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Wednesday, 10 April 2019

Avoid Kidney stones are on the rise

All pediatricians have certain “speeches” they can do in their sleep — like the safe sleep speech, the potty-training speech, the healthy diet speech, or the speeches for managing fever, common colds, or vomiting and diarrhea. But research over the past few years has changed one of those speeches: the speech about starting solid foods.

I still say the same things about waiting until at least age 4 months to start (closer to 6 months is likely better, especially if baby is getting breast milk), and about not starting two new foods at a time (so as to know the culprit should baby get constipated or a rash). But now, there are three big changes to what I will say:

    Don’t give rice cereal. Rice cereal used to be my go-to starting food. It’s mild and babies usually like it, and you can add breast milk or formula until you get to a consistency that works well for babies new to the concept of food on a spoon. But then the Consumer Products Safety Commission came out with a report raising concern about the amount of arsenic that may be in rice and rice products (the rice plant is very good at pulling arsenic out of the soil, where it is often found because of arsenic-containing pesticide use). Arsenic can cause all sorts of problems, including an increased risk of cancer. The report said that babies who get two servings of rice cereal a day could double their cancer risk over a lifetime. Given that there are other kinds of cereal (like oatmeal), there is simply no reason to take that risk.
    Do give peanut products. This is a real turn-around. For years, we told parents not to give peanut butter or any peanut products until children were two or three years old, for fear of causing an allergic reaction. It turns out that we had it entirely backwards; a recent study showed that giving peanut products early can actually prevent peanut allergy. Of course, parents should talk to their baby’s doctor before giving peanut products if there is a family history of peanut allergy or if their baby might be at higher risk of food allergies for another reason (like having bad eczema or other allergic symptoms). You should also never give whole peanuts or chunky peanut butter. But some smooth peanut butter on a cracker, or foods that contain peanut, should be one of baby’s early foods.
    Make fish part of your child’s diet. And your whole family’s diet, too. I never used to talk about fish as a first food, but now I do. It’s full of important nutrients — and a study from Sweden showed that children who ate fish during infancy cut their risk of allergies by 25%. The researchers followed the babies in the study until they were 12 years old, and that reduction in risk was still there — with just two fish meals a month! We do worry about the level of mercury in fish, but two servings a week is fine, especially if you stick to fish that tends to be lower in mercury, such as tilapia, catfish, or cod.

Those are the three things I make sure all families do now. There is one other thing I tell families to at least consider:

    Skip the spoon and let baby feed himself. In baby-led weaning, parents and caregivers wait until the baby can hold food and feed himself (of course, it’s really important not to give anything the baby could choke on, and to closely supervise all meals and snacks). Doing things this way has three advantages: It puts off feeding until the baby is really ready (as opposed to when the parents are ready). It puts the baby in charge of how much he eats (a study from New Zealand found that this kind of feeding decreased the risk of obesity). It also brings baby to the table and encourages family meals, and family meals are good for the health, development, and behavior of children as they grow.

Every baby and every family is different, and there are lots of circumstances that might change your pediatrician’s advice for your child. Be sure to talk to your doctor to get the best advice for you. Stress is rampant, and high blood pressure (what doctors call hypertension) is on the rise. So it’s no wonder patients often ask if stress is causing their hypertension. We have no proof that stress alone can cause persistently elevated blood pressure. (Part of the reason is that high-quality studies quantifying stress are difficult to conduct.) But stress can certainly raise blood pressure, sometimes impressively. And stress reduction can lower blood pressure, frequently improving overall well-being. Deep, slow breathing is the oldest and best-known technique to decrease stress.

The relationship between stress and blood pressure Blood pressure regulation is highly dynamic, responding to many interacting factors, ranging from alcohol and sodium intake to sleep and hormone levels. Stress is a key player, with all sorts of stressors (on the job, at home, in the classroom) contributing to a rise in blood pressure. Stress revs up the autonomic nervous system. This system oversees processes generally not under conscious control, including blood pressure and heart rate, but also more mundane functions like sweating and flushing. The hormone adrenaline is a fundamental part of its response.

For much of human evolution, increased nervous system activity has been protective, preparing us to “fight or flight” in a crisis. But today this response is rarely needed, and can even be maladaptive. Most people exhibit some instinctive reactivity: for example, if you’ve ever heard a police siren while driving, you probably noticed a jump in heart rate. There is tremendous variability in how people respond to stress, however.  Many people have a highly reactive system. Their nerves and stress hormones can fire in low-pressure situations, like waiting in line or losing a button — and this isn’t always associated with a noticeable feeling of anxiety. Sometimes the nervous system even responds to worried thoughts alone.
Getting a handle on the stress response

Luckily, you can manage that stress response. Common prescriptions include exercise, laughter, and a good night’s sleep. We can also interrupt the acute response to stress by reconditioning our reactions to its triggers.

Simply taking a deep breath is one way to start. A focus on breathing lies at the core of various relaxation techniques. Yogis have incorporated slow breathing as part of meditation practices for centuries, and in the 1970s, the medical world formalized this connection when Dr. Herbert Benson first described the “relaxation response.”

Many of us recognize the value of “taking a deep breath” in everyday situations. Doctors often ask patients to breathe deeply before getting their blood pressure taken, for example, and mindful people may take a deep breath before responding to an insult. But it is also helpful to incorporate deep breathing in a daily routine, especially for “type A” or stress-prone personalities, with an added benefit on blood pressure.
How to get started with deep breathing

One beginner method is called equal breathing, based on inhaling through the nose for a count of four, and exhaling for a count of four. With time, this cycle can be prolonged to counts of eight in, eight out. Another method, called guided visualization, encourages users to hold on to mental images of a peaceful place as they breathe deeply.

There is only one non-drug treatment approved for hypertension by the FDA — a device called RESPeRATE. It uses musical tones to guide deep abdominal breathing. Its goal is to reduce the number of breaths to under 10 per minute, and to prolong each exhalation. Clinical trials have shown that daily RESPeRATE use lowered blood pressure, sometimes as much as a blood pressure pill would have. This lowering effect also lasted long after each session. Instead of a RESPeRATE device, you can always use one of several free mobile apps that teach deep breathing.

Deep breathing shouldn’t replace blood pressure medications, but it can be a helpful supplement. Its advantages are obvious: it is free, portable, and healthful. The only cost is time — ideally, 10 to 15 minutes daily. Adding guided breathing to your routine is a great way to lower your blood pressure while helping you handle the ever-growing stresses of modern life. It’s well known that defective BRCA genes can increase a woman’s chances of developing breast, ovarian, and other cancers. But these same gene changes can also increase a man’s risk of dying from prostate cancer.

Now, a new study published in The New England Journal of Medicine has shown that men with prostate cancer who test positive for BRCA mutations can benefit from an ovarian cancer drug developed for BRCA-positive women. On the basis of this finding, the U.S. Food and Drug Administration is accelerating its review of the drug, called olaparib, as a possible new prostate cancer treatment.

During the study, 50 men with advanced metastatic prostate cancer took olaparib tablets twice a day. Sixteen of them responded: their prostate-specific antigen levels fell by at least 50%, the number of tumor cells in their blood dropped sharply, and several had their tumors shrink by a third or more in size. Moreover, olaparib improved pain control and quality of life, with responses among some men lasting more than a year. “What was impressive was not just the magnitude of the response, but also its duration,” said Dr. Joaquin Mateo, an oncologist at the London-based Institute of Cancer Research and the study’s lead author.
How olaparib gets its noteworthy results

Olaparib kills BRCA-positive cancer cells by interfering with a DNA repair protein called PARP. And when olaparib-treated cancer cells can’t repair the damage that accumulates naturally in their DNA, they die.

Upon analyzing biopsy samples from the men in the study, Mateo and his co-authors found that responders were limited to men who tested positive for defects in BRCA and a few other related genes. What’s more, the defects in some of the responders weren’t inherited, but rather had developed spontaneously in their cancer cells. Mateo said that’s a critical finding, because PARP inhibitors like olaparib have so far been investigated only in patients with inherited BRCA mutations. “Our trial suggests that many more patients might benefit from the drug, including those who develop DNA repair defects later in life,” he said.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, said the findings are promising for the roughly 30% of men with prostate cancer who have DNA repair defects. “Olaparib could provide another, much needed treatment option for many men with advanced prostate cancer,” he said. In the past, medical textbooks described the typical person unlucky enough to develop a kidney stone as a white, middle-aged, obese man who eats an unhealthy diet and doesn’t drink enough fluids. Those books may need an update.  A new study has found not only that the incidence of kidney stones is going up, but that they are also developing in people not considered high-risk in the past, including children, women, and African Americans.
Why stones?

Kidney stones develop when certain chemicals in the urine, such as calcium or uric acid, form crystals. Risk factors for stone formation include

    diet, including high intake of animal protein, sodium, and sugar, as well as low intake of fluids
    certain conditions, such as gout, diabetes, and obesity
    some medications, including calcium supplements
    family history and genetics — kidney stones can run in families, although the specific contributions of shared genes versus shared environments and diets are uncertain.

While a specific cause may be impossible to identify, kidney stones are common, affecting about 19% of men and 9% of women by age 70.
Do stones matter?

Occasionally, kidney stones are discovered incidentally and pass on their own, never causing symptoms or needing treatment. But, when they become stuck somewhere, they can cause pain or blocked urine flow. They can become lodged anywhere in the urinary system, including the kidney, the ureters (the narrow tubes connecting each kidney to the bladder), the bladder, or the urethra (the passageway between the bladder and the outside world). As you might have heard, “passing a kidney stone” can be agonizingly painful — that’s usually when it’s become stuck in a ureter.

In addition to pain and urinary problems, kidney stones can also cause bleeding and kidney damage. They can increase the risk of a urinary tract infection and have even been linked to cardiovascular disease. So, the answer is — yes, they do matter.
This just in

A study just published in the Clinical Journal of the American Society of Nephrology describes an analysis of more than 150,000 people in South Carolina who experienced kidney stones at some point between 1997 and 2012. The study’s major findings were:

    The frequency of kidney stones increased 16% over the study period.
    The biggest increases were among children, women, and African Americans.
    While more men than women had kidney stones (as has been noted in the past), women outnumbered men among those under age 25.

Why the rise?

This study and past research have not been able to determine the reason kidney stones seem to be on the rise. The rising rate of obesity may be playing a role. Another possibility is climate change, as warmer temperatures encourage dehydration. The fact is, no one knows for sure.
What’s a person to do?

If you have symptoms of kidney stones, see your doctor or report directly to an emergency room. The most common symptoms are waves of pain in the back or lower abdomen, pain with urination, or blood in the urine.

If you’ve already been diagnosed with a kidney stone, it’s important to figure out why it happened (if possible) and take steps to avoid recurrence. See your doctor to discuss dietary measures and medications to take (or avoid). The details vary depending on the type of stone you had and the results of your blood and urine tests.
What now?

We need more research to understand the reason — or reasons — kidney stones are becoming more common. If we can figure it out, there’s a good chance we can find better ways to prevent them. Considering how painful and potentially dangerous kidney stones can be, prevention is key. Ask anyone who has had one: kidney stones are definitely worth avoiding if possible.

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