This year has been one that we will never forget. And the core of this disruption has everything to do with our health and how to adapt to the fragility of life. But regardless of the pandemic, there is still plenty to talk about in reference to new breakthroughs in medicine. Here is my top 10 for 2020:

10. Telemedicine is a New Norm– Due to COVID-19, nearly a quarter of us had used a computer, app or phone for a telemedicine appt. Mental health counseling has also been done via Zoom which has been much needed, especially in areas where therapists are in short supply. Office visits are still important in certain circumstances (listening to lungs, abdominal exams, diagnosing the cause of joint pain, etc) but the shift to more online visits will become more common.

9. Biologics in Orthopedic Repair– It can take months or years to recover from orthopedic surgery.  Biologics are natural substances such as cells, blood components and growth factors that is injected to preserve tissue rather than cutting into it.        These can now be used to speed recovery and promote healing after surgery to improve patient outcomes.

8. Fast, Cheap Coronavirus Test– Abbott’s BinaxNOW rapid test received emergency-use authorization from the FDA in August. It detects COVID in fifteen minutes for around $5 per test—and without the need for specialized lab equipment.

7. New Class of  Migraine Medicine– Ubrelvy is the first FDA-approved new class of migraine meds known as Gepants, which has shown relief without the nasty downsides vs triptans. The drugs control the activity of a pain-regulating molecule called the calcitonin gene-related peptide (CGRP) whose levels elevate during an attack. Ubrelvy blocks CGRP’s ability to bind to its corresponding receptor in the body, effectively stopping a migraine in its tracks.

6. New HIV Prevention–  The HIV Prevention Trials Network study enrolled over 3000 women at risk for HIV across 7 countries in sub-Saharan Africa. It was very successful in preventing HIV. They found that a single shot given every 2 months could be more effective in preventing HIV in women than a daily pill.

5. Coronavirus Vaccine– The first of it’s kind with the UK being the first country to authorize the vaccine rollout. Sarah Lindsey, a critical care nurse at Long Island Jewish Medical Center in New York received the first coronavirus vaccine in the United States on December 14th.

4. Year of the Nurse and the Midwife– The World Health Organization (WHO) declared 2020 the year to honor nurses and midwives for their unrelenting work from refugee camps to rural towns to the front lines of COVID -19 and beyond.

3. Expanded use of Minimally Invasive Mitral Valve Surgery– A trans-catheter device has been FDA approved to repair the mitral valve in those with mitral valve regurgitation (MR). The FDA has broadened its approval to include those with an enlarged left ventricle, also known as secondary MR. This procedure can avoid major open heart surgery.

2. Immunology for Peanut Allergies– The FDA approved an oral immunotherapy treatment for peanut allergies in children. The oral capsule dose is increased over time to build a tolerance. This can lessen the fear of accidental exposure for kids with severe peanut allergy reactions.

1. New U.S. Leadership and a Renewed Focus on Global Health– President-Elect Biden announced his COVID-19 task force just days after election results. He promises to cooperate with countries around the world to coordinate coronavirus responses and join the international COVAX Facility, which is working on the development, production and access to COVID-19 tests, treatments and vaccines.

From Wellcast.org, we wish you a very healthy, hopeful and joyous New Year!

https://www.popsci.com/story/technology/best-health-innovations-2020/

https://www.globalhealthnow.org/2020-12/top-global-health-moments-2020

According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed both in men and women in the United States. Overall, the lifetime risk of developing colorectal cancer (CRC) is about 1 in 23 for men and 1 in 25 for women. Almost all colon cancers start in the lining of the colon or rectum as a benign poly that slowly develops into cancer.

The many risk factors include: over age 50, although we are seeing younger people diagnosed (Chadwick Boseman died at age 43 from CRC), African American or eastern European descent, high fat, low fiber diet and eating alot of red or processed meats, having inflammatory bowel disease (Crohn’s disease or ulcerative colitis), smoking cigarettes, drinking alcohol or family history. Certain inherited diseases can also increase the risk of developing colon cancer such as Lynch Syndrome.

By far this cancer is the most preventable as well as the most curable with early screening.

Chemoprevention, which is the use of a medication, vitamin or supplement used to prevent cancer from occurring, is very effective in preventing colorectal cancer due to its long latency period. In addition to ongoing screening, this review of 80 systematic reviews and meta-analyses in average risk people will show you what you can do to lower your risk of this very preventable cancer.

Agents that protect against CRC include aspirin, nonsteroidal anti-inflammatories drugs, folate, magnesium, fiber, dairy products, fruits and vegetables, and soy. Exercise and preventing constipation are also very important!

Agents that had no effect on CRC risk are Vitamin C, Vitamin E, antioxidants, beta-carotene, selenium, tea, garlic, allium and Vitamin D with or without calcium.

Meat and alcohol were associated with an excess risk of colorectal cancer.

What you eat in addition to supplementation can play an important role in preventing CRC. Certain medications such as aspirin and nonsteroidal anti-inflammatory drugs come with certain side effects, so please discuss the use of these with your practitioner before taking them on a regular basis.

References: Chapeelle N et al. Recent advances in clinical practice: Colorectal cancer chemoprevention in the average- risk population. Gut 2020 Sept 28; [e-pub]. (https://doi.org/10.1136/gutjnl-2020-320990)

Medlineplus.gov/ency/article/000262.htm

www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

With the numbers of COVID cases continuing to climb, we need to address (again) ways to reduce the inflammatory burden on our heart, lungs and immune system. Using nutrients and foods are the best way to do that. We have been under tremendous stress as a nation these past few weeks with the election. And quite frankly…it’s been exhausting! So if we drank too much alcohol, caffeine or ate more comfort foods like sugar and chocolate…you are not alone. But now we can put the election aside and get down to protecting ourselves, family and community by eating better and continuing COVID precautions.

Many phytochemicals naturally occurring in certain herbs and plant foods can down-regulate the inflammatory activation  brought about by SARS-CoV-2. The intense immune reactions seen in COVID cases are in part mediated by Inflammasomes- multi-protein complexes found in immune cells, pulmonary cells and other epithelial cells.  There are many types of inflammasomes, the NLRP3 subtype being the most prevalent and most well studied in the context of the lungs. Inflammasome activation leads to the release of pro-inflammatory cytokines and can damage the lungs causing high levels of oxidative stress and reactive oxygen species (ROS). This process in normal circumstances clears out infectious pathogens, environmental or metabolic toxins and neutralizes the situation. The inflammatory cascade should then “turn off”. In severe cases like we’ve seen with COVID, this process does not turn off resulting in excessive cell death, tissue fibrosis and ultimately organ dysfunction.

Respiratory distress doesn’t always respond to oxygen therapy. This is because the alveoli and surrounding capillaries become damaged and dysfunctional leading to thrombus, or clot formation. So alveoli are unable to deliver oxygen to the blood. Low oxygen levels then lead to more inflammasome that starts this deadly cycle again. When it comes to plant compounds that have anti-inflammatory and anti-oxidant properties that reduce inflammasome activity, polyphenols tend to steal the show.            Here are some of those compounds:

1. Curcuminoids: These are lipid (fat) absorbing polyphenol isolates derived from Rhizoma curcuma longa (Turmeric). Small amounts are also found in the Ginger species (Zingiber). It is a scavenger of Reactive Oxygen Species (ROS) which is a highly pro-inflammatory environment in the cell. Turmeric-rich foods and supplements is enhanced with the addition of black pepper and healthy fats and oils.
2. Resveratrol: A polyphenol present on the skins of red and purple grapes. It also scavenges ROS and reduces oxidative stress. This compound up-regulates the expression of Sirtuin I, which inactivates multiple inflammatory genes.
3. Epigallocatechin-3-gallate (EGCG): A major polyphenol found in green tea. It reduces the expression of many inflammatory mediators and lowers free radicals. One cup (8 oz) of brewed green tea contains approximately 50-100mg of EGCG. Drink 1 to 3 cups per day.
4. Sulforaphane glucosinolate (SFN): A natural compound in cruciferous vegetables. These foods reduce oxidative stress and ROS. Food sources include kale, broccoli, broccoli sprouts, Brussels sprouts, cabbage, bok choy, mustard greens and radishes. Not to get too technical, but Sulforaphane is produced from a precursor called glucoraphanin, in the presence of a certain enzyme (myrosinase). It is best to steam, sauté or even massage cruciferous vegetables to stimulate and express their phytochemicals. Supplements include DIM (di-insole-methane) and I3C (indole-3-carbinol) in capsule or powder.
5. Quercetin: A flavonoid commonly found in a variety of fruits and vegetables and herbs. It blocks inflammasome activity, inhibits damage from ROS and down-regulates cytokine expression. Examples are the red skins of apples and citrus fruits and purple onions. Supplements are available but not highly absorbable and best taken with healthy fats.
6. Ginsenosides: The active component of Radix panax ginseng. It lowers inflammasome activation and cytokine expression.
7. Modified Citrus Pectin (MCP): This is a low molecular weight dietary fiber derived from the inner peel of citrus fruit. It is best known as a Galectin-3 antagonist.  Galectin -3 is found in immune and epithelial cells and promotes inflammasome activation. Antagonist means that it blocks or inactivates Galectin-3 and down regulates the activation of  the NLRP3 inflammasome. MCP also inhibits fibrin minimizing the formation of clots.  This is an enzyme-processed product that can be absorbed through the small intestine and enter the bloodstream. Whereas, unprocessed food pectin is a large lectin molecule that is not digested or absorbed through the intestinal wall. The highest quality MCP products have the smallest particle size to ensure intestinal absorption. (See  blogs “What’s Needed for Healthy Aging” and “Modified Citrus Pectin- For Your Detox and Overall Health”).

Of course it’s best to consume these compounds through a plant-rich colorful diet with herbs and spices. Many natural compounds that influence inflammasome activity are found in these plant-derived foods. They also bind to many different receptors and influence several different pathways and genes all at once. A diet rich in phytochemicals has a powerful impact on long term health and inflammation control. It matters what we eat because our food is talking to our genes.  Be well…

References: Chilkov, N. Nutrients & Phytochemicals to Ease Pulmonary Inflammation. Holistic Primary Care. Fall 2020, p. 4.

Howrylak JA, Nakahira K. Inflammasomes: Key mediators of lung immunity. Annu Rev Physiol. 2017; 79: 471-47-94. doi: 10.1146/annurev-physiol-021115-105229.

You may think that because you are young and healthy, the symptoms of SARS-CoV-2 (the virus responsible for COVID-19) may not be serious enough to land you in the hospital. First of all…think again. There have been young adults and even children hospitalized who were otherwise healthy. Secondly, even if you were infected and recovered, you may develop long term symptoms that are chronic, lasting more than 3 months. These people are referred to as the “long-haulers”.

While COVID-19 is known for its effect on lung damage, long-haulers report other unusual symptoms that prevent patients from returning to work and their lives fully. To compare this coronavirus with SARS (severe acute respiratory syndrome), exhaustion and crippling fatigue plagued 52% of COVID patients 2 months after leaving the hospital in a study from Rome compared to 40% with longterm fatigue lasting 13-36 months after infection from SARS.

Other studies point to similar concerns: A German study found 78% of COVID-19 patients had lingering heart symptoms 2-3 months post infection. The CDC published a report documenting 35% of COVID-19 patients still had symptoms 3 weeks after diagnosis. Compare this to 10% after influenza. A US study published in August found that 70% of patients had lingering symptoms of shortness of breath and 13.5% still needed oxygen 4 weeks after discharge. CT scans of COVID-19 patients show continued signs of lung damage 12 weeks after hospitalization.

The other reported symptoms are confusion, forgetfulness, memory loss, difficulty focusing, dizziness, and grasping for everyday words. It’s becoming known as “COVID brain fog” and survivors say it impairs their ability to work and function normally. Symptoms vary widely and scientists don’t know what causes it, especially since it also effects people who became only mildly ill and had no previous medical conditions. Some theories are that the bodies immune response to the virus never shuts down and it is persistently activated. Another possible cause could be inflammation in blood vessels that release inflammatory molecules that are toxic to the brain which causes delirium, confusion and other types of altered mental function known as encephalopathy. And then there is the theory that it is an autoimmune reaction, when our antibodies mistakenly attack nerve cells. Some patients with brain fog can also experience respiratory and heart issues which can exacerbate neurological symptoms. So far according to neurologists, MRI scans have not seen damaged brain areas.

The average age of long-haulers is 44 years old, with women disproportionally affected. Women have higher rates of autoimmune disease (lupus, rheumatoid arthritis, hypothyroidism) and have higher sensitivity to lower oxygen levels.

We have much to learn about COVID-19 post viral syndrome and long term studies are underway to learn more about the nature and potential treatment of long-haulers. We do understand that much of  the problem the virus creates stems from damage to the lungs, heart, blood vessels, brain, nervous system, eyes, skin and immune regulation. Underlying chronic diseases are also made worse and critical nutrient levels fall in the wake of the inflammation brought on by the virus.

Natalie Lambert, PhD associate research professor at Indiana University Medical School found nearly 100 different long-term problems of a soon-to-be published  survey of close to 4000 patients. Some of these symptoms go well beyond typical COVID symptoms. This global network of COVID survivors whom support, educate and connect to groups of people who are struggling with post COVID syndrome is called the Survivor Corps.

Long-Hauler Survey

The frustration for patients also is that when they reach out to their primary care physicians for help managing these much lesser-known symptoms, they find that some physicians are unable or unwilling to help patients manage these symptoms due to lack of research. People are seeing cardiologists, neurologists and  rheumatologists seeking answers with very little hope or treatment. It has and will continue to take a huge toll on our healthcare system (please vote!). The fact is that facebook has over 100,000 followers on their support group for long-haulers. These patients are suffering physically, mentally and emotionally.

Integrated medicine is uniquely positioned to help long-haulers address the complexity of their symptoms. They are equipped in treating post-viral syndromes for decades which includes re-activated Epstein Barr virus, mononucleosis, West Nile virus, post herpetic neuralgia, Bell’s Palsy, Guillain Barre and influenza. Functional medicine testing can be done to assess inflammation, hormones, GI function, cardiac inflammation, brain function and nutritional status. This way a patient can have personalized treatment through medicines, nutrients, herbs and intravenous nutrient therapy, as well as monitoring the status of how a patient is healing and recovering. Acupuncture and oriental medicine is also an ideal tool in evaluating and treating a patient where western medicine has its limitations.

Prevention from the COVID-19 virus is best by wearing a mask, social distancing and hand washing. But if you have been infected, it is best to seek out someone who will listen and manage your symptoms to help you get back to a fuller recovery.

Brain Fog Plaques COVID Survivors

Different Syndromes of Post COVID

Click to access lambert-covid-symptom-study-doc.pdf

An advisory committee has recommended that the next set of dietary guidelines have some changes. These include that Americans cut back on their alcohol consumption and sugar intake. What they are proposing is only 1 alcoholic beverage per day on the days that alcohol is consumed. In the past, the limit was two drinks for men and one for women.

As far as sugar intake…the committee suggests that less than 6% of energy come from added sugars. The previous guidelines suggested less than 10%. The average sugar consumption in the U.S. is around 13%.  The Food and Drug Administration (FDA) has mandated a new food label, (first initiated in 2018) that must be in effect by January 1, 2021, this upcoming year. Many food companies have already embraced this new food labeling. One of the biggest changes has been the new “added sugar” section. This makes it much easier to differentiate “naturally occurring sugars” from “added sugars”. This new label separates the two and also includes the percent Daily Value (%DV) for added sugars, which previously was not required.

The report will be used by the Department of Agriculture and the Department of Health and Human Services to formulate the 2020-2025 Dietary Guidelines for Americans. For the first time, the guidelines will cover a broad range of recommendations for all age groups including, infants, toddlers and pregnant women. The guidelines also include dietary patterns in relationship to several different types of cancer such as colorectal, breast and prostate cancers.

Reference: Young, K. Physician’s First Watch. 7/16/2020. http://www.jwatch.org/fw116842.                                                          Rittiman, L. Total Sugars vs. Added Sugar-What You Need To Know. 9healthfair.org. 1/30/2018.

There has been alot of debate on whether hydroxychloroquine (HCQ) is effective in preventing or treating COVID-19. What got things started was a French study suggesting efficacy in lowering the viral load in patients with COVID-19 back in March 2020. We have learned alot since then and other studies have called into question both the efficacy and safety of HCQ in treating COVID-19.

The French study was a non-randomized study of 36 hospitalized people in which patients were recruited either into a treatment group or control (non-treatment) group. This was an observational study. Since then, there have been roughly 900 published studies in which the vast majority are observational studies. So whats the difference?

In an observational study, the effect of the drug being tested (in this case HCQ), is due to its true causal effect (lowering viral load or treating the infection) AND the characteristics of who was selected for treatment.

Whereas, in a randomized trial, because the selection is random, the effect is due solely to the true effect of the treatment. This is a much better type of study looking primarily at the effect of the drug treatment.

So if you are able to select the people in the treatment group, the researcher can tend to choose those that are younger, and who have fewer co-morbidities which is poised to do better than if the treatment was assigned randomly.

Observational studies are still good studies and should be used to design randomized studies. Randomized studies should then be used to guide therapy.

So the next time you are reading research about a new prevention or treatment for COVID-19, check to see if it is a randomized study. It will serve to be more reliable.

References:  Randomized clinical trials

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

https://www.globalhealthnow.org/2020-06/more-clues-potential-treatments

I was hesitant in posting this article because I didn’t want to give the wrong impression in stating that good hand washing and cleaning surfaces is not important. It is. This article explains how some companies emphasizing how they are disinfecting their areas may give us a false sense of security. This obsession of risk reduction rituals that make us feel safer but don’t actually do much to reduce the risk if transmission is called hygiene theatre.

In May, the CDC updated its guidelines to clarify that COVID-19 is spread primarily through the air, not by touching surfaces. According to Emanual Goldman, a microbiology professor at Rutgers New Jersey Medical School, “Surface transmission of COVID-19 is not justified at all by science”.

But wait…weren’t we told that the virus could remain on surfaces for hours and even days?!!! Yes! Backing up those many scary stories of how people were infected after touching their mail, packages and doorknobs were several Lancet studies in July that  were based on unrealistically strong concentrations of the virus. In other words, 100 people would have to sneeze on the same exact area of a table to mimic some of the experimental conditions. But now…we have more research.

The article below reviews other studies looking at how this coronavirus really spreads. There is new research and studies everyday. The one thing that has not changed is that this is an airborne virus, and that besides good hand washing, the importance of social distancing and wearing masks cannot be over-emphasized.

The problem with over cleaning and making us feel safe is that it justifies more social gathering places to open up, such as indoor seated restaurants, bars, gyms and now schools. I’m concerned people, especially students, will feel that as long as surfaces have been cleaned, wearing a mask is not as important.

A new study in South Korea, published Thursday in JAMA Internal Medicine, offers more definitive proof that people without symptoms carry just as much virus in their nose, throat and lungs as those with symptoms, and for almost as long. The South Korean team analyzed samples taken between March 6 and March 26 from 193 symptomatic and 110 asymptomatic people isolated at a community treatment center in Cheonan. Of the initially asymptomatic patients, 89 — roughly 30 percent of the total — appeared healthy throughout, while 21 developed symptoms. The participants were mostly young, with the average age of 25. A study last week found children, who were mildly infected also carried at least as much virus as adults. Yikes!

Asymptomatic People Carry coronavirus in High Amounts

Many  of us are either exercising too much or too little during this pandemic. Here is reason to get up out of your chair and get moving…

A molecule called Gpld1 (glycosylphosphatidylinositol (GPI)–specific phospholipase D1), seems to improve neurogenesis and cognition in mice. In a series of experiments in older mice, regular exercise, compared with sedentary behavior, improved neurogenesis, learning ability, and memory.

Blood extracted from older mice, midlife, or younger exercising mice that was injected intravenously into older sedentary mice produced improved neurogenesis, learning ability, and memory. Blood infusions from sedentary mice did not have this effect.

Mass spectrometry (a sophisticated tool used to measure the mass-to-charge ratio of 1 or more molecules) identified about 30 molecules that increased after exercise; one of the most prominent was Gpld1, a molecule produced by the liver. When scientists enhanced liver production of Gpld1, it led to improved neurogenesis and cognition.

Levels of Gpld1 are also higher in physically active humans than in sedentary humans. This is the equivalent to about 7100 steps per day. A molecule common to mice and humans has been linked to the benefits of exercise and the aging brain. Whether we see this being used in humans therapeutically is yet to be seen. But it suggest that specific molecules brought on by exercise can improve cognition.

Reference: Horowitz AM et al. Blood factors transfer beneficial effects of exercise on neurogenesis and cognition to the aged brain. Science 2020 Jul 10; 369:167.

You may not have signed up to be in an experiment…but we are all in one. This pandemic is the largest psychologic experiment in history to test human resilience under adversity. It will test all races, religions, genders, ages and socioeconomic settings. This virus spans all countries and has no borders. It effects everyone…everywhere!

As many as two thirds of people recover from difficult experiences without prolonged psychological effects, even if they have lived through extreme events like prisoner of war or violent crimes. But the other third suffer real psychological distress that can last for months or even years.

Even if most people prove resilient, the sheer numbers involved have experts warning of a mental illness “tsunami.” COVID-19 has disrupted so many peoples’ lives with the threat of disease, loneliness of isolation, loss of loved ones, repercussions of job loss and ongoing uncertainty about when the pandemic will end. Suicide deaths by health care professionals are a chilling reminder of the risks that are still present.

Epidemiologist Daisy Fancourt of University College London began a study in mid-March that grew to include more than 85,000 UK residents. They tracked depression, anxiety, stress and loneliness week by week. Six weeks in it was found that levels of depression were significantly higher than before the pandemic. In China, the first nationwide large-scale survey was taken where the crisis hit earliest and found that almost 35 percent reported psychological distress.

Generally, those with previous diagnosed mental health illness, those who live alone and younger people were reporting the highest level of depression and anxiety. Interestingly, there was a decrease in anxiety levels once the lockdown was declared. “Uncertainty tends to make things worse” according to Fancourt. Some people tend to find ways to carry on while others are frozen by not knowing what is to come.
Another study showed worrisome findings in older adults. Most adults older than 65 have better emotional well-being. This could be due to the fact that seniors have lived through more than younger people and had more time to develop skills for dealing with stress. Also many have retired and are less concerned about work. On the other hand, some seniors understand the higher likelihood of getting sick and of losing loved ones. Some are fearful of going out and fearful of anyone coming to their front door. They are also not as tech-savvy so it is difficult for them to get the information they need.

Successful coping in a crisis means continuing to function and engaging in day-to-day activities. Strategies that buffer the effects of stress include getting enough sleep, observing a routine, getting outside and enjoying nature, exercising, eating well and maintaining strong social connections. Spending time on projects and solving problems, even small ones that provides a sense of purpose are important. Factors that predict resilience are optimism, the ability to keep perspective, strong social support and flexible thinking. People who believe they can cope do, in fact, tend to cope better.

Also, in previous work by psychologist Anita DeLongis of the University of British Columbia who studies psychosocial responses to disease, those who are high in empathy are more likely to engage in appropriate health behaviors such as social distancing. They also have better mental health outcomes than people who are low on empathy. Her COVID-19 study will follow people’s behavior and attitudes for months to capture changes in empathy and coping over time. DeLongis says that empathy can be learned and encouraged with proper messaging, and depending how you respond will determine health behaviors and coping mechanisms.

Reference: Denworth, L. “The Biggest Psychological Experiment: What Can The Pandemic Teach Us About How People Respond to Adversity?”. Scientific American. July 2020, p 40-45.

Since we are all trying to make fewer visits to the grocery store, why not stretch those dollars and keep you fruits and veges as fresh as possible.

Here is a great article on just how to do that…

Keeping Produce Fresh Longer