NEW CAUTION WHEN CONSIDERING ANTACID MEDICATION

prilosec

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of  the most common form of stroke (“ischemic stroke”), according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.

“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia,” said Thomas Sehested, MD, study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”

Researchers analyzed the records of 244,679 Danish patients, average age 57. During nearly six years of follow up, they assessed stroke rates while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium)., all being obtainable over the counter in the U.S.A.

For ischemic stroke, researchers found:

  • Overall stroke risk increased by 21 percent when patients were taking a PPI.
  • At the lowest doses of the PPIs, there was slight or no increased stroke risk.
  • At the highest dose for these 4 PPI’s, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
  • There was no increased risk of stroke associated with another group of acid–reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

The study corrected for age, gender and medical factors, including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke. The authors suggested that their findings, along with previous studies, should encourage more cautious use of PPIs. .
“At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.”

Since it was an observational design, this study could not definitively establish cause and effect between PPIs and strokes. For this reason, the authors believe that a randomized controlled trial of PPIs and cardiovascular disease is warranted.

In the meantime, how should each of us respond to this information? First, we should carefully consider whether use of PPIs is warranted at all, and for how long:

Given the relative safety of the H2 blockers such as Zantac and Pepcid, they should be tried first after ordinary antacids such as Mylanta, Di-Gel, Gelusil, etc. are tried and found wanting. Only then should we consider the PPIs, and used for as brief a period as possible.

 

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UNIFYING THE NATION: A SUGGESTION

   As a physician, I have always been concerned with health—usually of the individual’s body and/or mind. Presented with a recent and blatant disregard for fairness in politics, I am very concerned about the health of our nation as a whole. What I write below should be of concern to all.

If you agree with me, please share this message with as many contacts as possible. Maybe we can make a difference!

                 OPEN LETTER TO DONALD TRUMP

After a divisive campaign that has threatened to leave sharp divisions in this country, you have now professed, in conjunction with your recent rhetoric, that you wished to unify this nation and provide a leadership for all Americans — no matter what race, religion, gender, or political party.

If this is your true wish, I have an important suggestion for you that will set you on this path and involve little risk to you or your party. Simply express your support for the appointment of Merrick Garland to the Supreme Court of the U.S.A.

Let’s look at the reasons for my suggestion: After graduating from Harvard College and Law School with high honors, he practiced corporate litigation and worked as a federal prosecutor in the U.S. Department of Justice, where he played a leading role in the investigation and prosecution of the Oklahoma City bombers. He later returned to public service in 1989, becoming an Assistant U.S. Attorney in the U.S. Attorney’s Office for the District of Columbia. As a prosecutor, Garland represented the government in criminal cases ranging from drug trafficking to complex public corruption matters.

In 1995, after being nominated to the vacated D.C. Circuit Court, the American Bar Association (ABA) Standing Committee on the Federal Judiciary gave Garland a “unanimously well-qualified” committee rating—its highest.   On January 7, 1997, Garland was renominated  for the Circuit Court, and he was confirmed in a 76–23 vote. The majority of Republican senators voted to confirm Garland, including Senators John McCain, Orrin Hatch, Susan Collins, and Jim Inhofe.

After the April 2010 announcement by Justice John Paul Stevens that he would retire, Garland was again widely seen as a leading contender for a nomination to the Supreme Court of the United States. President Obama interviewed Garland, among others, for the vacancy. In May 2010, Senator Orrin G. Hatch, Republican of Utah, said he would help Obama if Garland were nominated, calling Garland “a consensus nominee” and predicting that Garland would win Senate confirmation with bipartisan support. Obama instead nominated Solicitor General of the United States Elena Kagan, who was confirmed in August 2010.

On March 11, 2016, Senator Orrin Hatch, president pro tempore of the United States Senate and the most-senior Republican Senator, predicted that, although President Obama would name someone the “liberal Democratic base” wanted, he “could easily name Merrick Garland, who is a fine man”. Five days later, on March 16, Obama formally nominated Garland for Supreme Court Justice. Garland is considered a judicial moderate and a centrist. Tom Goldstein, the publisher of SCOTUSblog, wrote in 2010 that “Judge Garland’s record demonstrates that he is essentially the model, neutral judge. He is acknowledged by all to be brilliant”.

On March 16, 2016, President Obama nominated Garland to serve as an Associate Justice of the Supreme Court, to fill the vacancy created by the death of Antonin Scalia. To date, the Senate has not held a hearing or vote on the nomination, since the Senate Republicans have refused to consider it. Inasmuch he has already been vetted and believed to be highly qualified by both parties, his rejection has been clearly intended as a Republican repudiation of President Obama.

So now, Mr. Trump, the ball is in your court. Here is your chance to start the unification process by supporting the appointment of a truly gifted and centrally oriented justice, already recognized as an outstanding choice by both parties and providing a unifying force for all Americans! Put in your own parlance, what do you have to lose?

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DIETING: DON’T FORGET HUNGER

hunger

Throughout the evolution of all species, including humans, food intake has been governed primarily by the sensation of hunger. This may explain why obesity is seldom encountered in animals. Although records are obviously limited prior to the dawn of civilization, human obesity is likely also to have been rare. Thus it is likely that, when guided by the primordial sense of hunger, all bodies will likely respond with the attainment of a normal food intake and weight. Also, when combined with a large requirement of physical work through antiquity, humans were destined to keep food intake and caloric consumption in a delicate and proper balance.

For at least the past century, our dietary intake has been largely decoupled from hunger for a variety of reasons. We often adhere to regular “eating hours” such as noon for lunch, meals are often centered on social functions rather than hunger, snack foods are easily available when sitting to watch TV, with the addition of a “yummy” dessert, we often exceed eating requirements beyond the point of satiation, and the list goes on and on. Compounding this problem further, requirements for physical effort have been greatly reduced for obvious reasons.

So what am I trying to say? If our food intake were governed solely by hunger and limited by satiation, a large component of weight control would be in place, and any diet strategy would be more apt to succeed if this principle were observed.

This hypothesis has been recently tested by experimental data appearing in a 2016 study in the American Society for Nutrition entitled “Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population.” The study compared the so-called “intuitive eating, i.e., eating in response to physiological hunger and satiety cues rather than emotional cues, termed “unconditional permission to eat”. Prior evidence had supported the idea that such intuitive eating was associated with lower body weights, but little was known about its association with food intake per se.

The study noted above included a total of 9581 men and 31,955 women aged ≥18 years. Eating patterns were assessed by using a validated version of a detailed intuitive eating scale derived from dietary records over a six year period. The associations were compared between intuitive eating and unconditional permission to eat, and food intakes were assessed by statistical analysis.

Results from this study were quite illuminating: In women, higher physical reasons scores were associated with lower caloric intakes. Also, a higher physical reasons score was associated with lower sweet- and fatty-food intake in both women and men, as well as lower intakes of dairy products, meat, fish, and eggs, and a higher whole-grain intake in women. In contrast, higher intuitive eating scores were generally associated with a higher caloric intake that contained lower fruit, vegetable, and whole-grain intakes.

The conclusion of the study: Physical hunger is associated with healthier dietary patterns with better weight control, whereas the so-called “unconditional permission to eat”, was associated with unhealthier diets. From a public health perspective, these findings suggest that we all should be eating primarily in response to hunger and satiety signals rather than the myriad of emotional/social signals. What remains to be proved, however, is, whether those individuals already controlled by emotional factors can be converted to a dominant pattern of food consumption in response to hunger

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EATING TIMES AND OBESITY

obese

The first human test of early time-restricted feeding is showing that this meal-timing strategy may help reduce swings in hunger and altered fat- and carbohydrate-burning patterns.

In early time-restricted feeding (eTRF), individuals eat their last meal by the mid-afternoon and do not eat again until breakfast the next morning. In a recent new study, researchers found that eating only during a much smaller window of time than people are typically used to may help with weight loss.

Researchers at the University of Alabama found that eating between 8 am and 2 pm followed by an 18-hour daily fast kept appetite levels more even throughout the day compared with eating between 8 am and 8 pm. The findings suggest that eating a very early dinner, or even skipping dinner, may have some benefits for losing weight. The body has an internal clock, and many aspects of metabolism are at their optimal functioning in the morning. It is theorized that eating in alignment with the body’s circadian clock by eating earlier in the day may positively influence health.

The current study of eTRF suggests this eating pattern may affect metabolism. This first test of eTRF in humans follows rodent studies of this approach to weight loss, which previously found that eTRF reduced fat mass and decreased the risk of chronic diseases in rodents.

The researchers conducted a study with 11 men and women between aged 20 to 45 years (mean age: 32 years). All participants were followed over 4 days of eating between 8 am and 2pm (eTRF), and 4 days of eating between 8 am and 8 pm (average feeding for Americans). The researchers then tested the impact of eTRF on calories burned, fat burned, and appetite.

To eliminate subjectivity, the researchers had all participants try both eating schedules, consuming the same number of calories both times, and completing rigorous testing under supervision. They found that although eTRF did not affect how many calories participants burned, it reduced daily hunger swings and increased fat burning during several hours at night. It also improved metabolic flexibility.

This type of information opens up an intriguing possibility for those wishing to lose weight—nearly the entire population. Early dining during the afternoon hours not only reduces eating to twice daily but also allows for the avoidance of later crowds in restaurants. But, to be successful, this approach must not include a bedtime snack, difficult for many people!

 

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