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Triclosan and Antibiotic Resistance

Triclosan and Antibiotic Resistance

The New England Journal of Medicine recently published research regarding triclosan and its effect on bacteria.

Triclosan is a poly-chlorinated aromatic compound that targets fatty acid synthesis.  It is found in household items such as some toothpastes, deodorants, and shaving creams.  It is added to these products because of its antimicrobial properties.  Measurable levels of triclosan can be found in the urine of 10% of Americans.

Unfortunately, chronic low-level exposure to triclosan can lead to bacteria becoming resistant to medicinal antibiotics.  Two examples are multi drug resistant E. coli (a common cause of urinary infections) and multi drug resistant Staph (MRSA).

The FDA has banned the use of triclosan in soaps for this reason.  But unfortunately, this prohibition does not include other commonly used products.

Other than promoting antibiotic resistant bacteria, there is also an impact of triclosan on the normal human flora (the microbiome).  The long-term health consequences of changes in microbiome have yet to be studied.

Got Milk?

Got Milk?

By:  Sasha Klemawesch, MD

If you are a dairy lover who is also unfortunately lactose intolerant (and therefore, dependent on taking Lactaid capsules every time you want to eat some cheese or drink a milkshake), good news!  You may be able to scrap those pills!

Studies have shown that lactose intolerant patients who have regularly consumed dairy products (aided by Lactaid capsules), are often able to stop the pills after a few years.  Because they were partaking in dairy on a regular basis, the bacteria in their gut microbiome evolved to accommodate the milk, yogurt, etc.  Once the flora in your GI tract adjusts, the bacteria themselves can take over digesting the lactose, so even though the patient is still technically lactose intolerant, their microbiome has taken over the job that the Lactaid caps were doing and they’re now able to go out for ice cream without taking their medicine along with them.

Supplement Sources

Supplement Sources

By:  Sasha Klemawesch, MD

If the previous article freaked you out about taking supplements, here is a list of common things people often take in pill form and corresponding foods which they could instead be eating to reap the same (or better) benefits.  Every registered dietitian I’ve ever encountered says the same thing; “save your money”!  You don’t need oodles of vitamins and mineral tablets if you are eating a healthy balanced diet.  And the majority of the ingredients you are buying would be better absorbed from their natural food form anyways.

POTASSIUM –    Dried apricots, potatoes (esp. with the skin still on), dark greens like spinach and swiss                                      chard, lentils, prunes, tomato juice or puree, raisins, beans, and of course, bananas

CALCIUM             Milk, yogurt, cheese, sardines, dark greens like spinach and kale, figs, rhubarb, almonds                                  and many products which have been fortified such as cereal, OJ, soymilk, waffles, etc.

VITAMIN K          Kale, mustard & collard greens, swiss chard, natto, broccoli, brussel sprouts, and beef                                      liver

VITAMIN D          Salmon (in particular wild salmon as opposed to farmed), herring sardines, cod liver oil,

Oysters, egg yolks (esp. ones from free range chickens) as with Calcium many things like                                  milk & OJ are fortified with extra D as well

VITAMIN C         Guava, red & green peppers (esp. the sweet reds), tomato juice, oranges & OJ,                                                     strawberries, papaya, broccoli and potatoes

IRON                     Your body can absorb much more iron from animal sources like lean beef, oysters,                                            chicken and turkey, than from plants.  But, beans, lentils, tofu, potatoes, cashews, and                                      dark greens also have a good amount of iron, and many cereals and grains are fortified                                    with it as well

NIACIN (B3)        Liver, chicken breast, tuna, turkey, salmon (again, the wild type), anchovies, brown rice,                                  whole wheat, sunflower seeds, mangoes and nectarines

THIAMINE (B1)  Most breads, cereals and baby formulas are fortified in the US.  Foods naturally high in                                     B1 include pork, trout, black beans and acorn squash

FOLATE (B6)       Since 1998 the FDA began to require enriched breads, cereals, flour, etc. to contain a                                         substantial amount of folic acid, so very few Americans are deficient in it.  Natural                                             sources include beef liver, spinach, black eyed peas, asparagus and brussel sprouts.

VITAMIN B12     Clams, beef liver, rainbow trout, salmon and fortified breakfast cereals

PHOSPHORUS   Chicken, turkey, pork, organ meats, carp, pollack, low & non-fat dairy products and                                          sunflower and pumpkin seeds

OMEGA 3’s         Mackerel, salmon, herring, oysters, cod liver oil, caviar, sardines, flax & chia seeds and                                    walnuts

Dear Dr. K;

Dear Dr. K;

I read about a vaccine given to cats to make them less allergenic.  Is that true?

Not only is it true, but it works.  Swiss scientists coupled cat feline protein number one (the cause of most human cat allergy) to a cucumber mosaic virus and vaccinated cats.  The vaccine was safe for the cats and led to a marked reduction in their feline protein number one.

This research could provide a revolutionary new approach to humans with cat allergy:  making their cats “hypoallergenic”. The Swiss scientists also posited that the cats will also benefit because of improved relationship/fellowship with their owner.

Q – Tips: COPD

Q – Tips: COPD

Patients with COPD can have an exacerbation of their breathing problem for a variety of reasons.  Sometimes it is due to infection, but not always.  The New England Journal of Medicine just published research that indicated a very simple test that can determine if the exacerbation is due to infection (and therefore should be treated with antibiotics) is to measure a C-reactive protein (CRP).  If it is elevated, it indicates infection.

Q – Tips: Vancomycin

Q – Tips: Vancomycin

Vancomycin is a strong antibiotic that has found a great utility in treating serious drug resistant infections.  Generally it is a safe choice, but in a small percentage of patients it can cause a severe systemic allergy.

New research has discovered that a gene called HLA-A 32:01 is the factor predisposing to this allergic response.

Dear Dr K:

Dear Dr K:

You tested me to see if my childhood recollection of penicillin allergy was still valid.  Even though the tests showed I was not allergic my PCP still won’t prescribe it when I need an antibiotic.  Why the reluctance?

The simple and short answers are; medical malpractice and labeling.  Roughly 10% of malpractice suits are concerning medication errors.  Physicians are aware of this.  For some reason, once a person is labeled as “penicillin allergic” there is great reluctance to remove this label.  As it turns out, 12% of the American population carries this label.  However, when academic centers have done studies to confirm this diagnosis only 5% of this group is actually proven to be allergic.  So, to look at that in terms of numbers; for every 1,000 Americans 120 carry the penicillin label and only 6 are actually allergic.

The problem is that of these 6 individuals the potential exists for a life-threatening anaphylactic reaction.  So, many people (including doctors) choose what at first blush seems to be the safer route: avoid penicillin.  Unfortunately, this in not always a safer choice.  By denying the patient the “first line” treatment choice it results in utilizing less desirable and problematic antibiotics such as fluoroquinolones, vancomycin and clindamycin.  These antibiotics have their own potential to cause medical mischief such as tendon rupture, Clostridium difficile (C. diff) colitis, and the development of super resistant bacteria such as MRSA and VRE (vancomycin – resistant – enterococcus).  The University of Oregon has done research into this problem.  They posit that roughly 30 million Americans are mislabeled as penicillin allergic.  They found that patients so labeled have increased medical costs and longer hospital stays compared with patients not felt to be penicillin allergic.  The other dynamic that the University of Oregon researchers studied was the question of cross reactivity between penicillin and a separate family of antibiotics called cephalosporins.

Again, they discovered that most doctors will not prescribe cephalosporins to patients with penicillin allergy because of a fear of cross reactivity.  In fact, drug manufacturers include in their package insert the possibility for this interaction even though there is little or no evidence from scientific studies of a cross reactivity.  Most recent research would indicate that the small number of individuals who are allergic to both penicillin and cephalosporin have this dual allergy not because of a direct cross reactivity but because being an allergic individual per se raises their risk for developing separate but individual drug allergies.

Shocking News!

Shocking News!

By: Sasha Klemawesch, MD

 

Electrically augmented wound healing may seem farfetched.  I mean, most people were taught not to stick their finger in the light socket.  So, exploiting electricity to help heal wounds may seem ludicrous.  But when you think about it, doctors have been using electricity in various forms for years.  Even back in ancient Greece, there is evidence of electric eels being used in foot basins to help with circulation and pain.  Nowadays, Pacemakers and AICD’s (implantable defibrillators) are literally lifesaving for some cardiac patients.  TENS units can provide some relief to some chronic pain patients that feels lifesaving.  And ECT (shock therapy) can be life changing in patients with refractory depression.

But how does electricity help in wounds?  Turns out, in several ways.  A diverse array of studies exists reporting on a variety of forms of electric manipulation.  Conclusions from those include: improved surgical results, reduced infection, improved immunity and circulation, shortened healing times, improved flap and graft survival, and novel options for addressing complex and recalcitrant chronic wounds.

Again, you ask, “but how”?  Well, electric stimulation leads to increased fibroblast activity (fibroblasts are some of the building blocks of cells).  It inhibits the growth of many bacteria, and lowered bacterial load in the wound helps mean less hurdles to wound closure.  It increases perfusion to skin and veins, the latter due to increased vascular endothelial growth factor leading in turn to increased angiogenesis (blood flow).  And it also causes increased white blood cell migration to the site, especially neutrophils which help in fighting infection and macrophages which can help clean up the debris of the old dead wound parts.

Knowing all this, researchers have created a self-powered electric bandage (all the aforementioned studies utilized externally sourced/applied electricity).  Their invention is essentially a bandage containing tiny overlapping sheets of copper and other conductive materials as well as a built in nanogenerator.  Everyday movements lead to the sides of the wound moving and thereby sparking tiny electrical impulses across the nodes situated on opposite wound borders.  So far only tested on rats, the results are encouraging; wound closure dropped from 12 to 3 days on average.  Human subject testing is on the horizon.  In the meantime, I’d still stay away from hairdryers in the bathtub.

A Truly Crappy Treatment

A Truly Crappy Treatment

By: Sasha Klemawesch, MD

 

Many people have heard of C-diff.  If infected, you could be stuck at home in your bathroom with annoying (but benign) diarrhea, or you may wind up in surgery or the ICU with life threatening complications.  And while many people have heard of the disease, few are aware of how difficult it can be to eradicate.

Now get ready for a scary fact.  You might have C-diff.  Yes, you.  In fact, up to 3% of healthy individuals are walking around with it right now, a rate that jumps to 1 in 5 people who’ve been hospitalized ending up colonized with it.  Our GI tracts are home to millions of bacteria, up to 1000 different species at any given time.  But when a good & balanced mix of microbes exists, they all stay in check and actually promote health by doing jobs like making vitamin K, detoxifying chemicals, and augmenting the immune system.  They also make sure that “bad” bacteria don’t get out of control and run amok through your bowels.

This is the problem in C-diff; when you are given an antibiotic for something else, say a skin infection, or pneumonia, it doesn’t just target the one culprit bacteria causing that one infection in that one place; it also kills off a multitude of others, including most of the good guys in your gut.  When this happens, C-diff becomes the dominant force and starts causing distressing pathology.

You may say, “if an antibiotic caused it, why give me another to fix it?”  A good point.  Especially because the antibiotics we have to treat C-diff are often ineffective, and up to a third of people will end up relapsing even if the initial treatment helped.  C-diff is a “spore former” meaning it leaves little hard-shelled spores all over which antibiotics cannot penetrate, so even if the medicine got rid of the active bacteria, the spores are left behind which germinate new bacteria to then resume infecting your gut and releasing their toxins.  It is often a vicious cycle, with subsequent relapse increasing your likelihood of another future episode.