Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: How should we approach helping people with opioid use disorder? Elizabeth Tracey reports

Substance use disorders are causing an epidemic parallel to Covid-19, with over 80,000 deaths reported over the one year period ending in May 2020, according to the CDC. Eric Strain, a substance use disorders expert at Johns Hopkins, says we must revamp our entire approach to helping people overcome this problem.

Strain: We talk about patient centered care, but then we say what you should want is to be on buprenorphine, or maybe naltrexone. We need to better understand what do they want that they think would be helpful to them? What are the social factors that are impacting? How are we addressing those? And what are the things that drive them to find meaning and purpose in their lives? We should not be saying here’s a buprenorphine prescription, now you’re better. We need to understand what is it that will make them have more meaning, more purpose. How will they flourish in their lives?  :34

Strain says such an approach will require a treatment team as well as social supports and policy changes. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How many deaths due to opioid use disorder are suicides? Elizabeth Tracey reports

During the one year period from May 2019 to May 2020, 81,000 people died of drug overdoses, CDC data reveal. That number is almost certainly an underestimate, and is almost twice as high as the previous year’s data. Eric Strain, a substance use disorder expert at Johns Hopkins, says this high rate most likely includes quite a few suicides, or deaths of despair.

Strain: I think that there could be people who are demoralized, with all that’s going on socially. The isolation, depression, unemployment, economic uncertainty, housing uncertainty, there’s a lot of factors going on right now. Just like the general population is stressed I think this population is stressed as well. But this is a population that turns to using opioids at times when they’re stressed.  :25

Strain says these dire numbers call for increased vigilance on everyone’s part, as well as removal of barriers to treatment. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: In addition to Covid-19, overdose deaths are skyrocketing, Elizabeth Tracey reports

From May 2019 to May 2020, deaths due to opioid overdose were almost twice as high as the previous year, Centers for Disease Control and Prevention data indicate. Eric Strain, a psychiatrist and substance use disorder expert at Johns Hopkins, says even that number is most likely an underestimate.

Strain: I think previously the latest data were through 2018 but they announced this data through May of 2020. And it was 81,000 overdose deaths for that 12 month period. In 2018 I think we had something on the order of 46,000. Part of what’s striking about this is some of us thought that with Covid we might see a decrease in deaths because people were socially isolating and may not be out purchasing fentanyl and things like that and if anything its been the reverse.  :31

Strain says the numbers clearly point to an urgent need for intervention, and notes that all stakeholders need to be involved, including patients, clinicians and policymakers. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does limiting your eating to just six hours a day result in weight loss? Elizabeth Tracey reports

Confining food consumption to just six hours a day will help you lose weight and keep it under control, advocates say. Yet a study by Nisa Maruthur and colleagues at Johns Hopkins, which provided food to participants and allowed one group to eat as they usually did, while the other ate earlier in the day and over fewer total hours, did not demonstrate a difference between the two groups.

Maruthur: Our study shows that its probably still about calories in calories out. So if restricting your window helps you to restrict that that’s probably good. And then the other thing we’ve known about dietary patterns and trying to improve lifestyles is that you have to do something that works for you. And so if eating between twelve and six is not going to make your miserable and it works for you then that’s the other thing that’s really important. That’s what we’ve seen with all the studies of different dietary patterns is that any dietary pattern can be healthy; it has to be one you can follow.  :27

Maruther notes that being mindful of other personal habits such as sleep and  and integrating them with eating behaviors may also be important. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does limiting the duration of time during which you eat result in weight loss? Elizabeth Tracey reports

Consuming food for a limited amount of time earlier each day is advocated by some for weight loss. Now a study by Nisa Maruthur and colleagues at Johns Hopkins shows that if you eat the same amount of food each day, when you consume it really doesn’t matter.

Maruthur: In our study we provided all the food and randomized people to either the time restricted or their usual feeding pattern. The bottom line is that we found that eating earlier in the day didn’t seem to decrease weight more that eating later in the day if you keep your calories constant. We think now that eating earlier versus later should probably be based on individual preference more than anything else. If timing of feeding affects how many calories you eat then that’s a different story. If you find if you restrict your feeding you’re going to eat less than I think that will still serve you well but we worked to keep calories constant the whole twelve weeks of the study.  :30

This study had people eating most of their calories earlier during the day or following their usual custom. There was no difference in weight loss between the two groups after 12 weeks, Maruthur says. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: There are specific training strategies to help regain smell after Covid infection, Elizabeth Tracey reports

If you’ve lost your sense of smell due to Covid-19, you may have seen kits for sale that purport to help you regain it by regular sniffing of essential oils. Andrew Lane, an otolaryngologist at Johns Hopkins, says there are four scents that are typically utilized.

Lane: It’s rose, lemon, cloves, and eucalyptus. This was something that the group in Germany who originally came up with this, had picked them for a reason, that they had represented classes of odors in some scheme. Other people have said that it doesn’t have to be those, have even said how about smelling some household items might be just as good. Smelling coffee, vinegar, or smelling lemons. That’s better than nothing. We don’t really understand how this works so there’s probably nothing magical about those four.   :29

Lane says the strategy of regular retraining might make sense however, and it won’t cause any harms, so it is well worth attempting. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Both loss and altered sense of smell are features of Covid-19, Elizabeth Tracey reports

Smell and taste aren’t just senses that improve our lives, they also help keep us safe by alerting us to the smell of something burning or the taste of a food that may have spoiled. Andrew Lane, an otolaryngologist at Johns Hopkins, says that’s why persistent loss of these senses after Covid infection is so troubling.

Lane: There’s a very high rate of olfactory loss with Covid. Maybe 80%. Most people recover spontaneously. There’s some subset of people who have olfactory disturbances, either a change in their sense of smell where things don’t smell exactly right, or maybe they have higher thresholds where they can’t smell things until they become very intense. They may not know that they don’t have a sense of smell and they may say that generally it feels normal to them but if you test and look carefully you can see that there’s still some dysfunction that can persist for longer periods of time.  :29

Lane says anyone whose taste and smell are compromised for a prolonged period of time after Covid infection should likely be evaluated. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can smell training help people who’ve lost their sense of smell due to Covid recover? Elizabeth Tracey reports

Not only is loss of smell and taste a prominent symptom of Covid-19, for a sizeable number of people that loss continues long after they’ve recovered otherwise. Andrew Lane, an otolaryngologist at Johns Hopkins, says there is one strategy that may help.

Lane: Olfactory loss has been around before there was Covid. People have lost their sense of smell due to viruses, that’s a well-known entity. More than 10 years ago there was a series of studies that were published about olfactory training, which is a couple times a day, sniffing a series of odors, essential oils. Over a period of months improvement was seen in a patient’s sense of smell. It isn’t necessarily that it brings your sense of smell back to being normal, it’s just there’s evidence that it improves from what it was before you started doing it.  :29

Lane says persistent loss of smell, and loss of taste that frequently accompanies it, can compromise someone’s quality of life over time, so attempting to retrain this ability is likely worth trying. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Could using mouthwash help prevent Covid-19? Elizabeth Tracey reports

Using mouthwash may help reduce the number of Sars-CoV2 viruses in the mouth and throat and may therefore reduce infections. That’s at least the hypothesis being tested by one mouthwash manufacturer. Andrew Lane, an otolaryngologist at Johns Hopkins, comments.

Lane: The gist of that one was that you might be able to kill virus with mouthwash. It’s the same idea we talk about for the nose. We know that on surfaces you can disrupt the virus with soaps and with Betadine and those kinds of things. Whether or not it makes sense to put it in your body or in your nose or in your mouth it needs to be researched. I’m thinking that all those things the virus is fairly fragile, many things can disrupt it. It’s just really in practical terms how much of the viral load are you removing and is this really going to change the course of the virus.  :29

Lane says he’s had many many patients ask him whether they should use mouthwash to help reduce their risk for Covid-19, and he’s largely adopted an ‘unlikely to cause harm,’ approach. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Protein based vaccines are also being studied for Covid-19, Elizabeth Tracey reports

Even as several vaccine types are being rolled out against Covid-19, additional types remain in clinical trials and seem poised for wider use. Andrew Pekosz, a vaccine expert at Johns Hopkins, says one of these types is often referred to as protein-based.

Pekosz: Protein based vaccines, sometimes they’re called subunit vaccine, inactivated vaccines, these are the more tried and true approach that has worked since the days of polio vaccines. This is where you take the whole virus and treat it with compounds that make it no longer infectious. Subunit vaccines express just one or two of the proteins and then purify them and then give those. Protein based vaccines make some antibody responses but it doesn’t induce as strong and probably not as long of an immune response.  :32

Pekosz notes that all vaccine types have both advantages and disadvantages, so having choices especially for different populations of people, will help control the infection. At Johns Hopkins, I’m Elizabeth Tracey.