Health: the pH Debate

pH is a measure of the acidity of a substance — food, water, human tissue, whatever. It is measured on a scale of 1 to 14, where 1 is extremely acidic, 14 is extremely non-acidic (alkaline) and 7 is neutral.

Here’s what we know:

• The tissue in the human body around cancer cells is acidic. That’s true not just for cancer but for other diseases as well. Low pH is associated with illness
• Different parts of the body have different pH levels, depending on function. For example, the stomach is highly acidic. Blood in a healthy individual has a pH of 7.35 to 7.45, slightly alkaline.

Here’s what we don’t know:

• Does cancer/illness cause excess acidity, or does an excessively acid environment depress the immune system and enable disease to take root and develop? (Yes, this is a “which comes first, the chicken or the egg?” question. However, in this case, it matters.)
• Can diet affect the pH of human tissue?
• What’s a reliable measure of pH?

Traditional medicine says there is no scientific research supporting the role of pH in cancer development. That’s true. In fact, I haven’t been able to find any research at all on the topic. Who would fund it?

Non-traditional medicine relies on anecdotal information — which may not be generalizable to most people — and says that one can measure pH simply through testing saliva or urine. Using either as a test of whole body pH is silly, as both can be affected by level of water consumption as well as by foods eaten recently. There are other tests doctors can perform, but remember that some parts of the body are supposed to be acidic.

There are a lot of articles online, which I haven’t cited here, discussing pH in the context of pushing one supplement or another of unknown health value. Charitably, some of these might have some value, but many are probably just ways of taking your money. These are the modern versions of patent medicine “elixirs” that were sold in the 1800s by traveling salesmen.

There is an oncologist here who swears that anyone who drinks a smoothie made up of kale, green apple, pineapple and water will not get cancer. The mixture is rich in antioxidents and affects pH. Is there scientific evidence supporting this claim? No. Do people do it anyway? Yes, because there is no harm in this concoction.

Alkaline diets became a fad in 2013 after Victoria Beckham tweeted about them. As part of that, some celebrities have been promoting and consuming high pH water. There is evidence that this water can help with acid reflux by breaking down pepsin, but whether it has any other benefits simply isn’t established.

In fact, the consumption of any kind of water may have health benefits. However, uncertainty remains about how much water is appropriate for different body types as well as what the benefits really are. (1)

What you need to consider:

If something may be helpful and there are no risks associated with it, why not? There’s no harm in drinking water or broadening the array of vegetables you eat. However, the truism still applies — “everything in moderation.”

The bibliography below lists some of the more intelligent articles addressing both sides of the issue regarding hydration and pH.

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Sources:

1. Barry Popkin, Kristen D’Anci, Irwin Rosenburg, “Water, Hydration and Health,”
   Nutrition Review, 2010 Aug; 68(8): 439–458.doi:  10.1111/j.1753-4887.2010.00304.x. Abstract at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/
2. https://familydoctor.org/hydration-why-its-so-important/
3. Jami Foss, “The Benefits of Alkaline Water, Unfiltered,” Shape, 31 August 2015. http://www.shape.com/healthy-eating/healthy-drinks/benefits-alkaline-water-unfiltered
4. https://my.clevelandclinic.org/health/articles/avoiding-dehydration
5. Vicki Vanarsdale, “Signs of Poor pH Balance in the Body,” Livestrong, 18 July 2017. http://www.livestrong.com/article/30086-signs-poor-ph-balance-body/
6. Sonya Collins, “Akaline Diets,” WebMD, 2016. http://www.webmd.com/diet/a-z/alkaline-diets
7. Marcelle Pick, “Digestion & GI Health – The Truth About pH Balance,” Women to Women, 2017. https://www.womentowomen.com/digestive-health/digestion-gi-health-the-truth-about-ph-balance/
8. Oliver Childs, “Don’t believe the hype – 10 persistent cancer myths debunked,” 24 March 2014. http://scienceblog.cancerresearchuk.org/2014/03/24/dont-believe-the-hype-10-persistent-cancer-myths-debunked/
9. Pawel Swietach, Richard D. Vaughan-Jones, Adrian L. Harris, and Alzbeta Hulikova^{, “}The chemistry, physiology and pathology of pH in cancer”,

   Philos Trans R Soc Lond B Biol Sci. 2014 Mar 19; 369(1638): 20130099.

   doi:  10.1098/rstb.2013.0099

Antidepressants, Alzheimer’s and Brain Injuries: making bad worse

What we knew:

• Use of antidepressants with Alzheimer’s patients increases the risk for falls and hip fractures
• There is a protein found in the brain cells of persons with dementia and brain injuries that causes the Axon in the cell (electronic message transmitter) to swell and shut down. This protein is absent from normal cells. Elimination of the protein can cause the axon to start functioning again. (References are in previous blog.)

What the University of Eastern Finland has added to what we know:

• Use of antidepressants with Alzheimer’s patients results in an increased incidence of traumatic brain injuries among these patients

The mechanism for the injury is probably falling. With slower mental processing and thus slower reflexes, these patients are less able to protect themselves when falling. That means a higher rate of concussions.

This ties back to another previous post on this blog — “deprescribing”. Drugs may have a value in one stage of a person’s life and be counterproductive at another stage. Doctors know how to prescribe drugs, but there are few protocols (apart for drug interactions) regarding when to stop taking a drug.  There is a group in Canada developing guidelines for deprescription, and while NIH has published articles on the topic, I’m not aware of any similar projects to develop guidelines in the US. Some US physicians appear to be doing this on an ad hoc basis.

I suspect deprescription is not a popular topic among pharmaceutical executives, but it needs to be addressed. Continuation of unnecessary medication is just one of many factors that bloats medical costs in the US — and why spending level no longer indicates quality of care. Unnecessary medication poses risks to some patients.

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Sources:

1. Heidi Taipale, Marjaana Koponen, Antti Tanskanen, Piia Lavikainen, Reijo Sund, Jari Tiihonen, Sirpa Hartikainen, Anna-Maija Tolppanen. Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study. Alzheimer’s Research & Therapy, 2017; 9 (1) DOI: 10.1186/s13195-017-0285-3
2. University of Eastern Finland. “Antidepressant use increases risk of head injuries among persons with Alzheimer’s disease.” ScienceDaily. ScienceDaily, 9 August 2017. <www.sciencedaily.com/releases/2017/08/170809073627.htm>.
3. Gurusamy Sivagnanam, “Deprescription: The prescription metabolism,”
   J Pharmacol Pharmacother. 2016 Jul-Sep; 7(3): 133–137.

   doi:  10.4103/0976-500X.189680
4. http://deprescribing.org/
5. http://www.drjohnm.org/2014/10/to-deprescribe-adding-a-new-verb-to-the-language-of-doctoring/
6. Joaquín Hortal Carmon, IvánAguilar Cruz, FranciscoParrilla Ruiz, “A prudent deprescription model,” Science Direct, Medicina Clínica, Volume 144, Issue 8, 20 April 2015, Pages 362-369.

 

Stress and Health

Everybody has a story.

• The unreasonable boss or lousy job,
• The injury or illness
• Money problems
• The loved one with an addiction
• Something.

Most of the stories are real — things with which the person has to deal every day. (A few people make up stories to get attention; that’s a different topic for another time.)

In the lexicon of research, all of these things are stimuli. They’re things that happen that require some kind of response. In physics, Newton’s Third Law makes it easy —

For every action, there is an equal but opposite reaction.

Unfortunately, that doesn’t apply to thought and emotions. Instead, human responses can be —

• Proportional (optimal)
• Inadequate (hypofunction/allostasis, or inadequate adaptation to a stimuli)
• Excessive (hyperfunction).

In neurology, these stimuli are called “stressors.” How you respond to them is the “stress response” or “stress.” Stressors are perceived threats, and the human body reacts to them in ways not unlike when early humans stumbled into the path of a dinosaur. The body releases a variety of hormones that impact almost all major systems in the body.

The stress response is mediated by the stress system, partly located in the central nervous system and partly in peripheral organs. The central, greatly interconnected effectors of this system include the hypothalamic hormones arginine vasopressin, corticotropin-releasing hormone and pro-opiomelanocortin-derived peptides, and the locus ceruleus and autonomic norepinephrine centers in the brainstem. Targets of these effectors include the executive and/or cognitive, reward and fear systems, the wake–sleep centers of the brain, the growth, reproductive and thyroid hormone axes, and the gastrointestinal, cardiorespiratory, metabolic, and immune systems.  (1, emphasis added)

Inadequate or excessive stress reactions are linked to a massive array of both physical and behavioral problems.

• Physical: Asthma, exzema, migraines, low or high blood pressure, cardiovascular disease, indigestion, diarrhea, constipation, obesity and Type II diabetes, sleep disorders, panic attacks and psychotic episodes. In children, it may be related to stunted growth. In women, osteoporosis.
  • Recent research is placing greater emphasis on the role of stress in cardiovascular disease.(2)
• Emotional: Anxiety, depression, mental errors, loss of sex drive, OCD, alcoholism, etc.

Dr. Chrousos argues that stress response hormones were designed for limited use (e.g., see dinosaur, release hormones; lose dinosaur, stop release). In the modern environment in which stressors operate continuously over a long period of time (e.g., the bad boss), long term release of these hormones can have profound negative effects on the functioning of the body.

The portion of the brain that controls emotions is the amygdala. Recent research has shows that severe stressors cause physical chances in the amygdala, most notably enlarging it. (3)

What’s Important to Know:

1. Stress (or the stress response) is inside you. It’s not what someone does to you; it’s how you react.
2. Some of the stress response is automatic. You don’t tell you body to release hormones. And when someone is chasing you down a dark alley, be grateful that’s true.
3. However, you may have some ability to influence how long those hormones are released and the damage your body sustains.
   • You can take yourself out of a stressful situation.
   • You can “let go” of something that’s happened after it’s over.
   • You can use meditation, yoga, tai chi or other tools to moderate reaction to stressors.

Keeping the stress reaction alive when it’s not needed hurts you, not the stressor.

 

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Sources:

1. George P. Chrousos, “Stress and Disorders of the Stress System,” Medscape, 2009. http://www.medscape.com/viewarticle/704866
   Dr. Crousos is professor and chair of the Department of Pediatrics at the University of Athens, Greece. With 1,100 articles, he is one of the most quoted doctors and researchers on the planet.
2. Marlene Busko, “Study Links Stress-Related Amygdala Activity to Future CVD Events,” Medscape, 13 January 2017. http://www.medscape.com/viewarticle/874435
3. Megan Brooks, “PTSD May Be Physical, Not Just Psychological,” Medscape, 21 July 2017. http://www.medscape.com/viewarticle/883251

 

The Highlanders Take Care of Their Own

Scotland is the first country to introduce a program to provide free tampons and pads to poor women.

It makes sense. That’s a “tax” if you would on being female, and a cost that’s unavoidable even on a very limited budget.

The program is simple, low cost, easy to implement, and doesn’t require massive audit or oversight. After all, what sort of black market is there for tampons? Really?

Sometimes, you don’t need complexity, technology or a lot of money to do good. Very Scottish.

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Sources:

Jenavieve Hatch, “Scotland To Give Low-Income Women Free Menstrual Products In New Pilot Initiative,” Huffington Post, 12 July 2017. http://www.huffingtonpost.com/entry/scotland-to-give-low-income-women-free-menstrual-products-in-new-pilot-initiative_us_59662343e4b005b0fdca0697

Coffee Addicts Rejoice!

Coffee might actually be very good for you.

You’ve probably heard some of this online in the last couple of days, but not the full story. That’s unfolded over two years, and Facebook and News sites don’t have that kind of memory.

Here’s a litany of documented health benefits of drinking coffee.

Before I go into the list, there are two one big caveats.

1. If you drink overly hot beverages of any kind — hot enough to burn the lining of your throat — you can be setting yourself up for Barrett’s Syndrome and esophageal cancer. Aristotle extolled the virtue of moderation, and moderation in this case includes temperature.
2. It is possible to overdose on caffeine. I knew someone in college who had to be hospitalized due to excessive consumption of caffeine via a carbonated soda, Tab. In fact, caffeine overdose was cited as the cause of death of a teenage in May of this year. (1) That case was also related to soda, not coffee. Aristotle is correct again. Moderation includes caffeine consumption.

However, there are a number of important documented benefits from drinking coffee:

• People who drink coffee appear to live longer.  In an analysis by researchers at the University of Southern California,

Drinking coffee was associated with a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease for African-Americans, Japanese-Americans, Latinos and whites.(2, 4)

Previous research by USC and others have indicated that drinking coffee is associated with reduced risk of several types of cancer, diabetes, liver disease, Parkinson’s disease, Type 2 diabetes and other chronic diseases.(4)

According to one of the lead researchers,

“We cannot say drinking coffee will prolong your life, but we see an association,” Setiawan said. “If you like to drink coffee, drink up! If you’re not a coffee drinker, then you need to consider if you should start.”(4)

• Coffee-drinkers have better sex.  According to a report from the University of Texas in 2015, males consuming two to three cups of coffee per day reduce their risk of erectile dysfunction.(5)

• She might actually remember it. Seriously, another study from 2016 supports a role of caffeine helping reduce the risk of dementia among women.(6)

So, enjoy coffee but skip the decaf (unless your doctor says otherwise). Caffeine might actually be good for you.

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Sources:

1. http://www.nbcnews.com/health/health-news/south-carolina-teen-died-caffeine-overdose-coroner-rules-n759716
2. Marc J. Gunter et al. Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study. Annals of Internal Medicine, 2017 DOI: 10.7326/M16-2945
3. Song-Yi Park et al. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations. Annals of Internal Medicine, 2017 DOI: 10.7326/M16-2472
4. University of Southern California. “Drinking coffee could lead to a longer life, scientist says: Whether it’s caffeinated or decaffeinated, coffee is associated with lower mortality, which suggests the association is not tied to caffeine.” ScienceDaily. ScienceDaily, 10 July 2017. <www.sciencedaily.com/releases/2017/07/170710172118.htm>.
5. David S. Lopez, Run Wang, Konstantinos K. Tsilidis, Huirong Zhu, Carrie R. Daniel, Arup Sinha, Steven Canfield. Role of Caffeine Intake on Erectile Dysfunction in US Men: Results from NHANES 2001-2004. PLOS ONE, 2015; 10 (4): e0123547 DOI: 10.1371/journal.pone.0123547
6. Ira Driscoll, Sally A. Shumaker, Beverly M. Snively, Karen L. Margolis, JoAnn E. Manson, Mara Z. Vitolins, Rebecca C. Rossom, Mark A. Espeland. Relationships Between Caffeine Intake and Risk for Probable Dementia or Global Cognitive Impairment: The Women’s Health Initiative Memory Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016; glw078 DOI: 10.1093/gerona/glw078

 

 

 

 

ACA Repeal: The Latest

The Senate proposal is out. The proposed law is 142 pages of (perhaps unnecessary) complexity, and, given the rushed nature, probable errors. But it’s out.

It’s not out in time to prevent damage for 2018.

• Withdrawal of insurers: Aetna notified agents that it will be withdrawing from individual markets in 18 states. Notices to policy holders will be sent on or about July 1st. Other firms have announced withdrawals from a few states, most particularly Iowa and Indiana.
• Heavy rate increases: Insurers in the individual market in Virgina have asked for a 30% rate increase for 2018, based on uncertainty about whether the Federal government will continue subsidies for health insurance. Insurers in NY State have asked for a 16.6% increase. Most other states will be in that range.

The proposal represents a mixed signal for consumers.

• Pre-existing conditions: The Senate version conforms with the House version in requiring insurers to cover people with pre-existing conditions. HOWEVER . . .
• Coverage: States can apply for waivers allowing insurers to reduce the coverage they provide. Services required by people with pre-existing conditions may not be covered.
• Medicaid: The bill supports a contraction of Federal Medicaid funding, but delays the start of cutbacks until 2021. The House version started cuts in 2020, an election year. The Senate version of the cuts are later and deeper.
  • The Medicaid expansion was an increase of the income limit for eligibility from 100% of poverty level to 138%.
  • Under the Senate version people making more than 100% of poverty level would be prevented from enrolling in Medicaid starting in 2020.
  • All Federal funding for the expansion would be limited in 2023.
  • The impact on the Medicaid program for children, CHIP, is unclear at this time.
  • Inflation adjustments for Medicaid funding would be changed from an index based on medical costs to the overall Consumer Price Index (CPI), which would reduce annual increases in funding in all future years. (See graph.) (4) The focus of this change is strictly on reducing Federal spending, not helping consumers. Federal payments would lag behind increases in medical costs — who pays the difference?
• Tax credits to help pay for insurance: The House version based subsidies on age; the Senate version reverts to income as the basis, consistent with the existing ACA rules. However,
  • The Senate version reduces the maximum income eligible for these subsidies, making some people now receiving subsidies ineligible for them in the future. On low low end, the Senate version makes subsidies available for people earning below below poverty level who might not be eligible for Medicaid in their state. The Senate version maintains cost-sharing subsidies for insurers through 2019.
  • The Senate version reduces the amount of subsidy people receive, increasing out of pocket costs for everyone, and especially for those between age 50 and 64.
• Planned Parenthood: Both House and Senate versions remove funding for Planned Parenthood.
• Tax reductions for affluent households: The Senate and House versions are in agreement on this; the reductions remain intact.
• Individual mandate: Penalties for not having insurance are eliminated.

Sticking points:

• For conservatives: Treating healthcare as a human right. They would rather see the ACA eliminated without replacement.
• For moderates and those in competitive districts

Collateral damage:

• Insurance coverage: There’s a debate as to how many people will not have insurance coverage with this law.  Estimates vary between 13 and 23 million.  The reasons for the variance in estimates include:
  • Time frame — loss of coverage will build over time as insurance costs increase and subsidies don’t.
  • Medicaid — how many people will lose coverage under Medicaid. That impacts more people than you would expect. Most people don’t have Long Term Care insurance, and Medicaid has become the prime vehicle for paying for home health aides and nursing home costs. Since nursing home costs average nationally more than $9,000 per month and Medicare pays for only the first 100 days, there are a lot of middle income families that will be in trouble. Even some moderately affluent families will be affected, and the poor . . . forget about it.
• Tax increases: Healthcare for the uninsured will fall back on emergency rooms, largely of public hospitals. That will drive costs and budget increases and increases in local taxes. Tax savings for the rich will mean tax increases for everyone else.
• Economic stagnation: The US is a consumer economy. I’ve argued previously that money siphoned from consumers for education, housing and healthcare is money they can’t spend for anything else. One analyst sees 1.1 million jobs disappearing by 2020 with passage of the AHCA. (3)

 

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Sources:

1. M. J. Lee, Tami Luhby, Lauren Fox, Phil Mattingley, “Senate GOP finally unveils secret health care bill; currently lacks votes to pass,” CNN, 22 June 2017. http://www.cnn.com/2017/06/22/politics/senate-health-care-bill/index.html
2. Stephanie Armour, Kristina Peterson and Louise Radnofsky, “Battle Lines Drawn on Health Care,” The Wall Street Journal, 23 June 2017, P. A1.
3. Josh Bivens, “Millions of people have a lot to lose under the AHCA,” Economic Policy Institute, 21 June 2017. http://www.epi.org/publication/millions-of-people-have-a-lot-to-lose-under-the-ahca/?utm_source=Economic+Policy+Institute&utm_campaign=50e819bfcb-EMAIL_CAMPAIGN_2017_06_23&utm_medium=email&utm_term=0_e7c5826c50-50e819bfcb-58834721&mc_cid=50e819bfcb&mc_eid=0541ad0f29
4. Federal Reserve Bank of St. Louis, Economic Research. Chart downloaded 25 June 2017. https://fred.stlouisfed.org/graph/?id=CPIMEDSL,
5. Bob Bryan, “Unveiled: The Secret Senate Healthcare bill,” Business Insider, 22 June 2017. http://www.businessinsider.com/senate-healthcare-bill-trumpcare-ahca-details-2017-6

Cancer: Speed of Starting Treatment Matters

We already know that early detection of cancer

• Reduces the time required for treatment
• Reduces the cost required for treatment
• Improves the outcome in terms of five-year survival rate

Cancer screening is invaluable.

Now a new study from the Cleveland Clinic shows that the time lapse between detection of cancer and the start of treatment also matters. Each week that passes between diagnosis and the start of treatment impacts the five-year survival rate.

Longer delays between diagnosis and initial treatment were associated with worsened overall survival for stages I and II breast, lung, renal and pancreas cancers, and stage II colorectal cancers, with increased risk of mortality of 1.2 percent to 3.2 percent per week of delay, adjusting for comorbidities and other variables. (1)

In the example of stage I non-small cell lung cancer, the five-year survival rate is

• 56% if treatment starts within 6 weeks versus
• 43% if treatment starts later

The problem is that the length of time between diagnosis and treatment has been increasing since 2004.

What you need to consider:

• With cancer, once diagnosed, time is of the essence.
• Checkups and screening are essential.
• Cancer can strike at any age.

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Sources:

1. Cleveland Clinic. “Time to initiating cancer therapy is increasing, associated with worsening survival: Based on US analysis of common solid tumors in study population of 3.6 million.” ScienceDaily. ScienceDaily, 5 June 2017. <www.sciencedaily.com/releases/2017/06/170605151949.htm>.