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Tag: COPD

  • Can Vegan Fecal Transplants Lower TMAO Levels? | NutritionFacts.org

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    If the microbiome of those eating plant-based diets protects against the toxic effects of TMAO, what about swapping gut flora?

    “Almost 2,500 years ago, Hippocrates stated that ‘All disease begins in the gut.’” When we feed our gut bacteria right with whole plant foods, they feed us right back with beneficial compounds like butyrate, which our gut bugs make from fiber. On the other hand, if we feed them wrong, they can produce detrimental compounds like TMAO, which they make from cheese, eggs, seafood, and other meat.

    We used to think that TMAO only contributed to cardiovascular diseases, like heart disease and stroke, but, more recently, it has been linked to psoriatic arthritis, associated with polycystic ovary syndrome, and everything in between. I’m most concerned about our leading killers, though. Of the top ten causes of death in the United States, we’ve known about its association with increased risk of heart disease and stroke, killers number one and five, but recently, an association has also been found between blood levels of TMAO and the risks of various cancers, which are our killer number two. The link between TMAO and cancer could be attributed to the inflammation caused by TMAO, but it could also be oxidative stress (free radicals), DNA damage, or a disruption in protein folding.

    What about our fourth leading killer, chronic obstructive pulmonary disease (COPD), like emphysema? TMAO is associated with premature death in patients with exacerbated COPD, though it’s suspected that it’s due to them dying from more cardiovascular disease.

    The link to stroke is a no-brainer—no pun intended. It is due to the higher blood pressure associated with higher TMAO levels, as well as the greater likelihood of clots forming in those with atrial fibrillation. Those with higher TMAO levels also appear to have worse strokes and four times the odds of death.

    Killer number six is Alzheimer’s disease. Can TMAO even get up into our brains? Yes, TMAO is present in human cerebrospinal fluid, which bathes the brain, and TMAO levels are higher in those with mild cognitive dysfunction and those with Alzheimer’s disease dementia. “In the brain, TMAO has been shown to induce neuronal senescence [meaning, deterioration with age], increase oxidative stress, impair mitochondrial function, and inhibit mTOR signaling, all of which contribute to brain aging and cognitive impairment.”

    Killer number seven is diabetes, and people with higher TMAO levels are about 50% more likely to have diabetes. Killer number eight is pneumonia, and TMAO predicts fatal outcomes in pneumonia patients even without evident heart disease. Kidney disease is killer number nine, and TMAO is strongly related to kidney function and predicts fatal outcomes there as well. Over a period of five years, more than half of chronic kidney disease patients who started out with average or higher TMAO levels were dead, whereas among those in the lowest third of levels, nearly 90% remained alive.

    How can we lower the TMAO levels in our blood? Because TMAO originates from dietary sources, we could limit our intake of choline- and carnitine-rich foods. They’re so widespread in foods,” though we’re talking about meat, eggs, and dairy. “Therefore, restriction of foods rich in TMA-containing nutrients may not be practical.” Can we just get a vegan fecal transplant? “Vegan donors provided the investigators with a fresh morning fecal sample…”

    If you remember, if you give a vegan a steak, despite all that carnitine, they make almost no TMAO compared to a meat-eater, presumably because the vegan hasn’t been fostering steak-eating bugs in their gut. See below and at 3:40 in my video Can Vegan Fecal Transplants Lower TMAO Levels?.

    Remarkably, even if you give plant-based eaters the equivalent of a 20-ounce steak every day for two months, only about half start ramping up production of TMAO, showing just how far their gut flora has to change. The capacity of veggie feces to churn out TMAO is almost nonexistent. Instead of eating healthier, what about getting some vegan poop?

    In a double-blind, randomized, controlled trial, research subjects either got vegan poop or their own poop back through a hose snaked down their nose, and it didn’t work.

    First of all, the vegans recruited for the study started out making TMAO themselves, in contrast to the other study, where they didn’t make any at all. This may be because the earlier study required the vegans to have been vegan for at least a year, and this study didn’t. So, there wasn’t much of a change in TMAO running through their bodies two weeks after getting the vegan poop, but the vegan poop they got seemed to start out with some capacity to produce TMAO in the first place.

    So, the failure to improve after the vegan fecal transplant “could be related to limited baseline microbiome differences and continuation of an omnivorous diet” after the vegan-donor transplant. What’s the point of trying to reset your microbiome if you’re just going to eat meat? Well, the researchers didn’t want to switch people to a plant-based diet since they knew that alone can change our microbiome, and they didn’t want to introduce any extra factors. The bottom line is that it seems there may not be any shortcuts. We may just have to eat a healthier diet.

    Doctor’s Note

    Want to become a donor? Find out How to Become a Fecal Transplant Super Donor.

    For more on TMAO, check out related posts below. 

    See the microbiome topic page for even more.

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    Michael Greger M.D. FACLM

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  • Cleaning Products, Air Fresheners, and Lung Function  | NutritionFacts.org

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    There is a reason the U.S. Centers for Disease Control and Prevention prohibits not only smoking but also scented or fragranced products in its buildings.

    In a recent review entitled “Damaging Effects of Household Cleaning Products on the Lungs,” researchers noted: “Adverse respiratory effects of cleaning products were first observed in populations experiencing high levels of exposure at the workplace, such as cleaners and health-care workers, with a primary focus on asthma.” Occupational use of disinfectants has also been linked to a higher risk of developing chronic obstructive pulmonary disease, such as emphysema.

    As I discuss in my video Friday Favorites: The Effects of Cleaning Products and Air Fresheners on Lung Function, we now know that, in addition to workplace exposures, “exposure to household cleaning products has also emerged as a risk factor for respiratory disorders in childhood,” as well potentially being “an important risk factor for adult asthma.” Common household cleaning spray use accounts for as many as one in seven adult asthma cases. The thought is that inhaling chemical irritants may cause injury to the airways, leading to oxidative stress and inflammation. What can we do about it?

    Well, it may be limited to sprays. Researchers found that cleaning products that were not sprayed were not associated with asthma. It’s also possible that environmentally friendly cleaning products “may represent a safer alternative,” though they may still present some risk.

    Ideally, safer cleaning products should be available. Unfortunately, the research suggesting harm has “seldom been heeded by manufacturers, vendors, and commercial cleaning companies.” I wonder how much of that is because “most of the workers exposed to cleaning products are women”—both occupationally and, perhaps, domestically.

    One of the problems may be the fragrance chemicals. One in three Americans surveyed “reported health problems, such as migraine headaches and respiratory difficulties, when exposed to fragranced products.” And, for about half of them, the problems were so bad they actually lost work over it, either “workdays or a job due to fragranced product exposure in the workplace.”

    “Results from this study reveal that over one-third of Americans suffer adverse health effects, such as respiratory difficulties and migraine headaches, from exposure to fragranced products. Of those individuals, half reported that the effects can be disabling. Yet over 99% of Americans are exposed to fragranced products at least once a week, from their own or others’ use.”

    The effect on asthmatics may be even worse, affecting closer to two-thirds of Americans. One compound that may be of particular concern is called 1,4-dichlorobenzene, also known as para-dichlorobenzene, which is found in many air fresheners, toilet bowl deodorants, and mothballs. It breaks down in the body into a compound called 2,5-dichlorophenol, which we pee out, giving researchers a reliable measure of our dichlorobenzene exposure. Not only may it make respiratory problems worse for those already suffering from compromised airways, but exposure to dichlorobenzene “at [blood] levels found in the U.S. general population, may result in reduced pulmonary [lung] function” in people who start out with normal breathing. What’s worse, higher exposures “were associated with greater prevalence of CVD [cardiovascular disease] and all cancers combined,” another reason to avoid it. We’d better read labels, right?

    Surprisingly, “no law in the US requires the disclosure of all ingredients in fragranced consumer products.” In fact, for laundry supplies, cleaning products, and air fresheners, manufacturers “do not need to list the presence of a ‘fragrance’ on either the label or MSDS,” the material safety data sheet. We won’t know until we smell it.

    I support the U.S. Centers for Disease Control and Prevention’s ban. Not only is “the use of tobacco products (including cigarettes, cigars, pipes, smokeless tobacco, or other tobacco products)…prohibited at all times,” but “scented or fragranced products are prohibited at all times in all interior space owned, rented, or leased by CDC.” I wish rideshare services like Uber and Lyft would have a similar policy. I’d even be happy with just a fragrance-free option. About one in five of more than a thousand Americans surveyed said they “would enter a business but then leave as quickly as possible if they smelled air fresheners or some fragranced product,” so it’s in the best interest of businesses, too. “Over 50% of the population would prefer that workplaces, health care facilities and professionals, hotels, and airplanes were fragrance-free.”

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    Michael Greger M.D. FACLM

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  • Sinéad O’Connor’s Exact Cause Of Death Finally Revealed One Year After Devastating Passing – Perez Hilton

    Sinéad O’Connor’s Exact Cause Of Death Finally Revealed One Year After Devastating Passing – Perez Hilton

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    Nearly one year to the day after her shocking passing, we finally know exactly what took Sinéad O’Connor’s life.

    After the beloved Irish singer was tragically found unresponsive in her London home last July, police opened an investigation but declared that her death was “not being treated as suspicious.” Updates were slim, but six months later in January, a representative for London’s Southwark Coroner’s Court confirmed to TMZ that the late activist died of “natural causes.” There weren’t many other details, but the coroner “ceased their investigation in her death” after coming to the conclusion.

    But we now know exactly what those “natural causes” were.

    Related: Shannen Doherty Thought She Had ‘More Time’ — And Planned To Do THIS Before Passing!

    On Sunday, multiple outlets cited her death certificate, which reveals the late 56-year-old passed away as the result of chronic obstructive pulmonary disease (COPD) and asthma. According to the certificate, she was also battling a respiratory tract infection at the time of her death. The certificate officially declares her death as:

    “Exacerbation of chronic obstructive pulmonary disease and bronchial asthma together with low grade lower respiratory tract infection.”

    So sad.

    According to the Irish Independent, Sinéad’s death was officially registered by her ex-husband John Reynolds on Wednesday in Lambeth, London. The activist’s death was certified by Julian Morris, senior coroner for Inner South London.

    Our hearts are with all of Sinéad’s loved ones.

    [Images via Sinéad O’Connor & Dr. Phil/YouTube]

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    Perez Hilton

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  • Life Expectancy With COPD

    Life Expectancy With COPD

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    There’s no one-size-fits-all answer when it comes to predicting someone’s life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward.

    “COPD is a disease with a lot of moving parts,” says Albert A. Rizzo, MD, chief medical officer for the American Lung Association. “It’s not a death sentence by any means. Many people will live into their 70s, 80s, or 90s with COPD.”

    But that’s more likely, he says, if your case is mild and you don’t have other health problems like heart disease or diabetes. Some people die earlier as a result of complications like pneumonia or respiratory failure.

    COPD Severity and Life Expectancy

    Doctors use a classification system called the Global Initiative on Obstructive Lung Disease (or GOLD) system to determine how severe your COPD is. It’s based on how much air you can forcefully exhale in 1 second after blowing into a plastic tube called a spirometer. You’ll also hear this called a forced expiratory volume (FEV1) test.

    The classifications are based on results for an adult your same age, gender, and ethnic group but without COPD. So if your airflow was 80% of someone’s airflow who doesn’t have COPD, you’d be at GOLD or Stage 1. There four stages:

    In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD.

    Symptoms and Severity

    Do you have trouble breathing? Have you been hospitalized for COPD flare-ups, which doctors call exacerbations? Doctors look at your symptoms and put you in one of four categories, A-D. The most serious would be GOLD D (high symptom severity and high exacerbation risk).

    Smoking Plays a Role

    Smoking is the leading cause of COPD. One study found a small drop in life expectancy (about 1 year) for people with COPD who had never smoked. But there was a much larger reduction for current and former smokers. For men age 65 who smoke, the drop in life expectancy is:

    • Stage 1: 0.3 years
    • Stage 2: 2.2 years
    • Stage 3: 5.8 years
    • Stage 4: 5.8 years

    This is in addition to the 3.5 years of life all smokers, whether they have COPD or not, lose to the habit.

    The same study also found that women who were current smokers and at Stage 2 lost about 5 years of their lives at Stage 3 and 9 years of their lives at Stage 4.

    The BODE Index

    Another system doctors use to measure life expectancy with COPD is the BODE Index, which stands for:

    • Body mass: Are you obese or overweight?
    • Airflow obstruction: How much air can you forcefully exhale from your lungs in 1 second (the FEV1 test).
    • Dyspnea: How hard is it to breathe?
    • Exercise capacity: How far can you walk in 6 minutes?

    The higher your BODE score, the greater your risk for death from COPD. This test is considered more accurate than just the FEV1 score.

    Can Medication Help?

    Right now there aren’t any medicines that cure COPD. “We are still looking for drugs that can slow down the disease process itself and reverse inflammation in the airways,” Rizzo says. But there are bronchodilators (medications usually taken through inhalers) that can open your airways and improve shortness of breath.

    Corticosteroids can help control flare-ups. That’s important because more COPD hospitalizations are linked to a higher likelihood of death.

    If you’re constantly low on oxygen, your doctor might prescribe supplemental oxygen. You’ll get a device you can take with you anywhere to help you breathe.

    And you have to have access to care in the first place. Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level.

    Early Diagnosis Can Make a Difference

    An early diagnosis can also greatly improve your life expectancy. “Probably half the people with COPD had the disease for a number of years before they were diagnosed,” Rizzo says. “They didn’t bring it to the attention of their physician because they thought the cough and the shortness of breath were related to being overweight, out of shape, and still smoking.”

    Also, doctors have to diagnose COPD correctly by ordering the right tests, he says.

    Rizzo also points to studies under way figure out why some people are more likely to get COPD than others. A study started this year by the National Institutes of Health and supported by the American Lung Association will look at lung function in 25-35-year-olds (lung function reaches its peak in the mid-20s) and figure out what changes over the course of their lifetime. “We want to notice when an individual develops findings of COPD, what may have led to it, and what we can learn from that to improve survival,” he says.

    Make Lifestyle Changes

    While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life. You can:

    Once you’ve been diagnosed with COPD, follow your doctor’s advice to stop smoking, exercise, and take any medications prescribed. “And most important, stay active,” Rizzo says. “Walking is the best exercise for lungs, so walk on a regular basis.”

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  • New Screen Might Spot More Cases of Hidden COPD

    New Screen Might Spot More Cases of Hidden COPD

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    By Dennis Thompson 

    HealthDay Reporter

    THURSDAY, Feb. 16, 2023 (HealthDay News) — Doctors could soon have a new tool to help diagnose chronic obstructive pulmonary disease (COPD).

    A questionnaire called CAPTURE successfully identified almost half of clinical trial participants who had moderate to severe forms of previously undiagnosed COPD, researchers report.

    “The goal with trying to find COPD is to treat it earlier, which will help make patients feel better and hopefully prevent their disease from progressing,” said principal investigator Dr. Fernando Martinez, chief of the pulmonary and critical care medicine division at Weill Cornell Medicine in New York City.

    More than 15 million Americans have been diagnosed with COPD, and experts think millions more have it but don’t know it. COPD is a leading cause of death in the United States.

    Common COPD symptoms include coughing, shortness of breath, wheezing or whistling in the chest, and tightness or heaviness of the chest.

    The CAPTURE tool asks patients to answer five questions that assess their breathing and exposure to chemicals or air pollution.

    Those with medium scores take an in-office breathing test to gauge the force of their exhalation, a sign of lung function.

    People who score low on that test — or who scored high on the CAPTURE questionnaire — proceed to a spirometry breathing test, which is considered the gold standard for diagnosing COPD.

    CAPTURE screening gives doctors additional information to assess patients with respiratory symptoms, the study authors said.

    Only about one-third of COPD assessments include spirometry, because the tests can be difficult to integrate into a short visit with a primary care doctor.

    “CAPTURE was designed to be easy for physicians to use. The screening is simple, takes less than a minute, and helps identify adults with trouble breathing who should be evaluated further,” Dr. Antonello Punturieri, program director of the U.S. National Heart, Lung, and Blood Institute’s Chronic Obstructive Pulmonary Disease/Environment Program, said in an institute news release.

    CAPTURE’s clinical trial involved more than 4,300 adults aged 45 to 80, and ran from October 2018 to April 2022.

    By the end, about 2.5% of the study sample had been diagnosed with moderate to severe forms of COPD. Of those cases, CAPTURE accurately identified about 48% as having COPD.

    The researchers estimated that 1 in 81 CAPTURE screenings would identify an adult with treatable but previously undiagnosed COPD, based on these results.

    However, CAPTURE also gave a false positive result for 479 participants who did not have COPD.

    The researchers said they are studying ways to improve the tool’s accuracy through minor changes like altering questions or adding others. But they emphasized that the goal is to identify people who would benefit from COPD testing with spirometry.

    The findings were published Feb. 14 in the Journal of the American Medical Association.

    “The study shows that there is a high degree of respiratory burden in primary care, and physicians need to ask about it and do the appropriate testing to determine if symptoms are driven by COPD or another process so that patients can get the right treatment,” said principal investigator Dr. MeiLan Han, a professor of medicine in the division of pulmonary and critical care at the University of Michigan, in Ann Arbor.

    Larger studies are underway to further assess CAPTURE and how doctors use the tool in practice. Results are expected later this year.

    More information

    The U.S. National Heart, Lung, and Blood Institute has more about COPD and lung health.

     

    SOURCE: U.S. National Heart, Lung, and Blood Institute, news release, Feb. 14, 2023

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  • Cold Takes Your Breath Away: How to Breathe Easier in Winter

    Cold Takes Your Breath Away: How to Breathe Easier in Winter

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    Nov. 11, 2022 — Karen Ruckert doesn’t look forward to wintertime. The 69-year-old in Far Rockaway, NY, has chronic obstructive pulmonary disease (COPD), which makes breathing difficult at the best of times, especially during walking. But the cold air makes everything worse.

    “Cold takes my breath away — literally,” says Ruckert. 

    Nava Myers, a 31-year-old dental hygienist, has a similar problem. She has asthma. In cold weather, her lungs constrict. “If I’m walking, I have to stop, catch my breath, and I wheeze. I feel the tightness and constriction as soon as I walk out the door.”

    People with respiratory disorders (like asthma, COPD, sinusitis, or allergies) or who may be dealing with long-term effects of COVID-19 often find breathing difficult in colder temperatures. 

    Jodi Jaeger, a respiratory therapist at Ascension SE Wisconsin Hospital,

     says the low temperature and low humidity affect the airways. 

    “Cold, dry air irritates the lungs, causing the muscles around the airways to constrict so that the airways actually narrow,” she says. The technical term for the disorder is bronchospasm.

    The narrow airways mean there’s less space for air to enter and exit. Also, mucus within the airways tends to dry out and the narrower airways make it more difficult to get rid of it. So the mucus can clog the airways.

    “This can lead to shortness of breath, a sense of constriction or tightness, sometimes a burning sensation in the chest, and often wheezing or coughing,” Jaeger says. 

    Even healthy people exercising rigorously in very cold temperatures can put themselves at risk of these symptoms. 

    Fortunately, there are many simple self-care measures to reduce the risk and manage the symptoms.

    Cover Your Face

    Jaeger advises people to dress warmly and cover their faces in cold weather when they are going outdoors.

    “In particular, it’s extremely important to cover your mouth and nose with a scarf or a cold-weather face mask — not a thin surgical ‘COVID-type’ mask — or a neck gaiter that comes up over the face,” Jaeger says 

    This helps warm the air around the nose and also holds some moisture. Even though some people find it annoying when their scarf gets moist, you’re breathing in moisture instead of dry, cold air.

    Ruckert covers her face when she walks in cold weather but leaves a little area around the nose slightly uncovered because her glasses get steamed up so she can’t see where she’s going.

    Myers wraps her neck area in a “circle scarf.” She also wraps her ears. “I feel the cold even in the ears, so I wear a really good, bundly scarf that covers my throat, mouth, nose, and ears.”

    Breathe Through Your Nose

    Breathing through the nose is better than breathing through the mouth because the nose is a “better humidifier than the mouth,” says Jaeger. “If you combine breathing through the nose with face covering, that should go a long way toward preventing the tightness in the chest, the shortness of breath, and the cold-induced bronchospasm.”

    Avoid Rigorous Outdoor Exercise in Very Cold Weather

    Exercising makes it harder to breathe because when you’re exercising, you’re increasing the amount of air you’re breathing, compared to when you’re at rest, Jaeger explains. “That causes the tightness and burning sensation and can ultimately lead to wheezing.” 

    Even in people without lung disease, rigorous outdoor exercise in extremely cold weather — especially for more than 30 minutes — can trigger symptoms, which can last for as long as 24 hours.

    If you really love vigorous outdoor exercise like running, make sure you’re dressed properly and well-hydrated. And consider reducing either the intensity or the time of your workout — or both, Jaeger advises.

    Ruckers and Myers both avoid walking outdoors in the cold weather as much as possible. 

    “And if I do go outside in the cold, if I’m trying to walk with my friends, I have to stop and catch my breath,” Myers says.

    Myers can’t walk and talk at the same time in cold weather. “I might be trying to tell a story, but there comes a point when I have to stop, catch my breath, and finish the story when I get home.”

    Keep Hydrated

    The air, both outside and inside, is dryer during cold weather, Jaeger notes. “Drinking plenty of fluids will help the body stay hydrated so when you go outside, your lungs will be better protected and your mucus will be less thick and less likely to get stuck.” She also suggests using lotion and lip balm so the skin and lips don’t dry out.

    She recommends hot or warm herbal tea or water with lemon and raw honey. A bonus is that certain teas, like peppermint or chamomile, can also soothe the airways.  

    Take Care of Your Indoor Environment Too

    During the winter, people spend more time indoors, and there are things you can to do make your indoor environment more friendly to respiratory health. For example, be extra careful to keep your home clean and free of dust and other allergens that can affect breathing.

    Jaeger recommends using a humidifier to counterbalance the dryness in the air that can often come as a result of using radiators. 

    “That way, when you’re in your home, you’re building up the humidification within the body so that when you go outside, you’re not at a fluid deficit,” she says.

    Make sure the humidifier is regularly cleaned so that bacteria and mold don’t build up and get released into the air, she warns. Follow the instructions on the package or use vinegar and water for cleaning.

    Some portable humidifiers can be used with small disposable water bottles. They can be taken in the car, brought to the office, or used during travel. Using a disposable bottle prevents bacteria and mold from building up.

    Ruckert puts a pan of water on top of the radiators. As the water evaporates, the air becomes moister.

    Other than air quality, you can help your breathing by using essential oils, such as eucalyptus, peppermint, and tea tree oil. “You can rub it on yourself — somewhere where you can smell it — or put it on a cotton ball next to your pillow,” Jaeger says.

    Medications to Assist With Breathing

    People with respiratory conditions typically take medications to manage their conditions. Some are used regularly, while others are “rescue” medications to be used only when symptoms arise.

    “Take your prescribed rescue inhaler before exposure to the cold air,” Jaeger advises. Bring the medication with you in case you need it while outdoors. 

    Ideally, people with known respiratory conditions should have an action plan with their health care provider, Jaeger says. Most people with these conditions can measure the amount of air expelled from the lungs using a device called a peak flow meter. “You should know when your medications may need to be adjusted and when to contact your provider.”

    If you’ve never had difficulty breathing and you’ve just developed the problem, you should take it seriously, especially if simple self-care measures don’t work, she emphasizes. “And if you have severe breathlessness or wheezing and can’t complete your sentences, you need to get medical attention right away.”

    Myers takes several different types of inhalers, some consistently and others as needed. “I feel they don’t make a big enough difference in cold weather, and their cost is exorbitant, so I tend to just avoid going out in the wintertime,” she says. 

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