Do swimmers have an advantage?

When you swim, you are forcing your body to adjust to the lack of oxygen while also producing energy for movement. Competitive swimmers are better and being able to swim and breathe less frequently compared to non-swimmers. So what makes competitive swimmers better at adapting to a lesser intake of oxygen than a non-swimmer. Studies have shown that competitive swimmers have larger lungs and better lung capacity. Could it be that the swim training increased their lung capacity?

A recent study looked at a group of females between the ages of 11-14 (prime developmental ages for lungs). They compared two groups. One group females with competitive swimming experience and the other group of females equally competitive athletic ability. The competitive swimmers had larger and stronger lungs. However, after swimming season both groups had continued growth and stronger lungs. These attributes can be attributed to their normal growth patterns. No clear evidence indicated that the competitive swimmers had an increase of lung size and capacity. It is possible to predict that swimmers just naturally have larger lungs and chose the best sport for them. 

Bovard, J. M., Welch, J. F., Houghton, K. M., McKenzie, D. C., Potts, J. E., & Sheel, A. W. (2018). Does competitive swimming affect lung growth?. Physiological reports, 6(15), e13816.

Keto is Neat-o

You hear a lot of people these days talking about their keto diet. However, little did you know that the ketogenic diet can be beneficial in more ways than just a diet to help you lose weight.  In fact, the ketogenic diet is commonly utilized as a treatment for epilepsy in children. The ketogenic diet consists of a high-fat, low-protein, and low carbohydrate diet. The body will go into ketogenesis, producing ketones, which occurs when that body generates energy from fat when you have low carbohydrate sources. Essentially, the ketogenic diet is a way to put the body into a starvation-like state. 

Pyruvate is generated from glycolysis and sent into the citric acid cycle to produce NADH, which is converted to ATP via oxidative phosphorylation under normal conditions. When there is not a sufficient amount of glucose around to make Acetyl- CoA from pyruvate, then acetyl-CoA is formed by oxidizing fatty acids. This build-up of Acetyl-CoA induces ketogenesis. 

A recent study looked at the ketogenic diet and any predictors that may control seizures. Their study confirmed the efficacy of the ketogenic diet in patients with refractory epilepsy. Seizure control was also shown to have better odds with a higher fat ratio ketogenic diet, non-fasting induction, and female gender.

As providers it is our responsibility that we provide our patients with all information regarding their treatment, so that they can use their autonomy to make the best choice for them. For example, if a patient is curious about the ketogenic diet we can educate them on all the benefits and risks associated with the diet. As good as some of the benefits are from the ketogenic diet, a vast change in nutrition can be harmful for some patients that are on certain medications. 

Agarwal, N., Arkilo, D., Farooq, O., Gillogly, C., Kavak, K. S., & Weinstock, A. (2017). Ketogenic diet: Predictors of seizure control. SAGE open medicine, 5, 2050312117712887.

Tea is Tight

Walking around on a college campus, one will see lots of people drinking caffeinated drinks. My drink of choice is normally tea, mostly because I like the light caffeine and the taste. However, I recently discovered some new research that tea can provide some health benefits in addition to keeping us college students awake.

Tea has been around for centuries. In ancient times, people used tea remedies for all types of sicknesses. More recently, we have conducted experiments to determine the health benefits of tea. To name a few that have been tested, tea is antioxidative, anti-inflammatory, antimicrobial, anticarcinogenic, antihypertensive, neuroprotective, and cholesterol lowering (Hayat 2015)[i]. This is extremely relevant to physiology and disease prevention. Tea helps protect against cancer, stroke, cardiovascular disease (CVD), arthritis, diabetes, genital warts, and obesity (Hayat 2015).

Additionally, tea can cause epigenetic changes in women (Uppsala 2017). Epigenetic change refers to when proteins turn genes on or off. The main genes affected by tea are involved in cancer suppression and estrogen metabolism (Uppsala 2017). These changes were not linked to coffee drinkers or men (Uppsala 2017).

Tea contains bioactive polyphenols, which are complex polyphenol polymers that are hard to make and must come from our diet (Seeram 2006)[ii].  Some supplements are available, but the absorption and metabolism of the compound is limited since it is lab synthesized and mechanisms of breakdown are not well understood (Seeram 2006).  These bioactive polyphenols are the chemicals that elicit the positive health benefits through a series of chemical reactions (Seeram 2006).

In conclusion, drink your tea people! It’s good for you! If you need a boost during the day, why not go for something that has some health benefits too.

References:

Uppsala Universitet. (2017, May 31). Tea consumption leads to epigenetic changes

in women. ScienceDaily. Retrieved November 13, 2018 from www.sciencedaily.com/releases/2017/05/170531092458.htm

Hayat, Khizar, Hira Iqbal, Uzma Malik, Uzma Bilal, and Sobia Mushtaq. “Tea and Its Consumption: Benefits and Risks.” Critical Reviews in Food Science and Nutrition 55, no. 7 (June 7, 2015): 939–54. https://doi.org/10.1080/10408398.2012.678949.

Seeram, Navindra P. “Bioactive Polyphenols from Foods and Dietary Supplements: Challenges and Opportunities.” In Herbs: Challenges in Chemistry and Biology, 925:25–38. ACS Symposium Series 925. American Chemical Society, 2006. https://doi.org/10.1021/bk-2006-0925.ch003.

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[i] Hayat et al., “Tea and Its Consumption: Benefits and Risks.”

[ii] Seeram, “Bioactive Polyphenols from Foods and Dietary Supplements: Challenges and Opportunities.”

Blood Pressure Medications Increasing Risk of Death

Our recent physiology TBL topic included several categories of drugs that help to lower blood pressure, but some of those medications may be doing more harm than good.

An article published in March 2018 described a study by researcher Dr. Brian Clements and his team in Utah that looked at individuals with hypertension who used alpha blockers and alpha-2 agonists and found that these medications could have an increase in mortality risk due to the medications causing blood pressures to vary a lot. Alpha blockers (such as doxazosin/Cardura) work by dilating blood vessels, and alpha-2 agonists (such as methyldopa and clonidine) target the SNS and reduce blood vessel constriction. The two types of medication end up causing higher variability of systolic blood pressure (more variability of pressure on the arteries), resulting in a 15% increase in mortality.

The researchers took over 10,000 adults with high blood pressure and monitored the variability for 4 years and found that there are other medications that might be a safer option. Medications such as ACE inhibitors, calcium channel blockers, diuretics, and angiotensin receptor blockers do not cause the great amount of systolic variability that the alpha blockers and alpha-2 agonists cause.

Therefore, those who have a family history of high blood pressure, or know someone with hypertension who is on medication, should maybe check in to see which medications they are taking, because it may be causing more problems than providing a solution. This leads to a major ethical dilemma where providers may not take into account the dangers of the prescriptions. Also, the ideas of malfeasance and beneficence come into play as the alpha blockers and alpha-2-agonists may help reduce blood pressure for a time, but then end up increasing the risk of death for patients. Providers need to make sure they are taking into account the risks of the medications, and make sure that the benefits outweigh the risk, or many lawsuits may surface in the future. 

Endurance/Resistance Training and Psychosocial Stress Resistance

I was listening to a podcast recently, where a former navy seal captain recounted one of the most surprising things he noticed about going to battle. He recalled that during his first major exposure to combat, rather than losing his mind or “freaking out” about the immediate presence of death and danger, his training kicked in and he remained calm and focused on doing what he needed to survive and “win.” This piqued my interest, and I wondered what prior research said about the effects of training and this superhuman power of ignoring such incredible stress.

I found this study, where researchers found that trained men, or men who regularly engage in intense endurance or resistance (weightlifting) training, had less severe cardiovascular responses (exhibited less heart rate elevation) to psychosocial stress from a TSST, or a Trier Social Stress Test, compared to men with minimal training. In the study, three groups of men (endurance, resistance, and untrained men with minimal exercise beyond bike transportation) were subjected to a mock job interview where they delivered a speech to a panel of judges, followed by a mental arithmetic task (serial subtraction). Before, during, and after each TSST period, each subjects’ heart rate and salivary free cortisol was collected and analyzed. They found that for salivary free cortisol, resistance trained man had the lowest levels of salivary free cortisol, with endurance trained men close behind and with untrained men having much higher levels. These results were not statistically significant however. They found that for heart rate changes, endurance trained men had the lowest changes, closely followed by resistance-trained men and with untrained men having much higher heart rate changes. These results were statistically significant. In addition, the morning salivary free cortisol was higher in untrained men, but this was also not significant.

In an age of comfort and sedentary lifestyles, exercise and discomfort has become secondary to pleasure and convenience, and I believe this is reducing our ability to withstand the stress of reality and life. This study’s result is reason number 1,009,283 why exercise should be a major part of everyone’s life, and everyone who engages in regular exercise (whether endurance or resistance) can have the confidence of knowing that their daily toil is giving them an edge up in dealing with life and acute psychosocial stress in professional and/or social environments. In conclusion, JUST DO IT.

Study referenced in this article: Gröpel, P., Urner, M., Pruessner, J. C., & Quirin, M. (2018). Endurance- and Resistance-Trained Men Exhibit Lower Cardiovascular Responses to Psychosocial Stress Than Untrained Men. Frontiers in psychology, 9, 852. doi:10.3389/fpsyg.2018.00852

Impact Heart Surgery has on Cognitive Ability

It's known that after a procedure such as heart surgery, recent diagnosis of cardiac disease, recovering from cardiac arrest or coronary artery bypass graft, can have post-procedure depression and anxiety. However, something that is not as known is that in some cases patients have shown to have decreased cognitive ability following a procedure, in particular heart valve surgery has been studied.
Heart valve surgery is an operation to replace one or more valve--the bicuspid/mitral valve, tricuspid valve, pulmonary valve and aortic valve--inside the heart that is not functioning properly. The valves are either repaired or fully replaced either with a biological or mechanical replacement, either through open heart surgery or minimally invasive heart surgery. Similar to other surgeries of the heart, the patient is in intensive care unit (ICU) for a day or more for recovery before spending several days in a normal hospital room. In 20014, about 156,000 heart valve surgeries occurred with the most common condition leading to the procedure being aortic stenosis
 In a study, it was found that individuals who underwent heart valve surgery had a decreased cognitive decline over six months post-operation.There has been studies conducted on other reasons for heart surgery such as coronary artery bypass grafting (CABG). The above linked study focused on heart valve surgery found that six months after the surgery patients had a general decline in cognitive ability. The exact cause of what links these two things together is not certain, but there has been studies to confirm there is a link.

Llama to the Rescue

Can llamas’ blood save us from the flu? An odd thought but I recently read an article describing how llamas produce extremely small antibodies compared to that of humans which may allow them to be used to treat the flu. The flu virus is known as the great evader when it comes to viruses. It rapidly mutates, changing the proteins that our antibodies target when trying to prevent the virus from taking hold. Due to the flu viruses’ rapid mutation our body cannot produce to antibodies needed to beat the flu leading to millions of Americans getting influenza each year. The large size of human antibodies prevents them from being able to attack anything besides these proteins. This is where the llama antibodies come in. The llama antibodies are so small they can get past these proteins and attack other structures on the flu virus that are not constantly mutating.

This research has the potential to be one of the greatest medical break throughs of our time. A one-time flu shot that works forever would be incredible. No more flu shot every year that may or may not work depending on whether or not the vaccine carries the correct components to attack the ever-changing virus. The time and cost to vaccinate each person every year would be drastically reduced and the astronomical cost of treating influenza patients would also be reduced. A win-win for all!

Unfortunately, this research is very new and many hurdles have yet to be jumped. We have to figure out a way to inject llama antibodies into humans without eliciting an immune response that destroys them before they have a chance to destroy the flu virus. There are several other obstacles to this method but can you imagine a life without influenza. At least this research gives us hope!