Day: May 1, 2017

Medicine an anglo french word for a thousand years  from the Latin  The science or practice of the diagnosis, treatment, and prevention of disease  Latin Medicus healer ? from mead?  so did we give alcohol drinks to make people better.

I would like to add my own take to the Cholesterol Myth that swirls around the internet and occasionally breaks the surface, such as on the controversial Australian saturated fat and cholesterol Documentary by Mary Ann Demasi in 2013 on Catalyst. One of the problems is that everyone who promotes the myth also seems to promote their own version of alternate facts.  The argument made, with a little dash of snake oil, is that cholesterol is a natural substance that aids in repair of the body and has not been shown to cause an increase in the rate of heart attacks. Indeed in some studies the opposite. The medicines used to lower cholesterol also may have harmful side effects on the muscles and have a link to dementia.

The problem? A lot of this is true but irrelevant, it is how the facts are put together that should count.  What is cholesterol?  A few facts.

Cholesterol  is an organic molecule.  We make it so it is not a vitamin although it is essential for life. It is a type of lipid molecule, and is made by all animal cells and functions as a  component of all animal cell membranes; essential to maintain both membrane structural integrity and fluidity. Cholesterol is the difference between plants and animals as it enables animal cells to dispense with a cell wall (to protect membrane integrity and cell viability), thereby allowing animal cells to change shape rapidly and animals to move (unlike bacteria and plant cells, which are restricted by their cell walls). Cholesterol is made in much smaller amounts by plants  [100 times less] Human breast milk also contains significant quantities of cholesterol. Cholesterol is oxidized by the liver into a variety of bile acids. Equally important  is the range of other substances derived from cholesterol  that are absolutely important to life and function.it is the precursor molecule for the synthesis of vitamin D and all steroid hormones, including the adrenal gland hormones cortisol and aldosterone, as well as the sex hormones progesterone, estrogens, and testosterone, and their derivatives.    Every cell is capable of synthesizing it.

Most ingested cholesterol is esterified and poorly absorbed. The body also compensates for any absorption of additional cholesterol by reducing cholesterol synthesis. For these reasons, cholesterol in food has little, if any effect on concentrations of cholesterol in the blood. Cholesterol is recycled in the body. The liver excretes it into the digestive track. Only 20% of total daily cholesterol production occurs in the liver; other sites include the intestines, adrenal glands, and reproductive organs.  The main regulatory mechanism is the sensing of intracellular cholesterol. A human weighing 70 kgms  normally synthesizes about 1 gram (1,000 mg) per day, and his body contains about 35 g, mostly contained within the cell membranes. Typical daily cholesterol dietary intake for an adult is 300mg.  Every day, up to 1 g of cholesterol enters the colon and is excreted. It forms between  1 to 2 in a thousand parts  of our bodies by weight.

The take home message is that cholesterol is important to life and health, That the levels we have are well regulated and in balance  and that the body has mechanisms adapted over millions of years to regulate the amount of cholesterol that each person has and needs. The amount of cholesterol in the bloodstream reflects the amount of cholesterol in the cells and not the other way around.

Cholesterol and heart disease. Arteries develop plaques at sites of inflammation and the plaques build up cholesterol in modified inflammatory [foam] cells. The plaques rupture with age and size and can temporarily or permanently block an artery. If this is a coronary or brain artery the consequences are a heart attack or stroke. Yet the facts are also that only certain people develop atheroma and only certain blood vessels. So two people with the same diet, age and cholesterol levels can have widespread disease or no disease at all.  Veins  do not develop atheroma. This indicates the body is selective in where it has it’s problems. People are born with the capacity to develop bad arteries. Arteries can  respond to inflammation in the the body  and outside [smoking].

*[Proof? Consider the GIT. Stomach and large bowel cancer galore but hardly ever the 4 meters of small bowel. Similarly muscle cells and brain cells, nothing relatively speaking.]

Cholesterol levels vary widely , a common range in Australia is 3.0 to 7.0. but levels can go over 10. Unlike Blood pressure, where actuarial studies show that there is a causal relationship  between high BP and early death no such studies exist for cholesterol. It is the state of the arteries, not the cholesterol level that is important.

There is a wealth of evidence showing where treatment can be beneficial and this is when a diagnosis of arterial disease has been made.Post heart attack statins show a reduction in heart attacks in the months afterward. Hence people are commenced on statins commensurate with heart attack procedures even with low cholesterol. The jury is out on why,  a cholesterol lowering effect or an associated anti inflammatory effect.When one has cardiovascular disease there is some evidence that cholesterol lowering may slow or reverse the atheroma. Since  we have nothing else to offer people with proven disease, people with high risk of disease, diabetics, smokers, family history of disease or atheroma conditions such as past stroke are all strongly advised to take such treatment.

 

One suggestion I can make is for people who have a high risk averse nature and a family history but who are also concerned about side effects. Especially as they may have to take the medications for 40 plus years. There is a wonderful test known as a cardiac MRI.  This shows the amount of calcification in arterial vessels importantly those of the heart. This is extremely well correlated with the presence and degree of atheroma. and increases in age with all of us. Someone at risk whose MRI  shows disease worse than expected for their age group would be strongly advised to go on medication.

Dementia is associated with advancing age and atheroma and appears genetic in origin, Alzheimer’s in particular not seemingly due to atheroma but another sort of plaque formation should not be caused by drugs that lower cholsterol. After all it is not more prevalent in people with low cholesterol. Muscle and liver upsets occur as a side effect but like all medications if something upsets you stop and find another treatment. LDL and HDL cholesterol are protein/fat  complexes that carry the protein around. Small changes in outcomes are shown in studies of little value in my opinion as Cholesterol is made in the cells, not in the bloodstream.  If you do not want to take the treatment offered best check with the MRI.

 

This leads to a digression to one of the other topics. How to live longer.  What is the normal human lifespan. How can we prolong it.  Telomeres for the scientists here. The sad news is that in general nothing much is going to work. We are programmed for obsolescence. To get out of the way and let the younger ones through. There is so much to say on this topic. Humans , 70 years

Accidents and cancer,  disease and malnutrition are unavoidable. Muscle ageing, Immune system weakening, Bone thinning, loss of height, worn joints, heart disease and strokes are systemic. Atheroma in the blood vessels will get all of us given enough time. But only in the arteries , not the veins. Why not? because we are programmed to  develop atheroma in arteries. So no matter what diet or exercise you choose it will make no difference. Cancer diets, Blood type diets, Atheroma diets, Antioxidants, all useless. That little bit of cell that started you off writes finis. As in Gattica. You only have so many heartbeats. Mind you if you exercise or come toU3A lectures you may not live longer but it will certainly feel as if you have .

One diet works but it is a stretch to call it a diet. Fasting, starvation. It has been shown that people who are starved for long periods of time do live longer.  It may have to do with slowing down, slower heart rate, lower BP, less inflammation in the body, all things that happen naturally with starvation.

Inflammation reduction may help as disease and aging processes are accelerated by inflammation. One theory with heart attacks is that they may be caused by infections in some people. Hence antibiotics may help.

People with inflammatory diseases such as rheumatoid  and auto immune disease are much more prone to atheroma. Here a simple native medicine from the bark of a tree has shown promise in many areas but is usually overlooked. It’s name, aspirin.

In atheroma and prostate cancer it has proven to help more than harm with just small doses. Just look out for the stomach and some other side effects.

Metformin is an unusual drug which has an effect on insulin activity. It produces a wide range of other useful health outcomes. It is useful in polycystic ovary , fertility and obesity syndromes. and it reduces some cancer risk. Again some people cannot tolerate it with occasional difficult side effects.

The new MIB and MAB drugs for autoimmune and cancer problems work in part by inflammation reduction. They can however knock the immune system around seriously with infective side effects.  Could they be the elixir of life? It is now possible.

Thousands of Britons are dying from heart attacks and strokes after being scared away from cholesterol-lowering drugs by warnings of non-existent side effects, the lead author of a major study claims.

An investigation into statins has demonstrated aching muscles and other reported symptoms could not be blamed on the drugs.

The study, which involved about 10,000 patients at risk of heart and artery disease, highlighted a “nocebo effect” – the opposite of the placebo effect.

Warnings of common side effects listed on statin information leaflets were giving rise to nocebo symptoms despite having no provable connection with the drugs, researchers found.

Professor at Imperial College London and co-author of the study, Peter Sever, said reports of side effects had led to a fall in the number of patients taking statins and a reluctance among some doctors to prescribe them.

“There are people out there who are dying because they’re not taking statins, and the numbers are large, the numbers are tens of thousands, if not hundreds of thousands,” he said.

“And they are dying because of a nocebo effect, in my opinion.”

The study, published in The Lancet medical journal, was conducted in two phases, the first of which included 10,180 patients aged 40 to 79 from the UK, the Irish Republic and Scandinavia.

Patients in the first trial were “blinded” so neither they nor doctors knew who was receiving the active drug.

The study found rates of muscle-related symptoms were similar whether or not patients received the statin or placebo.

Subsequently when patients knew they were taking statins, reports of muscle-related side effects were 41 per cent more common among those being treated.

Prof Sever was highly critical of the Medicines and Healthcare products Regulatory Agency (MHRA) for “jumping the gun” by insisting on the side effect warnings in 2009.

“Many of us would say that the MHRA … did not make a profound value judgment based on the evidence,” Prof Sever said, adding the agency had acted on observational reports not based on robust science.

“These warnings should not be on the label … I would love to see these side effects removed.”

The study was funded by drug company Pfizer, which makes statins, but the authors stressed all data collection, analysis and interpretation of the results was carried out independently.

 

The superbug myth

We have been going to have superbugs resistant to all antibiotics spreading throughout the world due to overuse of antibiotics by GP’s and Hospitals.

While it is true that there are resistant bugs out there it is not a fact that widespread resistance is developing or that it will ever become a serious problem.

 

There are two reasons for this. One is that bacteria that carry and express extra genes have a hard time competing with their mates who do not carry the extra baggage  So over time the ones with the extra baggage miss out and die out.

TRhe second is that we do have some heavy antibiotic exposure in the food industry with livestock. Cattle sheep pigs and chickens to name a few Prawns and fish  in fish farms was a surprise. The reason farmers keep feeding the animals antibiotics is because they do not get as sick and hence put on more weight and size and are more valuable to the farmers.

Yet superbugs have not destroyed the farming industry even though the exposure is up to 100 times that of human exposure on a regular basis. Surely it is obvious that if they werr to develop they would have done so and taken over by now.

One other factor is the remarkable speed at which bacteria grow and exist. Alifetime for a bacteria is about 1 hour compared to our 70 years. Resistance develops quickly but is also bred out just as quickly.

As an aside this reduction in infection leads to a reduction in inflammation and could be one of the measures one could actually take to improve one’s lifespanb. In fact there is a myth out there that bacteria are a cause of heart attacks and some trials have been done on taking antibiotics to help reduce this risk.

 

 

Hello to everyone.

My name is Harry Lee and am am a partly retired GP wishing to share a bit of advice on Medicine gathered during my working years. The subject today is Skeptical Medicine which covers the myths in medicine and a look at some of the practices we do and the reality behind them.

To start with I am making some statements to show where I am not coming from.

Firstly, Vaccination is good, everyone should vaccinate their children and themselves appropriately. Fluoridation of the water supply is good, it protects teeth and at 66 years of  age and numerous dental visits later I can only reiterate how important dental health is.

Secondly I would like to comment on a comment by Dr John Tickle, a medical guru, whose advice was moderation in all things, except fish and laughter. and a sage friend of mine who says “Listen to your body”. My own version of this for good health would be “Listen to your wife”

Subjects I will discuss today include the Cholesterol myth. Diet, exercise and vitamins in the search for  living longer, An advance in the treatment of prostate cancer and the screening controversy,

Superbugs, The value and interpretation of screening and medical tests in general ending with what one should and should not do medically in life.

 

So in summary To live longer or to live happier, that is the question. Should we strive to prolong life or accept the blessing of what we have been given. Should we stay with our peer group or outlive them. Does it bring more happiness or just crowd the rowboat needlessly? Do we reach an emotional end point as well as a physical one.

Vitamins. Do we need them and when.

On solid ground here. Most people know that vitamin supplements are not helpful but still we take them. Why?

A through to K, are proteins essential to life but not normally able to be made in our bodies [exception Vit D]. They are all normally available through a normal diet hence there is no need to supplement them as we always get more than we need under normal circumstances. Is more better? No, as we get more than we need taking more does not make our bodies any better off. In some cases e.g. Vitamin A, overdosing can lead to illness and death.

Retinols are found in foods that come from animals (meat, milk, eggs). The form of vitamin A found in plants is called beta-carotene (which is converted to vitamin A in the body)

 

The mystery of the human condition

I am going to define life for a human being. 70 year average.

inflexion at 70. All gone by 84. Death rate from 1 year on 0.2 % a year slow rise to 0.3 at age 14. To 1.0%

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CO2 in Seawater: Equilibrium, Kinetics, Isotopes, 1st Edition Zeebe   &    Wolf-Gladrow   have some wonderful stuff on our topic though hard to copy and paste.
It backs up ATTP and his presentation of equations.
The money line is page 41  1.2.4  total alkalinity and charge balance
“Sillen [1961] argued that considering the origin of the ocean, we might say that the ocean is the result of a gigantic acid base titration in which acids that have leached out from the interior of the earth are titrated with bases that have formed from the weathering of primary rock ”
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That is the essence of what I have been saying.
In an authoritative text book.
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Side tracking  on permeability of sediments [undefined] and stating that the seafloor is covered with impermeable clay flies in the face of Broecker  “The high-CaCO3 sediments that drape the oceans’ ridges and plateaus typically have ?90% CaCO3 and a water-free density of 1 g cm?3.”
The  amount of CaCO3 available for dissolution in such a sediment is 72 g cm?2.
This amount could neutralize 6.3×1017 mol of fossil fuel CO2. This amount exceeds the combined oceanic inventory of dissolved CO2? (1.6×1017 mol) and of dissolved VHBO3? (0.8×1017 mol). It is comparable to the amount of recoverable fossil fuel carbon.”
In other words the first 8cm or so of the available usable sediment
is not covered by impermeable clay, it is usable now.
It has the capacity to soak up 4 times the amount of CO2 already present in the ocean as DIC without blinking.
Only then would it be used up under an impermeable blanket as Dikran puts it.
It would be available to soak up all the fossil fuel that can theoretically be discovered.
And we still would not have an acid sea of consequence for the carbonic acid itself in equilibrium with the available CaCO3 is the buffer of the sea.”We may be on the same page at times.
Dikran Marsupial says:    November 8, 2016 at 10:23 am
” Now I am not claiming that there is no transfer of CaCO3 from the ocean floor to the deep ocean,” but my understanding is that there isn’t very much. BTW note that sedimentary rocks such as limestone tend not to form in the deep ocean because of the dissolution process that Marco mentions, so it isn’t clear that there is an abundence of CaCO3 in the rocks forming the ocean floor to begin with (I suspect the Atlantic ocean floor is mostly baslt, i.e. silicate rock).

So what is your evidence for an unlimited supply of CaCO3 from the ocean floor?
Oh, BTW, thanks for putting up the second and third pictures. Your computer skills are way above mine. The second one shows the calcareous ooze right on top of the mid ocean ridges and further out under the red clay.
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Confirming my point “There are bucket loads of carbonate in the earth’s crust, every subsurface volcanic eruption exposes more to the ocean” despite your assertion to the contrary.
Dikran Marsupial says:    November 9, 2016 at 9:56 am    “. I don’t think this is necessarily correct.”
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You also said, incorrectly.
“the reason that land based volcanoes give off a lot of CO2 is because they are largely erupting magma formed from subducted crust from shallower oceans that has carbonate sediments.”
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The magma is the same, molten basalt under the sea and on land.
Any component of “subducted crust from shallower oceans that has carbonate sediments” can only be present in the ocean ridge volcanoes under the sea. That is where the subduction takes place.Subducted crust is melted,gone, not crust no more.
Land based volcanoes give off extra CO2 because  the magma passes through ordinary crust with layers of chalk limestone marble etc, carbonate sediments from 2 billion years of non subducted crust formation of sediments from shallower oceans.
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Finally, you state
“this one states that calcereous oozes are scarce below 5000m (i.e. below the CCD),”
the statement should read but doesn’t “recent calcareous oozes” as in the next sentence
[wonder why Dikran didn’t mention that one]  it says ancient calcareous oozes at greater depths if moved by sea floor spreading.
By the picture accompanying these calcereous oozes are abundant not scarce you would agree.
The term scarce applies to CaCO3 deposits on the red clay surface below the CCD
.””That said: I think the hard part isn’t learning d(x^2)/dx = 2x which kids can memorize just as easily as A=?r². It’s understanding “slope” = “rate” and understanding what to do with rates etc.””   Lucia Maths and need to get a book written

Plot trinity James one of 3 in the 5 series plot involves death in a plane but only being a computer simulation write whole novel then unpin/save heroine at end.

dikranmarsupial
“Also the mud in the abyssal ocean has no carbonates because it is below the CCD,”
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Mud in the abyssal ocean with no carbonates.
because it is below the CCD.
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Chemistry and knowledge and assertion.
“Mollusks from many different groups live in the deep sea. Our shell-makers can be found at all depth levels of the ocean bottom; no limit is known on the depths at which they can live. Mollusks have been found in the deepest point of all oceans, the Challenger Deep in the Marianas Trench, at 11,022 m (about 36,000 feet) depth”
I presume the 11,022 is well below the CCD.
I presume the molluscs have shells.
Therefore your contention that the CCD is the last word on the chemistry is wrong.
I point out to you the white cliffs of Dover Possibly thousands of meters deep CaCO3.
I point out sea shells in the highest Himalayas just to remind both of us of the vast, interminable  aeons that the earths crust has been forming and deforming.
The earths crust, even under the sea, is not just some miserable thin layer deposited in the last 10,000 years.
It is a vast amalgam of CaCo3 deposited over 2 billion years, crushed, serpentined, vapourised frozen, glaciated, vented, heated and pressured into all sorts of minerals and deposits.
It is intermixed with less important stuff for our argument like basalt etc which occur in bigger percentages at greater depths.
The sea sits on the crust. It has input from the earth’s crust not just from the bottom but from every drib and drab where water comes into contact with land as it drains back into the oceans. Wind blows dust particles, some of them CaCo3 into the sea. The volcanic ocean floor rips up this buried crust and periodically exposes great swathes of billion year old CaCO3 to the ravages of the abyssal deep waters [despite the mud layer].
Vast undersea rivers carry silt and debris down to the abyssal depths daily. Bacteria and worms live in the silt and mud, yes even at those depths and burrow and break their way through it exposing rich veins of CaCO3 to the water.
It might look quiet in a nautilus for a week but over a decade the floor is a vibrant freeway of activity, not a quilted protective blanket of CaCO3 less mud.
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The salient points surely are the supersaturated CaCO3 and pH of 8.1 of the whole ocean overall. How did it get that way?
The Ca part of the mix did not form from the CO2\H2O acid pathway.
It is there because the ocean sits in and on a pitcher of earth which has a CaCo3 matrix which has formed over billions of years,
The ocean is alkaline because of the dissolved earth chemicals in it and available to it at this particular temperature, earth size and water volume. They cannot dissolve out and leave us with pure water which would be acidic with the level of CO2 in the air.
The dissolved salts and CaCO3 are innumerably more abundant and available in the earths crust than all the CO2 that nature and Humanity can produce. The balance is robust, not delicate and is much more a feature of how much CO2 [DIC] is present in water due to the CaCO3  putting it into the atmosphere or stopping it from being absorbed into the sea than a simple current small oversupply.

I am not arguing AGW, or being obstreperous, I am trying to understand the pH conundrum better.
Some of these ideas must make sense

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