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Author: Stephen J. Klemawesch, MD

COVID-19 Update: The office is open our regular hours!

COVID-19 Update: The office is open our regular hours!

We will be open our regular office hours. If you are coming for an allergy shot, please sign in as usual and sit in the marked chairs. If you would like to get your shot in your car or outside, just let us know.

We also have Telephone Visits available, please call the office to schedule. The doctor will call you back to discuss your health concerns.

We are cleaning the office regularly and we do have hand sanitizer available – please wait outside if you have a cough of any type.

Fasting and Health

Fasting and Health

The New England Journal of Medicine recently featured a review article titled “Effects of Intermittent Fasting on Health, Aging and Disease” written in cooperation by the NIH and Johns Hopkins University.  They start out the review by pointing out that it is a blatant misnomer that humans should eat three meals a day plus or minus snacks (excepting the rare individual with special nutritional needs).  They go on to point out that over the million and a half years that humans have evolved our metabolic machinery has been programmed to eat less often and to sustain frequent short fasts.  Then comes the modern era of grocery stores, refrigerators, and fast food restaurants and with it a decline in health fueled primarily by obesity, but also by the uncoupling of healthy metabolic and immunologic pathways. 

The main benefits of fasting are:  the reduction of free-radical production, improved glucose regulation, improved stress resistance and suppression of inflammation.

The two main ways to fast are either intermittent (once a week) fasting for an entire day or by doing “time restricted” eating.  The former can be achieved by reducing your calorie intake to 500 calories for one day a week.  The latter can be achieved by eating your usual daily caloric intake during 6 hours and fasting for 18 hours. 

One of the main benefits of fasting involves the metabolic shift from glucose to ketones as an energy source.  Ketones act not only as an energy source but as potent signaling molecules that slow aging and reduce inflammation. 

The authors go on to cite hundreds of research articles demonstrating the benefit of fasting to help diabetes, cancer (both the development of cancer and its spread), neurodegenerative diseases, asthma, MS, and arthritis. 

Dear Dr K; I recently read about carriers of cystic fibrosis having potential health risks. Is this true?

Dear Dr K; I recently read about carriers of cystic fibrosis having potential health risks. Is this true?

Yes, it is true.  When I was a medical student, I was taught that people who were carriers for the cystic fibrosis gene would not manifest any of the problems of the disease.  As time and science move forward this turns out not to be the case. 

Cystic Fibrosis is inherited as an autosomal recessive disease; that is, it takes the bad gene from both parents to cause the disease.  Carriers have only one copy of the gene which is known as the cystic fibrosis transmembrane conductance regulator (CFTR) protein. 

The frequency for carriers varies by race:

White                     1 in 3,200

Black                       1 in 15,000

Hispanic                 1 in 14,000

Asian                      1 in 35,000

The disease, cystic fibrosis, affects the sinuses, lungs, pancreas, intestinal tract and other organs.  It commonly leads to chronic sinus and lung infections and pancreatic failure. 

Recent epidemiologic studies have revealed that carriers have increased risk for some of the same problems.  Carriers have a greater tendency for sinus and lung infections.  They also have a greater risk to develop bronchiectasis, a chronic infection in the bronchial tubes.  The risk for respiratory failure is higher too.  In the GI tract pancreatitis and pancreatic cancer are more common in carriers. 

To date there is no specific cure for cystic fibrosis, much less the carrier state.  But gene therapy is coming close to being a reality.  In the meantime, being aware of greater risk as a carrier could help early in the intervention and screening for infections and cancer. 

Milk and Health

Milk and Health

Not to be outdone by Johns Hopkins, Harvard Medical Group also published a review in the New England Journal of Medicine about milk and health. 

They start out by “stating the obvious” that the natural function of milk is to nourish and promote the growth of young mammals, not mature ones.  They go on to question the current dietary recommendation of three 8-ounce servings of milk/milk product per day. 

Because cows are bred for high milk production and because they are pregnant during most of the time they are milked, they produce high levels of insulin-like growth factor (IGF-1) and high levels of estrogen and other hormones. 

Exposure to IGF-1 and other hormones has been linked to a greater risk for certain cancers: breast, ovarian, uterus and prostate. 

Cow milk intake has been correlated with the development of diabetes, especially type 1 diabetes owing to cross reactivity between dairy proteins and pancreatic islet cells. 

A long-standing rationale for promoting lifelong milk consumption is to meet calcium requirements for bone health.  The concept is good but the practical outcome is the opposite.  Hundreds of scientific studies show that countries with the greatest milk intake have the poorest bone density.  Yes, milk is rich in calcium, but it also contains certain proteins that leach away the mineral content of our bones.  Countries with the lowest milk intake paradoxically have the best bone health.  Cow milk is also the most common cause for food allergy, at least in Western countries. 

Finally, there is the “fart” issue.  As hard as it seems to believe, the methane produced due to the large industrial scale of milk production is having a measurable effect on green house gases.  The Harvard group calculated that obtaining our protein from alternative sources such as soy, legumes, and grains rather than from milk would reduce global greenhouse gases by 10 percent.  

I didn’t even know they had venom!

I didn’t even know they had venom!

By:  Sasha Klemawesch, MD

Most people know the Duckbill Platypus as one of the only two mammals that lay eggs rather than give birth to live offspring (the other being the Echidna (spiny anteater) but no one remembers him!).   However, they are ALSO some of the few mammals who produce venom.  Others on the list include vampire bats, hedgehogs, shrews, and moles.

Researchers in Australia have discovered that the Platypus’s venom contains a hormone called GLP-1.  Humans also have a form of it, but ours has a very short half-life, while theirs is much more durable.  Both of them function similarly though, by stimulating production of insulin, which in turn helps to lower blood sugar, so researchers are studying the monotreme hormone to see if they can manipulate it to use in management of type 2 diabetes.  While there are already several GLP-1 Agonists on the market, (think Trulicity, Saxenda, et al), experts hope that the more natural derivation may provide further benefits; perhaps it may be able to be compounded in an oral tablet, since all the current GLP-1 medications are injections, or perhaps it may even be able to be used in a wider variety of patients, such as those with renal or pancreas dysfunction (in whom use of current GLP-1A’s is still considered controversial). 

Q – Tips : Garlic

Q – Tips : Garlic

Many people suspect they are allergic to garlic owing to “GI tumult” that occurs after eating it.  However, it is more likely due to a genetic deficiency in cytochrome P450 and FAD-linked enzymes which metabolize sulfur containing foods.  Garlic contains very high levels of alkyl and dialkyl sulfide which give it its characteristic taste and smell.

Q – Tips: Mushrooms

Q – Tips: Mushrooms

Another less common mimic of food allergy is mushroom intolerance.  In this syndrome the deficient enzyme is Trehalase disaccharidase.   Mushrooms contain “double” (di-) sugar (saccharide).   If the sugar isn’t broken down into single sugar (mono-saccharide) it ferments in the colon causing bloating, gas, and diarrhea.  

Good News/Bad News

Good News/Bad News

On September 13, 2019 an FDA advisory board recommended approval of an oral peanut vaccine (“OIT” for oral immunotherapy).  If this recommendation leads to approval, peanut allergic individuals will be faced with a tough decision.

Approval is based in part on large studies done in California on children and adults with severe peanut allergy.  In this study, 85% of the OIT treated patients were able to tolerate 4 grams of peanut without serious reaction.  That’s the good news.

The bad news is that stopping OIT lead to a fairly quick return of the severe allergy.  Additional bad news is that despite being protected from severe reactions a large number of patients had frequent mild allergic reactions and were prone to develop a condition called eosinophilic esophagitis – a form of allergic reflux.

High Dose Flu Vaccine

High Dose Flu Vaccine

High dose flu vaccine contains 4 times the amount of antigen (killed flu virus) than the standard vaccine.  People with the highest risk for death from influenza are infants, pregnant women and adults over 65.  The high dose flu vaccine is recommended as an option in the latter group.  People over age 65 have immune systems that are also aged and by giving them a higher dose there is a better chance of stimulating a good immune response.  In fact, research showed a 24% improvement in immune protection.

The tradeoff for some people is a greater likelihood of local reaction or systemic “achiness” after the higher dose.  For those individuals leery of these side effects the CDC proposes as another option receiving two of the regular dose vaccines a couple of months apart.   However, the second dose is not covered by Medicare or commercial insurance plans.

Vaping and Lung Disease

Vaping and Lung Disease

Vaping has become extremely popular in the last few years in part because it has been promoted as “a safe alternative to cigarettes”.  Currently 1/3 of all high school students report “some use” of vaping.

Unfortunately, hundreds of individuals have been hospitalized and died with an acute lung disease.  The most common cause of this lung disease is lipoid pneumonia which can affect multiple lobes of the lungs and lead to respiratory failure.  This form of disease seems to occur if the vaping material contains Vitamin E acetate, which is an unnecessary additive.

The two other forms of lung disease are acute eosinophilic pneumonia which is actually a severe allergic reaction to an excipient in the inhaled material.   A variety of excipients are available to promote usage such as fruit and candy flavors.  The second form of lung disease is cryptogenic organizing pneumonia.  This is a bit harder to diagnose and understand, but basically inhaling chemical and possibly infectious particles through the electronic system can allow direct and deep penetration of the pathogens into the lungs.

In all three forms of lung injury the patient becomes extremely short of breath and may need to be placed on a ventilator.  CT scans often show “diffuse white out” of the lung fields; that is, diffuse pneumonia.