Microscopic Colitis Foundation

How Serious Are the Health Risks Associated with Ultra-Processed Foods?

12/8/2024

by wayne persky

Some authorities have referred to ultra-processed foods as "a silent killer". How realistic is that opinion?

Ultra-processed foods have become a major part of our diet.

In recent years, the consumption of ultra-processed foods has surged, raising significant concerns among health professionals and researchers. These foods, characterized by their high content of additives and minimal nutritional value, are now a staple in the American diet. According to research from Florida Atlantic University (2024, February 20), nearly 60% of the average adult's diet and almost 70% of children's diets in the U.S. consist of ultra-processed foods.1 This shift in dietary habits could be the new "silent killer," akin to the unrecognized dangers of high blood pressure in previous decades, according to some authorities.

Exactly what are ultra processed foods?

Ultra-processed foods (UPFs) generally include food products that have undergone multiple industrial processes, and contain numerous added ingredients. Typically, they're significantly altered from their original state, and they include substances not commonly used in home cooking. They're often offered in highly convenient, ready to eat, or minimal preparation, forms. Despite the fact that they often have a high calorie content, most UPFs have a low level of essential nutrients. Common examples include snacks and baked goods, sugary drinks, frozen meals, prepackaged microwave dinners, sugary cereals, processed meats (such as sausages, hotdogs, chicken nuggets, deli meats, etc.), dairy-based desserts (such as ice cream, flavored yogurt, pudding cups, etc.), artificially sweetened products (such as sugar-free drinks and candies), bread and bakery products, and condiments and sauces.

The NOVA Classification System is used to rate UPFs.

Group 1 includes unprocessed or minimally processed foods (e.g., fresh fruits, vegetables, grains, meats).

Group 2 includes processed culinary ingredients (e.g., oils, butter, sugar, and salt).

Group 3 includes processed foods (such as canned vegetables, cheeses, freshly made bread).

Group 4 includes ultra-processed food and drink products (e.g., soft drinks, sweet or savory packaged snacks, reconstituted meat products, pre-prepared frozen dishes).

Various health risks have been associated with UPFs.

The extensive processing and the presence of artificial additives in UPFs have been linked to various adverse health outcomes, including obesity, diabetes, cardiovascular disease, and cancer. Additionally, for some people, digestive problems have been associated with the consumption of UPFs.

As the consumption of UPFs continues, our health is trending downward.

In the study mentioned above, health professionals urge a shift toward whole foods, and the reduction of the consumption of UPFs, pointing out that life expectancy in the US has declined for the first time in over a century, and the decline parallels the increasing rates of noncommunicable diseases that coincide with the rise in the consumption of UPFs. However, note that the decline in life expectancy also parallels other events, not the least of which was the disruption caused by Covid 19

UPFs also tend to have labeling problems.

The labeling on UPFs often misleads consumers about their healthfulness. Research from University College London (UCL) highlights some of these issues, revealing the complexities and potential misguidance problems in current food labeling systems (Dicken, Batterham, and Brown, 2024).2

The problems with the "traffic light" labeling system.

The primary problem with the labeling system used in some countries (using the U. K. as an example) is the front-of-package labeling (FOPL). The UK uses a "traffic light" system. Although this type of labeling is not mandatory, many food manufacturers choose to use it. This system uses red, amber, and green lights to indicate high, medium, and low levels of energy, fat, saturated fat, sugar, and salt, respectively. While this system aims to help consumers make healthier choices, it does not account for the degree of food processing, which is a significant oversight given the (alleged) health risks associated with UPFs.

Using the NOVA classification system, researchers at UCL compared the nutrient content and processing levels of foods to categorize foods into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. Their study, was published in the British Journal of Nutrition, and it yielded several noteworthy findings.

Labels on UPFs typically:

1. Contain higher levels of unhealthy ingredients, including calories, fat, saturated fat, sugar, and salt, compared with minimally processed foods, and this often results in more red and fewer green traffic lights on their FOPL (which would suggest that the labeling system is working correctly).

2. Lead to misleading health perceptions. Although this doesn't apply to all UPFs, some UPFs may appear healthy based on their labeling despite being less nutritious than minimally processed foods, leading consumers to mistakenly believe that UPFs are healthy options.

3. Tend to overlap between nutritional content and processing, typically having a worse nutritional profile and FOPL score when compared with minimally processed foods. Even so, some UPFs still manage to receive favorable POPL scores, and that creates confusion.

Because the current labeling system generally fails to incorporate the degree of processing into its assessment, consumers are often misled. For example a low-fat yogurt might appear to be healthy due to its green traffic light regarding fat content, but it can still be high in sugar and heavily processed. The resulting complexity makes it difficult for consumers to make truly informed choices.

UPFs have been shown to cause dozens of health issues.

A recent online Medical Xpress article describes the findings of a study published by the British Medical Journal (BMJ) (2024, February 28).3 The study provides consistent evidence linking higher exposure to UPFs with an increased risk of 32 damaging health outcomes, including the ones mentioned above, and many others, such as major heart and lung conditions, mental health disorders, and early death.

The BMJ study conducted an umbrella review of 45 meta-analyses from 14 review articles, encompassing nearly 10 million participants. This comprehensive analysis revealed that higher consumption of UPFs is consistently associated with numerous adverse health outcomes. Some of the significant findings of that study include:

1. Higher intake of UPFs is linked to a 50% increased risk of cardiovascular disease-related death. This convincing evidence underscores the significant impact of these foods on heart health.

2. The study found a 48-53% higher risk of anxiety and common mental disorders among individuals with high UPF consumption. This association highlights the potential mental health implications of diets rich in ultra-processed foods.

3. There is a 12% greater risk of developing type 2 diabetes associated with high UPF intake. The study also found highly suggestive evidence of a 40-66% increased risk of obesity and related metabolic disorders.

4. High consumption of UPFs is associated with a 21% greater risk of death from any cause. This finding is particularly concerning as it suggests a broad and significant impact on overall mortality.

5. The study also indicated increased risks of various other issues, including sleep problems (22%), depression (22%), and several gastrointestinal and cardiometabolic conditions, although the evidence for these associations remains limited.

6. Various characteristics of UPFs lead to various health issues. For example, the high levels of added sugars, fats, and salts can lead to obesity, hypertension and diabetes. Additionally the additives and preservatives used in UPFs can disrupt gut microbiota, possibly contributing to various gastrointestinal and inflammatory conditions.

UPFs are associated with an increased all cause mortality risk.

A 30-year study conducted by researchers in the United States and published in The BMJ highlights a concerning link between high consumption of UPFs and an increased risk of early death. The study, which spanned over three decades, tracked the health outcomes of 74,563 female registered nurses and 39,501 male health professionals (Fang, et al., 2024).4 Participants were initially free of cancer, cardiovascular diseases, and diabetes. Every two years, they provided updates on their health and lifestyle habits, and every four years, they completed detailed food questionnaires. This extensive follow-up allowed researchers to gather robust data on the dietary patterns and health outcomes of the participants.

48,193 people died during the study.

During the study period, over 48,000 deaths were recorded, including deaths due to cancer, cardiovascular diseases, respiratory diseases, and neurodegenerative diseases. The researchers found that higher consumption of ultra-processed foods was linked to a slightly higher risk of all-cause mortality. Specifically, participants in the highest quarter of UPF consumption (averaging seven servings per day) had a 4% higher risk of total deaths and a 9% higher risk of other deaths, including an 8% higher risk of neurodegenerative deaths, compared to those in the lowest quarter (averaging three servings per day). While this doesn't appear to be a relatively high increased risk, it's enough to be significant, by medical standards.

Certain UPFs were strongly associated with higher mortality rates.

1. Ready to eat meat, poultry, and seafood-based products showed the strongest and most consistent associations with increased mortality.

2. Both sugar sweetened and artificially sweetened beverages were linked to higher all-cause mortality.

3. Consumption of dairy based desserts was also associated with an increased risk of death.

4. Ultra-processed breakfast foods contributed to the higher mortality risk as well.

The study highlighted that while UPFs are often high in added sugars, fats, and salts, they lack essential nutrients like vitamins and fiber, which may contribute to their adverse health effects. Interestingly, no significant associations were found between UPF consumption and deaths due to cancer or cardiovascular diseases.

And that particular finding raises a very troubling point.

Cancer and cardiovascular disease are listed at the very top of the list of the most common causes of death (at least in the US) these days. If the study found that UPFs don't contribute to the risk of the most common causes of mortality, how can they possibly be associated with higher mortality risks? In that case, higher mortality risk could only happen if the consumption of UPFs leads to rare, or at least uncommon fatal health issues.

As unlikely as that might be, clearly this raises a valid question about the choice of statistical methods used to analyze the data in these research studies. In other words, the study results appear to be confounded (at least, in my opinion). That doesn't necessarily mean that the study findings are invalid, but it certainly raises some doubts about their statistical value.

In another study, UPFs have been associated with insomnia.

A new study published in the *Journal of the Academy of Nutrition and Dietetics* suggests a significant association between the consumption of ultra-processed foods (UPFs) and chronic insomnia, adding to the growing body of evidence on the negative health impacts of these foods (Duquenne, et al., 2024).5 The study, led by Marie-Pierre St-Onge, at Columbia University, utilized data from the NutriNet-Santé study, which included over 39,000 French adults. Participants provided detailed dietary records and information on insomnia symptoms every six months from 2013 to 2015. The research aimed to explore the link between UPF consumption and chronic insomnia, independent of sociodemographic, lifestyle, diet quality, and mental health factors. In the study,

1. On average, UPFs accounted for 16% of the participants' total daily energy intake.

2. About 20% of participants reported chronic insomnia.

3. Individuals with chronic insomnia consumed a higher percentage of their daily energy from UPFs.

The study found a statistically significant association between higher UPF intake and increased odds of chronic insomnia. The risk was slightly higher in males than females, with an odds ratio of 1.09 for males and 1.05 for females per a 10% increase in UPF intake. But again, this appears to be a rather modest association, rather than a truly significant effect.

Summarizing

Numerous research studies have found significant health risks associated with ultra-processed foods (UPFs), and because UPFs are a major part of the American diet, and they're commonly characterized by high levels of additives, and poor nutritional value, and they've been linked to health issues such as obesity, diabetes, cardiovascular disease, cancer, mental health disorders, and early death, how important is it for us to minimize their consumption?

Putting this all into perspective, it appears that the evidence, although significant, is less than overwhelming, or even compelling, when compared with research regarding health risks in general Yes, there's a large body of evidence that suggests that UPFs probably increase the risk of developing health issues, but the evidence appears to be relatively modest — reminiscent of the old saying about a lot of tempest in a teapot.

The bottom line seems to be that yes, most Americans would be significantly better off if they avoided, or at least minimized UPFs in their diet, but until better evidence becomes available it's rather difficult to conclude that UPFs are having truly substantial effects on our overall health, let alone acting as a "silent killer", except possibly in extreme cases.

References

1. Florida Atlantic University. (2024, February 20). "Could ultra-processed foods be the new 'silent' killer?." ScienceDaily. ScienceDaily, Retrieved from https://www.sciencedaily.com/releases/2024/02/240220144443.htm

2. Dicken. S. J., Batterham, R. . L, and Brown, A. (2024). Nutrients or processing? An analysis of food and drink items from the UK National Diet and Nutrition Survey based on nutrient content, the NOVA classification and front of package traffic light labelling. British Journal of Nutrition. Published online, 1-14. Retrieved from https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/nutrients-or-processing-an-analysis-of-food-and-drink-items-from-the-uk-national-diet-and-nutrition-survey-based-on-nutrient-content-the-nova-classification-and-front-of-package-traffic-light-labelling/30C871960D54E76E292BC1DE97FC3A00

3. British Medical Journal. (2024, February 28). Consistent evidence links ultra-processed food to over 30 damaging health outcomes. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-02-evidence-links-ultra-food-health.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

4. Fang, Z., Rossato, S. L., Hang, D., Khandpur, N., Wang, K., Lo, C., . . . Song, M. (2024). Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. British Medical Journal, Retrieved from https://www.bmj.com/content/385/bmj-2023-078476

5. Duquenne, P., Capperella, J., Fezeu, L. K., Srour, B., Benasi, G., Hercberg, S., . . . St-Onge, M-P. (2024). The association between ultra-processed food consumption and chronic insomnia in the NutriNet-Santé Study. Journal of the Academy of Nutrition and Dietetics, Retrieved from https://www.jandonline.org/article/S2212-2672(24)00094-7/fulltext#%20

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Why Covid Vaccines Don't Provide Long-Lasting Protection

12/1/2024

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by wayne persky

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Compared with common vaccines such as those for tetanus and influenza, the protective effects of COVID-19 mRNA vaccines decline relatively quickly. Recently published research offers some insights into the immune mechanisms involved, to help explain why the vaccines are so short-lived (Nguyen, et al., 2024).1 And as a National Institutes of Health (NIH) article points out, even an actual Covid 19 infection does not confer long-lasting immunity (Contie, 2024, October 29).2

This is very likely the main reason why so many people have had multiple Covid infections. The persistence of the virus to generate new variations of the disease relatively quickly surely adds to the risk of infection (and reinfection), but if the immune system was capable of generating a robust and longer-lasting immune response, the vaccines (or an actual Covid infection) would provide much longer-lasting protection.

Long-lasting immunity requires long-lived plasma cells (LL PCs).

LLPCs in the bone marrow can produce antibodies over extended periods, possibly for decades. Effective vaccines, like those used for tetanus and influenza, successfully generate LLPCs that establish themselves in the bone marrow and provide sustained antibody protection.

mRNA COVID-19 vaccines generate high levels of short-lived antibody secreting cells, but fail to establish LLPCs in the bone marrow. SARS-CoV-2 antibody levels decline within 3-6 months after vaccination, leading to reduced protection over time.

An apparent paradox exists.

SARS-CoV-2-specific plasma cells are detectable in the bone marrow but fail to transition into long-lived compartments. This raises questions about whether the issue lies in the nature of the spike protein, the vaccine delivery method, or other immune signaling factors.

Does the problem originate with the SARS-CoV-2 spike protein?

The spatial arrangement is less effective at cross-linking B-cell receptors compared with other viral proteins, such as those from influenza or tetanus. Cross-linking of B-cell receptors is essential for robust activation of B cells and their maturation into LLPCs.

Or does the problem originate with the mRNA platform?

It's unclear whether the rapid waning of antibody responses is specific to the SARS-CoV-2 spike protein or a limitation of the mRNA platform itself. Comparisons with other mRNA vaccines, like those for RSV, may help determine if the platform inherently hinders LLPC formation.

Despite their relatively short-lived umbrella of protection,

mRNA vaccines are the best option we have available for preventing the debilitating effects of Long Covid, and the life-threatening risks that are associated with the virus, and these vaccines have saved tens of millions of lives over the past few years.

Currently, frequent booster shots are needed in order to maintain protection.

Due to the short-lived protection provided by current mRNA COVID-19 vaccines, booster shots are required to maintain immunity. Boosters temporarily increase antibody levels, but may not address the underlying inability to establish LLPCs, necessitating ongoing research for more durable solutions. Hopefully, future research will allow the development of vaccines with longer-lasting effectiveness against the risks of the Covid 19 variants.

References

1. Nguyen, D. C., Hentenaar, I. T., Morrison-Porter, A., Solano, D., Haddad, N. S., Castrillon, C., . . . Lee, F.E. (2024). SARS-CoV-2-specific plasma cells are not durably established in the bone marrow long-lived compartment after mRNA vaccination. Nature Medicine, Retrieved from https://pubmed.ncbi.nlm.nih.gov/39333316/

2. Contie, V. (2024, October 29). Why protective antibodies fade after COVID-19 vaccines. National Institutes of Health, Retrieved from https://www.nih.gov/news-events/nih-research-matters/why-protective-antibodies-fade-after-covid-19-vaccines

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Where Have All the Experienced Primary Care Doctors Gone?

11/22/2024

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by wayne persky

The role of family doctors, once the cornerstone of American healthcare, is rapidly diminishing. Dylan Scott’s article “What happened to the family doctor?” published by Vox, highlights the profound transformation and ongoing challenges within the primary care system (Scott, 2023, September 14).1

Dr. Gerard Weigel’s career in Somerset, Kentucky, exemplifies the bygone era of family doctors who managed all aspects of patient care. From the 1960s through the 1980s, doctors like Weigel were integral to their communities, building deep, personal relationships with patients. This model fostered continuity and trust, essential elements of effective healthcare.

By contrast,

today's healthcare system is characterized by fragmented care. Dr. Joseph Weigel, Gerard's son, reflects on the transition from comprehensive, personal care to a more compartmentalized system. His son, Sam, now works in a hospital where patient interactions are brief and often impersonal. This shift underscores the broader systemic changes affecting primary care.

The number of Americans with a personal physician is steadily declining. Younger generations, in particular, prefer the convenience of urgent care clinics and retail clinics over maintaining a relationship with a single doctor. As of 2018, nearly half of adults under 30 did not have a primary care doctor【29†source】.

Today's clinics apparently can't afford experienced physicians.

The traditional model of independent primary care practices and clinics with experienced primary care physicians began to disappear years ago as it became economically unfeasible. High overhead costs and administrative burdens make it difficult for these practices to survive.

Consequently, hospital systems and corporate entities have absorbed many primary care providers and then gone on to replace them with physicians assistants and other recent medical school graduates who can be hired at a much lower cost than experienced physicians. This consolidation often leads to a more transactional approach to healthcare, prioritizing efficiency over personal relationships (and from the patient;s perspective, reduced quality of healthcare).

This trend flies in the face of quality healthcare.

Research consistently shows that long-term relationships with primary care doctors lead to better health outcomes. Patients with steady primary care relationships are generally healthier and live longer. By contrast, the current trend has led to increased emergency room visits, hospital admissions, and mortality rates.

Approximately 100 million Americans face barriers to accessing primary care. One in four Americans does not have a regular source of healthcare, a trend that has been growing since 2000. This lack of access is particularly pronounced in underserved areas, intensifying health disparities.

Some primary care practices are experimenting with new models

to re-engage patients and provide more personalized care. These include direct primary care and concierge medicine, where patients pay a flat fee for more accessible and personalized services. While these models offer a potential solution, they often cater to more affluent patients, leaving lower income patients underserved, because obviously such services increase the cost of healthcare for those patients who choose this option, adding insult to injury in view of the fact that healthcare is already way too expensive in the U.S.

But why have so many experienced physicians disappeared?

The pandemic dramatically increased the workload for primary care physicians, leading to higher levels of burnout. Many physicians faced extended hours, increased patient loads, and the emotional toll of dealing with COVID-19 patients, which prompted some to retire early or leave the profession altogether.
During the pandemic, many primary care practices faced severe financial challenges. With a significant drop in in-person visits and the rapid shift to telehealth, practices struggled to maintain revenue. Small and independent practices were particularly hard hit, leading some to close or merge with larger health systems.
Even before the pandemic, the U.S. was facing a projected shortage of primary care physicians due to an aging workforce. Approximately 2 out of every 5 physicians are expected to retire within the next decade. The pressures of the pandemic have accelerated this trend, pushing more experienced physicians to retire earlier than planned.
Women physicians and physicians of color were disproportionately affected by the pandemic. Many faced additional challenges such as balancing child care and professional responsibilities or addressing healthcare disparities in their communities. This added stress contributed to higher rates of burnout and workforce attrition among these groups.
While telehealth emerged as a critical tool during the pandemic, it also introduced new challenges. Providers had to quickly adapt to new technologies, often with little support or reimbursement certainty. Although telehealth helped maintain some level of patient care, it did not fully compensate for the loss of in-person visits, particularly for older or less tech-savvy patients.

The combined effects of these factors have led to a noticeable reduction in the availability of experienced primary care physicians across most medical institutions. Addressing this shortage will require systemic changes, including increased investment in primary care, better support for telehealth, and initiatives to reduce burnout and support the well-being of healthcare providers. Whether that can actually be done remains to be seen.

Patients are being forced to face a new era in U.S. healthcare.

Most patients (most older patients, at least) have always considered their primary care physician to be the cornerstone of their healthcare. In most cases, that cornerstone is either gone, or soon will be, as healthcare institutions phase those experienced clinicians out of their system, and replace them.

The face of U.S. healthcare is drastically changing.

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As discussed in detail in a 2023 Politico article titled "No one’s promising you can keep your doctor anymore." Him him him him, the landscape of primary care in the United States is undergoing a significant transformation, driven by workforce shortages, the impacts of the COVID-19 pandemic, and evolving healthcare policies (Payne, and Schumaker, 2023, November 26).2 The traditional model of a lifelong relationship with a primary care physician is becoming less common, and both Democrats and Republicans in our government are seeking to reimagine primary care to better serve the needs of the population.

The main cause of this shift is the shortage of primary care physicians.

Medical schools are not producing enough doctors to keep pace with the growing and aging population. This shortage is compounded by the retirement of older physicians and the burnout experienced by many during the pandemic. The American Association of Medical Colleges (AAMC) projects a shortage of between 17,800 and 48,000 primary care physicians by 2034.

Our government appears to be playing a leading role.

To address this gap, policymakers are promoting alternative models of care. Legislation proposed by Senators Bernie Sanders and Roger Marshall aims to reorganize primary care by emphasizing community health centers and expanding the roles of nurses and physician assistants. This approach reflects a pragmatic response to the reality that the traditional model of independent physician practices is no longer feasible on a large scale.

Healthcare will be dished out by NPs and PAs.

The reliance on nurse practitioners (NPs) and physician assistants (PAs) has been increasing. A study published in The BMJ found that the percentage of healthcare visits handled by non-physicians nearly doubled from 2013 to 2019. This trend is expected to continue, with NPs and PAs taking on more responsibilities to alleviate the burden on doctors.

Telehealth utilization will be expanded.

The COVID-19 pandemic accelerated the adoption of telehealth, making virtual visits a common part of healthcare delivery. Both the Trump and Biden administrations have supported the expansion of telehealth by lifting restrictions on Medicare reimbursements for virtual care. This shift has made healthcare more accessible, especially for routine check-ups and managing chronic conditions, though it also means less face-to-face interaction with doctors.

Looking ahead,

the primary care system is likely to continue evolving. Policymakers are pushing for more preventive care and better utilization of healthcare workers. The Biden administration has allocated over $100 million in grants to train more nurses and support their ability to open primary care practices independently. Additionally, there is a focus on increasing the compensation for preventive care services to attract more providers to primary care field.

Concierge medicine will be promoted for wealthy patients.

For those who can afford it, concierge medicine offers an alternative. This model provides personalized care with more immediate access to physicians, but it comes at a high cost, making it accessible primarily to affluent patients. Concierge medicine is growing, with a projected annual growth rate of over 10% through 2030.

The net effect of this transition is generally demoralizing.

These changes reflect a general trend that mirrors the way commercial feedlot operators process cattle and other animals destined for slaughter when admitting them into their facility. In other words, our future in the healthcare system appears to be reminiscent of the old saying that we'll be just a number in a vast system. We'll be pawns in an impersonal, faceless, one-size-fits-all system that focuses on speed and economy. This doesn't bode well for individuals who happen to be part of a subset of patients who don't fit into the overall pattern of the general population (such as MC patients).

And there are other problems weighing on primary healthcare providers.

A recent article in U.S. news discusses some additional reasons why doctors are leaving primary care and medical schools are not replacing them quickly enough (Shahidullah, 2023, January 4).3 The United States is facing a hidden crisis in its primary care system, characterized by an insufficient number of primary care physicians (PCPs) to meet the growing demand. This issue is compounded by the fact that fewer medical students are choosing to enter primary care fields, exacerbating the workforce shortage. This crisis demands immediate and comprehensive reforms to ensure that the healthcare system can effectively serve the population's needs.

PCPs are victims of "moral injury".

Unlike the commonly discussed "burnout," the concept of "moral injury" better captures the systemic issues within primary care. Moral injury refers to the stress caused by working in environments that prevent physicians from providing the best possible care. Primary care physicians are burdened with extensive clerical tasks and electronic medical record management, which detracts from patient care and diminishes job satisfaction. And all this extra clerical work is a primary reason why no one wants to be a PCP anymore.

PCPs are underpaid.

Primary care doesn't pay as well when compared with other medical specialties. Medical students, often burdened with substantial student debt, are more likely to choose higher-paying fields such as surgery or dermatology. Public health and preventive medicine, sectors that are crucial for serving vulnerable populations, offer the lowest compensation for physicians.

Primary care physicians often work long hours and manage large patient loads, averaging 20 patients a day with approximately 18 minutes per visit. This schedule does not allow sufficient time to address complex health needs, leading to suboptimal care and contributing to physician dissatisfaction and attrition.

Government regulatory policies are a major problem.

A recent article in JAMA Health Forum points out why new U.S. healthcare facilities are not being built (Chen, 2024, June 27).4 The issue of new construction and expansion of hospital facilities in the U.S. has been significantly hampered by various federal and state regulations intended to control healthcare costs but have inadvertently stifled growth and competition. These regulations, while well-intentioned, have led to a decrease in the number of hospitals, particularly in rural areas, and have made it challenging for new facilities to emerge. This has resulted in higher healthcare costs and reduced access to care for many Americans.

The CON laws.

One of the primary regulatory barriers to hospital expansion is the Certificate-of-Need (CON) laws. Initially introduced in the 1970s, CON laws require healthcare providers to obtain state approval before constructing new facilities, expanding existing ones, or offering new services. These laws were designed to prevent the duplication of services and to ensure that new facilities were financially viable and necessary for the community. However, these regulations have had several unintended consequences:

By requiring approval for new projects, CON laws have restricted the supply of healthcare facilities, leading to fewer hospitals and higher prices due to reduced competition. The intended control of healthcare costs has paradoxically resulted in increased costs and decreased accessibility.
The stringent approval process and the need to demonstrate community need have slowed down the construction of new hospitals and the expansion of existing ones. This is particularly evident in states with strict regulations, such as California, where seismic retrofitting requirements further complicate hospital renovations and expansions.
Rural areas have been disproportionately affected by these laws, with many communities facing a significant shortage of healthcare facilities. A 2017 study highlighted that nearly 30 million individuals lived more than an hour away from trauma care facilities. The limited number of hospitals in these areas exacerbates the healthcare accessibility crisis.

The COPA laws.

In addition to CON laws, Certificates of Public Advantage (COPA) laws have also contributed to the stagnation of hospital development. COPA laws allow hospital mergers that might otherwise be prohibited under federal antitrust laws, in exchange for increased regulatory oversight. While intended to streamline and coordinate healthcare services, COPA laws have often led to negative outcomes:

The Federal Trade Commission reported that hospital mergers conducted under COPA laws resulted in higher healthcare prices and diminished quality of care. The consolidation of healthcare facilities reduces competition, leading to higher costs for patients and less incentive for hospitals to maintain high standards of care.

The ACA also imposes disincentives.

The Affordable Care Act (ACA) introduced restrictions on physician-owned hospitals (POHs), further complicating the landscape of hospital development. These restrictions aimed to prevent conflicts of interest and the potential for unnecessary procedures driven by profit motives. However, the consequences have been largely counterproductive:

The ACA's restrictions on POHs, including limitations on expansion and new construction, have dampened market competition. This has resulted in fewer new facilities and hindered the growth of existing ones, limiting patient options and keeping healthcare costs high.
The anticipation of these restrictions led to the cancellation of numerous hospital projects, resulting in billions of dollars in lost economic activity. The lack of new facilities also meant less competitive pressure to lower costs and improve services.

So what can we conclude from all this?

Under currently emerging changes, as is usually the case, patients, and their needs, appear to be basically ignored, and are regarded no better than “commodities “by the healthcare system. The focus is on economies of scale, and policies are based on efficiency and economy. Patients have no input

The decline of experienced primary care doctors reflects a broader transformation and crisis within the U.S. healthcare system. Various factors, including regulatory barriers like CON and COPA laws, economic pressures, and the impacts of the COVID-19 pandemic, have contributed to the shrinking number of primary care physicians and the consolidation of healthcare facilities. These changes have led to higher costs, reduced competition, and limited access to care, particularly in rural areas.

The shift away from independent primary care practices toward a model that relies more on nurse practitioners, physician assistants, and telehealth represents an effort to adapt to these challenges. However, this transition has also resulted in a more impersonal and fragmented healthcare system, distancing patients from the long-term, personal relationships that have been shown to improve health outcomes.

To address these issues, comprehensive reforms are needed, including increased investment in primary care, better support for telehealth, and initiatives to reduce burnout and support the well-being of healthcare providers. Policymakers must reconsider the unintended consequences of existing regulations and explore new models of care that balance efficiency with the need for quality, continuity, and personalized patient care.

And it's worth noting that nowhere (neither in the recommendations of government regulatory agencies, nor in healthcare facility policies) is the concept of improved healthcare that actually caters to the needs of patients being considered. The needs of patients, as usual, is an afterthought, at best.

References

1. Scott, D. (2023, September 14). What happened to the family doctor? Vox, Retrieved from https://www.vox.com/23817170/family-doctor-primary-care-physician-general-practitioner-shortage

2. Payne, D. and Schumaker, E. (2023, November 26). No one’s promising you can keep your doctor anymore. Politico, Retrieved from https://www.politico.com/news/2023/11/26/future-of-primary-care-family-medicine-00128547

3. Shahidullah, J. D. (2023, January 4). The Hidden Crisis in Primary Care. U.S.News, Retrieved from https://www.usnews.com/news/health-news/articles/2023-01-04/the-hidden-crisis-in-primary-care-medicine

4. Chen, L. J. (2024, June 27). The Unintended and Anticompetitive Consequences of Laws to Control Health Care Costs. JAMA Health Forum, Retrieved from https://jamanetwork.com/journals/jama-health-forum/fullarticle/2820716

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Risks Associated with the Emulsifiers Used by Food Processors

11/15/2024

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by wayne persky

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In an era dominated by ultra-processed foods, the use of additives by food processors is probably at an all-time high. Among these additives, emulsifiers—commonly found in a range of processed and packaged foods—have recently drawn attention for their possible role in the development of increasing worldwide health issues.

Emulsifiers are a class of food additives used by food processors and manufacturers to improve the texture, consistency, and stability of various food products. These substances have the ability to form and stabilize emulsions, which are mixtures of two or more immiscible liquids, such as oil and water, that would otherwise separate over time. Emulsifiers achieve this by reducing the surface tension between oil and water molecules, allowing them to mix more evenly and remain dispersed throughout the food product.

Common emulsifiers used in the food industry include:

Lecithins, mono and diglycerides, polysorbates, carboxymethylcellulose (CMC), soy lecithin, and gums. Food processors and manufacturers use emulsifiers to create a smooth and uniform texture in products such as sauces, dressings, and spreads; ensure that the ingredients do not separate or settle out; decrease the risk of spoilage and extend the shelf life of their products; and reduce the fat content without negatively affecting the texture or mouth feel of the product. Looking more closely at these emulsifiers:

Lecithins are naturally occurring compounds found in sources such as egg yolks and soybeans. They are widely used as emulsifiers in food products like mayonnaise, chocolate, and baked goods to improve texture and prevent ingredient separation.
Mono- and diglycerides are synthesized from vegetable oils and are commonly used as emulsifiers in processed foods such as margarine, ice cream, and baked goods to stabilize fat-water mixtures and improve product consistency.
Polysorbates are synthetic compounds derived from sorbitol and fatty acids. They are often used in dairy products, salad dressings, and frozen desserts as emulsifiers and stabilizers to enhance texture and prevent oil and water from separating.
CMC is a cellulose derivative that functions as a thickener, stabilizer, and emulsifier in a wide range of food products, including ice cream, sauces, and beverages. It helps improve texture and prevent ingredient separation.
Soy lecithin is a byproduct of soybean oil production and is commonly used as an emulsifier in chocolate, baked goods, and processed foods to improve texture and prevent ingredient separation.
Gums are made from certain legumes, and xanthan gum is made from byproducts of fermentation of the Xanthomonas campestris bacteria. Gums are used in many products as an emulsifier, and they are often used as thickeners and stabilizers in nut milks, nut butters, and similar products.

While emulsifiers offer numerous benefits for food processing and manufacturing, concerns have been raised about their potential impact on gut health, and the possibility that they might raise the risk of the development of inflammatory bowel disease (IBD) and other health issues. Research into the effects of emulsifiers on the gut microbiome and intestinal inflammation is ongoing, highlighting the need for further investigation into the safety and long-term consequences of their use in processed foods.

How significant are these possible risks of developing IBD?

IBD is a serious worldwide health problem, and the prevalence has been increasing in recent decades. While the exact causes of this increased risk is unclear, emerging research suggests that dietary factors, especially many foods associated with a 'Western diet,' may play a major role. Additives commonly used in many of these foods, and food emulsifiers, in particular, are under scrutiny because of their possible adverse effects on gut health and inflammation, especially regarding IBD.

A comprehensive review published in the *Journal of Crohn's & Colitis* delves into the mechanisms by which food emulsifiers may contribute to the development or exacerbation of IBD (Bancil, et al., 2021).1 Ecological studies have revealed a positive correlation between emulsifier consumption and the prevalence of IBD, highlighting the need for further investigation into their potential role in disease pathogenesis. Both cell and animal studies have provided significant insight into the mechanisms by which dietary emulsifiers may be adversely affecting gut health and promoting intestinal inflammation. For example:

Emulsifiers have been shown to alter the composition and function of gut microbiota, favoring the proliferation of pro-inflammatory bacterial species.
Emulsifiers may disrupt the integrity of the mucus layer that protects the intestinal epithelium, thereby compromising its protective function and promoting inflammation.
Emulsifiers have the potential to increase intestinal permeability, allowing harmful substances to cross the intestinal barrier, where they can trigger an inflammatory response.
Emulifiers can activate inflammatory pathways within the intestinal epithelium leading to the production of pro-inflammatory cytokines, and an increase in tissue damage.
Emulsifiers may interfere with normal cell cycle regulation within the intestinal mucosa, contributing to abnormal cell proliferation and tissue inflammation.

Emulsifiers may be associated with the development of type 2 diabetes.

chronic exposure to emulsifiers. A groundbreaking study conducted in France, spanning over 14 years and involving more than 100,000 participants, sought to unravel the relationship between dietary emulsifier intake and the incidence of type 2 diabetes. The findings, published in The Lancet Diabetes & Endocrinology, revealed a troubling correlation between the consumption of certain emulsifiers and an increased risk of developing type 2 diabetes.2

The study found that:

Carrageenans were associated with a 3% increased risk per increment of 100 mg per day.
Tripotassium phosphate was associated with a 15% increased risk per increment of 500 mg per day.
Mono- and Diacetyltartaric Acid Esters of Mono- and Diglycerides of Fatty Acids were associated with a 4% increased risk per increment of 100 mg per day.
Sodium citrate was associated with a 4% increased risk per increment of 500 mg per day.
Guar gum was associated with an 11% increased risk per increment of 500 mg per day.
Gum Arabic was associated with a 3% increased risk per increment of 1000 mg per day.
Xanthan gum was associated with an 8% increased risk per increment of 500 mg per day.

The devil is in the details.

Those risks may seem small, until we consider that a thousand milligrams is only 0.0353 ounce. In other words, 1 ounce is equal to 28,349.523 milligrams. So these research findings are actually very significant. Doing the math, for example, shows that xanthan gum is associated with a 454% increased risk of developing type 2 diabetes. Overall, these findings suggest that there's a very good chance that habitual consumption of foods containing these emulsifiers may contribute to the development of type 2 diabetes over time.

In light of these findings, there's a growing need to re-evaluate current regulations governing the use of emulsifiers by the food industry. Regulatory agencies should prioritize consumer protection by reassessing the safety and long-term health effects of these additives. And as MC patients, especially, we should be particularly vigilant about ingesting emulsifiers, as they are commonly used in many of the commercially processed foods that many of us include in our diet. All of the commercially available milk substitutes, for example, contain emulsifiers.

Homemade is always safer.

That doesn't mean that we can't usage these products. It simply means that if we choose to use them, we should be aware of the risks involved. Those of us who make our own milk substitutes always have to shake up our homemade products, in order to remix the ingredients each time we use them, but at least they don't contain any emulsifiers.

References

1. Bancil, A. S., Sandall, A. M., Rossi, M., Chassaing, B., Lindsay, J. O., and Whelan, K. (2021). Food Additive Emulsifiers and Their Impact on Gut Microbiome, Permeability, and Inflammation: Mechanistic Insights in Inflammatory Bowel Disease. Journal of Crohns & Colitis, 15(6), pp 1068–1079. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33336247/

2. Salame, C., Javaux, G., Sellem, L., Viennois, E., de Edelenyi, F. S., Agaësse, C., . . . Touvier, M. (2024). Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study. The Lancet, Diabetes & Endocrinology, 12(5), pp 339–349. Retrieved from https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00086-X/fulltext

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"We'll Stamp out Cancer during Our Lifetimes"

11/10/2024

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by wayne persky

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Remember that old campaign slogan? Many of us are surely old enough to remember when it was widely publicized, and some of us are old enough to remember when the U.S. government launched an ambitious campaign based on that slogan in the mid-20th century

The campaign aimed to galvanize public support and funding for cancer research, leading to significant advancements in understanding and treating the disease. Yet, despite remarkable progress in treating certain types of cancer, a recent report from the American Cancer Society (ACS) indicates that the global fight against cancer is far from over, with cancer cases expected to rise significantly in the coming decades.

The campaign marked a pivotal moment in the history of cancer research.

It inspired increased investment in cancer research, leading to breakthroughs in early detection, treatment, and prevention. Key milestones over the past few decades include the development of targeted therapies, immunotherapies, and significant improvements in screening methods for various cancers.

Early detection methods, such as mammograms for breast cancer and colonoscopies for colorectal cancer, have dramatically improved survival rates. Moreover, public health initiatives to reduce smoking have led to declines in lung cancer rates in many countries. Vaccinations, such as the HPV vaccine, have shown promise in preventing cancers linked to viral infections.

That campaign was launched in 1971.

The National Cancer Act was signed by President Richard Nixon on December 23, 1971. The campaign was also referred to as the War on Cancer. The legislation was designed to strengthen the National Cancer Institute and significantly increase funding for cancer research with the goal of making substantial progress in the fight against cancer.

The Cancer Moonshot Initiative

45 years later, during President Barack Obama's January 12, 2016 State of the Union address, then Vice President Joe Biden announced the Cancer Moonshot Initiative. The initiative was initially funded through the 21st Century Cures Act, with the goal of accelerating cancer research in order to make significant progress in cancer prevention, diagnosis, and treatment within a decade. That decade is almost over.

Over the last half-century, the investment in cancer research has been huge.

The National Cancer Institute (NCI) has had significant annual budgets. For instance, in fiscal year 2022 alone, the NCI budget was approximately $6.8 billion. Over the past 50 years, the cumulative funding from the NCI alone is estimated to be over $100 billion.

Besides the NCI, other sources of federal funding include the Department of Defense, National Institutes of Health (NIH), and other government agencies which also contribute significantly to cancer research.

Private Sector and Non-Profit Organizations such as the American Cancer Society, various foundations, and pharmaceutical companies also invest heavily in cancer research. The American Cancer Society alone has invested over $5 billion since its inception.

When combining federal funding, private sector investments, and contributions from non-profits, it's estimated that the U.S. has invested well over $200 billion in cancer research over the past half-century.

So are we at least close to stamping out cancer?

Despite all the political hullabaloo and hundreds of billions of dollars spent on cancer research, The global burden of cancer is continuing to grow, and there is currently no cure for any type of cancer. Researchers predict more than 35 million new cancer cases by 2050, marking a 77% increase from 2022 (Thompson, 2024, April 4).1

Despite relatively modest advancements (in comparison with the huge investments), the American Cancer Society's "Global Cancer Statistics 2024" report paints a concerning picture of the future (American Cancer Society, 2024, April 4).2 In 2022 alone, approximately 20 million new cancer cases were diagnosed worldwide, and 9.7 million people died from cancer. As mentioned above, by 2050, the number of annual cancer cases is projected to reach 35 million.

This anticipated increase is claimed to be primarily due to the aging global population.

"This rise in projected cancer cases by 2050 is solely due to the aging and growth of the population, assuming current incidence rates remain unchanged," explained Hyuna Sung, a senior principal scientist for cancer surveillance at the ACS. Obviously, this implies that they aren't expecting any additional improvements in the prevention of cancer by 2050. The report also blames unhealthy lifestyle choices, such as poor diet, physical inactivity, heavy alcohol consumption, and smoking, as reasons why cancer cases are expected to continue to increase.

Basically unchanged from half a century ago,

lung cancer remains the most commonly diagnosed cancer globally and the leading cause of cancer deaths. It accounts for one in every eight cancer diagnoses and one in five cancer deaths. In men, prostate and colon cancers follow lung cancer in prevalence, while breast cancer is the most common cancer in women, followed by lung, colon, and cervical cancers.

The report underscores the critical importance of prevention.

"With more than half of cancer deaths worldwide being potentially preventable, prevention offers the most cost-effective and sustainable strategy for cancer control," said Dr. Ahmedin Jemal, senior vice president of surveillance and health equity science at the ACS. But after spending over $200 billion over the past half-century, we would much rather hear about substantial progress, rather than to hear a recommendation that we should try to avoid getting cancer because that's a lot cheaper and more effective than trying to treat cancer after it develops. We already knew that.

By emphasizing prevention, that serves to highlight the fact that gains in the treatment of cancer have been relatively modest. And any treatments that have been developed typically require increasingly expensive drugs that only the wealthy can afford. And while many of these drugs seem to be able to prolong life by months or even years, in some cases, the eventual outcome is still typically mortality.

The report notes that eliminating tobacco use alone could prevent one in four cancer deaths, or approximately 2.6 million deaths annually. But that advice appears to be similar to flogging a dead horse, in view of the drastic reductions in tobacco use over the past three or four decades because of government-sponsored anti-tobacco campaigns.

Vaccination programs also play a vital role in cancer prevention.

For instance, only 15% of eligible girls worldwide have received the HPV vaccine, even though nearly all cervical cancers are caused by HPV. Why hasn't this program been more effective, after so much money has been invested in it? Improving vaccination rates could drastically reduce the incidence of cervical cancer, which remains a leading cause of cancer death in women in many low-income countries.

And although this wasn't mentioned in the ACS report, despite the fact that males can't develop cervical cancer, boys should also be vaccinated. As pointed out in an online weblog on a Nationwide Children's Hospital website, 40% of cases of HPV related cancer are in males (DaJusta. and Fuchs, 2023, January 06).3 Obviously they should also be vaccinated in order to prevent the spread of these diseases.

Many people cannot afford timely cancer diagnoses and treatment.

The report highlights significant disparities in cancer outcomes between high-income and low-income countries. Inadequate early detection and treatment services contribute to higher cancer death rates in low-income countries despite having lower overall cancer incidence rates. For example, Ethiopia's breast cancer mortality rate is twice that of the United States, despite a 60% lower incidence rate.

Low income is not a crime.

"Understanding the global cancer burden is critical to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer," said Karen Knudsen, CEO of the ACS. But placing the blame for ineffective cancer management practices on financial disparities among countries of the world is a relatively poor excuse for the overall poor performance of cancer management. Instead of blaming poor cancer management on low income, perhaps the way the entire program is administered needs to be redesigned and drug pricing needs to be policed so that the detection and management of cancer is not unaffordable for so many people.

Why are cancer treatment drugs so expensive?

In 2023, research data were published regarding a cross-sectional study of 224 cancer drug approvals in the U.S. across 119 individual drugs that were approved between the dates of January 1, 2015 and December 31, 2020 (Miljković, Tuia, Olivier, Haslam, and Prasad, 2023).4 The study determined that the median annual cost of a treatment with any of those drugs was $196,000, and there was no significant difference in the cost of drugs, regardless of whether they were the first in class, next in class, or subsequent approvals of an already approved drug.

A degree in medicine is certainly not required by anyone to realize that once a drug treatment is developed, the cost of developing similar drugs that mimic the behavior of the original drug is virtually always much less expensive. The original research article, published in JAMA Network Open, concluded that:

The results of this study suggest that drug pricing cannot be explained by innovations alone; further study is warranted.

Cancer remains the biggest health concern for most people.

The University of Cambridge analyzed a poll conducted by Public First of 2000 United Kingdom (UK) adults (University of Cambridge, 2024, July 14).5 Their analysis of the poll results showed that:

Two-thirds of respondents expressed significant worry about being diagnosed with cancer, more than for any other health condition. The primary concern (70%) is that cancer would be diagnosed too late for effective treatment. Over half of the respondents (52%) worried about the effect of a cancer diagnosis on their loved ones.
55% of respondents prioritized advancements in early cancer detection and treatment over other transformative developments like eradicating diseases or eliminating poverty.
Aside from late detection, 41% were concerned about accessing the right treatment, and 36% worried about treatment side effects. 61% said they would be less afraid of a cancer diagnosis if they knew the cancer was treatable. Over half (51%) mentioned that improved early detection capabilities would alleviate their fears.
43% believe university research will significantly reduce cancer deaths, though 64% think reducing NHS waiting times would have the biggest impact.
The public largely supports the use of AI in cancer research and treatment, with 55% endorsing its use in speeding up research, 47% for aiding diagnosis, and 41% for assisting in treatment decisions. Researchers are developing AI tools to predict patient responses to treatments, expedite diagnosis, personalize therapy, and reduce costs.
The fear of a cancer diagnosis is second only to the death of a close relative, ranking higher than fears of nuclear war, terrorism, and crime. Younger individuals (18-34 years) are more likely to be very worried about cancer compared to older adults (over 65 years).

The University of Cambridge, in collaboration with Cambridge University Hospitals NHS Foundation Trust, is building a revolutionary cancer research hospital. This facility aims to integrate world-leading scientists and clinicians to advance early cancer detection and personalized treatment.

According to the National Health Service (NHS) of the UK,

“1 in 2 people will develop some form of cancer during their lifetime NHS” (NHS, 2022, October 13).6

In conclusion

The U.S. campaign "We'll Stamp Out Cancer in Our Lifetimes," initiated with the National Cancer Act signed by President Richard Nixon in 1971, aimed to significantly advance cancer research and treatment. Over the past five decades, substantial progress has been made in a few areas, including breakthroughs in early detection, treatment innovations, and public health initiatives.

Despite these advancements, and the investment of hundreds of billions of dollars in research, the global cancer burden remains substantial, with the American Cancer Society predicting a significant increase in cancer cases by 2050. Cancer research obviously continues to be a huge money pit, and despite all the appeals and excuses, we obviously are no closer to stamping out cancer within our lifetimes than we were half a century ago.

References

1. Thompson, D. (2024, April 4). Cancer cases will keep rising worldwide: Report. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-04-cancer-cases-worldwide.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

2. American Cancer Society. (2024, April 4). American Cancer Society Releases Latest Global Cancer Statistics; Cancer Cases Expected to Rise to 35 Million Worldwide by 2050. American Cancer Society, Retrieved from https://pressroom.cancer.org/GlobalCancerStatistics2024

3. DaJusta, D. and Fuchs, M. (2023, January 06). HPV Vaccine for Boys: Cancer Protection for the Future. Nationwide Children’s Hospital, [Web log]. Retrieved from https://www.nationwidechildrens.org/family-resources-education/700childrens/2023/01/hpv-vaccine-for-boys

4. Miljković, M. D., Tuia, J., Olivier, T., Haslam, A., and Prasad, V. (2023). Cancer Drug Price and Novelty in Mechanism of Action. JAMA Network Open, 6(12), e2347006. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812734#:~:text=Results%20There%20were%20224%20cancer,%24170%20000-%24277%20000).

5. University of Cambridge. (2024, July 14). Cancer is the biggest health concern among the public, poll reveals. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-07-cancer-biggest-health-poll-reveals.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

6. NHS. (2022, October 13). Overview - Cancer. NHS, Retrieved from https://www.nhs.uk/conditions/cancer/

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Monitor Your Kidney Function — Here's Why That's Important

11/4/2024

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by wayne persky

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A recent article published in JAMA, describing research conducted at Brigham and Women's Hospital discusses the association between cardiovascular health and kidney function (Ostrominski, et al., 2024).1 Focusing on heart failure, particularly, the article discussed how the function of the two organs are linked by shared risk factors, hemodynamic effects, and complex biochemical interactions. Statistically, compromised function of both organs frequently coexists, and when it does, the functional issues of one organ tends to negatively affect the function of the other in a self-perpetuating, mutually compromising cycle in which the deteriorating condition of one tends to exacerbate the dysfunction of the other.

This condition is frequently seen in older adults who are hospitalized because of heart failure, and it's referred to as a cardiorenal syndrome. The study found that a significant portion of these patients developed acute kidney injury, or progressed to end-stage kidney disease (requiring dialysis) within a year of their hospitalization. The cycle appears to be driven by the following issues:

Hemodynamic changes associated with heart failure lead to reduced cardiac output, and this results in reduced blood circulation within the kidneys. This reduced perfusion tends to cause ischemic injury and reduced filtration capabilities needed to acute kidney injury and chronic kidney disease.
Neurohormonal activation associated with heart failure triggers the activation of the renin angiotensin aldosterone system, and the sympathetic nervous system. While these processes initially help to maintain blood pressure and cardiac output, their chronic activation needs to vasoconstriction, sodium retention, and deteriorating heart and kidney function.
Inflammatory pathways resulting from the promotion of pro-inflammatory cytokines are a result of both heart failure and kidney disease. These cytokines contribute to the fibrosis and dysfunction of tissues in both the heart and the kidneys.
Metabolic dysregulation is often seen in patients with chronic kidney disease. Imbalances in calcium, phosphate, and vitamin D metabolism often lead to increased vascular stiffness and calcification, classic symptoms of cardiovascular disease and heart failure.

And and not surprisingly, the researchers suggested that certain steps should be taken to minimize the risks associated with this syndrome. They recommended that:

Integrated care should be used to simultaneously address both heart and kidney health including the establishment of clinics that specialize in the combined management of the two conditions.
Early detection and monitoring of kidney function in heart failure patients should be emphasized, including the measurement of estimated glomerular filtration rate (eGFR), and checking for albumin in the urine.
Therapeutic interventions should be made if deemed to be beneficial after weighing the potential side effects and contraindications.
Policy and reimbursement changes should be made to allow broader healthcare policy changes such as expanding Medicare reimbursement for interdisciplinary chronic care management in order to support better outcomes for patients with both heart and kidney disease.

But which came first — the chicken or the egg?

This was a one-sided study, that assumed that heart failure causes kidney disease. Based on the interdependencies of these two health issues, the reverse might possibly be true — chronic kidney disease might well be a primary cause of heart failure.

A study published in Kidney Medicine, explores this relationship in depth, focusing on patients with incident chronic kidney disease (CKD) within a large integrated health care system (Yu, et al., 2023).2 The findings illustrate why compromised kidney function may lead to heart failure and other cardiovascular issues.

Yu et al. conducted a retrospective cohort study involving 76,688 patients with incident CKD. They found that 18.6% of these patients had prevalent heart failure. Among those with heart failure, 59.2% had heart failure with preserved ejection fraction (HFpEF), and 23.3% had heart failure with reduced ejection fraction (HFrEF).

When the researchers looked at all cause mortality,

The hazard ratio (HR) for 1-year all-cause mortality was significantly higher for CKD patients with heart failure (HR, 1.70) compared to those without heart failure. Specifically, the HRs were 1.59 for HFpEF and 2.43 for HfrEF.

When the researchers looked at cardiovascular -related mortality,

The risk was even more pronounced for cardiovascular-related mortality. CKD patients with heart failure had an HR of 6.69 for cardiovascular-related death. For those with HFrEF, this risk was substantially higher (HR, 11.47).

These statistics highlight the severe impact of heart failure on CKD patients, particularly those with reduced ejection fraction, underscoring the need for integrated management strategies.

The findings showed these mechanisms linking CKD to heart failure:

Volume Overload — CKD often leads to fluid retention due to impaired renal excretion, increasing the volume load on the heart and leading to heart failure.
Uremic Toxins — Accumulation of uremic toxins in CKD can cause direct myocardial injury and contribute to cardiac dysfunction.
Hypertension — CKD frequently results in uncontrolled hypertension, a significant risk factor for the development and progression of HF.
Anemia — Reduced erythropoietin production in CKD leads to anemia, which increases cardiac workload and exacerbates HF.
Mineral Bone Disorder — Disturbances in calcium and phosphate metabolism inCKD can lead to vascular calcification, increasing cardiovascular morbidity and mortality.

A recent news article described a real-world example of this connection.

Lisa Pisano became the second person in the world to receive a kidney transplant from a genetically modified pig on April 12, 2024, and this was after she had received an artificial heart pump on April 4. Unfortunately, her doctors decided to remove the genetically engineered pig kidney 47 days after it had been transplanted, and placed her back on dialysis.

The removal wasn't done because her body was rejecting the pig kidney — it was done because the artificial heart pump was unable to supply enough blood in order to keep the pig kidney functioning properly, and the kidney was beginning to lose functional capacity, because of the tissue damage done by the limited blood flow.

Lisa's case clearly illustrates the complexity of treating patients who suffer from both heart failure and end-stage kidney disease, and mirrors the JAMA article's discussion of the interconnectedness of heart and kidney health, often referred to as cardiorenal syndrome. The JAMA article points out that reduced cardiac output in heart failure patients can lead to reduced blood circulation in the kidneys, thereby increasing kidney damage, and intensifying kidney dysfunction, in a self-perpetuating cycle of escalating damage.

And A recent Medical Xpress article

discusses the significant impact of CKD and the challenges associated with its early detection (Hanbury, 2024, July 10).3 Amber Paulus, Ph.D., R.N., an affiliate researcher with Virginia Commonwealth University's School of Nursing, emphasizes that CKD is a major health issue affecting nearly 37 million people in the United States, with 90% of those affected being unaware of their condition. Paulus identifies high blood pressure, diabetes, and obesity as primary risk factors, alongside smoking, heart disease, age, family history, and personal history of acute kidney injury. But similar to almost everyone else in the medical healthcare field, she completely overlooks the risk of compromised kidney function due to magnesium deficiency.

As the article points out, CKD often progresses silently without symptoms until it is advanced, making early detection difficult. Paulus advocates for community-based screenings, especially in high-risk areas like Richmond's East End, to improve awareness and early diagnosis. These screenings involve simple blood and urine tests to measure kidney function and detect damage.

The article highlights barriers to early detection, including lack of awareness, financial hardships, limited healthcare access, and systemic issues like inadequate laboratory supplies and poor medical record-keeping. Early detection and intervention, including lifestyle changes and medications, are crucial for managing CKD and preventing its progression.

Although this is not noted in the article,

if CKD is this widespread, some of the blame has to be placed on clinicians who either fail to properly test for kidney function, or don't properly follow-up on test results that indicate compromised kidney function.

So how important is all this to us in our own lives?

The importance of this is surely defined by our own personal health status as indicated by our test results (and probably by parameters that are not normally tested by our doctors). In retrospect, I can certainly relate, because the findings of studies such as these might have been very useful to me about eight or nine years ago, when my own test results suddenly began showing significant signs of compromised kidney function, and my doctor failed to address them. The association between kidney function and cardiovascular issues wasn't even on my doctors' radar, although there were earlier studies that showed an association.

My case was more complex than this.

In my own case, my situation was so complex that it's not surprising that my doctors overlooked the connection. About a year or so before my symptoms began to show up, I developed a magnesium deficiency because of inadequate supplemental dosing, and the deficiency became critical after three back-to-back antibiotic treatments for a series of dental procedures. I would wake up in the wee hours of the morning sweating like a pig (in the cold of winter), with tachycardia, and shallow, rapid breathing. And one morning, when I decided to check my blood pressure, my systolic pressure was very low, at 85 mmHg, suggesting the symptoms of shock. Yet, after I ate breakfast, my blood pressure tended to become elevated during the day, with the systolic pressure often increasing by about 80 to100 mg of mercury. As severe as my symptoms were, none of my doctors ever seemed to have a clue about what might be wrong.

When I would describe my symptoms to doctors, they would respond with a blank stare as if I were speaking in a foreign language. And I had a very unique symptom that makes severe magnesium deficiency obvious. My perspiration had a very powerful, unique, and noxious odor that would probably gag a buzzard a quarter-mile away. I've never smelled a similar odor before or since, but if I ever smelled it again, I would immediately recognize it as a symptom of a chronic magnesium deficiency, because it was so unique.

Unfortunately, doctors are totally aware of this unique (easy to identify) symptom because there is no well-established evidence that a chronic magnesium deficiency specifically causes a distinctive odor associated with perspiration. Magnesium deficiency can lead to various symptoms, including muscle cramps, fatigue, and irritability, but a characteristic odor is not commonly recognized as one of these symptoms.

Why is that true?

It's true because no medical research has never been undertaken to verify, dispute, or otherwise investigate an association of a unique odor with a chronic magnesium deficiency. I'm sure I had that odor as I was asking my doctors about my symptoms, because it was a very strong, persistent order that taking a shower didn't remove for long, but none of them ever recognized it. Instead, they almost surely assumed that I just needed a shower.

Looking back now, it's obvious that after I ate breakfast, my magnesium level increased slightly, so the deficiency wasn't nearly as severe. The deficiency only became severe during the wee hours of the morning as my body ran out of magnesium. And I had hypertension during the day, because chronic magnesium deficiency causes hypertension.

Doctors never detect magnesium deficiency.

When my PCP ordered a series of tests to try to locate the problem, they showed that my kidney function was quite low (an eGFR value in the mid-30s), but my doctor chose to ignore that, and focused instead on my TSH value (which was below the normal level), and cut my thyroid treatment in half. In retrospect, the thyroid test results were probably skewed because of my magnesium deficiency.

Emergency department doctors make the same mistake.

One morning my symptoms were so bad that I couldn't force myself to eat breakfast, so I went to the emergency department. Although the doctors there officially ruled my test results as "fine", and sent me home, a day or so later, when I looked at the online test results, I immediately spotted the problem. My magnesium level was flagged by the lab at significantly below the normal level. Tripling my magnesium dose resolved my early morning symptoms in one day, including the unique perspiration order, which totally disappeared.

At any rate, te damage done by the combination of the magnesium deficiency, and the inadequate thyroid treatment led up to an arrhythmia one day, and although that faded away on its own, later in the day, three weeks later, I had a stroke.

About a year and a half later, another arrhythmia caused me to wake up and smell the coffee. It dawned on me that unless I found the problem, and resolved it, I was probably about to have another stroke. So I did some serious online research and discovered that undertreated hypothyroidism can lead to compromised kidney function, and compromised kidney function can cause cardiac issues. When I pointed this research out to my doctor, he immediately restored my thyroid treatment to its original dose, and I haven't had any health problems since. Prior to this, every time some little health issue, or unusual symptom came up, my eGFR would plummet. Now (at least for the past six years), my eGFR stays consistently in the normal range, and I have no cardiac issues.

So the moral of this story is:

We can't rely on our doctors to diagnose, or even suspect, complex health issues that involve multiple organs. They're trained in med school to diagnose health problems by looking at test results based on the functioning of individual organs. Complex issues that involve multiple organs are almost never on their radar. It's painfully obvious that if we want to safeguard our own health, it's up to us to learn how to analyze our medical test results, and when anything looks suspicious, we have to do the research ourselves, because far too often, if we ask our doctor about suspicious test results, they'll simply shrug them off as nothing to worry about, or return a blank stare, because they don't have a clue. And spotting out of range test results is easy, because the lab even flags them to make them easier to notice.

If this research had existed a decade ago, and I or my doctors had been aware of it, could I have been able to avoid going through a stroke, and then having to recover from it? Probably not, because there were too many complicating factors. But that doesn't mean that this information can't be useful for anyone else who happens to find themselves in a similar situation. Always ask questions about suspicious test results.

References

1. Ostrominski, J. W., Greene, S. J., Patel, R. B., Solomon, N. C., Chiswell, K., DeVore, A. D., . . . Vaduganathan, M. (2024). Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure. JAMA Cardiology, Retrieved from https://jamanetwork.com/journals/jamacardiology/article-abstract/2819215

2. Yu, A. S., Pak, K. J., Zhou, H., Shaw, S. F., Shi, J., Broder, B. I., and Sim, J. J. (2023).All-Cause and Cardiovascular-Related Mortality in CKD Patients With and Without Heart Failure: A Population-Based Cohort Study in Kaiser Permanente Southern California. Kidney Medicine, 5(5), 100624. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10151415/

3. Hanbury, C. (2024, July 10). Researcher details risk factors for chronic kidney disease and barriers for early detection. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-07-factors-chronic-kidney-disease-barriers.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

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The Latest Vitamin D Recommendations

10/22/2024

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by wayne Persky

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And why those recommendations may be wrong for most people

The Endocrine Society recently revised their vitamin D guidelines for supplementation and screening, and the revisions sparked an uproar among clinicians (Endocrine Society, 2024, June 03).1

The new guidelines make a number of recommendations:

For Healthy Adults Under 75 — The guidelines recommend no vitamin D supplementation above the recommended dietary intakes unless there are specific health conditions that justify it.
Populations That May Benefit from Higher Doses — These include children and adolescents to prevent rickets and respiratory infections, individuals over 75 to potentially lower mortality risk, pregnant individuals to reduce various risks, and people with prediabetes to potentially slow disease progression.
No Routine Vitamin D Testing — The guideline advises against routine testing for 25-hydroxyvitamin D levels, citing insufficient evidence to link these levels with specific health outcomes, even in populations with darker skin or obesity.
No Specific Blood-Level Thresholds — The panel could not determine specific thresholds for 25-hydroxyvitamin D levels for disease prevention due to insufficient evidence.

These guidelines appear to leave a lot to be desired.

Except for people over 75, pregnancy, and prediabetes (which is not a disease), the endocrine society's guidelines are claimed to be sufficient to prevent rickets, but they have no recommendations to try to prevent or treat any of the other diseases associated with vitamin D deficiency. And the reason for this dilemma is the fact that they continues to be flummoxed by conflicting data regarding vitamin D and disease. In other words, since they don't know what to recommend for various test result levels, they simply recommend against testing.

Let's consider their recommendation for people over 75.

The Endocrine Society recommends that individuals over 75 years old should take 800 IU (20 MCG) of vitamin D daily through food or supplements to maintain adequate levels. This is claimed to be adequate for maintaining a blood level equal to or greater than 20 ng/mL, and this is said to be "Generally considered adequate for bone and overall health in healthy individuals". Is it? Probably, for a few individuals. But probably not for most people.

How many people are truly healthy these days?

Looking at research statistics, few people (less than 3% in the U.S., for example), can actually be considered to be "healthy individuals" these days. A comprehensive study from York University, published in PLOS One, reveals that nearly everyone has some health risk factors, and the relationship between these risk factors and mortality changes over time (York University, 2023, July 8; Yu, Pooni, Ardern, and Kuk, 2023).2,3

Patients suffer, and researchers fiddle, while this paradox goes on and on.

While it may be an oversimplification to say that "virtually every known disease" is associated with vitamin D deficiency, there is a substantial body of research indicating that low levels of vitamin D are linked to a variety of health issues, including bone disorders, autoimmune diseases, cardiovascular diseases, diabetes, infections, mental health conditions, and many others. Medical authorities are quick to point out that it's important to note that correlation (association) does not imply causation.

But here's why that argument is irrelevant:

Even if a disease causes vitamin D deficiency, rather than being caused by vitamin D deficiency, the resulting vitamin D deficiency prevents proper healing, and as a consequence, perpetuates the inflammation, thereby perpetuating the disease. Therefore, their argument is irrelevant as far as long-term health of the general public is concerned, and a huge segment of the population (possibly as many as 97%) might benefit from taking (additional) vitamin D supplements in order to either prevent the development of disease, or enhance healing in cases where disease is already present.

To support this point, criticism and concerns regarding the guidelines are widespread among clinicians.

Perceived Neglect of Broader Health Implications — Many commenters argued that the guidelines focus too narrowly on endocrinology and bone health, ignoring the broader implications of vitamin D deficiency on autoimmune disorders, chronic pain, immunosuppression, cancer prevention, and cardiovascular health.
Impact on Special Populations — Concerns were raised about the guidelines’ lack of consideration for populations with limited sun exposure (e.g., those with certain religious dress codes, night workers) and individuals with conditions affecting intestinal absorption, like Crohn's disease, celiac disease, and cystic fibrosis.
Oral Health Considerations — One commenter pointed out the potential role of vitamin D in maintaining oral health, particularly in balancing calcium and phosphate levels in saliva, which affect periodontal disease and dental caries.

Many healthcare professionals object to the No Screening recommendation.

Lack of Guidance Post-Screening — The guideline's recommendation against screening due to the uncertainty of how to proceed with treatment after detecting low vitamin D levels was met with strong opposition. Commenters argued that avoiding screening because of uncertainty is misguided and could lead to missed opportunities for preventive care.
Perceived Incompetence and Neglect — Several healthcare professionals criticized the recommendation as a failure to address patient needs and expressed skepticism about the motives behind it, implying that financial considerations from the pharmaceutical industry or insurance companies might have influenced the guidelines.

Many clinicians raised concerns about ignoring preventive care.

Impact on Preventive Health — Some commenters felt that the guideline could undermine preventive healthcare by discouraging testing and supplementation, leading to a reactive rather than proactive approach to managing health risks.
Long-Term Implications for Vulnerable Populations — There were specific concerns about the effects of vitamin D deficiency in pregnant women and the potential long-term health consequences for their offspring.

These guidelines discourage professional discretion.

While the new guidelines don't disallow professional discretion, they certainly appear to discourage discretion. If clinicians order a vitamin D test outside of the allowed selections, then insurance is not likely to cover the cost of the test, nor is Medicare. Making a test more expensive for patients is definitely a disincentive for testing.

The bottom line appears to be:

Vitamin D testing (and vitamin D supplementation) in the future will be discouraged except for certain specific groups. And most importantly, these new guidelines have now been incorporated into the electronic health records (EHR) system. And this likely infuriates many clinicians because it means that in order to get reimbursement from Medicare or insurance for a vitamin D test for any patient, a specific listed reason for ordering the test must be selected, and the listings are limited to the new guidelines. In other words, disease prevention will be discouraged, because patients must have certain symptoms before the electronic health record system will allow reimbursement for a test. The net result will be a combination of declining health due to fewer vitamin D tests, and an increase in the cost of healthcare for many patients.

Vitamin D is especially important for those over 75.

Not only is vitamin D important for calcium absorption, and bone health, but along with magnesium, it's critical for proper immune system function. As we get older, the importance of bone health and immune system function increase dramatically. Bones tend to become fragile with age, and hip fractures often lead to complications that are difficult to overcome, especially with poor healing because of compromised immune system functioning.

We no longer produce enough vitamin D.

Older adults are less able to produce sufficient vitamin D due to decreased skin efficiency in synthesizing the vitamin from sunlight. This, combined with a tendency to spend more time indoors and wear more clothing, significantly reduces natural vitamin D production. Additionally, aging affects the liver and kidneys, organs that are essential for converting vitamin D into its active form, and that tends to increase the likelihood of a more severe deficiency. Consequently, vitamin D deficiency is common in older adults, and in high-latitude countries like the UK, almost half of the population over 75 does not reach sufficient vitamin D levels. Anyone over 75, who has a vitamin D deficiency, almost surely needs more supplemental vitamin D than 800 IU per day.

And what about MC patients?

The 800 IU daily dose of supplemental vitamin D that the endocrine society recommends for people over 75 is a rather unrealistic amount for IBD patients, including microscopic colitis (MC) patients. MC patients (and other IBD patients), typically have unique vitamin D needs due to factors such as impaired absorption and increased inflammation. And that statement is probably true for anyone who has any type of autoimmune disease. While IBD patients who have their symptoms well under control might be able to get by with 1000 to 2000 IU of supplemental vitamin D per day, those who are living with active disease probably need higher doses, such as 4000 or 5000 IU (or more) per day, especially if they are having serious malabsorption problems

And MC (and other IBD) patients, should monitor their blood levels of 25-hydroxyvitamin D to make sure they are absorbing and maintaining adequate levels. Blood tests can help determine if higher doses are needed, especially in patients with persistent deficiency despite supplementation. Optimal blood levels of vitamin D for IBD patients are generally considered to be at least 30–50 ng/mL (75-125 nmol/L). Adequate vitamin D levels helps reduce disease activity and improves overall outcomes. Research suggests that vitamin D has anti-inflammatory effects, which can be particularly beneficial for managing flare-ups and maintaining remission in IBD patients, and that finding almost surely applies to MC patients, as well as most other autoimmune diseases, also.

What are the Microscopic Colitis Foundation's vitamin D recommendations?

Because some MC patients are vitamin D deficient when they initially develop the disease, and because MC depletes vitamin D, the Foundation has always recommended that MC patients should take a vitamin D supplement, especially when they are trying to initially put the disease into remission.

Although it's theoretically possible that a newly diagnosed MC patient might have a high vitamin D level, in practice, that possibility appears to be very unlikely. But because vitamin D supplementation is a multifaceted issue, and vitamin D regulates calcium absorption, we recommend reviewing the information in the newsletter at the following link before choosing to begin taking a vitamin D supplement.

https://www.microscopiccolitisfoundation.org/uploads/5/8/3/2/58327395/2956298.pdf

References

1. Endocrine Society. (2024, June 03). Vitamin D for the Prevention of Disease Guideline Resources. The Endocrine Society, Retrieved from, Retrieved from https://www.endocrine.org/clinical-practice-guidelines/vitamin-d-for-prevention-of-disease

2. York University. (2923, July 8). Surprising Health and Mortality Study: Is Anyone Truly Healthy? SciTechDaily, Retrieved from https://scitechdaily.com/surprising-health-and-mortality-study-is-anyone-truly-healthy/

3. Yu, W. W., Pooni, R., Ardern, C. I., and Kuk, J. (2023). Is anyone truly healthy? Trends in health risk factors prevalence and changes in their associations with all-cause mortality. PLOS ONE, Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0286691

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Do Specialists Listen to Patients?

10/16/2024

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by wayne persky

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As microscopic colitis (MC) patients, many of us would insist that the gastroenterologists with which we've had appointments devoted precious little attention to many of the symptoms we described. We get the impression that most gastroenterologists still prefer to think of MC as a nuisance disease — just a little diarrhea. And despite all our descriptions of the abdominal pains, joint pains, brain fog, fatigue, and various other symptoms that make life so unpleasant during the day, and prevent us from sleeping at night, if our gastroenterologist acknowledges any of those symptoms at all, he or she typically does so while recommending that we see a good psychiatrist. The disconnect sometimes seems so bad, that we may be surprised that we actually received a correct diagnosis.

Are specialists really experts, as their state's certification attests?

Do the state certified medical "experts" in other specialties follow the same modus operandi? We can only speculate, because to date, published research is scarce . However, an article was recently published regarding specialists who diagnose Neuropsychiatric Systemic Lupus Erythematosus (NYPSLE). NYPSLE is poorly understood, and difficult to diagnose (does that ring a bell), and it's diagnosed and treated by neurologists and rheumatologists. In this particular study, published in the journal Rheumatology, researchers analyzed how clinicians prioritize the evidence on which they base a diagnosis, from a 13 item list (Sloan, et al., 2023).1

Actual diagnostic criteria varied widely among clinicians.

The study showed that clinicians assessments of SLE patients symptoms varied widely, with a high level of uncertainty. 46% of patients reported that they were either rarely, or never asked if their SLE was flaring, and 24% of them reported that their own assessment of their disease status was rarely, or never in agreement with their clinicians.

In a recent online Medical Xpress article, the researchers discussed how fewer than 4% of the clinicians in the study ranked their patients' opinions in the top three (out of 13) evidence categories. Even though the clinicians were aware that neuropsychiatric symptoms are typically associated with a low quality of life, and can lead to premature death, and such symptoms are more likely to be misdiagnosed, they still ranked their own opinions highest, acknowledging that they tend to have a low level of confidence in diagnoses that involve invisible symptoms, such as headache, hallucinations, and depression. Obviously, it could certainly be argued that this is clearly a biased attitude.

Does certification as an expert exempt a clinician from good manners?

One patient in the study pointed out how "degrading and dehumanizing" the experience can be when a clinician ignores a patient's symptom description. In that patient's own words,=

If I had continued to have regard for clinicians' expertise over mine, I would be dead. When I enter a medical appointment and my body is being treated as if I don't have any authority over it and what I'm feeling isn't valid then that is a very unsafe environment. I'll tell them my symptoms and they'll tell me that symptom is wrong, or I can't feel pain there, or in that way.

Many of us can identify with that patient.

Somatization and bias are the source of the problem.

Somatization involves the conversion of a mental state (such as depression or anxiety) into physical symptoms. Despite the fact that psychiatrists (and sometimes other practitioners) seem to diagnose patients with issues such as depression, anxiety, and other neurological issues at the drop of a hat, descriptions of the symptoms of such neurological issues by IBD (or other autoimmune patients) to a gastroenterologist, or some other specialist treating a different autoimmune disease, often fall on deaf ears. This suggests that in the eyes of most specialists, it's okay to have depression or anxiety is a separate issue, but it's not okay for patients to have such issues in association with an IBD or some other autoimmune disease.

Gastroenterologists have traditionally only dealt with physical symptoms.

So it's not surprising that they (similar to most specialists) would resent the implication that many, or most autoimmune diseases also cause clinical symptoms that are not included in the official medical descriptions of the diseases that they normally treat. For example, gastroenterologists resist recognizing neurological symptoms, that the patient claims to have, primarily because gastroenterologists cannot verify the symptoms with their normal diagnostic testing methods. Most specialists would prefer to deal with disease symptoms that are "well behaved", and are entirely within their area of specialization, simply because it makes their job much easier.

And the reluctance (or refusal) of specialists such as gastroenterologists, for example, to consider neurological issues as symptoms specifically due to gastrointestinal disease, surely adds to the neurological issues (especially depression and anxiety) of their patients. The point is, if the neurological issues are part of the symptoms of an IBD, a patient shouldn't have to go to another specialist in order to get the rest of the diagnosis.

In the U.S. healthcare system, everyone wants to be a specialist.

The medical community has evolved into a system that sends patients from one specialist to another during the diagnostic process, so that all the specialists get a piece of the pie in the form of a big boost to their bank account (at the patient's expense, of course). Whether Medicare, insurance, or the patient pays for this, we are all paying for it, one way or another. There are no free lunches. That's just one of the reasons why healthcare in the U.S. is the highest priced in the world, and it has one of the lowest patient satisfaction ratings among the developed nations

All this added churning during diagnosis surely causes more depression.

As patients are handed from one specialist to another, the clock keeps running, and after waiting months to see each successive specialist, getting the final diagnosis (or diagnoses) can sometimes take years. Empathy for patient suffering apparently means little to most specialists, and to the healthcare system in general. If the healthcare system was actually concerned about patient well-being, it would provide a prompt, accurate diagnosis, and treatment would be quickly begun. In the current arrangement, prompt treatment only occurs for the simplest of health issues.

References

1. Sloan, M., Andreoli, L., Zandi, M. S., Harwood, R., Pitkanen, M., Sloan, S., . . . Pollak, T. A. (2023). Attribution of neuropsychiatric symptoms and prioritisation of evidence in the diagnosis of neuropsychiatric lupus: mixed methods analysis of patient and clinician perspectives from the international INSPIRE study, Rheumatology, kead685, Retrieved from https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/kead685/7473364?login=false#

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New Bowel Prep Option Is Claimed to Taste Better

10/8/2024

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by wayne persky

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When following our gastroenterologist's prescribed cleanout procedure to prepare for a colonoscopy, many of us have discovered that it could be argued that the worst part of the procedure, is convincing ourselves to finish drinking the rest of that prep solution, after we've discovered how nauseating the first few swallows tasted, and we've managed to force about half of it down.

Many of us have nausea problems during cleanout preparation.

Apparently, about 1/3 of MC patients are plagued by nausea issues that can range from minor to debilitating, at times. So deciding whether or not to continue drinking the liquid, as the nausea increases, requires a lot of soul-searching, unless we happen to feel invincible (or foolhardy). In some cases, the nausea can be so bad that we're unable to finish, for fear of regurgitating all of it.

Is GoLytely appropriately named?

The cleanout solution known as "GoLytely", for example, requires drinking a gallon of solution — a formidable task for someone who has the digestive issues typically associated with active MC. Incidentally, whoever named that product must've been a real joker (or a cruel sadist) — there's nothing "lyte" about the process of "going", after drinking GoLytely. Cleanout solutions are typically caustic, and many are nauseating and inflammatory to our intestines.

Some cleanout products have been removed from the market.

In the past, some of the cleanout solutions that had been previously approved by the FDA, have been removed from the market, because they were so caustic that for some patients, they were causing the development of MC or other health issues where they didn't exist prior to drinking the solution. In fact, studies have been done on the association of emergency room (ER) visits following colonoscopy exams of IBD patients.

For example, one such study, of 212,205 IBD patients who had at least one colonoscopy between 2007 and 2010, showed that 3, 699 of those patients had an ER visit within 10 weeks after having a colonoscopy Burnett-Hartman, et al., 2019).1 The researchers looked at ER visits during two particular time frames — 1–4 weeks after having a colonoscopy, and 7–10 weeks after having a colonoscopy. Because visits during the first time period were likely to be associated with a colonoscopy, and visits during the second time period were more likely not to be associated with a colonoscopy, they compared the ratio of these visits.

Prep solutions using sodium phosphate appeared to be a smoking gun.

The researchers found that in general, the relative risk (RR) of an ER visit was 1.24 during the month after a colonoscopy. And they found that the RR jumped to 2.09, for those who had used a sodium phosphate bowel preparation prior to the colonoscopy.

Products that have been removed from the market include:

Fleet Phoso-Soda and Fleet Phoso Soda EZ Prep Bowel Cleansing System. C.B. Fleet, Inc. stopped selling these products over the counter when the FDA issued a requirement for black box warnings on two similar prescription only products, Osmoprep® and Visicol® (both based on sodium phosphate). A generic version of the products sold over the counter by C.B. Fleet, Inc., is still available, in over-the-counter form.

HalfLytely (active ingredient polyethylene glycol 3350) and Bisacodyl Tablets Bowel Prep Kit has also been removed from the market. Currently, based on products that are available, it appears that the preferred cleanout solution is a mixture of MiraLAX and Gatorade.

But now, the FDA has approved Suflave.

Will it be kinder and gentler on our digestive system? A company press release claims that it will taste similar to a lemon lime sports drink, and it was scheduled to be available in August, 2023. According to an article in Gastroenterology & Endoscopy News, the ingredients appear to be somewhat familiar.2 The product will consist of a combination of an osmotic laxative utilizing 178.7 g of polyethylene glycol 3350, 7.3 g of sodium sulfate, 1.12 g of potassium chloride, 0.9 g of magnesium sulfate, 0.5 g of sodium chloride,, and lemon-lime flavoring. And it will be designed to be taken in two doses. Looking at the ingredients, it's difficult to visualize how this will be less nauseating than GoLytely (at least, for those of us who have nausea issues associated with MC), but will tell. At least, it's another new option.

Before agreeing to a repeat colonoscopy request from your gastroenterologist,

always remember that colonoscopies are not risk-free procedures, and according to published medical research, perforation rates range from 0.005–0.085% (Kim, Kim, and Park, 2019).3 This is a small percentage, and the rate seems to be holding steady over the last 15 years, but a perforation requires prompt emergency surgery, and that surgery is associated with a relatively high mortality rate, because of the rather high risk of infection.

MC can only be diagnosed by using a colonoscopy to collect biopsy samples.

A colonoscopy (or at least a sigmoidoscopy) is required in order to collect the biopsies necessary for a diagnosis of MC, but once the disease is diagnosed, it's a permanent diagnosis. Some gastroenterologists have a much worse track record of adverse events, than others, and the age, and fragility of their patients matters. When a gastroenterologist's prescribed treatment is not effective, most of them will request a repeat colonoscopy so they can search for another reason for the continued diarrhea. But another reason is almost never found, because the problem is virtually always due to the ineffectiveness of the treatment that the gastroenterologist prescribed, and not some other issue.

"New" gastroenterologists usually want to perform a colonoscopy.

If a patient changes gastroenterologists, the new gastroenterologist will often request a colonoscopy, despite the fact that a colonoscopy may have been performed within the last few months by the previous gastroenterologist. Incorrect diagnoses of MC do not exist. An MC diagnosis is virtually always 100% correct. By contrast, many cases of MC are misdiagnosed as IBS, or some other issue, but anyone who has been diagnosed with MC after biopsy samples from the lining of their colon have been examined under a microscope by a pathologist, definitely has MC. And a follow-up colonoscopy to verify that diagnosis is almost never productive.

Preparing for a colonoscopy can also be risky.

As discussed above, in addition to the risk imposed by the colonoscopy itself, some of the prep solutions used before a colonoscopy have been associated with causing MC for some patients, who didn't have MC before the prep solution was used. Most of the products that are prescribed for this procedure are very irritating (inflammatory) for the epithelial lining of the colon. Those that are not, are not as popular with gastroenterologists, because they're less effective for providing a clear view through the scope, during a colonoscopy.

References

1. Burnett-Hartman, A. N., Hua, X., Rue, T. C., Golchin, N., Kessler, L., & Rowhani-Rahbar, A. (2019). Risk interval analysis of emergency room visits following colonoscopy in patients with inflammatory bowel disease. PLoS One, 14(1), e0210262. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326490/

2. Gastroenterology & Endoscopy News Staff. (2023, June 27). FDA Approves New Drinkable Bowel Prep Option With Suflave. Gastroenterology & Endoscopy News, Retrieved from https://www.gastroendonews.com/FDA-Update-and-Product-News/Article/06-23/FDA-Approves-New-Drinkable-Bowel-Prep-Option-With-Suflave/70675?sub=&tken=28D0302C8A43FD2FA8C07583E1176C63D13D7F836F03BE9FDCFC2888550&enl=true&dgid=&utm_source=enl&utm_content=1&utm_campaign=20230629&pos=1&utm_medium=button

3. Kim, S. Y., Kim, H. S., and Park, H. J. (2019). Adverse events related to colonoscopy: Global trends and future challenges. World Journal of Gastroenterology, 25(2), 190–204. Retrieved from https://www.wjgnet.com/1007-9327/full/v25/i2/190.htm

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Is Human Evolution Falling behind the Advance of Technology?

10/1/2024

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by wayne persky

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The rapid pace of technological advancement and modernization is outstripping the slow process of human evolution, leading to significant adverse effects on our lives, well-being, and societal stability. This phenomenon, termed evolutionary mismatch, occurs when traits that evolved under previous environmental conditions become maladaptive in the current environment. A recent article published on a phys.org webpage outlines several ways this mismatch appears to be affecting us, and its impact on contemporary issues, including the increasing prevalence of antisocial behavior (Yong, 2024, June 3).1

Some of the issues discussed in the article include, for example.

1. Our sweet tooth — Our ancestors' preference for sweet, calorie-rich foods helped survival in nutrient-scarce environments. But in today's world, this preference leads to obesity, diabetes, and tooth decay due to mass-produced sugary foods.

2. Our social structure -- Humans evolved in small, kin-based tribes, fostering strong social bonds and a sense of belonging. Large, impersonal cities cause loneliness and social isolation, increasing stress and mental health issues.

3. Crowding and stress — Studies show that social animals in crowded environments suffer from stress, reduced immune function, and lower fertility. People in crowded cities experience similar stress and health problems.

4. Social inequality and status anxiety — Humans are sensitive to social status, which helped in small, egalitarian societies. Extreme wealth disparities and media focus on the rich heighten status anxiety, leading to unhealthy behaviors like incurring debt to appear affluent.

5. The role of social media — Social media often presents an idealized version of life, increasing feelings of inadequacy. Likes and followers on social media intensify social comparisons and anxiety.

6. Behavioral trends — Status anxiety drives obsessions with education, prestigious jobs, and material wealth. To cope with societal pressures, people engage in risky investments and dangerous cosmetic procedures.

7. Changing life goals — Due to high living costs, younger generations are shifting focus from traditional goals like homeownership and starting a family to maintaining mental and physical health.

8. Mental health issues — Intense societal demands lead to anxiety, depression, and in severe cases, self-harm and antisocial behavior. Perceived social injustices can result in cynicism, aggression, and hostility, as seen in "incel" communities.

Did we learn anything from the book "Future Shock"?

Alvin Toffler's 1970 book, "Future Shock," explores the disorienting effects of rapid technological and societal changes on individuals and societies. Toffler argues that the accelerated rate of change leads to "future shock," a state of distress and disorientation caused by an overload of new information and technology that individuals struggle to adapt to. Some of his key concepts include:

1. Accelerating rate of change — Toffler emphasizes how the exponential rate of change in technology and society outpaces human adaptability, leading to stress and disorientation.

2. Cultural lag — The gap between the rapid development of technology and the slower adaptation of societal norms and institutions.

3. Information overload — The overwhelming amount of information individuals must process, leading to decision paralysis and anxiety.

4. Transience issues — A sense of impermanence in relationships, jobs, and locations due to constant change, causing instability and insecurity.

Toffler appears to have been right on target.

We currently appear to be experiencing evolutionary mismatch. Modern environments, drastically differ from those in which our ancestors evolved, and those differences create significant adverse effects on mental health, social stability, and well-being. We're now dealing with widespread

1. Mental health issues and stress — Modern urban environments and societal pressures contribute to loneliness, stress, depression, and anxiety.

2. Social inequality and status anxiety — The disparity between past egalitarian societies and current social inequalities fuels anxiety and unhealthy behaviors.

3. Changing life goals — Younger generations are adjusting life goals due to the pressures of modern society, leading to dissatisfaction and unfulfillment.

4. Antisocial behavior — The pressure to succeed contributes to mental health issues and antisocial behaviors, disrupting social harmony.

5. Need for mitigation strategies — Aligning modern environments with our evolved nature through urban planning, reduced consumerism, and mindfulness practices.

What did we learn from "rat utopia"?

Between 1968 and 1970, American ethologist John B. Calhoun experimented with rats, particularly his famous "rat utopia" or "Universe 25" experiments. His experiments provided several insights into the dynamics of population behavior under conditions of overcrowding and social stress.

Calhoun observed what he termed the "behavioral sink," a collapse in social behavior due to overcrowding. Despite having unlimited resources (food, water, and shelter), the rats exhibited severe social breakdowns as population density increased.

Overcrowding led to the emergence of various social pathologies among the rats, including:

Aggression — Increased instances of violence and aggression.
Submissiveness — Some rats became overly passive and withdrawn.
Social Withdrawal — Many rats became isolated, avoiding social interactions.
Abnormal Sexual Behavior — Disruptions in mating behaviors, with some rats showing a complete lack of interest in reproduction.
Maternal Neglect — Mothers neglected their young, leading to high infant mortality rates.

Despite the availability of resources, the rat population eventually stopped growing and began to decline. The breakdown in social behaviors meant that the population could no longer sustain itself.

In normal conditions, rats form social hierarchies and territories. In the overcrowded environment, these social structures broke down, leading to chaotic and unpredictable behaviors.

Calhoun suggested that his findings could have implications for understanding human societies, especially in terms of urbanization and population density. He hypothesized that similar social stresses and breakdowns could occur in human populations under extreme conditions of overcrowding.

In conclusion

The concept of evolutionary mismatch highlights the profound impacts of the rapid pace of technological advancement and modernization on human well-being and societal stability. As Alvin Toffler predicted in "Future Shock," the accelerated rate of change is causing significant stress and disorientation, contributing to widespread mental health issues, social inequality, and antisocial behavior.

And these challenges are surely exacerbated by the disparity between our evolved traits and the demands of contemporary urban environments. To address these issues, we need to design modern environments that align more closely with our evolved nature, incorporating strategies such as nature immersion, minimalism, and mindfulness. By doing so, hopefully we will be able to enhance our mental and physical well-being and foster more stable and harmonious societies.

References

1. Yong, J. (2024, June 3). Human culture is changing too fast for evolution to catch up—here's how it may affect you. phys.org, Retrieved from https://phys.org/news/2024-06-human-culture-fast-evolution-affect.html?utm_source=nwletter&utm_medium=email&utm_campaign=weekly-nwletter

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Everyone talks about global warming, but exactly what's causing it?

9/22/2024

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by Wayne persky

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Recent research from the University of Leeds discusses the outsized impact of long-distance travel on greenhouse gas (GHG) emissions, suggesting this is luminal a primary driver of global warming. Is it really? The article points out that despite accounting for less than 3% of all trips by UK residents, long-distance journeys (defined as trips over 50 miles one way) are responsible for a staggering 70% of all passenger travel-related carbon emissions (University of Leeds, 2024, July 2).1 The disparity is even more pronounced when looking at international travel alone, which constitutes just 0.4% of total trips but contributes 55% of emissions. This stark contrast underscores the importance of targeting long-distance travel to achieve meaningful reductions in carbon emissions.

The research suggests that current efforts to reduce carbon emissions from passenger travel have focused too narrowly on local and commuter travel, overlooking the significant impact of long-distance travel. Policymakers are encouraged to reassess their strategies and prioritize initiatives that target long-distance travel, especially flights, to achieve more substantial emission reductions.

This begs the question, "How are emissions by commercial aircraft regulated?"

The International Civil Aviation Organization (ICAO) is a specialized agency of the United Nations, and it plays a significant role in regulating aircraft emissions. In 2016, ICAO adopted the first-ever global CO2 emissions standard for aircraft, which will apply to new aircraft designs from 2020 and to new deliveries of existing designs from 2023. This standard aims to improve fuel efficiency and reduce CO2 emissions.

The ICAO also developed the Carbon Offsetting and Reduction Scheme for International Aviation (CORSIA). CORSIA is a global market-based measure to offset CO2 emissions from international flights. It aims to stabilize net CO2 emissions from international aviation at 2020 levels by requiring airlines to purchase carbon offsets for emissions that exceed those levels.

The EU has incorporated aviation into its Emissions Trading System (EU ETS). Under this system, airlines operating within the European Economic Area (EEA) must monitor, report, and verify their CO2 emissions and surrender allowances corresponding to those emissions.

The Environmental Protection Agency (EPA) in the U.S. has set greenhouse gas (GHG) emission standards for aircraft, aligning with ICAO's standards. However, these regulations have faced criticism for not being stringent enough to significantly reduce emissions.

Technology continues to improve efficiency.

While regulatory measures are in place, the aviation industry also relies on technological advancements (such as more fuel-efficient engines and lighter materials) and operational improvements (like optimized flight paths) to reduce emissions.

Programs like CORSIA and the EU ETS aim to mitigate emissions through market mechanisms, but their effectiveness can be influenced by the cost and availability of carbon offsets and allowances.

There is ongoing research and development into sustainable aviation fuels (SAFs), which can significantly reduce lifecycle CO2 emissions compared to conventional jet fuels. Regulatory support and incentives are important for the widespread adoption of SAFs.

Regulations need to be coordinated.

Effective regulation of aircraft emissions requires global coordination, as aviation is inherently international. Differing regulations and standards across regions can complicate compliance for airlines

But will tightening aircraft regulations significantly reduce GHG emissions?

Aviation accounts for approximately 2-3% of global CO2 emissions. While this may seem small, the impact is amplified due to the high-altitude release of these emissions, which has a greater warming effect than ground-level emissions.

Aircraft emissions contribute to radiative forcing, a measure of the change in energy balance in the Earth's atmosphere due to greenhouse gases (GHGs) and other pollutants. The combined effects of CO2, water vapor, nitrous oxides, and particulates from aircraft (especially in the upper atmosphere) can significantly enhance global warming. The entire transportation sector is responsible for about 14% of global emissions, with aviation being a subset of this figure.

Looking at the statistics.

Electricity and Heat Production — 25% of global GHG emissions.
Agriculture, Forestry, and Land Use — 24% of global GHG emissions.
Industry — 20% of global GHG emissions.
Transportation — 14% of global GHG emissions.
Buildings — 6% of global GHG emissions.

The largest source of GHG emissions globally is the burning of fossil fuels.

1. As noted above, generating electricity and heat (energy production) account for about 25% of global emissions.

2. Agriculture, Forestry, and Other Land Use (AFOLU) contributes to emissions through activities such as deforestation, land use changes, and agricultural practices. It accounts for about 24% of global emissions. This sector contributes through CO2, methane (CH4), and nitrous oxide (N2O) emissions.

About 40% of methane comes from natural sources, and the other 60% is a result of human activities. The anthropogenic (due to human activity) methane production is mostly a byproduct of agriculture, the burning of fossil fuels and biofuels, the decomposition of landfill waste, and wastewater treatment.
Nitrous oxide is produced during various agricultural soil management processes, such as the application of synthetic and organic fertilizers, the management of livestock manure, burning of crop residues, forest fires, and certain industrial processes. Nitrous oxide amounts to about 6% of total greenhouse gas emissions.

3. Industrial processes are responsible for approximately 20% of global emissions. This sector also contributes through CO2, methane (CH4), and nitrous oxide (N2O) emissions.

Roughly 75% of the emissions produced by industry are due to burning fuel in order to create heat, and the rest is associated with the production processes that transform raw materials into finished products.

4. GHG production associated with transportation is obviously associated with the burning of fossil fuels and biofuels.

5. The GHG production associated with buildings is due mostly to energy used for heating and cooling.

What are the primary GHG sources?

Approximately 76% of total GHG emissions are CO2.
Methane is the second largest component of anthropogenic GHG production, at approximately 16%.
Nitrous oxide amounts to about 6% of total greenhouse gas emissions.

How significant are the contributions of natural events to GHG production?

Volcanic eruptions can inject large quantities of aerosols and gases, such as sulfur dioxide (SO2), into the stratosphere, which can have both cooling and warming effects on the climate.

The primary effect of large volcanic eruptions is a temporary cooling of the Earth's surface. This is due to the reflection of solar radiation by volcanic aerosols. For example, the eruption of Mount Pinatubo in 1991 caused a temporary global temperature decrease of about 0.5°C (0.9°F) for a couple of years.

Overall, volcanic eruptions are considered to have a short-term cooling effect rather than a significant long-term warming impact. On a much smaller scale, volcanic CO2 emissions can contribute to the greenhouse effect, but this is negligible compared to human emissions.

Changes in solar radiation can affect the Earth's climate.

The Sun's energy output varies slightly over time due to sunspot cycles and other solar phenomena. The 11-year solar cycle leads to small variations in solar output. While these variations can influence short-term climate patterns, they are not significant drivers of long-term global warming.

Studies suggest that changes in solar radiation have contributed less than 10% to the observed warming over the past century. But note that this is still a significant amount over which we have no control.

Natural processes such as decomposition and respiration can release GHGs

Natural sources of methane include wetlands, termites, and oceanic processes. While these sources contribute to the greenhouse gas inventory, their levels have been relatively stable over time. But again, these sources are beyond our control.

Natural CO2 emissions come from processes like respiration and ocean-atmosphere exchanges. However, natural CO2 emissions are balanced by natural sinks like photosynthesis and ocean absorption, so they don't significantly contribute to the observed increase in atmospheric GHG concentrations.

Do carbon offsetting schemes actually have any merit?

Carbon offsetting schemes are mechanisms designed to compensate for emissions of carbon dioxide (CO2) and other greenhouse gases (GHGs) by funding equivalent CO2-saving projects. While the concept of carbon offsetting has theoretical merit, its effectiveness and impact can vary significantly depending on how the schemes are implemented.

The actual benefits (if any), of these schemes is debatable. Personally, my own opinion of carbon offsetting schemes is that 10 years from now, we'll all be looking back at what a pathetically optimistic idea that was, and feeling ashamed, because it will be painfully obvious that it made absolutely no difference at all in total GHG emissions.

Why? Because precious few individuals are going to sell a carbon offsetting plan unless the practices in that plan are part of their normal operation, anyway. They're much less likely to sell a plan for which they'll have to go to the trouble of actually doing something different. Consequently, most of these plans will probably turn out to be worthless, because they involved carbon offsetting actions that are a part of normal operations, so they would have been done anyway.

And anyone who has been forced or coerced into buying an offsetting carbon scheme will surely resent being forced to do that, so that they certainly are not going to go out of their way to make sure that everything they do will minimize GHG emissions. These combined disincentives will probably cause the program to be self-defeating.

In conclusion,

When put into perspective, it's obvious that long-distance commercial aircraft flights contribute only a relatively small amount of GHG emissions when compared with other major sources of anthropogenic GHG emissions. However, recent research shows that, despite being a small fraction of overall trips, these journeys contribute significantly to global warming, due to the fact that these emissions occur at relatively high levels in the atmosphere, where they have a greater effect on global warming.

Overall, global warming is occurring as a result of many aspects of human existence as we all try to not only survive, but also take advantage of the available comforts and every day pleasures that modern technology has to offer. The planet could probably continue to support us for at least thousands of generations, if we didn't produce so many GHG emissions that interfere with the planet's solar energy balance.

But at the current rate, global warming will eventually make the production of adequate amounts of food increasingly difficult, and at some point, impossible. Hopefully, we can correct the problem long before we get to that point. Ultimately, it will require a blend of regulation, innovation, and international cooperation, if we ever hope to make any meaningful progress in combating global warming.

References

1. University of Leeds. (2024, July 2). True scale of carbon impact from long-distance travel revealed. Phys.org, Retrieved from https://phys.org/news/2024-07-true-scale-carbon-impact-distance.html?utm_source=nwletter&utm_medium=email&utm_campaign=weekly-nwletter

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The Association Between Perfectionism and MC

9/16/2024

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Founder and President of the Microscopic Colitis Foundation

I've had constipation problems most of my life. I can remember events from my childhood, when typically, several days would pass before I would have a bowel movement, and of course, even then, the event usually wasn't accomplished easily. As I was growing up, I didn't realize that this was an abnormal pattern of bowel movements. But when I was in my early 50s, my bowel movements suddenly became marked by a little fresh blood with each event.

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