Breakdown of Saturated, Unsaturated, and Trans fat

I have always known trans fats are bad, unsaturated fats are good, and saturated fats somewhere in-between. But I never knew exactly why. It has to do with their different effects on cholesterol and lipoprotein molecules. Different fats have complex actions on various lipoprotein levels and it is the levels and ratios of these lipoproteins that can affect health risks, particularly cardiac health risks.

LDLs are low density lipoproteins and are considered the bad cholesterol because they carry cholesterol to parts of the body including to injured arterial walls where the cholesterol forms artery blocking plaque. HDLs are high density lipoproteins which are considered the good cholesterol because they pick up cholesterol and return it to the liver where it is processed and removed. High levels of LDLs and cholesterol as well as low levels of LDLs are risk factors for cardia disease. Unsaturated fats, particularly mono unsaturated fats tend to lower LDL levels and there for decrease cardiac risk. Saturated fats, found in dairy and red meats, are considered bad since they are found to increase LDL levels. Trans fats are the worst as they both increase LDL levels and decrease HDL levels. Trans fats are only found in very tiny insignificant amounts in plants and animal food sources but are produced in food processing and used to increase longevity of packaged foods. They are so bad that there is no listed dietary amount that is considered safe and many countries and local governments have banned their use completely. While this is the basic explanation of how these fats affect HDL and LDL levels, it is actually a bit more complicated. For example it is known that if in a particular diet saturated fats are reduced but replaced with carbohydrates, the results are a worse LDL to HDL ratio. But overall it is healthiest to eat mostly unsaturated fats (olive oil, avocados, almonds), limit saturated fats ( dairy and meats), and completely avoid all trans fats (packaged baked goods, frozen pizza, and microwave popcorn). Something to note is that there is various data on the effects of red meat, and it is not always consistent because the groups that are being studied have different diets/lifestyle and are well controlled. One meta analysis showed some benefits in regards to lipids versus combined animal protein, carbohydrates, or usual diet, and had mixed effects when red mead was compared to fish or poultry. With this, it is important to note that lifestyle and other foods consumed need to be taken into account when performing studies on the effects of certain foods on diet. 

Harvard School of Public Health: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/#:~:text=Monounsaturated%20fats%20are%20found%20in,as%20pumpkin%20and%20sesame%20seeds

Guasch-Ferré, M., Satija, A., Blondin, S. A., Janiszewski, M., Emlen, E., O’Connor, L. E., Campbell, W. W., Hu, F. B., Willett, W. C., & Stampfer, M. J. (2019). Meta-analysis of randomized controlled trials of red meat consumption in comparison with various comparison diets on cardiovascular risk factors. Circulation, 139(15), 1828–1845. https://doi.org/10.1161/circulationaha.118.035225 

Mensink, R.P., et al., Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr, 2003. 77(5): p. 1146-55.

Psychological Effects of Working in Healthcare

  While working in healthcare can be an extremely rewarding profession, it also comes with a great deal of difficulty both physically and mentally. It is no secret that burnout is becoming more prevalent in healthcare workers which has just been accelerated with the COVID-19 pandemic. However, it is also important to note that these fl aws of the system were occurring before the pandemic happened, the pandemic just brought these issues more to light and amplified them.  

       Burnout can be described as overwhelming exhaustion and feeling depleted in one's physical and emotional resources which can lead to cynicism and detachment from the job. Burnout may be caused by overworking, feeling a lack of support, and/or compassion fatigue, and chronic stress which can lead to a number of physiological problems such as high blood pressure and impaired memory. In addition to burnout, a less talked about psychological impact on healthcare workers is secondary traumatic stress which can be amplified by burnout. STS is considered a stressor for post-traumatic stress disorder (PTSD) and occurs through an ongoing or cumulative exposure of triggering or traumatic events, such as taking care of trauma patients, witnessing many patient deaths, etc, Overtime, secondary traumatization can occur and create a permanent and cumulative change of perception on empathetic work. 

        When taking care of others, it is easy to forget about the fragility of one’s own well-being, especially when there is pressure to perform at an elevated level. Emotions get pushed down in order to complete the job, but then never get revisited after the day or job is complete. In order to promote mental well-being it is important that hospitals incorporate avenues for healthcare professionals to have access to therapy and support groups. Social and peer support groups are an easy and low-cost way to offer support and have proven to have a major effect on prevention and relief from the impact of trauma. Other ways to support healthcare professionals include offering seminars on mental health and preparation for traumatic events and promoting a healthy work-life balance in all employees while keeping in mind that experiencing a traumatic event on the job can happen to all healthcare professionals, not just those on the front-line.  

    

 

Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals. Australian & New Zealand Journal of Psychiatry, 43(4), 373-385. 

Raudenská, J., Steinerová, V., Javůrková, A., Urits, I., Kaye, A. D., Viswanath, O., & Varrassi, G. (2020). Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Practice & Research Clinical Anaesthesiology, 34(3), 553-560. 

The Truth: Are There Fetal Cells in Your Vaccines?

The recent pandemic has sparked mass controversy over the idea of vaccinations. A large amount of this controversy is due to misinformation of people and the mass hysteria that COVID brought about. One major reason for not getting a vaccine is the supposed use of fetal cells to create the vaccine. This technique is something that has been used in science for many years. The use of fetal cells was used to create the vaccines for things like rabies and chickenpox. It has helped to save millions of lives over the past few decades and the impact of these vaccines have been greater than anyone could ever fathom. However, certain people in our population, specifically those that follow the Catholic faith, have reserved feelings about the new COVID vaccine because of its supposed use of fetal cells when developing the vaccines. However, this is not entirely true. The only COVID vaccine that did use fetal cells was the Johnson and Johnson vaccine. Pfizer and Moderna used no fetal cells at any point in their development so, if this was an argument of anti-vaccine because of the use of fetal cells it would be reasonable to suggest that people should instead get a Pfizer or Moderna vaccine. Now looking to the argument that vaccines that have used fetal cells are against God as well, the Vatican actually reviewed this data and released a statement. The Vatican declared that despite the sins of people in the past that led to the availability of the feels cells that had been from an abortion, the users of any vaccine are not responsible for the sins of someone in the past period instead they should work to vaccinate their families and their friends as well. In my opinion, there is very little reason to not get vaccinated and i have found that having this knowledge has helped me to have more educated conversations around this topic as well.

Wadman M. (2020). Vaccines that use human fetal cells draw fire. Science (New York, N.Y.), 368(6496), 1170–1171. https://doi.org/10.1126/science.368.6496.1170

Did you know Colorado allows Euthanasia? Where do you stand?

There are some people that believe that euthanasia is ethically wrong because it is considered to be a form of suicide. Meanwhile, there are others that believe that euthanasia can be a good thing because it allows people to die with dignity and without pain. Ultimately, I believe that the decision of whether or not to support euthanasia is a personal one.

With the controversies of this ethical topic, comes the discovery of several types of euthanasia by philosophers and ethicists. There is active euthanasia (killing patients via active means of lethal dose injection), passive euthanasia (withholding patient care till death), voluntary euthanasia (with the consent of patients), involuntary euthanasia (without the consent of patients), self-administered euthanasia (patient administering means of death), other-administered euthanasia (patient family administers means of death) and others (MU School of Medicine, n.d). Other philosophers group them into mercy killing (active, involuntary, and other-administered euthanasia) and physician-assisted suicide (active and voluntary).

The practice of Euthanasia remains tricky today. Peter Singer, the Australian philosopher, argued in his book Practical Ethics that “If there is no intrinsic difference between killing and allowing to die, active euthanasia [performed by a physician] should also be accepted as humane and proper under certain circumstances” (Hentoff, 1999). Singer believes that active euthanasia should only be performed when there is a clear and present danger to the patient's life, when the patient has made a clear and informed decision to end their life, and when there is no reasonable alternative available.

It all should depend on the governing laws of the state or country where Euthanasia is allowed. There really isn’t a right or wrong with this subject because states that allow physician-assisted suicide enforces primary care providers to make sure the patient is terminally ill, can administer the lethal dose themselves, and is in the right mind to understand what they are doing and make decisions. 

It comes down to living and dying with dignity as well as giving patients the chance to make decisions of their own. People have the right to die with dignity such as Daniel Eduardo Ostropolsky who was diagnosed with amyotrophic lateral sclerosis. This terminal neurodegenerative progressive disease is horrible and Ostropolsky described his pain as crumbling where everything is failing (Linares et.al., 2021). People with such terminal illnesses, losing all motor skills do not want to leave their loved ones with the memory of them suffering as when the right protocols are followed, they should be given the right to choose to die with dignity where their loved one last memory is not of them been insufferable.

So far 8 states in the United States including the District of Columbia allow physician-assisted suicide via a mandate by state law while a mandate by court ruling is required for Montana and California (CNN, 2022). 

However, several activists also share their concern about how legalizing euthanasia could result in a “slippery slope” phenomenon where numerous non-voluntary euthanasia may take place (Annadurai et.al., 2014). Do you see this happening? What do you think about euthanasia? Should it be legalized? Should it be ethical?

CITATION:

Euthanasia. Euthanasia - MU School of Medicine. (n.d.). Retrieved November 28, 2022, from https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia#:~:text=Active%20euthanasia%3A%20killing%20a%20patient,a%20ventilator%20or%20feeding%20tube. 

Hentoff, N. (1999, September 11). A professor who argues for infanticide. The Washington Post. Retrieved November 28, 2022, from https://www.washingtonpost.com/archive/opinions/1999/09/11/a-professor-who-argues-for-infanticide/cce7dc81-3775-4ef6-bfea-74cd795fc43f/ 

Linares, A., & Telemundo, N. (2021, October 21). These people want to die. will their countries allow euthanasia? NBCNews.com. Retrieved November 28, 2022, from https://www.nbcnews.com/news/latino/people-want-die-will-countries-allow-euthanasia-rcna3307 

CNN. (2022, May 26). Physician-Assisted Suicide Fast Facts. CNN. Retrieved November 28, 2022, from https://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html 

Annadurai, K., Danasekaran, R., & Mani, G. (2014). 'Euthanasia: right to die with dignity'. Journal of family medicine and primary care, 3(4), 477–478. https://doi.org/10.4103/2249-4863.148161

Ethics in Esport Doping

 

In recent years the esports culture has exploded in part due to the pandemic. This market continues to grow as more and more people play video games. Whether you considered competitive video games as a sport or not it faces many similar issues as those with physical activity. There are hundreds of thousands to millions of dollars on the line in the form of championships and sponsorship.  Those who are competing like in any professional sport use any and all opportunities to gain an edge over their opponents. This could come in the form of cheat codes, mods, faster computer inputs, and performance-enhancing drugs (PED).

 These esports events have had reported issues with PED’s in some of the biggest tournaments. Some common PEDs that are used by many in the community include some items that you can find at nearly any grocery store including energy drinks for caffeine. Some even use prescription medications such as Adderall to enhance their performance. The use of Adderall increases the Sympathetic nervous system and could help players interpret information faster.  The use of these PED allows for these participants to practice for a longer duration without fatigue than the competition. This creates an unfair advantage for those who do not have access or a medical need for prescription drugs such as Adderall. At the moment there are few regulations on what can and cannot be taken to aid in the tournaments.

What ought esports to do going forward? esports is going to have to answer some major ethical questions for it to continue to grow. With so much at stake justice would say each participant should have a level playing field but where do they draw the line? Should over-the-counter drugs be allowed and what about prescription? They will really have to consider nonmaleficence with the youth that watch these tournaments and try to imitate the players they see. When they see the piles of crushed energy drinks and the logos on player's shirts they are sure to want to consume these drinks themselves. Kids drinking large amounts of caffeine can become fatal. No one needs a caffeinated kid “flossing” all over the place. Esports should act on the beneficence of the players to try and prevent some unhealthy habits from forming as well as creating a fair playing field. These are all tough questions and I am unsure if there is a simple answer.

 

Ryan P. Toomey. UPHOLDING THE INTEGRITY OF ESPORTS TO SUCCESSFULLY AND SAFELY LEGITIMIZE ESPORTS WAGERING.Gaming Law Review.Feb 2019.12-18.

Watch out, too much intense exercise may cause “Myocardial Fibrosis”

Did you know that too much intense exercise increases your risk of myocardial fibrosis? Overuse of intense exercise can increase your risk of myocardial fibrosis, according to a study in the journal Medicine and Science in Sports and Exercise. 

Myocardial fibrosis is known to be a common heart failure characteristic with is associated with frequent ventricular premature beats as well as ventricular tachycardia. This condition leads to the progression of the deterioration of the cardiac muscle as well as left ventricular dilatation which results in the failure of pump function (Liu et.al., 2017).

The study found that people who exercised at a high intensity (defined as intensity that causes muscle damage) more than three times per week had a greater risk of developing fibrosis, compared with those who exercised less intensely. The study participants were asked about their exercise habits and whether they had developed fibrosis over the previous five years. Fibrosis is a condition in which the muscles become stiff and thickened, and it can lead to heart problems. Long-term intense exercise induces several changes in the heart to adapt to the rise in oxygen demand of the body. These changes according to the researchers increase the mass of the whole heart resulting in increased contractility, high cardiac output, as well as a rise in left and right ventricular end-diastolic volume (EDV) (Rajanayagam et.al., 2021). 

The process that results in myocardial fibrosis is a chronic inflammatory response from cardiac remodeling. The increase in the heart’s contractility, cardiac output, and left & right ventricular volumes as Rajanayagam said, all lead to an increased number of free radicals, which are basically unstable molecules. Free radicals can damage cells, which can then lead to myocardial fibrosis. Cardia remodeling is detected based on morphological changes such as the size, geometry, and mass of the heart after an injury (Azevedo et. al., 2016). The sequence of events that takes place to result in myocardial fibrosis often starts with injuries such as pressure or cardiac volume overload or inflammation which may be caused by long-term intense exercises. This first event initiates cardiac remodeling which can be in the form of structural changes, molecular changes, biochemical changes, and cellular changes. Lastly, there is ventricular dysfunction following cardiac remodeling which results in symptomatic or asymptomatic heart failure (Azevedo et. al., 2016).

The researchers noted that people who develop fibrosis often have symptoms such as chest pain, shortness of breath, and fatigue. They suggest that people who are planning to start exercising at a high intensity should talk to their doctor first to make sure they are safe.

CITATION:

Rajanayagam, J., & Alsabri, M. (2021). Intense Endurance Exercise: A Potential Risk Factor in the Development of Heart Disease. Cureus, 13(1), e12608. https://doi.org/10.7759/cureus.12608

Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. https://doi.org/10.5935/abc.20160005

Liu, T., Song, D., Dong, J., Zhu, P., Liu, J., Liu, W., Ma, X., Zhao, L., & Ling, S. (2017). Current Understanding of the Pathophysiology of Myocardial Fibrosis and Its Quantitative Assessment in Heart Failure. Frontiers in physiology, 8, 238. https://doi.org/10.3389/fphys.2017.00238

You’ve got 99 problems, but a gallbladder shouldn’t be one: Porcelain Gallbladder

 Porcelain gallbladder (PGB) is also referred to as gallbladder calcification. This condition results from calcium encrusting the inner gallbladder wall (Jones et.al., 2022). Many do not take gallbladder calcification seriously because of the low occurrence rate of 0.06% to 0.8% (Lee et.al., 2005). Although the etiology of gallbladder calcification remains unknown, the condition displays a similar mechanism of gallstones (Jones et.al., 2022), and PGB is often associated with gallstones in about 95% of cases (i.e. the hardening of bile stored in the gallbladder due to the high presence of bilirubin, cholesterol, or bile salt) which eventually is associated with the development of cancer in the gallbladder (Morimoto et.al., 2021). 

This is a cause for concern because many PGB patients are normally diagnosed via incidental radiography meaning, these patients go asymptomatic with the condition until it is worse or caught in search of another diagnosis (Morimoto et.al., 2021). Researchers report that there is a 5:1 female predominance over males and about 6 million men, as well as 14 million women between the ages of 20 to 74, tend to have gallstones (Jones et.al., 2022). Since prevalence increases with age and the number of individuals with gallstones is extremely high, prolonged presence becomes a major factor in the progression of gallbladder calcification.

It is important to seek medical attention if you experience sudden pain in your upper left side that doesn't go away, especially if you have had cirrhosis or any other type of liver disease before. Other symptoms may include nausea, vomiting, abdominal pain, and fever.

Oftentimes, PGB is misdiagnosed with palpable masses such as neoplastic growth, abdominal hernias, or lipomas. Other differential diagnoses may include calcified renal cysts, pancreatic degenerative cystic lesions, echinococcal cysts, calcified adrenal tumors, etc (Jones et.al., 2022).

Some noncancerous PGB patients are treated with cholecystectomies while others undergo cholecystitis surgery. These two patients tend to have very good prognoses while cancerous PGB patients have much worse prognoses. Just like any other cancer, the survival rate depends on the stage it’s at, and stage 1 of cancerous PGB patients have a 50% 5-year survival rate, stage 2 has 28%, stage 3 has 8%, and stage 4 has a 2% survival rate (Jones et.al., 2022).

CITATION:

Jones MW, Weir CB, Ferguson T. Porcelain Gallbladder. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518979/

Lee, T.-C., Liu, K.-L., Lai, I.-R., & Wang, H.-P. (2005). Diagnosing porcelain gallbladder. The American Journal of Medicine, 118(10), 1171–1172. https://doi.org/10.1016/j.amjmed.2005.04.023 

Morimoto, M., Matsuo, T., & Mori, N. (2021). Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review. Diagnostics, 11(6), 1073. https://doi.org/10.3390/diagnostics11061073

Chlorophyl Supplement for.... Humans?

 It seems as though the market for new supplements and vitamins is a revolving door these days. Stepping into the Vitamin Shoppe, you're likely to see shelves upon shelves of them - in 2016, it was proposed that Americans spend somewhere around $30 billion dollars per year on supplements alone (Nahin et. al, 2016). A surprising recent addition to this line of products is Chlorophyll - yes, the green plant pigment. Some of the most popular touted benefits of such a supplement include, but of course are not limited to elimination of body odor, heal damaged skin, aid in weight loss, and neutralize toxins - as expected, the list goes on, seemingly becoming more far-fetched as it does. 

That being said, Chlorophyll supplementation is not to go without any consideration. A 2016 study by Wang et. al investigated the affect of chlorophyll supplementation on oxidative stress and aging in Caenorhabditis elegans (Wang et. al, 2016). The team extracted Chlorophyll from spinach and administered it to C. elegans in several different doses, later exposing them to oxidative stress via the toxin Juglone for a period of 3 hours (Wang et. al, 2016). The worms who were treated with the Chlorophyll were found to have their survival rate to the toxin increase by 207.5%, as opposed to the control group (Wang et. al, 2016). That being said, it was found that a high dose of Chlorophyll was necessary in order to exhibit these effects. Additionally, wild type C. elegans were treated with various levels of Chlorophyll and observed for life-span duration - it was found that post-administration, life span increased in a dose-dependent manner, as opposed to the control group (Wang et. al, 2016).

As amazing as this all sounds, perhaps don't reach for the little green bottle just yet. It is important to remember that dietary sources of Chlorophyll are readily available at the grocery store, or perhaps even in your fridge already - leafy vegetables (spinach, collared greens, broccoli). Additionally, it is important to remember that the FDA does not hold the authority to regulate dietary supplements in regards to effectiveness or safety (FDA, 2022) - i.e, you may not really even be sure that what you're purchasing is the all-mighty Chlorophyll. If it were me? I'd reach for the spinach. 

References:

Commissioner, O. of the. (n.d.). FDA 101: Dietary supplements. U.S. Food and Drug Administration.             Retrieved November 28, 2022, from https://www.fda.gov/consumers/consumer-updates/fda-101-                dietary-supplements

• Nahin RL, Barnes PM, Stussman BJ. Expenditures on complementary health approaches: United States, 2012. (433KB PDF) National Health Statistics Reports. Hyattsville, MD: National Center for Health Statistics. 2016.
• Wang, E., & Wink, M. (2016). Chlorophyll enhances oxidative stress tolerance in Caenorhabditis elegans and extends its lifespan. PeerJ, 4, e1879. https://doi.org/10.7717/peerj.1879

How High Blood Pressure Can Accelerate Memory Loss

     While hypertension clearly has a detrimental effect on cardiovascular health, it is interesting to investigate how poor cardiovascular health affects other areas of the body, such as the brain. As we know our cardiovascular system is an open system, meaning that the blood reaches outwards to the body to many lymphatic tissues. Large epidemiological studies have shown that high blood pressure, especially during midlife, can accelerate cognitive decline and increase risk for dementia and Alzheimer’s disease. This occurs because high blood pressure can lead to hypertension which causes decreased circulation in the brain. The decreased perfusion in the brain inhibits the brain’s ability to clear potentially harmful proteins like β-amyloid which are associated with dementia and Alzheimer’s Disease when they start to build-up and create β-amyloid plaques.  

With this knowledge, researchers have been looking into the possibility of antihypertension medicines that can decrease the risk of dementia or Alzheimer’s Disease. It has been found that antihypertensive medication, especially ACE inhibitors and diuretics, may be helpful in reducing the risk for and progression of dementia. The use of diuretics and ACE inhibitors increases the concentration of salt in the blood and therefore decreases the amount of water retention. The decrease of water in the blood decreases blood pressure and allows better perfusion of blood into the brain.  

When thinking of different systems in the body such as the cardiovascular and nervous systems, it is crucial to not think of them as independent systems without any other influences, especially when thinking about diseases and how medications interact with the body.  

 

Shah, K., Qureshi, S. U., Johnson, M., Parikh, N., Schulz, P. E., & Kunik, M. E. (2009). Does use of antihypertensive drugs affect the incidence or progression of dementia? A systematic review. The American journal of geriatric pharmacotherapy, 7(5), 250-261. 

Walker, K. A., Power, M. C., & Gottesman, R. F. (2017). Defining the relationship between hypertension, cognitive decline, and dementia: a review. Current hypertension reports, 19(3), 1-16.