Information and Answers to Questions
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CU MINI MED SCHOOL 2009 Information and Answers to Questions |
If you're interested, you can browse the questions & answers from the 2008 Mini Med School by clicking here.
Anatomy and Physiology 1 and 2
Q: I know that when most people like me think of diabetics, we tend to associate it with too much sugar....is this correct or do other factors come into play? If so what are these factors?
A: It isn’t the sugar itself, it’s the body’s inability to handle sugar (glucose) properly that causes problems. In Type 1 (mostly children) diabetes the cells that make insulin are attacked by an abnormal immune response. With decreased insulin, the cells cannot take up glucose properly and they “starve” even though the blood sugar is high. In Type 2 (adults) there is enough insulin, but for some reason the cells are resistant to responding to it and taking up sugar from the blood.
Q: Unfortunately our web link froze up for most of the answer to the "raging hormone" question.
A: Basically my answer is that our organ systems are under neuroendocrine control but during puberty, the neuro part (brain) and endocrine part (hormones) are colliding .....like two novices trying to learn to tango. Eventually, the two dancers figure out the steps and the dance gets smoother. Puberty is like the worst dancers on Dancing with the Stars....
Q: What do energy drinks that contain alcohol do to your body? Could they lead to death?
A: A very bad idea. They are marketed directly at kids, and they carry the implied message that the caffeine they contain will keep you from getting drunk on the 7% alcohol they contain (they are twice as strong as a supermarket beer. In theory they could lead to death in someone who drank very large numbers of them, but they are full of sugar and would likely make you sick first. There seems to be no point to them>
Q: How does the food you eat affect your body and brain?
A: It makes you fat and happy. But we break it down to the basics in out intestines, so even if you are eating muscle you don’t get strong, and eating brain won’t make you smart. Eat a bit of everything, especially if it’s good, and you will be a well-adjusted and prosperous person.
Q: About how many cells do you have in your stomach?
A: On average a human stomach weight 1 kilogram. That works out to about 10 to the power 12 cells, or a million million.
Q: Can you burn a fair amount of calories with your brain? If you can what kind of brain activity does it require to burn a fair amount of calories?
A: The brain uses about 1.4 grams of glucose a minute, so that’s about a teaspoon of sugar in 5 minutes. When you think hard the usage goes up in some places but down in others, so there is not much net change. Fever increases metabolism and so, brain glucose usage goes up a bit then (maybe 10%).
Q: Why do pregnant women get angry easily?
A: Not everyone does, of course. Hormone levels change and some hormones affect our mood and behavior (for example, in adolescence) and that could do it.
Q: When oxygen level drops from normal, does that affect the number of ATP molecules that are produced, therefore reducing the energy level?
A: Yes, in general. So when you live or train at higher altitude (low oxygen levels) you make more mitochondria in your cells, so you can use what oxygen there is as efficiently as possible.
Q: In stage 1 kidney failure is the kidney making less red blood cells?
A: Stage 1 kidney disease is the mildest form, with kidney blood filtration at normal levels. This implies not much wrong with the blood flow to the kidney, and so it does not make large amounts of the hormone erythropoietin (EPO) which would cause increased blood cell production in the bone marrow; nor has it yet lost the ability to make EPO, so that red blood cells are not made. But individuals vary.
Q: Tinnitus: anything new?
A: Tinnitus is the phantom perception of sound in the absence of overt acoustic stimulation. Its impact on the military population is alarming. Annually, tinnitus is the most prevalent disability among new cases added to the Veterans Affairs numbers. Also, it is currently the most common disability from the War on Terror.
No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact.
Q: Microvilli vs cilia?
A: Microvilli are microscopic cellular membrane protrusions that increase the surface area of cells, and are involved in a wide variety of functions, including absorption, secretion, cellular adhesion, and sensing mechanical signals. From Yahoo: A cilium waves, resulting either in motion of the cell, or motion of the material over the surface of the cell. In humans, you'll find these lining the respiratory tract, to move fluid (and small particulates) out of the lungs. A microvillus does not wave. Its function is to increase the surface area of the cell, to increase the rate of diffusion of materials into the cell. In humans, you'll find these on cells lining the small intestines, where you'd want to absorb the small molecules that have resulted from digestion of food you ate.
Q: Frozen diaphragm
A: We were more or less right. It isn’t a term used frequently, but refers to a part of the diaphragm that does not move in coordination with the rest of the diaphragm, often because of damage to its nerves.
Q: If the brain requires so much glucose to function, how is the brain of someone who is hypoglycemic affected? Does that affect brain function?
A: Yes, but the body adjusts blood flow to supply the brain at all costs. A person with real hypoglycemia (diagnosed by a real doctor, that is) must have the cause of the problem investigated since there are some very serious problems that may be involved. And the doctor can answer other questions. This doc would usually be an endocrinologist.
Q: What is potentially going on when one's oxygen in the blood level (as measured by the little clip with the red light they put on your finger) drops into the low 80's-mid 70's? What effects can that have on a person? Can asthma problems aggravate how much oxygen is absorbed?
A: In that range, you would probably be in a hospital and they would be able to explain your problem. Yes, some asthmatics may have decreased oxygen absorption.
Q: Can perpetually low blood pressure (90/50) trigger episodes of dizziness? Is that just an unfortunate side effect of low BP? Could it also be an issue with something else?
A: People with low BP often get “head rushes.” As for the second question, you’d have to ask your health care provider.
Q: What is pneumonia?
A: Any inflammation of the lung themselves (not just the bronchi.) It can be microbial (viral, bacterial, fungal) or chemical.
Q: How does blindness or eye defects happen?
A: Genetics, injury, infection…
Q: How is it possible that ear problems due to music are not repairable?
A: Once you knock the cilia in the organ of Corti down hard, the cannot get up again, and that cell loses most of its response to sound waves.
Q: If nerves become damaged how does the nerve damage effect the body as a whole? From Jasmine
A: It depend a lot on which nerves; if the damaged nerves affect balance, for example, many functions will be impaired.
Q: Since the brain is folded in order to fit in our skull, is it possible to unfold the brain into a flat surface?
A: No, as the fold develop there are many cross-growths made so the brain is not un-foldable.
Q: Attending medical school, do you learn everything about the body as in every detail and every function of every part of the body?
A: You learn every fact in existence, and then forget most of them.
Q: Please describe atrial fibrillation.
A: The Mayo Clinic has a nice discussion: http://www.mayoclinic.com/health/atrial-fibrillation/DS00291
Q: What causes auditory hallucinations- thumping sound- when there is electrical stimulation connection disruption in the heart?
A: It sounds like you are describing palpitations; it’s no hallucination. When the heart skips a beat, the next beat is twice a big, and the surge of all the blood through the system can be felt and, by many people, heard. It even makes many people cough.
Q: Do white blood cells die? How?
A: Neutrophils only live 17 hours on average, and then the die by the normal physiological process called apoptosis.
Q: I've heard tiny cartilaginous sacs are being inserted between vertebrae that are collapsed. Will they start using a similar procedure in other joint areas (knees, hips) so that the joint can articulate properly?
A: I am sure they will, as there is a lot of research in this area, including the growth of artificial human cartilage in tissue culture.
Q: Anomalous pulmonary venous return is fairly rare cardiac condition. Beside right atrium and right ventricle enlargement, what other complications can exist this condition if it is not surgically corrected?
A: The NIH discusses it: http://www.nlm.nih.gov/medlineplus/ency/article/001115.htm
Q: How can I donate my body at death, for medical study and maximum use of all transplantable parts? I have marked my driver’s license as a donor, but want to do more.
A: The contact person for donations to the State Anatomical Board is Kate Torgler (katie.torgler@ucdenver.edu or 303-724-0505). She can answer questions or send out information and /or donation forms as requested.
Q: Can I get a chart of “fun facts about calories and exercise” for kids? I’m a teacher and would like to share these facts with my kids so they can understand about why to avoid junk food. Or, could I get a web link to this info for kids?
A: Here’s where to go: http://www.healthlit.org/scienceInside/documents/Obesitybook.pdf
Cell Biology
Strange interview: Dr. Francis Collins, the new head of the NIH, was on The Colbert Report the day after Dr. Coughlin told us about stem cells; coincidence?
Q: I've studied meiosis so I have an idea of how that process renews DNA in offspring. What I don't understand is how the DNA in the mitochondria is renewed. It seems that there must be a process or the mitochondrial DNA would degrade and become susceptible to damage within a couple of generations. What's the story here?
A: Each mitochondrion contains about 2-10 copies of the mitochondrial DNA (mtDNA), which unlike the nuclear DNA, is circular like the DNA molecules of bacteria. mtDNA codes for 13 proteins involved in energy production, plus specific proteins involved in its own replication, including polymerases. The nucleus supplies many other proteins for mitochondrial function. When a cell is ready to divide it replicates its mitochondria. The DNA is duplicated in much the way that it is in bacteria, using what is called a D-loop mechanism: one strand replicates until it reaches the origin of replication of the other strand, and then the process continues in the opposite direction.
Q: Please explain/describe MGUS, multiclonal gammopathy of undetermined significance.
A: “The term 'monoclonal gammopathy of undetermined significance' denotes the presence of a monoclonal protein in patients without evidence of multiple myeloma, macroglobulinemia, amyloidosis or related plasma cell proliferative disorders. The disorder has been found in approximately 3% of persons older than 70 years and in approximately 1% of persons older than 50 years. A population-based study included 1384 patients from south-eastern Minnesota who had the disorder diagnosed at the Mayo Clinic from 1960 through 1994. Risk of progression was about 1% per year, but patients were at risk of progression even after 25 years or more of stable monoclonal gammopathy of undetermined significance. The risk for development of multiple myeloma was increased 25-fold; the risk of macroglobulinemia, 46-fold; and the risk of primary amyloidosis, 8.4-fold. Concentration and type of monoclonal protein were the only independent predictors of progression. The presence of a urine monoclonal protein and the reduction of one or more uninvolved immunoglobulins were not risk factors for progression. Monoclonal gammopathy of undetermined significance may be associated with various disorders, including lymphoproliferative diseases, leukemia, von Willebrand disease, connective tissue diseases and neurologic disorders.” Therefore, discuss the plan carefully with your doctors.
Q: Is SNP measureable? If so, how?
A: Single nucleotide polymorphisms can easily be measured on “gene chips” some of which can compare 5 million or more SNPs between different people’s genomes.
Q: How many diseases have been helped with adult stem cell research versus embryonic stem cell research?
A: No disease yet.
Q: From Bob-Does cell mutation increase the chance of cancerous or "misbehaving” cells?
A: Yes, there are many mutations that take place between the initiation and final development of cancer.
Q: Is it possible to change the DNA of an embryo, and can you duplicate DNA by human manipulation? From Jessica
A: Yes, we can repair genes in mouse embryos, and can add new ones, for example, normal or mutated human genes to see the effects on mouse development and learn what they might be doing in humans. We have not yet tried adding or changing human embryonic genes.
Q: Are you born with poor metabolism or does it develop through various lifestyle effects? If so can you reverse it to a extensive metabolism or "good metabolism"?
A: I don’t know what poor metabolism might mean. People with diabetes, for example, have trouble utilizing glucose, and there are several malabsorption conditions.
Q: Does the term "well differentiated" in cancer terminology refer to cells? If so, what does it mean? The diagnosis was a "well differentiated adenocarcinoma."
A: Well-differentiated refers to the overall look of the tissue; does it look like a normal tissue, or very abnormal? So a well-differentiated adenocarcinoma looks a lot like normal glandular tissue. It is usually a good prognostic sign.
Q: Can genetic information be done to detect future illness and be treated early?
A: Absolutely, we already do this, for example by screening all newborns for phenylketonuria (PKU) which is devastating, unless it is diagnosed early and the patient put on a phenylalanine-free diet; then they can be perfectly normal.
Q: When do doctors do the genetic testing for diagnosis? Does the fact that DNA is wrapped &/or coiled so tightly help to protect the bond from free radicals? Therefore, is DNA more vulnerable when it is unzipping?
A: There are routine screens of newborns, when identification can lead to prevention. And there are adult human genetics labs that can screen for genetic variants that can be significant, for example certain variants of the BRCA gene with high association to breast cancer. The uncoiling is brief and not in itself associated with increased mutation; but only when DNA replicates do mutations become “locked in.”
Microbiology
Q: Do viruses mutate at a predictable rate as they replicate?
A: Yes, and it is different for each type of virus; some have error-correction systems and some, like HIV, do not, which makes them extremely mutable.
Q: What causes a mutation of a virus or bacteria?
A: Error-prone replication machinery always causes a few mutations. Then, chemical mutagens in the medium and ionizing radiation (UV, gamma rays) also contribute.
Q: If the flu is found in any animal and can be 100% cured, can it still once again emerge later on in years?
A: Flu does not go latent in a cured animal or person the way herpes viruses do, so they do not re-emerge later. But a virus can disappear from the human population only to reappear years later; in that case it has probably been in an animal host.
Q: I heard in the news about the H1N1 flu and it talked about how many women that are pregnant have died and lost their babies. Is that possible? How does that happen?
A: We do not yet know why this new flu seems to be particularly hard on pregnant women.
Q: When you get the chicken pox vaccination, does it contain herpes 1 and herpes 2 virus?
A: No, only Varicella-zoster (chicken pox) virus, which is an distant member of the herpes family.
Q: A classmate of my daughter's was diagnosed last week with seasonal flu, H1N1, and pneumonia. If she was exhibiting flu symptoms, would it be typical to test for all of these at the same time?
A: Pneumonia can be a consequence of flu, and can either be caused by the virus or by a secondary bacterial infection. No one has yet been reported to have pandemic H1N1 2009 and seasonal flu at the same time.
Q: How can you attack or overcome viruses that get lodged into the DNA?
A: At this time we do not know how to get rid of latent viruses.
Q: Measles Vaccine - As a youth the school system requires vaccine 3 times: kindergarten, jr high, and college entry. As an adult, do we need additional vaccines, and if so how often?
A: There are a series of vaccines recommended for adults; measles is not included. Read more: http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm
Q: How does the plague affect their animal carriers? Is there a difference between the effects on an insect like a flea and a mammal such as a rodent?
A: Fleas that acquire plague get “blocked” by the high numbers of bacteria, so when they bite a mammalian host the bacteria are regurgitated into the wound. The flea will die as it cannot absorb blood. Host animals (certain rodents) have lived so long with plague that they are not susceptible to it, but can pass it via flea bites to susceptible rodents and people.
Q: Hasn't MRSA become endemic throughout the U.S. in the last few years?
A: Yes, there is community-acquired MRSA everywhere now.
Q: How is the H1N1 that we face now, different from the H1N1 of 1918 and the H1N1 of 1977?
A: Very different. It just happens to have similar (but not identical) H and N genes.
Q: How does the death rate with the current H1N1 compare to the common seasonal flu?
A: It is about the same or a bit higher. But it affects younger people more severely.
Neuroscience
Q: How do you stimulate speech if that part of the brain is dead?
A: Stimulating the speech areas (Broca's area was illustrated in the lecture) is probably not the right way to state the phenomenon. What is happening is actually stimulation-induced interruption of speech. The patient names objects while sites on the cortical surface are sequentially stimulated. Broca's area is a site or sites in the frontal lobe where the stimulation interrupts the patient's ability to generate speech (without producing other obvious motor or sensory phenomena)
Q: The example of the dog and the bell made the dog pant for food, is this the same for our reactions we have to certain life circumstances that has implanted a memory in our nervous system, which then creates fear which has us react this way over and over to certain challenges in life? This would make it hard for one to get out this pattern unless retained like the dog with the bell.
A: The example of Pavlov's dog was meant to illustrate learning of new associations. Several neurobiological mechanisms of associative learning have been described, and in several different parts of the brain. Learned associations between some stimulus and an axious or aversive reaction seem to depend on a structure in the temporal lobe called the amygdala (means "almond"), and almost certainly depends on the kind of neurobiological mechanisms of synaptic placticity that I discussed in lecture. .
Q: Is the essential tremors (ET) considered the sign of Parkinson's or disease by itself? What is the specific name of the electrical device placed in the center of kent brain?
A: The device is called a Deep Brain Stimulation (DBS) system. It is manufactured by Medtronic. ET is not considered a sign of Parkinson's disease. They are different conditions, although it is true that patients with ET probably have a greater incidence of also developing Parkinson's disease, and it is also true that patients with Parkinson's disease are more likely than non-Parkinsonian individuals to develop ET. The reasons for the overlap in incidence is not known, but they are nevertheless thought to be separate conditions.
Q: If someone has had a severe head injury but a regular MRI of the brain shows no problem...would a functional MRI be of benefit? What could a fMRI show in this case?
A: Head injury can produce damage to the nervous system at a microscopic level, frequently in the form of shearing axonal processes from their cell bodies. This damage is not visible at the level of MRI, and it can explain any number of problems or deficits a person may experience following a head injury. functional MRI may show patterns different from the norm, but what functional MRI shows depends largely on the behavioral task and the control task employed. That is, functional MRI images are obtained by subtracting one set of images obtained while the subject does one thing (say moves fingers), from another set obtained while the subject does something different (for example, lies still) the difference between the two tasks should isolate one facet of behavior (in the example finger movement).
Q: Would you please explain the term neural delay or neuronal delay.
A: Not sure what this is. Can you furnish a context in which the term is used?
Q: Do they still use a gamma knife to treat essential tremors?
A: There have been published descriptions of using stereotactic radiosurgery (of which Gamma Knife is one subtype) to create a lesion in the thalamus for essential tremor, although I have not found reason to offer this to patients myself. One major drawback of the therapy is that it is challeging to be sure about the size of the lesion being created, and that once created, the lesion cannot be adjusted (i.e. in case of side effects).
Q: What are good foods for brain?
A: Fish, isn’t it? Or carrots? Actually, there is no special brain food, and even though the brain has a lot of fat in it (the myelin sheathing each nerve axon is a form of fat), even people on very low fat diets seem to get enough. Babies need more fat because their brains grow so rapidly, and they should not normally be put on a low-fat diet, no matter whether they are chunky (reduce total calorie intake instead.)
Q: What does the latest neuroscience research tell us about correlation of cell phone usage over time versus tumor production in the neural tissue.
A: No definitive study has made the association. These studies are surprisingly difficult to do, as there are many ways they can confound data. A good review is at the National Cancer Institute site. Note, a site that ends .com is usually not a reliable source of information about health or science; look for .gov or .edu.
Pharmacology
Q: I am a dental hygienist and the dentist I work for and I would like more information on a condition Dr. French mentioned that involves caucasian women and the inability to metabolize Vicodin.
A: Dr. French has provided 2 articles, one on the Amplichip and another that reviews pharmacogenomics, that may be helpful as a start. Anything that mentions or applies to codeine is also relevant to hydrocodone (Vicodin) which is more widely prescribed than codeine.
Q: Do you have some guidelines on drug disposal?
A: Yes, Dr. French does.
Q: For years a plant based drug has been approved for use in Europe that controls the thinning of blood. It does not require the monthly INR blood test like Coumadin (rat poison). What is the name of this drug? Why is it not FDA approved?
A: The drug you are referring to is probably Ximelagatran (Exanta®). It has been approved for use in thromboembolic disorders in 7 European countries. It was submitted to the FDA, but approval was denied due to significant liver toxicity (1 in 200 patients, twice the rate of liver toxicity that forced the diabetes drug Rezulin off the market). A similar drug, that doesn’t require INR monitoring, is undergoing clinical trials in the US at this time – Rivaroxaban. It does NOT appear to have liver toxicity but an approval and release date has not been announced, maybe within a year. Stay tuned.
Q: Do toxic medications store in your fat cells such as isotretinoin (acutane)? How does a drug like this affect your brain? One of the side effects is suicide and delusions, why would it affect people in this way?
A: Whether drugs undergo significant storage in fat cells depends not on their toxicity, but on whether they are lipid (fat)-soluble. Isotretinoin is fat-soluble and can undergo significant binding in fatty tissue. Because this binding helps them remain in the body longer, whatever toxicity they do have may be enhanced by this potential accumulation. Little is known about the effects of isotretinoin on the adult brain. There are warnings about depression / suicidal thoughts / suicide (med guide attached), but the link is controversial as epidemiological studies have NOT shown an association. Acne itself may be a risk factor for depression.
Q: Why are some drugs taken before food or say with food?
A: Many reasons, two of the most common are: Take before food (empty stomach) is most commonly advised for drugs that are broken down by stomach acid (penicillin G) as a full stomach has more acid to aid in food digestion. Take with food or water is often recommended for drugs that are irritating to the stomach or tend to cause nausea and vomiting. The presence of food can moderate these problems. Also, some antibiotics (tetracycline) are not to be taken with dairy products or antacids because they contain calcium, which may bind the tetracycline and reduce its absorption in the blood.
Q: Are we moving towards a time when controlled substances will be handled in such a way that patients will not be able to go from doctor to doctor to maintain their addiction? Is there an effective way to manage this? If not what would be recommended to prevent this abuse?
A: We are at this time now. Colorado is one of 38 states that has a “Prescription Drug Monitoring Program” to track the prescribing (MDs and Dentists) and dispensing (Pharmacists) of Controlled Substances. All prescriptions for controlled substances in Colorado are required to be entered into a statewide data base. This can then be accessed by prescribers and pharmacists when there is concern that a patient may be receiving multiple prescriptions from multiple prescribers. This system has had a major impact in reducing drug abuse and diversion.
Q: Lately we have had issues with using acetemetephin and something like pamprin to alleviate discomfort, are there liver side effects?
A: Yes, I’ve attached an excellent patient info sheet that should address this very issue.
Immunology
Q: What is the relationship between stress and immunology?
A: There is a fair bit of research going on about this. It is safe to say that chronic stress affects the immune system, but the size and importance of the effects have not really been established yet.
Q: What are your thoughts on the placebo and nocebo effects and immunology. Can you tell yourself you are not going to get N1H1 and have a boost in immunity?
A: Almost nothing has been done on the placebo effect in human immunology, largely I think because of ethical concerns (is it right to lie to patients about what drugs they are receiving?) Nocebo effects (adverse) are quite common: Patients who get ill just seeing the doctor who gave them the drugs that made them sick, for example. In animals, conditioned immunosuppression has been repeatedly demonstrated. No one has done any research on that final question, as far as I know.
Q: Is there a link between Osteogenesis Imperfecta and a lowered immune system, or would the lowered immune system be caused by something different?
A: There is no published association between OI and immune abnormalities. However, OI is a genetic condition that affects several body systems, some of which could lead to increased infection rates (such as the difficulty keeping airways clear that some OI patients have).
Q: If you contract mono (since it is a form of herpes) can it manifest itself in the body as another form of herpes, say genital or oral?
A: There are 8 known human herpes viruses, but they have very different properties, and each causes its own set of problems; it’s like humans and rats are both in the mammal family butt are quite different otherwise. Herpes simplex 1 and 2 cause cold sores and genital herpes, respectively. VZV causes chicken pox and shingles. HHV 6 and 7 cause roseola. EBV and CMV cause infectious mononucleosis. HHV8 causes Kaposi’s sarcoma as seen mostly in AIDS patients.
Q: Cancer surgeons are always cutting out lymph nodes in cancer patients. Setting aside any discussion of the necessity and efficacy of this, what, if any, are the medium to long term effects for your immune system of not having those lymph nodes?
A: Probably none. The surgeon rarely removes every last scrap of lymph node because they are simple too small to see; and the residual tissue can expand with time to replace it. And the rest of the body is full of lymph nodes to maintain immunity.
Q: A general question about the type of med school that you have to pay for: It seems that many of the health problems that affect people in this country - type 2 diabetes, obesity, cancer, heart disease - are known to have a relationship to diet. And, yet, doctors are not generally known to have any knowledge or interest in diet. Has med school, or will med school, change to equip doctors with more knowledge of the role of diet in health?
A: At CU School of Medicine there is very extensive teaching about nutrition. It is old guys like JJ Cohen who weren’t taught much, (though even he had a whole course in it.) Patients seem to be a group who needs more teaching about healthy, rather than trendy, life style modifications.
Q: There seems to be a wide variety in how people respond to H1N1 or other influenza. Some people get the full range of symptoms and others experience very mild symptoms. Does this have to do with the antibodies that are already built in one's immune system? Or does it have more to do with what variation of the virus they have been exposed to?
A: This is a very good question, and I’d have to say it must be both. I used to go to DC 3 times a year for very intense grant review meetings, and I’d always come home with a cold. I told my colleague that it was because my immune system was depressed by the stress of travel and work. He, a virologist, said that was nonsense: what really caused it was the exposure to a room full of people from around the country, all coughing new virus strains that we don’t have in Colorado on me. I think we were both kind of right.
Q: In our household, we practice regular nasal washing...we increase this practice when we have been around sick people. We think that it has helped us stay healthy or it sometimes lessens the effects of a cold. Is there any fact supporting our belief or are we just making this up?
A: A study from Sweden reported in 2004: “A daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.” Another study compared zinc lozenges to hand washing and said hand washing is the best thing to do. So, use saline, not some special stuff (not zinc! it can permanently destroy smell receptors) and do it with clean hands.
Q: When the last war with Iraq started, the US military began to be vaccinated for Anthrax. Had this vaccine been tried in humans prior to this and are there any known side effects?
A: Yes it had been tested, mostly in military volunteers. There is a pretty acrimonious literature about it, but I was unable to find a single study that showed convincingly that it is harmful. Nevertheless, 60% of people in the military think it is or may be, and do not want it. This issue was more intense when we believed that there was a risk of anthrax bioweapons in Iraq.
Q: Heart murmur. What is it and what causes it?
A: Blood flow in the heart is supposed to be streamlined, like flow down a straight-sided river. If the valves become damaged, flow can be turbulent (either through the valve in the usual way, or backwards if the valve is leaky). Turbulence is audible, and listened for with the stethoscope; turbulence in heart blood flow is called a murmur.
Q: Is strep throat a result of the harmful cross-reaction of bacteria and antibody (pg 13) and is there then a link to heart murmur?
A: People with a Streptococcus infection like strep throat make antibodies to the bacteria. A very small proportion of people make enough of an antibody that also binds to a protein associated with heart valves (this is called “cross-reaction.”) Then the immune system, thinking the heart is a bacterium, attacks it. This can lead to valve damage. Many older people with heart murmurs had rheumatic fever (as this cross-reaction following a Strep infection is called) as children. It is rare now because we treat so early with antibiotics that people make only a little antibody; but it is still common in the developing world.
Cancer
Q: For what types of cancer is the so-called "cyber-knife surgery effective?
Q: When you hit a growth spurt does that mean that the promoter switch is ‘on’ for a period of time and then goes back ‘off’?
A: Well, the promoters work at a cell-by-cell level, so it is hard to answer this. But in general, about a hundred genes are involved in growth, that is, direct signaling to the cell to divide. Some of these are growth genes and some, anti-growth; so the progress is carefully regulated. Any of these can get abnormally turned on or off in cancer cells. In dividing cells, as in a rapidly-growing child, more of the ‘on’ genes are active, yes.
Q: It seems that for many effects (causes) of cancer we don’t have the “why”. Is this a hamper to counter methods?
A: Absolutely. But when JJC was in medical school he was told, “We’ll never be able to treat cancer until we can understand what causes it.” Now in most cases we do know what causes it, or at least what genes get abnormally activated. But we’re really just at the beginning of designing new treatments based on the new knowledge. Stay tuned, exciting things are coming.
Q: Yes, this question has been fermenting here awhile... The last lecture mentioned avoiding fermented foods to decrease cancer risks. Would you give examples please? Yogurt? Miso? Tempeh? Kefir? cheeses? Does the pickled include things like the ginger one gets at Asian restaurants and regular pickles too? Thanks for your good info!
A: The people who warn about fermented foods are, for the most part, talking about ‘natural’ or ‘wild’ fermenting, which usually involves bacteria instead of, or as well as, yeast. The yeasts we use for foods like beer and bread are so genetically modified after millennia of use that they seem to just do the one job, and not make too much in the way of awkward, maybe dangerous, metabolites. So it looks like cheeses (but maybe not some of the very stinky artisanal ones), beers (maybe less so the Belgian wild-fermented beers), tofu (but Chinese ‘stinky tofu'??) are OK. The milk products use special lactobacillus cultures and are apparently completely safe.
Q: How does grapefruit interfere with medications? Grapefruit seed/peel concentrate has been used for infections. How does this work and is it related to the interference problem of grapefruit with some medications?
A: Grapefruit contains a chemical that if metabolized by the same cytochrome in liver that handles many drugs. Because it binds to the cytochrome, it reduces its activity, and drugs therefore may get to higher levels than anticipated, which could be dangerous sometimes. I doubt that that is the mechanism that alternative drug-makers have in mind when they make extracts etc. Remember, has been used is not the same as has been shown to be effective.
Q: Is it known how Echinacea works to promote immunity function?
A: Almost all studies with herbals are done in the test tube, not in animals or patients. Lots of things work in the test tube, as all the big drug companies know, but only a tiny fraction of them will make it through all the testing that would be required to make them into drugs. Since herbals are considered food supplements, they need no testing for safety or efficacy to be sold to (sometimes gullible) people. In one study, the researchers found that none of three preparations of E. angustifolia at the 900 mg per day dose had significant effects on whether volunteers became infected with the cold virus or on the severity or duration of symptoms among those who developed colds. However, critics of this study believe the dose of E. angustifolia used was too low. NCCAM (NIH) will continue to support research on Echinacea. A number of preclinical, Phase I, and Phase II studies of Echinacea products are currently under way. This research is being done both because of the public health burden of the common cold and the public's widespread use of this natural product. A recent survey of complementary and alternative medicine use by adults in the United States found that, among those who reported using natural products, Echinacea was the most commonly used.
Q: I have "Thymic Protein A" by ProBoost. It is a powder that you dissolve under your tongue before swallowing in order to prevent the problem of digesting the protein. Do you think this would be effective in eliminating that problem of administration?
A: No, we don't absorb very much orally. But be a little careful; some protein can be absorbed in the mouth, and if you are allergic to it (or a cross-reacting substance) you may get ‘oral allergy syndrome.’
Q: In Class 8, you mentioned problems with fermented foods. Because of problems with Candida, I limit the amount of sugar and fermented food I eat. I know that "Red Yeast Rice" comes from the fermentation of a strain of yeast on rice. I have been taking this daily to help lower cholesterol. Is this just adding to the problem of Candida?
A: Probably not; the two organisms are not related. But red yeast rice is said to contain a chemical similar to lovastatin, the cholesterol-lowering drug, and the FDA is considering regulating it. Here is from About.com: "Red yeast rice products have been found to contain citrinin, a toxic by-product of the fermentation process. Pregnant or nursing women and children should not use red yeast rice. People with liver disease or at risk for liver disease should not use red yeast rice, as red yeast rice may impair liver function. People with acute infections, kidney disease, or who have had an organ transplant should not use red yeast rice. People taking red yeast rice who develop muscle pain or tenderness should discontinue the product immediately and check with their doctor."