Category: Diseases & Conditions

A Permanent Vaccine for the Flu?

By Mark A. Kelley, MD |2/5/18
Founder, HealthWeb Navigator

The current flu season is the most severe in nearly a decade. In a typical year, influenza causes 3 to 5 million cases of severe illness, and anywhere from 290,000 to 650,000 deaths around the globe.

But this year may be even more worse because the flu vaccine has been only 10-20% effective in preventing the flu—less than half its usual protection.

The flu virus mutates rapidly, so creating an effective vaccine is largely a game of chance. The process requires scientists to decide in advance which strains they think will be the most prevalent each flu season. That decision determines how the flu vaccine is manufactured, a process that takes about six months.

This year the H3N2 virus emerged unexpectedly. It is particularly nasty and tends to be more resistant to flu vaccines.

The flu virus, particularly type A, can also blend its genes with other viruses, including those infecting animals like pigs and birds. These changes produce new surface coatings on the virus, which pose a major challenge for our body’s defenses. If our immune system recognizes a virus from a previous infection or vaccine, it can quickly kill it. However, new forms of the virus are hard to recognize and can make it difficult for the immune system to react quickly. Such a delay can be deadly if it allows the infection to gain a foothold.

Compared to vaccines for polio, smallpox, and measles, the current flu vaccine falls considerably short:

• It offers limited protection that changes year to year.

• It does not provide lifelong immunity.

• It is unlikely to protect against more dangerous strains of flu like the 1918 pandemic that killed 50–100 million of the world’s population.

Can we produce a better and more effective flu vaccine? The short answer is yes—but only if we have the will to do it.

Scientists have known that certain parts of the flu virus do not change their genetic profile. These areas hide from our immune system. A more effective vaccine would expose and target those areas so that our immune system can always recognize the virus and eliminate it. Other approaches include reengineering some of our own cells to look like the flu virus and making the immune system better prepared to reject it.

These and other innovations are aimed at developing more effective and predictable protection against the influenza virus. Although it will likely take years and considerable funding to develop, the costs are paltry compared to the estimated $8.4 billion in lost productivity every year in the U.S. resulting from the flu. A new vaccine that uses modern technology and offers better protection would be a bargain.

Influenza has plagued mankind for centuries. Every winter, this disease reappears around the world. It may spread even more rapidly with population growth, international travel, and urbanization.

There are reasons to be optimistic about a new vaccine. In this era of “precision medicine,” the science of virus biology has advanced far beyond the 70-year-old technology used for the current vaccine. If the nations of the world choose to accept this challenge, we may be able to protect millions of people who suffer or die from influenza every year.

Are Allergies Preventable? You May Be Surprised

By Mark A. Kelley, MD |1/30/18
Founder, HealthWeb Navigator

Chances are you or someone you know has experienced an allergic reaction at some point. The statistics are eye-opening:

Allergies affect as many as 30% of American adults and 40% of children in the U.S. An estimated 20% of Americans have hay fever; about 4% of children and adults have a food allergy; and 10-20% of children and 3% of adults have significant skin allergies. Also common are allergies to dogs and cats.

Thankfully medical science can prevent and even eliminate some of these conditions. But how?

Our immune system is finely tuned to recognize and repel invaders, especially bacteria and viruses. An allergy develops when the body’s immune system detects a foreign protein and reacts to its presence.

Take the example of pollen. Most people have no problems with pollen. However, anyone with seasonal rhinitis (like me) suffers through the pollen season with a runny nose and cough.

Peanuts are the source of another common allergy. Most people have no problem with peanut products, but for others, peanut consumption can be dangerous. When exposed to a peanut product, these patients can develop serious breathing problems within minutes. Without treatment, this reaction can lead to life-threatening shock.

Of course, the best defense against an allergy is to avoid exposure to the agents that trigger it. Never eat peanuts if you are allergic; stay away from grass and flowers in pollen season; and give away your pet if you are allergic to it.

But sometimes these steps are impractical. For the peanut allergy, any food can be risky because peanut products are common in many foods. In pollen season, staying inside may be impossible if you work outside. As for a cat or dog allergy, patients are very reluctant to part with their pets.

Another way to fight an allergy is to “teach” the body to be more tolerant to allergens. The key is to introduce the offending proteins to the immune system in very small doses. This therapy of “allergy shots” has been around for decades. Small injections of the offending allergy protein (like ragweed) tone down the immune system so that any future reaction produces minimal symptoms. This approach is called “immunotherapy.”

For decades, this tolerance-building approach has been widely used for common allergies such as pollen and animal dander. With new technology, the allergens can now be delivered more easily, either under the tongue or orally, instead of by injection.

New evidence suggests that tolerance develops naturally in early childhood. From birth to about 4 years of age, the immune system seems to have a learning curve about how and when to react to allergens like animal dander and peanuts.

It was once thought that if children had less exposure to allergens, they wouldn’t be as likely to develop an allergy. For years, parents were advised to keep peanuts and other complex food away from children until the age of four. Similar advice pertained to exposure to pets.

Recent research has changed this thinking. New studies have shown that infants introduced to oral peanut extract before the age of one have much lower rates of peanut allergy. In other studies, children who grow up around domestic animals and pets have much lower rates of animal allergies and hay fever. This research suggests that childhood exposure to some allergens teaches the immune system tolerance and reduces the likelihood of developing some allergies.

Most mild allergies are easily treated and prevented. However, others are more serious, their therapies more complex. It is wise to discuss any allergies with your doctor and, if necessary, consult an allergy specialist.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Should I Get the Shingles Vaccine?

By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator

I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.

Fortunately, this condition can be prevented.

What Causes Shingles?

Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.

In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.

However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.

For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.

With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.

Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.

In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.

What Are My Options?

Currently there are two injectable vaccines that can prevent shingles.

Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.

Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.

Is the Shingles Vaccine Right for Me?

The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.

These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.

The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.

I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.

Consult your physician to see if and when the shingles immunization is right for you.

Radiology Imaging Tests: The Basics

By Carla Dellaporta |12/8/17
Director of Education, NeedyMeds

You’re out walking your dog, enjoying the fresh air and holiday decorations, when suddenly — bam! Down you go on a patch of black ice. Standing, you realize you can’t put weight on your ankle.

The doctor says she’s not quite sure how bad the damage is. To get a better idea, she wants to schedule what she calls a “radiology imaging test.”

Say what now? Isn’t radiology like, nuclear?

Medical jargon gets thrown around left and right these days. Thankfully this one’s pretty simple. “Radiology” is the branch of medicine that relies on technology to diagnose or treat diseases. And “imaging” means the technology involved to take pictures inside your body.

So your doctor is saying she needs to get a better picture—literally—of what’s going on inside you.

There are many radiology tests out there. They differ in terms of the technologies used to produce images of your body. Some common radiology tests requested by doctors include:

X-ray: Uses a small dose of radiation.

CT scan: Combines multiple X-ray images.

Ultrasound: Uses high frequency sound waves.

MRI: Uses magnetic fields and radio waves.

From 2000-2010, imaging services and costs grew at twice the rate of other healthcare technologies. One reason why may be what’s called “defensive medicine.” This term refers to doctors prescribing or recommending unnecessary tests to protect themselves from potential malpractice lawsuits.

A recent study estimated that unnecessary medical tests cost the U.S. nearly $7 billion dollars annually. Overly cautious medicine is a common practice that, unfortunately, comes at the patient’s expense. Don’t rush to get a test without having a clear idea of what your options are and whether or not you can afford treatment.

Below, we’ll cover some questions to ask before scheduling your radiology imaging test. That way you’ll know you’re getting the best bang for your buck.

Questions to Ask Your Doctor Before Scheduling the Test

Do I need this test? You’ll want to understand why you need a scan and how the results will change your course of treatment. If the doctor can’t justify how the results of the test would change the treatment course, then you probably can do without it. No use in wasting time or money on unnecessary tests.

Are there safer alternatives? A CT scan exposes you to much more radiation than a standard X-ray. An MRI, on the other hand, doesn’t use radiation at all. Because radiation can potentially cause DNA damage, you want to limit your long-term exposure. Ask whether there are any lower-radiation but still effective options.

How much will this test cost? Imaging fees vary widely between hospitals, private facilities, geographic location, etc. Always ask for the bottom line cost before scheduling a test. Keep in mind, there’s something called a “global fee” you’ll want to be aware of. This fee charges for the test itself as well as the professional interpretation of the results. Being aware of the global fee ensures you won’t be blindsided when the bill arrives.

How long before I get the results? Radiology test results are generally read on-site by a trained radiologist. However, it’s the doctor who usually delivers those results to the patient, and a variety of factors will influence when you’ll receive them. Ease your mind by asking up front how long this process will take. Consider calling if you haven’t received your test results after five days.

Some Final Cost-Saving Tips

Confirm which location(s) your health insurer considers in-network and how much they cover. Few people know that most of the time, imaging tests cost more when performed at a hospital rather than private facility. Contact your health insurance company directly to find out which facilities they consider in-network. By staying in-network, you won’t have to pay the for the full price of care. There’s a reason you have health insurance—let your insurer help cover the costs!

Ask for a cash discount or sliding scale payment plan. Paying out-of-pocket doesn’t mean you’re doomed to pay up-front and in-full. Most healthcare centers will work with your financial situation, but first you have to ask. A payment plan is a much more reasonable choice compared to putting the total fee on a credit card. You wind up paying a lot more money in interest if you can’t pay off your credit card bill immediately.

Check the credentials of the imaging facility. You know you can trust a facility if it’s been accredited by the American College of Radiology. That means the center has undergone a rigorous evaluation process led by experts in the imaging field. Generally, accreditation can tell you if the center’s radiologists are experienced, and whether or not the center’s equipment and staff meet/exceed nationally accepted standards. Obviously you want the best care for your money.

To learn more about the field of radiology imaging, our reviewers recommend RadiologyInfo.org as a great introductory resource. This website explains the various forms of medical imaging including their indications, complications, and relevant tips for patients undergoing tests. Read our full review for more information.

Crohn’s and Colitis — Common but Misunderstood

By Nathan Blake |12/7/16

The first week of December marks the fifth annual Crohn’s and Colitis Awareness Week. These two conditions affect the digestive tracts of nearly 1.6 million Americans each year, although many more remain undiagnosed and deal with persistent pain and discomfort on a daily basis.

If you or a loved one has been diagnosed with either of these conditions, it is important to educate yourself about them in order to best manage the symptoms and reclaim a sense of normalcy.

What are Crohn’s and Colitis?

Crohn’s and colitis are among the most common forms of inflammatory bowel disease (IBD). IBD refers to a family of conditions that causes prolonged inflammation of parts or all of the intestinal tract. IBD and its various forms are known as invisible illnesses, referring to chronic conditions that impair a patient’s day-to-day activities yet show no outward signs.

Crohn’s disease is an inflammatory condition that can affect any part of the digestive tract from mouth to anus. The lining of the digestive tract becomes swollen and develops deep, open sores called ulcers, which can manifest in multiple areas including the esophagus, stomach, small intestine, colon, appendix, and in rare cases the skin and joints. Commonly, there are healthy portions of the intestine between inflamed areas that remain unaffected.

Ulcerative colitis is also an inflammatory disease, although its effects are specific to the superficial tissues of the colon and anus. With ulcerative colitis, ulcers develop on the inner lining on the large intestine. These ulcers may bleed and/or produce pus. Ulcerative colitis generally begins in the rectum and spreads upward to the first part of the colon.

Both diseases often appear gradually and then worsen with time, though many patients report periods of remission during which symptoms disappear for weeks or months. Periods of painful inflammation, on the other hand, are called flare-ups.

Common Symptoms of IBD

Because Crohn’s and colitis affect similar parts of the body, diagnosing these two diseases can be difficult. Their symptoms are often indistinguishable and can vary from person to person. Inflammation of the gastrointestinal tract often leads to the following symptoms, many of which are common for people dealing with Crohn’s or colitis.

• Diarrhea

• Rectal bleeding

• Urgent bowel movements

• Constipation

• Abdominal cramps/pains

• Fatigue

• Unintended weight loss

• Fever

• Night sweats

• Loss of appetite

What Causes Crohn’s and Colitis?

The intestine’s absorptive area spans over 4,300 square feet, making it the single largest surface in the human body, including the skin. Previously, diet and stress levels were implicated as the main determinants of IBD, but today they are seen as aggravating factors and not the actual cause.

While researchers are still unclear as to the exact causes of Crohn’s and colitis, many agree that they likely originate from a combination of factors.

Individual genes: People with a family history of IBD are 10 times more likely to develop the condition than those with no history.

Immune system: It is possible that Crohn’s and colitis appear in response to a viral, bacterial, or fungal infection of the intestinal tract, where the immune system produces an inflammatory response in the intestines to fight off the foreign agent(s). However, people with IBD often have inflammation even when no infection is present, leading researchers to believe that the patient’s immune system may be attacking the body itself. This phenomenon is known as an autoimmune response.

Environmental factors: Clinical and experimental evidence indicates that IBD may be associated with a range of seemingly unrelated environmental influences including cigarette smoking, diet, stress, use of hormones, vitamin D levels, and geographic/social status, among others.

Complications in IBD

Though these two diseases are rarely life-threatening, if left untreated, Crohn’s disease and ulcerative colitis can result in several serious complications deserving of immediate medical attention.

Fistulae: When ulcers extend completely through the intestinal wall, they create fistulae, or abnormal fusions between different parts of the body. The most common site for IBD fistula formation is the tissue surrounding the anus, where the fistula creates a connection between the rectum and the skin. Fistulae can occasionally become infected and form a life-threatening abscess—a localized pocket of pus—if left untreated.

Bleeding: Blood often appears in the stool of people with IBD, caused by inflammation, ulcer formation, and anal fissures. Some even pass blood alone in the absence of stool. Bleeding in the rectum is more common in ulcerative colitis than Crohn’s, but will vary depending on the area(s) affected.

Anemia: People with IBD have difficulties absorbing important nutrients from food, especially iron, which is absorbed in the small intestine (an area commonly affected by IBD). As a result, nearly half of people affected by Crohn’s or colitis do not receive adequate levels of vitamin B12, iron, and folic acid, all of which are necessary for the creation of new red blood cells. Patients with low levels of red blood cells develop anemia, resulting in headache, fatigue, chest pain, and weakness.

Treatment and Management

The goal in treating Crohn’s and colitis is to achieve and maintain remission, and mostly involves drug therapy to reduce the inflammation that causes IBD’s signs and symptoms. Immunosuppressants and anti-inflammatory drugs called aminosalicylates and corticosteroids have proven to be helpful in improving or completely stopping the symptoms of IBD. Biologics are a more recently developed therapy, created out of biological antibodies rather than chemical medications. Biologics also suppress the immune system but offer a distinct advantage in that they target specific proteins in the IBD patient rather than affecting the whole body.

However, there is currently no cure for Crohn’s disease, and ulcerative colitis can only be cured in the most severe cases when the entire large intestine is surgically removed.

Fortunately there are several ways that people with IBD can manage their symptoms. If you or a loved one has been diagnosed with IBD, consider the following strategies in conjunction with a physician’s oversight to help alleviate symptoms of the disease.

Manage stress: Many patients report an intensification of symptoms in times of stress. Consider adopting a meditation, yoga, or acupuncture routine to reduce symptoms, and get plenty of exercise, preferably daily.

Stay hydrated: Inflamed colons do not absorb water and electrolytes properly, resulting in diarrhea, increased bowel movements, and dehydration. Keep yourself hydrated with distilled water in order to combat this increased fluid loss, and monitor your urine to determine whether or not you are drinking enough liquids.

Limit “trigger” foods: Foods that cause flare-ups depend on the individual, but some are more commonly associated with intensified symptoms than others. They include fatty, spicy, and high-fiber foods; alcohol; coffee; carbonated drinks, nuts and seeds; raw fruits and vegetables; and red meat.

Get your vitamins: IBD flare-ups can negatively impact nutrition due to the increased bowel movements, loss in appetite, fatigue, etc. When the small intestine becomes inflamed, the body is unable to absorb nutrients from food. Coupled with a reduced appetite, IBD can easily lead to malnutrition. Patients can avoid malnutrition by eating smaller, well-balanced meals throughout the day. Your doctor may also recommend vitamin supplements as well.

What Does Medical Science Say About Fish Oil Supplements?

By Nathan Blake |11/23/16

A recent survey of over 11,000 consumers revealed that fish oil is currently the second most popular nutritional supplement on the American market today, with annual spending exceeding $1.2 billion for over-the-counter fish oil pills and related supplements.

Fish oil has long been touted for its supposedly positive effects on a variety of bodily functions including lowering blood pressure, triglycerides, and cholesterol levels; preventing heart disease; inhibiting the formation of cancer cells; combatting depression and mood disorders; reversing the effects of macular degeneration; and countless others.

But what does medical science have to say about these claims? Is fish oil the cure-all it’s advertised to be, or would consumers be better off spending their money elsewhere?

Fish Oil’s (Not So) Secret Ingredient

Fish oil capsules contain concentrated amounts of omega-3 polyunsaturated fatty acids. Omega-3 fatty acids are necessary for human health, playing a crucial role in brain health and the regulation of inflammatory responses. There are three main types of omega-3 fatty acids, two of which can be found in fish oil capsules.

Eicosapentaenoic acid (EPA) is absorbed into the body by eating oily, coldwater fish like salmon, menhaden, sardines, mackerel, albacore tuna, halibut, and herring. EPA is also found in edible strains of seaweed as well as human breast milk.

Docosahexaenoic acid (DHA) is an important structural component of the human brain and is essential for its proper functioning. It also plays a primary role in maintaining the health of the eye, cerebral cortex, skin, sperm, and testicles. The human body can produce a small amount of DHA on its own, but like EPA, we get the majority of our DHA from cold-water ocean foods. DHA can also be found in organ meat, poultry, and egg yolks, though in small amounts.

Cardiovascular Health

The positive effects of fish oil on the human cardiovascular system have well been established, but that’s not to say no controversy exists. After evaluating the potential benefits of fish oil supplements for patients with multiple pre-existing cardiovascular disease factors, scientists concluded that DHA and EPA had neither a positive nor a negative effect on cardiovascular health. However, an early meta-analysis of fish oil studies revealed a possible correlation between fish oil supplementation and lower blood pressure. Further, scientific data indicates that fish oil consumption can reduce the risk of coronary heart disease, decrease mild hypertension, and prevent certain cardiac arrhythmias. Other studies show that fish oil capsules can be effective in the prevention of primary and secondary cardiovascular disease. In multiple clinical trials, fish oil supplements have been linked to the suppression of major coronary events. The most conclusive benefit of fish oil supplements seems to be that fish oil capsules are effective in lowering triglycerides in the blood. One study found that a prescription dose of EPA + DHA (2x the normal amount) lowered patients’ triglycerides by 27%.

Mood Disorders

Fish oil is not considered to be an effective replacement for mental health treatments, but when used in conjunction with other therapies, fish oil seems to provide beneficial effects to patients diagnosed with borderline personality disorder, unresponsive depression, and schizophrenia. EPA in particular has been studied for its possible use in regulating mood disorders, and researchers found that EPA-heavy omega-3 supplements appear to be effective against primary depression when used alongside prescription medications and other treatment. There is some evidence, however, that fish oil supplementation does not improve mood when tested against a placebo.

Alzheimer’s Disease

In a double-blind study spanning 26 weeks, researchers found that neither high nor low doses of fish oil had an observable effect on cognitive performance in patients age 65 and older. A much longer study, however, found that fish oil intake is associated with lower rates of Alzheimer’s disease. That being said, in a study of 174 Alzheimer’s patients, fish oil supplementation was not shown to reduce cognitive decline in patients with mild or moderate Alzheimer’s disease, though some positive effects were shown in a small group of patients with very mild Alzheimer’s. Other trials confirmed these finding that omega-3 supplementation is beneficial only for patients with mild cognitive impairment. While it’s still too early to make firm recommendations regarding the potential benefits of fish oil intake, daily DHA supplementation in excess of 180 mg is associated with a 50% decrease in dementia risk.

Eye Health

Regular consumption of EPA and DHA fatty acids significantly reduces the risk of developing age-related macular degeneration in women. Other findings suggest that increased omega-3 intake via fish oil capsules can prevent age-related macular degeneration in all subjects, sometimes by an estimated 22%. While the precise role of omega-3 fatty acids in eye health is unclear, there is some evidence that suggests DHA supplements can prevent cell damage and eye stroke injury in the retina.

Inflammation

A study of 250 patients with neck or back pain revealed that fish oil supplements are an equally effective but safer treatment for reducing arthritic pain compared to NSAIDs like ibuprofen and aspirin. Some studies suggest that EPA, independent from DHA, is a potential therapeutic treatment for arthritis-related inflammation in mice, and that EPA has a stronger anti-inflammatory effect than DHA. While another study’s findings suggest that fish oil supplements are not as effective in reducing chronic low-grade inflammation in obese men compared to weight reduction, multiple studies seem to suggest that omega-3 fatty acid supplements can decrease inflammation in patients, particularly those diagnosed with rheumatoid arthritis or ulcerative colitis.

Cancer

Some evidence points to the benefit of fish oil’s anti-inflammatory effects on reducing the overall number of cancer cells in the colon. Another investigation found that EPA + DHA are good candidates for primary and secondary breast cancer prevention due to their abilities to reduce inflammation. Strangely enough, one recent study has shown a correlation between elevated levels of omega-3 fatty acids and an increased risk for developing aggressive prostate cancer; men with the highest DHA levels were 2.5x more likely to develop high-risk prostate cancer, though similar studies proved inconclusive. Further, other studies revealed opposite findings, that fish oils are actually helpful in reducing the risk of prostate cancer in healthy individuals, as well as preventing colorectal and breast cancer formation.

The Last Word

Ultimately, the health benefits of fish oil supplements are still unclear. Studies surrounding omega-3 supplements, as we have seen, are conflicting at best, contradictory at worst. That being said, multiple organizations agree that the potential benefits of fish oil capsules outweigh the potential risks for generally healthy people, though more evidence is needed before making a definitive claim.

Continue taking fish oil capsules if they have been prescribed to you by a physician. If you are planning to begin a fish oil regimen, consult with your primary care physician beforehand to make sure you are healthy enough and that they will benefit you. General consumers should be aware that while many of the findings referenced above are interesting, it’s entirely possible you may not be receiving the benefits you’ve been paying for.

What Do You Know About Diabetes?

By Nathan Blake |11/9/16

November is designated National Diabetes Awareness Month.

In 2012, over 9% of the American population—roughly 29 million people—had some form of diabetes. Worse, one in four people with diabetes do not know they have the disease. With over 1.5 million new cases of diabetes being diagnosed every year, this disease is quickly becoming one of the nation’s fastest growing and most serious epidemics. In fact, diabetes was the seventh leading cause of death among Americans in 2010. That number, if current trends continue, is sure to rise.

What is Diabetes?

Diabetes is a group of health conditions that makes it difficult for the human body to properly control the level of sugar in the blood. When we eat, our bodies convert food into sugars, one of which is called glucose, which our cells rely on as a main source of energy to carry out the basic bodily functions of our muscles, brain, heart, liver, and more.

Because of the importance of glucose in everyday health, there are very intricate biological processes at play to regulate glucose in the blood. These processes ensure that our glucose level does not rise above or fall below a healthy range.

The Importance of Insulin

The cells in our body cannot use glucose directly and must rely on a hormone called insulin. After eating, insulin is released into the bloodstream by the pancreas. Insulin attaches to cells and prompts them to absorb glucose from the bloodstream. The cells then turn the glucose into energy.

When there is an overabundance of sugar in the blood—for instance, after a big meal—insulin stores this excess glucose in the liver to be used later when blood sugar levels drop, such as during the period between meals or while exercising. Normally, glucose is kept under tight control by the pancreas which uses insulin to regulate the blood levels. Diabetes occurs when this regulation system fails to control the levels of glucose.

Types of Diabetes

Type 1 diabetes (formerly called “juvenile-onset diabetes”) occurs when the body cannot create its own insulin. This is because the body’s immune system has destroyed the insulin–producing “beta cells” in the pancreas. Without insulin, glucose cannot enter cells. The cells must then use other inefficient sources of energy while glucose levels rise. This metabolic imbalance can be life–threatening. To prevent this problem, patients with Type 1 diabetes must receive insulin injections daily in order to regulate their blood sugar levels.

Type 2 diabetes (formerly called “adult-onset diabetes”) occurs when the body continues to create insulin but the cells have a sluggish response to its effects. The result of this “insulin resistance” is elevated levels of glucose in the bloodstream. Over time, the high glucose level can also affect the pancreas and reduce its production of insulin.

Gestational diabetes, occurring in roughly 4% of pregnancies, results from hormonal changes during pregnancy that inhibit insulin’s ability to regulate glucose levels.

Risk Factors

While the risk factors for developing type 1 diabetes are still being studied, research shows that having a family member with diabetes can increase your risk for developing the disease. Type 1 diabetes occurs most commonly in children and young adults, accounting for roughly 5% of all people diagnosed with diabetes.

More is known about what causes type 2 diabetes, as it is the disease’s most common form. Several risk factors include a family history of diabetes, being overweight, not getting enough regular physical activity, an unhealthy diet, high blood pressure, and increasing age.

Pregnant women at risk for developing gestational diabetes include those over the age of 25, people with a family history of diabetes, and women who are overweight. For reasons that are not fully understood, gestational diabetes occurs more frequently among black, Hispanic, Asian, and Native American populations.

Treatment

Many diabetics require treatment with insulin or other medications that help control glucose. Equally important are lifestyle habits that can be helpful in preventing diabetic complications. Diabetes can be managed by taking the following precautions:

• Eat meals balanced in starches, fruits and vegetables, proteins, and fats.

• Make physical activity a daily routine.

• Monitor blood sugar levels to be sure they are under control.

• Manage blood cholesterol and lipid levels by eating healthy and taking prescribed medications as recommended by a healthcare provider.

• Control blood pressure to a healthy range (below 130/80).

Prevention

Type 1 diabetes cannot be prevented, although many studies have shown that patients can take a few simple steps to drastically reduce their risk for developing type 2 diabetes.

The Diabetes Prevention Program was a federally-funded project that monitored over 3,000 individuals who were at risk for type 2 diabetes. Researchers discovered that adults at risk for the disease were able to reduce their susceptibility by half by following two practices: healthy eating and regular exercise.

Adhering to a low-calorie, low-fat diet and getting at least 30 minutes of physical activity for five days a week were shown to be effective markers for lowering the risk for diabetes.

To learn more about diabetes diagnosis, treatment, and prevention, visit the National Institute of Diabetes and Digestive and Kidney Diseases, supported in part by the National Institutes of Health.

Prostate Cancer — Does Everyone Need Treatment?

By Mark A. Kelley, MD |09/20/16

Last week, the New England Journal of Medicine published an important study about prostate cancer. The research showed that men with early stage prostate cancer can safely choose “monitoring” instead of treatment.

This might seem like a strange recommendation for such a serious disease. However, prostate cancer is an unusual malignancy. It is more common as men age but it rarely causes death.

Prostate cancer can be detected very early with the simple blood test, the prostate-specific antigen (PSA). The treatment is either surgically removing the prostate gland or treating the prostate area with external radiation. Both treatments are effective but can cause impotence and incontinence.

This is an unusual paradox in cancer treatment. A very simple blood test can detect prostate cancer in its early stages but the cancer grows slowly and is rarely fatal. Furthermore, the treatments have important side effects. Should a patient undergo treatment for a cancer that is rarely causes death?

The new study helps to answer that question. The major goal was to determine if prostate-cancer survival is better with early treatment versus to a “watch and wait” strategy. The study recruited over 1600 men between 50-70 years old with localized, early stage prostate cancer. These volunteers were randomly assigned equally to one of three groups: immediate surgery; immediate radiation; or “active monitoring” of their cancer by a medical specialist. During that monitoring, patients whose cancer became more aggressive were offered treatment. All patients, on average, were followed for ten years.

The major results of this study are:

1.  For all patients with localized prostate cancer, the 10-year survival from the disease was 99%.

2. There was no survival advantage from early treatment or the type of treatment (surgery vs. radiation).

3. Progression of prostate cancer occurred in 20% of the “active monitoring group” and in less than 10% in the treatment groups. This difference did not have any affect on survival over the ten years of the study.

4. About 60% of the “active monitoring group” eventually had surgery or radiation during the follow-up period. However, the remaining 40% had no progression of their disease.

What did we learn from this study?

The study confirms that localized prostate cancer does not behave aggressively. Over ten years, survival is excellent. Nearly half of the patents assigned to follow-up had no progression of their disease. They were spared unnecessary procedures. This lends support to follow-up as an option for patients.

What still remains in question?

More of the “active monitoring” patients had progression of their cancer compared to early treatment patients. (20 % vs. 10 %). This difference did not affect mortality in this study. However, the significance of this finding is unknown and warrants further research.

What will physicians recommend now?

Before this study was published, most experts have been offering follow-up as an option for men with localized prostate cancer. This new study gives convincing evidence that follow-up, instead of immediate treatment, can be a safe choice for newly diagnosed prostate cancer patients. In 40% of such patients, the tumor remains stable over a decade and requires no treatment. If the tumor grows during that period, and treatment is needed, the survival rate is still 99%.

A warning: in this study, specialists carefully followed men with “active monitoring”. Men who do not have this follow-up may have less favorable results.

This study may be especially helpful for patients who are hesitant about treatment. Those concerns are often about the complications of treatment or the risks of co-existing medical conditions. For such men, this study confirms that monitoring is a reasonable choice. This information will make it easier for doctor and patient to plan the next steps.

This is a great example of how medical research can help patients make informed choices.

To read more about prostate cancer, see the American Cancer Society website.

 

Are the Health Risks of Smoking Reversible?

By Mark A. Kelley, MD |09/07/16

As a lung specialist, I am often asked whether the body can recover from many years of smoking.  Based on decades of research, the answer is a resounding “Yes” … but only if you quit smoking – completely.

What Are The Risks of Smoking?

Cigarette smoking kills over 400,000 Americans each year – more than the combined deaths from alcohol, illegal drug use, homicide, suicide, car accidents, and AIDS combined.

Cancer – Before cigarette smoking became widespread in the twentieth century, lung cancer was a rare disease. However, as smoking become popular, lung cancer rose to became a leading cause of death.  Scientific research demonstrated that the toxic chemicals in cigarette smoke are carcinogenic. Smoking is also associated with cancers of the throat and digestive tract.

Heart and Vascular Disease – there is a strong association between smoking and the development of atherosclerosis, the “hardening of the arteries” that causes heart attacks, strokes and aneurysms. These conditions are among the major causes of death in smokers. A heart attack is 2-4 times more likely in a smoker than a non-smoker. Quitting smoking is the single most effective way to reduce the risk of a future heart attack.

Lung Injury and COPD – A person’s first puff from a cigarette invariably causes coughing.   This is the body’s warning sign–inhaled smoke damages the lung. Cigarette smoke irritates the lung’s bronchial tubes, causing mucus production.  The smoke also paralyzes the cells that clear mucus and debris out of the lung. . Over time, cigarette smoke causes mucus plugging, swelling and, sometimes, destruction of the bronchial tubes. This makes the lung more vulnerable to infections. When bronchial tubes are blocked or distorted, it is also much harder to move air in and out of the lung. This condition, called chronic obstructive pulmonary disease (COPD), is a leading cause of death and disability.

Nicotine Addiction – Nicotine is one of the most addictive substances known — often compared to heroin.  Nicotine withdrawal produces symptoms similar to opiates, which is why is it so difficult to quit smoking, Cigarette smoke delivers nicotine immediately to brain areas associated with pleasurable sensations. Nicotine also increases heart rate and blood pressure, and constricts blood vessels. This puts strain on the heart and promotes vascular disease..

If You Quit Smoking, Health Risks Fall Dramatically. 

Cancer – Smoking cessation for 10 years cuts the risk of lung cancer in half.  The reason is that the lung is no longer exposed to the carcinogens in cigarette smoke. With continued abstinence from smoking, the risk continues to decline. Similar results have been seen with laryngeal and other forms of cancer.

Heart and Vascular Disease – For someone with known coronary artery disease (CAD), smoking cession reduces the risk of a future cardiac event by 50%. For someone without CAD, quitting smoking for one year reduces the risk of CAD by 50%. If abstinence continues for 15 years, the risk of future heart events is almost the same as a lifetime non-smoker. The same is true for the risk of stroke.

COPD – Smokers expose their lungs to the constant irritation of cigarette smoke, and have a faster decline in lung function than non-smokers.   This decline occurs slowly and is not noticeable until the lung function is so low that it affects everyday activity. At that point, smoking cessation will reduce lung irritation but the chronically diseased lung cannot repair years of damage. The best strategy is to stop smoking before significant damage has occurred. The good news is smoking cessation can halt the rapid decline in lung function before more damage occurs.

Nicotine Addiction – Most smokers want to quit smoking but nicotine withdrawal is a major obstacle. As the old saying goes, “if it were easy, everyone would do it”. Most smokers who try to quit fail multiple times. However, the encouraging statistic is that millions of Americans have kicked the habit. The best results come from planned programs to break the nicotine addiction and eliminate lifestyle habits associated with smoking. (see references below)

In summary, smoking has life-threatening health care risks. Once a person stops smoking, these risks decline significantly over time. While kicking the habit is challenging, the health benefits are enormous. It is never too late to quit.

For more information about smoking and health risks, see the Centers for Disease Control (CDC) and the American Lung Association.

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