Monthly Archives: July 2013

Feces Transplant

Feces Transplant

Reference:  Jr. of Clinical Gastroenterology Khoruts June 2013

Yuck!  Warning.  You may be grossed out so just skip this week.  Or you may be fascinated.  Here are the facts about your colon.  90% of the cells in the human body are in the colon.  Said another way, there are 10 distinct cells in your colon for every cell in your body.  99% of the DNA variety is in your colon.  Said another way, you have 100 times the genetic variability of your own genes and DNA in the bacteria in your colon.  That variety and number come from the bacteria resident in your colon.

We thought the colon was just the organ than concentrated waste products and conserved water so that we could live on dry land.  How naïve!  There is a whole emerging science to the value of the “biome” or variety of DNA and bacteria in our colon and the contribution they make to our good health.  It is increasingly apparent that our colon biome acts like a separate organ.  Each of us has our own “condo association” that is determined in part by the food we eat, the first inoculation we had when we started life and all the other exposures and toxins we are exposed to during our lives.  As much as it may give you pause, each of us who started life with a vaginal birth breathed our first breath and opened our mouths to scream and cry with small amount of our mothers feces smeared on our faces.  Folks delivered by C-section don’t have that exposure.  When followed clinically, C-section babies have higher rates of allergic and autoimmune diseases years later.  We are also becoming increasingly aware of the contribution of nutrients that we extract from the biome of our colon.  Not just Vitamin K but the essential amino acids are all created by our colonic friends.  The interplay of our colonic biome and our immune system is the next frontier.

That’s where this weeks study comes in.  Dr Khoruts describes how he cures refractory C. difficile infections with a stool transplant.  C. difficile is a bacteria most of us likely have in tiny amounts in our gut.  When we alter the natural balance of bacteria in our gut with antibiotics, C. difficile occasionally blossoms and flourishes like nothing else.  It can often be controlled and contained by new antibiotics, but on occasion it can’t be.  Continued diarrhea and weight loss follow.  In this case, the C. difficile was cured almost immediately after many months of failure with other traditional therapies. What was the procedure? Simple.  A healthy donor, without  HIV or hepatitis who had a “healthy diet” and normal gut health gave a sample of stool that was diluted in normal saline and injected via a colonoscope into the colon, essentially transplanting a whole new biome of bacteria in such quantity that it took over from the traces of the host original damaged biome that couldn’t recover from the C. difficile infection.  This story has now hit the standard media.

Youtube is full of stories and anecdotes of people saving themselves from Crohn’s and Ulcerative colitis.   Are we moving to a world of discovery outside of traditional medicine?

WWW. What will work for me?  The worst damage to our own biome comes from taking antibiotics and eating lousy food. “Good food”, from a colons’ point of view has lots of fiber, vegetables, few sugars, healthy fats live coconut and olive oil, a wide variety of fruit and nuts.  Hmmm.  Sounds like a good healthy diet for all of us.  As the head of my own condo association, I’m going to make sure my fellow condo dwellers (my gut biome) are well cared for.  I’m having quinoa, ground flax and blueberries for breakfast, with coconut milk.  And if you want to know how to conduct your own transplant, give me a jingle.

 

Pop Quiz

1.  Your colon has more cells in it than the rest of the body by an order of  4,  10,  100,   1000?

Answer:   10 cells in your colon for every cell in the rest of the body

2.  The best estimate we have is that your have how much more distinct DNA genes in our colon compared to our body?   10 times, 30 times, 100, 200

Answer:  100

3.  We damage our colons’ biome when we take antibiotics?  T or F

True

4.  There are both traditional doctors and home inventors administering stool transplants with successful outcomes?  T or F

True

5.  You can protect and nourish your own biome most effectively by eating lots and lots of?   Sugar, french fries, ice cream, flax seed or green beans.

Answer:  Flax seed and green beans.

Do Omega Fatty Acids Cause Prostate Cancer?

Do Omega Fatty Acids Cause Prostate Cancer?

Reference:  Brasky, J Natl Cancer Institute July 11, 2013

Headlines! Fish Oil causes prostate cancer.  Oh dear.  Now what?  Is it real?  What did they find?  Here are the details.   After screening 800 men that went on to develop prostate cancer versus 1300 men that didn’t, comparison of blood omega-3 fatty acid levels showed that the men who had higher blood levels had a 43% increased chance of developing prostate cancer and 71% chance of getting aggressive prostate cancer.  The blood level indexes were in the range of 3.2% for the low group and 5.7% in the higher group.  It seems to have been a well-designed study that has lots of statistical power to it.  What to make of it?  It certainly made the headlines.

Here is my take on it and how to consider it.  First of all, it was an epidemiological study showing association, not causation.  Lots of other unintended forces could be going on in the background.  A similar epidemiological association view of prostate cancer could be to look at Japanese. They eat about 8 times the amount of omega 3 fatty acids.   They should all be dead from prostate cancer.  In North America, Caucasians have 63 deaths per 100,000 lives and African Americans have 102 deaths.  Japanese have 10 deaths per 100,000 lives.  Hmmm.

Secondly, the index levels of omega-3 weren’t very high.  A level of 5.7% isn’t that high.  In the Framingham study, folks not taking omega-3s had a 5.2% index and those taking it had 7.5%.  Framingham didn’t show an epidemic of prostate cancer in the high consumption group, even with a much higher index.

How about relative risk from the beneficial effect of fish oil on heart disease compared to prostate cancer?   American men die at 7.4 times the rate from heart disease than they do from prostate cancer (even though 60% of us have it on autopsy at death at age 80).   If fish oil reduces risk of heart disease by a conservative 10% (considering the recent NEJM article downplaying the value of fish oil) and increases prostate cancer by 50%, the beneficial ratio would still 4.4 times more chance of heart disease over prostate cancer, still leading to relative benefit.   This is a crude analysis, but you get the gist.

Finally, there are about 5-6 studies that also show the opposite finding including some by Brasky himself with Grapeseed oil (another omega 3).  His interest in omega fatty acids is real and he certainly has been looking.  What to make of this careful and well designed study?

WWW. What Will Work for Me?  This is how science works.  It’s uncomfortable.  We find new ideas only by publishing well-designed research and following the conclusions.  My hunch is that this is a blind alley with confounding factors not considered playing a role. Vitamin D wasn’t measured, for example.  I’m still taking my two grams of DHA and EPA a day.  I’m not getting too worried yet.  The Japanese also eat natto and get huge amounts of K2 by so doing.  That I can’t do.  I’m just taking my K2 supplement.  Maybe that’s why they don’t have prostate cancer.  We’ll see.   But it caught my attention.

 

Pop Quiz

1.  Braskey found, in a well designed study, that men who had the highest omega-3 index had a 41% increased risk of developing prostate cancer.  T or F

T.  In a nutshell.

2.   This study proves that prostate cancer is caused by eating too much fish?  T or F

False in the strongest terms.  It’s an association study.  Many other confounding factors could be making the effect

3.   Japanese men have much more prostate cancer than American men and eat much more fish.  T or F

They have about 15% of the prostate cancer we have in America, suggesting an opposite conclusion to this study.  They do eat a lot more fish.

4.   American men’s risk for prostate cancer is greater than their risk for heart disease.  T or F

False.  It’s much lower.  50% of American men die from heart disease.  Prostate cancer is number ! for men, but still not as common as heart disease.

5.  You should stop taking fish oil.  T or F

False, but you should pay attention. This study could be opening the door to a new idea.

Vitamin D and Hypertension Risk

Vitamin D and Hypertension Risk

Reference: European Genetics Conference in Paris, Jun 2013

It’s summer, the sun is out, we are all outside playing in the beautiful sunshine.  And getting our Vitamin D.  That means we are lowering our blood pressure.  At least according to Dr. Karani S, the lead researcher in the University College, London study.  Because there have been many inconsistent findings about Vitamin D and cardiovascular risk, the research team decided to pool every study they could find that was of sufficient quality and bring a whole new methodology of study to settle the issue of causality.

This is a powerful new tool in genetics.  Taking genetic variability in human and measuring “SNPs”, or “Snips”, (single nucleotide polymorphisms) they tested for a causal relationship between Vitamin D status and hypertension.  The tool they called Medelian randomization allows cause and effect conclusions to be identified despite the many confounding background problems like actual blood levels, skin type, time of year, level of blood pressure and all the other variabilities that make for a such complexity that clear conclusions get lost.  As we get better at studying SNPs and our genes, more research of this type might be forthcoming.  “Mendelian Randomization”.

This study took 35 studies with 155,000 participants in them.  That makes it pretty credible because of its size.   The conclusion was clear.  For every 10% increase in Vitamin D blood level, there was an 8.1% decrease in risk of developing hypertension.

How does this translate into everyday life?  In Wisconsin, most of us have Vitamin D levels that are higher in the summer than in the winter.  We vary from levels of about 40 ng in the summer with Caucasian folks who have skin that tans but can burn (Skin Type III) and who get outside and garden, play golf, bike and hang out at the pool to 12 ng for folks with Skin Type V (most African Americans).  Asians, middle Eastern folks and Hispanics with variable skin pigment levels have variable sun absorption qualities somewhere in-between.   In the winter, we drop down to 15 ng for Caucasians, and 6 for African Americans.

My level was 7 ng when I first measured my Vitamin D level some 10 years ago.  My blood pressure was in the 130s.  My blood pressure today is usually in the 115s.   I am a knowledge worker who is usually indoors and my dermatologist makes sure I’m covered up to protect me from any more skin cancer.  When I garden, it’s usually in the late afternoon or evening, or early morning.   I’ve seen Vitamin D drop many peoples’ blood pressure in the range of 5-10 points.   I believe this research.

WWW.  What will work for me.  I’m getting older so my skin doesn’t make the D it used to.  So I take my supplement every day.  I want a blood level somewhere in the 50-60 ng range which requires me to be on about 5,000 IU a day.  We know that is the equivalent of about 5 minutes of sunshine. (At age 20, skin type III makes 1000 IU of D a minute)  Be wary of those who tell you that anything over 800 IU a day may be toxic.  They are telling you, usually with great sincerity and a very straight face that more than 10 seconds of sunshine might be toxic.  (Be sure to run from your car to your house so you don’t get toxic blood levels! Tongue in cheek.)  If you have skin pigment of a variable degree, please, please, please don’t stop at 800 IU a day. You MUST be on more D.  If you are African American in Wisconsin, this could explain part of the runaway epidemic of hypertension in the AA community.

 

Pop Quiz

1.  If you have more Vitamin D in your blood, your risk of developing high blood pressure drops.  T or F

True. You got the gist of it.

2.  Caucasians with light skin absorb more sunlight and make Vitamin D faster than folks with skin pigment.  T or F

True.

3.   African Americans in Milwaukee have more hypertension than Caucasians.  T or F

True.  This is clearly not sufficient to make it a pure causal connection but it sure could be part of the picture.

4.  For every 10% increase in Vitamin D, the risk of hypertension goes down 8%.  T or F

True.

5.   The Institute of Medicine recommends 800 IU a day for bone health.  Many health care systems in Milwaukee warn against higher levels.  They are being too timid to your detriment.  T or F

True

6.  Innovation in health care takes 17 years to get from research to the bed side.  Your health care system may be slow.  Do you want to wait?

No.  Take the D

Silver Antibiotic, Rediscovered

Silver Antibiotic, Rediscovered

Reference:  Science Translational Medicine, July 19, 2133

This isn’t a huge study but it is very interesting.  Dr Morones-Ramirez and colleagues show that silver makes some antibiotics work better when applied to mice with lab induced gram negative infections.   That’s interesting.  Silver was also shown to help break up biofilms in which bacteria can survive the effects of antibiotics.  Biofilms are layers of protein, cells and fibrin that form in parts of the body that antibiotics can’t easily penetrate.   I got interested when I heard a lecture on it from the PhD of Microbiology for NASA who is worried about bacterial resistance on the space station.  It’s a problem having resistance on 2 year missions to Mars.

How does silver work?  In very delicate suspension where silver is formulated with just 4-5 atoms together, it can penetrate bacterial, fungal and viral membranes and denature their DNA.  There is no resistance to that.  Human (and all mammal) membranes resist silver penetration so we are not prone to DNA damage.  We are plagued with antibiotic resistance right now and are running out of effective antibiotics. This makes silver a big deal.  And it’s not new.  Roman soldiers used to put a silver coin in their animal skin water bottles so that no bacteria would grow and the water would stay fresh.  American soldiers in Afghanistan have silver in their uniforms so that, if injured, they have silver applied to their wound early.  Emergency doctors have applied silver sulfadiazine to burns for the last century.

You can make those silver suspensions at home but you risk making formulations that don’t have the delicate balance of just a few atoms. When you take too much colloidal silver, you risk turning “blue”.  (Scroll down).   Other than the blue color, silver is not exactly toxic.  For those who haven’t seen Smurfs before, they are real.

But it’s pretty clear that the stuff works.  Giving it IV is quite a delicate matter as it lasts just seconds and has to be infused very slowly so as not to damage your red cells with the water it’s suspended in.  It only last about 10-15 seconds in your blood before it is all taken up and disposed of. When properly formulated, you can take about 50 ccs a day, every day of your life and only get to 10% of toxicity – because the effective proper dose is so dilute.

Silver has been around a long time.  Why isn’t it being used more?  Several reasons are likely. First, it’s very hard to give internally as it has to be given so slowly and carefully.  My belief is more focused on the second reason.  The amount you give is so tiny, you are getting such miniscule amounts that it doesn’t cost much, and hence has no profit attached.  You can’t patent a mineral.  Not many pharmaceutical companies want to pursue a strategy with little profit.

WWW.  What will work for me.  I’ve tried a couple of treatments on myself.  I got two identical blisters on both my feet from an imprudent 5 mile hike in Crocs with no socks.  The silver treated side got better in half the time.  So, I keep a tube of it around the house.  I’m pretty sure I won’t turn blue with that dosing, but I’m not throwing out my silver polish just yet.  If you want to give it a try, we have it in the office for sale.  It’s cheap, and soothing.  Now, the oral stuff, that’s another whole story.

 

Pop Quiz

1.   Silver coins can be used to prevent infections.  T or F

Probably false.  Romans used to carry a coin in their animal skin water bottles to prevent water going bad, but that’s the best we know.  There are reports of Roman soldiers looting water bottles instead of weapons.  Priorities, you know.

2.  Silver can penetrate the membranes of bacteria, viruses and fungi.  T or F

True. That’s how it works.

3.  Mammalian membranes aren’t penetrated by silver.  T or F

True.

4.  We have used silver in modern medicine in burn units, in newborn eye drops and other topical antibiotics?  T or F

True

5.  Too much silver ingested orally with improperly prepared solutions can lead you to look like Papa Smurf.  T or F

True. Strange, but true.

6.  Silver may have some promise as a future IV antibiotic.  T or F

May. We need something