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DOES ANTIBIOTIC USE INCREASE THE RISK OF GETTING DIABETES?

J Clin Endocrinol Metab

A study from Copenhagen has shown a 53% increased risk of getting diabetes and taking antibiotics. For years, antibiotics have been over prescribed and we are not only seeing resistance to current antibiotics but there are not a lot of new antibiotics in the pipeline.. Most outpatient infections that we see in the office are caused by viruses which will resolve on their own. Even some common bacterial infections, like sinusitis and ear infections do not require antibiotics. Antibiotics do have side effects and can adversely affect the bacteria microbiome in the intestines.

“Martin J Blaser, MD, the Muriel and George Singer Professor of Medicine, professor of microbiology, and director of the Human Microbiome Program at New York University Langone Medical Center, New York, called this an “important paper” and a “very well-conducted large-scale study” that provides further evidence of the importance of gut microbiota in human health and disease”

When you come in to see us (or any doctor, for that matter) try not to get upset when we do not prescribe antibiotics for your cold.

 

L-CARNITINE AND MUSCLE CRAMPS

Atif Zaman, MD, MPH reviewing Nakanishi H et al. Clin Gastroenterol Hepatol 2015 Aug

A recent study showed that L-Carnitine supplements improved leg cramps in 88% of patients who had cirrhosis of the liver. This was an observational study (not scientific) but the results were consistent.

Leg cramps are very common in patients who take Statins  (Lipitor, Crestor) for their cholesterol. Many treatments have been tried including co-enzyme C10, calcium, Magnesium, vitamin D, salty foods, fluids, etc. but I am not aware of any study actually proving any of these remedies actually work. It’s basically trial and error- if it works great.

The researcher hypothesize that L-carnitine works by affecting energy metabolism.  The dose used was 300mg 3-4 times daily

The question, since it was only studied in liver patients,  could it work when cramps are caused by other reasons?

 

 

 

HORMONE REPLACEMENT THERAPY FOR WOMEN OVER 65

Gass MLS et al. Menopause 2015 Jul

 

At one time it was thought that the side effects of hormone replacement therapy (blood clots, heart disease, strokes) far outweighed the benefits in women over 65. This was published in JAMA in 2002. In 2012, the North American Menopause Society noted several studies that showed that low dose hormonal replacement can be safe for older women. So, the question is: Should otherwise healthy women over 65 who are still symptomatic from menopausal symptoms be denied treatment totally based on age?

According to more recent studies, it looks like it may be continued for selected women over 65 who are given counseling and frequent follow up care when benefits outweigh risks

 

NEW SAFETY WARNINGS ABOUT NSAIDs (ADVIL, ALEVE, etc.) FROM THE FDA

It has been known for years that both OTC and prescription non-steroidal anti-inflammatory drugs can increase the risk of heart disease and strokes. (Are any of my readers old enough to remember VIOXX?) The FDA has had warnings on the medication boxes since 2005 but has recently strengthened the wording.

The updated warnings are as follows:

1.       A heart attack or stroke can occur as early as the first few weeks of use

2.       Not enough information is available at this time whether the risk is the same for all medications in this class. Aleve has always been thought of as the least offensive to the heart

3.       Even those people without risk factors for heart disease have an increased risk of a heart attack or stroke

4.       If you have already had a heart attack or stroke, your risk is even greater.

5.       Heart patients who take NSAIDs are more likely to die within one year when compare to those not taking these medications.

6.       There is also an increased risk of congestive heart failure.

Please remember that NSAIDs may also cause kidney failure and internal bleeding stomach ulcers.

When possible, try to use Tylenol (even though the safety of Tylenol is currently being questioned)

 

 

VIAGRA (CIALIS, LEVITRA, etc.) SAVES LIVES IN DIABETICS

American Diabetes Association 2015 Scientific Sessions; June 7, 2015; Boston, Massachusetts.

Researchers have found that men using phosphodiesterase type 5 (PDE5) inhibitors, like Viagra, were associated with a reduction of ALL CAUSE mortality in Type 2 diabetics, even those with a prior history of heart attacks. This makes no sense since erectile dysfunction is associated with poor circulation in the penis (and elsewhere )and should be associated with an increase in mortality. They even found that those men using both PDE5 inhibitors with testosterone also showed a decrease in death!. Testosterone has been the center of controversy for the past several years because some recent studies have questioned the safety of testosterone.

“The researchers speculate that this improved survival in patients taking a PDE5 inhibitor may be partly explained by the fact that these drugs decrease the PDE5-mediated breakdown of cyclic GMP, with the latter being cardioprotective.”

More tests need to be done, but in the future, all male diabetics may be prescribed a daily Viagra-like pill in addition to their statin and other diabetes meds.

 

DO ALL PATIENTS WITH APPENDICITIS NEED SURGERY? NEW ENGLAND JOURNAL OF MEDICINE

The has been conflicting studies comparing surgery versus antibiotics in the treatment of appendicitis. For years, the only treatment was surgery. In a study performed in Finland, 530 patients with CT confirmed uncomplicated appendicitis were either treated with antibiotic or surgery and followed for 1 year. Both groups did well but 27% of patients in the antibiotic group eventually required surgery. The surgical group was associated with a 20% incidence of surgery related complications. Of note, is that there were no deaths in either group.

In conclusion, antibiotic treatment of appendicitis remains controversial, but may be a viable alternative to those who do not (or cannot tolerate) surgery.

 

A NEW CURE FOR ALZHEIMERS PATIENTS????

Researchers in Australia have found that by using sound waves (non-invasive ultrasound), they could break up neurotoxic amyloid plaques in the brain. Amyloid is a protein that is thought to be associated with memory loss.

Publishing in Science Translational Medicine, the team describes the technique as using a particular type of ultrasound called a focused therapeutic ultrasound, which non-invasively beams sound waves into the brain tissue.  By oscillating super-fast, these sound waves are able to gently open up the blood-brain barrier, which is a layer that protects the brain against bacteria, and stimulate the brain’s microglial cells to move in. Microglial cells are basically waste-removal cells, so once they get past the blood-brain barrier, they’re able to clear out the toxic beta-amyloid clumps before the blood-brain barrier is restored within a few hours.

The team reports fully restoring the memories of 75 percent of the mice they tested it on, with zero damage to the surrounding brain tissue. They found that the treated mice displayed improved performance in three memory tasks – a maze, a test to get them to recognize new objects, and one to get them to remember the places they should avoid.

New trials are underway to study sheep and human studies are slated for 2017.

UPDATE ON TESTOSTERONE

New England Journal of Medicine

There have been 2 major controversies about testosterone replacement concerning the risks of heart disease and prostate cancer. I have written several blogs recently that looked at heart disease and saw no proof of a connection. Now we have a study of over 1000 men that actually showed a lower incidence of prostate cancer than those who were not taking testosterone. The researchers found an incidence of 30-50 cancers/ 10,000 men. The overall incidence of prostate cancer in the general population was 100/10,000 men.

This study only lasted 5 years. This is also not an excuse not to be screened for prostate cancer if you are taking testosterone.

 

 

UPDATE ON TESTOSTERONE

New England Journal of Medicine

There have been 2 major controversies about testosterone replacement concerning the risks of heart disease and prostate cancer. I have written several blogs recently that looked at heart disease and saw no proof of a connection. Now we have a study of over 1000 men that actually showed a lower incidence of prostate cancer than those who were not taking testosterone. The researchers found an incidence of 30-50 cancers/ 10,000 men. The overall incidence of prostate cancer in the general population was 100/10,000 men.

This study only lasted 5 years. This is also not an excuse not to be screened for prostate cancer if you are taking testosterone.

INCREASED DEATH RISK IN DIABETICS USING INSULIN

Researchers have found a link connecting increased risk of dying with higher doses of insulin in Type 2 Diabetics. Besides death, there was also an increased risk of cancer, heart attacks and stroke. We have many great options for treating diabetes but our greatest roadblocks are the insurance companies that will not pay for newer and better therapies. When we physicians have to practice medicine with our hands tied, we can’t always treat patients the way we would like. Not only does insulin carry a higher risk of death, it also leads to weight gain (diabetes’ enemy!). The risks of low sugar from taking insulin is much greater than having higher sugar values because low sugar (hypoglycemia) can kill in minutes whereas high sugar takes years.

Diet and exercise continues to be the cornerstone of treatment and insulin should be used as a last resort.

 

 

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