses with 28 new mosquito-borne viral outbreaks… is unprecedented.”

Researchers looking at the spread of Zika virus in Africa concluded that it has altered since its initial discovery. Looking at the PloS map of the progression of the outbreaks, it’s hard not to wonder about mosquitoes compared to human-to-human transmission.

We may not be dealing with something that deadly to most of those infected, but we are dealing with a slow-growing pandemic. Authorities should be crediting the virus with the ability to adapt to different transmission routes. Avoiding mosquito bites may not be enough.

Figure2

 

Posted by: Chris Maloney | January 26, 2016

What Causes You To Die?

We have so much information about health, it’s hard to get a clear picture of something as basic as what will help me stay alive?

But there are experts working hard to give you this information. They publish reports with titles like: “Actual causes of death in the United States.”

Let’s start with some ancient history. Back in 1990, the major things that made you die faster were: “The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000).”

Fast forward a few years, and the major things that made you die have been updated. Now the major things that make you die faster are: “The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).” That’s funny, that second list looks almost exactly like the first one. Only now we have more crashes and less death by sexual behaviors.

If you look around, nothing has changed that much since the last published “actual causes of death.” So the major reasons you die remain the same.

Posted by: Chris Maloney | January 8, 2016

What Should You Eat In 2016? New USDA Diet Guidelines

The USDA has come out with dietary guidelines, compiled in three chapters and fourteen appendixes. Before the ink is dry, critics are yelling that the guidelines don’t go far enough. But have they ever, and what do they say now?

For those with the normal American attention span, eat the Mediterranean diet. Lots of veggies and fruits, whole grains, lean meats and seafood. Low fat dairy or soy. Avoid sugar, saturated fats, and salt.  And get off your butts three hours a week. Got it? Back to your cat videos.

Now the rest of us can look at the report in a little more detail.

Let’s start off with the reality that past guidelines haven’t really fixed anything. According to USDA’s estimates,”About half of all American adults have one or more preventable, diet-related chronic diseases, including cardiovascular disease, type 2 diabetes, and overweight and obesity.” If you wondered what they were really talking about, it’s that we’re all fat. “In 2009-2012, 65% of adult females and 73% of adult males were overweight or obese.” (But that’s buried in a table pop up. The same one that says nothing has changed in 25 years.)

Previously, we’ve seen a plate, a pyramid, the four food groups, etc. But the USDA is finally recognizing the flaw in that reasoning, “Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. However, people do not eat food groups and nutrients in isolation but rather in combination” In other words, we won’t be getting a new graphic this year.

Or maybe we do. I don’t know about you , but this makes my food choices as clear as…a jigsaw puzzle?  es-1-plate

Instead of a new graphic in the Executive Summary we get some platitudes:

1.Follow a healthy eating pattern across the lifespan. Yes, we’d like to, what would that be?

2. Focus on variety, nutrient density, and amount. Variety and amount are understandable. What is nutrient density? How do you determine it? (The definition is hidden in the report and says eat whole foods. Here it is.)

3. Limit calories from added sugars and saturated fats and reduce sodium intake.The critics say this doesn’t go far enough, but it’s a bold, bold step for the USDA. They’re paving the way for asking people to cut meat, or at least make leaner choices. Buried later in the report they don’t mince words, “the main sources of saturated fats in the U.S. diet include mixed dishes containing cheese, meat, or both.”

4. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups… unfortunately, the term nutrient-dense isn’t spelled out here. So we still don’t have a clear picture.

5. Support healthy eating patterns for all. I think what they wanted to say was “stop feeding your kids and gramma junk food” but that was too direct.

Then we get some percentages, which make everything confusing. Rather than telling someone to “Consume less than 10 percent of calories per day from saturated fats” you should say what you mean: avoid sugar, avoid saturated fats, avoid salt.

We are supposed to limit alcohol to 2 drinks a day, but – let’s be clear on this – only if we’re legal. As if parents would take the guidelines to start giving junior hard whiskey for his health. In the footnotes (yes, there are footnotes in the executive summary) they make it clear, “It is not recommended that individuals begin drinking or drink more for any reason.”

I like that they completely bury physical exercise way down in a table. In our teens, a third of us make the grade. The rest of the time less than 20% of us can do physically what the USDA thinks we should be able to do. (Table here) Which isn’t that much (that’s buried in an appendix-link further down).

Even in the introduction, this is clearly a policy wonk document. They go into detail about how they do the research process and add pop-ups to say that they will be expanding the guidelines to include babies in the future.

I guess we’re still using the MyPlate graphic, which has dumped meat for protein but still has dairy as a separate food group (well done, Dairy Council).

introduction-3

Yes! I found the definition of “nutrient dense.” It’s hidden in the introduction pop up for additional definitions. If they’d put it on the summary page, it would have been clear. Also very bad for the packaged food industry, because it basically says eat whole foods without added sugars. (Here’s the definition) If you want a cup by cup breakdown of the diet, they have that as well, including a lot more meat than you would think.

Now we’ve left the political stuff (the lobbyists know no one but geeks gets this far) so we have some very cool bits. The cup equivalent graphics are nice. Too bad they’re buried in the first section. Later on, we get a sample menu for the day, meeting the USDA guidelines.

They go through the different food groups in detail, basically compromising on getting half of what they want. Instead of saying no fruit juice, they say half whole fruit. Instead of trying to cut out refined flours, they say half whole grains.

When we get to the meat section, we get this fairly straightforward pop up, “Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of meats as well as processed meats and processed poultry are associated with reduced risk of CVD in adults.” In other words, don’t eat lots of red or processed meat. I can see why that got buried.

For those of us looking at fats, it’s pretty clear the USDA is taking aim at coconut oil. It’s listed as almost twice as much saturated fat as pig lard, making it look pretty terrible. There’s no discussion of the different effects of animal vs. vegetable fats.

For the hypertensives out there, we’ve got a nod to the DASH diet, but the focus is on a Mediterranean eating pattern. You can even go vegetarian with the Mediterranean diet and be healthy, which has to have really made the meat industry furious.

By the time we get to section two in the report, it’s really clear that we are nowhere near where we need to be. Even getting us to half our food from good sources is going to be a major change. Notice that dairy got itself in as a separate category. Do you see a separate category for tea? That’s the power of the Dairy Council.

figure-2-1

By the time we’ve reached the third section, the lobbyists have pretty much given up and gone home. So we get a section entitled “the Socio-ecological model.” If that didn’t slow you down, the text certainly will, “Professionals can work with individuals in a variety of settings to adapt their choices to develop a healthy eating pattern tailored to accommodate physical health, cultural, ethnic, traditional, and personal preferences, as well as personal food budgets and other issues of accessibility.” OK, take all that into account when making people eat healthier food. If I were an industry lobbyist, I’d use that language to defend even eating deep fried oreos. “This here is a cultural difference. Massive heart attacks are traditional.”

Buried in the first appendix, we have kids needing to do an hour a day of activity, and adults doing three hours (yes, they say 2.5 hours, but that’s the problem with the whole report).

I found the USDA guidelines pretty gutsy, enough to make a lot of lobbyists very uncomfortable. But the real picture is buried in the report, because the lobbyists know we have the attention spans of mayflies.

There’s lots more information available.

 

Posted by: Chris Maloney | November 16, 2015

What Does Added Sugar Do To You?

Eat real food. That’s the goal.

Posted by: Chris Maloney | October 20, 2015

How Common Is Anaphylactic Shock From The Flu Shot?

Short answer: very, very rare.

Longer answer: not as rare as we’d like.

An older study of anaphylactic shock for other vaccines found five cases in almost eight million doses of vaccine given, which works out to less that one in a million chance of getting anaphylactic shock from other vaccines. (See full study here.)

A recently published study for influenza vaccination found the risk of anaphylactic was slightly higher. Slightly more than one in a million, but not quite two in a million. (Study here.)

The take home? Having an anaphylactic shock reaction after a vaccine is about one in a million. But that doesn’t mean it doesn’t happen, and it may be delayed. “The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).” (study above.)

Posted by: Chris Maloney | October 19, 2015

Setting Aside Your Own Blood For An Operation…And Stool?

The process of donating blood before an operation for your own use is considered a wise one. Even though the blood supply is checked for the things we know about, there are other things we may not know about yet. (Or just be learning...)

Blood makes sense, but stool? (For those of you who’ve missed the microbiome revolution, have a look.) Now there’s a renewed interest in donating your own stool for personal use after chemotherapy destroys all your gut flora. A NYT article says Sloan Kettering in New York is starting a program to donate your own feces to yourself after treatment. The initial results were a decreased risk of dying after treatment, which is a big plus in my book.

If you don’t happen to be a patient at Sloan, you may be able to donate and store your own elsewhere. Openbiome stores fecal material, but the strangest hurdle exists. You can only get your stool out to treat a C. difficile infection, not for “reconstitutional” purposes. Why? Because fecal material is classified as a drug, not as a tissue like blood. OK, poop is a drug. Right. I’m trying to think of a one-liner that can do that one justice.

All of us can improve our diets. But when you create and name a syndrome yourself (and trademark and copyright it) then follow it up by prescribing a diet that you claim improves a wide range of brain illnesses, then you’d better have some evidence to back yourself up.

In looking at Dr. Natasha Campbell-McBride’s website, I can’t help but like her. I also noticed that she doesn’t have any way for patients to schedule with her. According to some online posts about her, she has been touring the U.S. and elsewhere. It’s also mentioned that she has a child with developmental disabilities herself, giving her personal experience in the field.

I also like Dr. McBride’s focus on the gut bacteria and the microbiome. She’s well ahead of her time, and there’s a lot of emerging evidence out there. A recent study on irritable bowl syndrome came up with a lot of what she’s saying, but almost a decade later.

That said, her diet has been out for quite a while now, and autism is a very big research area. What are the results of doing her protocol? It’s hard, because her GAPS does not appear on medline anywhere. I guess when you name and trademark your own syndrome other researchers don’t use that terminology.

The studies on mice and the microbiome are stunning and indicate all sorts of dramatic changes in the brain as a result of changes in the microbiome. Gut transmitting fatty acids may be a causative factor for brain changes. But these are done on germ-free mice in a laboratory setting and may or may not bear a direct relationship to anything that happens to humans.

We do have some preliminary data on the connection between autism and the microbiome. Yes, there is an association, but it isn’t a cause-and-effect relationship. Comparing siblings with-and-without autism, many of each had gastrointestinal symptoms. The symptoms were more common in autistic children, and behavioral problems seemed worse in this group. Autistic children and siblings ate the same food, and “(t)here was no significant difference in ASD (autism spectrum disorder) severity scores between ASD children with and without FGID (functional gastrointestinal disorders). No significant difference in diversity or overall microbial composition was detected between ASD children with NT (neurotypical) siblings.” (study here) So, according to this study, autistic behavior is not determined by either what you eat or by what’s happening in your gut.

Dr. McBride’s initial assumption of an imbalance of bacteria at birth isn’t borne out in a cohort study comparing Caesarian vs. vaginal births. ” no association between planned CS and ASD or ADHD” (study here).

While autistic children have gut disorders at a higher rate than control children, there is little evidence that the gut disorder causes autism. It is more likely that it is a compounding issue for children with other issues. Whether it is more is still under investigation, and all caregivers are involved in creating research guidelines.

We are fortunate to live in a state that is leading the way in the local farm and food movement. The number of young farmers is on the rise. Independent chefs and food entrepreneurs continue to put down roots and build sustainable businesses.

Source: Healthcare uprising in Maine? It’s already happening – PenBay Pilot

Posted by: Chris Maloney | October 6, 2015

Can Adding Bacteria To An Infant’s Food Prevent Asthma?

Quick, what do you know about Faecalibacterium, Lachnospira,Veillonella, and Rothia? Not much? Join the rest of us. But these four bacteria, FLVR for short, can really impact a child’s chances of developing asthma if given in the first three months of life.

Think of it as a bacterial gut vaccine or gut grass seed to avoid inflammation later in life. But why do we need them now? Asthma rates have been increasing dramatically in recent years. “Increased use of prenatal and perinatal antibiotics, increased urban living, and formula feeding in infancy may all play a role.”

The researchers were so impressed by their findings, they are hustling to patent their results. Currently, you can’t buy this mix anywhere, and your pediatrician is unlikely to know anything about it. Part of the problem is that we all have been taught to fear bacteria. “We need to revisit our relationship with bacteria,” Turvey says. “Our species have coevolved with them, and they’re really important for our health.”

My own contribution to increasing our knowledge has been a short book, Tending Your Internal Garden, in which I point out some current myths about our bacterial internal world and even some possible solutions.

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