Liver Failure from Supplements and Arsenic in Infant Foods

Supplements, Liver Failure and Arsenic

In our environment there are many substances that can damage or even result in liver failure. These include Carbon Tetra-chloride (formerly used in dry cleaning) and Acetaminophen (Tylenol) which in overdose results in total liver failure.

Complementary and alternative medications are established as a common cause of drug-induced liver injury; second only to prescription medications. However, in a recent review, researchers found that these "natural" medications are an increasing cause of liver damage (from 12% in 1998 to 21% in 2015). And they appear relatively more toxic; 56% of those required liver transplants versus 32% in drug injury; and they had a lower success rate after transplant. The limited oversight of these products may be one of the reasons. Being "natural" does not always correlate with safety!

Hillman L et al., Am J Gastroenterol 2016 Apr 5

In a welcome move, the FDA has decided to limit arsenic in infant rice foods. Arsenic levels are higher in rice than in other foods partly because rice plants, as they grow, absorb the element from the environment more than other crops do.

Rice consumption among infants is three times higher than that among adults (relative to body weight), according to the FDA. What's more, rice intake (again, relative to body weight) peaks at roughly 8 months of age.

The proposed arsenic limit — 100 parts per billion (ppb) — was only being met by about 50% of infant rice cereals tested in 2014. Roughly 75% were at or below 110 ppb.

The FDA is accepting public comments on the proposed measure for 90 days.

Natural Treatment of Erectile Dysfunction

Natural Treatment of Erectile Dysfunction - Flavonoids

Viagra and similar drugs are some of the best selling pharmaceuticals. But a recent study confirms that a diet high in fresh fruits and vegetables (mainly flavonoids) can lower the risk of erectile dysfunction.

As part of the Health Professionals Follow-Up Study, some 25,000 U.S. men (aged 40–75) completed food-frequency questionnaires and reported on their erectile function about every 4 years. During an average 10 years' follow-up, roughly one-third reported incident ED. Men with the highest intake of flavones, flavanones, or anthocyanins had a roughly 10% lower risk for ED than those with the lowest intake.

Common food sources of the flavonoids in question include blueberries, citrus fruits, melons, and peppers.

Not a surprise that once again fresh fruits and vegetables are good for you!

http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.full.pdf+html

Coffee is Good; Omega -3 might be

Some Recent Findings about Coffee and other Foods

There are many studies about the risks and benefits of the foods and supplements we eat and drink. Some are good, some not. In general moderation is best. Here are some of the recent reports. be aware that the risks and benefits are often very small.

Coffee and Colon Cancer

Moderation in coffee has not been shown to have any adverse effects, and it definitely improves awareness and can prevent drowsiness. Now, researchers have found that any coffee consumption was tied to a 26% reduced risk for incident colon cancer, compared with no coffee intake. The risk was lowest in the highest consumption group (more than 2.5 cups a day). Benefits were seen with both regular and decaf coffee. They studies about 10,000 patients, half of whom had cancer, and asked about their prior coffee intake. They theorize that coffee acts as a laxative similar to a high fiber diet.

And in another study :(http://circ.ahajournals.org/content/early/2015/11/10/CIRCULATIONAHA.115.017341.full.pdf+html)

researchers found that in an analysis of responses of over 200,000 individuals, participants who drank one to five cups of coffee (decaf or regular) daily had slightly lower risk for all-cause mortality than nondrinkers by about 10%. For heavier coffee drinkers, there was no association. When the analysis was limited to people who never smoked, there was an inverse linear relationship between coffee consumption and all-cause mortality, with those drinking over five cups daily having the lowest risk by about 12%. Among never smokers, coffee appeared protective against mortality related to cardiovascular and neurological diseases and suicide.

Omega-3 Good for the Brain; not the Heart

Are Omega-3 supplements (or diets high on these) useful? They seem to have an anti-inflammatory effect. But a recent review of the 1968–73 Minnesota Coronary Experiment, a cohort of adults in mental institutions or a nursing home were randomized to one of two diets: one that replaced saturated fats with vegetable oil rich in omega-6 linoleic acid or a control diet high in saturated fat. Researchers have now reanalyzed the data, including unpublished material, of 2400 participants who followed the diets for at least 1 year. Although the Omega-3 group had lower cholesterol levels, there was no benefit in mortality; in fact this group had a slightly higher mortality! BMJ 2016;353:i1246

On the other hand, in Amminger GP et al. Nat Commun 2015 Aug 11., researchers found that Omega-3 supplementation in a group of 81 teenagers and young adults at high risk for psychosis (such as schizophrenia) had the risk reduced by a factor of 4.

So Omega-3 supplements probably have some beneficial effects; especially in the pre-senior age group.

So continue to drink your coffee, and I would eat foods high in Omega-3; but probably limit supplements to higher risk patients for psychiatric disease.

Exercise makes you smarter!

Recently three studies have been published that show, once again, that regular exercise really does help your thinking.

Senility

As I age, this of course becomes more important. I love to exercise hard, so I was happy to see the study where researchers looked at 1200 patients of average age 70. Those who had low levels of physical activity had significantly decreased cognitive functioning as compared to the active group. So get off the couch!

Willey JZ et al., Neurology 2016 Mar 23;

Neurogenesis - or Brain Health

In a study of rats (which may or may not apply to us) researchers discovered that aerobic exercise (like running, cycling, etc) but not resistance training (like weight lifting - I wonder how they convinced the animals to do bench press?) resulted in increased new growth in the hippocampus. This is the area of the brain that is crucial for memory and deteriorates as we age. I love cycling, and you should, once again, get off the couch and do something!!

Nokia MS et al. J Physiol 2016 Feb 4

Bullying and Mental Health in teens

In a study of 13,000 students, grades 9-12, researchers found that increased frequency of exercise was associated with decreased frequencies of sadness, suicidal ideation, or suicide attempt. These protective effects of exercise were similar though slightly weaker among bullied students; those who reported exercising ≥4 days/week had a 23% lower likelihood of suicidal ideation and attempt. So keep an eye on your kids; and encourage regular exercise!

Sibold J et al. J Am Acad Child Adolesc Psychiatry 2015 Jul 17.

Zika Virus

Zika Virus

Zika Virus was first discovered in Africa around 1947, and is a relative of Dengue Virus and Yellow Fever. Initial reports thought that it was relatively innocuous.

In about 2003 it migrated (probably through air travel) to the French Polynesian, then in the past 2 years to Brazil; and now is spreading.

It is transmitted by the same mosquito as Dengue, Yellow Fever and Malaria. This insect requires tropical climates, so unless the virus mutates and can be transmitted by other insects it will not leave the tropical environment.

It wasn't until the neurological issues hit Brazil; that is microcephaly (an inhibition of brain growth in fetuses) and a slight increase in Guillan Barre syndrome, that scientists discovered its dangerous effects. Going back to 2003 in Polynesia they found similar increases in these syndromes there that had not been reported.

For someone who is not planning on becoming pregnant, or is not pregnant, the risk of serious illness is minuscule. However, since the virus may be transmitted sexually and present for several weeks after disease (which can be asymptomatic) the CDC recommends avoiding pregnancy for 2-3 months after travel to such a location. Scientists are working on a vaccine.

Travelers can bring the virus back, and it can be transmitted; especially in tropical regions. Based on travel history, a map of the areas most likely to see Zika virus is shown below.

So what should you do? If pregnancy is not an issue, just the normal insect repellents when travelling to an endemic area. If you think you or your spouse could become pregnant then don't go there!!

http://www.eurekalert.org/multimedia/pub/111210.php

Prilosec and Dementia (Alzheimer's)

A recent study about PPIs suggested that their long term use was associated with increased risk of dementia.

jamaneurol.2015.4791

I had a patient who immediately stopped her prilosec without discussing this with me!

In the study, German researchers simply looked at their health system database of over 70,000 patients over age 75. Using the data they looked at patients who did not have a dementia diagnoses in 2004; then did have one in 2011. Then they looked at medication use in those almost 30,000 who had this diagnosis, and found that, of the 2,800 original patients who had chronic use of PPI there were about 1600 diagnoses of dementia as opposed to expected 1200.

This is an absolute increase of 400 patients in over 30,000 cases. As well, this study depended on the proper diagnosis being sent to the insurance company. Furthermore, patients who took over the counter PPIs, like prilosec could not be controlled for.

Unlike newspaper headlines that stated this was a cause and effect (it certainly was far from it) the researchers stated that the association was interesting and rated further studies.

I prefer not giving any medication if possible. However if there is a clear need for a PPI; such as an ulcer, gastritis, or reflux, the risk of stopping the drug is probably much worse than that of dementia!

Unnecessary and Dangerous Treatments in the Elderly

Many studies are being published that show certain treatments are associated with lower general mortality. Often these benefits are very small, and the old (over 75) are not included.

For example, recent news stories about the SPRINT study published in the New England Journal of Medicine said that the ideal blood pressure now should be 120/80 or lower. However this study only looked at people with increased risk of heart disease. They also did not include diabetics, where another study showed increased risk if we lowered blood pressure to 120 from 140.

These results can be confusing. I would recommend that if the blood pressure can be lowered without complications (like dizziness, falls, etc.) that is ideal. But to be too aggressive can be dangerous.

Many older patients are taking statins such as Lipitor. These drugs have been shown to prevent inflammation in the arteries and decrease the risk of heart disease.However life span is shorter in older individuals, so are these drugs really helping?

Using a model of the U.S. population, researchers estimated the effects of treating all adults aged 75 to 94 with statins for primary prevention over 10 years. They found, based on statistics that there was a definite but small benefit; however a 10-30% increase in risk for adverse events could cancel out the cardiovascular benefits.

So yes, if well tolerated certainly continue statins in the elderly; but with any side effects (most common being muscle pain) we should not hesitate to stop them without too much concern!

Finally, we all know colonoscopy every 10 years after the age of 50 can prevent up to 80% of colon cancer deaths. But when do we stop? When life expectancy is less than 10 years, the risk of screening (as opposed to follow-up for disease) colonoscopy is higher than any potential benefits. For most people this is at age 75; for some in the early 80's; but really never over 85.