Insane Medicine – Chikungunya Virus Gone viral – The arthritis virus in the Caribbean!

Insane Medicine -Chikungunya  Virus
Chikungunya Virus at elcetron microscope magnification levels.



Aedes mosquito on human

 

  • Chikungunya Virus was first found inTanzania in 1952. It is an RNA virus of the alphavirus genus and the Togaviridae family.
  • It is primarily found in Western Africa, similiar to where ebola is currently found this year. It is endemic in West Africa, but in 2103, it was found in the Caribbean, including St. Martin and Puerto Rico. Two mosquitos,  Aedes aegypti and Aedes albopictus (African tiger mosquito) are the mosquito vectors for the disease. The Aedes albopictus mosquito can carry Yellow fever and Dengue fever as well as Chikungya.
  • The virus causes crippling arthralgias  and fever. The illness can result in a rash. It lasts for several months, with the arthritis pain being prolonged and severe. Hence, the name Chikungunya, which in Tanzania means ”stooped over.’
  • The initial fever lasts 7-10 days and there may be swelling if the fingers and toes. In severe cases, a person can get an inflamed heart muscle, known as myocarditis and kidney failure.
  • Similar viruses include O’nyong-Onong (Central Africa), Baima-Ross River virus, Semili Virus, Mayaro virus (South America), and the Sindbis group virus. All of them cause severe arthritis.
  • Treatment – supportive care only, Fluids and pain management are cornerstone to treatment. There is no vaccine currently available. The best treatment is prevention – prevent mosquito bites by wearing  long clothes and lots of bug spray! If you are traveling to the Carribbean, be certain to wear bug spray to prevent infection.

http://www.cdc.gov/chikungunya/geo/index.html

 

Irritable Bowel Syndrome and new dietary management for it! Zofran for IBS with diarrhea symptoms!

General bowel anatomy
General bowel anatomy
  • Irritable Bowel Syndrome (IBS) affects a lot of people with low abdominal discomfort and bloating, diarrhea, and/or constipation.The disease is chronic and relapsing. It is, in part,  a result of malabsorbed carbohydrates that are fermented by gut bacteria to produce gas.
  • FODMAPS (fermentable oligo-saccharides/disaccharides/monosaccharides/and polyols) are believed to be a major cause of bloating and abdominal cramping symptoms in IBS patients.  FODMAPS are carbohydrates found in our diets.Many people who perceive that they have Gluten intolerance (celiac disease) in fact have FODMAP intolerance.
  • FODMAPS include fructose, lactose, fructans (in wheat), galactans, and polyolo sweeteners.
  • FODMAPS are not absorbed in the small intestine and pass to the large intestine where they get broken down by bacteria in the gut, forming gas.
  • Sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol are present in many food products and are FODMAPS. They are found in artificial sweeteners, as well as many fruits, such as apples, cherries, peaches, and a wide range of fruit.
  • Galactose  (Galactans) are a oligosaccharides  that are found in beans
  • Fructans (Fructose) are present in wheat, rye, barley, onions, and many other vegetables.
  • A recent study in the journal, Gastroenterology, demonstrated that FODMAPS are the primary cause of abdominal cramping and IBS symptoms, not gluten intolerance. Changing ones diet to avoid FODMAPS helped many patients with IBS symptoms.
  • How does one change to a diet that is low in FODMAPS? There are apps that have dietary recommendations as well as the following site:  www.med.monarch.edu/cecs/gastro/fodmap/
  • General information: Animal protein is low in FODMAPS
  • Fats and oils are low in FODMAPS, but remeber that butter, palm and coconut oil are high in saturated fat, so avoid too much of them
  • Cheeses have lactose, a FODMAP, but hard cheeses, such as brie and camembert or feta cheese are lower in lactose than cream cheese or ricotta cheeses.
  • Garlic and onions are high in fructans ( a FODMAP), so avoid too much of them. These are frequently added to oil-based sauces and condiments and increase the FODMAP levels.
  • Some flours have lower amounts of FODMAPS, such as spel or oats, whereas wheat and rye are high.
  • Fruits have variable amounts of FODMAPS, but drying may concentrate them even more.
  • A recent study demonstrated the use of Ondansetron, a 5- hydroxytryptamine-3 receptor antagonist, as being effective for irritable bowel symptoms if the person has diarrhea-type symptoms primarily. Ondansetron is an anti-emetic agent and was found to increase stool consistency, decrease urgency and bloating, and decrease the number of bowel movements in patient with diarrhea caused by IBS.
  • If you are concerned over the glycemic index of the foods that are  low in FODMAPS, consult www.glycemicindex.com
  • So, if you suffer from irritable bowel syndrome, consider consulting a dietician and trying a low FODMAP diet, as opposed to a gluten-free, celiac-type diet. You might not have gluten-intolerance!!

www.med.monarch.edu/cecs/gastro/fodmap/

http://www.glycemicindex.com/

Niacin seems to be very unhelpful as a supplement for low HDL!

Niacin fails to improve coronary health
Niacin fails to improve coronary health
  • If you have been taking niacin to help your HDL, there is more and more evidence that it may be hurting you! Besides the red flushing it can cause if taken in large amounts that is needed to help increase HDL levels, it also can cause liver damage.
  • In the AIM-HIGH study in 2011, no benefits were found from Niacin supplementation, and in fact there were increased side effects, including bleeding risks.
  • In the HSP2-Thrive study, Niacin supplementation had no effect on major vascular events. There were bad side effects including a 32% increase in new-onset diabetes, and  a 55% worsened glucose control in diabetics taking the supplement. In fact, mortality risk increased by 9%
  • I think it’s time to throw out the Niacin supplements and not worry so much about an isolated HDL problem. Low HDL is probably a symptom of another lipid and metabolic problem.

Toenail problems? New solutions for fungal nails!

Onychomycosis
Onychomycosis – yellowed, thickened nails
  • Onychomycosis – refers to nail infections by fungus, including yeasts and molds.  Toenail onychomycosis is most commonly due to dermatophytes, a type of fungus (i.e. Trichophyton rubrum and T. mentagrophytes)
  • Risk factors for the problem include swimming,   athlete’s foot, diabetes, genetics, and living with family members who have the disease.
  • Besides being unsightly, the nails can be difficult to cut and also can increase the risk of bacterial infection. Pain can be an issue as well, as nails can become sensitive to pressure.
  • Yeasts, like Candida Albicans, can also cause some cases of nail fungus, especially on the hands. People who immerse their hands in water a lot are at risk.
  • Some fungal infections can discolor the nail black –  (dematiaceous fungi  – pigment-producing molds)
  • As a result of these infections, the nails get thickened, discolored,  with crazy shapes and debris under the nail.
  • Two recent approved topical therapies that appear to have excellent effectiveness have come to the market.
  • Kerydin (Tavaborole) topical solution can be applied to the nail daily for 48 weeks. No nail removal is required and the solution is not absorbed to any degree by the body. About a third had significant improvement without adverse reactions to any large degree. It is expensive (~400$)
  • Efinaconazole (Jublia) topical solution is another new arrival to treat the standard nail infections caused by T. Rubrum/T. Mentagrophytes. It is a topical triazole that blocks the fungus from producing it’s cell membrane. Applied at a drop a day to the affected nail for 52 weeks,  40% had mycological cure with minimal side effects, but at a cost of $450 a month.
  • Oral treatments that are mainstay include  Terbinafine (Lamisil) daily for 12 weeks and itraconazole daily for three months. Their effectiveness is about 30%-40% with more side effects.
  • Alternative therapies with some possible efficacy include applying Vicks Vapor rub (a mixture of menthol, eucalyptus oil, camphor, and thymol) to the nails every day for up to a year. This has worked well for quite a few people.
  • Tea tree oil is another alternative topical therapy with unproven results.
  • Still, oral therapies are still the best options as of yet. Oral Lamisil (terbinafine) cures 40% to 60% of patients…compared to less than 9% for Penlac (ciclopirox) and 11% for clotrimazole 1% topical solutions (less effective topical agents also on the market).
  • Key preventative measures include wearing flip-flops around a shared shower or pool, wash and dry feet thoroughly every day , do not clip your nails too low to the base, and avoid nail polish.

Diet and Heart attack prevention

 

 

 

 

The Mediterranean diet has scientific evidence of its efficacy in preventing heart attacks. There are several foods that play a large role in decreasing the inflammation in the body that leads to plaque build-up.

  1. Insane medicine - olive oil
    Olive Oil

    Extra Virgin Olive Oil (EVOO) is produced from olives and is rich in polyphenols that have anti-oxidant and anti inflammatory effects. It also has omega-3s and flavenoids, which are cardioprotective. It has a high content of monounsaturated fatty acids, which can decrease your LDL levels (bad cholesterol), and this is cardioprotective as well. EVOO can be cooked up to a temperature of 410 degrees F, so it can be used in most recipes. For higher temperatures, use regular olive oil. There are about 120 calories per teaspoon, so be careful how much is used! Compounds in EVOO include polyphenols (hydroxytyrosol, tyrosol, oleupein) and monounsaturated fats.

  2. Salmon and fatty fish such as halibut and sardines contain heart-healthy omega-3 fats. These lower triglycerides in your blood and stabilize plaques. The Omega-3 fatty acids are EPA (eicosapentanoic acid) and DHA (decosahexanoic acid).
    Insane medicine - Salmon
    Salmon –

     

  3. Red wine – is loaded with flavenoids and the antioxidant resveratrol. A glass of wine a day keeps the doctor away!
  4. Lentils and legumes – including beans and peas, have an abundance of minerals and vitamins and fiber, which lowers cholesterol. You can use soymilk to supply your daily dose of legumes in place of cow’s milk. Present in legumes are flavenoids (quercetin, anthocyanins) and isoflavones (genistein and daidzein), fiber, and phenolic acids (ferulic acid), all of which prevent artery plaque build up and inflammation.
    Insane medicine -Lentils
    Lentils

     

  5. Walnuts and flaxseeds – have a lot of alpha linoleic acid, a vegetarian omega 3 fat and fiber as well. Flaxseeds can be added to baked goods and pancakes to increase their fiber content and flavor.
    Insane medicine - flaxseeds
    Flaxseeds

     

  6. Greens and vegetables – including spinach, a very nutrient- dense vegetable, and red-purple colored vegetables such as radicchio, eggplant, and red beets all contain pigments that increase glutathione in our system, a natural antioxidant.You want to mix many different colored vegetables into your diet every day.
  7. Dark Chocolate and green tea – lowers blood pressure and cholesterol. Green tea is rich in antioxidants, especially polyphenols.
  8. Figs and fruits – dried fruits, pureed fruits – all are healthy, aim for three servings a day. They are high in polyphenol flavenoids and vitamins.
  9. Oatmeal and other whole grains – Oats are filled with soluble fiber ( a beta-glucan) that soaks up cholesterol. They are also high in antioxidants.

Alzheimer’s Disease – new screening tests in the near future?

 

 

Alzheimers disease brain tissue

Insane Medicine -Alzheimers disease
Alzheimer’s disease – neurons affected by plaques.
  • 5 million people are affected by Alzheimer’s Disease (A.D.) in the U.S., with a 1% incidence in the age group of 60-70 and 6-8% in the 85 year old category.
  • It is a progressive disease leading to eventual functional incapacity. There is a resulting loss of retention of recent memories at first with a progression to loss of remote memories in later stages. Language, abstract reasoning, and executive or decision making functions are impaired. Patients become household and work impaired. Some become delusional or psychotic.
  • This disease is the result of hyperphosphorylated Tau proteins that form neurofibrillary tangles inside the neurons. Also there are plaques of beta-amyloid that deposit in the brain, disrupting neuronal function.
  • Family history plays a role in the disease, with an individual having twice the average risk of disease if a first degree relative has Alzheimer’s.
  • Genetic changes, such as the presence of Apolipoprotein E4 mutation, increases the risk of A.D. by 2-5 times average risk by the age of 60-80.
  • Other causes of dementia must be ruled out before Alzheimer’s Disease is diagnosed. Reversible causes especially must be looked for, such as B12 deficiency, infections such as syphilis, thyroid disorders, autoimmune disorders, medication side effects, and drug abuse, especially alcohol.
  • A.D. results in difficulty in performing sequential tasks with poor decision-making skills eventually. This results in an at-risk population of elders, who are easy prey for con-artists looking to make money off impaired individuals.
  • Neuropsychiatric testing can help determine a person’s capabilities.
  • Cedar-Sinai Medical Center is developing a retinal imaging device that may identify A.D. 15-20 years earlier than other tests, such as PET scanning. Using curcumin, a compound found in the spice Tumeric, researchers discovered that the curcumin bound the Alzheimer’s plaques and could be seen in the retina. This resulted in 100% detection of the disease. Some people without the disease, however, tested positive with this testing.
  • Another retinal test is being evaluated by the Banner Alzheimer’s Institute using Fluorescent Ligand Eye Scanning (FLES). Researchers could detect beta-amyloid in the retinas of A.D. patient 85 % of the time.
  • Such retinal scans will allow for earlier detection of A.D.
  • There is no specific treatment for Alzheimer’s Disease, so there are a lot of ethical considerations that need to be evaluated in performing such tests. However, earlier detection may allow an individual to protect their financial and personal well-being from poor decision-making by allowing  specified power-of-attorneys to help make decisions when executive functioning starts to fail.
  • Other A.D. findings: Recently, a new protein, TDP-43, also seen in Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) ,has been associated with A.D. Additionally, A.D. patient can be screened for impairment through an inability of smell detection as well, using a 40-item smell detection test, called the University of Pennsylvania Smell identification Test.

Ebola Virus

Ebola Virus Infection

Ebola virus_virion
Ebola virus_virion magnified under electron microscope
  • Ebola has continued to spread in West Africa, infecting over 4500 people through September 2014, with 2300 deaths. The average mortality rate has been 70% with this infection.
  • This epidemic is the Zaire Ebola virus. There are several other sub-types of Ebola. It is an RNA virus of the filovirus family. It’s reservoir is the fruit bat and is spread among humans by direct contact with body fluid or the consumption of infected food or plants contaminated with bat droppings.
  • This epidemic started in Guinea in march.
  • Humans, apes, certain mammals, and potentially rodents can get Ebola.
  • There is no specific treatment as of yet, various interventions have been tried, but the main treatment is isolation of the individual, intravenous fluids, hydration, management of electrolyte issues, and prevent co-infection from bacteria.
  • Ebola life cycle
    Ebola life cycle

    According to a CDC prediction tool recently released, if current conditions persist, the cases will double every 20 days up to 20,000 infected by early November. This can be prevented by isolating at least 70% of the infected patients in specialty Ebola units. The more delay there is in obtaining this critical isolation and treatment number, the more likely infection rates will increase.

  • The CDC still predicts that the epidemic will end even if counter-measures are delayed, it will just result in more deaths.
  • Ebola virus infection isolation and treatment is needed to decrease spread.
    Ebola virus infection isolation and treatment is needed to decrease spread.

     

  • Many health care providers have lost their lives in Africa treating the sick, including researchers, nurses, and doctors. Fear of the disease and customary burial practices have increased the transmission rate and death rates. There are fewer and fewer doctors and nurses available to help stem the infection.

 



Exercising, even a small amount, benefits older adults!

Exercising and stretching are important to maintain mobility
Exercising and stretching are important to maintain mobility

 

  • Many studies have recognized the importance of exercising, especially in older individuals. Some physical activity is better than none in decreasing mobility issues in the elderly (Journal of American Medical Association – May 2014).
  • Flexibility and balance training, combined with walking, with a goal of 30 minutes at least for a total of 150 minutes a week reduced major health complications from poor mobility.
  • Walking, strength, and balance training decreased muscle loss in the elderly, and a structured physical activity routine is probably a great way to reduce disability in the elderly.
  • You may have wondered why some older people end up never walking again after a brief illness. They are doomed to a bed-bound existence because they suffer from sarcopenia, or muscle loss. That muscle does not come back, hence the need to preserve and maintain the strength one has before illness strikes so they do not lose mobility.
  • You should consult with your doctor before starting an exercise program. Local senior centers or health clubs may have exercise programs for older adults. It is best to have a training partner to give you more motivation to work out.
  • As one ages, it is very important to stay active and maintain what muscle mass that you have.
  • Tai Chi helps maintain balance and muscle strength.
    Tai Chi helps maintain balance and muscle strength.

     

  • Tai chi is a proven method of helping with balance and strength maintenance. It is low-impact, using slow, gentle bodily exercises and can alleviate a variety of physical and mental disorders.
  • Tai chi is effective in pain reduction, since physical inactivity results in increased pain and muscle mass loss. It is important to maintain flexibility and balance, both of which Tai Chi provides. Studies have shown that Tai Chi reduces the amount of falling in Parkinson’s disease.
  • Tai Chi allows you to manage your stress more effectively.
  • There are a variety of DVD’s available which demonstrate how to practice Tai Chi. Likewise, local resources in your community may offer Tai Chi classes.

Phosphorus in our diet: A problem or a marker for a bad diet?

  • Phosphorus is found in a wide variety of foods, both processed and unprocessedPhosphorus
  • It is found in meats, nuts, seeds,, whole grains, seafood, and poultry.
  • Additives in the form of phosphates are another form of phosphorus that we ingest. The inorganic form like this is readily absorbed. They are used as leavening agents, stabilizers, flavor enhancers, emulsifiers, and moisture binders in many food products.
  • Sodas, in particular, Colas are sources of phosphates.
  • Basically any processed food is generally filled with extra phosphorus.
  • We need Phosphorus for energy metabolism, regulating calcium, genetic information, and cell maintenance.
  • Too much phosphorus can increase the risk of cardiovascular events, bone loss, and kidney failure.
  • The RDA is 700 mg a day. Amounts over 1400 mg a day are associated with increased risk of mortality even in healthy people.
  • The type of food and it’s phosphorus load may play a role in the extent of problems. Phosphorus in an inorganic form is absorbed quickly and is present in processed food . This along with phosphorus present in meat products seems to pose an increased risk. In milk and dairy products, which have calcium and phosphorus in large amounts, there is not as much danger. In fact, dairy products lower high blood pressure.
  • Colas contain a lot of phosphorus, and this may result in displacement of calcium in the body, resulting in low bone density and fractures.
  • High phosphorus intake may increase risk for osteoporosis.
  • A hormone, FGF-23 may be increased in patient who consume a lot of phosphorus. This hormone  may cause cardiovascular problems such as calcification of the arteries and stiffening of the arteries.
  • Excess phosphorus may be associated with cancer and type 2 diabetes risk.
  • In short, decrease your processed food intake, cola consumption, and consider following the DASH diet (Dietary Approaches to Stop Hypertension)
Dash Diet Pyramid
Dash Diet Pyramid

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