Insane Medicine – Lineoleic acid decreases cardiovascular death risk

Insane Medicine - Omega fatty acids
Insane Medicine – Omega fatty acids come in two flavors – omega-3 and omega-6!
Insane Medicine - fat pyramid
Insane Medicine – fat pyramid


  • Omega-6 fatty acids are also important for heart health. Evidence suggest that linoleic acid, an omega-6 fatty acid, when found in higher levels in the blood, decreases the chance of death from cardiovascular disease .
  • Sources of linoleic acid are: walnut oil, sesame oil, sunflower oil, corn oil, safflower oil.

Insane Medicine – Hearing loss associated with acetaminophen and ibuprofen use!

  • The frequent use of ibuprofen and acetaminophen may contribute to hearing loss in women. This risk is increased up to 24 % in women who take the products more than twice a week, especially if they are younger than 50. There is no association with hearing loss in women and the use of aspirin.
  • Aspirin use in some studies, was associated with hearing loss in men.
  • This hearing loss results from damage to the cochlea in the ear,  which is central to auditory perception. The use of these medications may decrease blood flow to the cochlea, causing the damage.  Using these medication more often increases the chance of hearing loss. For example, the use of ibuprofen 6 or more times a week was 24% more likely to cause hearing loss, whereas use of it only twice a week resulted in a 13% increased chance of hearing loss.
Insane Medicine - The cochlea
Insane Medicine – The cochlea – involved with hearing.

American Journal of Epidemiology


Insane Medicine – Ebola threats continue to rise

ebola virus infections

Insane Medicine -Reported ebola cases - they continue to rise and unreported cases are definitely increasing as well!
Insane Medicine -Reported ebola cases – they continue to rise and unreported cases are definitely increasing as well!
  • Are US hospitals prepared for Ebola? Not really. The entire process of protecting health care workers has been in a state of flux. The CDC itself has been changing the rules of engagement for healthcare providers in terms of the protective mechanisms that need to be applied in the event of an Ebola patient’s arrival.
  • Most Emergency Departments would need to shut down after the arrival of such a patient due to decontamination needs. As was seen in Texas, even with protocols the disease still is able to spread to healthcare workers. It seems logical that patient with risk factors in the US for Ebola should be transported immediately to centralized facilities capable of handling such biohazards. They should bypass smaller ED’s and free-standing ED’s., where staff have little or no training in biohazard protection. In the US, there are probably less than 15 dedicated isolation centers for hazardous infections, Emory having two of them.
  • The disease continues to increase in the number it has infected. There is no current accepted treatment for it. The graphs above show the large numbers infected and the continued rise in affected individuals. As expected, some of those with the disease will travel abroad…
  • There are many gaps in the current data for infections, the total number being vastly under-reported. The fall in the number of infections in some areas may be due to overwhelmed facilities turning away Ebola victims, many of whom go on to die elsewhere. Those people fall through the cracks of epidemiological surveys. Many patients may not be seeking medical care because they live far away or the facilities are full. They die at home and are buried.
  • Many patients in Africa do not get tested for the disease but have symptoms of it. There are not enough resources to test in many areas. In Liberia, only 22% of the cases were confirmed by testing.
  • The worst case scenario per the CDC is that 1.4 million people may be infected in Africa by January 20. Currently, the number of cases is doubling every three to four weeks and is continuing. The key to containment will be control measures to prevent spread in theses areas, including safe burial practices.
  • In the US, the presence of a single infected patient who flew into Texas demonstrates the degree of risk and magnitude of strain on resources that occurs. Tracking hundreds of contacts on planes and casual contacts is very difficult and costly.

Links to Ebola related reports are as follows:  < Science Magazine special collection.  <– statistical data from MIT  < Ebola infection data model of number of infections.


  • Currently, two vaccines are being developed in trials for Ebola. NewLink genetics (NLNK) has a vaccine in trials now that uses the Ebola surface protein in a weakened version  of vesicular stomatitis virus (a virus that attacks farm animals). GlaxoSmithKline is developing and testing another Ebola vaccine, in which genes for a surface protein from two different strains of Ebola have been stitched into a chimpanzee adenovirus. Hopefully one of these systems will be effective.

Insane Medicine – Saccharin may be causing impaired glucose metabolism and obesity!!!

‘The most difficult part of a diet isn’t watching what you eat. It’s watching what other people eat!’

Insane Medicine - Saccharine causes glucose intolerance
Insane Medicine – Saccharine causes glucose intolerance.
  • Artificial sweeteners may cause the very problem that dieters are trying to avoid – obesity and diabetes. A study in Nature (September 17) showed that a diet high in saccharin resulted in impaired glucose metabolism in human volunteers and mice.
  • Saccharin is found in Sweet’N Low, jam, salad dressing, and many low-calorie foods. The effect of saccharin on humans and mice was consistent. Feeding a diet high in saccharin, whether the subject was obese or skinny resulted in higher blood glucose levels. Those who were fed glucose based diets had normal metabolism.
  • What was discovered was that the microbes of the gut were altered by saccharin and that seems to enable bacteria that feed on saccharin to thrive. These bacteria somehow cause glucose intolerance (pre-diabetes). Antibiotics that are given to these individuals to kill the gut bacteria can reverse these changes in sugar metabolism, suggesting that the bacteria were the clear cause of the problem.
  • Thus it seems that saccharine and even other artificial sweeteners (aspartame and sucralose for example) induce changes in our natural gut bacteria. These changes predispose us to glucose intolerance and even diabetes!It is possible that heavy antibiotic use in our society results in some people being more sensitive to the effects of saccharin. Obesity and diabetes may, in part, be linked to the bacteria in our gut!
  • Bottom line: using artificial sweeteners is clearly not as healthful as we think!!
Insane Medicine - saccharine
Insane Medicine – saccharine is linked to impaired glucose metabolism and obesity!


Insane Medicine – Dancing decreases knee and hip pain in the elderly

“Whenever I feel like exercise, I lie down until the feeling passes.” – Robert Maynard Hutchens

Insane Medicine - Dancing decreases knee and hip pain the elderly
Insane Medicine – Dancing decreases knee and hip pain the elderly.
  • A program, called Healthy-Steps, in which low impact dancing twice a week for 45 minutes was used, demonstrated that elderly patient with hip and knee pain had much less discomfort by 12 weeks. The dancing could be performed sitting or standing and was slow and rhythmic.
  • The program results in increased flexibility and strength leading to better movement and less falls potentially. The slower someone walks, the more likely they will fall.
  • Here’s a link to the Lebed method —>
  • The bottom line: Get out and Dance!!


Insane Medicine – High Blood pressure and the new Rules

Insane Medicine - Blood pressure cuff
Insane Medicine – Blood pressure cuff
  • Blood pressure is force that is exerted on your arteries with every heart beat, with the systolic pressure (top number) being the peak pressure the moment the hear contracts, while the diastolic number (bottom number) is the pressure when the heart relaxes. There is always residual pressure in the circulatory system when the heart is at rest due to the elastic, expansile ability of veins and arteries in the cardiac cycle that expand and collapse with each heart beat.
  • normal blood pressure is anything less than 120/80
  • When a person develops high blood pressure, that puts stress on the vital organs inside the body, especially the brain, heart, and kidneys. This increases your risk of stroke, heart disease, and kidney failure. Vascular dementia due to damaged vessels and strokes in the brain results in dementia.
  • As people age, high blood pressure becomes more and more common, with ~70% having high blood pressure by the age of 65-74.
  • There have been recent changes in the blood pressure goals per a recent report by JNC-8.  If you are age 60 or older, any blood pressure up to 150/90 mm of Hg is acceptable, unless you have diabetes, in which case 140/90 mm Hg is the acceptable goal. This new goal has not been accepted by all the medical authorities.
  • The American Society on Hypertension (ASH) suggests that patients age 80 and over should be allowed to have a blood pressure up to 150/90, unless they have high risk issues like diabetes or kidney disease, in which the 140/90 upper limit should be used. If the person is less than age 80, then 140/90 is the upper limit of acceptable and probably a goal of 130/80 should be used if they have poor heart function or kidney disease.
  • Which target should you be using? Ask your doctor, but it seems reasonable to be more aggressive with blood pressure treatment if you have diabetes, kidney disease, protein in your urine, or heart disease.
  • Lowering a person’s blood pressure too low may make them dizzy when they stand or even pass out due to low blood pressure. This is something we want to avoid!
  • First line treatment includes lifestyle changes such as dietary modifications such as reducing salt intake and eating more antioxidant-rich fruits and vegetables. Physical activity is a key component as well.
  • Have your doctor check for possible secondary causes of high blood pressure such as ‘white-coat’ hypertension (stress in the doctor’e office that goes away when you measure blood pressure at home). Also medications such as prednisone, or over-the-counter agents for colds and cough can increase blood pressure. Have your doctor review your non-prescribed medicines.
  • Have your doctor consider looking for thyroid disorders, kidney disorders, or sleep apnea that can elevate blood pressure.
  • Keep track of your home blood pressure with a home blood pressure cuff that is properly calibrated and used. This can be more accurate when properly done than a doctor’s office single reading of blood pressure.
  • For those who need medications, doctors will start low and titrate medication upwards slowly. There is more evidence that ACE inhibitors or ARB inhibitors mixed with amlodipine ( a calcium channel blocker) are excellent first line therapies. Beta blockers are not in favor for primary or secondary use unless there is some specific reason to be taking them (such as heart disease). Be prepared to take two or even three medicines to control your blood pressure.
  • Again, the best treatments to start with are lifestyle modifications! Lose weight, take in less salt. Consider following the DASH diet!

The DASH diet to help control high blood pressure:

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


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