All posts by:empress

  • August 16, 2018

    The Top Five Things You Don’t Know About Stem Cells

    Girl Meets Stem Cells: A Short Story

    Y’all know the little career interest boxes they make high school students designate on standardized tests? As if fourteen year olds should really know what they want to be doing 30 years later. Well, when I took the PSAT, a million or so years ago, there was an option for bioengineering, and I had never heard that term before. So naturally, I checked it and never looked back.

    I correctly assumed that bioengineering would be the discipline in which smart people figured out what to do with stem cells, and I was obsessed with stem cells and the problems they would solve in my lifetime. At the time, the only stem cells I knew were embryonic stem cells, but the press was super convincing:

    Embryonic stem cells can grow any tissue in the human body!

    Embryonic stem cells can cure cancer!
    (fact: they were actually causing cancer)

    Embryonic stem cells will make you more popular and social!
    (that was just a lie I told myself while hiding in the back of the AP chem classroom, but I think it was totally helpful)

    As a person of adult age but soundly teenaged disposition, I have had to face this shocking but ultimately fantastic truth about stem cells:

    The majority of stem cell media coverage will lead you to completely incorrect conclusions about them.

    So today I’m covering the top five things you don’t know about stem cells but really should. Before I get into that, just to be clear, embryonic stem cells, and in fact all stem cells, will not make you more popular and social, no matter how fantastic a Disney movie that premise would make.

    Now that I’ve cleared that up, let’s move on to the top five things you don’t know about stem cells but should!

     1. There are as many different kinds of stem cells as there are flavors of ice cream.

    The term “stem cell” is as broad as the term “doctor.” In fact, the definition of a stem cell only provides two defining characteristics: they can make copies of themselves (self-renewal), and they can turn into a different kind of cell (differentiation). There are literally hundreds of different types of cells that meet this definition. Embryonic stem cells that can make exact duplicates of themselves OR turn into literally any cell type in the body. Hematopoietic stem cells can clone themselves OR turn into any blood cell. Mesenchymal stem cells, my personal favorite, along with making their own copies, can turn into connective tissue, cartilage, bone, and fat tissue.

    Every type of stem cell has unique properties that make them suitable for very different applications. A hematopoietic stem cell is great as a part of leukemia treatment, but it’s as useless at bone healing as I am at break dancing. Neural stem cells can become new neurons and glial cells, which may one day be an incredibly powerful tool in the treatment of neurological damage. But you probably won’t want to use them to fix that bald spot you swore you wouldn’t inherit from your dad.

    Each different type of stem cell functions correctly in a specific environment. Embryonic stem cells need the very specific environment only found in utero. If they are applied outside of that environment in a place where they cannot receive the intricately measured, timed, and delivered signals they need, they almost always cause a type of cancer called a teratoma. As I’ve explained a million times – embryonic stem cells are like adventurous children. If left to their own devices with no supervision, they’re probably going to play with matches and burn the house down. But, with the right signals (the ones only found in utero), they can make it out of childhood and become overly sarcastic scientists instead.

    Mesenchymal stem cells, a type of adult stem cell, are primed to function in the human body at all ages – from infancy to your centennial years. Since their natural environment is your body, at whatever age you are, they do what they’re supposed to do when used in your body. That’s why my co-authors and I titled our review paper, “Mesenchymal Stem Cells: Environmentally Responsive Therapeutics for Regenerative Medicine.”

    It’s incredibly important that anyone attempting to use stem cells in the treatment of any human injury or pathology chooses the right stem cell for the job. Nobody who ever needs brain surgery thinks, “I’ll just have this podiatrist down the street do it. A doctor’s a doctor, right?”

    So when you hear the term “stem cell” you should always ask – what kind of stem cell? And so should every media outlet that covers stem cells, especially when people have done irresponsible things with them. The type of stem cell matters, and in my experience, when people choose to do irresponsible things with stem cells, it is because they don’t understand the most basic properties of stem cells, including the most obvious fact that all stem cells are not created equal.

    For more information on the kinds of stem cells, including which ones are used in clinical practice right this moment, in this country, read this post that I haven’t written yet but will. Check back later for a live link, or join the email list!

    2. Stem cells live in almost every tissue in your body.

    Yes, your adult human body. They’re in your brain and in your muscles, in your bones, in your heart, and even in those jiggly parts you can’t lose without giving up carbs. Your body is literally chock full of stem cells at this very moment.

    What does that mean?

    It means that you and I are probably going to see some really wild stuff happen with medical advancements in the next 10-20 years. Most of my friends have heard me say this, so apologies to everyone who already knows: I fully expect to live to 120 and do handstands and cartwheels the whole time.

    Because of stem cells.

    #WhatATimeToBeAlive

     3. Embryonic stem cells are the most useless kind of stem cells.

    Say whaaaaat?

    I’ll say it again. Embryonic stem cells are the most useless kind of stem cells. For now at least.

    You shouldn’t take my word for it though, so let’s break it down. Most of the applications in which we, living, breathing, hashtagging humans would want to use stem cells involve replacing or repairing some tissue inside our bodies. That means the stem cells would need to stay and live happily in our bodies.

    You know who has a lot to say about what stays and lives happily in your body? Your immune system. It has two basic jobs: (1) distinguish between your body and not your body, and (2) destroy and eradicate anything that qualifies as not your body.

    Now, are you an embryo?

    If you are, and you’re reading this, mazel tov – you’re probably the great white hope of this universe, and I hope you grow up to be kind and just funny enough to laugh at yourself all through middle school.

    For the rest of you, you’re not an embryo. Even if you’re in the reading audience identifying as your spirit animal instead of a human, you’re not an embryo. Unless your spirit animal is an embryo, in which case we need to talk about all the other possible spirit animals you could have chosen. White tigers, unicorns, mermaids, leviathans (because I still have nightmares about that movie), those teacup raptors from every Jurassic Park movie, and REGULAR RAPTORS. But I digress.

    Assuming you are not an embryo – if someone were to put embryonic stem cells in your body, what would happen? (Other than them doing their best to form a teratoma)

    Your always on, omnipresent immune system would recognize those cells as not your body. Then those not your body embryonic stem cells would be labeled with the molecular equivalent of giant flashing lights that say “DESTROY ME IN THE MOST VICIOUS WAY POSSIBLE IMMEDIATELY.” And then your immune system would do its job and kill them.

    So ignoring the fact that we still aren’t great at telling embryonic stem cells which type of cell to turn into, ignoring any of the many passionate views people have about them for personal/religious/financial reasons, embryonic stem cells are the most useless type of cells because they are not your cells. And as such, they can’t live in your body without copious amounts of immune suppressing drugs, just like an organ transplant.

    Important Note: There is a specific type of embryonic-like stem cell made from your own body that may turn out to be the next great advancement in medical science. I’ll cover them in detail in another post, because there’s way too much information about them and way too many cool things being done to cover them in this post.

    4. Clinical stem cell treatments are available in the United States, right now, and they DO NOT cost $50,000 – $100,000 cash.

    I have personally assisted hundreds of adult stem cell cases using mesenchymal stem cells from bone marrow. No, I was not there for procedural assistance. I’m not a medical doctor, y’all. Do you know how much med school costs???

    Because I’ve personally seen these cases, I know that there are hundreds if not thousands of qualified, trained physicians specializing in orthopedics, spine, pain management, obstetrics, aesthetics, and even some general practitioners who offer treatments utilizing adult stem cells from the patient’s own bone marrow. So why haven’t you heard of this yet?

    Believe it or not, doctors aren’t great at marketing, nor do they really learn much about it in med school. So most of them are depending upon word of mouth, or their favorite scientist, to get the word out.

    I say most, because there are some who are fantastic at marketing. They also often happen to be people who are charging what I would label as highway robbery prices. In this particular story (<– click the link), you see that one patient paid $30,000 for a stem cell treatment (administered in Mexico, which is a whole other issue).

    That’s not normal.

    You do not need to go to another country, and you do not need to pay tens of thousands of dollars or mortgage your home to get a legitimate stem cell treatment. I’ll do a separate post on which treatments are clinically sound and which you should avoid at all costs, because I could write an encyclopedia on that topic. For now, let’s just focus on the average and reasonable costs for adult stem cell treatments from bone marrow. For a single procedure, let’s say the most common – a knee arthritis treatment, you’re looking at an average cash price of about $5,000. Some places will be a little more, some places will be a little less.

    Where are these places? There’s this one in Colorado, this other one in Colorado, this one in Dallas, this one in Portland, this one in Cleveland, this one in Tyler, and a whole slew of others that I don’t have the time or space to list on this page.

    You know what else is awesome? Just last month, an insurance company announced that they will begin covering bone marrow derived adult stem cell treatments as a way to provide better care to their customers. You can bet that more will follow, and I predict that within three years, all major insurers will have jumped on this band wagon. These kinds of treatments are better for patients, and they’re actually about 1/5 – 1/10 of the cost of currently available and covered treatments.

    5. Stem cells are not magic. Stem cells are science.

    If you’ve attended any of my presentations, you’ve heard me say this ad nauseum. Stem cells are not some kind of magic bullet panacea that will fix anything we throw them at. When physicians (or people posing as them) assume they are, people get hurt, sometimes irreparably.

    In order to use their powers for good, we (the scientific and medical community) have to educate ourselves on the mechanisms by which stem cells can or could treat a particular injury or pathology. We need to consider the environment from which they are coming as well the one in which they will be placed. We need to read up on the literature. We need to understand how this group grew cartilage with their patient’s bone marrow derived stem cells, and how this doctor treated osteonecrosis with them. We need to appreciate the science behind this doctor’s treatment of fractures that wouldn’t heal.

    There is a wealth of information on stem cells, a 30+ year history of safe and effective use of bone marrow derived stem cells in orthopedic treatments, and textbooks full of information on why this particular cell type seems to work so well.

    Do we have all the answers?

    Absolutely not.

    But do we have enough of them to make operating in the dark, closing our eyes and hurling them at macular degeneration or cerebral palsy, inexcusable?

    Absolutely.

    When we embrace the knowledge behind stem cells, everyone wins.

    And that, y’all, is science.

    Image adapted from ZEISS Microscopy from Germany [CC BY 2.0], via Wikimedia Commons

  • August 8, 2018

    References Matter | Click The Links!

    Y’all, one of my favorite people called me yesterday and reminded me to discuss my references soapbox. I can’t believe I haven’t done it yet, because standing on a soapbox is literally the only time I make it to average height.

    Here’s what’s up:

    There are metric tons of misinformation in the media, especially the mother ship of fake news, social media. Most of that misinformation is actually pretty easy to recognize, because it’s not supported with any real references.

    What do I mean by “real references”? Let’s break it down.

    Real References Are Peer Reviewed

    First of all, Gwyneth Paltrow’s blog is not a real reference. I’m pretty sure she doesn’t know that bacteria are actually necessary for our survival, so her 3 am epiphanies about feminine hygiene do not qualify as legitimate information.

    Now, there’s no real way to ensure that any piece of scientific evidence is 100% bulletproof. But the scientific community has several principles that ensure we get as close to bulletproof as possible over time. The first of those principles is peer review. You can read the different takes on peer review from Wikipedia, Elsevier, and Wiley, but they all say essentially the same things.

    Peer review maintains standards of quality, improves the science, and provides credibility for published data.

    The process is pretty simple. An investigator (scientist, doctor, enterprising fifth grader) documents how they did an experiment, their results, and what they believe those results mean. They then submit that documentation to a scientific journal. If the submitted information is strong enough, the journal shares it with individuals who are knowledgeable in the area of investigation. Those individuals (peer reviewers) then go through the entire document with a fine toothed comb. If they find a problem with the manuscript, they send it back to the original investigator for additional experiments, revised conclusions, and any number of other modifications intended to increase the quality of the information.

    Peer Review Rejects Flawed Attempts At Science

    Most publications are not accepted for publication without changes, and the vast majority will go through at least two rounds of revisions before the reviewers deem it high enough quality to share with the world.

    And – the scientific community actually rejects a significant portion of submitted manuscripts for scientific shortcomings. This applies only to situations in which the reviewers find scientific shortcomings too serious to be fixed through the process of peer review, but it happens fairly often. It also protects the integrity of published information by preventing mass-distribution of incorrectly reasoned or executed experiments.

    Real References Include Statistics

    Listen, I hate statistics too. Believe me. But much like a Good Housekeeping seal of approval or a great score from Consumer Reports, statistics help us determine whether or not we can trust data.

    Let’s say you’re doing an experiment. You want to see if fifth grade girls carry the same amount of gum as fifth grade boys. You bump into one fifth grade girl who has 2 pieces of gum, and one fifth grade boy who has 4 pieces of gum.

    At first blush, it seems like you could say that fifth grade girls do not carry the same amount of gum as fifth grade boys. But this is where statistics would help. If you did a simple test on your data, you would find out that your data is not significant – i.e. statistics say that the 2 pieces of gum for the girl and the 4 pieces of gum for the boy aren’t necessarily different. Probably because your sample size – i.e. the two kids you polled – was too small.

    Now, if you expand that experiment to polling 500 fifth grade girls and 500 fifth grade boys, you might find out that girls have 2.3 pieces of gum on average. And boys have exactly 3 pieces of gum on average. Well those two are actually closer than our first small poll, right?

    But statistics takes into account the fact that your second poll involved 1000 kids instead of just two. And then statistics say that the difference between 2.3 pieces of gum is significant. Statistically significant.

    That’s an important phrase – statistically significant. It’s your neon flashing light saying “this data matters.” You don’t have to know what a p-value is or a chi squared test. You can even skip right over t-tests and quartiles. All you really need to know is that published data with real value is statistically significant. And the authors will usually come right out and say, “our results were statistically significant.”

    Statistics involve many more subtleties, and I refuse to execute that deep dive until someone requests it.

    Because I hate statistics too. I just know they’re necessary. Like doing laundry and not wearing yoga pants to work.

    This Blog Includes References and Statistics

    Sort of. I absolutely include references. Any time you see me mention a study, a researcher, an investigator, the word is a link to the study. Every single time. If ever you can’t find a link, that’s a mistake. So let me know, please!

    I will not include the actual p-values and statistical information you might find buried in the scary parts of my dissertation. If you want information like that, please find the mustiest part of your local university library and go nuts. Or click the links to the studies.

    In this blog, I will include statements about statistical significance. Like in this post, where I say there is a “real statistical difference” between the two groups of women tested. Or in this one where I make several statements including the fact some data was not statistically significant.

    Reliable Data Can Be Repeated

    When a scientist is lucky enough to achieve statistically significant results, either through a deal with the devil or a well-designed experiment, the data still isn’t beyond question. Once published, other researchers around the world execute their own similar experiments, building on or directly repeating the original experiment.

    That’s how people discover what turn out to be the biggest scientific scandals ever. Bunches and bunches of scientists repeat experiments without arriving at the same results as the original publication, and then the internet yells about it. A lot. All leading to the giant discovery that either someone lied about their original data, or they left important information out of their methods.

    Repeatability also leads to what we call scientific consensus. Science Moms actually do a pretty great commentary on the value of scientific consensus in this video. The gist is that over time, scientists all over the world repeat and build upon previously published data. Eventually the scientific community as a whole arrives at a consensus, an accepted agreement that the original data is valid. Because. So many people directly reproduced it or built further data upon the validity of the original data.

    Is This Reference Legit: A Checklist

    As you’re scrolling through Facebook, wondering why your grandmother posts so frequently about the health benefits of red wine, use this checklist to decide if grandma knows her stuff.

    Or is just an apologetic wino.

    • Is there a reference for the stated “facts”?*
    • If so, is that reference peer reviewed?*
      • Not sure?Go to PubMed and search for it. If it’s in PubMed, it’s probably peer-reviewed.If it’s not in PubMed, try Googling the publisher. If it’s a legitimate journal, they will have a site and an explanation of their peer review process.No site, no explanation of peer review? Not legitimate.
    • Does the reference say the results were statistically significant?*

    If you answer yes to all of the starred question above, the reference is probably be legitimate. As with all things, there are exceptions. But this list will get you to the right conclusion 95% of the time.

    Not sure if a reference is legit? Don’t have time to check it out yourself? Just do what my fabulous friends do, and ask me in the comments or send me a message!

    Photo by Sunyu on Unsplash

  • August 1, 2018

    Does Pregnancy Accelerate Aging?

    URGENT DISCLAIMER: I have never been pregnant, so I have no personal experience with any of the real life side effects of pregnancy. I am in awe of those of you who do. Several of my brave friends have shared a few choice tidbits, which is how I know that pregnancy is not for the faint of heart. Well, that and a lot of science.

    Anyway, the reason for this post is a recently published study in which the authors have boldly declared that pregnancy does in fact accelerate the aging process. This is what they’ve titled their study:

    Reproduction predicts shorter telomeres and epigenetic age acceleration among young adult women

    I can already hear my friends – of course pregnancy accelerates aging! Because it ends in children, and children give their parents gray hair and heart disease. They’re always finding that one outlet you forgot to cover, mouth kissing the dog, and discovering their acrobatic skills on the second story balcony, precariously balancing twelve feet from the concrete floor that now seems like more of a health hazard than a “sleek feature for the modern homebuyer.”

    And also, our mothers have been loudly beating this concept into our brains pretty much since birth.

    But science says (1) your mom was right (Take a moment to get your arms around that. If you’re struggling, remember that no one can make you tell your mom that she was right.), and (2) babies actually do even more to steal away their mothers’ youth*.

    How exactly do they accomplish this? Well, first, take heart. Your baby isn’t using it’s tiny fingers to damage your DNA. Technically, your body is doing that. The biochemical processes involved in pregnancy shorten the ends of your chromosomes and they alter a process involved in DNA traffic management*, both of which contribute to aging at the cellular and molecular levels.

    Telomeres Keep Your DNA Young

    Your genetic material hangs out in chromosomes, the three-dimensional DNA sculptures found in the nucleus of each and every one of your cells. Every time a cell replicates, and most of the cells in your body do that pretty frequently, it copies that DNA and passes it on to the new cell. For the process to go off without a hitch, the cell uses a complicated system that I’m going to grossly oversimplify and probably offend any molecular biologist who stumbles upon this post. But, if you’re not a scientist, you’ll get the take-home message. And that’s why I’m here.

    Imagine that your chromosome is just a straight line, not a complicated three dimensional shape. At the end of that straight line is a little tail that we call a telomere. The telomere exists to make sure that your DNA is copied completely and faithfully, so that you don’t lose any important information toward the end of your DNA strand. The DNA copying process looks kind of like this:

    telomeres shorten during pregnancy

    It takes TONS of cycles (yes, that is the technical scientific term for it) of cell division for telomeres to get short enough to cause real problems in your cells. But, when that happens, the problems are very real. The cell with the short, sad telomeres (or none at all) will enter a phase called senescence, which basically means that the cell stops working correctly and may die.

    Fortunately for most of us, our bodies make this cool enzyme that adds pieces back to our telomeres after they’ve been lost. Kind of like when you lose your favorite t-shirt. You think you’ll never see it again, but then it turns out your mom just sewed the sleeve back on for you, and you get another 15 years with it.

    So, what does that have to do with pregnancy and aging?

    Pregnancy Shortens Telomeres*

    Yep, this study investigated a group of women, average age 27 years old, who had experienced varying numbers of pregnancies. Here’s the breakdown:

    0 Pregnancies | 507 Women
    1 Pregnancy | 174 Women
    2 Pregnancies | 102 Women
    3 Pregnancies | 28 Women
    4 Pregnancies | 7 Women

    When they analyzed the effects of pregnancy on telomere length, they found that each additional pregnancy generated between 0.34 and 3.67 years worth of telomere aging. This finding was determined after controlling for other variables like age. So it wasn’t just that older women were more likely to have been alive long enough to have three pregnancies. There was a real, statistical shortening in telomere length as a result of additional pregnancy.

    These researchers found something else kind of interesting. Additional pregnancies don’t seem to affect future fertility.

    So even though each pregnancy ages mom’s cells, it doesn’t seem to affect her ability to inflict that damage on herself again with another pregnancy.

    Pregnancy Changes Your DNA*

    Sort of.

    This study also investigated the effects of pregnancy on something called DNA methylation, which the video below hilariously explains.

    Basically, methylation alters the parts of your DNA that can be expressed. It doesn’t add or subtract information, it just hides or shows it. Kind of like when you’re supposed to be reading your history book but you’ve put Harry Potter inside your history book. You’re not learning history, but the information is still there for when you’ve had enough Hogwarts for the day. I know there’s no such thing. Just use your imagination.

    Back to this methylation issue.

    Your cells run into a lot of problems when methylation gets in the way of their normal functions.

    The researchers in this study assessed what they call DNA-methylation age, and it turns out pregnancy affects that too*. Each additional pregnancy in the study increased DNA-methylation age by between 0.29 and 0.63 years. 

    What Does It Mean?

    Don’t start blaming your children for the fact that you can never find your sunglasses just yet. Unless they’re relentless little kleptos, in which case, please carry on as usual.

    For the rest of you, as is often true in science, one study is not definitive on its own. At least not for the whole population.

    Another study from 2017 looked at the same basic concepts, and you know what they found? Something completely different.

    The CARDIA Study actually began in 1985 and has been conducted exclusively in the United States. At the 20 year follow-up point, 72% of the original 5115 subjects were still reporting their data, which is kind of amazing in and of itself. #GeekMoment

    More interesting to me is the fact that this study found no relationship between number of pregnancies and telomere associated aging.

    Note: The study at the beginning of this post was done in the Phillipines.

    Given the conflicting information between these two very different populations of women, I’d venture to say that pregnancy does age your cells. If you happen to live in the Phillippines and possibly other places in which the conditions of pregnancy create the same cellular conditions.

    No Really, What Does It Mean?

    Well, we know women in the Philippines experience aging at a genetic level during pregnancy, adding years to the state of their genetic code. We also know that the same isn’t true for women in the United States.

    So what’s the moral of this story? If you’re going to have a baby, and you’re choosing between pregnancy in the US or in the Phillippines, choose the US.

    It’s science, y’all!

    *All starred statements only apply to the subjects of the Philippines study.

    Also, scientist gripe: that study title was all kinds of wrong. For science. Here’s an appropriate modification:

    Reproduction predicts shorter telomeres and epigenetic age acceleration among young adult women IN THE PHILIPPINES

    #NailedIt

    Photo by Arteida MjESHTRI on Unsplash

  • July 27, 2018

    Is Your Antiperspirant Poisoning You?

    “I stopped using antiperspirant yesterday, y’all.”

    #TopThreeThingsYouDontWantToHearInACompactCarCarryingSixAdultHumans

    Yes, that is one of the many terrible things I’ve inflicted on my family over the years. I explained that my motive was not ice cold revenge for that time (27 years ago) I paid my brother $20 of hard-earned chore money for the GodMode cheat code in Duke Nukem only to have him erase the game two days later. Nope. As heartbreaking as it was, I had recently learned that the active ingredient in antiperspirant, the magic bullet I credit with getting me through some of my most aggressive social anxiety as a teenager, was linked to Alzheimer’s disease.

    As a perpetually anxious perspirer (spellcheck says that’s not a word, but I’m making it a word #IDoWhatIWant), I was beyond reluctant to give up my antiperspirant. It was almost as vital to my survival as coffee. And I am a coffee before people person. Still, the specter of early onset Alzheimer’s weighed more heavily in my (sort of) still functioning brain.

    So I did what I always do and turned to PubMed to investigate. After all, one study doesn’t make it science. Sometimes one study just makes it an accident, or a data analysis error. I hoped.

    Know what I found in PubMed, and what you would find? This terrifying statement:

    … aluminum is a widely recognized neurotoxin that inhibits more than 200 biologically important functions and causes various adverse effects in plants, animals, and humans

    and also this one:

    Aluminum, the most abundant metallic neurotoxin in the biosphere, is an extremely pro-inflammatory, pathological and genotoxic element that is particularly deleterious to the normal homeostatic operation of brain cells.

    These are just the tip of the iceberg. And, they’re from peer reviewed scientific publications. These aren’t my mom’s favorite crunchy granola blog telling you to wear a magnet headband to banish stress dreams. They are scores of scientists talking about aluminum, the thing that snaps your sweat glands shut, as an incredibly powerful, cell killing substance with a special attraction for your brain cells.

    I know what you’re thinking. Is this something I really need to worry about? Wouldn’t there be some kind of warning from the FDA or the CDC by now? No, no there would not. In order for the FDA or CDC to make a pronouncement about the negative health effects of something in widespread use with far-reaching financial implications for stakeholders who make millions of dollars of political contributions, you need to have a smoking gun, four eye-witnesses, DNA evidence, and a time-stamped, live broadcasted video of the substance in question murdering a bunch of people.

    So how can we know whether or not to embrace the nauseating musk of our ancestors who never lived without the possibility of spontaneous pit stains?

    We investigate the science.

    Aluminum Is Elevated In Alzheimer’s Brains… ?

    No, the ellipsis question mark is not a mistake due to my own personal aluminum exposure. It’s a punctuationary embodiment of the disagreement within the scientific community over the years. In 1996, this group of scientists called their paper, “Content of brain aluminum is not elevated in Alzheimer’s disease.” For scientists, that’s the equivalent of, “Obviously aluminum is not involved in Alzheimer’s, you idiots.” But it contrasts starkly with recent findings in the field, likely due to the development of advanced aluminum measurement tools.

    And y’all, that’s something about science that we all have to kind of accept. Sometimes our initial findings are WRONG. They’re wrong, because we had terrible tools or didn’t understand that our results were contaminated. We are always learning new things, and those new things often invalidate older findings. That’s the nature of science. #ItsScienceYall

    Anyway…

    In the publication I initially stumbled across, a group of scientists in England found that, in 60 human brains (an admittedly small sample size) with 700+ tissue samples, the median aluminum content was about 1 microgram of aluminum per gram of brain tissue. In another study of Alzheimer’s only brains, the same research group found what they termed extremely high levels of aluminum – some more than ten times the “normal person” median discovered in their earlier study.

    The sample sizes in both studies were relatively small in light of the almost 7.5 billion people in this world. But, they still begin to demonstrate a correlation between aluminum in the brain and Alzheimer’s. Of course, correlation is not causation. But these aren’t the only data points we have. Let’s take a quick tour of a few others:

    With all that information, it’s not surprising to discover the quote below while scanning the literature:

    However, recent reports concerning sporadic AD and environmental and occupational exposure to aluminium have allowed the conclusion to be drawn that, under certain conditions, it is inevitable that aluminium will contribute towards Alzheimer’s disease.

    As a scientist, I’m going to admit that the above statement, though pulled directly from this publication, is an opinion. There is no evidence as yet to indicate a direct causal link between aluminum and Alzheimer’s disease.

    BUT

    Is there enough evidence, combined with the widely accepted fact that aluminum is a neurotoxin, to make this scientist limit aluminum exposure?

    Absolutely yes.

    Limit Your Aluminum Exposure – All The Cool Kids Are Doing It!

    Before I jump in here, let me say it one more time: there is no definitive data indicating that aluminum causes Alzheimer’s disease. There is just a lot of correlation between the two. Because of that correlation, I personally made a choice to limit my aluminum exposure. I want to continue annoying the crap out of my brothers for as long as possible, and that means I need to stay at the top of my game.

    So how can we minimize aluminum exposure?

    According to various  sources, including the European Food Safety Agency, the largest exposure risks come through food, specifically breakfast cereals, pots, pans, aluminum foil, and aluminum cans. I have a bit of a hard time with that due to the fact that aluminum testing of canned drinks reveals a content of between 0.1 and 74 ppm. So… 74/1,000,000 of a canned drink is aluminum. Besides, most aluminum cans are lined with something else we apparently need to worry about. But we’ll talk about that in a later post.

    By my estimation, as well as this publication, the things we really need to avoid are antacids, allergy shots, dialysis, and industrial air, but I also choose to avoid antiperspirants. They carry 25x more aluminum than water and 50% more than a vaccination, and most people use them daily if not multiple times daily.

    If you Google this topic, you’ll probably stumble upon a few articles, some from reputable places, that will tell you there’s nothing to worry about with your antiperspirant. Carry on as usual. None of that aluminum can get through  your skin anyway, silly!

    Spoiler Alert: that’s not true!

    Antiperspirant Can Get Through Your Skin

    The argument against antiperspirant as an aluminum exposure risk hinges on the concept of your skin as a physical barrier. So putting something on your skin couldn’t possibly expose the interior of your body to it, right?

    Have you ever used topical anesthetic or Icy Hot? Do you think that stuff is making your skin numb (or psychotically alternating between hot and cold) through psychokinesis and good intentions? It’s not, I assure you. It is being applied to your skin, passing through it, and getting right down to your nerves, where it prevents them from sending information to your brain. Passing materials through your skin is actually a really common mode of drug delivery. Think about those old school birth control patches, nicotine patches, anti-nausea patches.

    Usually when a scientist or physician is trying to pass a therapeutic substance through the skin, it needs to meet certain criteria (smaller than 500 kD). Not everything will pass through, that’s true. But, it’s actually a well-accepted phenomenon in the dermatology world that many of the substances we believe should not get through the skin do sneak in somehow. Even some that are 100 times larger (or 1000!)  than the aluminum salt found in antiperspirant are known to ninja their way through and exert effects on cells several layers beyond the external skin barrier.

    So, should we trust someone who makes the blanket proclamation that something applied topically can’t possibly get through to your skin simply because skin is a barrier?

    No, y’all, we should not.

    Because that’s kind of like saying, “My kids won’t throw a party while I’m gone this weekend, because they’re supposed to be studying and doing the dishes.”

    I have cleaned up after that party.

    So if you put aluminum on your skin, it is likely that you are putting at least some aluminum in your body. Is it more than the safe level? That’s hard to say. But wouldn’t you rather err on the side of not Alzheimer’s?

    Me too.

    You Don’t Have To Embrace The Musk

    Don’t despair just yet though. Abandoning antiperspirant doesn’t mean you have to embrace agoraphobia. There are options. You just have to (1) ensure you are grabbing something that DOES NOT say ANTIPERSPIRANT. Because if it does, it has aluminum in it. For sure. And then (2) pick something that smells good enough to make you believe it’ll survive your day.

    I’ve tried a lot of different things, and this is what I know. None of these work as well as antiperspirant. That’s just the truth. But, there are a couple that work almost as well and don’t contain ingredients that I think will contribute to any cognitive decline or an inexplicable desire to listen to Nickelback non-stop.

    1. Primal Pit Paste | Jasmine
      This stuff smells nice, and works pretty well. The essential oils can irritate your skin if applied directly after shaving though.
    2. Schmidt’s Deodorant Stick | Rose + Vanilla
      I can’t smell the vanilla in this at all, which is great, because I wouldn’t be a fan of smelling baked goods all day. But, it is hands down my favorite for scent, efficacy, and low tendency to irritate skin. And that’s saying a lot for someone who sweats as much as me (from all the cardio, y’all).
    3. Tom’s of Maine | Unscented
      I have a love hate relationship with Tom’s deodorant. I love it because it’s super kind to skin. I hate it because it always ends up smelling weirdly like lemongrass, no matter which flavor I buy. Still, I keep some on the shelf for days when my skin is feeling extra stabby.

    One last thing – if you absolutely can’t survive without antiperspirant, and it’s so life altering that even a causal relationship with Alzheimer’s wouldn’t sway you, that’s cool. You do you. But maybe try to alternate. Don’t wear antiperspirant every day. Do what you can to limit the amount of high aluminum content you’re slathering all over your skin.

    And I know this post isn’t about antacids, but y’all, don’t eat them like candy. It seems like that’s a terrible idea. OR, know what makes a great antacid? Blue Bell Homemade Vanilla Ice Cream.

    That’s not science though. Unless we do a study on it…

    Aight – that’s it for me today. If you’ve tried life without antiperspirants or have a great zero aluminum deodorant, please share that awesome info in the comments!

    Photo by Becca Matimba on Unsplash

  • July 1, 2018

    Are Female Doctors Better?

    Female doctors are better than their male counterparts under some circumstances, at least according to a study currently making the media rounds.

    No, seriously. According to science.

    Alright, don’t harpoon me for being an angry, militant feminist just yet. Let’s talk about this study first, and then you can be the judge.

    First, a little context.

    Women Are At Higher Risk Of Death After Cardiac Events

    This is a real thing, y’all. Women were twice as likely to to die after hospitalization for a heart attack in this study (from 1996). And the authors noted that women were generally not treated as aggressively as men. I.e. they were half as likely as men to undergo some of the more invasive but lifesaving procedures. <– statistically significant

    Women and elderly people received primary percutaneous coronary intervention – aka lifesaving procedure after heart attack – less often and later than men in this more recent study. <– statistically significant

    In another study, younger women and those with a specific arrhythmia were more likely to develop prehospital cardiogenic shock and less likely to be prescribed “evidence-based treatment at discharge.” <– statistically significant

    This one’s a bit of a head scratcher for me. Women were literally discharged without prescriptions, the same prescriptions that men with similar pathology were given. I honestly can’t imagine what’s responsible for that, but I’m sure some fancy psychologist can figure it out.

    Anyway, my point here is that science supports the idea that women really are at higher risk of death, and, honestly, receiving sub-standard medical care after a cardiac event.

    But that’s not the point of this post.

    Female Doctors (General Internists) Have Lower Readmission And Death Rates

    In unearthing the fact that women are at higher risk than men after cardiac events, researchers wondered what it meant about the treating doctors. What caused this gender disparity? So they did a little digging and looked at WAY more data than I ever want to. Thank goodness these researchers didn’t feel the same way though.

    In 2017 a group of investigators affiliated with Harvard Medical School published data examining a physician’s effect on patient mortality and their likelihood to return to the hospital. They included over 1.5 million individual hospitalizations, 18,000 female doctors, and 39,000 male doctors.

    Patients treated by female doctors were less likely to die (11.07% for female doctors vs. 11.49% for male doctors) and less likely to return to the hospital after treatment (15.02% for women vs. 15.57% for men). Both of these data points were statistically relevant, even though the raw difference was only on the order of 0.5% for both patient death and return to hospital.

    To put these small differences in perspective, the authors calculated the number of patients a female physician would need to treat before preventing one additional death or return to hospital vs. a male physician.

    Number of Patients To Prevent One Death: 233
    Number of Patients to Prevent One Return To Hospital: 182

    So these differences aren’t apparent unless we’re looking at pretty large volumes of patients, but those volumes exist in a lot of hospitals. Meaning that this trend really demands our attention and further investigation, which brings me to the study currently making the rounds.

    Women Treated By Male Physicians Die More Frequently

    than when they are treated by female physicians, according this this recently published study. The authors said, and this is a direct quote:

    female patients treated by male physicians were the least likely to survive an episode of care

    They also noted that patients treated by female doctors, in general, regardless of patient gender, were more likely to survive.

    This study involved 581,845 patient treatment episodes between the years of 1991 and 2010. In other words, this study brings the heat when it comes to sample size and duration. It’s no bubblegum investigation between two fifth graders. Which means there are a LOT of statistics.

    Researchers anaylzed this data six ways from Sunday. This paper has so many statistical references that I had to Google a couple to jog the cob-webby parts of my brain. And those part of my brain do not want to be jogged.

    The moral of the story though: the results are statistically significant. This publication represents another data point indicating that female patients are at higher risk than their male counterparts. Especially if a man treats them instead of a female doctor.

    But wait, there’s more!

    These researchers wanted to draw some conclusions about the root cause of this male/female difference.

    Male Physicians Who Interact More With Women Are Better At Treating Them

    than male physicians who interact less with women. Seriously, this study showed a trend toward decreased risk for women treated by male physicians as those male physicians’ level of interaction with women in general increased.

    Cue the laugh track now. I feel like I’m telling a story about the Rosetta Stone instead of trends in modern healthcare. Because it seems like female doctors have a secret decoder ring, and the men just don’t. It also seems like the decoder ring works with both men and women.

    Also, how funny is it to say – when men interact more with women, they’re better at communicating with them??

    That’s like saying, “It turns out children become better at language after they talk for a few years.”

    Communication Tutors For Med Schools?

    Maybe med schools will start teaching physicians how to communicate with women the way Rice University teaches their engineers how to communicate with humans. True story, as a freshman at Rice, I listened to a representative of the engineering department explain why everyone had to attend workshops put on by the Cain Initiative. Which, despite the name, is not a creepy cult that meets in the basement of Baker Hall, the most gothic dorm on campus.

    It boiled down to this. Engineers are unskilled at communicating with humans. Which puts them at a disadvantage in life, not just in the workplace. Rice wanted to ensure their engineers were good communicators, so they created a team of communications tutors. From freshman year on, all engineering students were taken by the hand, critiqued, coached, and forced to present endlessly.

    And not to brag, but it totally worked. When I came into grad school, I remember several people commenting on the quality of my slides and presentation style*. “You don’t sound like other engineers.” And not just because I talked way too much about Disney movies.

    So, Tracy Voss, maybe you could head over to Baylor and teach them a few things about remedial communication techniques for people who are naturally terrible communicators.

    *Y’all don’t judge Tracy Voss and Rice University on the quality of this blog. You can attribute all shortcomings to the fact that I was raised by wolves and am wildly unapologetic about that.*

    Advocate Assertively

    for yourself and/or your loved ones. That’s the moral of this story.

    Yes, it seems that male physicians communicate poorly with female patients, leading to increased mortality risk for those female patients. You can’t choose a female physician every time you need healthcare. So whether you’re a man or a woman, you need to communicate as clearly as possible any time you’re in need of healthcare. Especially anything urgent involving your heart, lungs, or brain.

    Don’t ever skip over information, even if you think it might not be relevant. And don’t be a hero. I was raised to suck it up and work through the pain. Bleeding hands? Do that bar routine anyway. Soles of your feet black and blue from an aggressive beam crash? You’re still vaulting.

    But I know now, from watching hundreds of cases and hearing about thousands, sucking it up is often bad for you. Now, you don’t need to whine about a paper cut. But, you do need to recognize that pain, even if you can handle it, is telling you something important about your body’s needs. And you need to listen to that, or at least communicate it to a physician. Clearly. And proactively.

    Female Physicians Are Better

    according to these studies anyway. But, that doesn’t mean they’re better scientists, or smarter. None of the studies I’ve mentioned, or the ones they reference say anything about raw talent or intelligence. In fact, they clearly state that we don’t know why female physicians appear to treat their patients more effectively than their male counterparts. Some of them suggest that it does indeed come down to communication.

    But at this point, we don’t know why. We only know that female patients are at a disadvantage when treated by male physicians. And as much as I dislike this data (because it kind of sucks for everyone), it’s still science.

    Do you have any suggestions for improved communication between physicians and patients? Sound off in the comments or send me a message!

    Photo by rawpixel on Unsplash

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