New research reveals that the measles virus, if infected, can cause long term problems with the immune system. Even after you recover, the immune system is left weaker than before for several years which can make you vulnerable to other infections such as flu and pneumonia. The virus kills cells that apparently make antibodies leading to “immune amnesia”.

How do you know if you are immune?
1. Written documentation of age-appropriate vaccination
2. Laboratory test of immunity
3. Laboratory confirmation of having the disease
4. Even if born before 1957, you still need to have documentation of 2 vaccinations or antibody titers that show immunity.

Complications of adult measles can lead to pneumonia. One in 1000 adults will get encephalitis (brain infection).
One-two in 1000 children will die.
We have seen epidemic cases of measles this year in the U.S. as well as Europe. Of those infected, 71% were unvaccinated.
Make sure you have immunity to prevent acute and long-term complications.

www.cdc.gov>vaccines>acip.

We know that our blood pressure (BP) can reveal a lot about our cardiovascular risk factor for heart disease. About 50 years ago, the diastolic, or lower number, was the one causing more concern if elevated and more predictive of cardiovascular events (CV) than the systolic number. More recently, The systolic, or top number, may be deemed more important although both are important to maintain at normal levels (NEJM JW Gen Med Dec 15 2017 and J Am Coll Cardiol 2018; 71:e127).

A multivariable analysis (data collected on systolic and diastolic blood pressures) were collected to determine the 8 year CV outcomes (heart attack, stroke) in more than 1 million adults, average age 53, from North California’s Kaiser Permanente health system. The researchers found that for systolic BP’s of 136 and 160 mm Hg, the predicted 8 year risks for CV events were 1.9% and 4.8% respectively. On the other hand, for diastolic BP’s of 81 and 96 mmHg, CV event rates were 1.9% and 3.6% respectively.

This shows that both systolic and diastolic BP are independent predictors of adverse cardiovascular outcomes. In general, an ideal BP should be less than 130/80. Do you know your blood pressure?

Reference: Flint AC et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med 2019 Jul 18; 381:243

The current definition of a healthy body mass index (BMI) has been under some scrutiny after a new research study found that the BMI we consider “normal” may actually be too low and unhealthy.
A recent study collected data and adjusted results using a wider range of potential confounders (other variables) than in prior studies looking at measuring and interpreting BMI. The new data showed the impact of newer treatments to reduce cardiovascular disease illness and death while past studies relied on data from earlier times when less cardiovascular disease protection occurred. The current study included people from lower-income countries, although the finding is just as applicable to people who live in high-income countries, who were also included in the study population, noted Salim Yusuf, MBBS, principal investigator for the study.
The study showed that middle-aged adults with a body mass index of 25-29 kg/m2 (currently considered “overweight”) had a significantly better adjusted survival during an average follow-up of nearly 10 years than did people with a “normal” body mass index of 20-24 kg/m2 in a worldwide study of more than 140,000 people. This suggests that the current, widely accepted definition of normal body mass index is wrong.

This is where other tools come into play that can be better predictors for survival. One is the ratio of hand-grip strength to body weight. This assesses the importance of muscle mass to overall weight. The optimal strength/weight ratio is 0.42 in women and 0.50 in men according to Dr. Darryl Leong, a cardiologist at McMaster University and the Population Health Research Institute, both in Hamilton, Ont.
In a large longitudinal population study, it was found that grip strength measurement can be a strong predictor of cardiovascular mortality and a moderate strong predictor of cardiovascular disease. This new study, called the Prospective Urban-Rural Epidemiology Study (PURE) included about 140,000 people that were examined between 2003-2009. Grip strength was measured using a hand grip dynamometer.
Another very important and good predictor of weight is the waist/hip ratio which adds the dimension of the location of body fat rather than just the amount. An optimal waist/hip ratio for survival according to Dr. Leong is 0.83 in women and 0.93 in men. This means that a man whose hand/grip strength (in Kg) is half of the person’s body weight, then his chance for survival is very good.
So even though being “overweight” according to the BMI readings we currently use seems to lower mortality rates, we need to remember that the link between total mortality and BMI was strongest in the group of people that were on 1 or more treatments aimed at preventing cardiovascular disease (which may include being on a Statin drug or anti-hypertensive med) while there was no benefit among people not receiving any cardiovascular disease preventative measures.

https://www.mdedge.com/clinicianreviews/article/207836/lipid-disorders/survival-overweight-bmi-surpasses-normal
https://www.mdedge.com/anticoagulationhub/article/99720/acute-coronary-syndromes/grip-strength-predicts-cardiovascular

The CDC (centers for disease control) has now issued notices to warn people who are traveling to Europe about the risk for measles exposure. Measles outbreaks are occurring in England, France, Italy Greece and Germany. (https://wwwnc.cdc.gov/travel/notices/watch/measles-global).

Measles cases in Europe topped 41,000 in the first half of 2018 and included 37 deaths, with the highest incidence in children less than 1 year of age. This is more than twice as many reported annually between 2010 and 2017!! As in the U.S., low immunization rates are responsible for the rise. The popularity and ease of traveling to and from Europe accounts for many measles cases in the U.S.

In the U.S., measles cases have just exceeded 1000 which seems minimal compared to Europe even though it’s still quite high. The problem is that children who are unvaccinated are at risk while at home, but even more so when traveling to areas with continued measles circulation.

If you are traveling to Europe, consider:

1. Review your immunizations to assess the need for additional vaccinations. If you were born in 1957 or later then you should
get a measles titer to see if you still carry immunity to this virus.
2. Infants should be vaccinated starting at age 6 months if traveling to areas with measles outbreak.
3. Infants less than 6 months should delay travel until the child reaches 6 months of age.
4. Children over the age of 1 year should receive two-measles containing vaccines separated by at least 28 days prior to travel.
5. If you have traveled to these areas and develop a fever and rash, contact your health practitioner ASAP.

Although I understand the divided opinions about vaccines to be a real issue, I often stress to my patients when they are at significant risk for contracting the illness. This would be it!

Measles is a very contagious respiratory disease that spreads through the air by coughing or sneezing. Symptoms don’t appear until 10-14 days after exposure, so you could be a carrier and spread this virus and not know it. Complications include ear infections, pneumonia, encephalitis (brain infection) and problems during pregnancy. There are no treatments to this virus except treating symptoms with over the counter remedies to help discomfort. Those at highest risk are young children and the elderly. Don’t take chances and please talk to your practitioner about prevention through a vaccine.

Reference: Angelo KM et al. Spread of measles in Europe and implications for US travelers. Pediatrics 2019 Jul 1; 144e20190414

Glucosamine sulfate is a natural occurring chemical found in the body. It is used in the body to produce other chemicals that help build tendons, ligaments, cartilage and the fluid surrounding joints. This is where the supplement is touted as a pain reliever for osteoarthritis, especially with osteoarthritis of the knees. It may also slow the breakdown of joints and prevent the condition from getting worse. The effectiveness of glucosamine in patients with osteoarthritis and joint pain continues to be debated.

Now there’s another reason to consider using glucosamine…to lower the risk of cardiovascular disease (CVD). A prospective study was done in the U.K. where researchers examined the association between regular use of glucosamine and CVD risk in close to 500,000 people without known CVD at baseline. They completed a supplement use questionnaire where 20% of the respondents answered “yes” when asked if they used glucosamine regularly.

During a 7-year follow-up, 10,200 adverse CVD events occurred. After adjusting for multiple variables, regular glucosamine users had significantly lower risks for overall adverse CVD events including CV-related death, coronary heart disease and nonfatal stroke than did non-users.

These results are plausible considering glucosamine has anti-inflammatory properties and regular use is associated with lower levels of C-reactive protein, which is a marker for inflammation. It is best to wait for a randomized trial to repeat and confirm these findings as the study design (questionnaires) may not be as reliable.

One last thing is that the form of glucosamine supplement (glucosamine sulfate, glucosamine hydrochloride, N acetyl glucosamine) was not collected. Therefore it’s difficult to assess whether the association between various forms of glucosamine supplement and CVD risk might differ. Glucosamine is closely regulated in most European countries where it is only sold by prescription. However, in the U.S. and Australia it is a dietary supplement and sold over-the-counter where it is not regulated.

Ma H et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in U.K. Biobank. BMJ 2019 May 14;365:l1628.

Most of us have been exposed to Epstein-Barr virus (EBV). We were probably exposed as a kid or teen since it’s transmitted by saliva, kissing, shared drinks or utensils and even coughing or sneezing. It is the primary causative agent in infectious mononucleosis. So what’s the big deal? And why is there a vaccine in progress against this innocuous “kissing disease”?

What you may not know is that EBV causes about 200,000 cases of cancer (nasopharyngeal and gastric cancer, Burkitt and Hodgkin lymphomas) and about 140,000 deaths annually. It’s also a co-factor in other serious illnesses, including multiple sclerosis. Symptoms of infectious mono include extreme fatigue, sleep abnormalities, pain and other symptoms that worsen with activity. These symptoms can last for over 6 months which makes it debilitating and difficult to work.

An international team identified the specific antibodies that block binding of the virus to epithelial and B cells (EBV molecules attach to specific B cell receptors). This team developed a vaccine using nanoparticles that enhanced the immune system’s production of these blocking antibodies. The vaccine potentially neutralized EBV’s ability to infect the epithelial and B cells in both mice and nonhuman primates.

The next step would be to perform randomized clinical trials and safety studies in humans. Both of these are planned for the next few years.

References: Komaroff, A. Progress in developing a vaccine against Epstein-Barr virus. JWatch.org June 15, 2019; p. 95.Photo by The U.S. National Archives

Almost 3/4 of adults older than 70 have some form of hearing loss. It effects about 37.5 million Americans, yet most people don’t do anything about it. Among those younger than 70, fewer than one in five use hearing aids. Those older than 70 aren’t much better with only 1 in 3 using these devices.
When hearing starts to go, many people feel they are losing their memory. Research shows that more than half of people who see their doctor about memory concerns have a hearing problem. Even though these people may not have any memory loss, hearing difficulty can be a precursor for a decline in memory and thinking skills.

In a study that followed 1,164 adults (average age 73) for 24 years, 70% had some degree of hearing impairment at the start of the study. Follow up consisted of these adults taking tests of their brain function. Those with severe hearing loss since the start of the study got the lowest scores on the test. Any hearing difficulty was linked to a quicker decline in thinking than those whose hearing held steady, but education helped make up for mild impairment. Another study of older adults indicated that those that had even minor loss were twice as likely as their fully hearing peers to have signs and symptoms of depression.

Another important development of this last year according to Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer’s Association, is that hearing loss has been added to the list of significant modifiable risk factors for dementia. We don’t really know what links hearing loss to dementia but it is speculated that hearing problems force the brain to work harder to understand what’s being said. Over time, that extra burden may cause harm. The other theory is that dementia may come from social isolation. If your poor hearing does not allow you to socialize and participate fully in conversations, you may lose the brain benefits that come from that type of mental stimulation.

As with sleep, it’s not yet known whether correcting hearing loss (with hearing aids) will reduce the risk of dementia. But most hearing loss occurs outside the brain and is not related to the brain at all. Mental stimulation and socialization is huge and appears to offer protection against dementia.

The good news is that age-related hearing loss is reversible. Hearing aids can help. The problem has been cost, lack of insurance coverage for hearing devices and a required medical appointment that has kept people from pursuing treatment. A new federal law is designed to bring lower-cost, over-the-counter hearing aids to market by the end of 2020. Preliminary studies have shown that these devices available under the new law are just as good and work just as well as their more expensive prescription counterparts.

Reference: Collins, S. “The latest: New research on hearing loss”. WebMD, June 2019, p. 67.
McMillen, M. “Guarding the mind: The latest research points to ways you can lower your odds of developing dementia”. WebMD, June 2019, p. 50-53.Photo by The U.S. National Archives

Photo by The U.S. National Archives

There have been many dietary recommendations to reduce the risk for cancer throughout the years. Most include a reduction in sugar, processed foods, alcohol, and food allergens. This study stems from the federally funded Women’s Health Initiative which is a long-term health study launched back in 1993. The study enrolled women in their 50’s, 60’s and 70’s at the time it started.
About 20,000 women were coached to change their diets for at least 8 years. Women were asked to reduce their total fat intake and to increase their intake of fruits, vegetables and grains. A comparison study of 30,000 women were asked to continue their normal diet. The results showed that women in both groups were diagnosed with breast cancer, but the women who changed their diets had a 21% lower risk of dying from breast cancer.

Even though this study may be significant in the reduction of deaths from breast cancer, it goes against the most recent research about eating plenty of healthy fats such as fish, olive oil, avocados and other plant based oils. Remember that this study was conducted in the 1990’s when the low-fat boom was at its peak. A lot has changed since then…healthy fats=good; refined carbs and sugars=bad! Notice I said “good fats”. As mentioned in this article, lollipops and lentils are both low fat, whereas avocados and butter are both high fat. The women in this study were asked to achieve a low-fat diet through eating more fruits, veggies and whole grains which would increase their fiber and nutrient intake.

Also, the women in the study who modified their diet lost on average about 3% of their starting body weight. Obesity is a risk factor of breast cancer so shedding weight may have also reduced cancer risk.

I believe weight reduction has a bigger impact on breast cancer risk reduction than we once thought. Dr. Ruth Patterson, Ph.D professor and cancer researcher at UCSD was involved in a recent study of 2500 breast cancer survivors. In this study, WHAT you ate was not as important as WHEN you ate. The results showed that women who fasted at least 13 hours had a reduced recurrence of breast cancer by 40%!!! Fasting also lowered the risk of diabetes, non-alcoholic fatty liver disease and gastroesophageal reflux.

The concept behind this is that women that are overweight or obese produce too much insulin. Estrogen is stored in adipose (fat) tissue. Both estrogen and insulin are growth factors, which means it increases the growth rate of tumors. We also know that fat causes more inflammation. So you can see the effect of this trio…more estrogen, more insulin and more inflammation. Insulin also decreases sex hormone binding globulin (SHBG) which allows estrogen and testosterone to be unbound and more freely available to again increase estrogen and inflammation.

Intermittent fasting is becoming very popular for many health conditions. If weight loss is your goal then I would increase your fasting times so that your eating window is 5-6 hours. I know…thats like 17-18 hours fasting, so move the fasting times by 1 hour and try it slowly. If that is difficult, then fast for at least 13-14 hours and stop eating earlier at night. In the study, women fasting for 13 hours may not have lost weight but they did reduce inflammatory markers if they stopped eating earlier.

My opinion, is not to reduce fats but to increase fruits and vegetables and eat small portions of whole grains. Aim to eat dinner early and then wait a full 13-14 hours (or more) before eating breakfast. Avoid smoking and alcohol and exercise regularly. Don’t forget a good night’s sleep. Sleep repairs a lot more damage when fasting and can help DNA repair and “autophagy”-clearing away damaged cells, which has the potential to increase further inflammation. Work towards these daily goals and your breast cancer risk as well as other diseases will be significantly reduced.

https://www.npr.org/sections/thesalt/2019/05/18/724309081/calories-carbs-fat-fiber-unraveling-the-links-between-breast-cancer-and-diet
Stephens, G. “Delay, don’t deny: Living an intermittent fasting lifestyle.” 2017.
https://www.foundmyfitness.com/episodes/ruth-patterson

Many of you may know of melatonin as the hormone supplement to be used for sleep. Although that’s true, there is so much more that this hormone can do. Some researchers feel that even if you sleep well, melatonin is still worth taking for other reasons.

One thing to note is that Melatonin, like many other hormones, starts to decline in our 40’s. It is a hormone produced not just in the brain but in many other tissues throughout the body: the most abundant production being in the intestine. Researchers have also found that it is produced in the retina, the skin, the bone marrow, the thymus and in white blood cells which makes it an important regulator of the immune system.
Here are the many effects of Melatonin:

1. Protects against viral and bacterial infections-Studies have shown that melatonin reduces the ability of bacteria to reproduce, provides a non-conducive environment for bacteria to live, and decreases inflammation. It has also shown to be effective in treating viral infections, and in treating premature infants suffering from respiratory distress syndrome and septic shock. This is where melatonin can have a profound effect in strengthening our immune system.

2. Cardiovascular health- Studies in mice as well as humans have shown a reduction in blood pressure when taking melatonin. As we age, the risks of coronary disease, high blood pressure, heart failure and stroke increase and melatonin decreases. Melatonin can prevent and treat heart disease and high blood pressure due to its anti-inflammatory and anti-oxidant effects.

3. Alzheimer’s and neurodegenerative diseases- Melatonin is the major antioxidant in the brain and nervous system. Since oxidative stress is the primary destructive force on our brain cells, having enough melatonin is essential to preserving brain cells and function, especially over the age of 60. Melatonin acts directly on the DNA and mitochondria in our cells allowing them to behave more like our younger selves.
When our brain cells die (due to poor health, drugs, malabsorption, sedentary lifestyle and aging), we rely on brain stem cells to replace them. But these cells diminish as we get older and they are harder to replace. Melatonin can help this process of neurogenesis (brain stem cells replacing dead cells). It also stimulates hippocampal neurogenesis, which is important because the hippocampus is the region in the brain that regulates short-term memory and spatial orientation.

4. Menopause- Melatonin has been shown to help menopausal symptoms including mood and reducing depression. There seems to be a recovery of pituitary and thyroid functions in melatonin-treated women.

5. Ionizing radiation- X-rays, CT and PET scans are the main sources of ionizing radiation which with repeated and prolonged exposure increases the risk of cancer. Children are especially at risk. Melatonin in human studies has been able to cancel the potentially damaging effects of ionizing radiation. The doses used in research are 300 mg of melatonin which seems quite high but the effects were amazing. Lymphocytes (WBC’s) in blood samples were taken from men and women. After exposure of the equivalent of 1000 CT scans (I know…that’s alot!) all the samples had a degree of genetic damage due to the radiation. The cells that were taken an hour and two hours after the melatonin dosing had significantly less genetic damage. Something to think about if you need these procedures done.

6. Macular degeneration- Melatonin is produced in the retina, the part of the eye that is affected by macular degeneration. People with macular degeneration (MD) have lower levels of melatonin. Oxidative stress is the primary cause of this condition. Studies have shown that it can prevent and slow the progression for either dry or wet MD.

7. Cancer- There are several published studies on the use of melatonin and cancer. Researchers have reported that not only has melatonin been shown to have an anti-cancer effect but it also has an immune reaction against cancer. It protects healthy cells from the negative effects of chemotherapy and radiation. Some studies showed that adding melatonin to chemotherapy enhanced the treatment effect of the drug while at the same time decreasing the side effects. Melatonin has been used in breast cancer studies since it has SERM (selective estrogen receptor modulator) and SEEM (selective estrogen enzyme modulator) properties. This means it has anti-estrogen and anti-aromatase actions. Melatonin also stimulates apoptosis (programmed cell death). Melatonin has shown cancer prevention and benefits in the treatment of prostate cancer whether cancer cells were sensitive to hormones or not. The anti-cancer properties of melatonin include colorectal, breast, prostate, pancreas, liver and brain cancer.

Choose a pure melatonin in a powder or use capsules free of additives. If side effects occur (ie. waking up with vivid dreams) try a different brand. Also, there is no negative feedback inhibition with melatonin. This means that there is no concern with taking melatonin that it can cause the body to stop making its own. You can take as much as you want and it will not interfere with your own production of melatonin.

Just a side note…I have used melatonin for teens with great success. I find it especially good for kids with sensory integration issues. So it’s not just for people older than fifty. By the time you are 20 years old, you have some deficiencies, but even those with alot of stress, inflammation, malabsorption, food sensitivities and repeated infections, melatonin may be a part of your healing program.

Reference:
Shallenberger, F. Melatonin isn’t just for sleeping-from cardiovascular disease and cancer to aging and macular degeneration the research will shock you. Townsend Letter. Feb/March 2019. pp.50-57.
Sanchez-Barcelo EJ, et al. Melatonin uses in oncology: breast cancer prevention and reduction of the side effects of chemotherapy and radiation. Expert Opin Investig Drugs. 2012 June, 21(6):819-31.