Programmed Cell Death To Fight Infection

Just in time for cold and flu season, this article.  Abstract:

Eukaryotic cells can die from physical trauma, which results in necrosis. Alternatively, they can die through programmed cell death upon the stimulation of specific signalling pathways. In this Review, we discuss the role of different cell death pathways in innate immune defence against bacterial and viral infection: apoptosis, necroptosis, pyroptosis and NETosis. We describe the interactions that interweave different programmed cell death pathways, which create complex signalling networks that cross-guard each other in the evolutionary 'arms race' with pathogens. Finally, we describe how the resulting cell corpses - apoptotic bodies, pore-induced intracellular traps (PITs) and neutrophil extracellular traps (NETs) - promote the clearance of infection.

The human body has many defenses against infection and we should do what we can do help: healthy diet, adequate sleep, physical activity, and hand washing.

The Best Christmas Gift (Letters from My Friend)

 

Introduction

Hana was my best friend for seven years. The first five of these years were at the University, where we both studied and graduated with BS/MS in Biotechnology. Our graduation coincided with the explosion of a societal chaos. The chaos was fueled by the dying socialism and the newly-born capitalism. The nascent but deformed capitalism in Eastern Europe was the child of the former socialist leaders floating on the vast funds of their communist parties. 

There were no jobs for University graduates anymore. In the past, the communist party was handing job assignments to each graduate; however, at the the end of the eighties, the jobs and all socialist structures and enterprises collapsed.  I still carry the stigma of joining the unemployment line as soon as I was awarded my Master's degree.  Before even being employed for the first time in my life, I had to experience the feeling of being useless and unworthy. My solution was to start a PhD program in a pharmaceutical research institute. The position secured a small stipend; however, my mentor “disappeared”. This is another long story that is not worthy narrating.  Absurdities like this disappearance were abundant and we did not pay them any attention, for our focus was on mere survival.  Eventually, I learned English on my own, took the TOEFL and GRE exams required for applications to US graduate schools, and in two years after graduating with MS degree, I left for New York city and a PhD program there.  Hana stayed behind with her family and her job. She had always had an excellent command of English and she was able to find jobs requiring English in the mushrooming private enterprises.  Hana intended to join me in the USA once ready to switch to studying mode again.

I met Hana during lectures in our first college year. She was reticent and hesitant to talk to us, the other four girls in the student group. She was darker than all of us. She had darker skin color, dark and shiny long hair, exotic dark eyes. She carried the enigma of a foreigner. She also seemed depressed and even permanently offended by something.

Forward seven years. Hana and Joy were the two friends who sent me at the airport before my flight to New York city.  I was leaving for my PhD studies. My English was poor, and I relied on approximately $1,000 that my parents had borrowed from relatives.  My ticket was paid by a charity foundation. I was desperate to get out of the country.  After a heartfelt goodbye at the airport, I never saw Hana again.

During the seven years of our friendship, Hana proved to be the kindest, most sophisticated, knowledgeable and smart person I had ever met in my life. She could derive mathematical formulas, bake amazing cakes, cook delicious pasta, tailor jackets and pants, play the piano, sing, discuss all famous music bands, movies, singers and actors, and speak Farsi, English, Russian, German, and Bulgarian. She was also studying Norwegian. She was impeccable in all aspects and she was my inspiration to become better in everything I did.

During my first year in the USA, I received three letters from Hana and then the letters stopped; the news from and about her dried out. I asked my parents about Hanna, and they reluctantly said that she had been in a car accident. She was treated in a hospital, they added. This was the story that mom and dad kept repeating until I went back home for a visit after the first year of PhD studies. And then they told me the truth. Hana had passed away. She had died months before I got home. The car accident happened on an icy road, somewhere in the provinces. Everyone else in the car got out unscathed. Only the part of the overturned car where Hana was sitting was so badly crumpled that had to be cut by emergency workers. A small provincial hospital nearby took care of Hana. Her condition was stable at the beginning but deteriorated suddenly. The likely cause was a blood clot. There was no defibrillator, and a helicopter was sent to transfer Hana to the capital, but it was too late. 

People say that time heals. Time never healed my pain and never changed my refusal to accept the reality. No one can accept the death of a 25-year old smart and talented young woman. And probably because it was so painful, I avoided thinking about her until recently. 

It has been 27 years.

This past week before Christmas, I was looking for colored paper that I had boxed away, along with a bunch of letters from my mom and relatives. As I was going through the box, a small picture of Hana fell out of an envelope. The envelope also contained three letters from Hana. These are the only letters she wrote to me after I came to the US. The last letter was written two or three weeks before her death.  I must have hidden these letters from myself long time ago, because I did not want to cry anymore. I re-read the letters 27 years later. I did not remember even a word.

The three letters were the best Christmas gift I have ever received. I did cry again when I read them; however, for the first time I felt a newly-found appreciation for the gift of friendship in my early life.  Along with the sharp bitterness of the loss, for the first time, I felt gratitude of having had someone so special. Hana will be always in my thoughts as an inspiration to become better in everything I do.  This is the power of a great example. 

The three letters below do not reflect the true intellectual and emotional strength of Hana, for she always doubted herself and put herself down.

 

Letter #1

Dear Pari,

I am guilty. My conscience is uneasy and most of all, I feel guilty because of abandoning you. But you know me well – I cannot change, I keep postponing everything as if tomorrow I would do it in a better way. Since you left, I have been thinking about you and praying for you. I was aware of how much you expected a letter from me and despite of this, I did not sit down to write one. If I tell you that it was lack of time, you probably would not believe it and you would not be mistaken. When I read the first and last sentences of your letter, a sharp heartache impaled me! No, I am not the kindest person you have ever known, I am not even good, but I would like you to know that I miss you tremendously and I am miserable without you.  Please, do not conclude that I will not write to you! Maybe not as frequently as I wish, but I will try.

I am happy that all is well there. It is terribly interesting to read your letters - it is as if I am in New York city! You do not know, but at the beginning, I was very worried about you – being in a foreign country and all, but now I have been reassured. You are going to make it! I can hardly imagine myself in your shoes – to have lectures in English, to do homework and take tests with grades higher than 90% … All of this seems to me so impossible and unachievable. You are the best! I do not believe that your English has not improved, on the contrary! I wish I could let you listen now to Suzanne Vega… and I greatly envy you that you are so close to her (she lives in N.Y.). You did not write anything about your job – how is it? Do you get tired? Do you have enough money? And most importantly, are you coming home for a visit? I apologize, I am so nosy, right?

Maybe you would be more interested to find out something about me, despite that my life is not so exciting and bubbling with new experiences like yours.  I will start from the beginning. Soon after you left, I went to the resort of Basko with Sophia. I did not feel like going there; however, we happened to have a great time! Every morning we rose early and went to the mountains with the service bus for the personnel of the cable car line. This bus is not allowed to serve guests like us, but we begged since all other buses for the mountains were stopped. High in the mountains, we hiked for hours and at five o’clock in the afternoon, we again used the service bus to go back to the town. We spent a lot of money this week, but spoiled ourselves with everything – chocolate, ice cream, orange juice and even Irish Cream (but not the original, of course…). Admittedly, I had my brief depression episodes, but everything else was superb. By the time I got back home, I had taken a firm decision to sever relations with my “dear” boss and quit my job. I had to wait, however, till the beginning of September, when she was to return from her vacation. Till then, I decided to have a great life and frequently skipped on going to work. Moreover, during that time, the boss’s niece came to live in our office. The office is in fact the apartment of my boss’s brother, who is married and lives in Germany. Can you imagine that the niece was born on 09/03/1968!!! (yes, my birth date) and, of course, she was the cutest! Most of the time, we just talked over a cup of coffee and a coke. She even insisted on treating me because of our common birth date, so we went to a disco and a night club. I got back home at 4:00 AM. We had a great time, but at the end, my boss came back and on her first day in the office, I presented her my resignation (which to my surprise, was accepted well ... thank God!). I had to continue working there till the end of October since the company's policy calls for a 30-day advanced resignation. And this was the worst of times. The boss decided that I should finish the most difficult and least rewarding tasks; so, I ran like a Phoenician to do it all.

You cannot imagine the relief I felt the first day after I was done with that job. I woke up in the morning and realized I did not have to catch the bus to that office ever again! Took three days of “rest” (this is in quotation marks because I had to finish myriad of postponed tasks and obligations) and then I started the new job, which is highly satisfying. My starting salary will be 3,000 xxx (or higher) and the environment is incomparable. The colleagues are extremely nice and congenial. Although there is lots of work to be done, all is accomplished in a quiet manner, without stress and anxiety. There are always people around and I no longer feel like I am confined to a solitary prison cell like I experienced in my previous job. I work on a computer and translate directly from English; this experience would be of help for my future [studies]. After the torture with the nasty typewriter at my former office, the place here feels like a paradise. There are also games her!. Outside the job, life is more or less the same. I go to the movies, take music lessons (now I am studying harmony), and so on. It is not that interesting to describe.

I received a letter from my cousin in Connecticut, who on request by my father, paid my application fee to Boston University and Clarkson University. My cousin also asked me to send him all my documents and he will try to secure my admission in his university, which is unfortunately a private institution and I may not be able to afford the tuition. There is nothing else. I hope to be together with you next year.

This is all for now. I have not called Joy because I lost her phone number. I hope she remembers me and calls one of these days.

Pari, I miss you.

With lots of love,

Hana

 

PS Please, forgive my ugly handwriting.

 

Letter #2

Hello, dear Pari!

This time you have the right to be angry with me. I am a horrible person. I cannot stop procrastinating. I have been planning to write you a letter and I carry with me a pack of letter stationary all the time. And yet, I could not find the time to do it until now. Finally, here it is this blank page of paper that I started to fill with letters. It is a Sunday evening, and all is quiet!

Pari, forgive me that I do not write you on a regular basis. I do think about you frequently. Many things happened to me recently – they may seem strange to you, but believe me, they are not less strange to me. Do you remember when we talked about God? You said that everyone has their own God, and until recently I more or less thought the same. But something happened to me (not a miracle, but SOMETHING), which made me believe in the one and only God – the one who created all around us and who is above all. I cannot explain the change within myself, but I cannot deny that I had not expected this change. For a long time, I have been preparing for this and now, I know that there is nothing impossible for God, and all goes according to God’s plan.

I have always been looking for a meaning in everything, but I could never find the meaning anywhere. It is frightening to think that we live just like that, just because we were born (to overjoy our parents), to achieve something (if we could), to create children (who could give some meaning to our lives and then make them meaningless again), and to disappear into the nothingness. When I start reasoning like this, I do not want to live anymore. Now, however, I believe that there is something to live for, albeit, I have still not discovered what it is exactly.  Excuse me that I am bothering you with these thoughts, but this is what's on my mind lately.

Here, nothing is happening except for the prices steadily climbing up. Thank God, for now, I have not had financial problems. I am relatively well paid, but most importantly, I have amazing colleagues and every day go to work with pleasure. There is lots of work especially for me; I just finalized the translation of a magazine. In addition, there is always something new to do, there are lots of in-coming and out-going communications and faxes, etc. I do not event notice how the time flies; whereas, at my previous job, I could not wait for 6:00 PM to leave. The only thing that troubles me is that my eyes strain terribly. But obviously this is the inevitable evil when working on a computer. Besides work, I am quite busy – I go to church three times a week, twice a week I join the choir rehearsals, and take lessons in music harmony, etc. I go home only to take a shower and sleep. Our neighborhood just got central heating and it is a bliss!

I hope that you do not feel estranged and lonely anymore in NY.  You are going to make it. I am glad that you are there, where you deserve to be. How were your Christmas and New Year’s Eve? (all was normal for me). Excuse my belated postcard! 

Write me about your studies, it is so interesting!  I still do not have any news from Fordham University, but I have been accepted in Clarkson University (stipend?). Boston University acknowledged that my document package was complete, and the application was sent for a review. I am pretty sure that next year we will trod the same grounds.

This is all for now. I have many other things to share, but I can hardly keep my eyes open (my handwriting evidences this). I love you and I pray for you!

Hana

 

Letter #3

Dear Pari, 

Good Morning!

It is 21 minutes past midnight. You probably still have daylight. It is so strange that at the same time somewhere is night, and somewhere else is daylight… As in the song of Suzanne Vega, “…half the world in sweetness, the other in fear”. I received your letter a day ago, after finding my mailbox empty every day for a long time. I was overjoyed! 

The pictures are amazing – one of them (the one with you, of course) decorates my shelves now. You look great and your friends seem cute. Yale University is stunning; it is probably fantastic to study there (in all these buildings, architecture, etc.). I have no new pictures, so I cannot surprise you with anything. I have been thinking of buying a camera, but the film developing here is quite expensive.

This does not mean that I am frugal. My last acquisition is over 9,700 xxx – a CD player and a speaker. Finally, my dream is a reality! At the moment, I am writing and listening to the sounds of Tubular Bells II by Mike Oldfield.

Thank you so much for watching the interview with Suzanne Vega on my behalf! What would not I give just to be able to peek at her. 

Lately, I frequently catch myself thinking that I would like to go to the United States. This is strange, since until recently I perceived this possibility as a burden. Maybe I am changing – the mere fact that I am sitting down to reply to your letter in such a short time is very indicative. With the risk of being annoying, I will quote Suzanne Vague again, “I think it is called my destiny that I am changing…”.

I still have not received a notice from Fordham University about my application. I am accepted in NEU and Clarkson University; however, there is still no decision about a stipend. Boston University acknowledged that my application was complete, but they are still reviewing it.

Pari, I have this strange feeling that next year we will be together! I miss you very much, I need a close friend like you.

There is nothing interesting around me. I go to work, sing in the choir, hang around here and there… But it is TERRIBLY interesting to read about your American life, it is not the least boring or stupid as you qualify it!

My dear, my eyes are closing… Do not despair and do not fear, because “God has given us not a spirit of fear, but a spirit of strength, love, and self-control” (II Quran 1:7).

I love you!

Waiting for news,

Hana

 

 This is my real life, but all names of people and locations are changed.

Some Adventures In Body Composition

Does body composition affect food intake and, hence, obesity?  It seems so.  Abstract:

In his last review entitled "Some Adventures in Body Composition," Gilbert Forbes reminded us that "lean body mass and body fat are in a sense companions." To what extent the lean body mass (or fat-free mass) component in this companionship impacts on energy intake is rarely a topic for discussion, amid a dominant adipocentric view of appetite control. Yet an analysis of the few human studies that have investigated the relationships between objectively measured food intake and body composition reveals a potentially important role for both an increase and a decrease in fat-free mass in the drive to eat. These studies are highlighted here, together with the implications of their findings for research directed as much toward the elucidation of peripheral signals and energy-sensing mechanisms that drive hunger and appetite, as toward understanding the mechanisms by which dieting and sedentariness predispose to fatness.

A deficit in lean body mass may lead to overeating/obesity, dieting may, and a sedentary lifestyle.  It would seem that exercise that builds lean body mass, overall physical activity, and a healthy diet that avoids overly strict "fad dieting" may all be helpful in regard to this.

Exercise Non-Responders?

Are any people real “non-responders” to exercise?  This paper says “no” – those people just need a “higher dose” of exercise in order to see a response. In this case, the exercise was aimed at “cardiorespiratory fitness,“ but presumably the same applies to muscle-building as well. This does not mean, of course, that with a sufficiently high dose everyone will ultimately obtain the same results. Some people are indeed “hard gainers.” But they should be able to achieve some reasonable gains, albeit not at the level of all those “easy gainers.” 

Rare Variants For Human Height

At left, genetics of height. By The original uploader was Pete.Hurd at English Wikipedia - Transferred from en.wikipedia to Commons by MichaelSchoenitzer using CommonsHelper., Public Domain, 

https://commons.wikimedia.org/w/index.php?curid=19496489

Interesting paper, abstract:

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

Obviously, there's nothing you can do about what gene variants you inherited and nothing you can do about height as an adult, but genetic height potential can be maximized by having adequate nutrition while growing, which is why people in given populations tend to be taller today than in centuries past.

Synthetic Oxytocin And Postpartum Emotional Problems

Oxytocin is used to facilitate childbirth and is important for social bonding.  The latter role suggests that synthetic oxytocin would decrease postpartum depression or anxiety, but the opposite seems to be the case, conclusions from abstract:

CONCLUSIONS:Contrary to our hypothesis, results indicate that women with peripartum exposure to synthetic oxytocin had a higher relative risk of receiving a documented depressive or anxiety disorder diagnosis or antidepressant/anxiolytic prescription within the first year postpartum than women without synthetic oxytocin exposure.

There may be many variables involved here, but perhaps – and this is my hypothesis – excess oxytocin above and beyond natural levels causes a negative feedback with respect to its emotional effects?

In any case, this is how science is done, you make a hypothesis and test it.  The authors noted that their hypothesis was wrong, enabling the field to move forward. That’s how it is properly done.

Unable to meditate? Watch YouTube

 

The title is not a joke. 

I have listened enough about the benefits of meditation and yet, I am the type of person who cannot stand still and empty her mind on will. 

Cruising the YouTube channels has become my favorite way to escape reality. Especially in these days of absurdities and death.

I have previously recommended a few channels, but they all have utilitarian trends.  

Here is one channel that with music, images and words is the closest to what mediation may achieve for me.

Do you need beauty and magic in your everyday life? Watch this channel. The young German  Leena Henningsen will lead you to a world of forests, valleys and mountains. The world of fairy tales and nature.

Here is her story:

 

Flexible Daily Undulating Periodization For Powerlifting

Here is a paper about daily undulating periodization (DUP) – defined here – for powerlifting, abstract:

Colquhoun, RJ, Gai, CM, Walters, J, Brannon, AR, Kilpatrick, MW, D'Agostino, DP, and Campbell, WI. Comparison of powerlifting performance in trained men using traditional and flexible daily undulating periodization. J Strength Cond Res 31(2): 283-291, 2017-Daily undulating periodization (DUP) is a growing trend, both in practice and in the scientific literature. A new form of DUP, flexible daily undulating periodization (FDUP), allows for athletes to have some autonomy by choosing the order of their training. The purpose of this study was to compare an FDUP model to a traditional model of DUP on powerlifting performance in resistance-trained men. Twenty-five resistance-trained men were randomly assigned to one of 2 groups: FDUP (N = 14) or DUP (N = 11). All participants possessed a minimum of 6 months of resistance training experience and were required to squat, bench press, and deadlift 125, 100, and 150% of their body mass, respectively. Dependent variables assessed at baseline and after the 9-week training program included bench press 1 repetition maximum (1RM), squat 1RM, deadlift 1RM, powerlifting total, Wilks Coefficient, fat mass, and fat-free mass (FFM). Dependent variables assessed during each individual training session were motivation to train, Session Rating of Perceived Exertion (Session RPE), and satisfaction with training session. After the 9-week training program, no significant differences in intensity or volume were found between groups. Both groups significantly improved bench press 1RM (FDUP: +6.5 kg; DUP: +8.8 kg), squat 1RM (FDUP: +15.6 kg; DUP: +18.0 kg), deadlift 1RM (FDUP: +14.8 kg; DUP: +13.6 kg), powerlifting total (FDUP: +36.8 kg; DUP: +40.4 kg), and Wilks Coefficient (FDUP: +24.8; DUP: +26.0) over the course of study (p = <0.001 for each variable). There was also a significant increase in FFM (FDUP: +0.8 kg; DUP: +0.8 kg) for both groups (p = 0.003). There were no differences in motivation to train, session RPE, or satisfaction with training session measurements between groups (p = 0.369-0.702, respectively). In conclusion, FDUP seems to offer similar resistance training adaptations when compared with a traditional DUP in resistance-trained men.

Take home message: allowing lifters flexibility in choosing how they arrange their training yields results similar to more structured traditional DUP regimes.

Dietary Interventions For Sarcopenia

Sarcopenia is the loss of muscle with normal aging.  What dietary interventions can help improve muscle mass in these patients?  Abstract:

BACKGROUND: Inadequate nutritional intake and altered response of aging muscles to anabolic stimuli from nutrients contribute to the development of sarcopenia. Nutritional interventions show inconsistent results in sarcopenic older adults, which might be influenced by their basal nutritional status.

OBJECTIVE: To test if baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations and dietary protein intake influenced changes in muscle mass and function in older adults who received nutritional intervention.

METHODS AND DESIGN: Post-hoc analysis was performed in the PROVIDE study that was a randomized controlled, double blind trial among 380 sarcopenic older adults. This study showed that those who received a vitamin D and leucine-enriched whey protein medical nutrition drink for 13 weeks gained more appendicular muscle mass (aMM), and improved lower-extremity function as assessed by the chair stand test compared with controls. To define low and high groups, a baseline serum concentration of 50 nmol/L 25(OH)D and baseline dietary protein intake of 1.0 g/kg/d were used as cut offs.

RESULTS: At baseline, participants with lower 25(OH)D concentrations showed lower muscle mass, strength and function compared with participants with a high 25(OH)D, while the group with lower protein intake (g/kg/day) had more muscle mass at baseline compared with the participants with higher protein intake. Participants with higher baseline 25(OH)D concentrations and dietary protein intake had, independent of other determinants, greater gain in appendicular muscle mass, skeletal muscle index (aMM/h2), and relative appendicular muscle mass (aMM/body weight × 100%) in response to the nutritional intervention. There was no effect modification of baseline 25(OH)D status or protein intake on change in chair-stand test.

CONCLUSIONS: Sufficient baseline levels of 25(OH)D and protein intake may be required to increase muscle mass as a result of intervention with a vitamin D and protein supplement in sarcopenic older adults. This suggests that current cut-offs in the recommendations for vitamin D and protein intake could be considered the "minimum" for adults with sarcopenia to respond adequately to nutrition strategies aimed at attenuating muscle loss.

It may not be surprising that patients with higher baseline vitamin D and protein intake showed greater muscle gains when given the enriched drink intervention.  It is curious that at baseline, while the higher vitamin D intake group had greater muscle mass, it was the lower protein intake group that had greater muscle mass.  The higher protein intake group had more women that the lower group, less weight and less fat, so there are a number of factors to consider.  The bottom line though is that gain of muscle above baseline required sufficient vitamin D and protein.

More On Caloric Restriction

Caloric restriction has benefits, but I would think that those few who are either underweight or close to underweight should be careful here.  The average American, however, who is overweight/obese, may derive some benefits, after consultation with their physician (obviously there are health conditions for which fasting/caloric restriction would not be advised).  Abstract:

PURPOSE OF REVIEW:

Obesity and obesity-related diseases, largely resulting from urbanization and behavioral changes, are now of global importance. Energy restriction, though, is associated with health improvements and increased longevity. We review some important mechanisms related to calorie limitation aimed at controlling of metabolic diseases, particularly diabetes.

RECENT FINDINGS:

Calorie restriction triggers a complex series of intricate events, including activation of cellular stress response elements, improved autophagy, modification of apoptosis, and alteration in hormonal balance. Intermittent fasting is not only more acceptable to patients, but it also prevents some of the adverse effects of chronic calorie restriction, especially malnutrition. There are many somatic and potentially psychologic benefits of fasting or intermittent calorie restriction. However, some behavioral modifications related to abstinence of binge eating following a fasting period are crucial in maintaining the desired favorable outcomes.

Diagnostic Tests And Patient Reassurance

Do diagnostic tests reassure patients?  Possibly not, abstract:

OBJECTIVE: This review is a narrative synthesis of the RCTs which studied the efficacy of using diagnostic tests to reassure patients.

METHODS: We searched for RCTs that examined the level of reassurance after diagnostic testing in outpatients. We used PubMed, Psychinfo, Cochrane Central, Ongoing Trials Database and Scopus.

RESULTS: We found 5 randomized controlled trials that included 1544 patients. The trials used different diagnostic tests (ECG, radiography of lumbar spine, MR brain scan, laboratory tests, MR of lumbar spine) for different complaints (e.g. chest pain, low back pain and headache). Four out of 5 RCTs did not find a significant reassuring value of the diagnostic tests. One study reported a reassuring effect at 3 months which had disappeared after one year.

CONCLUSION: Despite the sparse and heterogeneous studies, the results point in the direction of diagnostic tests making hardly any contribution to the level of reassurance. We recommend further studies on the use of diagnostic tests and other strategies to reassure the patient.

PRACTICE IMPLICATIONS: A clear explanation and watchful waiting can make additional diagnostic testing unnecessary. If diagnostic tests are used, it is important to provide adequate pre-test information about normal test results.

Of course, diagnostic tests (that are presumably not necessary) are not only given to reassure patients, but – possibly in some cases - to protect doctors from malpractice liability.

Beets and apples salad

Is your diet too low in fiber? Here is a little unusual combination for a salad to try along with your main dishes.  It delivers lots of fiber even during the winter, when fresh salads may not be easily available.  

Use your imagination and add as many other ingredients as you wish (and have at hand). For example, for more splash of color, vitamins and fiber, add a grated carrot and/or a few slices of a tangerine.

For us, today "the main dish" is composed of a can of salmon with tahini-lemon-onion seasoning and baked chickpea balls. For these recipes, I will post additionally.



Beets and apples salad
Ingredients
1 Tbsp olive oil
1 Tbsp apple cider vinegar
1 Tbsp strawberry preserves (or any other preserves you like)
salt to taste
1 14-oz can of beets (whole or sliced)
1 medium apple, cored and diced (any variety you like)
chopped parsley (optional)

Directions
Mix the first four ingredients well and then combine with the apples and beets. Sprinkle with some parsley.

Workplace Bullying Interventions

At left, possible workplace bullying?

Public Domain, https://commons.wikimedia.org/w/index.php?curid=393839

A paper on workplace bullying is found here, two sections from the abstract are reproduced below:

BACKGROUND: Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.

AUTHORS' CONCLUSIONS: There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well-designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up.

So, there is only “low quality evidence” that the interventions actually do any good to prevent workplace bullying. One possibility is that the organizational interventions are pushed by administrators who want to “cover themselves from potential liability (“see – we did something!”) or to burnish their resumes with their “impressive intervention sessions.” Or, we may have “experts” without actual data to back up their assertions, as well as (possibly well-meaning) individuals who do not know how to best approach the problem. As the authors state: “Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up.”

Banana Bread Pudding

I have not baked bread pudding until now. Recently, got inspired by Kirsten Wick and her video.

So, I decided to make my own recipe. First, went through one of the cookbooks I had and then, the substitutions of ingredients started. No sugar, but bananas. No milk, but some unsweetened apple sauce and peaches in light syrup. I did not substitute the butter, however.

I also made a double batch, so that I could freeze a few delicious breakfasts.

Here is the recipe:

Banana bread pudding

Ingredients:
5 frozen ripe bananas
10 slices Oatnut bread (or any other bread you prefer), sliced in cubes
1 stick butter (melted in the microwave for the oiling of the pan and for the pudding mixture)
8 oz unsweetened apple sauce (I use two 4-oz cups)
14.5-oz sliced peaches in water (the peaches were cut into small pieces)
1 cup raisins
3 Tbsp vanilla extract
1 Tbsp cinnamon powder
7 eggs

Directions:
Preheat the oven to 400 F and butter a pan (mine is 10' x 13'). Combine the peaches with their syrup, the apple sauce, the raisins, vanilla, cinnamon and the bread cubes. In a separate bowl, beat the eggs and mix with the mashed bananas and melted butter. Add to the bread cubes and mix well. Bake for 30-35 minutes or until set and slightly golden on top. Cut when the pudding cools down.

Cruciferous Vegetables, Sulforaphane, And The Nervous System

At left, Brussel sprouts, By Eric Hunt - Own work, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1318818

Can agents found in the diet help with neural stem cell proliferation and differentiation, therefore possibly being of benefit for nervous system diseases and disorders?

It seems that sulforaphane, found in cruciferous vegetables, can enhance neural stem cell proliferation (growth) and differentiation (maturation into mature neural cells) as described in this paper here.

I myself always like to eat Brussel sprouts, and these findings increase my desire for that food.

Exercise For Hip Osteoarthritis

Can a specific exercise program enhance hip muscle strength and therefore be of benefit to patients suffering from hip osteoarthritis?  Here is a paper that says yes, abstract:

PURPOSE: To evaluate the effect of an exercise therapy concept (the Tübingen exercise therapy approach THüKo) for increasing hip muscle strength (HMS) in patients with hip osteoarthritis (OA), and to investigate whether patients do adhere to the intervention and if there are any adverse events related to the intervention.
METHODS: A total of 210 hip OA patients (89 females, 121 males) were randomized into a 12-week exercise intervention (THüKo) including group sessions (1/week) and home exercising (2/week), a placebo ultrasound group (1/week) or a control group (no treatment). HMS was measured as isometric peak torque of hip abduction, adduction, flexion, and extension. Adherence to exercise and safety aspects were monitored as additional outcomes.
RESULTS: Baseline adjusted post intervention HMS of the THüKo group were higher compared to the control group (differences of 0.11-0.27 Nm/kg, p < 0.01) and to the placebo ultrasound group (differences of 0.09-0.19 Nm/kg, p < 0.01). Adherence to exercise was high (about 90%). No subject had to refuse from training because of an exercise related adverse event and exercise related pain was only of intermittent nature without sustainable adverse effects.
CONCLUSIONS: The Tübingen exercise therapy approach has shown to have a significant positive effect on HMS. Its implementation has shown to be feasible and safe according to the percentage of exercise participation and the absence of sustainable adverse events.

More details about the exercise program can be found in this paper here.  If you have hip osteoarthritis, this may be something you can discuss with your physician.

The evil in your medicine

About a week ago, I listened to the podcast of Peter Attia, MD, with Kathrine Eban, the author of the book Bottle of Lies. It was one of the longest podcasts Attia has produced, and yet, I could not stop listening. It was a captivating and anxiety-inducing narrative about generics, the cheaper version of the brand-name medications.

As the minutes turned into hours, the discussion revealed the depths of a global crime with the main motivation being the GREED. 

After the podcast, I obtained the book and read it in three days. Several times through the book, I started crying (yes, I am a cry-baby). Several times, I had to stop reading because the words felt like punches to my chest and left me breathless. I was facing one of the most detailed and harrowing accounts of EVIL.

And here is some of the story.

First was the GREED of global pharma. The drugs were developed based upon huge intellectual and research effort, and yes, based upon lots of funds. But the profits exceeded the expenses beyond any imagination. The drug prices that pharmaceutical companies extracted from the patients and the US health system supported the companies’ manicured headquarters and campuses, the lavish caviar-and-champagne office parties, the helicopters and the multi-million-dollar salaries and bonuses of the executives.

The second layer of GREED story was revealed when the pharmaceutical companies in China and India were allowed to deliver the cheaper versions of the brand-name medicines – the generics. The lower price, however, compromised the quality of the medications. As noted in Kathrine Eban’s book, each drug is a poison, and its therapeutic range is rather narrow. Anything outside this range could damage or kill. If to the not-so-precise dosing of the generics, one adds impurities, carcinogens, fast degradation/decomposition or deregulated bioavailability of the active ingredients, then the result is a generic drug that acts as a placebo (the best case scenario), or functions as a lethal weapon. 

The death of the pharmaceutical manufacturing in the USA, the rise of pharma in India and China, the resulting genocide in the form of substandard or murderous generics, and the inability (unwillingness?) of the federal government to address this genocide are all documented in Bottle of Lies.

If you, your family and friends rely on any medication, you should listen to the podcast of Attia and read the book Bottle of Lies.

What can you do when prescribed and dispensed a generic medication that might make you sicker, kill you or is just ineffective?

I hate to say that there is no hope or solution to this tragedy. But for most people who are not aware of what is happening, there is no solution. Many patients would end up poisoned or even killed by the medications. 

And yet, you may try to fight the established system by insisting that your doctor and pharmacy give you the brand version of the medicine. It will certainly cost you.

There is also the very first online pharmacy Valisure, that analyzes for reliability all drugs they dispense. They also keep a list of Indian and Chinese companies that they would never order drugs from. Learn more about this company from another podcast of Dr. Attia, this of his conversation with David Light.  

Finally, eat healthy, move, destress so that your dependence on drugs is decreased. Above all, read the book, be aware. Let your friends and family know the truth.

If you live in Europe, you will find this video revealing and troubling:  How Safe Are Our Medicines.