The New Science On Anxiety And Gut Health

“Gut health is so important! Great read.”

— Dr. Dale

From The New Science On Anxiety And Gut Health

While docs used to treat mental health conditions with a pill and a glass of water, the times are changing. Probiotics are arguably the new Prozac already—and now there’s a concrete case for combating anxiety with good bacteria, too.

In a new study conducted at the University of Cork in Ireland, researchers broke new ground in understanding the relationship between gut health and anxiety. While the microbiome-brain connection—AKA the link between digestive and mental health—has been established in other studies, this time they found a first-of-its-kind connection between gastrointestinal microbes and gene regulators in the brain (called microRNAs).

In the study, researchers discovered the mice living a germ-free life ended up having unusual amounts of anxiety.

“Gut microbes seem to influence miRNAs in the amygdala and the prefrontal cortex,” lead research Gerard Clarke said in a press release. “This is important because these miRNAs may affect physiological processes that are fundamental to the functioning of the central nervous system and in brain regions, such as the amygdala and prefrontal cortex, which are heavily implicated in anxiety and depression.”

In the study, researchers introduced gut bacteria to two groups of mice: One raised in a germ-free environment, and the other made up of mice raised in a normal environment. They discovered the mice living germ-free ended up having unusual amounts of anxiety, but they weren’t stuck with it: When they added the gut bacteria back in later on, they normalized the changes to the miRNAs, showing a healthy gut could be the answer to regulating the miRNAs.

Additional research still needs to be done, but this study is definitely a step in the right direction. If your probiotics seem to help keep your anxiety at a healthy level, keep doing what you’re doing: The little guys in your stomach are on your side.

Thousands Of Americans Still Die Of AIDS Every Year

“Very educational. ”

— Dr. Dale

From Thousands Of Americans Still Die Of AIDS Every Year

Yet antiretroviral therapy can turn the deadly disease into a manageable chronic condition.

Antiretroviral therapy has transformed HIV from a death sentence to a manageable chronic condition for many. Yet as the death of 41-year-old Broadway composer Michael Friedman this past Saturday reminds us, thousands of Americans still die every year from HIV/AIDS.

In 2014, the last year for which these data are available, 12,333 Americans with HIV died of any cause, and 6,721 of them died from causes directly attributable to HIV. 

“AIDS has certainly not gone away,” said Dr. Jeffrey Klausner, a professor of medicine and public health at the UCLA David Geffen School of Medicine. “At an average of 20 deaths a day, it’s something that’s occurring regularly.”

An estimated 1.1 million people in the U.S. are living with the disease, although about 15 percent of them don’t know they have it. But HIV/AIDS doesn’t draw the media attention it once did.

“We need to continue to be aware, continue to talk about it and continue to advocate for prevention and treatment resources,” Klausner said.

To Prevent And To Heal 

The message from public health officials is clear: If you test positive for HIV, get into treatment right away. Taking antiretroviral medicines every day can bring HIV levels in a person’s body so low as to be almost undetectable, which drastically reduces the chances of passing the virus to someone else.

At the same time, lower HIV levels drastically reduce the chances that you’ll die of HIV/AIDS complications. Untreated HIV weakens the immune system, leaving a person more susceptible to other infections and cancer. The virus also keeps the body in a state of chronic inflammation, which increases the risk of heart disease, stroke and dementia.

Getting into treatment as soon as possible is key to preventing HIV from wreaking havoc on the body. Federal funds are available for those who can’t afford medication. But still not everyone gets tested soon enough, obtains the medication and/or manages to take it daily. 

The more pills skipped, the more patients run the risk that their virus levels will spike. In rare cases, they may even become resistant to the antiretroviral medication.

“Treatment is great for those who can access it early and take it every day, there’s no question about it,” said Dr. Steven Deeks, professor of medicine at the University of California, San Francisco. “But a lot of people just cannot get the drugs, or when they do, they can’t take them for a variety of reasons.”

Reasons for not taking medication or missing checkups range from the mundane (too busy, difficulty in scheduling appointments) to the alarming (homelessness, lack of transportation, depression and shame). Many people who need care also struggle with mental illness and substance abuse. 

“So in countries like Switzerland, where there’s a lot less poverty and they have a health care system that delivers these drugs universally, they’re doing better than the U.S., where we have a tremendous amount of social and economic issues that get in the way,” said Deeks. 

The People Most At Risk

AIDS-related deaths are down around the world ― from about 1.9 million in 2005 to about 1 million in 2016. While the numbers are also dropping in the U.S., the country’s staggering socioeconomic inequality and lack of universal health care means that it still outpaces other wealthy developed nations in new HIV infections and falls behind them in widespread testing and treatment.

In the U.S., 39,513 people were diagnosed with HIV in 2015, the last year for which that number is available. The same year, only 29,747 people were diagnosed with HIV in the 31 countries that make up the European Economic Area and whose combined populations are about 200 million more than the U.S. population. 

Klausner pointed to “this great imbalance of the haves and have-nots” in explaining why the American rates of HIV infection and AIDS deaths are still so bad.

In 2015, about half of all new HIV diagnoses in the U.S. were among people living in the South, which is home to some of America’s poorest citizens and offers the least access to affordable health care. In addition to having the highest rates of new HIV diagnoses and HIV-related deaths, the South is burdened with high rates of diabetes and cancer, the Centers for Disease Control and Prevention notes. 

New HIV diagnoses in 2015 were also concentrated among gay and bisexual men of all races and among black straight women.

“We still have major gaps in our ability to address certain populations, particularly in southeastern parts of the U.S., and particularly among African Americans,” Klausner said.

Subpopulations representing 2 percent or less of HIV diagnoses are not reflected in this chart. The abbreviation “MSM” here stands for men who have sex with other men.

How To Stop More Diagnoses And Deaths

One way to stem the tide of new HIV infections in the U.S. would be to present people who get tested with two pathways, Klausner said. If they test positive, they should receive treatment right away. If they test negative, doctors should still talk with them about a plan to forestall future HIV infection ― potentially including taking a medication like PrEP that substantially lowers the risks of contracting the disease.

While this approach is standard at publicly funded clinics, Klausner said, private-sector health care ― which serves most Americans ― has been slow to adopt such prophylactic medicine. 

“While we say HIV is manageable and AIDS is preventable, it’s much better to prevent someone from getting HIV in the first place,” he said.

Doctors, nurses and other clinic staff should also recognize how much their actions affect patients’ will and ability to follow a treatment plan. A 2015 qualitative study conducted by researchers at the University of Pennsylvania found that simple things like positive relationships with clinic staff, patient-friendly services such as arranging transportation, and even calls to remind people of an appointment were a big factor in helping patients stay on their regimen. 

More Young People Are Dying of Colon Cancer

“Scheduling a colonoscopy is more important now than ever. Book an appointment with us today.”

— Dr. Dale

From More Young People Are Dying of Colon Cancer

When researchers reported earlier this year that colorectal cancer rates were rising in adults as young as their 20s and 30s, some scientists were skeptical. The spike in figures, they suggested, might not reflect a real increase in disease incidence but earlier detection, which can be a good thing.

Now a sobering new study has found that younger Americans aren’t just getting cancer diagnoses earlier. They are dying of colorectal cancer at slightly higher rates than in previous decades, and no one really knows why.

“This is real,” said Rebecca L. Siegel, an epidemiologist with the American Cancer Society and the lead author of the current study, published as a research letter in JAMA, as well as of the earlier report. “It’s a small increase, and it is a trend that emerged only in the past decade, but I don’t think it’s a blip. The burden of disease is shifting to younger people.”

The study found that even though the risk of dying from colon and rectal cancers has been declining in the population over all, death rates among adults aged 20 to 54 had increased slightly, to 4.3 deaths per 100,000 people in 2014, up from 3.9 per 100,000 in 2004.

“This is not merely a phenomenon of picking up more small cancers,” said Dr.Thomas Weber, who was not involved in the study but is a member of the steering committee of the National Colorectal Cancer Roundtable. “There is something else going on that’s truly important.”

No one knows what underlying lifestyle, environmental or genetic factors may be driving the rise in cases.

While rates of cancers tied to human papillomavirus, or HPV, have been rising in recent years, that virus causes cancers mainly of the cervix, back of the throat and anus, and scientists do not believe sexual behaviors or HPV are driving the increase in colon or rectal cancer (anal and rectal cancers are distinct).

Obesity, a diet high in red or processed meats and lack of physical activity are among the factors tied to increased risk, but new research is looking at other possible causes. One recent study found, for example, that prolonged use of antibiotics during adulthood was associated with a greater risk of developing precancerous polyps, possibly because antibiotics can alter the makeup of the gut microbiome.

Scientists are also exploring whether the colorectal cancers emerging in younger adults are different from those seen in older people — and whether they can be detected and treated with the same tools. There is some evidence that young people are more likely to have precancerous polyps that are harder to see and remove during a colonoscopy because of their location in the colon or because they are flat rather than tubular, according to Dr. Otis Brawley, who is chief medical officer for the American Cancer Society.

The findings add to the urgency to find reliable ways to detect colorectal cancer early in young people. Most medical groups have for years recommended people start routine screening only at age 50 unless they have specific risk factors, like a family history of the disease or chronic conditions like inflammatory bowel disease that raise the risk. One organization, the American College of Gastroenterology, recommends that African-Americans start routine screening at 45 because they are at higher risk for colorectal cancer than whites.

Any proposal to expand universal screening, however, will be both controversial and potentially costly, since the vast majority of colorectal cancer deaths still occur among older adults.

“I don’t know that this very small uptick in mortality means we ought to start doing colonoscopies on 20-year-olds as a routine matter,” said Dr. Michael Potter, a professor of family and community medicine at the University of California, San Francisco. More lives would be saved by increasing screening at age 50, he said, adding, “It’s worth doing research in this area to determine whether lowering the age of colorectal cancer screening would yield more benefits than harms. These are not risk-free procedures.”

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Screening tests are also expensive, though cost is not the driving issue. Looking for colon cancer in young people is like looking for a needle in a haystack — you’d have to screen a lot of people to detect even a small number of cancers or precancerous polyps. Most young people would go through the process for no good reason, and some would sustain injuries or other harms.

Complications from colonoscopy, considered the gold-standard test, are fairly frequent. A study of over 300,000 healthy Medicare patients who had colonoscopies found that nearly 2 percent wound up in an emergency room or hospital within a week of the procedure because of complications such as tears in the wall of the colon or rectum, which can be life-threatening.

But while some organizations specifically state that colonoscopy is the preferred screening method, the United States Preventive Services Task Force endorses a variety of screening tests, including some that are less expensive or noninvasive, though they may not be as effective in finding and preventing cancers. Stool tests that examine fecal samples for microscopic amounts of blood and DNA changes, for example, can indicate the presence of a tumor or polyp, but such tests need to be done more frequently and may have to be followed up with a colonoscopy if the result is positive.

All of the testing options have pros and cons, and some may yield a false positive test, subjecting someone to additional testing for no reason, or a falsely reassuring negative result.

But Dr. Brawley said there is good scientific data to show that stool sample tests save lives, and added that some patients may be better served by these noninvasive tests. “In the U.S., we have all gravitated toward the new high-tech screening methods, and we may be leaving old technology that is still very good,” he said.

Screening guidelines aside, people concerned about colorectal cancer at any age should talk to their doctor, said Dr. Douglas Owens, vice chairman of the Preventive Services Task Force. “There are always circumstances in which individual decision making is appropriate,” he said.

Many physicians may be reluctant to order screening tests for younger adults, because they are also unaccustomed to seeing this cancer in younger people, Dr. Weber said. He said efforts are being made to raise awareness in physicians as well as patients, adding, “We need to set the trigger much lower to investigate these symptoms and rule out malignancy.”

Warning signs of colorectal cancer include rectal bleeding, bloody stools, unexplained weight loss, fatigue and digestive complaints, or persistent changes in bathroom behavior. Anemia in men is also a warning sign and should be explored further, and while many doctors typically attribute anemia in a premenopausal woman to menstruation, experts say that if a woman is experiencing any other symptoms, doctors should assess her for colon cancer.

Make sure you know your family’s medical history — including not only whether any close relatives had colorectal cancer, but whether they had benign polyps, which can be precancerous. Tell your physician of any medical conditions, such as inflammatory bowel disease, that may increase your risk.

Doctors say you may be able to reduce your risk of colorectal cancer if you maintain a healthy weight, get a lot of physical activity, eat a healthy diet, don’t smoke and avoid excessive use of alcohol.