Can a cup of coffee prevent type 2 diabetes?

I stumbled across an article that talks about type 2 diabetes prevention with a drink that many individuals in the US consume, coffee. Marilyn Cornelis, a nutritionist at Northwestern University Feinberg School of Medicine, is exploring the idea that black coffee has the most potential to prevent type two diabetes. Coffee drinkers have had a slightly reduced risk of cardiovascular disease, cancer, and Parkinson’s disease in addition to the decreased risk of type 2 diabetes. Epidemiological studies have begun supporting this statement and it is inferred that the chemical compounds released in the roasting process and high levels of antioxidants have a huge influence of how the body is interacting with them. However, at the end of the day Dr. Cornelis states that it is the metabolites, small building blocks, that are directly helping prevent type two diabetes. Dr. Cornelis is in the process of completing a study that takes into consideration 46 individuals that go from a four week coffee-free diet to a whopping eight cup coffee diet for a month. The FDA has acknowledged the coffee benefits and has suggested five cups as a healthy upper limit. However, with data supporting the prevention of type two diabetes we have to take into consideration individual’s tolerance to coffee. Some individuals genes influence the ability to metabolize caffeine and make it more efficient without feeling the immediate jitters or jolt of energy (ultimately allowing them to drink more coffee and having a greater prevention for type 2 diabetes). These are hopeful findings for the US population, since as a nation we struggle with diabetes and cardiovascular disease. Knowing that a simple adjustment to our everyday lifestyle can be beneficial to our health should be an easy transition.

http://www.diabetesforecast.org/2016/jul-aug/can-a-cup-of-coffee-prevent.html?loc=dorg_recentadv

Do opioids really help?

I just read a study published in March of this year comparing the effect of opioid and non-opioid treatments for patients with chronic back pain and hip/knee osteoarthritis pain. In the group treated with opioids, included treatments were immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. In the non-opioid group, treatments involved acetaminophen or NSAIDs. The study found that over a period of 12 months opioid therapy was no better than non-opioid therapy in improving pain-related function, but did lead to an increase in adverse side effects. Pain intensity was slightly lower in non opioid-treated patients.

            This article caught my interest because a lot of states have tightened their opioid laws recently in an attempt to combat the widespread opioid abuse the United States is currently in the midst of, which is responsible for thousands of deaths a year among other issues. As anyone who has worked in a clinical setting no doubt knows, the use of opioids in the treatment of chronic musculoskeletal pain is a relatively standard approach. Many of the doctors I’ve worked with through the changeover have struggled with how to continue treating patients with chronic pain. Many are poorly equipped to handle treating addiction and do not have much in the way of alternative options, at least in family practice settings. At some point there is uncertainty about how much of a patient’s pain is chronic and how much is coming from the opioid use itself. The most recent guidelines now discourage use of opioids for chronic pain because there is not sufficient evidence for benefits that outweigh the potential serious harm they can cause.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885909/

                          

Double Post- Sorry...beware of IUDs

I know I just posted but I just recalled another extremely interesting thing I learned.

I worked as a clinical researcher for the CU School of Medicine in the Division of Rheumatology. As many people know, women get Rheumatoid Arthritis (and autoimmune diseases) more than men, so one of the research studies in the division was looking at women specifically. The studies generally college self-reported information on diet, health history, family history, and other general data points. On top of the paperwork, we'd collect blood (to test for antibodies), sputum (also to check for antibodies...long story, but ~50% of RA patients also have lung disease so it's almost standard to always consider the lungs as a factor), vaginal + cervical fluids, and sometimes stool (to also test for antibodies and the bacteria).

Some of you may already know, but most of the people who develop RA (and other autoimmunity) are usually pretty young. Most of the people in our studies who had RA were often young women. The PI of this study essentially came to the conclusion that IUDs played a significant role in the development of RA!

Netflix Documentary, "The Bleeding Edge"

I recently watched this documentary called, "The Bleeding Edge". It was about faulty medical devices and how these devices were able to land on the market. One interesting example it showed was hip replacements.

Currently, one of the options for hip replacements is to use cobalt. It was advertised to be the most effective and longest-lasting material to use. The person who has advocating to educate surgeons to NOT use cobalt was a surgeon himself; he got a cobalt hip replacement and suffered neurological consequences. He was starting to have Alzheimer's/Dementia-like symptoms and had a severe mental relapse.

He later discovered that the cobalt used for his hip replacement was seeping into his blood and he had 100x the normal amount of cobalt in his blood. His health improved after removing the cobalt hip.

He did studies on his own patients (he was an orthopedic surgeon) and did scans of the brains of his patients and saw that patients with cobalt hips had scans that are similar to Alzheimer's patients.

It was interesting to learn that the FDA regulates both drugs and medical devices but the latter has been much more profitable and often times much more dangerous.

Possible Hangover Cure?

I am sure that most of us have, at one point, experienced a hangover. If you are lucky enough to have never experienced one, congratulations. However, if you have, you might have tried countless different ways that are supposedly “hangover cures.” With the search to find the “miracle pill” to cure all symptoms of a hangover, there have been some research that has tested multiple ideas. One, specifically, was done in 2016 by Chinese researchers who studied 57 different herbal and carbonated drinks and the impact they had on the enzymes that break down acetaldehyde and acetate.

If you are unaware, when you drink alcohol, an enzyme called alcohol dehydrogenase metabolizes the ethanol (alcohol) into acetaldehyde, which is then metabolized into acetate by aldehyde dehydrogenase (ALDH) in the liver. The more acetaldehyde in the system from too much drinking causes the terrible symptoms of “the hangover” such as nausea, dry mouth, headaches and dizziness.

The study observed how Sprite/7-up, which contains taurine (helps metabolize fats), showed the greatest increased ALDH activity, causing less acetaldehyde in the system. However, tea products such as green tea ended up prohibiting the metabolism of alcohol. So if you plan on going out, try drinking some Sprite to see if the research holds up to you.

Diclofenac, a common anti-inflammatory, may raise cardiovascular risk

Vioxx, a COX-2 inhibitor used as an anti-inflammatory and a painkiller was withdrawn from US markets in 2004 because of known cardiovascular risks—those who took it suffered blood clots and strokes, even though it was effective for pain reduction. This week, a study published in the British Medical Journal indicates that another common anti-inflammatory, diclofenac (also known by the brand name Voltaren) may cause similar problems. Diclofenac is also a selective COX-2 inhibitor, and is the most commonly used NSAID around the world, as it is commonly available over-the-counter in most countries. The authors of the study used the data of 6 million Danish adults over two decades (1996-2016) to create virtual trials in which they compared the 12-month health outcomes of patients who started taking diclofenac for pain as compared to those who took acetaminophen (Tylenol), naproxen (Aleve), and those who took nothing at all. The adults taking diclofenac were 50 percent more likely to have a cardiac event within a month than those who took no pain medication. They were also at a higher risk than those who took the other pain medications.

The authors suggest that this may be because diclofenac is prescribed at relatively high doses to be effective for pain since it has such a short half-life. The concentration of diclofenac in the plasma after high doses therefore exceeds the amount needed to inhibit COX-2 and so ends up inhibiting COX-1 as well. After the concentration of diclofenac decreases, the COX-1 effect subsides while the COX-2 inhibition continues. This selective inhibition of COX-2 leads to blood clots by inhibiting prostacyclin (clotting inhibitor) production without affecting thromboxane (clotting promoter) production. The researchers recommend that diclofenac only be prescribed by physicians (rather than being available OTC) and that providers consider the danger of increased clotting on a patient-by-patient basis to avoid unnecessary risk.

Steroid-induced ischemic necrosis in the hip: a frequent problem in physiatry

Before I came to study at Regis, I worked for approximately two years at physiatry clinic in Boulder. Some of our most popular treatments were corticosteroid injections into joint spaces and bursae, which can be very effective in the short term for pain and inflammation—we usually expected the results to last between 3-6 months without other treatment (for this reason, a steroid injection was usually followed with a referral to physical therapy for maximum benefit). I saw this treatment used for everything from carpal tunnel to trigger finger to “frozen” shoulders, often with good effect.

However, one use of the steroid injections the doctors were reluctant to use too frequently was in the case of hip joint pain caused by osteoarthritis in the hip. Technically, intra-articular hip joint steroid injections can be effective for arthritic hip pain when a patient is trying to postpone a replacement, but a rare side effect of a steroid injection there is avascular necrosis of the femoral head: complete bone death and sometimes collapse of the femoral head (visible on x-ray). In the time I worked there, I saw this twice, and both patients were subsequently referred out for hip replacements.

Above: Stages of SI-IBN-caused collapse in the hip (source) 

The mechanism behind steroid-induced ischemic bone necrosis (SI-IBN) is not well-understood. A 2014 review by Xie et al hypothesizes that the administration of steroids reduces bloodflow directly, or that it causes an increase in fat deposition resulting in higher pressure on the joint and compression of blood vessels. Steroids are the second most common cause of ischemic bone necrosis after trauma, but it is difficult to predict which patients are at risk simply from their x-rays. A 2009 study in rabbits showed that a functional perfusion MRI (a type of imaging that shows the amount of blood a particular joint is getting) could detect ischemia in bones before necrosis sets in, potentially allowing providers to monitor patients after high-dose steroid administration and to intervene before collapse. 

Providers can minimize the risk of SI-IBN by administering steroids by a low-dose oral route and advising patients to avoid alcohol while taking the steroids and also to consider bedrest during medication but this does not completely remove the risk. Stage I and II SI-IBN hips can be treated with a core decompression or bone graft when the patient is trying to postpone a total hip arthroplasty. Joint replacements are also an option, especially if the patient is older and less active, but for younger, more active patients, the failure rate of a THA is much higher so it is generally advised that providers consider joint-preserving methods first.