Insane Medicine – Parasites – Cyclospora in food

Insane Medicine - Cyclospora - a cause of food poisoning that results in diarrhea illness
Insane Medicine – Cyclospora – a cause of food poisoning that results in diarrhea illness
  • We don’t think much of parasites in the United States as a source of illness because they seem like such tropical diseases, however, there are quite a few problems caused by parasites here, some that are transported to us, especially on food. Recently, in Texas, an infection caused by a protozoan, Cyclospora cayetanensis resulted in diarrhea-type illness in Texas. The culprit was cilantro imported from Peubla, Texas!
  • Cyclospora has been an occasional culprit of gastrointestinal infections in the United States. it is not endemic, but rather is tropical or sub-tropical in it’s origins.
  • It is a single celled organisms that is spread from fecally contaminated food and water.
  • Food products that have been found to carry Cyclospora in past outbreaks include snow peas, raspberries, and basil. No frozen products have been associated with outbreaks. It can occur at any time of the year but mostly in spring and summer months.
  • Symptoms of infection develop in a week, resulting in abdominal bloating and cramps, with primarily diarrhea, less often, there may be vomiting. Infected people can lose a lot of weight. Symptoms may last weeks to months with diarrhea alternating with constipation even.
  • It is diagnosed by examining stool for the parasite specifically. There is no blood test for this. Its’s treatment is with a sulfa- based antibiotic (trimethoprim-sulfamethoxazole).
  • Cyclospora is not killed by routine disinfection and sanitation measures, but it is best to wash fruit off thoroughly.
  • Do you have this infection? Unlikely, but in a group setting of infection, especially with the symptoms listed above, it is something to consider.  <— Link to prior outbreaks of Cyclospora in the United States.

Insane Medicine - Cyclosporiasis life cycle - from CDC
Insane Medicine – Cyclosporiasis life cycle – from CDC

Insane Medicine – High Cereal fiber intake is associated with decreased cardiovascular risks after a heart attack

  • Fiber plays an improtant role in our diet. Evidence shows that high amounts of cereal fiber intake is associated with decreased cardiovascular risk after a first hear attack.
  • There are two forms of fiber. Insoluble fiber, which dissolves in water. Examples of this include oats, beans, peas, apples, rice bran, barley, citrus fruits, strawberries, rice, and peas. Examples of insoluble fiber include whole wheat bread, brussel sprouts, rye, grains, cabbage, carrots, turnips, and apple skins.
  • The goal of intake for fiber is 25 grams a day, which would be the equivalent of 6 cups of oatmeal (cooked) a day, as an example.
  • Increasing you rcereal fiber intake after your first Heart attack results in a 35% decrease in risk of death from cardiovascular causes and a 31% decrease in death from any cause.
  • Increasing fiber intake works by improving your glycemic response and insulin  sensitivity. This decreases LDL cholesterol and diabetes risks. You will eat less because you feel full after high fiber meals and ths will tend to lose more weight.
  • Eating fibers from fruits is less associated with improved outcomes after a first heart attack than cereal fibers.
  • You need to aim for 6-8 servings of grains per day and 8-10 servings of vegetables and fruits per day. Remember that a half-cup of fruit is a serving while a single cup of leafy vegetables is a full serving.

Insane Medicine – Key factors to prevent cognitive decline and dementia.

Insane Medicine -Preserve your mind to prevent cognitive decline
Insane Medicine -Preserve your mind to prevent cognitive decline.
  • Alzheimer’s disease results from accumulation in the brain of aberrant proteins (amyloid-beta and tau). This results in faulty connections in the brain and brain cell death. With that, memory and skills are lost over time.
  • 30 million people are affected by Alzheimer’s disease in 2010. One-third of these cases are attributable to modifiable risk factors such that there is a chance to prevent cognitive decline in some people. (Lancet Neurology, 2014)

There are controllable risk factors: What are they?:

  1. A lack of exercise.
  2. Smoking
  3. Poor diet
  4. Low level of education
  5. Depression
  6. Poor lifestyle
  7. Obesity
  8. High Blood pressure
  9. Uncontrolled diabetes.
  • Keeping a healthy hear may prevent dementia, in that reduced blood flow to the heart due to no exercise or poor diet also impacts flow to the brain as well. The above factors overlap in that depressed people may smoke more and get less exercise. They gain weight and also eat poorly.
  • Per the JAMA (July 2014) there has been a 24 % drop in first time strokes and a 20% drop in death from strokes. This is due to better control of risk factors causing strokes such as treating elevated blood pressure, stopping smoking, and statin use to control cholesterol levels.
  • It is important to stimulate your brain with mental activities and mental challenges such as cross-word puzzles or card playing. This resulted in greater brain volumes, especially in the hippocampus and better memory and executive functioning.
  • Moderate exercise in the 50-65 year range decreases the risk of cognitive decline significantly. The same was true for even older individuals (70 and above). SO be certain to exercise 30 minutes a day at least 5 days a week!

Insane Medicine : Testosterone – who needs it?

Insane Medicine -Depo-Testosterone 200 mg per ml injection Testosterone cypionate
  • Testosterone is a hormone with many biological effects. It binds to androgen receptors in the body, or is converted to  dihydrotestosterone,(via the enzyme enzyme 5-alpha-reductase ), which then can bind to androgen receptors in the body. Testosterone can act like an estrogen as well after being converted to estradiol via an aromatase.
  • Dihydrotestosterone’s main action is on the external genitalia and prostate in men, while testosterone affects muscle maintenance and strength. The estradiol function of testosterone affects sexual functioning and decreases body fat in men. Likewise, it has an effect on bone mass.
Insane Medicine - The hypothalamus  releases a gonadotrophal releasing hormone that stimulates the pituitary to make FSH and LH that, in turn, stimulates the testiles to produce testosterone.
Insane Medicine – The hypothalamus releases a gonadotrophin releasing hormone that stimulates the pituitary to make FSH and LH that, in turn, stimulates the testicles to produce testosterone.
  • Symptoms suggestion androgen (testosterone) deficiency include low libido, loss of erections,  low bone mineral density, enlargement of the breasts, anemia, decreased muscle mass, decreased energy, and increased body fat.
  • The goal for testosterone replacement in males is to increase libido, muscle mass restoration, increase fat-free mass, increase bone density, and decrease body fat.
  • Testosterone should be measured in the morning on three different occasions, as there is a circadian rhythm in testosterone secretion. If it low each time and the patient has symptoms consistent with testosterone deficiency, then replacement would be indicated. Again,  low libido, decreased morning erections, loss of body hair, low bone mineral density (BMD), gynecomastia, and small testes suggest a need for treatment.
  • In appropriate candidates, testosterone replacement leads to improved muscle strength and fat-free mass. Bone density can also improve as well by as much as 40% in patients who are hypogonadal (low testosterone).
  • As for sexual dysfunction, Testosterone replacement may  increased sexual desires, but that maynot necessarily result an increased satisfaction rate.
  • Testosterone seems to render no improvement in cognitive abilities in patients.
  • Risks of testosterone replacement include the potential to increase the risk of prostate cancer, worsen sleep apnea, increased risk of venous thromboembolism (blood clots in the legs), andpotential increased cardiovascular risks.
  • Thus – using testosterone is best saved for those with clear indiciations. Consult your doctor. More later on all this.
Insane Medicine - Testosterone
Insane Medicine – Testosterone


Insane Medicine – No sugars are health foods: Coconut palm sugar is not healthful – it’s just sweet!

Insane Medicine - Coconut-Palm-Sugar
Insane Medicine – Coconut-Palm-Sugar
  • Coconut palm sugar is a sugar alternative from Southeast Asia made from the flowering buds of a coconut tree. It has minimal processing in it’s production.
  • It is not highly nutritious in vitamins and minerals, but rather it is just sucrose and does not have a low glycemic index. It does not help in weight control or prevent cancer.
  • It’s use is mainly just for it’s taste, which is a more caramel flavor, and is useful in cooking and baking. Consider coconut palm sugar to be empty calories otherwise. There is no proof of health benefits to using it.

Insane Medicine tip- Eat at least two 3.5 ounce servings of fish per week!

Insane Medicine - canned salmon
Insane Medicine – canned salmon
  • The American Heart Association recommends that you eat two 3.5 ounce servings of a fatty, omega-3- rich fish every week. Salmon and Albacore tuna are examples of such fish.
  • Omega-3 fatty acids decrease platelet stickiness and decrease your chances of a heart attack. They also reduce your triglyceride levels and prevent heart rhythm abnormalities. They also decrease inflammation in the body.
  • Canned salmon is generally obtained from wild salmon and tends to have less PCB’s (polychlorinated biphenyl) that is found in plastic containers. Salmon is low in mercury, which is great!

Insane Medicine – It’s the dietary pattern that matters for heart health! Saturated fats – good or bad?

Insane medicine -butter
Insane medicine -Based on current evidence, per the Annals of Internal Medicine, there is no support for encouraging high consumption of polyunsaturated fats and low consumption of saturated fats.
  • The recent Annals  of Internal Medicine (2014) study mentioned in the photo above , reviewed the harm of saturated fat and found a poor connection between saturated fat consumption and cardiovascular risks based on a meta analysis of 600,000 people.
  • Fatty acids are classified as saturated, monounsaturated, or polyunsaturated. Nutritional guidelines generally encourage low consumption of saturated fats, high consumption of ω-3 polyunsaturated fatty acids from fish or plant sources, and avoidance of trans fats, particularly those from partially hydrogenated fat, to promote cardiovascular health.
  • The Annals study found no associations between total saturated fatty acids and coronary risk. The study found a “possible inverse association between circulating margaric acid (an odd-chain saturated fatty acid that is moderately correlated with milk and dairy fat consumption) and coronary disease, suggesting that odd-chain saturated fats, which reflect milk or dairy consumption, may have less deleterious effects in risk for coronary heart disease.”  Again, to summarize this, margaric acid, a saturated fat found in dairy, seemed to lower the risk of heart disease. So you can increase your low fat dairy intake.
  • Omega-6 polyunsaturated fats, found in vegetable oils and processed foods were linked to higher cardiac risks.
  • Trans-fatty acid intake increases risk of heart disease in this same study and monounsaturated fat has no effect on heart disease.
  • Circulating levels of eicosapentaenoic and docosahexaenoic acids (the 2 main types of long-chain ω-3 polyunsaturated fatty acids) and arachidonic acid are each associated with lower coronary risk in this study,.  ω-3 and ω-6 polyunsaturated fatty acid supplements did not help heart health.

Summary for what you should do:

  • This doesn’t mean you can eat all the saturated fats you want or replace them with processed food. Eating a lot of cream and fatty meats would be harmful in all likelihood.
  • Follow the Dietary Approaches to Stop Hypertension (DASH) Plan and the Mediterranean-type diet.
  • Be certain to follow a healthy pattern of eating, including vegetables, fruit and whole grains, legumes, nontropical vegetable oils and nuts. Include low-fat dairy products, poultry, and fish. Watch out for processed foods and limit sweets and sweetened beverages and red meat.
  • It is the pattern of eating, not the individual choices that affects your cardiac risk.

Insane Medicine – Probiotics for inflammation, gut health, antibiotic-associated diarrhea, and many other things!!

Insane Medicine - probiotics help!
Insane Medicine – probiotics help!
  • The symbiotic organisms found in the gut and elsewhere are called “probiotics.” These organisms help metabolize foods, absorb nutrients, prevent pathogenic colonization, and  help maintain intestinal health by living within our gut and competing with other unhelpful bacteria.
  • Some foods have probiotics added in them, such as: yogurt, kefir, kombucha tea, cheese, buttermilk, fermented cabbage like sauerkraut, and kimchi,  and acidophilus milk.
  • Lactobacillus species, Bifidobacteria species, and Saccharomyces boulardii are the most commonly used probiotic species used. Lesser probiotics include Streptococcus thermophilus 
  • Processed foods do not have live probiotic organisms. The processing kiolls the organisms. Look for labels that say “contains live active cultures.”
  • Probiotics work by competing with the growth of harmful bacteria in the gut by taking up space and nutrients. Siome produce antibacterial substances, such as hydrogen peroxide, acetic acid, or lactic acid, that prevents bacterial growth.
  • Probiotics appear to be immunomodulators,  stimulating lymphocyte and macrophage activity, reducing markers of intestinal inflammation such as tumor necrosis factor and alpha-1-antitrypsin. They can increase the secretion of immunoglobulin A in the gut against harmful bacteria.
  • Probiotics not only fight intestinal and urogenital pathogens, but they also are helpful for several conditions such as inflammatory bowel disease,  food allergy, pouchitis,  and as an adjuvant to vaccination.
  • Remember to use only proven blends of probiotics. Not all brands of probiotics are equivalent, even if they have the same agents in them!
  • Primary uses of Probiotics include uses for Antibiotic-associated diarrhea, Clostridium dificile infections, irritable bowel syndrome, and preventing respiratory infections.
  • The use of a probiotic with antibiotics can reduce diarrhea by 45 % or so.  Lactobacillus has the best evidence for success, with  Florajen ( Lactobacillus acidophilus) being very effective. Lactobacillus plantarum299v (ProViva) is also useful.
  • Bifidobacteriuminfantus and Bifidobacterium longus are effective as is Saccharomyces boulardii for reducing antibiotic-associated diarrhea.
  • Combination products such as Lactobacillus acidophilus LA-5 plus Bifidobacterium BB12 (AB-Yogurt), Bifidobacterium lactis plus Streptococcus thermophilus (Nan 2), and  Lactobacillus bulgaricus plus Streptococcus thermophilus plus Lactobacillus casei DN114401 (DanActive, Actimel) are also effective, reducing diarrhea by 40%.
  • Probiotics are also helpful for reducing the risk of Clostridium difficile infection in patients taking antibiotics. The combination of Lactobacillus acidophilus CL1285 plus Lactobacillus casei (Bio-K+Cl1285 is effective in reducing C. dificile infection when taking antibiotics by over 80 %.
  • Lactobacillus planarium299v (ProViva) can reduce recurrence of C. dificile infections. Saccaromyces boulardii(Florastor) also can reduce C. dificile infections by over 60%.
  • Combination products include Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Lactobacillus bulgaricus, and Streptococcus thermophilus (VSL#3) and DanActive/Actimel (Lactobacillus bulgaricus plusStreptococcus thermophilus plus Lactobacillus casei)
  • For irritable Bowel syndrome, Bifidobacterium infantis 35624 (Align or Bifantis Procter & Gamble) works well, decreasing abdominal complaints. The product, VSL#3, works well in decreasing IBS symptoms.
  • Probiotics also decrease respiratory infections by 30 % or more. Lactobacillus plantarum, Bifidobacterium longum, Bifidobacterium bifidum, Lactobacillus gasseri, and Streptococcus thermophilus are helpful in various combinations.
  • Avoid or be careful with probiotics if you are immunocompromised. Ask your doctor first before using them in that case.

Products you can use include:

  • Activia yogurt (Dannon –Bifidobacterium lactis), Align (Proctor and Gamble -Bifidobacterium infantis) for digestive health and antibiotic induced diarrhea.
  • Culturelle (ConAgra Foods – Lactobacillus GG) with multiple varieties,  It helps with digestion and decreases bloating sensation.
  • Danactive, with a mixture of probiotics in it, for antibiotic associated diarrhea.
  • Fllorajen (Lactobacillus acidophilus) with many varieties, useful for antibiotic-associated diarrhea and bowel health.
  • VSL#3(Sigma-Tau Pharmaceuticals – Lactobacillus acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Bifidobacterium breve, B. infantis, B. longum, and Streptococcus thermophilus mixture) useful in inflammatory bbowel disorders and puchitis.
  • Fem-dophilus- Lactobacillus rhamnosus, for urinary health, preventing bacterial vaginosis and promoting vaginal health.
  • Probabclac and Lactinex are other agents used as probiotics with efficacy.  <—Activia probiotic  <—Culturelle  <– Danactive <–Probalac probiotic  < –Jamieson probiotic sticks  <–Florastor probiotics   <—vsl#3 probiotic

Insane Medicine – Grapes and raisins

  • Raisins have three times the antioxidants of red and green grapes. Six ounces of grapes makes and ounce of raisins, but the drying process destroys the resveratrol ( an antioxidant) , so raisins have little of this. Raisins have a little less Vitamin C.
  • Golden raisins are higher in antioxidants becuase they are preserved by added sulfites during the drying process. Beware if you have a sulfite allergy.
  • Raisins have a lot of fiber, potassium, and iron, but a cup of raisins has 440 calories, while a cup of grapes has 100 calories. Beware of the extra calories in the raisins!

Insane Medicine – Inflammation and Aging – Mechanisms of poor aging!!

  • Inflammation affects the body in a number of ways, some we recognize physically and others not so much. For example, a cut on the skin can get red and inflammed. But there is a low grade, chronic inflammation that also occurs that increases as we age.
  • Many factors influence this inflammation, including genetics, lifestyle, and environmental agents. This can cause premature aging and disorders that accompany it, such as diabetes.
  • A study in the Canadian Medical Association Journal did suggest a link between elevated levels of Interleukin-6 (IL-6), a pro-inflammatory cytokine that when elevated, appears to drive other inflammatory marker up, such as CRP (C-reactive protein and fibrinogen).
  • IL-6 elevation appears to play a role in aging, causing people to age poorly when levels are elevated.
  • Successful aging is considered to have occured when an individual has good cardiovascular function ( no heart attacks) , good respiratory and musculoskeletal functioning (no emphysema/arthritis), and good mental well-being. In other words, there is an abscense of disability such as diabetes and severe arthritis or heart failure.
  • High levels of inflammation in the body are linked to cognitive decline (dementia and poor memory)
  • General body inflammation is involved in coronary artery disease, obesity, diabetes, chronic obstructive pulmonary disease (COPD), asthma, allergic conditions, rheumatoid arthritis, inflammatory bowel disease, and Alzheimer’s disease.
  • Inflammation can result in insulin resistance that then promotes obesity. Fat releases pro-inflammatory compounds that then worsens insulin-resistance. This results in a positive feedback cycle, making everything much worse.
  • Inflammatory markers being looked int incude tumopr necrosis factor (TNF), IL-6, C-reactive protein, prostaglandins, and leukotrienes. Elevations of these indicators reflects other conditions in the body, such as worsening arthritis.
  • In the Jupiter study, it was found that people with a nromal LDL (‘bad’) cholesterol would benefit from treatment with a statin to reduce the LDL even further if their CRP was elevated. The CRP elevation reflected an increased risk of heart attacks in these people despite normal or low cholesterol already. The statin (rosuvastatin), decreased the CRP and LDL cholesterol and ppears to decrease the risk of coronary events. Again, the elevated CRP reflects the inflammation in the coronary system, and this inflammation was improved by treatment with the statin.
  • Smoking worsens inflammation in the body and increases the risk of stroke and heart attacks. It promotes inflammation in the coronary arteries.
  • Obesity and high blood pressure also promote inflammation.

It is felt that IL-6 may be the driver of the inflammatory process, especially as increased levels of IL-6 (>2ng/L) increases mortality over three years. High IL-6 levels are associated with poor aging and increased risk of cardivascular events and death.

What to do:

  1. Eat a heart healthy diet including fatty fish, fruits, and vegetables. Include wine, tea, and chocolate, which have anti-inflammatory effects). The Mediterranean diet reduces inflammation.
  2. Avoid saturated fats, trans-fats, and refined sugar, which are pro-inflammatory.
  3. Get aerobic exercise. Being sedentary increases inflammation and pain.
  4. Lose weight  – obesity increases inflammation.
  5. Quit smoking.
  6. Take low dose aspirin if you had a prior heart attack.
  7. Take a statin if your docstor indicates a need. It helps inflammation and cholesterol.
  8. Don’t drink to excess.

Sleep at least 8 hours a day. AVoid stress, anxiety, depression through better coping mechanisms. Social isolation increases chronic inflammation.


Other inflammatory markers:

Lipoprotein-associated Phospholipase A2) measures inflammation in the arteries –reference range: 81–259 ng/mL – below 200 is consistent with reduced risk of heart attack or stoke.


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