rosanna.feroldi | MY SPECIAL DOCTOR

Antibiotic resistance worsened by environmental sanitation

18 February 20246 January 2024 by rosanna.feroldi

Antibiotic resistance, that is, the growing ability of pathogenic bacteria to survive in the presence of the drugs that are supposed to kill them, is one of the greatest challenges facing medicine today and on whose victory the chances of survival of humankind in the coming decades depend.

For those born in the era of antibiotics, it is difficult to realize this emergency, but to find oneself out of the blue without medication that can fight infectious diseases as severe as tuberculosis, pneumonia or bacterial gastroenteritis means being exposed to a very high risk of epidemics capable of claiming millions of lives and extremely difficult to contain.

In an effort to limit the spread of bacterial resistance, for more than two decades, the World Health Organization and other health institutions internationally recommend using antibiotics cautiously, sparingly, and properly: that is, only when essential, at the dosages and for the time period prescribed by the doctor, and never on a do-it-yourself basis.

However,antibiotic resistance can also be promoted in non-health care settings. The best known of these is animal farms, where antibiotics are often used to protect livestock from infection. New evidence now indicates that the hygiene of closed environments such as homes and offices can also facilitate the selection of “super-bacteria.”

Specifically, research recently published in the scientific journal Nature Communications reports that in the enclosed rooms of buildings of any type, the biodiversity of bacteria is less than that typical of the outdoor environment (urban or natural), and that the strains less sensitive to commonly used antibiotics are more likely to be represented.

According to the researchers, this finding may be a consequence not only of the type of occupancy and human activities carried out in the buildings and the more or less pronounced isolation from the outside environment, but also of the products and methods used to clean the surfaces. In particular, it is hypothesized that theuse of broad-spectrumantibacterial detergents may play an unfavorable role, rewarding the “stronger” bacteria that would be able to multiply prevalently.

Given that domestic cleanliness, the premises and buildings frequented by many people is indispensable to prevent diseases and hygiene problems of various kinds, to avoid promoting bacterial resistance in enclosed environments, researchers suggest alternating the cleaning substances used (so that bacteria cannot habituate) and reserving overtly antibacterial products for circumscribed places deserving of increased disinfection (bathrooms, kitchen countertop, garbage compartment, etc.).

Other useful measures include using steam to sanitize surfaces that can tolerate high temperatures, putting plants in rooms (avoiding those most at risk of allergies), and increasing indoor-outdoor exchanges (for example, opening windows often).

Source

Mahnert A et al. Man-made microbial resistances in built environments.

Nature Communications 2019;10:968. doi:10.1038/s41467-019-08864-0 (https://www.nature.com/articles/s41467-019-08864-0)

Physical and cognitive activity protect women’s brains

18 February 20246 January 2024 by rosanna.feroldi

Any physical and cognitiveactivity performed by women around age 40-55 can protect intellectual function in later life years, reducing the risk of developing cognitive decline and dementia of various types and levels of severity. Had you already been told this? Most likely, yes, because there have been many studies in this area conducted in recent decades.

The added value inherent in the results of the research conducted at the University of Gothenburg (Sweden) is the particularly long observation period (follow-up was as long as 44 years) and the clarification of the protective effects of physical and cognitive activity against vascular dementia and Alzheimer’s disease, respectively.

The study, recently published in the peer-reviewed journal Neurology, involved 800 women with a mean age at enrollment of 44 years (in the range of 38-54 years), selected from the general population. For all participants, intellectual, artistic, manual, social, religious and sports activities habitually performed were recorded at the beginning of the evaluation, and periodic monitoring of cognitive performance was, therefore, initiated from 1968 to 2012.

During follow-up, 194 women were diagnosed with dementia, 102 with Alzheimer’s disease, 27 with vascular dementia, 41 with mixed dementia, and 81 with dementia associated with cerebrovascular disease. All diagnoses were made based on the criteria provided in the reporting period, taking into account the outcomes of neuropsychiatric interviews, visits and examinations, data collected in medical records and patient registries.

Analysis of available information showed that, in general, women who remain intellectually active between the ages of 40 and 55 have a reduced risk of developing a form of dementia by about one-third (-34%). The protection was found to be particularly pronounced against Alzheimer’s disease, the occurrence of which would be practically halved (-46%) compared to women who were less inclined to read, study, listen to music, take classes, attend museums, go to the theater or movies.

Even more favorable has been shown to be the impact o fexercise, particularly against mixed dementia and cerebrovascular disease-related forms. In fact, the risk of developing the former was found to be 57 percent lower among the more physically active women, while the risk of developing dementia related to cerebrovascular disease was found to be 53 percent lower.

The magnitude of these preventive effects is surprising, to say the least, when one considers that, at present, medical has very few weapons (moreover, of very limited effectiveness) to protect against these neurodegenerative diseases, and that the outcomes cited were obtained after excluding major confounding factors such as educational level, socioeconomic status, presence of hypertension, diabetes or cardiovascular disease, body weight, smoking, stress and depression.

Of course, more confirmation is needed before we can come to any firm conclusions, but in the meantime, it’s worth banishing all laziness and trying to keep as intellectually and physically active as possible, shall we?

Source

Najar J et al. Cognitive and physical activity and dementia. A 44-year longitudinal population study of women. Neurology 2019;92:e1322-e1330. doi:10.1212/WNL.0000000000007021 (https://n.neurology.org/content/92/12/e1322.long)

Drug excipients: inactive, but not for all

18 February 20246 January 2024 by rosanna.feroldi

The excipients, that is, “biologically inert” substances added to a drug to improve their taste, color, absorption efficiency, mode and time of action in the body, are generally considered safe and harmless for those taking them, following favorable outcomes of countless tests conducted over decades and extensive use in clinical practice.

However, what is true for many people is not true for everyone. A recent research conducted in collaboration between two prestigious U.S. research centers, the Massachusetts Institute of Technology and the Brigham and Women’s Hospital – Harvard Medical School of Boston, indeed indicates that many of the theoretically “inactive” compounds contained in a tablet, capsule, effervescent powder or syrup may, in fact, be the source of intolerances, allergic reactions and hypersensitivity in susceptible patients.

In most cases these are not serious reactions, often being limited to headaches, gastrointestinal complaints, itching or other dermatological manifestations. However, these drawbacks may lead to discontinuation or discontinuation of necessary treatment (reducing its effectiveness) or may worsen the underlying disease they are supposed to treat, especially in people who are more frail and debilitated or who have to take many different medications at once, such as the elderly.

For example, an excipient that causes gastrointestinal discomfort such as nausea or diarrhea may prevent adequate nutrition or absorption of needed nutrients in the intestines, while an “inactive” compound that induces nighttime itching may hinder rest and promote fatigue and a sense of malaise during the day.

Unfortunately, although all substances contained in a drug are listed by law in the package insert, it is not so easy for either the person taking it or the prescribing physician to have a full understanding of the associated risks, since the dosages of individual excipients are not reported and many compounds become potentially harmful only as a result of accumulation with continued use and not after one or a few intakes.

Moreover, for most of the drugs containing the same active ingredients (i.e., compounds actually endowed with therapeutic activity) there are countless different formulations containing different excipient mixes, which have further multiplied since the introduction of equivalent drugs. How to solve the situation?

According to the researchers, action needs to be taken mainly on two fronts: at the level of pharmaceutical companies, efforts should be made to develop new formulations of drugs in use, paying close attention to avoidance of excipients not necessary potentially allergenic/sensitizing (dyes, flavors, lactose, gluten, lecithins, FODMAP sugars, etc.); at the legislative level, forcing Indicate more precisely all excipients used in the package inserts.

A third and no less important aspect concerns the rational and conscious use of medications by patients, who should use medicines of any kind (over-the-counter or prescription) only in cases of actual need, respecting the directions given by the doctor or found on the package insert regarding timing and dosage, and reporting to the doctor or pharmacist any unanticipated adverse reaction, to enable more timely pharmacovigilance.

Source

Reker D et al. “Inactive” ingredients in oral medications. Science Translational Medicine 2019;11(483):eaau6753. doi10.1126/scitranslmed.aau6753 (http://stm.sciencemag.org/content/11/483/eaau6753.abstract)

Childhood obesity: two “household” risks

17 February 20246 January 2024 by rosanna.feroldi

Sitting for too long in front of a computer screen, TV, smartphone or tablet or playing playstation, especially with a high-calorie snack in hand, puts children and adolescents’ fitness and health at risk.

A conclusion that certainly is not surprising and could have been easily predicted even without doing an ad hoc study that comes from theEndocrine Society‘s congress, ENDO 2019, held in New Orleans, USA, March 23-26. But you know, science has to measure phenomena before it can state anything.

Thus, we now know “for sure” that the guys who maintain these habits, in spite of the invitations from parents to unplug and engage in more dynamic pastimes, they are exposed to a risk not inconsiderable to accumulate extra pounds and early development of metabolic syndrome, a condition given by the simultaneous presence of overweight (especially concentrated at the abdominal level), hypertension, hypercholesterolemia, and hyperglycemia/diabetes type 2 (the typical adult one, mostly resulting from an incorrect lifestyle).

In the research, which analyzed the usage habits of technological devices and lifestyle of nearly 34,000 Brazilian adolescents (average age 14.6 years), spending more than 6 hours a day sitting in front of a screen resulted in a 71 percent increased risk of metabolic syndrome compared to those who sat less.

Since metabolic syndrome is associated with a significantly increased risk of developing cardiovascular disease, and that problems on this front increase over time, it is crucial that parents who recognize excessively sedentary behaviors of their children, especially when associated with disordered and unhealthy eating, intervene immediately with appropriate measures to modify the lifestyle. Agreed: it is not easy, but it is important. And setting a good example helps.

A second, decidedly less obvious piece of news coming out of ENDO 2019 concerns the potential weight-shape implications for children, adolescents, and adults of exposure to chemical compounds that accumulate in indoor dust.

Based on analysis of dust collected by researchers at Duke University’s School of the Environment in Durham, U.S., in 194 North Carolina homes, about 70 percent of the 100 chemical compounds in the household dust would appear to be able to promote the development of adipocytes, which are the cells in which subcutaneous fat is deposited in the human body.

In essence, this means that the substances that accumulate in our homes may make us gain weight more easily. The finding, at present, has been obtained in cellular systems and should, therefore, be considered as basic biological information to be further investigated in complex organisms. However, this is a very interesting indication because it may suggest a non-food and external mechanism outside the body that can promote the development of overweight and obesity.

Source

Annual meeting of the Endocrine Society – ENDO 2019, March 23-26 New Orleans (USA):

https://www.endodaily.org/study-shows-increased-risk-of-obesity-tied-to-unhealthy-snacking-coupled-with-extensive-screen-time-in-teens/
https://www.endodaily.org/researchers-link-chemicals-in-household-dust-to-fat-cell-development/

Too much stress and too little sleep enemies of the heart

17 February 20246 January 2024 by rosanna.feroldi

Several studies on this have already been done, but new evidence and quantification of the cardiovascular risk associated with excessive stress at work and at the sleep poor, taken singly or in combination, reported by the group coordinated by Karl-Heinz Ladwig of the German Research Centre for Environmental Health – Technical University in Munich, Germany, cannot go unnoticed, especially if you have high blood pressure.

Based on data obtained from the analysis of nearly 2,000 workers hypertensives between the ages of 25 and 65, in fact, those who are subjected to occupational stress and suffer from sleep disorders have a risk of death from cardiovascular causes as much as three times higher (+300%) than those who have relative job serenity and sleep well. And this is in the absence of aggravating risk factors such as metabolic syndrome, diabetes or known cardiovascular disease.

Even taken alone, work stress has anything but beneficial effects on the cardiovascular system, being associated with a 1.6-fold (+60%) increase in the risk of death from cardiovascular causes, while if fragmented and/or insufficient sleep is present in the absence of work stress, the increase in the risk of death from cardiovascular causes is 1.8-fold (+80%), compared to those affected by neither problem.

In absolute terms, over an 18-year follow-up period, work stress and inadequate sleep were associated with a risk of death from cardiovascular causes of 7.13 per thousand person-years compared with 3.05 per thousand person-years of those who are not stressed and sleep well, 4.99 per thousand person-years of those who are only stressed, and 5.95 per thousand person-years of those who sleep poorly without the work stress component.

The authors of the study point out that job stress is established in situations in which the worker is required to perform at a high level of performance with little or no decision-making power, that is, when in addition to being under pressure, one is also forced to carry out orders, without having a voice. Conversely, even a heavy workload can be irrelevant or beneficial to health if you can be in control of the situation and choose for yourself how to act.

Job stress is often associated with difficulties in fall asleep and to early awakenings that leave ample room for prolonged ruminations on the difficulties and frustrations of the day that has just passed or that will have to be faced after the alarm clock sounds, preventing the physiological stand-by that the cardiovascular system needs to stay healthy. If the situation involves short periods (days or weeks) it is not a big problem, but if it goes on for a long time (years) the matter changes dramatically, and the risks increase.

To avoid problems it is essential to act on both fronts, because while it is true that stress disrupts sleep it is equally true that unsatisfactory sleep makes one more nervous and prone to develop anxiety and stress. In particular, experts from the European Society of Cardiology (ESC) suggest:

Learn relaxation techniques and use them several times a day;
Follow a healthy lifestyle (balanced diet and regular physical activity);
Avoid smoking, alcohol and stimulants (excess caffeine, energy drinks, etc.);
Maintain regular rhythms and fall asleep and wake up at fixed times;
Identify personal strategies to reduce work stress;
Improve social relationships and increase leisure time;
If sleep does not improve, seek the help of a Sleep Medicine specialist;
If anxiety and stress are frankly excessive and difficult to control independently, seek psychological support.

Source

Li J, Atasoy S, Fang X, Angerer P, Ladwig KH. Combined effect of work stress and impaired sleep on coronary and cardiovascular mortality in hypertensive workers: The MONICA/KORA cohort study. Eur J Prev Cardiol 2019; doi:10.1177/2047487319839183.

Chronic constipation related to vitamin D deficiency

17 February 20246 January 2024 by rosanna.feroldi

Difficulty going to the bathroom, feeling of fullness and abdominal discomfort, bloating and flatulence; sometimes, cramping. These are all typical symptoms of a condition, constipation, that everyone has undoubtedly experienced more than once in their lifetime for a wide variety of reasons. Stress, disordered eating, inadequate fluid intake, travel, drug therapies that interfere with bowel motility, pregnancy, etc. are just some of the most common causes, which generally occur occasionally and persist for short periods.

For some people, however, constipation can become a faithful and persistent companion, without being able to identify a factor that can justify it and on which to act to alleviate the discomfort. In these cases, we talk about chronic functional constipation: a condition that primarily affects the elderly and women and is usually associated with a significant reduction in quality of life, as well as increased health care expenditures for visits and examinations, often unhelpful therapies, and treatments to manage possible complications.

A recent Italian study, conducted in collaboration between the“Xavier de Bellis” Hospital of Castellana Grotte (Bari), the University of Bari and the University of Chieti-Pescara, indicates that chronic functional constipation may be related to low levels of vitamin D in the blood, suggesting a new possible strategy to alleviate their discomfort, based on the supplementation of this essential vitamin to protect bone health, immune system function, maintenance of good mood, and many other key organic functions.

In the study, 86 patients with chronic functional constipation and 86 healthy subjects with overlapping demographic and general clinical characteristics (85% women; mean age 50 years) were evaluated with respect to intestinal motility/functionality, possible dysbiosis (alterations in composition of the intestinal microbiota) and plasma levels of 25-hydroxy-vitamin D (25-OH-D). In addition, all participants were assessed on mood and quality of life.

The analysis showed that patients with chronic functional constipation had significantly lower plasma levels of 25-OH-D than controls with normal bowel function and that vitamin D deficiency was a significant risk factor for chronic functional constipation even after removing possible confounding factors. In addition, reduced bowel function was accompanied by symptoms of anxiety and/or depression and reduced quality of life.

Pending the understanding of the mechanism underlying the correlation between reduced bowel function and vitamin D insufficiency, the researchers suggest measuring plasma levels of 25-OH-D in all patients with chronic functional constipation and, if deficits are found, compensating for them with targeted vitamin D supplementation, which is also certainly beneficial in terms of bone and immune metabolism, especially among postmenopausal women and the elderly.

Source

Panarese A et al. Chronic functional constipation is strongly linked to vitamin D deficiency. World J Gastroenterol. 2019;25(14):1729-1740. doi:10.3748/wjg.v25.i14.1729 (https://www.wjgnet.com/1007-9327/abstract/v25/i14/1729.htm)

More effective double support for smoking cessation

17 February 20246 January 2024 by rosanna.feroldi

Two is better than one. A rule that is true in many cases and remains true when it comes to quitting smoking. No small feat, which is rarely successfully accomplished without serious determination and the support of nicotine replacement preparations, which help reduce the withdrawal symptoms typical of the first few weeks.

The substitutes for the nicotine on the market are now many, allowing each person to choose the one that is most comfortable and best tolerated among slow-release transdermal patches, lozenges to dissolve in the mouth, chewing gum, nasal or oral sprays, some freely available from pharmacies without a prescription, others to be arranged with the doctor as part of a more structured cessation plan.

Generally, especially when using them spontaneously, only one type of nicotine replacement is used at a time, in view of the fact that the amount of active ingredient released is believed to be sufficient to lessen the desire to smoke, without inducing significant side effects.

According to the results of a review by the Cochrane Group, however, using two nicotine replacement preparations at the same time instead of just one would increase the likelihood of sustained, if not permanent, success in quitting smoking. The reviewers arrived at their conclusion by analyzing the results obtained in the 63 most robust studies that tested the effects of different nicotine substitutes and their combinations, on a total of more than 41,500 smokers with an average consumption of at least 15 cigarettes per day and eager to quit.

In particular, the most effective approach to abandoning the smoke appears to be one based on a combination of a slow-release patch to be applied to the skin and a second, fast-acting substitute, such as lozenges, chewing gum, or nasal spray, to be taken as needed, adhering to the timing and dosages indicated on the packages or recommended by the physician.

Lozenges and chewing gum with higher nicotine dosage (4 mg) were more effective than those with lower dosage (2 mg), while for patches it is unclear whether higher (21-25 mg) or lower (14-15 mg) nicotine dosage results in significantly different outcomes. Conversely, it would seem to be advantageous to start applying the transdermal patch and/or taking fast-acting substitutes not on the day set for quitting cigarettes, but the day before (this evidence, however, requires further verification).

“Nicotine substitutes are safe, effective and well-tolerated preparations,” said Nicola Lindson of the University of Oxford (UK), lead author of the review, “but to derive maximum benefits in smoking cessation, they must be used properly so as to maximize their potential, which is often not the case. The combined use of a slow-release patch and a fast-acting nicotine substitute offers greater chanches to quit smoking: many people fear that using two nicotine substitutes at the same time may pose risks, but clinical evidence informs that this is not the case.”

To be even safer, if you decide to quit smoking, the advice is to contact a specialized Smoking Cessation Center or your medical professional and identify a personalized plan, taking into account your age, gender and any medical conditions you have. In addition to nicotine substitutes, psychological support can further increase the likelihood of success.

Source

Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019; Issue 4; Art. No. CD013308 (https://www.cochrane.org/news/featured-review-different-doses-durations-and-modes-delivery-nicotine-replacement-therapy)

Customized cardiovascular risk calculators

15 February 20246 January 2024 by rosanna.feroldi

For more than two decades now, cardiologists have been developing algorithms to calculate the cardiovascular risk, i.e., the probability that a person may be a victim of a heart attack or brain stroke over the next 5-10 years and plan, based on the outcome, preventive and therapeutic strategies aimed at minimizing it.

Hand in hand with the improvement of knowledge, algorithms have been periodically reviewed and refined to make the estimate of the increasingly precise risk, but until now the calculation system used was essentially unambiguous and internationally shared. At most, it was provided for the use of somewhat different parameters in Europe and the United States, in view of the different average characteristics of the population and of the different preventive approaches.

Based on the teachings of personalized medicine, it is now understood that in order to properly assess cardiovascular risk and optimize lifestyle guidance and drug therapies it is crucial to employ different calculators in different categories of patients, taking into account age (in particular, above or below 70 years of age), the presence of type 2 diabetes (a disease that multiplies the risk of cardiovascular disease 2 to 4 times that of unaffected persons), concomitant cardiovascular disease (e.g., atrial fibrillation or heart failure), or a history of acute events (myocardial infarction or stroke/TIA), as well as additional diseases (such as rheumatoid arthritis) and the therapies needed to treat them, which can increase overall cardiovascular risk.

To facilitate physicians and patients in accessing and properly using these algorithms, an international group of experts belonging to several clinical and academic centers and scientific societies in the cardiovascular area have developed U-PREVENT : a freely searchable website (in English and Dutch) by all persons interested in calculating their own cardiovascular risk, that of a family member or, in the case of physicians, of the patients they follow.

For patients, having a simple system to know their cardiovascular risk is important in order to understand when it is appropriate to see their doctor and to be encouraged to faithfully follow his or her preventive and treatment advice. But the U-PREVENT system is even more useful for physicians, as the indications provided by the algorithm are based on the integration of all the best scientific evidence obtained in clinical and epidemiological studies and allow the best strategy to be defined for each patient, on a personalized basis, to protect him or her from cardiovascular events.

In addition to calculating the 5- or 10-year cardiovascular risk, U-PREVENT can be exploited to estimate the preventive effect of major drug therapies (in particular, antihypertensive, cholesterol-lowering, and antithrombotic drugs, in the case of nondiabetic persons), thus enabling physicians to assess which treatments single or in combination may better protect the patient in later years and to what extent.

In addition, the site provides sources from the literature and material educational to support a better understanding of computers, their use and their meaning, broken down according to user profiles, that is, patient, physician or researcher. If to spontaneously use U-PREVENT is the patient and the result shows a nonnegligible cardiovascular risk, the advice is to always consult with your physician for an interpretation competent of the outcome and any appropriate further investigation.

Source

Rossello X et al. Risk prediction tools in cardiovascular disease prevention. Eur J Prev Cardiol 2019; doi:10.1177/2047487319846715 (https://www.escardio.org/The-ESC/Press-Office/Press-releases/Predicting-how-long-you-can-live-in-good-health)

Cranberry: an aid against antibiotic resistance?

15 February 20246 January 2024 by rosanna.feroldi

Antibiotic resistance continues to grow globally, and in Italy, the situation is among the most severe in Europe, with many fearsome bacteria now unassailable by most available antibiotics. According to data from theEuropean Center for Diseases Prevention and Control (ECDC), our country accounts for 1/3 of all deaths (10,000 deaths/year) related to antibiotic resistance on the European territory: in the EU/EAA area, a situation of similar severity affects only Greece, Croatia, Bulgaria and Hungary.

In addition to recommending that fewer and better antibiotics be used on the market to preserve their effectiveness and trying to identify new drugs that are more active against bacteria (long, complex, and rarely successful work), researchers are testing the possibility of enhancing the action of current antibiotics or restore their bacteriostatic/bactericidal activity by combining them with other compounds.

Among such strategies that could help overcome the problem is one based on a protein found in the inviting red berries of the cranberry: plant also known as “American cranberry” or “American oxycock” and has long been exploited for its favorable action against inflammation of the female lower urinary tract (in addition to any specific therapy indicated by the doctor).

In particular, a study published in Advance Science indicates that the pro-anthocyanidin protein (c-PAC) contained in cranberry is able to interfere with two important resistance mechanisms developed by pathogenic microorganisms: selective membrane permeability, which allows bacteria to not absorb or to absorb in minimal amounts the antibiotic that should kill them; and active “pumping” outward from the bacterial cell of antibiotic molecules that have already been absorbed, before they can do damage. By reducing the effectiveness of these two defensive mechanisms, c-PAC would have the effect of increasing the response to antibiotics by pathogenic microorganisms.

L’protective effect of c-PAC has been shown in in vitro and in vivo tests on some of the bacteria most dangerous to human health in case of infection and most frequently resistant to available drugs, such as Escherichia coli (mainly responsible for severe and life-threatening gastrointestinal infections, especially in children, the elderly, and people with reduced immune defenses), Pseudomonas aeruginosa (the cause of difficult-to-fight airway, urinary, and eye infections, severe otitis, endocarditis, and often fatal septicemia); and Proteus mirabilis (mainly at the origin of severe urinary tract infections).

In the case of E. coli and P. aeruginosa, c-PAC has been shown not only to prevent the development of tetracycline resistance, but also to reduce the tendency of these bacteria to form biofilms on the surface of target organs. The formation of biofilms, i.e., dense and compact patches of bacteria tightly adhered to mucous membranes and interacting with each other, is a colonization mechanism that microorganisms use to increase their ability to survive, reducing the ability of drugs to attack and kill them. Hindering biofilm formation, therefore, amounts to making bacteria more isolated and fragile.

Whether this initial evidence can be converted into a combination drug containing an antibiotic and the cranberry protein remains to be evaluated, but the avenue opened is certainly interesting and gives cause for hope.

Source

Maisuria VB et al. Proanthocyanidin Interferes with Intrinsic Antibiotic Resistance Mechanisms of Gram-Negative Bacteria. Advance Science 2019; doi:10.1002/advs.201802333 (https://onlinelibrary.wiley.com/doi/epdf/10.1002/advs.201802333)

Fainting in pregnancy not to be overlooked

16 February 20246 January 2024 by rosanna.feroldi

Fainting in pregnancy is an uncommon occurrence and is generally thought to be a benign, consequence-free phenomenon related to the effects of hormonal changes characteristic of gestation on the cardiovascular system. In order to facilitate blood flow to the placenta and fetus, in fact, pregnancy hormones induce increased heart rate and vasodilation, which can cause extemporaneous drops in blood pressure and/or a sudden and transient decrease in oxygen flow to the woman’s brain.

This type of fainting of a cardiovascular nature. (also called syncope), until now, has been considered a minor malaise in the young and overall healthy pregnant woman: an inconvenience that is certainly bothersome, but which passes on its own in a few minutes by lying down for a while in a quiet place, with legs slightly elevated, and taking some water and sugar and/or mineral salts.

New data, obtained as part of a research Canadian study involving 481,930 births in the province of Alberta between 2005 and 2014, indicate, however, that this is not always the case and that fainting in pregnancy deserves to be brought to the physician’s attention and possibly investigated with some targeted testing, as it could be a sign of maternal and/or fetal health problems. Especially, when it occurs in the 1st trimester.

Specifically, it was observed in the study that fainting occurs in about 1% of pregnant women and that in one-third of cases (32.3%) fainting occurs in the 1st trimester. In the latter case, women who have at least one syncope are more likely to give birth pre-term, that is, before 37 weeks of gestation, with all that this entails in terms of fragility and possible health complications for the baby in the first months of life.

In addition, among those born to mothers who had fainted at least once in the 1st trimester , congenital heart defects were more common , while the mothers themselves were at risk of experiencing cardiac arrhythmias and further episodes of syncope in the year after the baby’s birth. In-depth medical investigation and subsequent monitoring are even more important if the pregnant woman faints more than once: an occurrence that in the study occurred in 8% of women with syncope, accounting for about one in every 1,000 of those monitored. In fact, congenital abnormalities and low birth weight of the newborn were more frequently found in these cases.

Given this evidence, researchers believe that fainting in pregnancy should be considered an important warning sign and included among the risk factors for mother and baby, on par with preeclampsia (hypertension in pregnancy) and gestational diabetes.

The recommendation to undergo medical evaluation, on the other hand, should not lead to undue concern: in the majority of cases, fainting in pregnancy is indeed benign and free of sequelae; performing a few checkups is important to eliminate any doubts and/or detect early the few cases in which there might be problems deserving of treatment.

Source

Chatur S et al. Incidence of Syncope During Pregnancy: Temporal Trends and Outcomes. J Am Heart Assoc. 2019;8(10):e011608. doi:10.1161/JAHA.118.011608 (https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011608?url_ver=Z39.88-2003&rfr_id=oriridcrossref.org&rfr_dat=cr_pubpubmed)

Allergies and mood disorders, a curious link

16 February 20246 January 2024 by rosanna.feroldi

Those with fairly intense respiratory allergies are unlikely to be in a good mood when they are in environments or periods when critical allergens are abundant and symptoms become so bothersome that they prevent them from serenely performing daily activities, concentrating or sleeping well. Inflamed and watery eyes, runny nose, localized or diffuse itching and redness, difficulty breathing, up to episodes of allergic asthma, can put a strain on even people with the most positive attitude toward life.

A German study coordinated by the University Center for Health Sciences – University Hospital Augsburg (UNIKA-T) reports that the correlation between respiratory allergies and mood disorders may be even deeper and more complex, but most importantly, biunivocal. Building on recent evidence indicating that there is a link between psychological profile and allergic dermatitis or asthma, researchers sought to understand whether depression, anxiety, and mental stress may increase susceptibility to developing seasonal respiratory allergies to pollen or to perennial allergens (i.e., always present in the environment, such as mold, dust mites, and animal dander), food allergies, or drug allergies.

Well, from the analysis of the different types of allergies present in the population of the Augsburg area (Germany) cross-referenced with the assessment of the psychological state of the nearly 1,800 people involved, it was found that those suffering from depression also more often have respiratory allergies to perennial allergens while those among those suffering from anxiety disorders have seasonal pollen allergies more prevalent.

Conversely, those who suffer from respiratory allergies perennials would appear to be protected against the development of anxiety-a finding that, according to the researchers, could be related to the fact that those who constantly have to deal with respiratory allergy develop protective psychological strategies that make them less sensitive to additional external stressors that underlie anxiety. As if, in order to be able to live with allergy symptoms and the limitations they impose, one becomes globally somewhat “zen,” adopting a more relaxed attitude in all areas of life.

Regarding depression, however, the reasons behind the correlation with perennial allergies is decidedly unclear, in the sense that it is not known whether it is the mood disorder that predisposes to the development of the allergy or the presence of the allergy that depresses. The second hypothesis should certainly not be trivialized, but the first may also have a rationale, given the known interferences of mood disorders with immune system function (demonstrated in various studies, but yet to be specified in detail).

In contrast, German research found no association between food or drug allergies and reduced psychological well-being. A result that, at least in the first case, is somewhat surprising, since having to eliminate some or many foods from your diet can create some frustration and not a few practical problems in your daily life, especially if you eat out or travel for business or pleasure.

Further studies, already planned, will provide a better understanding of how the psyche and immune system talk, leading-hopefully-to new strategies to protect against both allergies and the psychoemotional disorders that can accompany them-two increasingly common health problems that now affect about a quarter of the Western population.

Source

Harter K et al. Different Psychosocial Factors Are Associated with Seasonal and Perennial Allergies in Adults: Cross-Sectional Results of the KORA FF4 Study, International Archives of Allergy and Immunology 2019; doi:10.1159/000499042 (https://www.karger.com/Article/Abstract/499042)

Pollution and health: new evidence of harm

16 February 20246 January 2024 by rosanna.feroldi

After decades of underestimating the unfavorable effects of pollution on human health, studies and evidence on the subject have been multiplying for some years now, unfortunately all of them directed toward confirming what has always been feared in science: the environmental pollutants have direct detrimental effects at multiple levels (in particular, on the cardiovascular system, the nervous and immune systems, the reproductive level, etc.) and, even when not properly harmful, can alter the metabolic balance in various ways.

Among the many researches supporting this claim, two recent ones can be mentioned. The first, conducted at the University at Buffalo (U.S.), assessed the change in the levels of 886 metabolites in the human body before, during and after the Beijing Olympics (China, 2008): three moments when environmental pollution in the city and surrounding areas went, first, from very high to low (thanks to government actions aimed at making the air more acceptable during the competitions), then from low to the same very high pre-Olympics levels.

Metabolomics analysis of blood samples taken at each of these three periods from the more than 200 Beijing residents involved in the study indicated that as many as 69 metabolites normally present in the body increase or decrease in response to increased or decreased air quality. In particular, varying the most are lipid compounds (mono- and polyunsaturated fatty acids, branched fatty acids, steroids, etc.) and dipeptides (i.e., small proteins), which are often involved in the regulation of innumerable cellular, metabolic, and hormonal functions (in particular, cell stability, oxidative stress, antioxidant activity, and inflammation).

This type of metabolomic analysis, able to provide a snapshot of all the significant molecular changes induced by pollution in the human body, does not indicate which diseases may result from living in areas (urban or rural) characterized by low environmental quality, but confirms that pollution interferes with a great many physiological activities and provides the biological basis for explaining the link between the observed disorders (cardiovascular and metabolic diseases, cancers, immunological or hormonal alterations, etc.) and pollution.

The second publication is even more alarming. This is a review and meta-analysis of data available in the literature on the effects of automobile pollution in children, with particular reference to the risk of developing leukemia (the most common cancer in the early years of life, the incidence of which has increased continuously since 1975 to the present).

The cross-validation of the 29 major studies on the subject, in which researchers from the University of Modena and Reggio Emilia also participated, indicated that car traffic pollution may actually increase the risk of pediatric leukemia only when very high. The same goes for nitrogen dioxide (NO2) levels, a major component of exhaust gases along with benzene. Conversely, exposure to an aromatic hydrocarbon such as benzene (and its derivatives) has definite carcinogenic effects at any dose and always increases to some extent the risk of developing leukemia in children less than 6 years old (specifically, acute lymphoblastic leukemia, ALL).

Two findings that, combined with countless others in the literature, should prompt all of us, every day, to strive to reduce emissions and environmental pollution in general (using the car less, avoiding excessive home heating and producing more waste than strictly necessary) and to demand that governments take measures aimed at improving the healthiness of air, water and soil in both urban and natural areas. Because there is no doubt: our health depends on the health of the place where we live.

Sources

Mu L et al. Metabolomics Profiling before, during, and after the Beijing Olympics: A Panel Study of Within-Individual Differences during Periods of High and Low Air Pollution. Environ Health Perspect. 2019;127(2):057010. doi:10.1289/EHP3705 (https://ehp.niehs.nih.gov/doi/full/10.1289/EHP3705)
Orioli R et al. Exposure to Residential Greenness as a Predictor of Cause-Specific Mortality and Stroke Incidence in the Rome Longitudinal Study. Environ Health Perspect 2019;127(2):27002. doi:10.1289/EHP2854 (https://ehp.niehs.nih.gov/doi/full/10.1289/EHP2854?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pubpubmed)

Rubbing the skin increases the risk of food allergies

17 February 20246 January 2024 by rosanna.feroldi

Logic would dictate that what triggers food allergies. was the simple ingestion of a food containing substances (usually, proteins, peptides or particular sugars) toward which the individual immune system reacts abnormally, recognizing them as potentially dangerous and activating a whole series of defense mechanisms to try to eliminate them from the body or, at least, to neutralize their action (in fact, in itself completely harmless).

In fact, when a food to which one is allergic is ingested, the immune system initiates reactive processes such as the synthesis of histamine (on which depend the onset of oozing, red patches, rashes of various types, swelling and itching in various parts of the body) and the production of immunoglobulin E (IgE, which trigger and sustain the allergic response in various organs and tissues), to the point of triggering, in the most severe cases (fortunately rare), an anaphylactic reaction, characterized by skin reactions, bronchoconstriction, angioedema (especially in the face and throat), hypotension, and anaphylactic shock with possible onset of coma, sometimes fatal.

A study recently conducted in animal models (specifically, mice) has, however, indicated thatfood allergy could be linked to or, at the very least, be made more likely not only by the ingestion of certain foods, but also by stresses on the skin, such as those typical of scratching.

In particular, it has been observed that by mimicking scratching through the application and tearing of patches from the skin of mice, it is possible to trigger/increase intestinal reactivity to food allergens on the part of the animals, making them more likely to go through the typical symptoms already mentioned after ingesting food that is in itself completely harmless.

At the origin of this effect there would be a molecular link between the skin and the intestinal epithelium: repeated skin rubbing would trigger the release of a substance called interleukin 33 (IL-33), which, together with IL-25 produced by particular cells of the intestinal epithelium (tuft cells or “tuft cells”), would go on to stimulate a subset of immune system cells called innate lymphoid cell type 2 (ILC2) cells. The latter, through the release of IL-4, would stimulate other cells of the immune system called mast cells, which, in turn, would release mediators capable of increasing intestinal permeability to food allergens and, therefore, their absorption, resulting in an increased risk of leading to systemic allergic reactions and anaphylaxis.

If this initial evidence is confirmed in humans, the newly identified allergic communication and elicitation mechanism could explain why those with atopic dermatitis (a condition associated with skin discomfort and a tendency to repeated scratching) are more likely to also develop food allergies.

Source

J-M Leyva-Castillo, C Galand, et al. Mechanical skin injury promotes food anaphylaxis by driving intestinal mast cell expansion. Immunity 2019; doi:10.1016/j.immuni.2019.03.023 (https://www.cell.com/immunity/fulltext/S1074-7613(19)30140-2)

Time change: the effects on the gut

15 February 20246 January 2024 by rosanna.feroldi

The transition from daylight saving time to daylight saving time and vice versa causes some transient discomfort for many people, especially in terms of resynchronization of sleep-wake rhythms and mealtimes, fatigue or feeling slightly unwell/nervous during the day. Generally, for those with no health problems, everything works out in less than a week, the maximum period needed to realign one’s biorhythm to the legally mandated time.

For those with risk factors or specific diseases, however, changing the time every six months can result in far greater inconvenience. Numerous epidemiological studies have long indicated that the incidence of severe acute cardiovascular events (heart attack and stroke), as well as episodes of depression or anxiety in predisposed people, increases in the weeks after the hands of the clock move.

Recent data have, moreover, shown a correlation between the transition from daylight saving time to summer time and the risk of seeing worsen chronic inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease, with a significant increase in the number of flare-ups in the following 30 days in patients who were under control in the previous month. An observation entirely in line with the knowledge regarding the link between circadian rhythms and the regulation of gastrointestinal activity and the immune and inflammatory response.

In addition, it should be considered that the abrupt change in the amount of daylight to which one is exposed, resulting from the fake “time zone,” has a not insignificant impact on mood, and this aspect can also significantly affect the gastrointestinal symptoms of IBD or irritable bowel syndrome (IBS), which are also known to have a psychosomatic component.

Considering the considerable discomfort associated with IBD flare-ups (not infrequently disabling for several days/weeks), as well as the acute cardiovascular events already mentioned, and the expenditure of health care resources required to treat them, one frankly wonders whether it is ethically permissible and economically viable to continue to maintain the ritual change of the time twice a year, even in view of the now limited energy savings it makes in the face of the drastic change in the population’s living and working habits.

In Europe, the situation is expected to improve from 2021, when a recent decision by the European Commission envisaged the final switch to the single, year-round timetable. In other areas of the world, legislative changes along these lines have yet to be considered, to the detriment of those with health problems that may be exacerbated by a transient mismatch between the internal and external clocks.

Source Föh B et al. Seasonal Clock Changes Are Underappreciated Health Risks-Also in IBD? Front Med (Lausanne) 2019;6:103. doi:10.3389/fmed.2019.00103

When work takes your breath away

15 February 20246 January 2024 by rosanna.feroldi

When it comes to safety in the workplace one is inclined to think primarily of accidents that can occur while using machinery and tools, while driving motor vehicles, through accidental contact with irritants/corrosive substances or otherwise capable of causing immediate and obvious damage to the body, or from injuries and falls.

The attention devoted to the air quality breathed in factories, construction sites, or areas characterized by high air pollution, chemical pollution, or burning of hydrocarbons or other materials, on the other hand, tends to be very low, despite the fact that the detrimental effects on the respiratory system of many gases, fumes, and more or less fine dust are well known.

Emphasizing the importance of increasing precautions and protective measures from air toxics for people employed in risky work settings are the two leading international scientific societies concerned with respiratory medicine: the European Respiratory Society (ERS) and the American Thoracic Society (ATS).

Conducting an extensive review of the major studies on the subject published in the literature, ERS/ATS experts found that those who work (and breathe) in high-risk locations have a markedly elevated likelihood of developing numerous chronic respiratory diseases, which are characterized by a high impact on health, productivity and the health care expenditures that countries must incur to provide appropriate treatment and care.

Even without considering neoplasms of the respiratory system (which were not the subject of the research), the societal and health repercussions appear enormous, including in terms of associated disability and mortality.

In particular, respiratory diseases most frequent chronic diseases promoted by occupational exposure are sarcoidosis and other granulomatous diseases (30%); alveolar proteinosis (29%); idiopathic pulmonary fibrosis (26%); hypersensitivity pneumonitis (19%); asthma (16%); chronic obstructive pulmonary disease-CPD (14%); chronic bronchitis (13%); community-acquired pneumonia of working age (10%); and tuberculosis (2.3% in workers exposed to silica; 1% among those working in health care).

In many cases, these are pathologies that cause non-reversible, progressively evolving and tend to be disabling damage/ dysfunctions, as well as often lacking adequate therapeutic solutions and such that not only the quality of life is substantially reduced, but also its duration.

In the face of these outcomes, ERS/ATS experts recommend the timely adoption of appropriate measures to reduce the production of hazardous volatile compounds in workplaces and the introduction of effective protective measures that can protect the respiratory system as much as possible of all those who necessarily have to perform their professional activities in hazardous environments. Will they be heard?

As we await a legislative response from governments and a positive response from employers, it pays to be aware of the health hazards that can be incurred in relation to the type and location of work being done and to not neglect any of the safety measures already in place, firmly calling for their improvement where they are insufficient. In addition, it is crucial to pay attention to any respiratory disorder that tends to persist beyond 7-14 days or recur frequently and submit it for medical evaluation, specifying its occupational context.

Source Blanc PD et al. The Occupational Burden of Nonmalignant Respiratory Diseases An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2019;199(11):1312-1334. doi:10.1164/rccm.201904-0717ST (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543721/)

Alzheimer’s disease: beware of those drugs

15 February 20246 January 2024 by rosanna.feroldi

Despite intense research, the causes of Alzheimer ‘s disease continue to be essentially unknown. It has long been believed that mainly two protein factors, ß-amyloid plaques and Tau protein, are involved in its onset. But not all neurologists are convinced of this, and, in any case, it remains to be understood what determines the formation of these toxic substances for brain cells and what is their exact action.

Undoubtedly, the genetic predisposition individual plays an important role in determining the extent and speed of the cognitive decline, but study after study is becoming increasingly clear about the negative contribution of various environmental factors that can interfere with brain cell function and integrity, either directly or indirectly: from substances taken in with food to pollution, from sources of oxidative stress to drugs.

Precisely with regard to the latter, a new call for attention comes from a study conducted by researchers at the University of Nottingham (UK) who investigated the impact on intellectual performance and its age-associated deterioration of anticholinergic active ingredients-a class of drugs comprising molecules used to treat countless clinical conditions and whose use is widespread among the elderly.

They are anticholinergics, e.g., amitriptyline and paroxetine (two commonly used antidepressants), some antipsychotics (quetiapine, olanzapine, chlorpromazine), first-generation antihistamines such as promethazine (used against allergies and sleep disorders), furosemide (a diuretic indicated in cases of hypertension heart failure, and other diseases associated with water retention), amantadine (for the control of Parkinson’s disease), colchicine (prescribed for acute gout attacks), and baclofen (a centrally acting muscle relaxant).

Analyzing the medical records of some 58,800 patients diagnosed with dementia and 255,600 subjects without a diagnosis of dementia (all over the age of 55 and included in British family physician registries), the researchers found a correlation between taking anticholinergic drugs such as those mentioned above and increased risk of developing Alzheimer’s disease.

Specifically, people over 55 who had been chronically using these drugs for more than three years, at the higher dosages or in the “more active” versions, had a 50 percent higher risk of dementia over the next 10 years than those who had never taken them.

Responsible for the largest increase in the risk of Alzheimer’s disease were antipsychotics (+70%), antimuscarinics used against urinary incontinence (+65%), and anti-parkinsonian drugs (+52%), while antidepressants and antiepileptics seem to have a smaller, but still not negligible impact (+30% and +40%, respectively), especially in light of the fact that no effective therapies are currently available against Alzheimer’s disease.

How then to behave? Of course, if an anticholinergic drug is absolutely necessary to treat a significant health problem it must be used. But this need needs to be evaluated with caution, opting for safer alternative therapies whenever possible and, above all, avoiding administering these drugs chronically, over several years, if the benefit obtained is modest and not such as to justify the potential risks to brain health.

Source Coupland CAC et al. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med 2019; doi:10.1001/jamainternmed.2019.0677 (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353?widget=personalizedcontent&previousarticle=2736349)

Menstrual symptoms reduce productivity in women of childbearing age

15 February 20246 January 2024 by rosanna.feroldi

If you think that the physical and psychological discomforts that can accompany the days of menstrual flow and those leading up to it are a minor thing, you are either a man or a very lucky woman. Even when one does not suffer from actual conditions associated with the menstrual cycle such as endometriosis, in fact, the symptoms that most women have to deal with periodically throughout all or part of their fertile lives are quite challenging to endure and manage. Cramps and pain in the lower abdomen, which may radiate to the legs; back pain; nausea and intestinal discomfort; difficulty concentrating and headache; fatigue and general malaise; irritability, nervousness; depression or anxiety. Although benign and transient, combined in various ways in type and intensity, these manifestations can significantly interfere with daily activities for one or more days, preventing one from fulfilling one’s study and work commitments to the best of one’s ability. With socioeconomic repercussions as well, given the loss of productivity. A nationwide Dutch study involving nearly 33 thousand women, recruited from the general female population of childbearing age (15-45 years), assessed this impact through the administration of online questionnaires that investigated both the loss of productivity associated with menstrual flow-related absences from school or the workplace and that associated with “presenteeism,” i.e., being present in less than excellent mental and physical condition. The responses obtained showed that 13.8 percent of women of childbearing age occasionally have to take time off work or study commitments due to menstrual disorders, losing an average of 1.3 days per year. While this figure may appear reassuring (but it is not, considering that this is an average value and that menstrual flow is a physiological phenomenon and not a disease), the same cannot be said of the percentage of related presenteeism and reduced productivity, experienced by as many as 80.7 percent of the study participants for an average of 23.2 days per year (i.e., about 2 days per cycle). The researchers calculated that a loss of productivity of one-third (33 percent) of that secured under optimal psychophysical conditions for the average recorded period of presenteeism corresponds to a total annual loss of productivity of nearly 9 days: on a par with real illness. In addition, it should be considered that the absenteeism found among the women involved in the survey is likely to be lower than the actual absenteeism, since those responding to the online questionnaire were predominantly women with higher levels of education and engaged in activities that require less physical exertion than those performed by women with lower levels of education. The study also confirms that despite the considerable discomfort caused by menstrual flow, only a minority of women turn to the doctor for a satisfactory solution (45 percent according to the Dutch research, but around 15 percent in other surveys), resigning themselves to living with periodic discomfort. This is a situation that should be sought to be changed through increased education of both women and physicians in the protection of women’s well-being and reproductive health, and by developing labor policies geared toward providing greater flexibility of hours and tasks, with a view to reducing inconvenience and loss of productivity during the most critical phase of the cycle. For the benefit of all.

Source: Schoep ME et al. Productivity loss due to menstruation-related symptoms: a nationwide crosssectional survey among 32748 women. BMJ Open 2019;9:e026186. doi:10.1136/bmjopen-2018-026186

Photo by Katarzyna Grabowska on Unsplash

Early diagnosis of breast cancer with liquid biopsy: now you can

15 February 20246 January 2024 by rosanna.feroldi

With 2.1 million new diagnoses worldwide in 2018, breast cancer is the most prevalent neoplasm in the female population globally, but also the one that can be cured best, often definitively and with nondemolishing methods, especially if it is diagnosed early, when it is still very small and not very aggressive. For this reason, regular breast self-examination and, starting at age 45-50, mammography every two years are recommended for all women to detect any minute masses that are not perceptible by touch but are already potentially risky, to be biopsied and then subjected to histological and molecular analysis to characterize them precisely and identify optimal treatment. In the near future, this already highly efficient approach may be enriched with new noninvasive diagnostic system based on the analysis of circulating tumor DNA (ctDNA), i.e., DNA fragments released into the bloodstream from aged and destroyed breast cancer cells. The ctDNA can be obtained by a simple blood draw and analyzed by an extremely precise and rapid sequencing technique called NGS (Next Generation Sequencing), aimed at detecting certain genetic mutations that are distinctively present in the DNA of breast cancer cells. The first data supporting the clinical utility of this method, termed “liquid biopsy,” come from a pilot study, coordinated by researchers at the University of Málaga (Spain), which compared the diagnostic sensitivity of the new ctDNA test before classical tissue biopsy with that of molecular analysis after classical tissue biopsy, using mutations in the PIK3CA and TP53 genes as markers. The evaluation resulted in identifying identical mutations in 8 of the 29 patients considered (27.6%): four in TP53 and five in PIK3CA. In addition, analysis with NGS on ctDNA revealed four additional genetic mutations (three in TP53 and one in PIK3CA), which had not been reported by molecular analysis of breast tissue taken by classical biopsy: which underscores the high sensitivity of “liquid biopsy” at an early stage. One of these patients had mutations in both genes under consideration. The likelihood of testing positive for markers on ctDNA examined with NGS was higher in women who were younger, had larger tumor masserella and higher imaging scores on mammography (indicative of a higher probability of actually having cancer). At the moment, the new test is still being evaluated and not available in clinical practice, but if upcoming studies confirm the performance and diagnostic sensitivity highlighted the “liquid biopsy” may soon join the classical one in the early detection of breast cancer and, perhaps, one day supplant it. In this way, women with positive mammograms, but not necessarily breast cancer, could be prevented from having their suspected breast tissue harvested for diagnostic purposes.

Source: Rodriguez BJ et al. Detection of TP53 and PIK3CA Mutations in Circulating Tumor DNA Using Next-Generation Sequencing in the Screening Process for Early Breast Cancer Diagnosis. J Clin Med 2019;8:1183-1207; doi:10.3390/jcm8081183

Eating nuts lowers the risk of cardiovascular disease and mortality

15 February 20246 January 2024 by rosanna.feroldi

Walnuts, hazelnuts, almonds, and pistachios contain high amounts of omega-3 and omega-6 series polyunsaturated fatty acids, which countless studies have shown to be valuable allies of cardiovascular health and nervous system function, to the point of recommending targeted supplementation in situations of deficiency (insufficient dietary intake) or increased need (for example, in pregnancy or after an acute cardiovascular event). Although recent reviews of the scientific literature have, in part, cast doubt on the ability of some of these essential fatty acids to help prevent heart attack and other cardiovascular diseases, a large body of evidence suggests that these compounds are beneficial to human health at various levels. Among the most recent evidence supporting the benefits of their regular dietary intake are those provided by research presented at the European Society of Cardiology Congress (ESC 2019), held in Paris from Aug. 31 to Sept. 4. Specifically, the study monitored the incidence of cardiovascular disease (myocardial infarction, unstable angina, and sudden cardiac death), stroke, cardiovascular mortality, and all-cause mortality in a cohort of more than 5,400 healthy people over the age of 35 followed for a period of 13 years, in relation to the extent and frequency of nut consumption. The evaluation found that people who habitually consumed larger amounts of walnuts, hazelnuts, pistachios, and almonds were less likely to experience cardiovascular events and to die from cardiovascular or other causes. After repeating the analysis taking into account potentially confounding factors such as age, sex, smoking, educational attainment, level of physical activity, place of residence (rural or urban setting), family history and individual risk of cardiovascular disease, etc., the favorable effect of nut consumption zeroed out in terms of reduced risk of cardiovascular disease and all-cause mortality, but remained significant for cardiovascular mortality. More specifically, the study indicated that, compared with those who consumed little or no nuts, those who consumed at least two servings per week (equal to about 3-5 nuts each) had a 17% lower risk of mortality from cardiovascular causes: a value that corresponds to protection comparable to that offered by many drug treatments specifically designed for this purpose, but completely free of side effects. Since nuts contain not only omega-3 and omega-6 essential fatty acids, but also vitamins, antioxidant compounds, phytosterols, minerals and other micronutrients that are potentially beneficial to the body, on the basis of this study it is not possible to assign a precise protective role to any single element or to provide guidance for specific supplementation. What does seem clear, however, is that munching on a few walnuts, almonds or pistachios as snacks throughout the day or adding them to salads or other dishes can benefit your health as well as your palate. The only caveat is not to overdo the quantities, since nuts are quite caloric (about 550-650 kcal per 100 g), and to prefer “fresh” or freshly dried/toasted ones, but not salted or sweetened, to avoid seeing blood pressure and blood sugar rise, wiping out the potential cardiometabolic benefit.

Sources:

– Mohammadifard N et al. Nut consumption, the risk of cardiovascular disease and all-cause mortality: Isfahan Cohort Study. ESC 2019; Abstract 46

– Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016;37:2315-2381.

Photo by Daria Rudyk on Unsplash

Microplastics in water: a lurking danger

15 February 20246 January 2024 by rosanna.feroldi

Seas and oceans invaded by bottles, saucers, glasses, straws and shopping bags. Fish and birds killed by excess plastic ingested or filtered through gills. Idyllic beaches awash in garbage that will take centuries to dispose of. These are disturbing scenes, to say the least, that the media have been proposing for several months in an effort to raise awareness of the environmental disaster for which we have “unknowingly” made ourselves responsible and the urgent need to remedy. Before our health also loses out. But it is not only the macroscopic plastics abandoned in nature that we need to worry about. The microparticles released from beverage and food bottles and containers and the plastic fragments that may be present, albeit invisible, in the drinking water that flows from taps and that we take in without realizing it also deserve much more attention and more research than has been done so far. This is highlighted by the World Health Organization (WHO) in its recent Report “Microplastics in drinking-water,” which takes stock of the state of scientific evidence on the subject. In summary, although currently available data do not indicate significant risks to human health from microplastics present at low levels in drinking water, WHO believes there is an urgent need to undertake new studies on this issue and to immediately activate policies aimed at curbing the production and use of plastic items to avoid exacerbating the already critical environmental damage. The Report reassures that plastic fragments larger than 150 µm (invisible to the human eye) that may be present in drinking water and in foods to which it is added during preparation are not absorbed by the intestines and should, therefore, not have a metabolic impact. Smaller particles may, on the other hand, enter the body, but the average amount absorbed should still not be a health detriment. On the other hand, the conditionalities are many and the certainties few, partly because the problem is relatively “new,” because standardized methods for measuring human exposure levels to microplastics have not yet been developed, and because any adverse effects may only manifest themselves over the long term or in a manner that is not clearly referable to a single material or compounds derived from it once absorbed by the body (catabolites). While waiting for new useful data, WHO suggests treating drinking water and sewage with purification systems already in use to remove various chemical agents and pathogens responsible for gastrointestinal diseases, which can also remove microplastics, protecting both humans and the environment. Proper filtration of wastewater, for example, can remove up to 90 percent of the microplastics present. Unfortunately, not all areas of the world have these purification systems nor do they have the ability or sensitivity to invest in actions that protect the environment. As much as this is a global problem, which needs to be addressed at the policy level as well as the scientific level, everyone can help reduce the impact of large and small plastics on the environment and human health by: choosing alternative, easily biodegradable/recyclable and health-safe materials as much as possible; preferring items that can be reused for a long time instead of single-use; sorting items properly; and never abandoning waste in the environment.

Source: Microplastics in drinking-water. Geneva: World Health Organization 2019. Licence: CC BY-NC-SA 3.0 IGO.

Photo by Jasmin Sessler on Unsplash

Six signs and symptoms not to be underestimated

14 February 20246 January 2024 by rosanna.feroldi

There is certainly no need to be too alarmed at the first speck on the skin, for a little discomfort in the throat or at every slightest tingle Of unclear origin. However, there are some signs and symptoms, including. modest, which it is good not to underestimate and which, if they do not pass in a reasonable period of time or worsen, they should prompt consultation with the doctor of family to have competent judgment and initiate, if necessary, appropriate Insights. Do you know what are the signals of our body not to be neglected? Here are six particularly important ones to pay attention to.

New flu season kicks off: recommendations for preventing it

14 February 20246 January 2024 by rosanna.feroldi

Once again this year, with the first case found in Parma in a 6-year-old girl in late September, the flu season has officially begun. Although it will take a while to get into full swing, aided by the still mild temperatures that do not allow viruses to multiply and spread efficiently, one should not feel too safe. In a few weeks, the situation will be quite different, and the likelihood of finding oneself in bed with a high fever, cold, cough, general malaise, and bone pain will be decidedly high for everyone.

Experts predict that about 6 million Italians will fall ill and that the viruses circulating will be particularly aggressive. To avoid the discomforts and risks of complications associated with the most classic and frequent of winter ailments, the Ministry of Health and all health institutions at the international level recommend, as they do every year, taking the seasonal flu vaccine, which is effective and safe at all ages (starting from the 6th month of life) and in any category of people, including the period of pregnancy and lactation (unless specific individual contraindications are extremely rare).

Vaccination is especially important for the elderly (over65 years old), people with chronic respiratory (asthma, chronic obstructive pulmonary disease-BPCO, cystic fibrosis, etc.), cardiovascular (heart failure, coronary artery disease, atrial fibrillation, etc.), metabolic (diabetes, etc.), blood (coagulation disorders, anemia, etc.), or immune system (congenital or acquired immunodeficiency) diseases.) or the immune system (congenital or acquired immunodeficiency), as well as cancers, chronic inflammatory bowel disease (ulcerative colitis, Crohn’s disease, etc.) and/or malabsorption, renal or hepatic failure, and other conditions that increase the risk of severe complications (pneumonia, respiratory and cardiometabolic decompensation, encephalitis, etc.) and influenza mortality.

In all these cases, as well as in pregnancy, those in occupations in contact with the public, at high risk of virus transmission, and/or of public utility (health care personnel, veterinarians, animal keepers, law enforcement, etc.) and blood donors, the flu vaccine is offered free of charge by the National Health Service (NHS). The rest of the population will have to pay for it out of their own pockets, but at a cost of a few euros, certainly less than the cost of the drugs that would be needed to keep flu symptoms under control.

The preparations available today for influenza vaccination are numerous, have different characteristics, and can be tri-valent (i.e., able to protect against three types of viruses) or quadri-valent (i.e., able to protect against four types of viruses). Those trivalents indicated for the 2019-20 season, based on the types of viruses expected to have the greatest prevalence in the coming months, contain the following antigens: A/Brisbane/02/2018 (H1N1)pdm09; A/Kansas/14/2017 (H3N2); a B/Colorado/06/2017 (B/Victoria/2/87 lineage). In addition, the quadrivalent vaccines available in Italy contain B/Phuket/3073/2013-like (B/Yamagata lineage) as the fourth antigen.

The vaccine to be taken should always be agreed upon with the family doctor or, in the case of children, with the Freely chosen Pediatrician, who will also take charge of its administration through a harmless subcutaneous injection in the upper arm or, for younger children, in the thigh (alternatively, one can contact the nearest Vaccination Center). In order not to be blindsided by the viruses before you have developed sufficient immune protection (it takes about 15 days after the vaccine is administered), it is recommended to get vaccinated between late October and early November or, at any rate, by mid-December (also in view of the fact that Christmas celebrations are at very high risk of infection). However, if you have not been sick before, you can take the vaccine even in early January.

In addition to the seasonal vaccine, to reduce the risk of contracting the flu and other seasonal illnesses carried by viruses and bacteria, it is important to adhere to well-known and proven rules of hygiene and practical prevention. That is: wash hands often, with soap and water or disinfectant preparations; avoid touching your nose, mouth and eyes with hands that are not perfectly clean; limit spending time in crowded enclosed places (public transportation and offices, cinemas, theaters, stores, gyms, etc.); avoid being near people with suspected respiratory symptoms or who are already ill; support the body’s defenses through healthy diet (including fresh foods rich in vitamins and antioxidants), good hydration (1.5-2 liters of fluids per day), sufficient sleep, moderate physical activity, avoiding smoking and stress; ventilate the rooms in which you stay often, especially if there are family members or co-workers with cold symptoms.

Sources: EpiCentro-Istituto Superiore di Sanità (ISS)(www.epicentro.iss.it/influenza/Raccomandazioni-Ministero); Ministry of Health – Influenza portal(www.salute.gov.it/portale/influenza/homeInfluenza.jsp)

Sexuality: the most common problems

14 February 20246 January 2024 by rosanna.feroldi

Una sessualità soddisfacente è un elemento fondamentale della salute fisica e psichica e va tutelata a ogni età. Quando si manifestano disturbi, un sereno dialogo tra i partner e il supporto medico sono la chiave per risolvere la situazione.

Sexuality is not only a source of pleasure, but is a fundamental aspect of the physical and psychological health of every person, man or woman, regardless of age. Recognizing and affirming this for several decades is even the World Health Organization (WHO), which includes sexuality among the cornerstones of the official definition of health.

At every age, however, men and women have a different way of experiencing sexuality and may experience various disorders that can risk turning an extraordinary source of balance and well-being into a problem that is anything but trivial, even to the point of causing them to avoid relationships altogether in order to avoid feeling distressed.

An essential concept to remember, in these cases, is that sexuality is never an individual matter, but a couple’s experience and as such must be dealt with, both when everything is going perfectly and when there is something wrong. Remedies to resolve the situation are many and effective in most cases, but they work best if two people are handling them, with serenity, a spirit of cooperation and mutual affection.

The difficulties of youth

As young people, in the absence of specific pathologies of the genitourinary system or severe systemic diseases, the main critical issues in the sexual sphere are generally related to insecurity and fear of “not being up to par” (because they are not fit enough, sensual or “technically prepared”) or inexperience and a lack of confidence with one’s body, leading to not knowing how to manage one’s emotions and the physical reactions that accompany them.

All these unresolved psychological difficulties can interfere with desire or lead to reaching the climax of pleasure too early, too late, with extreme difficulty or even never. Included in this group of sexuality disorders are: performance anxiety, erectile dysfunction, and premature or delayed ejaculation, on the male side; insufficient desire, unpleasant or painful intercourse, and difficulty reaching orgasm, on the female side.

Problems can occur from the earliest relationships and be particularly difficult to deal with given the limited experience of both partners and, not infrequently, from the precariousness of the relationships. These early critical issues can undermine the quality of one’s later sex life if not addressed early, by talking frankly to one’s partner and/or seeking the support of one’s medical professional and possibly a psychologist experienced in sexuality disorders.

In general, disturbances without an objective organic basis are more frequent and significant during relationships that are short-lived and characterized by a lack of mutual empathy while they greatly improve (until they disappear) when a deep and lasting relationship can be established, which allows one to find a good physical and psychological harmony and to experience sexuality in a gradually more relaxed and natural way.

On the other hand, even young, healthy and initially close-knit couples may, at some point, lose interest in sexual activity or derive less pleasure from it. In these cases, the origin of the problem often has to be sought in factors of a different nature, such as instability or stress at work, worry about economic difficulties, fatigue due to too many commitments, insufficient sleep or unhealthy lifestyle.

In this regard, it should be remembered that smoking, alcohol, being overweight, low physical activity and disordered life rhythm are declared enemies not only of general health, but also of sexual health (especially for men). Their negative impact is felt at every age and becomes gradually more pronounced as we approach “age.”

Another critical phase for couples of childbearing age is that of pregnancy and postpartum, due to a mix of physical and psychological factors that can put a strain on both partners, for different and sometimes opposing reasons, especially at the time of the first child.

Reduced desire, fear of harming the fetus, anxiety about becoming a parent, postpartum physical and psychological discomfort, arrival of the newborn, and redefinition of family balance can seriously interfere with sexuality for several months, especially if it is not discussed within the couple and support from the gynecologist (for the woman) and possibly the psychologist (for both partners) is not sought.

Maturity disorders

Like all functions of the organism, the sexual function also transforms with the passage of time, and although some may be annoyed or disappointed by it, all that remains is to accept the inevitable change, which nonetheless also has some positive implications such as greater experience, more relaxed approach to relationships, finer knowledge of oneself and partner, etc.

In both men and women, what drives the transformation is primarily the gradual decline in sex hormone levels (androgens and estrogens, respectively) that occurs from the age of 40-50, compounded by a progressive decrease in muscle and cardiovascular performance and, in many cases, the onset of diseases or disorders that may interfere with sexuality either directly or as a consequence of the therapies one has to take to keep them under control.

In men, for example, many cardiovascular diseases, type 2 diabetes, and prostatic disorders can reduce the ability to achieve an erection or maintain it, as can medications needed to lower high blood pressure or hyperglycemia, counteract coronary artery disease or symptoms of prostatic hypertrophy, and improve heart function in those with atrial fibrillation or heart failure.

In women to interfere with sexuality can be ovarian, thyroid, or pituitary dysfunction and symptoms associated with menopause or postmenopause, starting with decreased lubrication and gradual changes in vaginal mucosal sensitivity and structure (all changes that can result in unpleasant or painful intercourse).

Also not to be overlooked are the conditions of mental distress that can become particularly prevalent and pronounced in women over 40, first and foremost depression and anxiety (from which men also suffer less frequently), as well as the negative repercussions on sexuality of some of the medications required to treat them (antidepressants, mood stabilizers, etc.). Also on the psychological front, especially when confronted with a new partner, creating problems when one is no longer very young can be the idea of not having an aesthetically desirable body, at least according to current standards: in this case, greater awareness of one’s own value and a little self-deprecation are the keys to success.

How to solve the situation?

Assuming that sexuality is a couple’s issue, the first piece of advice for dealing with any kind of physical or psychological problem is to talk about it openly with your partner(s), simply and calmly. This will also help the partner not to feel like the “cause” of the reduced desire or less pleasure experienced, and will allow the level of intimacy and cohesion of the couple to increase, as well as sometimes to identify together, without too much difficulty, an appropriate solution.

If sharing the problem and addressing it together with simple strategies (e.g., creating more stimulating situations, prolonging foreplay, changing positions, modulating the timing of reaching orgasm, etc.) is not enough to improve the situation, the next step is to contact your medical professional to check your general health status, assess the specific disorder, and identify possible interventions that can help alleviate it (see, for example, erectile dysfunction drugs or hormone therapies).

Seeking medical advice before taking any type of medication or supplement is essential, both because the drugs available to improve sexual performance can have several contraindications and be dangerous in certain clinical settings and because, at times, sexual dysfunction can be a telltale sign of an as-yet undiagnosed organic disease that needs to be evaluated and managed (such as, for example, cardiovascular disease, hormonal disorders, or prostate problems).

When the sexuality disorder appears to be related to genitourinary aspects, a gynecological (for women) or andrological/urological (for men) consultation should be sought. Especially after the age of 50, it is especially at this level that disorders capable of greatly reducing the possibility of having satisfactory relationships (or having them tout-court) can arise, and it is important that an experienced specialist be the one to investigate the causes and suggest appropriate solutions, whether pharmacological or surgical.

Sources:

National Institute on Aging – NIH (https://order.nia.nih.gov/publication/sexuality-in-later-life)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/premature-ejaculation/symptoms-causes/syc-20354900)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358)
von Hippel C et al. Sexual Function among Women in Midlife: Findings from the Nurses’ Health Study II. Women’s Health 2019;29-4:291-298
Hatzichristou D et al. Clinical Evaluation and Management Strategy for Sexual Dysfunction in Men and Women. Journal of Sexual Medicine 2004;1(1):49-57
Knoepp LR et al. Sexual Complaints, Pelvic Floor Symptoms, and Sexual Distress in Women over Forty. Sex Med 2010;7:3675-3682
Avasthi A et al. Clinical Practice Guidelines for Management of Sexual Dysfunction. Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry 2017;59(Suppl 1):S91-S115
Mernone L et al. Psychobiological Factors of Sexual Functioning in Aging Women – Findings From the Women 40+ Healthy Aging Study. Frontiers in Psychology 2019;10:546

Overweight and obesity: if you know them (maybe) avoid them

14 February 20246 January 2024 by rosanna.feroldi

In a world where everyone wants to be thin, one is increasingly overweight, even from childhood. With all that it entails in terms of physical and psychological discomfort and health repercussions, especially after a certain age. What to do? Here are some tips.

When it comes to nutrition and body weight, it opens up a universe of contradictions. You want to stay in shape or lose weight, but also eating what they like without paying too much attention to quantity. Hundreds are spent of euros for the gym, but then you almost never go. A thousand diets, but none are maintained. You buy jumpsuits and sneakers, but you don’t can do without an elevator and a car. The most ironclad healthy living resolutions, but the tomorrow to implement them never comes.

The result is always the same: month after month, the needle of the balance goes in the opposite direction from what is desired or, at best assumptions, remains inexorably fixed on a somewhat round figure. Despair does not help, because it often leads to drowning one’s own frustrations. Resign even less, because it makes people get used to standards of weight and fitness that tend to get progressively worse, almost without realizing it account. So what? As always, the solution lies in the middle, viz. In identifying a healthy balance between actual metabolic needs of the body and pleasures for the palate and spirit.

The origin of the extra pounds

No use cheating or looking for alibis in slow metabolism or the unfavorable constitution: except for a very small proportion of cases in which indeed there may be a significant genetic component or specific pathologies that work against it, if you gain weight or don’t lose weight, the reason goes sought in lifestyle errors, that is, essentially in the combination of a diet that is high in calories relative to individual needs and/or unbalanced and insufficient movement. This rule applies at any age, but in childhood/adolescence can have a metabolic impact particularly negative, which also has unfavorable repercussions on body weight and health In adulthood.

Numerous studies have now indicated that a child in strong overweight or obese will remain so as an adult (or who will slim down with effort), resulting in exposure to an increased risk of cardiovascular disease, diabetes, hormonal disorders and different types of neoplasms (e.g., breast cancer in women and colorectal cancer in both sexes.

For women, then, obesity (as well as being overweight) can impair fertility or cause serious problems during pregnancy and at the time of delivery, not the least of which is to also predispose the child to develop overweight/obesity and diabetes. Not to mention the psychological implications and Relational of the many extra pounds in adolescence and early adulthood adult, when physical appearance plays an important role in the perception of self and in interactions with others.

For women, even those who were initially thin or normal weight, A critical moment on the body weight front is the pregnancy. If you gain too much weight at this stage (i.e., more than the 10-12 kg. physiological, which gynecologists recommend not to exceed), lose weight after childbirth can be difficult, especially if you are over 35-40 years old, if you have a demanding family to care for and/or a job sedentary, leaving little time for physical activity. Residual extra pounds neglected for a long time, in fact, tend to “settle” by constituting the starting point for further increases in subsequent years.

In both sexes, then, the coming of age 40-45 involves. an initial, inevitable metabolic slowdown, which will worsen later: especially after age 50-55 for women, corresponding to the onset of the menopause; and shortly thereafter for men, also due to the reduction of hormones male and muscle mass (which is the one that burns the most calories). If, During and after this transition, you do not revise your habits food (reducing the calories introduced each day and increasing the consumption of vitamins and antioxidants that support metabolism), fattening by a few pounds is practically inevitable.

As mentioned, in a minority of cases, overweight and obesity can arise and persist due to diseases, mainly of endrocrine-metabolic type, or as a side effect of drugs needed to treat a variety of ailments. Among the former include. hypothyroidism, adrenal gland dysfunction, and the ovary polycystic, just to give a few examples.

Among the latter are insulin used for the treatment of more severe forms of diabetes, cortisone, some antidepressants, the antiepileptics, mood stabilizers, antipsychotics, some hormone therapies used for women’s issues and anti-androgenic drugs Against prostate disorders and cancers in men. In all these cases, the Body weight management must go hand in hand with disease treatment basis and be defined and monitored by the physician.

Healthy diet: better start with children

First, recall that the concepts of normal weight, overweight and obesity are based on the calculation of body mass index or BMI (Body Mass Index), a value that is obtained by dividing the weight expressed in kilograms by the square of the height expressed in meters. So, for example, a person who is 1.70 m tall and weighs 70 kg will have a BMI = 70 kg / (1.70 x 1.70)^{m2 =} 24.22 kg/^m2. This person will be “normal weight,” a category that includes all those with a BMI between 18.50 and 24.99 ^kg/m2. It will be, instead, “overweight” Those with a BMI between 25.00 and 29.99 ^kg/m2 and “obese mild” (class I) those who have a BMI between 29.99 and 34.99 ^kg/m2; with BMI between 35.00 and 39.99 ^kg/m2 you fall into medium obesity (class II), while from 40 ^kg/m2 upwards we speak of severe obesity (class III).

Assuming that overweight and obesity in childhood/adolescence. influence the characteristics of metabolism and health in adulthood, it is crucial that the habit of keeping fit through a healthy diet and exercise regular be promoted to children. This also creates a kind of “imprinting behavioral” that makes it more spontaneous and natural to follow a style of Healthy living and continue to keep body weight under control over the decades Next.

If the child/adolescent is already overweight by several pounds, the advice is to consult the pediatrician and agree with him or her on a regimen age-appropriate diet and exercise, after ruling out any disorders organic not yet diagnosed. If there are many pounds to lose, it is almost imperative to also consult a dietician/nutritionist, whereas if approach to food appears to be influenced by psychological aspects is useful Also consult a psychologist/psychiatrist experienced in eating disorders.

The most important thing, however, is not to trivialize nor dramatize the problem and not nag the child about his or her weight, to what he eats or why he doesn’t move enough. Much better results will achieve by creating a serene and cheerful family environment (where meals become a pleasant time of sharing), filling the pantry and refrigerator with healthy foods (fresh fruits and vegetables first and foremost), cooking light and, above all, setting a good example, both at the dinner table and on the activity front physics.

Many teenagers and young adults are often is tempted from promises of rapid weight loss through diets as curious as they are ineffective, if not downright dangerous to health. Avoid them and recommended to avoid them in any case. If the pounds to be lost are few (3-5 kg), in most cases it is sufficient to make an honest analysis of the their own eating habits (perhaps by compiling a food diary for some days) and correct trivial mistakes (such as regularly taking drinks sugary drinks and alcohol, nibbling while cooking or at aperitifs, exceeding With bread and buns at the table, add too much oil or cheese to salads etc.).

A few suggestions for adults

In addition to the classic advice to reduce intake of the carbohydrates in general and to a minimum that of simple sugars (added or contained in sweet foods), favor proteins from legumes and fish, and Increase fiber consumption (i.e., low-sugar vegetables and fruits), a trick useful for cutting calories without revolutionizing your habits too much food is to gradually reduce portions. It may sound trivial, but by 10-20 g less pasta on your plate you hardly notice (especially if you have shrewdness to start using smaller plates), but week after week week can make a difference on the scale.

On the contrary, it is important to drink more water or other beverages unsweetened (teas, herbal teas, infusions, natural flavored waters, etc.): both because liquids have an immediate satiating effect and help to dampen attacks of starvation; both because it has been observed that many people fail to distinguish well between the stimuli of hunger and thirst and end up with the eat when they should actually drink (the kidneys will also benefit).

When the pounds to be lost are more than 5-10, it is good to consult first their own physician and then a dietitian/nutritionist to set up an eating plan compatible with the needs and characteristics Individuals (age, gender, presence of other conditions and any therapies hired, specific needs, etc.) and establish a “calendar” of the weight loss that has the dual purpose of stimulating adherence to the program dietary and physical activity (which should always be provided in combination) and of allow strategies and goals to be recalibrated, depending on the results via via reached.

As already reported for children/adolescents, also for the adults psychological/psychiatric support can be very helpful, if we realizes that he attributes to food valences that have little to do with hunger (e.g., compensation for frustrations and nervousness). In cases of severe obesity or Very severe, the doctor may prescribe certain appetite-reducing drugs or support weight loss, or consideration may be given to the bariatric surgery, weighing its pros and cons well.

Absolutely to be avoided, however, is any kind of Supplement or “miracle” remedy touted online or by centers aesthetics, gyms, clinics of dubious reputation: experience has shown that they do not serve no purpose and can damage health, at great cost.

Slimming down after the “hip”

Given that metabolism physiologically slows down starting from age 40 and increasingly in later years, slimming down will require more commitment and time after this age. But one should not be discouraged or give up because it is precisely after “age” that eliminating (or reducing) pounds of Too much becomes more important to prevent cardiovascular disease and diabetes Type 2 or help keep them under control.

Numerous studies have shown that a weight loss of equal to at least 10% of the initial one significantly reduces the risk global cardiovascular and may even reverse type 2 diabetes in early stage. In addition, at any age, losing weight helps to snore less, to alleviate (or resolve) gastroesophageal reflux disease, to avoid many sore back, not to put too much stress on the hip and knee joints, and to maintain satisfying sexuality for longer.

Of course, to achieve this and get these benefits, you need a some good will and be convinced that it is a good right thing. The suggestion is to start trying hard, without wait until you are too old, but remembering that losing the excess weight is possible and useful at any age.

Sources:

National Heart, Lung and Blood Institute – NIH (https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity)
National Institute of Diabetes and Digestive and Kidney Diseases – NIDDK (https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight)
World Health Organization – WHO (https://www.who.int/nutrition/topics/5keys_healthydiet/en/; https://www.who.int/en/news-room/fact-sheets/detail/healthy-diet)
Arnold M et al. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women’s Health Initiative: A Longitudinal Study from the United States. PLoS Med 2016;13(8):e1002081 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987008)
Johnson RJ et al. Perspective: A Historical and Scientific Perspective of Sugar and Its Relation with Obesity and Diabetes. Adv Nutr 2017;8:412-422
Gardener H et al. Diet Soda and Sugar-Sweetened Soda Consumption in Relation to Incident Diabetes in the Northern Manhattan Study. Curr Dev Nutr 2018;2:nzy008

ALIMENTAZIONE E NUTRIZIONE	NATURA SPORT LUOGHI	COLTIVARE LA SALUTE	MENOPAUSA	MAMMA IN FORMA
MEDICINA TRADIZIONALE CINESE	CARDIOCHIRURGIA	FARMACI E DISPOSITIVI MEDICI	GENITORIALITÀ	LA CULTURA DELLA SALUTE
LE UTILITIES DELLA SALUTE	MEDICINA GENERALE	MEDICINA NATURALE, TERMALE	MENTE E CERVELLO	DISTONIA NEUROVEGETATIVA
MODI DI ESSERE	SALUTE E SOCIETÀ	SANITÀ E PAZIENTI	SESSUALITÀ	TERZA ETÀ
TUMORI	URGENZE

ALIMENTAZIONE E NUTRIZIONE	NATURA SPORT LUOGHI
COLTIVARE LA SALUTE	MENOPAUSA
MAMMA IN FORMA	MEDICINA TRADIZIONALE CINESE
CARDIOCHIRURGIA	FARMACI E DISPOSITIVI MEDICI
GENITORIALITÀ	LA CULTURA DELLA SALUTE
LE UTILITIES DELLA SALUTE	MEDICINA GENERALE
MEDICINA NATURALE, TERMALE	MENTE E CERVELLO
DISTONIA NEUROVEGETATIVA	MODI DI ESSERE
SALUTE E SOCIETÀ	SANITÀ E PAZIENTI
SESSUALITÀ	TERZA ETÀ
TUMORI	URGENZE

APPARATO DIGERENTE	APPARATO RESPIRATORIO	APPARATO UROGENITALE	CUORE E CIRCOLAZIONE	CUTE
INFETTIVOLOGIA	OCCHI	ORECCHIE NASO E GOLA	OSSA E LEGAMENTI	SISTEMA ENDOCRINO
SISTEMA NERVOSO

APPARATO DIGERENTE	APPARATO RESPIRATORIO
APPARATO UROGENITALE	CUORE E CIRCOLAZIONE
CUTE	INFETTIVOLOGIA
OCCHI	ORECCHIE NASO E GOLA
OSSA E LEGAMENTI	SISTEMA ENDOCRINO
SISTEMA NERVOSO

CULTURA E SALUTE	AGGIORNAMENTI
PERCORSI

Una sessualità soddisfacente è un elemento fondamentale della salute fisica e psichica e va tutelata a ogni età. Quando si manifestano disturbi, un sereno dialogo tra i partner e il supporto medico sono la chiave per risolvere la situazione.

RELATED SPECIALISTS

RELATED SPECIALISTS

RELATED ARTICLES

Measuring blood pressure correctly, two methods compared

Probiotics beneficial, but beware of some possible side effects

Prevention of osteoporosis

Helping independent and nonprofit research alongside Fadoi

Depression after “age”? Here’s why

Risk factors, complications and prevention of obsessive compulsive disorder (ODD)

App improves medication adherence for cardiac stent patients

Vitamin E: which are the benefits?

Reviving couples’ sexuality during the vacations

Free from Meningitis

portal info

for patients

for doctors

your advertisingexclusively ONMY SPECIAL DOCTOR

complete the form and you will be contacted by one of our managers

your advertising
exclusively ON
MY SPECIAL DOCTOR