Exploding Gallbladders: Just the Facts

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Let’s take a look at the actual case study on the exploding gallbladder and figure out what’s relevant and what’s conjecture—by all parties.

The Case Study

The paper was the result of a close examination of the medical information gathered when a 69-year-old man went to the emergency room at SUNY Brooklyn Medical Center with a perforated gallbladder. There were three parts to the paper:

  • The introduction focused on curcumin and its potential for causing issues in people with gallbladder disease.
  • The second described the treatment plan for the patient, mostly antibiotics and pain relievers.
  • Finally, a review laid the groundwork for why curcumin caused the perforation in the gallbladder.

The reason? Curcumin may increase the strength of the contractions in the gallbladder duct as it moves bile. A large stone was blocking the duct, so curcumin caused the pressure to buildup in the gallbladder and boom: explosion! Well, perforation, but you get the idea.

The Problem

There was no evidence to show that curcumin directly contributed to the gallbladder issues. What was also in the case study but not considered was that the patient had a history of gallstones. He was also taking five medications for hypertension, high cholesterol, and an enlarged prostate.

The writers of the case study were a medical student and a nephrologist (a kidney specialist). Based on published information, neither was an expert in the digestive system. It appears to have been conjecture on their part as to the cause of the gallbladder perforation. The comments on food and supplement oversight, while referenced, did not demonstrate any understanding of the FDA’s oversight of food and supplements; they’re not controlled as pharmaceuticals are, but both the FDA and FTC have control over the claims they can make. The amount of curcumin used by the patient was within the standard range for use of the supplement.

The Bottom Line

I can’t fault the writer for the Daily Mail; writers sometimes tend toward the sensational, and an exploding gallbladder is a perfect fit. The physicians and the article reviewers should have realized the faults in the analysis. Could a gallbladder explosion have been possible? Yes, but without accounting for the current status of the patient’s disease and considering pharmaceutical interactions of the meds the patient was taking, they used the “Ready, Fire, Aim” approach to assess what might have happened. We might expect that from reporters with no health background but not from medical professionals.

They were right about one thing. More research on interactions between food, herbs, and pharmaceuticals is necessary—but that isn’t news.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Exploding Gallbladders!

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Health Memo readers frequently forward health-related articles to me to ask my opinion; I read them all and respond to the sender if asked. Combined with my health news feeds, I read a lot about health—opinions about health, that is. I’m going to share a couple with you in the next few Memos and—wait for it—give you my opinion about whether what is being said is accurate, and more important, meaningful.

Let’s begin with curcumin, a very popular dietary supplement and a component of the herb turmeric used in cooking. It’s generally used as an anti-inflammatory for a variety of conditions, including joint health. The health headline in the Daily Mail implied that a 69-year-old man’s gallbladder exploded due to the interaction of the gallstones in his gallbladder with the high doses of curcumin he was taking. The Daily Mail seems to focus on celebrity news more than other types of news, but that doesn’t mean we can ignore the story.

The Daily Mail article was based on a case report published in a journal focused on just such case studies. The reporter took language from the paper that suggested that supplements avoid the regulatory process, creating a set of circumstances that could be potentially dangerous, as in this case. It also suggested that adverse reports with supplements are not reported. Is that all true? More importantly, what are the implications of such an article? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Another Buffalo Bill’s Cardiac Arrest

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I hope that you took 60 seconds to watch the video from Tuesday’s Memo and learn CPR. As I said, it’s simpler than when I taught it, and it may just save someone’s life—someone you love or maybe a stranger.

In the close, I mentioned another Buffalo Bill who suffered a cardiac arrest several months before Damar Hamlin’s on-field experience. The owners of the Bills and Buffalo Sabres and CEO of the Buffalo professional sports teams are Kim Pegula and her husband Terry. One night last June, Terry was awakened by Kim going into cardiac arrest. One of her grown daughters happened to be staying with her parents and performed CPR until emergency services arrived. She saved her mother’s life.

In an open letter in The Players Tribune, Kim’s daughter Jessica, a top-ranked tennis player, told the story of her mom. This time, without the immediate attention from a couple dozen experts, Kim’s brain was without oxygen for longer. While she continues to improve every day, she suffers from expressive aphasia. She can probably understand almost everything, but she sometimes can’t get the correct words to communicate well. No one knows whether she’ll regain lost function, but she’s alive to make that journey because of CPR. It’s a very moving story and I urge you to read it.

Who can do CPR? Almost anyone. The American Heart Association has no minimum age for learning CPR. They say, “The ability to perform CPR is based more on body strength than age. Studies have shown that children as young as nine years old can learn and retain CPR skills.” Now—are you going to take the time to learn CPR in 60 seconds? Just click this link.

Aging with a Vengeance

After the Super Bowl Webinar on Taking Back Your Muscle last Sunday, I had inquiries about the prior Super Bowl Webinar Reclaiming Your Power. I’m happy to let you know you can purchase both replays in the Store at drchet.com. If you order one or both, make sure you use the correct email address; it’s the only way you can get the link to listen to the replay. And if you want to gift the replay to someone, you can; when you’re checking out and get to the billing details page, enter their email address instead of your own.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge
2. https://www.theplayerstribune.com/posts/jessica-pegula-tennis

Happy Heart Health Month!

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Happy Valentine’s Day to everyone! February is American Heart Month; it also has an emphasis on women’s heart health with Go Red for Women. That’s symbolized by wearing red as often as you can during February. I can’t think of a better day to do that than today—Valentine’s Day. There’s a lot that we can do for our hearts with diet, exercise, and more, but that’s not what this memo is about. It’s about responding to a challenge.

Whether you’re a football fan or not, you’ve probably heard about Damar Hamlin, the Buffalo Bills safety who had a cardiac arrest on the field in January. He has recovered and is doing well, and he hopes to get back to playing football. But he’s alive only because the immediate training staff responded by doing CPR on the field.

Damar is part of American Heart Month with #3forHeartTM CPR Challenge. The first part, and probably most important, is to learn how to do CPR in 60 seconds; follow the link to watch the video. Even though I’ve taught CPR, it was a good refresher and, wow, it’s a lot simpler than it used to be. Take a minute today to be prepared in case your Valentine or anyone else has a problem.

There is another part to this story about another Buffalo Bill who had a cardiac arrest. I’ll tell you about her on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge

What Your Body Needs for Bone Repair

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When it comes to broken bones, especially in adults, what can be done to help the healing process? Pain management is always paramount because of the second reason: joint rehabilitation. If any movement is too painful, no one wants to rehab the muscles and tendons surrounding the joint, especially with a dislocation that stretches them beyond their normal capacity. Putting the bone in place is one thing, but getting the tendons and muscles to repair is another. There’s no being brave or gutting it out; rehab is necessary to restore complete joint function.

That raises the question: are there any supplements that can help with the healing process? The research is virtually non-existent, as outlined in a recent article, but there are some nutrients that make sense:

  • Vitamin C: an additional 1,000 to 2,000 mg per day. Vitamin C is involved in building connective tissues; bone, tendon, and ligaments are all connective tissue.
  • Vitamin D: an additional 50 to 100 mcg per day. Vitamin D is known for helping build bone, so it makes sense to increase the amount.
  • Glucosamine: 1,200 to 2,400 mg per day in total. Glucosamine, like vitamin C, is used in making all connective tissue. This appears to be important within the first two weeks after the injury, based on animal studies.
  • Calcium: 500 to 1,000 mg/day in total. The formation of the callus and conversion to bone requires calcium. Taking an extra amount, providing stone formation is not an issue, is important.

The final part of bone repair is patience. We all progress at our own pace. If ever there was a time to be consistent, this is the time.

Manage the pain, perform the rehab once you’ve been given a program, take some nutrients that can benefit bone growth, and don’t stop until you have full function. That’s the bottom line on broken bones.

Super Bowl Webinar Tomorrow!

The research is done, the presentation is ready, and I’ve practiced as much as I can. At this point, I can’t guarantee you’ll be on the live webinar, but if you’re not, you will still get the opportunity to watch it later in the day or whenever it’s convenient. Taking Back Your Muscle is the kick-off for Aging with a Vengeance 2023. I also think it’s the one that can benefit us the most. Hope to see you tomorrow!

What are you prepared to do today?

        Dr. Chet

Reference: J Orthop Res 38:695–707, 2020.

When Elbow Met Sidewalk

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Riley’s mom, Jamie, slipped and fell on a patch of ice when she got home from work late on Friday. Although she was home, she lay outside in the 10 degree temperature until she could get inside and call me. A former farm girl, she’s no wimp and had fallen off horses plenty of times, but she was in severe pain. Off to the emergency room we went. She had dislocated the radius and had a small fracture at the head of that bone. The orthopedist determined that the fracture was small enough to forego surgery, and that they could get the bone back in its joint. They put her out during the procedure for about five minutes. The pain of resetting the bone is severe, but she remembered nothing.

The pain was back when she woke about 8 a.m. The prescription pain relievers weren’t working and the ice wasn’t helping much. She added another pain reliever they recommended, ibuprofen. As the day progressed, she got some relief. I told her that the swelling would come down rather quickly on the simple fracture, and the pain would decrease to just uncomfortable as long as she didn’t move it. She’s already doing much better.

Jamie has a long road until she teaches dance again, but she’ll be working on rehab soon. Is there anything she can do to heal faster? I’ll give you the answer on Saturday along with other tips to help with this type of injury.

Super Bowl Webinar is This Sunday!

If you want to attend the live version of the Super Bowl Webinar on Aging with a Vengeance: Taking Back Your Muscle, sign up today. About half the spots have been purchased and based on past experience, 60% sign up in the last three days before the webinar. If you don’t get into the live webinar, you’ll still be able to watch the recording at your convenience after it’s posted. Registration is $12.95; Members and Insiders get their usual discounts. Whatever your age, you’ll learn how to keep what you’ve got and take back the muscle you’ve lost. Don’t delay!

What are you prepared to do today?

        Dr. Chet

When Supplements Aren’t Absorbed

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If you take any type of dietary supplement, you want to make sure that you’re getting the active ingredient whether that’s turmeric, the mineral iron, or omega-3 fatty acids. The problem is that whether in its natural form in food or put into dietary supplements, nutrients can be difficult to absorb. In addition, the same holds true for pharmaceuticals as well. Here are some of the reasons why:

  • Taking supplements with food is important for nutrient absorption. If they’re fat-soluble, they need fat present to be absorbed. That’s problematic if someone takes the supplement without food or is on a low-fat diet.
  • I seem to always talk about increasing fiber in the diet, and we should, but fiber can interfere with the absorption of some nutrients. It may be the increased transit time or some form of mechanical blockage, but it happens.
  • Finally, gut health may also impact the absorption of nutrients. Lack of enzymes, too acidic or too alkaline, or lack of a healthy microbiome can also impact nutrient absorption.

All is not lost; the pharmaceutical and supplement industries have been working on ways to help deliver more active ingredients. I’ll cover those on Saturday.

What are you prepared to do today?

        Dr. Chet

Childhood Obesity: A Family Thing

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I hope you took some time to scan the Executive Summary of American Association of Pediatrics Guidelines for Physicians. If you couldn’t, here are the three things that stood out to me.

Screening by Pediatricians and Primary Care Physicians

The focus of the guidelines was to assess risk factors for degenerative disease such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, indicating overweight, and 95th percentile, indicating obesity. The guidelines recommend beginning at 2 years of age and continuing through 18.

Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions.

It Must Be a Family Thing

Without exception, the guidelines recommend intensive health behavior and lifestyle treatment. “Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to twelve-month period.”

That’s not the same as giving Mom and Dad a diet for the child and sending them on their way. Family-based programs have demonstrated great success, but it has to be a family thing.

It’s All About the Money

The summary also talked about obstacles to the family-based treatment approach. The major obstacle is money:

  • Money for training pediatricians and family practice physicians on how to assess childhood obesity.
  • Money for training more people to teach and work with families—it’s labor intensive.
  • Money for public health and community programs that can support the family-based approach.

It’s a situation we’ve seen many times: Everyone knows how important preventive healthcare and early treatment is, but no one wants to pay for it. But maybe we shouldn’t always look to government to foot the bill; maybe schools, community organizations, and churches could offer programs for their members. If what we’ve always done isn’t working, let’s try something different.

The Bottom Line

The guidelines introduce a couple of new approaches for those with the most severe weight problems, but the focus is on intensive nutrition and behavior-change training for the entire family. That’s not just “Here’s a diet and exercise program, and I’ll see you next year.” The guidelines give a reasonable approach to help the future health of the nation. The approach is simple: Eat less. Eat better. Move more. What they’re saying is that healthcare professionals need training to be able to do that effectively as a team in a reasonable family-based approach. That’s the right approach as I see it.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-060641

New Guidelines on Childhood Obesity

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If you pay attention to health news, you know the American Association of Pediatrics issued new guidelines on how to treat childhood obesity. Depending on where you read or listened to how those guidelines were presented, all you may have heard is that kids over 12 can get medications to help with weight loss and teens over 14 can have gastric by-pass surgery.

Then the experts weighed in (no pun intended). One pediatric physician predicted doctors would just pull out the prescription pad and not address the root cause of obesity. Psychological experts said this is going to cause increases in disordered eating, which includes anorexia and bulimia.

This story hits home for me because food was love in a Polish household like mine. I’ve been overweight since I was around eight years old, and it’s been a life-long struggle to get to a normal BMI. But even at my heaviest, I was nowhere near the weight many kids are today.

Is that all that was in the guidelines? You can read the summary at the link below. Then on Saturday I’ll break them down to get the bottom line.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-06064

Almonds to the Rescue!

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Delayed-onset muscle soreness (DOMS) is common in sedentary people who overdo it—the weekend warriors who catch up on all the yard work in one day or people who have to shovel out a long driveway after a big snow. Researchers wanted to test what benefits these occasional exercisers may get from eating almonds compared to a cereal bar.

Researchers recruited a group of sedentary volunteers between the ages of 30 and 65. They wanted to examine the effect of eating two ounces of almonds every day for four weeks on measures of pro-inflammatory hormones and oxylipins, which are oxidized fats that can have pro- or anti-inflammatory effects. The control group ate a cereal bar with the same caloric content.

After 28 days, all subjects performed a 90-minute workout session designed to damage muscle that included a bout of maximal aerobic exercise, weight training, jumping, and other activities. Did they damage their muscles? Absolutely, based on the blood levels of enzymes indicating DOMS as well as standardized questionnaires assessing pain after exercise. The subjects who ate almonds every day had more anti-inflammatory oxylipins after exercise while the controls had an increase in pro-inflammatory oxylipins. Most important, the almond eaters appeared to recover a little faster.

Almond skins are a treasure of phenolic compounds. While this was a small study (69 total subjects), there were benefits to eating almonds every day for non-exercising weekend warriors. Could other high-phenolic foods have the same benefit? Time will tell. Almonds are also a treasure trove of omega-3 fatty acids, fiber, and protein, so substituting almonds for some other snack may prove beneficial. How about you regular exercisers? I’m betting you’ll get some benefit as well. It’s all part of eating better.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Nutr. 9:1042719. doi:10.3389/fnut.2022.1042719