Vitamin D and Bone Health; Infarcts in Middle Age: It’s PodMed Double T!

PodMed Double T is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of digital media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, have a look at the highest medical tales of the week. A transcript of the podcast is beneath the abstract.

This week’s matters embrace a bleeding drawback after cannabinoid use, infarcts in center age and cognitive decline, Vitamin D and bone well being, and dietary proteins and mortality.

Program notes:

Zero:41 Animal and plant protein consumption

1:45 More animal protein and extra complete power

2:45 Impact of protein on mortality

three:45 Disparage inexperienced tea?

Four:19 Vitamin D and bone well being

5:19 Reduction in bone energy with increased doses

6:17 Infarcts in mind and cognition

7:18 Those with each small and massive infarcts at highest threat

eight:18 Hypothesis is huge and small vessel illness

9:07 Bleeding and cannabinoid use

10:08 Blood was skinny and remedy begun

11:51 End


Elizabeth Tracey: More about consuming plant-based proteins.

Rick Lange, MD: Does high-dose vitamin D enhance bone well being?

Elizabeth: If you have received little areas the place your mind appears to be like prefer it’s been compromised, what’s that must do along with your cognition?

Rick: And skinny blood after cannabinoid use.

Elizabeth: That’s what we’re speaking about this week on PodMed TT, your weekly have a look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I am Elizabeth Tracey, a medical journalist at Johns Hopkins, and this might be posted on September 13th, 2019.

Rick: And I am Rick Lange, President of the Texas Tech University Health Sciences Center in El Paso, the place I am additionally Dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, how about if we begin with this concept of animal and plant protein consumption and all-cause and cause-specific mortality? Gosh, we simply discuss this so usually. This is in JAMA Internal Medicine.

This was an enormous research, virtually 71,000 of us in Japan. They entered this research 45 to 74 years of age, no historical past of most cancers, cerebrovascular illness, or coronary heart illness once they entered. And then they took a glance till the top of December in 2016, after which just about 12,000+ deaths had taken place. They checked out what did these folks eat. In Japan, after all, they ate an entire lot of fish and greens and soy sorts of merchandise. They related that with their loss of life. They calculated intakes of all these several types of animal proteins and plant proteins as a proportion of their complete power that was consumed.

They do admit the contributors who consumed extra of the plant-based proteins have been extra prone to often drink inexperienced tea. I do not know if that is a confounder or not. And in addition they discovered that those that consumed extra animal protein additionally tended to devour extra complete power.

They had come to a conclusion that there could possibly be an absolute threat discount at 15 years for loss of life if there was simply an isocaloric, so no change in the full variety of energy consumed, however a shift of animal protein to plant protein if there was three% power from plant protein. So they discovered that these of us … and it isn’t shocking that increased intakes of plant protein have been related to decrease complete mortality, additionally with cancer-related mortality, and additionally that animal proteins that could possibly be given up could be purple meats and processed meats; that would additionally assist complete cancer-related and cardiovascular-related mortality.

Rick: Two elements to this research. The first was the affiliation of a high-protein weight loss plan with mortality as a result of high-protein diets have been related to some good issues: superior weight reduction, enhancements in cardiovascular threat components, together with blood stress, blood lipid, and glycemic regulation. But alternatively, in addition they have an effect on macro/micronutrients and additionally polyphenols.

What this research confirmed was general, high-protein diets didn’t have an effect on morality. But as you highlighted, once they seemed on the several types of protein, if any person had a plant-protein-based weight loss plan — versus a meat-based-protein weight loss plan — it diminished mortality by someplace round 15% to 20%, and particularly in case you changed the purple processed meats with the vegetation. Now, we did not discuss what these plant proteins are. Do you need to spotlight what we’re speaking about, Elizabeth?

Elizabeth: Oh, I might love to try this. Because earlier than we began to document, we had slightly dialogue about what in the world is a pulse. It seems that is, after all, a legume, beans, and peas. Those are good issues to eat, for positive. Which different of those would you want to say?

Rick: They talked about cereals, greens, fruits, in addition to the pulses that you simply talked about.

Elizabeth: You disparage the concept that inexperienced tea consuming may need one thing to do with it.

Rick: It’s laborious to match these populations as a result of it wasn’t a randomized trial, however there’s actually not excellent knowledge that consuming inexperienced tea can decrease mortality by as a lot as 15% to 20%. I feel it has loads to do with the helpful weight loss plan we have talked about.

Elizabeth: Well, since we’re speaking about issues that folks devour, allow us to flip to the Journal of the American Medical Association. This one I believed was actually fairly fascinating, the potential deleterious results of supplementing with vitamin D.

Rick: Vitamin D has been thought of to be helpful for stopping and treating osteoporosis. However, while you have a look at the research, it is solely proven to be helpful in these people which have low vitamin D ranges. Using vitamin D dietary supplements, in normal, hasn’t been helpful in phrases of bone well being. But about 1 in 30 sufferers throughout the U.S. take not solely vitamin D, however take excessive doses of it. An everyday dose could be about 400 items, however some folks take Four,000 and some as a lot as 10,000 items. In these people, does the ingestion of high-dose vitamin D both enhance bone density or does it one way or the other enhance bone energy?

So there have been 311 contributors in this research that have been randomized to obtain both 400 worldwide items of vitamin D, Four,000 items, or 10,000 items and adopted at baseline, three months, and three years. When they measured each bone density and bone energy, the people that took the upper doses — notably the 10,000 items — really had a bigger discount in bone density, additionally a discount in bone energy.

This goes counter to what you’d assume. It appears to be like like the upper doses of vitamin D have been related to each extra bone resorption and decreased ranges of parathyroid hormone, and that is a hormone that’s vital for bone energy. So is there a bonus to taking high-dose vitamin D? The reply isn’t any. And in reality, it could be deleterious.

Elizabeth: I feel this actually illustrates the truth that many, many individuals are taking dietary supplements and lots of them are additionally taking them with the concept that if slightly is sweet, extra have to be higher. And there actually aren’t many tips with regard to how a lot of it may possibly you’re taking and is there a hazard to taking an excessive amount of? We’ve seen this additionally with huge doses of vitamin C, for instance, the place folks then may develop kidney stones consequently.

Rick: And once more, I need our listeners to know I feel the research are fairly clear. The advantage of vitamin D supplementation is simply seen in the remedy of vitamin D deficiency.

Elizabeth: Let’s flip then to Annals of Internal Medicine, this concept that a few of these issues that we discover after we check out the mind are actually, I will say, simply type of unsure predictive worth. And as extra persons are present process imaging, after all, we’re beginning to see this stuff much more usually, incidentalomas. This is, in some respects, to me that is the way it smacks.

These are two research populations, the Atherosclerosis Risk in Communities Study. That’s one the place there’s MRI imaging knowledge and as much as 5 cognitive assessments over 20 years, and they used two of these research. They checked out infarctions, areas in the mind the place it was clear that there was an interruption in the blood provide, subsequent, what I will name scarring, for lack of a greater phrase, proper? They had folks characterised as having none, smaller ones solely, or bigger ones solely — these could be three to 20 millimeters — or really had each of these.

1,884 contributors who got here into this at about 62 years of age. Participants with each smaller and bigger infarctions had steeper cognitive decline by greater than half a regular deviation. That’s a fairly highly effective type of predictor with regard to the cognitive threat. The smaller and the bigger alone weren’t essentially related to something. They nonetheless noticed cognitive decline, however there was no actual separation between these. Basically, including to this concept that we will check out these findings and say, “Oops, you’re at risk for cognitive decline.” It’s unclear to me what the motion level is.

Rick: And our listeners needs to be conscious is [that] we’re speaking about sufferers that didn’t have any medical proof of stroke. So Elizabeth, I agree with you. First of all, it is shocking to me that both small or massive strokes independently weren’t related to a cognitive decline. I might have thought that in case you discover this in midlife, later in life you are going to have superior cognitive decline.

And in a small variety of sufferers, solely 2% that had each small and massive strokes, once more, asymptomatic, they did have a a lot bigger cognitive decline. The speculation is that is proof of each huge and small vessel illness. And both a type of, there’s some resilience related to it. But when you’ve each collectively, there is no wiggle room, and that is what outcomes in elevated cognitive decline.

Based upon that info, to begin with, is it plausible or not? It must be replicated in further research, in my opinion. But secondly is, what do you do with that info now and what do you inform that affected person?

Elizabeth: I assume the opposite factor is the danger components we’re properly conscious of, hypertension and so on, that hopefully would already be being managed for, so I am unsure I agree with you [as to] what further info or motion factors this factors us towards.

Rick: You’re proper. If somebody has diabetes or hypertension or excessive ldl cholesterol, you are not going to say, “Their MRI scan looks normal so we’re not going to treat the underlying cause.” You’re going to try this anyway.

Elizabeth: OK. Finally, in Annals, let’s flip to a relatively disturbing sequela of hashish use.

Rick: This is artificial cannabinoid use. It’s uncommon. This is definitely a case report. We do not normally discuss case experiences. We need bigger research. It’s endemic of slightly bit bigger problem. In March of 2018, an outbreak of coagulopathy — that’s, skinny blood — occurred in Illinois after folks smoked an artificial cannabinoid. It was believed to be contaminated with a rodenticide. That rodenticide was like coumadin, however these new rodenticides are literally referred to as tremendous coumadins or tremendous warfarins. These tremendous warfarins’ results can final for months.

What this case report highlighted was a 26-year-old in any other case wholesome girl who offered to the emergency division with bleeding of the gums and extreme bleeding along with her menstrual intervals as properly. She had a Four-year historical past of smoking cannabinoids day by day and she did that in order that she did not fail drug testing as a result of the drug testing detects hashish, however not cannabinoids.

What they came upon was, positive sufficient, her blood was “thin,” and they started to deal with it with the routine measures. They gave her blood merchandise to switch a few of the coagulants and additionally gave her vitamin Ok, and it normalized. But then inside a day and a half later, it rebounded. Again, her blood was excessively skinny and they handled it once more. Then at six days, it rebounded once more.

They needed to put her on high-dose vitamin Ok. In reality, it was excessive sufficient a dose of vitamin Ok that the native pharmacy could not present it, in order that they needed to hold her in the hospital for longer. And then, the associated fee was prohibitive as properly for her to proceed it, so she stopped it and 62 days after the preliminary report, she nonetheless has skinny blood. I convey this to the eye of our listeners and well being care suppliers is in case you detect a coagulopathy in an individual that has used artificial cannabinoids, suspect a rodenticide. And if it must be handled, it could have to be handled for weeks and months.

Elizabeth: Has this case resolved?

Rick: It’s laborious to know as a result of, as I discussed to you, 2 months afterward she was reported to nonetheless have a coagulopathy, and the case experiences notes that she was misplaced of followup after she moved out of state, so we haven’t any specific followup on this particular affected person.

Elizabeth: Certainly, we’re seeing folks proper now. In reality, somebody who did die because of vaping and a few of the stuff that is in there — a number of experiences now occurring about that. I assume I simply must say, “Gosh, smoking things, not a good idea, and smoking synthetic things, even a worse idea.”

Rick: Elizabeth, I feel that sums it up.

Elizabeth: On that observe, then, that is a have a look at this week’s medical headlines from Texas Tech. I am Elizabeth Tracey.

Rick: And I am Rick Lange. Y’all pay attention up and make wholesome selections.


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