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So is it your thyroid after all?

Wednesday, November 30th, 2011

Is this woman depressed, hypothyroid or both?

On November 21, 2011, The New York Times had an article entitled “For Some, Psychiatric Trouble May Start in Thyroid." As a mental health therapist who is hypothyroid, my wife has a particular interest in this subject and pointed out the article for me.

The premise, put forth by Dr. Russell Joffe, a New York psychiatrist, and a group of his professional peers, is that subclinical hypothyroidism may play a significant role in depression. A Brown University professor of psychiatry and human behavior also commented on this connection asking, “Is there an underlying thyroid problem that causes psychiatric symptoms, or is it the other way around?

From the endocrinology side, Dr. James Hennessey, at Beth Israel Deaconess Medcsl Center in Boston, noted "Psychiatric symptoms can be vague, subtle and high individual."

A study, published five years ago by Chinese researchers, gave six months worth of  thyroid hormone replacement therapy (see links below for the NIH's info sheet on this medication, levothryroxine and other info from MedicineNet.com), to patients with subclinical hypothyroidism and found improvements in brain scans, memory and executive functions.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000684/#

http://www.medicinenet.com/levothyroxine-oral/article.htm

sketch of the thyroid gland

So how is this condition diagnosed? and what does your thyroid do anyway? Most of us are familiar with this two-lobed, twenty to sixty gram,two-inch structure, located in the front of our necks and wrapped around our windpipe. It's a hormone producing gland with two products, thyroxine or T4 and its active hormone, triiodothyronnine or T3. I've always thought of its function as a major regulator of metabolism, but in reality that's only one of its duties: it does control how speedily we use energy, but also has a role in how we make proteins, how we react to other hormones and how our bodies handle calcium.

I've spent much of today reading about the thyroid; some things I knew; some I hadn't reviewed since med school basic science classes (1962-1964) and other were brand-new to me. Fetal development of the gland is stimulated by two other hormones released by the hypothalamus and pituitary and those are at high enough levels to cause the fetus to make T4 in clinically significant amounts by 18-20 weeks of gestation. The active hormone, T3, stays at low levels for another 10 gestational weeks, then increases until term.

The net result, it is felt, is protection of fetal development, especially of the brain, in the event the fetus's mother is herself in a hypothyroid state.

But back to adults and the link between thyroid status and mental health.  One of the crucial measurements of thyroid function is the level of TSH, thyroid stimulating hormone. Normal levels for this pituitary hormone are 0.4 to 5.0 in most labs in the United States; nearly nine years ago, the American Association of Clinical Endocrinologists recommended the doctors consider treating patients whose TSH levels are higher than 3.0. Other scientific groups agreed.

If a TSH level above 5.0 is abnormal, then ~5% of our adult population is hypothyroid. But if that level is reduced to 2.5 to 3.0, then ~20% of us are hypothyroid.

I wonder if a new field of medicine, halfway between the endo folk and the mental health practitioners, is on the horizon.

http://www.umm.edu/endocrin/thygland.htm

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Posted in depression, medically-oriented background info, mental health issues, psychiatric drugs, scientific controversies, subclinical hypothyroidism | No Comments »

Issues with Psychiatric Drug use

Saturday, November 26th, 2011

Are drugs always the answer?

An article in the Wall Street Journal for November 16th caught my eye. My wife is a mental health therapist (the non-prescribing variety) and I knew this one would interest her. The title was “Psychiatric Drug Use Spreads: Pharmacy Data Show a Big Rise in Antipsychotic and Adult ADHD Treatments.”

She wasn’t especially surprised to hear that one in five adults were taking at least one psychiatric drug.  But as opposed to anti-anxiety drug use, both of us were struck by the comment that drugs given (and perhaps overused) for kids with ADHD are also increasingly being given to adults.

I went to the Internet to find the data. There’s an enormous company called Medco that provides pharmacy services for greater than 65 million people. I had never heard of the firm, but it’s rated number 35 of the Fortune 500 and in 2009 reported revues just under $60 billion.

Their senior psychiatrist, a Dr. David Muzina, has a great CV, working in major roles at the Cleveland Clinic from 1999 to 2009. I did note his “Summary” claimed “17 year’s of Cleveland Clinic experience as a Staff Psychiatrist,” but he graduated from medical school in 1993, presumably finished his Psychiatry residency in 1997 and then ran an inpatient psych unit at Lutheran Hospital (location unspecified) for two years.

In any case Medco, where Dr. Muzina is a Vice President, in and presumably heading their Neuroscience Therapeutic Resource Center, published an extremely interesting report titled “America’s State of Mind.” (see link below). This summarizes research on the prescriptions of greater than two million people in this country from 2001 to 2010.

http://www.anxiolytiques.net/wp-content/uploads/2011/11/Medco-2001-2011.pdf

The trends are stunning.

Boys and girls, men and women are all now more likely to be taking a drug used for mental health problems. Fifteen percent of adult men are on one or more of these medications and, amazingly, twenty-six percent of adult women.

In reality the ADHD drug use in adults is still comparatively uncommon (less than 2%), but NPR recently reported a severe shortage of Ritalin. Newer drugs which treat ADHD will enter the generic market in 2012; that should save patients considerable amounts of money.

The real impact is in the antidepressant arena: twenty-one percent of women 20 and over take these meds and the percent rises with age. It’s 16% of women ages 20 to 44, 23 percent of those between 45 and 64 and 24% of women over 65 years old. For men in comparable age groups the percent are 8, 11 and 13.

Then there’s regional distribution: what I call the “Middle West” and my own Mountain region have the lowest percentage on mental health drugs while Kentucky, Tennessee, Alabama and Mississippi have the highest.

So how many are actually taking their meds as prescribed? And how many are having serious side effects?

An issue raised in one of the publications is that of patients not taking prescribed dosages of their meds (if any), having increased symptoms and physicians therefore increasing their medication dosage.

Then if they do start taking the drug as prescribed....

 

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Posted in medically-oriented background info, mental health issues, psychiatric drugs, Publications, statistical analysis | No Comments »

Do our kids have a bleak future?

Saturday, November 19th, 2011

As close to a salad as he'll get

I'm taking a break today from my series of posts on greenhouse gases, alternative energy source, volcanoes and global warming. All of those will affect the generations to come and those now growing up, but I want to re-examine another side of their issues. This morning I read two articles and one newspaper report on the heart health prospects for our American kids (and, by extension, kids elsewhere in the developed/rapidly developing world). The initial article came from a section of the Wall Street Journal I hadn't gotten around to reading yesterday and was about to recycle. Then I saw a title that caught my eye, "Kids' Hearth Health Is Faulted."

I found a CDC website with an explanation of the National Health and Nutrition Examination Survey, NHANES. This is a continuation of a US Public Health Service effort started 40 years ago and is updated annually. Medically-trained interviewers may well come to your town and even to your front door someday. The data they obtain is used in many ways (I'll paste in a website that leads you to some comments on NHANES as well as to a link to a video).

Now a portion of the survey/study looked at 5,450 kids between 12 and 19, finding they were a long ways from matching the American Heart Association's (AHA) seven criteria for idea cardiovascular health (see 2nd link below to Harvard's Beth Israel Deaconess Medical Center's article on the subject). The adult health measures, known as Life's Simple 7, are: 1). Never smoked or quit more than a year ago; 2). Body Mass Index (a measure of height versus weight) <25; 3). Physical activity on a weekly basis for 75 minutes (vigorously) or 150 minutes (moderate intensity).; 4). a healthy diet (four or more components meeting AHA guidelines); 5). total cholesterol <200 mg/dL; 6). blood pressure (BP) <120/80; and fasting blood glucose (AKA blood sugar) <100 mg/dL. The original article was published in the journal Circulation January 20, 2010 and is available free online. The metrics are slightly different for kids.

So where do our kids stack up? If you exclude eating a healthy diet, only 16.4% of boys and 11.3% of girls meet the standards for the other six criteria; if you include diet, none of them do. They don't eat four to five servings of fruits and vegetables a day; they also don't get enough whole-grains or fish and they consume far to much salt and sugar-sweetened drinks. Only one fifth of them even eat "fairly well."

drop that hamburger and run for an hour

Many of then also don't exercise on a daily basis for at least sixty minutes (50% of the boys do and 40% of the girls). More than a third are overweight or obese.

There's some hope: a just-published article in the New England Journal of Medicine, examining the data from four studies following 6328 kids, found that those who do manage to lose weight had lower risk for type 2 diabetes, hypertension, abnormal lipids and carotid artery disease.

So I'm heading to the health club and will read the 2010 Circulation tome on an exercise bike.

Thus far my one biologic grandson, about to be 12,  is physically active and slender. I'll encourage him to stay that way and the non-biologic grandkids to follow his example.

More on this subject to come.

Check out these articles:

Survey Results and Products from the National Health and Nutrition Examination Survey

AHA Defines "Ideal" Cardiovascular Health

 

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Posted in Complications of Obesity, diabetes type 2, Exercise possibilities, Food Choices, Food-related disease, Life Expectancy, medically-oriented background info, our kids and their weight issues, physician initiatives, Publications, strategies for healthy aging, Unhealthy eating | 3 Comments »

Seemingly disparate topics tied together with MRSA

Thursday, November 10th, 2011

Staph bacteria growing on a culture media

I read two NYT articles  about medical diseases that conflate to a really frightening juncture. They led me to find background data from a medical website and to do a Google search on one lead author.

Let's start with MRSA, the acronym for methicillin-resistant Staphylococcus aureus.  Roughly 25% of us are staph carriers, but only 2% of us carry MRSA, the antibiotic resistant form that causes deadly complications so frequently  and is so difficult to treat. Infections with "ordinary" staph bacteria can be very serious, but respond, in most cases, to the drugs commonly used. The NIH has an excellent summary of MRSA issues and I'll paste in a link to it below.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/

An August 11, 2011 NYT article mentioned that MRSA skin infections occur in those more prone to cuts and scrapes: athletes, the military and our kids among them. A professor of Medicine and Pediatrics at UC Davis Medical School is quoted as saying, "...in most communities, community acquired MRSA has become the dominant cause of soft tissue infection requiring emergency department care and inpatient care."

In a previous post I noted that a neighbor ended up in our local ICU for a prolonged stay after a scape on his elbow resulted in a rapid spread of redness up his arm unto his chest. As you might surmise, this was an MRSA-caused illness.

MRSA is a major urgent medical problem; almost 19,000 people died from this dire staph in 2005. In that timeframe most MRSA infections were felt to occur in immunocompromised patients.

But now hospital admissions for skin infection in kids have climbed; the rate of these more than doubled between 2000 and 2009. The overall rate still seemed low, 9.4 cases per 10,000 children, but that translates into just under 72,000 kids being hospitalized in that one year.

In the average year roughly 4,000 kids wind up in pediatric ICUs yearly because of severe flu infections and of course many times as many have mild cases of flu. The current study, headed by an associate professor of Anesthesia at Harvard, looked at children who got flu infections during the 2009-2010 H1N1 epidemic and were admitted to ICUs in 35 different locations. Of those  838 youngsters, nearly nine percent, 75 of those kids, died; their median age was 6.

More than a quarter of the children in the study were previously considered totally healthy; they didn't have asthma or a neurological disease; they were not immunosuppressed and didn't have other chronic conditions. So of the total, 251 kids were otherwise healthy prior to getting the flu; 18 of them died. The only predictor of death in healthy children in this group was MRSA infection; if they had this co-existing risk factor their risk of dying increased eight times when compared to those who did not have MRSA.

Please ask your pediatrician about flu vaccination

My take on the study, and that of the lead researcher, is it's time to make sure our kids and grandkids get vaccinated for flu on a yearly basis.  There are still people who never want their children vaccinated; physicians in almost all cases would disagree with them.

Talk it over with your own pediatrician.

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Posted in Life Expectancy, medically-oriented background info, physician initiatives, Publications, scientific controversies | 1 Comment »

Should the kids be in the middle? It may depend on the kid's middle

Tuesday, November 1st, 2011

This is not the example you should set

A Wall Street Journal headline caught my eye, "Obesity Fuels Custody Fights." It noted that childhood obesity is frequently being used by one parent or the other as grounds for custody changes with accusations concerning poor diets and lack of exercise flying back and forth.

That led me to a July 13, 201 article in The Journal of the American Medical Association (henceforth JAMA), "State Intervention in Life-Threatening Childhood Obesity."

We're not talking about mildly overweight kids here; in 2009 a 555-pound fourteen-yer-old boy, living in one of the southeastern states, was taken  by court order from his mother and placed into foster care. She in turn was charged with criminal neglect as the Department of Social Services for that state felt they must intervene or the boy would be at considerable risk for major obesity-related problems, especially diabetes type 2. I found a photo online of the boy and my jaw dropped.

The JAMA article notes "even relatively mild parenting deficiencies" can contribute to a child's weight problems: having junk food in the home, frequently taking the kids to fast food restaurants, failing to model an active lifestyle.The CDC estimates `17% of America's kids and teens are obese (we're not just talking mildly overweight); that's 12.5 million kids at risk. The two Boston authors who wrote in JAMA quote a study showing 2 million of those obese kids are grossly obese with a BMI at or beyond the 99th percentile for their age (a very small percentage of those grossly obese kids, it turns out, may have a genetic abnormality; in those rare cases, the parents aren't to blame).

What can we do about this horrendous problem? Well, there are a variety of "bariatric" operations available in pediatric surgery programs; in dire cases state legal action may be

this makes more sense

necessary. But I liked what I saw the other day walking Yoda, our nine-year-old Tibetan terrier, on his morning constitutional (he gets an evening walk as well, which means either my wife or I or both get some extra exercise).

We came near the elementary school near us and there was a long line of kids, punctuated by an occasional teacher, running past. We stopped to watch, realized these were kindergarden and/or first grade kids, and finally had an opportunity to ask one of the teachers what was going on.

"It's a new program we've started in the Poudre School District," she said. "We keep the kids moving for thirty minutes. They can run and most do, or twirl around and walk the field next to the school, but they've got to keep moving."

The conclusion in the JAMA article was stark, but offered a road to resolution. The authors noted, "An increasing proportion of US children are so severely obese as to be at immediate risk for life-threatening complication including type 2 diabetes." They mentioned the pediatric weight loss surgical programs and state protective services, but finished with our need to decrease the need for those options through beefing up the social infrastructure and policies to improve both kids' diets and guide them toward more physical activity.

Those solutions may work.

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Posted in Complications of Obesity, diabetes type 2, Governmental Efforts, Life Expectancy, medically-oriented background info, Obesity, our kids and their weight issues, Publications, Unhealthy eating | No Comments »

Getting it off versus keeping it off

Saturday, October 29th, 2011

What should you do when your scale calls for help?

I saw an interesting New York Times article on the 26th and kept it on my Kindle. It mentioned an article which just was published in The New England Journal of Medicine on why people who succeed in losing weight often find it difficult to not regain the pounds they've lost. Prior studies have speculated that a dieter's metabolism changes with altered hormone levels bringing about increases in appetite.

I just looked at the short form of the NEJM article online; I don't subscribe to that publication anymore and will have to get the whole article at the local hospital's medical library. It's a small but significant study, done by researchers in Melbourne, Australia utilizing fifty overweight or obese patients on an extreme ten-week diet, measuring levels of a number of hormones involved in appetite both at the end of the diet period and one year later.

The goal was to have the subjects lose ten percent of their body weight. Then they were to go on a maintenance diet to keep the weight off. Only thirty-four finished the diet period with the goal weight loss, some quit the study and others lost less than 10%.

So it's really a very small group, thirty-four successful dieters, who were followed for an additional year. They started at an average of 209 pounds, ate only 500 to 550 calories a day for the initial ten-week study period and lost an average of 29 pounds (14%) of their initial weight. A year later the average patient had gained back half what they had lost and the hormone measurements, especially of leptin, ghrelin and peptide YY, all involved in appetite one way or the other, were still not totally back to normal.

Maybe that's the reason so many people gain weight back after dieting. This may not have  been a large-scale study, but it speaks volumes.

Eat a healthy diet, not a 500-calorie/day plunge

The Los Angles Times commended on the article and on dieting in general. They noted that four out of five initially successful dieters regain their weight, sometimes more than they lost by dieting. Of course most of them hadn't gone on such a stringent diet. It makes much more sense to me to lose weight gradually, a pound or so a week is a reasonable goal.

I did that back in early 2009, losing ~30 pounds, and this morning I was still 27 pounds down. I also decided to make exercise a must in my busy schedule and go to the gym six days a week on the average. I can burn ~550 calories on the recumbent bike before I do stretches and work on a few machines. I also walk our new dog twice a day for 20-30 minutes.

Many people say they can't find that much time in their day and yet they find time for TV or movies or their email.

I think it's time to change priorities; take some of the time you spend sitting and walk or exercise instead. Gradual weight loss combined with an increase in calories burned makes much more sense than going on 500-calorie diets. I'd like to see measurements of those same hormones in a group who try this approach.

Otherwise you're just paraphrasing Admiral David Farragut at the 1864 Battle of Mobile Bay, "Damn those hormone levels; full speed ahead."

 

 

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Which study should I believe?

Wednesday, October 26th, 2011

Vitamin E has this chemical structure

I just read the recent (Oct 12, 2011) JAMA article on "Vitamin E and the Risk of Prostate Cancer." It was a long-term, prospective, randomized study of 33,533 men followed in 427 study sites in the US, Canada and Puerto Rico. The investigators were from major academic centers, Duke, the Cleveland Clinic, Brigham and Woman's Hospital (e.g., Harvard) and the National Cancer Institute among them.

This was an impressive study of the effects of Vitamin E and/or selenium versus placebo that began in 2001 with the subjects being "relatively healthy men." Seven years after it began, in September 2008, the independent data and safety monitoring committee decided that the supplements should be stopped as there had been no positive results (reduction in prostate cancer detection) and futility analysis (a statistical tool) said the results were quite likely to be negative (more cases of prostate cancer). I hadn't heard of that term and found a medical website that discussed a number of reasons for ending a study prior to the intended date. I'll paste in the URL if you want to read a one-pager on what is called "interim analysis."

http://www.childrensmercy.org/stats/plan/interim.aspx

In this study, though the researchers stopped giving supplements and published an article (JAMA.2009;301(1):39–51) on the results to date, which showed a higher (but not statistically significant) number of cases of  prostate cancer in the groups receiving Vitamin E, selenium or both, they also continued following the patient group.

Prostatic cancer under the microscope

The later data, though July 5, 2011, was quite impressive. There was a 17% higher incidence of prostate cancer in the group taking Vitamin E. In most scientific studies a p-value of 0.05  is felt to be significant. That translates to a probability of 5% or less that whatever happened did so by chance. If the data calculates to a p- value of 0.01, there's a 1% chance this was a random occurrence. Here, after ~eleven years the p-value for Vitamin E increasing the chance a man was diagnosed with prostate cancer was 0,008. (I'll paste in a website that explains more of this stuff if you're remotely interested).   http://www.childrensmercy.org/stats/definitions/pvalue.htm

Why all the math and statistics?

Well, for starters, a few years back a large study showed the exact opposite, but in a highly selected group: men in Finland who were smokers. Another study, done with physicians as the subjects, showed no effect on the incidence of prostate cancer. A post by a physician harshly criticized the SELECT trial as part of a lengthy defense of supplements, but made sweeping pronouncements without supplying data or references to specific articles.

I read the articles, the blog post and the new study in detail. I know that medical research projects often come to conclusions that, a few years later, are "proven" incorrect. But I think this study was carefully done, had a clear-cut purpose in mind and included a large enough group of subjects that I'm going to believe its conclusions.

Plus I'm certainly not a Finnish smoker.

 

 

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Posted in medically-oriented background info, Publications, scientific controversies, statistical analysis, supplements | No Comments »

The Five-Second Rule revisited

Friday, October 21st, 2011

don't wind up here, or worse

When I was a kid, we often used the Five-Second Rule, that meant food falling on a relative clean surface could be eaten if it was picked up in less than that amount of time. In recent years I've heard jokes about this rule: when parents have their first child, they use five seconds as a safe time, with the second, it's ten seconds and with later children, it's wipe off the mud and let them eat whatever dropped.

I received the November issue of the Center for Science in the Public Interest's Nutrition Action Healthletter several days ago  and noticed this month's focus was "Safe at Home: How to keep your kitchen from making you sick." I haven't had time to read much of the issue, but leafed through it and saw a brief blurb titled "Ignore the five-second rule."

So today I re-read that section, then went online and found the original article in the Journal of Applied Microbiology and Googled the lead author. Dr. Paul Dawson is a Professor of Food Science at Clemson, got his PhD at North Carolina State University, then did a two-year post-doctoral fellowship. Since joining the Clemson faculty he's published over 80 research manuscripts.

He was on a CNN TV show in 2010 discussing the 5-second rule, double-dipping (chips into a cheese or salsa dip) and, most recently was working on a project on the bacteriologic safety of blowing out birthday candles (See link below).

I read the online 2006 version of the original article in the Journal of Applied Microbiology, which appeared in paper format in April of 2007. Some of the background data is of interest: over 75,000,000 cases of food-borne illness occur in the United States each year and 5,200 of these result in deaths. Dawson's experiments were performed using Salmonella bacteria, which is found in a substantial percentage of poultry, roughly 10% in two studies by the USDA.

Every surface is a danger zone

My take on Dawson's results is 1). bacteria excrete chemicals allowing them to adhere to nearly any kind of surface (e.g., tile, rugs, cutting boards); 2). once they do so they have "biofilms," microscopic layers that allow them to survive for extended periods of time; 3). they can transfer from those surfaces to a variety of foods (Dawson used bread and bologna) very rapidly; so 4). the five-second rule is invalid and we all need to work on more effectively cleaning "food contact surfaces (counter tops and cutting boards come to mind).

I enjoyed watching the CNN interview with Dr. Dawson and will be intrigued to find out what his birthday candle research will show. In the meantime, I'll quit picking up food that has fallen on what appear to be clean surfaces; they're not.

http://newsroom.blogs.cnn.com/2010/08/01/five-second-rule-urban-myth-or-scientific-fact/

 

 

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Posted in Food safety, Food-related disease, Healthy eating, medically-oriented background info | 2 Comments »

Do I need to eat my words?

Wednesday, October 19th, 2011

Different choices for different ages

An old friend forwarded an article on vitamins yesterday, one that I read with special interest. It came from MedPage Today, an online medical news service for healthcare professionals that partners with the University of Pennsylvania School of Medicine to offer physicians continuing medical education credit (CME) for reading articles and then answering a few questions.

The article was titled "Vitamin Studies Spell Confusion for Patients" and extensively quoted Dr. David Katz fromYale's prevention research center. He is an adjunct Associate Professor at Yale's School of Medicine and an internationally renowned authority on nutrition. He comments that, based on the recent study I mentioned several posts ago, many clinicians say they've written off supplements for good.

Yet 50% of Americans take supplements; many take more than just a multivitamin.

Then Dr. Katz offers some caveats as I did, stating the Iowa study is "merely observational and can't prove cause and effect." He still recommends omega-3 fatty acids (AKA "fish oil") and vitamin D for most of his patients and adds calcium for women and prenatal vitamins and folic acid for pregnant women. otherwise he only uses vitamins when there are deficiencies.

A recent pole of clinicians found that 70% favor annual screening of specific vitamin levels to treat deficiencies. Which vitamins (and minerals) might be measured as part of an annual focused screening examination and whether medical insurance plans would cover such laboratory tests has not been delineated, as best I can find.

But I'm seventy, and articles from 2005 to 2010 in authoritative sources, talk about seniors needing much more B12, having multiple minor, but significant, vitamin deficiencies, and not eating well-balanced, healthy diets, even here in the United States, much less in other spots around the world. I'm lactase deficient and small-boned; do I need a calcium supplement?

clearly the best way to get your vitamins

I agree with Dr. Katz that eating a balanced diet would be a better answer, at least for those who are younger. The concept of "eating your colors," i.e., having multiple suit and vegetable dishes over the day which contain different phytochemicals as represented by the color of the food itself, makes great sense.

How many Americans do that at present or are likely to do that even if medical figures recommend such?

I regard this as an ongoing discussion. Dr. Katz is certainly correct in saying that vitamins have been shown to treat disease states, but not to prevent chronic disease. The surmise in the article in MedPage seems sound to me: vitamin isolates are less effective on their own and a full blend of antioxidants and phytochemicals (again, best found in those whole fresh fruits and vegetables, may be the key to obtaining maximum benefits.

This discussion is likely to go on and on, so I'll supply two URLs that may help you, in consultation with your own physician, make choices that are relevant to your nutritional status, age and degree of health.

http://www.uspharmacist.com/content/d/senior%20care/c/21981/

http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ucm110493.htm

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Listeria

Friday, October 14th, 2011

The culprits, this time.

Reading "USA Today" online, I found an article detailing the repercussions of the recent/ongoing outbreak of disease linked to cantaloupes coming from one specific farm in Colorado. That operation, Jensen Farms, re-called its fruit in mid-September. The Food and Drug Administration and the Seattle-based Institute for Environmental Health have not yet found the root cause of the outbreak. Since the normal shelf life for cantaloupe is ~two weeks, none of the Jensen Farm product should still be in stores. And no other sources have been implicated. Nonetheless, cantaloupe producers in California and Arizona, the two states with the largest crops of this fruit, are seeing sales plummet 80% or more.

That probably shouldn't surprise us. Spinach sales, devastated by the 2006 E. coli outbreak, are still down nearly a third in one California county.

As of October 12, the current outbreak had led to 116 illnesses and 23 deaths, making it the deadliest in more than a quarter century. There was another outbreak in Texas in October of 2010; that one was related to celery and resulted in 10 total illnesses and five deaths.

I went to several online medical sites to refresh my memory on Listeriosis. When I dealt with infections from this bacteria it was in immuno-compromised patients. Listeria is found worldwide, often in association with farm animals, many of which are otherwise healthy carriers of the bacterium. People can also be carriers and perhaps five to ten percent of us have Listeria in our bowel flora.

There are roughly 2,500 US cases of Listeria infections yearly and about a fifth of those infected die. Most are isolated cases, not major outbreaks The bacteria isn't transferred from person to person with the exception of pregnant women and their fetuses or newborn babies.

This is a foodborne illness, most commonly associated with improperly processed deli meats or unpasteurized milk products.

About 30% of all reported US cases occur in pregnant women. As opposed to the majority of us, who may have nonspecific symptoms, or none at all, pregnant women can transmit the infection to their fetuses or to their newborn infants. They also may have minor symptoms, if they are otherwise healthy, but Listeria can lead to miscarriages, stillbirth, premature birth or, potentially, to serious disease or death of newborn babies.

Others at higher risk for serious disease when infected with this bacterium include the elderly, diabetics, cancer patient, AIDS patient, those with significant kidney disease and anyone on immunosuppressive drugs.

It's tough to diagnose Listeria infections: the most common signs and symptoms include fever, muscle aches, nausea and/or diarrhea. There are no reliable tests for the bacteria, so the diagnosis is difficult in the absence of a history of exposure to a potentially contaminated food source during an outbreak.

Most of us clear the infection without any treatment; those at higher risk should be considered for immediate IV antibiotics and consultation with an Infectious Disease specialist is recommended (and if a pregnant woman has the inception, an Ob-Gyn specialist and a Pediatrician should be involved.

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Posted in environmental issues, farm-worker issues, food and food-producing animals, Food producers and less-healthy foods, Food safety, Food-related disease, Governmental Efforts, medically-oriented background info, Publications | No Comments »

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