Tag Archive for: New England Journal of Medicine

COVID-19 and Blood Type

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This week we’ll examine reports about comorbidities and other factors associated with the severity of the COVID-19 virus. We’ll begin with a question from a long-time reader and family member who shares DNA with Paula: her brother, Steve. Both have blood type A, which has been in the news as a factor in the severity of COVID-19.

The study that got the most attention was published in the New England Journal of Medicine. It was an observational study, which is important. They didn’t select a group of people with specific genetic mutations for the ACE2 gene and the ABO gene, which determines blood type, and then give them the virus; no ethics committee in the world would approve that study. Instead they collected patient data from the hardest-hit areas in Spain and Italy, including tissue or blood samples. They had limited historical data on the patients, especially known comorbidities such as heart disease, high blood pressure, and type 2 diabetes. They also knew the severity of the disease for each patient, including who was on oxygen and ventilators. It should be noted that about 80% of the most severe cases were people with comorbidities.

The researchers analyzed the entire genome of each patient and the control subjects, people from the same geographical area who didn’t get the virus. That worked out to 1,600 with the virus and 2,200 controls. To analyze every gene with potential mutations requires an average of 8.5 million combinations per person. They found two mutations or SNPs (single nucleotide polymorphisms) that seemed to increase the risk of a severe case of the virus: one area was responsible for blood-type proteins and the other for specific proteins use by the ACE2 receptor. They found that people with blood type A were 45% more likely to get a severe case of the virus requiring oxygen or a ventilator; people with type O blood had a 35% lower risk of the same response. They don’t know yet what the ACE2 protein area SNPs mean.

What does that mean in the real world? As this research continues, they may be able to determine a profile for a person most at risk so that they can get preventive treatment (if one is developed) and early treatment upon diagnosis. What I don’t think it means is that those with blood type A are at greater risk of catching the virus or type Os are at less risk of catching the virus, but I’d recommend that blood type A people should be even more diligent in reducing their exposure, and if they suspect they are infected, seek treatment earlier, rather than later.

Insider Conference Call

The Insider Conference Call is tomorrow night at 9 p.m. Eastern Time. Besides answering questions, I’ll report what I’ve learned about a Texas physician who claims to have found the “silver bullet” to cure COVID-19. You can become an Insider up through 8 p.m. and still participate live.

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/3gX1Bmh
2. NEJM. 2020. DOI: 10.1056/NEJMoa2020283.

Early Research on MSG

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People have been ranting against MSG for decades, but I never paid attention until I read a study on a group of subjects who said they had a negative response to eating Asian foods. The subjects were tested under four scenarios consecutively, dependent on their response to the prior test results. The study demonstrated that when exposed to massive amounts of MSG versus a placebo, there were no consistent responses from this sensitive group of subjects. That’s meaningful because it challenged common knowledge.

That common knowledge began with a letter to the New England Journal of Medicine by a physician after reporting symptoms he felt after eating a meal of Asian foods; it wasn’t research, just a personal anecdote. At the same time, a researcher from Washington University in St. Louis began a series of studies on glutamate and other protein precursors that demonstrated the excitotoxicity affects on brain tissue; excitotoxicity (ex-SIGHT-o-tox-ISS-i-ty) refers to nerve cells being damaged or killed by excessive stimulation by the neurotransmitter glutamate. That was when the bulk of the negative research on MSG drew attention. However, over a period of years, other researchers attempted to duplicate those studies with unsuccessful results.

Where does that leave us? Other than a variety of conspiracy theories, MSG doesn’t seem to have the negative impact that has been attributed to it. I’ll finish this up on Saturday but my original question still stands: if you feel you respond negatively to MSG, reply to this email and I’ll let you know the results next week.

What are you prepared to do today?

        Dr. Chet

References:
1. N Engl J Med 1968; 278:796.
2. Science. 1969 May 9;164(3880):719-21.

Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Aspirin and Unintended Consequences

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We began the week considering a type of shortcut to health called biohacking. The polypill was a biohack to reduce the risk of CVD events, but there’s no research showing whether the polypill will ever prove to be effective. However, the results of the ASPREE trial may give us an idea whether the long-term trials should ever be attempted (1-3). Let’s take a look at the results of the ASPREE trial and the effects of an aspirin a day on healthy older adults.

In the first paper, the researchers evaluated the data to see if those who took the aspirin had less disability (1). In other words, did taking the aspirin convey benefits that reduced the risk of death, disability, or dementia? The data showed no differences between the aspirin and placebo group as it related to those outcomes.

In the second paper, the researchers examined the differences in all-cause mortality (2). What surprised the researchers was a slight increase in death from cancers in the group that took the aspirin; no specific type of cancer seemed to be impacted. Because aspirin has been shown to be beneficial in almost all other studies of cancer and mortality, the researchers said the results should be taken with a degree of caution.

In the final paper, researchers examined whether aspirin reduced the rate of CVD events and stroke (3) and found no difference, but the risk of hemorrhagic stroke was significantly higher in the aspirin group versus the placebo. This was the primary reason the study was terminated after five years.
 

The Problem

There were several problems with the study including the low adherence in both the aspirin and placebo group: if people didn’t take the pills, obviously that impacts the results. But the biggest question I have is a very simple one: who thought it was a good idea to give healthy people a medication every single day? Taking an aspirin for a headache or muscle ache is one thing. Taking it when you don’t need it is another.

The study demonstrated the logical fallacy of the polypill. “People won’t take care of themselves, so let’s put everyone on the medications that can reduce the risk of CVD.” No, let’s not. The results were unintended consequences that put the entire idea of biohacking into question.
 

The Bottom Line

When it comes to health, there are no real shortcuts. Biohacking, while a cute contemporary term, is fool’s gold. Yes, you can use your time and resources more efficiently to improve your health, but there are no shortcuts.

There is also one other obvious conclusion. Healthy people shouldn’t take medication. I take an 81 mg aspirin every day because I have had a stent and my doctor told me to. But I don’t take a statin any more because I changed my diet and lifestyle to keep my cholesterol normal. I control my blood pressure with diet and exercise. I don’t take medications I don’t need.

If you’re willing to do all you can to avoid medications and you still need medication to help you out, do it. But don’t take them to avoid doing the work. There are unintended consequences of taking the easy way out.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.

 

An Aspirin a Day

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In Tuesday’s Memo, I talked about biohacking. Specifically, I talked about the idea of having everyone over a certain age take a pill that can impact the risk factors for CVD: high blood pressure, cholesterol, high heart rate, and blood cell stickiness. The idea is that taking that single pill in low doses every day might help reduce CVD events such as strokes and heart attacks.

Researchers in Australia and the U.S. decided to test one component of the polypill: aspirin. The study was called the Aspirin in Reducing Events in the Elderly (ASPREE) trial. They recruited over 19,000 people 70 and older or 65 if they were Black or Hispanic in the U.S. They randomly assigned half the subjects to take 100 mg of enteric-coated aspirin while the other half got a similar looking placebo. The subjects were tracked for an average of 4.7 years. The researchers examined many variables including mortality and the incidence of disease.

The results were published in three separate papers in a recent issue of the New England Journal of Medicine. The study was terminated after five years by the primary funding organization, the National Institute on Aging. The results were not exactly what was hoped. We’ll get into the details on Saturday. If you’d like to read the studies, all are available online at the links in the references.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.

 

Healthy Hunger-Free Kids

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There’s no easy way to say this so I’m just going to blurt it out: we’re raising a generation of overweight and obese children. They eat too much saturated fat, too much sodium, not enough vegetables, not enough fruit, and they’re way too sedentary. When Paula and I go out to eat, I can always predict what nearby children are going to order or what they’ll be eating: chicken nuggets or mac and cheese. I’m always right, but I wish I weren’t. I understand that it’s tough to be a parent who . . .

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