A Medical Student Blog

Unofficial thoughts on medicine and medical school

a “new” take on eggs — they’re not bad!

 Today, we had an AWESOME patient management class on syncope, loss of consciousness, with these wonderful clinical vignettes, which I hope to share with you soon.  But for this post, I wanted to make a quick note on eggs, because some of my friends are afraid of eating egg yolks, worrying that by doing so, they will boost their cholesterol levels, and give themselves heart disease.

So the good news: eggs, including egg yolks, in moderation (which is defined as 1 a day or 7 eggs/week) are safe and healthy and you don’t have to be scared of them:

http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/eggs/

 

 

The other important thing to clear up is that, often in health news, you hear about being careful with your cholesterol, HDL, LDL levels — “too high” of LDL, and that’s bad.   

 

It’s then easy then to assume that “eating” cholesterol is bad for you.

 

But there’s surprisingly little evidence to support that assumption.  In fact, it appears that there is no link between eating lots of cholesterol, and giving you heart disease.

 

That is what I concluded after I read a review article written by Harvard professors Frank Hu, Joanne Manson, Walter Willet, who are respected principal investigators of large-scale studies on nutrition, preventive medicine, such as the Women’s Health Initiative, and the Nurses Health Study.  I highlighted some of the passages in that article if you were more interested (for the full article, click here Fat, eggs and heart disease):

 

In controlled metabolic studies conducted in humans, dietary cholesterol raises levels of total and LDL cholesterol in blood, but the effects are relatively small compared with saturated and trans fatty acids, and individuals vary widely in their responses. A significant positive association between dietary cholesterol and CHD was found in some epidemiologic studies, but not in others. In a pooled analysis of four studies [5–7,11], the relative risk of CHD was 1.30 (1.10 –1.50) for a difference of 200 mg/1000 kcal in dietary cholesterol [124]. But this analysis included only those studies with positive findings. The Nurses’ Health Study found a weak and nonsignificant positive association between dietary cholesterol and risk of CHD (relative risk for each increase of 200 mg/1000 kcal 5 1.12, 95% confidence interval 0.91–1.40).

Surprisingly, there is little direct evidence linking higher egg consumption and increased risk of CHD…The null association between egg consumption and risk of CHD observed in these studies may be somewhat surprising, considering the widespread belief that eggs are a major cause of heart disease. One egg contains about 200 mg cholesterol, but also appreciable amounts of protein, unsaturated fats, folate, B vitamins and minerals. It is conceivable that the small adverse effect caused by cholesterol is counterbalanced by potential beneficial effects of other nutrients.

These findings do not suggest that one should go back to the traditional high cholesterol Western diet. Instead, they suggest that among healthy men and women, moderate egg consumption can be part of a nutritious and balanced diet. Because eggs are excellent and relatively inexpensive sources of essential amino acids and certain vitamins, they can substitute for other animal products such as red meat. These results also illustrate the danger of judging health effects of a food by single nutrients or components contained in the food.

 

June 24, 2008 Posted by | Health news, Nutrition | , , , , , , | 5 Comments

Strategies to Prevent and Treat Vitamin D Deficiency

Hi Everyone!   

Wow very sorry for not writing in such a long time.  It’s been a little difficult these days as second-year medical school has been much busier than I thought it would be.  I wanted to post up this table from Dr. Michael Holick’s New England Journal of Medicine review article (N Engl J Med 2007;357:266-81) on Vitamin D defiency and how to prevent it.   Basically, many many people we care about — 1 billion worldwide, have vitamin D deficiency.  It’s very sad, because not having enough vitamin D can contribute to many diseases — like osteoporosis, and even common cancers, autoimmune disease, infectious disease and heart disease.  Please if you get a chance, read the Holick article (http://www.uvadvantage.org/portals/0/pdf/NEJournalofMedicine.pdf).  And check out the following table, which is from that article, which can help you make some of your decisions together with your doctor.

Best wishes!

Jeff

Strategies

October 13, 2007 Posted by | Nutrition | , , , , , | 8 Comments

Fish Oil Saves Babies

 Dear All, 

If I had to pick one nutrient to tell you about, I’d probably start with fish oil and omega-3 fatty acids: get yourself a good bottle, or eat some flaxseeds, or wild deep sea fish!  Now.

But before I go on, you should know that I’m heavily biased.  Right now, I’m in a pediatric surgery lab at the Children’s Hospital of Boston, and the team here has seen firsthand how fish oil can save babies with short gut.  Plus, Dr. Bruce Bistrian, an esteemed professor of medicine and clinical nutrition, has been very kind to take about three hours explaining to me how fish oil works biochemically.  So, I guess you could expect that I’d be excited about fish oil.   But I am also aware that when people get excited, they can get incredibly carried away, like some authors of “superfoods” or “miraculous detox” books that you bump into at a bookstore. 

That said,  special things do happen, and I wanted to tell you a short story about it.  But I hope I don’t get carried away, and I hope can be objective…  

Prior to 2005, children with short gut, or more formally, “short bowel syndrome,” had a very difficult life.  Many of them couldn’t eat because their guts were too short, due to birth defects or injury.   Because their intestines weren’t functioning, nutrients had to be given intravenously through a process called “parenteral nutrition.”  Everyday, the children had to live with needles stuck into their veins in order to receive liquidized food formula – it was highly unpleasant.

The hope was that, while on parenteral nutrition, the babies’ guts could get healthy enough to start absorbing food.   Ever so often, however, the gut just never recovered, at which point the baby would have to rely on parenteral nutrition for an indefinite period of time.

When that happens, the outlook immediately dims.  Patients on long-term parenteral nutrition often develop serious liver problems that lead to death from liver failure.  The only option at that point would be a liver transplant.  It’s an option, but not a cure, and waiting on the transplantation list can be excruciating for parents.  If the babies did not get the transplant, they would die; this was the conventional wisdom for decades. 

But when 2005 came around, a medical team here in Boston with an inclination for fish decided they were going to give babies none other than…fish oil.  You might be wondering, where in the world did they get that idea?  And if it’s such a great idea, why did it take so long to figure out?  The team did previously test the idea on mouse models, which showed promise.  But perhaps more importantly, when faced with an emergency, you find new avenues of inspiration? 

I’m not sure what was the catalyst, but what I do know was that the fish oil worked.  Once the medical team started pumping omega-3 fatty acids into the babies’ veins, their livers started to heal — so much so that even extremely ill patients who were waiting for liver transplantations no longer needed transplants! 

All of the above that I said is true, and, at least for me, it’s exciting to learn about.  But I did want to take a step back and point out that more research needs to be done — randomized controlled trials, larger studies.  And I think it’s important to point out that patients with short gut — even if they are on fish oil and are doing much better than anyone could ever expect — still have to fight courageously.  Their families still have to be very supportive, and sadly, some patients, regardless of their omega-3 fatty acid status, will pass away from other health complications related to their short gut problems.  

Nevertheless, things are encouraging.  It’s not often that you’ll find a serious article, published in a serious medical journal, begin with the word “reversal” when describing the effectiveness of a treatment.  Typically, treatments don’t “reverse” disease.  They “ameliorate,” or “improve outcomes.”  Editors are usually careful to save lofty words for only the most dramatic encounters.   In this case, when it came time to submit the report of fish oil for publication, this was the title: “reversal of parenteral nutrition–associated liver disease.” 

And without any changes, the editors accepted it.

August 8, 2007 Posted by | Health news, Nutrition | , , , , , , | 4 Comments

Youtube Summary of Probiotics

Here below, you will see my amateur bad attempt to try to make this topic a little more fun to digest.

Main point #1: clostridium difficile is a serious, bacterial problem in the U.S., that can cause death.

Just today (4/30/07) our professor was telling us how four people died in the hospital of this infection last year. Usually it’s treated with antibiotics, but sometimes they fail — at which point, the outlook is grim for the patient. There is good news though! Patients could be potentially treated with probiotics (although a funkier version of probiotics). With Dr. Aas, he’s reported much success with this form of treatment when patients can’t fight off C. difficile with metronidazole or vancomycin (these are the common antibiotic treatments).

Main Point #2: Von Niel argues that probiotics should be considered a mainstream therapy (see the Von Niel reference).

There are enough randomized controlled trials out there to support such a statement. But it is slow to catch on in the U.S., possibly because it usually takes 17 years for new scientific discoveries to get widely disseminated (Balas & Boren, 2000).  For safety information on which strains are safe and who can take probiotics:http://www.ajcn.org/cgi/content/abstr… The authors noted: “We found that probiotics are safe for use in otherwise healthy persons, but should be used with caution in some persons because of the risk of sepsis.” 

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Probiotics (from Von Neil, 2005)

We definitely know it works for:

Acute infectious diarrhea
Prevention of antibiotic-associated diarrhea Conditions that are potentially treatable by probiotics:Chronic diarrhea
Inflammatory bowel disease
Irritable bowel syndrome
Food allergyConditions that are potentially preventable:Traveler’s diarrhea
Necrotizing enterocolitis
Urogenital infections
Atopic disease
Dental cariesFuture applications proposed for:
Cystic fibrosis
Rheumatoid arthritis
Cancers

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What is clostridium difficile? (from JG Bartlett, 2006)

It’s a nasty bacteria.

Who gets it?

If you’ve taken antibiotics, are of advanced age, or in the hospital or recently came from the hospital.

What’s the significance of this problem?

A new epidemic strain of C. difficile has emerged that causes more frequent and more serious disease.

What are some symptoms?

“Clinical disease and C. difficile toxin are present almost exclusively in patients with recent antibiotic exposure, with rare exceptions.” So if you’ve taken antibiotics, that increases your risk. Clinical expression of infection almost always includes diarrhea, but symptoms vary widely.

Common findings in patients with infection: 1) colitis (inflammation of the colon) with cramps, 2) fever 3) abdominal pain 4) fecal leukocytes (white blood cells in the stool) 5) and inflammation on colonic biopsy (if you do a biopsy of the colon).

Pseudomembranous colitis (a type of infection of the colon) represents an advanced stage of disease, and although considered “nonspecific,” it is nearly diagnostic of C. difficile infection.  The disease is almost always restricted to the colon.

A recent report implicates gastric acid–suppressive agents as a risk for disease, but this has not been consistently observed.

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How come my microbiology professor doesn’t think probiotics work?

“Frequently, years or even decades are required for laboratory discoveries to reach clinical practice. It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice” (Balas & Boren).

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Why the Healthcare System Should Care

Based upon their hospital’s rate of CDAD (clostridium difficile associated diarrhea) in 0.7% of discharges,they estimated that the total excess in US healthcare costs attributable to CDAD was likely >$1.1 billion.– from the Center for Disease Control.  Emerging Infectious Diseases • http://www.cdc.gov/eid • Vol. 12, No. 3, March 2006 

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References

Aas et al., 2003. Recurrent Clostridium difficile Colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clinical Infectious Diseases 2003; 36: 580-5

Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000

Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006 Nov 21;145(10):758-64. Review.

Savino et al., (Randomized controlled trial talking about probiotics and cholic) Pediatrics 2007;119;e124-e130

Van Niel Pediatrics 2005; 115; 174-177

Weisman et al., (talking about randomized controlled trial looking at probiotics and infections in day care centers) Pediatrics 2005;115;5-9

August 8, 2007 Posted by | Health news, Youtube Summary | , , , | 6 Comments