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