Nicotine in E-Cigarettes a Deadly Poison!

Electronic cigarettes (E-cigarettes), promoted as a safe way to smoke, or stop smoking, are not without dangers. And recent studies show that they do not help to stop smoking!

The fuel of e-cigarettes, liquid nicotine enables the satisfaction of cravings without smoke; however, nicotine is a neurotoxin. Even a highly diluted teaspoonful of the stuff can kill a small child.

Calls to poison control centers for liquid nicotine tripled between 2012 and 2013 and are projected to double this year.

Most nicotine refills for e-cigarettes are diluted to about 2% strength, but online vendors offer it at 10% strength — a tablespoon of which "could kill an adult," according to a toxicologist.

The FDA has said it plans to regulate e-cigarettes, but it hasn't said how.

Read more in this New York Times Story (picture below from the article)

Omega-3 and Heart Health - A Possible Retraction of Negative Data!

After much publicity about Omega-3s and the results of the study that suggested it was of no use; or possibly dangerous, many researchers reviewed the original analysis. They found major flaws and in truth Omega-3 may prevent heart disease; but certainly is not harmful as the original researchers suggested.

Most interestingly this study and analysis received almost no publicity, unlike the original review!

Bottom line - stick to a low fat healthy diet. If you want to take Omega-3 go ahead; the jury is still out.

DNA Analysis - Pandora's Box??

In the movie "Atticus", set in the near future, a person's genes could be analyzed and predictions made about their risks for many diseases. Of course this is frightening - especially if such information could get in the hands of prospective employers, insurers, etc.

In the movie and play "Twilight of the Golds" a woman discovers through genetic analysis that her unborn child has a 90% chance of becoming gay, like her brother. Her dilemma and relation with her brother creates an interesting story.

We are getting closer to being able to perform genetic analyses for diseases and personality traits. In fact there are now companies which advertise this service.

Researchers decided to see if current rapid whole gene analysis, which is financially feasible could provide useful information. The answer - not yet! They used two accepted methods of sequencing technologies on the same patient in a group of 12.

First, the sequencing technologies did not read the entire genome accurately: 10% to 19% of known inherited-disease genes were not identified clearly. Moreover, for previously unknown genetic variants, the two sequencing technologies often did not give the same answers. A team of geneticists independently analyzed the raw sequence data. The geneticists often did not agree on disease risk.

In a hypothetical exercise in which these findings were provided to practicing physicians, they would have ordered additional tests with costs ranging from US$351 to $776.

Not yet ready for prime time; but something to think about in the future.

Prostate Blood Testing - Yes or No

PSA, or Prostatic Specific Antigen, is a test that was once thought to be a valuable way to screen for prostate cancer. Unfortunately many studies have shown that screening every male does not seem to lower mortality rates.

Many doctors have strong feelings about this. I still perform the test in men over 40, but may stop at age 75. The US Public health Task Force no longer recommends routine screening.

Now studies are being performed in subgroups to see when it might actually be useful.

In a large group in Sweden, researchers found that if screening was done at age 60, if the PSA level was less than 2.0 there was no advantage to further testing. However for levels of 2 or higher, mortality was decreased by continuing annual testing.

My belief is that testing should be done annually until a man's life expectancy is less than 10 years. This is usually at about age 75 but in healthier adults can be later. But I have no solid scientific evidence for this opinion.

Diet, Supplements, ADHD, Heart Disease and Itching

Micronutrients, Food Additives and Omega-3 - new information

In three recent reports, there is evidence about benefits of micronutrients in ADHD in adults, the effects of food additives on chronic urticaria or itching, and the absence of any benefit of Omega-3 or Omega-6 supplementation in most people.

In the first, researchers gave ADHD adults a vitamin and micronutrient supplement and then evaluated their symptoms. The patients saw more improvement subjectively than the physicians, but both did see some changes. Unfortunately the effect was small. Participants received a manufacturer-supplied micronutrient formula containing all vitamins (except K) and 16 minerals (at 2–400 times the recommended daily allowance), including methylfolate, vitamin B6, niacin. This is extremely preliminary and will need further study.

Many people have suggested that food additives can cause a syndrome know as chronic urticaria; where patients have itching and rashes for unknown reasons. Of 43 patients with this syndrome who claimed food or additive allergies, none showed any changes in symptoms after exposure to multiple food additives and artificial food coloring. The authors estimate that these products are rarely a cause of this disease.
Finally, researchers studied the effects of Omega-3 supplementation, up to 1 gm, in patients who had never had a cardiovascular event. The results were no significant difference in the two groups in future cardiovascular events. The conclusion is that Omega-3s are not a useful preventative medication (except for those patients with very high triglycerides).

Effects of Marijuana on our brains

Marijuana and the Adolescent Brain

Now that "pot" has been legalized in to states, and medicinal marijuana allowed in many more, questions about its long term use are again coming out.

It is pretty clear that marijuana does not lead to harder drugs any more than alcohol or cigarettes do. But we know heavy alcohol or tobacco use has harmful medical effects. What about pot?

Using adolescent monkeys as subjects, researchers found that heavy use (equivalent to 2 marijuana cigarettes 5 days a week) in developing brains resulted in permanent impairment of spatial memory (location) but not object memory.
As usual moderation is the key. And anyone who tells me they have no sense of direction, well......

Do you have to get weaker as you age?

Reversing Muscle Weakness in Aging

As we get older not only do our muscles get weaker, but it becomes harder and sometimes impossible to regain muscle strength. Why is this?

Doing molecular research, scientists discovered that there are certain cells, called satellite cells, in muscle, that respond to exercise and training by making new muscle cells and strengthening existing ones. However, as we age these cells become "tired" and do not seem to be able to work as hard.

In looking at young and old satellite cells, they discovered a molecule that seemed to make the cells less vigorous. By blocking production of this the muscles became responsive once again as if they were young.
There is much research needed, but this might be a target to prevent the muscle wasting of aging and can have dramatic consequences!

Is your Cold Medicine dangerous?

Over the Counter Speed - Cold Meds?

Many current cold medications that contain phenylephrine, or decongestants, are now behind the counter because they can be transformed to methamphetamine rather simply. These medications can cause some hyperactivity and prevent sleep; however the doses usually given are supposedly minimal.

Many people complain that these drugs not only keep them awake but send them flying; out of proportion to the dose. Now researchers have found that mixing this drug with acetaminophen (Tylenol) can increase its relative dose by a factor of four!
This can lead to serious and possibly dangerous effects.

New York Times Article

Did You Have the Flu and not know it?

How Many of us are Getting the Flu?

Influenza, or the flu, can be a very serious illness, especially in the elderly and sick. But most of us rarely seem to see people with the actual flu. Yet the CDC keeps telling us it is common and we should all get flu shots.

To see how many actually get sick, researchers studied thousands of unvaccinated patients in England before and after flu season; and took blood tests to see if they developed flu that season (their antibody levels will change).

They discovered that 20% of the population showed evidence of flu - that is a very high number. However 75% of those had absolutely no symptoms.
It seems that the majority of people have no symptoms. The big question is whether they can transmit it.

I got a flu shot this year. Should you? If you are in a higher risk class; definitely. If you have minimal exposure to large groups or sick people the CDC still advises it but the evidence is not as strong.

Changing your Genes?

Gene Therapy - The next big jump in medical treatment?

An exciting new study has been recently published where researchers actually altered the genes of patients to make them more resistant to HIV.

There is a small subgroup in our population with a certain genetic marker that seems to prevent the HIV virus from infecting them. This is actually a structural change on the surface of their T-cells, rather than a chemical or drug we can use.

Researchers extracted T-cells from patients, then used a sophisticated technique to alter a gene in these cells before re-infusing them. They discovered the changed cells were resistant to HIV.

This study is extremely preliminary, but it may be that in the future gene alteration therapy will become commonplace. It is fascinating!

Predicting Alzheimer's Disease

Blood Test for Alzheimer's?

You may have read recently about a series of blood tests that could help predict if you are going to develop Alzheimer's.

Researchers collected blood from normal adults 70 and over, and followed them for three years. At that time, 18 had developed some signs of memory impairment. They went back to their blood samples and discovered 10 markers that had a 90% association.

This may be a welcome first step. IT is far too early to consider this a breakthrough for this untreatable disease. The way the study was done leaves possibilities of outside exposures, diet, and other factors that could have influenced the levels of these markers. Lets see how this develops.

Sleep Habits and Health

We all know that sleep deprivation results in poor performance as well as irritability and many other effects.

But what about changes in sleep timing; that is changing the time you go to bed and wake up.

Researchers subjected patients to a change in their sleep time by 4 hours; but allowed them to sleep the normal amount of time. This is similar to jet lag.

They discovered there were significant changes in the amount of protein and metabolism of certain hormones in these patients. Although they did not establish the effects, it is clear that jet lag can have adverse affects. The subjects did develop increased signs of depression as well.

This won't stop our traveling, but if you are on a schedule where your regular bedtime varies greatly it might improve your well being to develop a better routine.

Is Society going to the Thumbs?

Mobile Devices and Caregivers

We have become a society of cell phone addicts. It seems that everyone is looking down pressing buttons; indeed it is now one of the major causes of auto accidents!

Sometimes I wonder why we text so much instead of simply having a conversation. Is texting the new communication?

With that in mind, researchers decided to see how much attention caregivers (nannys, babysitters, etc). Sitting in fast food restaurants, they observed 55 caregivers of children up to age 10. They found 16 were continuously on their mobile device, while 40 of 55 used it at least once.

While the adults were absorbed in their devices, children often engaged in limit-testing behavior. Adults who were paying attention to their devices often responded by first ignoring the behavior and then scolding the child, giving robotic instructions without looking at the child, not addressing the child's needs, or responding physically. And what example are we giving to our children?

Just think about that next time you are ignoring someone while using your phone fro texting, facebook (its OK to read my articles :)) or other distracting activity.

Working in Weston April 8

As you all probably know, we are spending most of our time in Las Vegas. I am still happy to consult on your cases, and do see patients about every month or two in Weston.

I will be there Tuesday morning April 8, and you can make an appointment at 954-349-3030. You can also email me your questions at any time.

Currently I have obtained my medical licenses in Las Vegas and Oregon. I am going to be working in Oregon at the OHSU medical school as a fill in Family Practitioner, and am looking for part time work here in Las Vegas as well.

Antibiotics and Health - More insights - Why are farmers still using them??

Antibiotics and Health - More insights - Why are farmers still using them??

In the past antibiotics were given freely and overused. Recently we have begun to be more cautious so as to prevent resistant germs.

However, more evidence is arising that the germs that grow in your intestine can affect your health. Using antibiotics, and possible eating meat that contains trace amounts, can change your "gut microbiome" or naturally occurring germs in the intestine.

Not only have changes been associated with obesity and intestinal disorders, but a recent article showed that such changes greatly increase your risk for asthma. We don't fully understand the interaction at this time, but is is clearly important to our health.

I was upset to see recently that the FDA has decided to allow some 18 of 30 penicillin and tetracycline antibiotics used as additives in animal feed. Even though this puts humans at high risk for exposure to resistant bacteria through the food supply, according to an FDA analysis of 2001-2010 data. And who knows what it does to our microbiome.

You may have heard that giving animals antibiotics increases yield. While this was true when the practice was started, further study showed that keeping the pens clean and washing them down before transferring animals had the exact same effects. This is now standard practice, and many studies have shown no advantage to antibiotics. This makes the FDA decision even more suspect.

In any case, stay away from antibiotics whenever possible and do not eat meat that has been fed antibiotics (or hormones of course). Stay healthy!!

Vitamin C and E - Unhealthy and Harmful

Vitamin C and E - More bad news

many of us often neglect the possible downsides to vitamins and supplement - most often without proper evidence. How many know of someone who insists the high dose vitamin C prevents colds - even though there is nothing to back that up.

Even I have been guilty when I have counseled patients that I have never heard of any harm coming form it - even though I thought it would not help.

Unfortunately I was wrong. Both Vitamin E and Vitamin C have been shown in studies to hinder the metabolism of sugar and raise the risk of Alzheimer's disease. These also shown, by way of blocking sugar metabolism, to prevent the benefits of exercise training. Those who took vitamin C and E did not show any improvement in cardiac fitness after a 3 month program while those who did not did get more fit.

Supplements can hurt you.