Posts tagged with "MD"

Collagen: Rejuvenator and healer, or edible hoax?

December 25, 2019

In 2020, in the United States alone, consumers have doled out nearly $300 million on collagen supplements—up from just $50 million in 2014, according to market research firm Nutrition Business Journal. Globally, as collagen makes its way into more foods and beverages, topicals, and even the operating room, the market is projected to reach $6.5 billion by 2025.

The wildly popular supplement is said to plump up skin, banish acne, thicken hair, and strengthen nails and bones, according to fans nationwide.

But despite the widespread acclaim, WebMD says; questions remain about how well it works and how safe it is.

“It’s definitely among the top three products people ask me about, and I believe it does hold promise in some diverse areas of medicine,” Mark Moyad, MD, director of the Complementary and Alternative Medicine program at the University of Michigan Medical Center, told the medical news outlet. “It’s also one of the most wacky and controversial.”

Collagen is often called the body’s scaffolding. “It’s the glue that holds the body together,” according to New York dermatologist Whitney Bowe, author of The Beauty of Dirty Skin: The Surprising Science of Looking and Feeling Radiant from the Inside Out.

She says collagen makes up about 75% of the dry weight of your skin, providing volume that keeps skin looking plump and keeps lines at bay. It’s also rich in in the amino acids proline and glycine, which you need to maintain and repair your tendons, bones, and joints.

“As we get older, we break it down faster than we can replace it,” she told WebMD in an interview, noting that we begin to lose about 1% of our collagen per year in our mid-20s and lose as much as 30% during the first five years of menopause.

And while injecting collagen directly into skin folds—which was frequently done in the 1980s—has fallen out of favor in many dermatology practices, consuming it has gained advocates.

Indeed, when Bowe  learned a few years ago that people were eating collagen, she was skeptical. But she has since changed her mind. “Just in the last few years, there have been some impressive studies showing that ingestible collagen can indeed impact the appearance of skin,” says Bowe.

One 2014 study of 69 women, ages 35 to 55, found that those who took 2.5 or 5 grams of collagen daily for eight weeks showed a lot of improvement in skin elasticity, compared with those who didn’t take it.

Another found that women who took 1 gram per day of a chicken-derived collagen supplement for 12 weeks had 76% less dryness, 12% fewer visible wrinkles, better blood flow in the skin, and a 6% higher collagen content.

And a 2019 review of eight studies including 805 patients concluded that “preliminary results are promising for the short- and long-term use of oral collagen supplements for wound healing and skin aging.”

Moyad, author of The Supplement Handbook: A Trusted Expert’s Guide to What Works and What’s Worthless for More Than 100 Conditions, cautions that many of the studies done so far on collagen are small and at least partially funded by industry.

“The science is truly in its infancy,” he says. “There’s a lot of conflict of interest, and not enough quality control.”

But he, too, believes collagen holds promise WebMD reports..

As a protein source alone, collagen is an excellent one, packing in more protein per calorie than other sources while containing less sodium and sugar. And Moyad finds the evidence suggesting it may improve body composition, joint health, and healing rates intriguing.

Collagen has been shown to act as a powerful wound healer, able to stop bleeding, recruit immune and skin cells, and stimulate new blood vessel formation. One study of 89 long-term care residents with pressure ulcers found that those who took collagen supplements three times daily for eight weeks saw their wounds heal twice as fast. Another, of eight patients who had a small surgical skin biopsy, found that daily topical collagen healed their wounds at least as well as sutures.

“We are desperate for more low-cost, nonaddictive, and safe pain-modifying products,” he says.

All that said, some health professionals remain skeptical.

Augusta, Georgia-based dermatologist Lauren Eckert Ploch  told WebMD stomach acids break down collagen proteins you eat before they reach the skin intact, so she’s not convinced it helps at all. “The jury is still out.”

Then, there is the ick factor.

Meanwhile, dermatologists and consumer groups have also expressed concerns that those ground-up hooves, hides, bones, and nerve tissues—particularly if they come from cows—could carry diseases like bovine spongiform encephalopathy, or mad cow disease.

On the other hand, Andrea Wong, senior vice president for Scientific and Regulatory Affairs for the industry trade group the Council for Responsible Nutrition, says that as ingredients go, collagen has an excellent track record.

“It has been around for ages, and there is a large body of evidence supporting its safe use,” she told WebMD. She notes that studies that see how well it works also look at side effects. In general, collagen has been shown to be safe, Wong said.

Moyad says many of the concerns expressed about collagen supplements can be addressed by choosing wisely. Look for companies that get their bones and tissues from cage-free, free-range, and antibiotic-free sources. Look for a trusted brand with a third-party label like NSF or USP. And check out the company’s website to see what it’s doing to keep heavy metals and other contaminants out of their products.

“Consumers need to have the attitude of ‘just prove to me that it’s clean and I’ll try it,’” he says, noting that it can take up to 12 weeks for results to show. “It might help, and it probably won’t harm, unless you are not being diligent about quality control.”

Research contact: @WebMD

What’s wrong with you? Network of doctors diagnoses 100 previously unsolved cases

October 25, 2018

Not every doctor is an adroit diagnostician—and even those who are will admit to being stumped occasionally by a patient’s symptoms. Now, there is help, even for the hardest cases, from the Undiagnosed Diseases Network—a program created by the National Institutes of Health in 2012.

The program, which first was conceived back in 2008, now depends on a network of collaborative healthcare institutions nationwide—and cross-disciplinary physicians at those institutions—including Baylor College of Medicine, Brigham and Women’s Hospital, Boston Children’s Hospital, Massachusetts General Hospital, Children’s Hospital at Philadelphia and University of Pennsylvania, Duke University and Columbia University, Harvard Medical School and University of Alabama at Birmingham, Mayo Clinic, Stanford Medicine, UCLA, University of Miami School of Medicine, University of Utah, University of Washington School of Medicine and Seattle Children’s Hospital, Vanderbilt University Medical Center, and Washington University in St. Louis.

Through the efforts of the network, more than 100 patients afflicted by mysterious illnesses have been diagnosed to date—and 31 new diseases have been identified.

“Our goal is to take on the hardest cases in medicine — to find patients and families with conditions that no one has been able to solve,” explained Euan Ashley, M.D., a professor of Medicine (Cardiology) at Stanford University, in a news release from the school. “We wanted to provide a place that these people could come, so the Undiagnosed Diseases Network came together to try to answer that need.”

The group, which comprises hundred of doctors, has so far sleuthed out 132 of 382 previously unknown ailments —or roughly 35%.

Some of these patients had been waiting decades to put a name to their illness. They tell us how much of a relief it is simply to know what they were up against,” Ashley said. But what’s most exciting, he said, was that for 80% of the network’s diagnoses, they distilled actionable information, such as changes to patient therapy, adjustments to future diagnostic testing and recommendations for family screening.

“Our findings underscore the impact that establishing a clear diagnosis can have on clinical decision-making for previously undiagnosed patients,” said Kimberly Splinter, associate director Research Operations for the network’s Coordinating Center and a genetic counselor at Harvard Medical School. “We hope that the results of this analysis will provide a compelling case for adopting some of the network’s diagnostic approaches more broadly in an attempt to clarify diagnoses and refine treatment for patients with rare conditions.”

Splinter is the lead author (and Ashley is the senior author) of a paper describing the study that was published online on October 11 in The New England Journal of Medicine.

Of the 1,519 applications from patients that the network received when it was formed, 601 were accepted based on the likelihood that the network would be able to help them, given their past medical records and available data. Now, Ashley and the team of physicians have seen more than half of those patients, combining traditional medicine with increasingly cutting-edge diagnostic tests. The network continues to accept applications.

 “We do this Sherlock Holmes-like detective work-up by carefully observing, gathering information and asking pointed questions, but we’re also pairing that with the most advanced genomic technologies to try to solve their case,” Ashley said.

Every patient had their genome sequenced, even those whose genomes had been previously sequenced. The field of genetic and genomic testing moves so quickly, Ashley explained, that even patients who’ve had their genome sequenced six months ago benefit from another look. In coordination with genome sequencing, the physicians looked at patients’ RNA profiles, analyzing precursor molecules to the proteins found in their bodies. They also broke down a collection of molecules called metabolites, which form as a product of metabolism and can hint at where metabolic processes go wrong.

“Some cases are solved simply because we know more today than we did a year ago,” Ashley said.

Among those diagnosed, most exhibited rare versions of known diseases, broadening the symptomatic information doctors can look for when evaluating patients for those particular diseases in the future. But in 31 patients, the network identified previously unknown syndromes.

A particularly interesting case study is provided by co-author Matthew Wheeler, M.D., assistant professor of Medicine at Stanford and executive director of the Stanford Center for Undiagnosed Diseases.  The case involved a patient whom the network followed for multiple years. The patient had mysterious and life-threatening episodes of something called lactic acidosis, a dangerous buildup of lactic acid in the body.

“It’s sort of like an extreme version of when you exercise intensely, and you feel that burn from the lactate buildup — only it’s your whole body that feels that way,” Wheeler said. “Lactic acidosis can also cause your acid-base balance to be out of whack, and when people have severe acid-base disturbances, they’re at high risk for arrhythmia or death.”

It wasn’t clear why the patient was experiencing these symptoms, which seemed to be prompted by a cold or flu. After giving the patient the full gamut of tests and analyzing sequencing information, a team of Stanford scientists found the culprit: a single mutation in the gene ATP5F1D, which is involved in the function of mitochondria, the cell’s powerhouse.

The genetic oddity and symptoms had never been classified together officially, but from connections within the network and in some instances word of mouth, the scientists found that other doctors around the world had patients plagued by this syndrome. In verifying that the mutation causes the syndrome—called mitochondrial complex V deficiency, nuclear type 5 — network collaborators on the study developed animal models to show causality.

“This is a new type of scientific odyssey,” Ashley said. “We’re learning about biology in a way that could help not just one family, but potentially dozens, even hundreds, of families who suffer that same rare condition. That’s the biggest benefit of this network effect — the impact of identifying one patient’s disease could end up being global.”

Even the patients who did not receive a diagnosis benefit from knowing that a team continues to investigate their conditions and that the future may hold an answer even if the present does not.

“We’ve had patients tell us that just knowing that there is a team looking into their condition, that there is someone in the world who has not given up on them, scientists continuing to keep an eye on the literature — that provides hope,” Ashley said.

Research contact: euan@stanford.edu

Have another helping of whipped cream: Dairy fat may protect against diabetes

October 16, 2018

How sweet it is! As the holidays approach, most of know we will take guilty joy in having a dollop of whipped cream or ice cream with our portion of pie. But maybe it’s time to cut back—on the contrition, Medscape reports.

In a recent epidemiologic study, researchers found that adults with higher blood and fat tissue levels of three fatty acids—which correlate with intake of high-fat dairy foods—were less likely to develop type 2 diabetes.

The study, led by Fumiaki Imamura, Ph.D., an epidemiologist at the University of Cambridge, United Kingdom, was published online on October 10 in the journal, PLOS Medicine.

Dr. Imamura and his co-authors analyzed data from 16 pooled international cohorts with more than 60,000 people from the Fatty Acids and Outcomes Research Consortium (FORCE) project, based at Tufts University in Massachusets.

At the beginning of the study, the participants had baseline measurements of three fatty acids—pentadecanoic acid, heptadecanoic acid. and trans-palmitoleic acid—that reflected consumption of fat from dairy products such as milk and cheese.

During up to 20 years of follow-up, 23.8% of the participants developed type 2 diabetes. The people with the highest levels of all three fatty acids (highest quintile) had a 35% lower risk of developing type 2 diabetes during follow-up than people in the lowest quintile. 

“Our results provide the most comprehensive global evidence to date about dairy fat biomarkers and their relationship with lower risk of type 2 diabetes,” Imamura said in a statement by the UK Medical Research Council.

“We’re aware that our biomarker work has limitations and requires further research on underlying mechanisms,” he conceded, “but at the very least, the available evidence about dairy fat does not indicate any increased risk for the development of type 2 diabetes.”

Senior author Dariush Mozaffarian, M.D., Tufts University, added: “While dairy foods are recommended as part of a healthy diet, U.S. and international guidelines generally recommend low-fat or non-fat dairy, due to concerns about adverse effects of higher calories or saturated fat.” However, he said, these latest results “suggest a need to re-examine the potential metabolic benefits of dairy fat or foods rich in dairy fat, such as cheese.”

What do these findings mean for clinicians and patients?Medscape Medical News asked Robert H. Eckel, M.D., of the Division of Endocrinology, Metabolism and Diabetes, and Cardiology, and Director of the Lipid Clinic, at the University of ColoradoAurora.

Should people switch to high-fat instead of low-fat dairy and eat more dairy?

“Epidemiology is epidemiology,” he stressed in an email. “No changes in a heart-diabetes-cancer-healthy lifestyle are recommended until more science affirms this relationship” between high-fat dairy foods and lower risk of type 2 diabetes.”

According to Eckel, “It’s not ‘good foods’ or ‘bad foods’, it’s the overall diet.”

Nevertheless, the study’s “novel findings,” Imamura and colleagues conclude, “support the need for additional clinical and molecular research to elucidate the potential effects of these fatty acids on glucose-insulin metabolism, and the potential role of selected dairy products for the prevention of type 2 diabetes.”

Research contact:  fumiaki.imamura@mrc-epid.cam.ac.uk

Falling leaves lead to flare-ups of mold allergies

October 1, 2018

The apple may not fall far from the tree—but this time of year, the leaves plummeting from a small thicket can cover an entire lawn and driveway. And for some of us, the beautiful autumn tones of orange and russet soon will be a close match for the red of our inflamed nostrils, as we sneeze and sniffle our way through this major allergy season.

Indeed, falling leaves herald not only the start of fall, but also the flare-up of mold allergies, Michael Beninger, MD, an ear, nose and throat expert at the Cleveland Clinic told The Weather Channel recently.

Mold allergies can create the same symptoms as other seasonal irritants: itchy, watery eyes, runny nose, and nasal congestion—which often causes sleepless nights and daytime fatigue. Sore throats and headaches also are common.

As ragweed season winds down in the North and Northeast, the leaves start to fall, ramping up mold production. When leaves just sit in your yard, moisture accumulates— accelerating mold growth. Fallen foliage from summer gardens gone bad and more can also be mold hot spots.

As with all allergens, avoidance is your best strategy, Dr. Beninger advises, adding, “If you’re a person with bad mold allergies, you probably should spend more time indoors. Don’t rake your own leaves [and] be careful with any kind of vegetables that are rotting [such as Halloween pumpkins].”

It’s also best to roll up the windows in your car and at home, and to run a fan at home to circulate air throughout your abode to fight fall allergies, Warner Carr, MD, an allergist and fellow of the American College of Allergy, Asthma and Immunology, told the weather news outlet. It’s also essential to visit an allergist to find out to which allergens you are sensitive, so you can create the best-possible treatment plan.

“There are simple, safe and effective therapies that we can do, so people aren’t suffering from seasonal allergies,” Dr. Carr said. “Allergies can have a huge impact on quality of life, and it’s completely unnecessary suffering.”

For people with asthma, mold can exacerbate their symptoms when it’s inhaled, regardless if they have other allergy symptoms —although 70% of asthmatics also have allergies, according to the ACAAI.

Research contact: @anniehauser

To have and to hold: Why people hoard

July 16, 2018

Do you have a friend who will not let you inside his or her home? That person may not be trying to keep a distance, so much as trying to keep a guilty secret about what is lurking behind the front door—belongings and trash piled from floor to ceiling.

There is more awareness of this issue today, thanks in part to the popular television series, Hoarders (on A&E) and Hoarding: Buried Alive (on TLC).

Before that, many people had heard of the Collyer brothers, Homer and Langley, who lived like hermits in a Harlem, New York, brownstone, where the obsessively collected books and newspapers. The brothers were found dead in the home in 1947, surrounded by over 140 tons of hoarded items that eventually had trapped them and killed them.

It is not surprising that the brothers took to hoarding together: Compulsive hoarding is can be an extreme form of obsessive-compulsive disorder (OCD), which often is inherited among family members, according to Psych Central.

Today there are an estimated 700,000 to 1.4 million U.S. residents who hoard, based on findings by Gerald Nestadt, M.D., director of the OCD Clinic at Johns Hopkins University School of Medicine. Between 18% and 42% of people with OCD experience some sort of compulsion to hoard, Netstadt says. Typically, the condition starts in childhood or adolescence, but does not advance to a severe state until adulthood.

However, there are other hoarders who do not have OCD. They may be affected by depression, bipolar disorder, or social anxiety that exhibits itself in symptoms of hoarding.

People who have the disorder typically become extremely anxious when they must discard anything, from trash to treasures. They also continue to acquire home goods, collectibles, and clothing, even when there is no room left to put them. Before long, every space inside the home—including the shower, the bed, the kitchen and the bathroom—is clogged and covered by belongings. Bugs and vermin flourish in this mess.

The Johns Hopkins researcher believes that many hoarders are perfectionists. They fear making the wrong decision about what to keep and what to throw out, so they keep everything.

Indeed, according to the website, Clutter Hoarding Cleanup, “Trust is key when approaching a hoarder about [his or her] condition. It is important to remember that majority of those in need of hoarding cleanup services have suffered from a trauma [ … or psychological distress] that triggered the condition.Often, the services of a psychologist who specializes in hoarding can help the sufferer to accept the cleanup process.

Finally, animal hoarding is a specific version of the problem that involves collecting dozens, if not hundreds, of cats or dogs to “save them” from shelters. While the hoarder loves the animals, it becomes impossible for him or her to clean up around them—leading to progressively deteriorating conditions in the home and rampant illness among the animals. About 1,500 new cases are discovered nationwide each year, according to Tufts University Professor Gary Patronek.

Research contact: @GeraldNestadt