Monday, April 27, 2015

Dying of Loneliness

Cigarette smoking, obesity, and alcoholism are all well-known causes of premature death.  Recently, two closely related risk factors---social isolation and loneliness---have also been identified as being important in causing early mortality.  Social isolation can be characterized by living alone, having few social network ties, or having infrequent social contact. These issues are considered to be “objective” or actual, not dependent on one’s personal perception. Loneliness, on the other hand, is the perception of social isolation, or the “subjective” experience of being lonely.

Results of a Recent Study   In a published report from researchers from Brigham Young University, data from 70 separate studies involving over 3 million participants were pooled and analyzed.  Study participants were older (mean age of 66 years), but generally healthy.  Approximately one third of the participants did have a medical condition, such as heart disease or diabetes. In the analysis, an increased likelihood of dying prematurely was found in association with loneliness (26%), social isolation (29%) and living alone (32%).  This risk level is comparable with other risk factors for premature death including physical inactivity, obesity, substance abuse, lack of access to medical care, and poor mental health. The authors of this report also noted that social isolation was particularly harmful for middle-aged adults as compared to older people in a similar situation.

One Possible Explanation   Other researchers have suggested that the physiologic basis for this increased death rate occurs because loneliness triggers a stress response in the brain which affects certain endocrine glands (hypothalamic-pituitary-adrenal axis) in the body.  High levels of stress hormones are produced that can bring about a number of health problems including depression, high blood pressure, and autoimmune disease.

A Growing Problem   In the U.S., more people are living alone or reporting being lonely than ever before. The Census Bureau reports that 27% of households are single-person households, a figure that is up significantly over the past few decades. With social isolation on the rise, an “epidemic” in loneliness has been predicted by the study’s authors.  They contend that social isolation and loneliness should receive greater attention by health care organizations since this will become an increasingly serious public health issue.

A (not so simple) Solution?  Based on the results of the Brigham Young study, it appears that reaching out to family members or neighbors who are socially isolated or lonely may be one of the most effective actions that we can take to improve their well-being and longevity.  While social isolation has been shown to present an added risk to health, there is also evidence that the existence of social ties can provide a protective effect on health.

Friday, April 17, 2015

Listeria in the News Again

Listeria monocytogenes, or Listeria for short, is a bacterium that causes an infection called listeriosis. Recently, Sabra Dipping Co. voluntarily recalled 30,000 cases of its Classic Hummus because of possible Listeria contamination.  Just prior to that, several people became infected with Listeria due to contamination of Blue Bell ice cream.   As of this writing, no one has become infected due to a contaminated Sabra product.  Due to infections linked to contaminated Blue Bell products, however, the CDC has recommended that consumers avoid any Blue Bell brand products made at their Oklahoma production facility.

How does someone contract listeriosis?  Listeria bacteria are found in soil and surface water, as well as in animals that do not appear to be infected.  Food can become contaminated when it is handled by an asymptomatic carrier or if it comes in contact with Listeria bacteria in fertilizer or animal waste.  The great majority of people who develop listeriosis get it through contaminated foods.  Foods that have most commonly been associated with Listeria contamination include processed meats (hot dogs, deli meats, etc.), cheeses (particularly those made with non-pasteurized milk), raw milk, and smoked seafood.  Thus far, contamination of fresh produce has been uncommon.  Infections that occur in pregnant women are particularly troubling since they can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn.

What are the symptoms of listeriosis? Most people that are infected have few or no symptoms. When symptoms are present, they are usually flu-like in nature, including fever, muscle aches, nausea and/or diarrhea. In severe cases, nervous system involvement including meningitis and brain abscesses can occur.

Who is at risk for developing listeriosis? In the United States, an estimated 1,600 persons become seriously ill with listeriosis each year. Some groups of people are at higher risk of becoming infected and developing complications than others. Those at increased risk include:
  • Individuals with immune system weakness due to AIDS, cancer, or from taking immune-suppressing medications.
  • Pregnant women, who are approximately 20 times more likely to contract listeriosis than other healthy adults.
  • People with chronic illness, such as diabetes, alcoholism, liver or kidney disease.
  • Older individuals.

  • Newborns, particularly if their mother is infected at the time of delivery.
How is listeriosis diagnosed?  The diagnosis is often suspected based on typical symptoms occurring during a Listeria outbreak. With the first cases of an outbreak, or when the diagnosis is uncertain, culturing the bacteria from the subject’s blood or spinal fluid can be performed.
How can you reduce your risk for listeriosis? Some of the most important ways to reduce your risk of developing listeriosis are as follows:
  • Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature.
  • Rinse raw fruits and vegetables thoroughly under running tap water before eating (even if the peel is not eaten).
  • Keep uncooked meats and poultry separate from vegetables and from cooked foods and ready-to-eat foods.
  • Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.
  • Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
  • Consume perishable and ready-to-eat foods as soon as possible.
Persons at high risk, such as pregnant women and those with weakened immune systems, need to take additional precautions. These include: (1) avoiding soft cheeses (brie, feta, blue, etc.) unless made with pasteurized milk, (2) refrigerated smoked seafood (which may be labeled as "nova-style," "lox," "kippered," "smoked," or "jerky”), and (3) refrigerated pâté or meat spreads from a deli or from the refrigerated section of a store.
What should you do if you’ve eaten food that could have been contaminated with Listeria?  Even if the food contained Listeria, the risk of developing listeriosis is very small. No tests or treatment is necessary if symptoms do not occur after eating food suspected of being contaminated.  If the person is in a high-risk group, the CDC recommends seeking medical attention if fever or signs of listeriosis occur, even if this develops several weeks after eating the suspect food.
Can Listeriosis be treated?  In healthy individuals, Listeria bacteria are cleared by the body in about a week without specific treatment.  For high-risk patients with symptoms, antibiotics delivered through an intravenous line, are usually required. Ampicillin and Bactrim (trimethoprim-sulfamethoxazole) are two of the antibiotics that are typically used.  Treatment with antibiotics is particularly important in pregnant women due to the risk to the fetus.

Monday, April 13, 2015

Why People Have to Pee during the Night

Nocturia is defined as “excessive urination at night”. Normally, the amount of urine the body produces goes down at night, reducing the need to urinate for the 6 to 8 hours that people are sleeping. Since waking to urinate on one occasion during the night is generally considered to be “normal”, having nocturia generally implies that someone wakes up more than once a night to urinate.
Nocturia becomes more common as people age with some surveys finding that over half of men and women over the age of 60 have this complaint.  In addition to being associated with a number of medical problems, nocturia can result in sleep deprivation and an increased risk for developing depression. Particularly in the elderly, getting up during the night to urinate can also cause accidental falls and fractures.

Causes of Nocturia:
  1. Advancing age:  Antidiuretic hormone (ADH), released from the pituitary gland in the brain, causes the kidneys to hold onto water, reducing urine volume.  Normally, ADH production increases while someone is sleeping thus decreasing the amount of urine produced.  In the elderly, ADH levels have been noted to decrease at night, resulting in increased urine volume and the need to urinate.
  2. Drinking too much fluid during the evening.  Consuming caffeine or alcohol-containing beverages after dinner will contribute to this even further.
  3. Infection of the bladder or urinary tract.  When present, this usually causes (UTI) symptoms, such as burning or stinging during urination or blood in the urine.
  4. Enlarged prostate gland (BPH). This is one of the most common causes in older men. With ageing, the prostate increases in size which causes blockage of the flow of urine. The response to this blockage is thickening of the muscular walls of the bladder and subsequent reduction in the size of the bladder and capacity to hold urine. Known as “prostatism”, symptoms of an enlarged prostate gland include nocturia, the need to urinate urgently, and dribbling after urination.
  5.  Diabetes mellitus. In poorly controlled diabetes mellitus, high levels of glucose in the bloodstream can cause increased urination (osmotic diuresis). This can lead to a vicious cycle of dehydration, increased water consumption and polyuria (frequent urination).
  6. “Third Spacing”.  This term refers to the movement of fluid from inside the blood vessels into the interstitial space (between the cells of the body).  This results in fluid retention, usually in the legs (edema) or abdomen (ascites). Congestive heart failure, venous disease of  the lower extremities, and high intake of salt are some of the most common causes of third spacing.
  7. Certain medications. Foremost among these are diuretics (water pills), taken for a number of medical problems including heart failure and hypertension. Others that can potentially cause nocturia include digitalis (a heart medication), lithium (used in the treatment of bipolar disorder) and Dilantin (also known as phenytoin, an anti-seizure medication).
  8. Sleep apnea. In this condition, partial obstruction of the airway leads to low oxygen content and constriction of blood vessels in the lungs. This stimulates the release of a hormone that is responsible for increasing urine production.  
Evaluation of Nocturia.  It is important to note that nocturia is a symptom, not a specific disease.  While aging can be responsible for causing nocturia, it should not necessarily be assumed that it is always due to “getting old”. There are a number of medical conditions that can cause someone to have to urinate more than once during the night.  Determining the underlying cause can be quite challenging with the evaluation touching on causes as diverse as congestive heart failure, sleep apnea, prostate enlargement and diabetes. Use of a “voiding diary” and measurement of urine volumes during the day and night can help with determining the underlying cause.

Treatment of Nocturia.  Treatment for nocturia is directed at the underlying cause. For example, improvement in blood sugars can help in uncontrolled diabetes. If an obstructing prostate gland is the cause, a medication or surgery to reduce the size of the prostate will help. The use of continuous positive airway pressure (CPAP) in someone with sleep apnea can reduce associated nocturia. In a rare condition known as diabetes insipidus, use of a synthetic version of antidiuretic hormone (desmopressin) will help. If taking diuretic medication is responsible, the medication administration may need to be moved to earlier in the day to avoid having to void during the night.

When the underlying cause is not serious enough to warrant specific treatment, several lifestyle measures may help:
  • Limit fluid intake 3 hours prior to bedtime
  • Restrict consumption of coffee, caffeinated beverages, and alcohol in the evening.
  • Elevate legs in the evening to help prevent the development of lower extremity edema.
  • Wear compression stockings if venous disease is causing fluid accumulation.
  • Pre-emptive voiding prior to going to bed may delay the need to urinate during the night.

Monday, April 6, 2015

Eggs-cellent News

For several decades, the humble egg has been maligned because of its cholesterol content and the concern that eating eggs raises coronary heart disease risk. Most of this concern appears to be theoretical, however, since more recent data from population studies indicates that moderate egg consumption does not significantly raise cholesterol levels, nor does it represent a risk factor for the development of coronary heart disease.

Debunking a myth.
In a report published in the British Medical Journal, the results of eight studies evaluating the risk of eating eggs on the development of coronary heart disease and stroke were pooled. This method of combining results, called a "metanalysis," provides more reliable conclusions than an individual study. Following the author’s analysis, they found that "higher consumption of eggs (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke".
There were two subgroups of study subjects in which the results varied from this conclusion. In diabetic patients, egg consumption did appear to be associated with a higher risk of developing coronary heart disease. In another subgroup with the highest reported consumption of eggs, their risk for a particular type of stroke (hemorrhagic) was reduced by 25%.
Nutritional value of eggs.
Eggs are a uniquely nutritious food. Each egg, at around 75 calories, packs 7 grams of the highest quality protein of any food. The fat content is approximately one-third monounsaturated, considered to be the healthiest type of fat. Eggs also contain iron, vitamins, minerals, and other healthy nutrients like lutein, omega-3 fatty acids, and choline, important for vision and brain health.
Dietary vs. Blood Cholesterol.
The American Heart Association (AHA) recommends eating no more than 300 mg of cholesterol per day. At 200 mg of cholesterol per large egg (all within the yolk), it would seem that egg consumption should be limited or eliminated in order to avoid going over the AHA’s recommended limit. Actually, most of the cholesterol that circulates in the blood stream does not come from cholesterol in foods but is produced in the liver in response to eating saturated and trans fat. In American diets, the majority of saturated fat comes from animal products such as beef, pork, butter, cream, cheese and other full-fat dairy products. Trans fats are found in many fried foods and baked goods such as pastries, pizza dough, pie crust, cookies and crackers.
Guilt by Association.
The biggest problem with eggs may not be the eggs themselves, but the company they keep at mealtime. Combining eggs at breakfast with cheese, sausage, hash brown and biscuits will almost certainly raise your cholesterol level as well as expanding your waistline.
The Bottom Line.
Based on current evidence, it appears that eggs, eaten in moderation, can not only contribute to our eating pleasure but are also an important component of a healthy diet. Moderate consumption is commonly set at one egg per day or seven eggs per week. People who have elevated total or LDL cholesterol, may want to decrease this number or choose to eat egg whites instead. Likewise people with diabetes or heart disease should reduce their egg consumption to around three per week.
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