Dr Ford Brewer - PrevMed

There is a new simple measurement of Body Fat. It has been researched using the NHANES study population compared to DEXA body fat measurement. It is called Relative Fat Mass (RFM). Researchers are suggesting that it is better than the Body Mass Index (BMI). Initial studies indicate that it's true.

Vitamin B12 deficiency is more prevalent than most docs ( or patients realize). We cover a review article for psychiatrists. It provided an exhaustive review, a plea for more screening, and a summary of the mechanism of disease. Cobalamin(B12) nutritional needs and habits were covered as well.

Multiple mechanisms for the neurological and psychiatric disease were covered, ranging from destruction of the nerve's myelin sheath to methylation problems.

Don't throw your salmon, halibut or other omega 3s back in the water yet! After years of bad news for Omega 3 fans, there is a glimmer of hope. How clear is that glimmer? Not very, at least for now. It's basically fueled by stock prices. But I do think there's enough there to keep taking Omega 3s. And be patient. In 6 weeks, we'll get a lot more info.

In JAMA 2016, there was a publication of original research looking at intermittent fasting and breast cancer. Marinac et al did a re-analysis of the Women's Healthy Eating and Living study. Data collection for the larger study was done 1995-2007. This post-collection analysis was done in May-Oct 2015.

13 hours or less of daily fasting was associated with a significant increase in breast cancer recurrence and death. Increased periods of fasting were associated with improved carb metabolism, sleep, and breast cancer survival.

Many people say that prolonged fasting results in decreased metabolic rates. This study indicates that's not true. Not only is it not true, but it also appears that the opposite may be the case. Basal metabolic rate may actually increase.

Zauner et al measured metabolic rate using indirect calorimetry. They saw a 50% increase in metabolic rate using 11 lean, healthy volunteers on an 84 hour fast. Why did this increase occur? It may have been due to the tripling of Norepinephrine.

A study from Edinburg claims to have critical new information re: the development, prevention, and cure of Alzheimer's dementia. They say they decreased cognitive decline in lab rats.

I approach with skepticism any statements re: new drugs for Alzheimer's dementia.

However, the discussion re: small vessel disease is enlightening. The processes of again, heart attack, kidney disease, stroke, and dementia all appear to be associated with endothelial damage.

Vitamin B12 deficiency is being found much more often than before. Docs are still often not aware. There are 3 major reasons for increasing prevalence:

1. aging population demographics leading to increasing prevalence of decreased stomach acidity;

2. Medications (mostly the antacids like Nexium or Prilosec, but also Metformin and some others);

3. vegan, vegetarian, and plant-based diets.

This New England Journal article covers several key facts about what it calls a "common clinical presentation". It is a 57 yo patient with B12 deficiency with a normal serum B12 level. The patient had homocysteine and methylmalonic acid levels that were very high.

The ASPREE study was a trial of aspirin in 20,000 healthy adults, age 70 and older. It was published in September 2018 in the New England Journal of Medicine.

Surprisingly, aspirin did not show a preventive benefit. Even more surprisingly, it showed an increased risk. And even more surprisingly, it was in cancer. Even the authors suggested that we look at these results with caution since there are meta-analyses that showed just the opposite.

There's one more surprise. The mortality rate was less than half of that predicted in the study. This is being seen in several studies, such as the ASCEND trials. Are we getting healthier in our old age? Is this washing out benefits of less powerful interventions such as aspirin and low-dose Omega 3s?

The ARIC re-analysis & the PURE study showed opposite conclusions.