Health & Fitness

There are certain areas in which conventional medicine excels, and the ability to perform brain surgery to remove tumors is one of them. This is particularly true in the case of awake brain surgery, also known as intraoperative brain mapping, which is performed while the patient is sedated but awake.

Awake brain surgery is typically performed to treat epileptic seizures or remove tumors without clear borders that have spread throughout the brain. Because the tumors are often close to brain regions responsible for controlling vision, language and movement, it would be too dangerous to attempt to remove them while the patient is completely under anesthesia, as doing so could result in a significant loss of function.¹

Awake brain surgery allows neurosurgeons to remove or shrink tumors that may otherwise be inoperable, while preserving the patient's speech and other skills. In the video above, you can watch a particularly remarkable case, in which a woman not only remained awake during brain surgery but played her violin throughout — ensuring she wouldn't lose this skill that she held near to her heart.

Musician Plays Violin During Brain Surgery

Violinist Dagmar Turner, 53, was diagnosed with a brain tumor in the right frontal lobe, which is near the area that controls fine movements of her left hand.² As a musician who plays with the Isle of Wight Symphony Orchestra, Turner was concerned about losing the ability to play the musical instrument, so she asked her doctor if she could play the violin during the procedure.

Surgeons at King's College Hospital in London agreed. Dr. Keyoumars Ashkan, her neurosurgeon, told Time:

"We knew how important the violin is to Dagmar, so it was vital that we preserved function in the delicate areas of her brain that allowed her to play … We managed to remove over 90% of the tumor, including all the areas suspicious of aggressive activity, while retaining full function in her left hand."³

Before the surgery, doctors mapped brain areas that were active when Turner played the violin. She was awoken in the middle of the surgery to play the violin and "ensure the surgeons did not damage any crucial areas of the brain that controlled Dagmar's delicate hand movements," according to a statement from the hospital.⁴

"The thought of losing my ability to play was heart-breaking but, being a musician himself, professor Ashkan understood my concerns," Turner told Time. "He and the team at King's went out of their way to plan the operation — from mapping my brain to planning the position I needed to be in to play."⁵

Guitarist Also Plays During Brain Surgery

In a similar case, South African musician Musa Manzini also played a musical instrument during brain surgery to remove a tumor.

Playing the guitar requires complex interactions in the brain, and by playing during the surgery, "It increased the margin of safety for us, in that we could have real-time feedback on what we were doing," Dr. Rohen Harrichandparsad, one of the neurosurgeons involved in the procedure at Inkosi Albert Luthuli Central Hospital in Durban, told The Guardian.⁶

The surgery was a success, with 90% of the tumor being removed and Manzini's ability to play the guitar preserved. Other cases have also made headlines, including a musician who played a saxophone during brain surgery in 2015 and an opera singer who sang during a brain operation in the Netherlands in 2014.⁷

Computer Images Create a Map of the Brain

There are a number of considerations that go into deciding whether awake brain surgery is the best option. In his book, "Do No Harm: Stories of Life, Death, and Brain Surgery," British neurosurgeon Henry Marsh wrote, "Often it is better to leave the patient's disease to run its natural course and not to operate at all."⁸

According to Johns Hopkins, other considerations include the patient's general health, as awake brain surgery isn't performed in people who are obese or have sleep apnea. The patient must also be able to stay calm during the surgery and respond to the neurosurgeon, and the tumor must be able to be removed without causing damage to critical areas of the brain.⁹

The patient may be awake for the entire procedure or could be sedated or put to sleep at the beginning and end of the procedure and be awake only in the middle. The neurosurgeon then uses small electrodes to stimulate the brain, and, to locate functional areas of the brain to avoid, will ask the patient to perform different tasks such as speaking, counting or playing an instrument.

Computer images of the brain help with this, creating a map of functional areas of the brain. Marsh wrote:¹⁰

"Brain surgery is dangerous, and modern technology has only reduced the risk to a certain extent. I can use a form of GPS for brain surgery called Computer Navigation where, like satellites orbiting the Earth, infrared cameras face the patient's head. The cameras can 'see' the instruments in my hands which have little reflecting balls attached to them.

A computer connected to the cameras then shows me the position of my instruments in my patient's brain on a scan done shortly before the operation. I can operate with the patient awake under local anaesthetic so that I can identify the eloquent areas of the brain by stimulating the brain with an electrode.

The patient is given simple tasks to perform by my anaesthetist so that we can see if I am causing any damage as the operation proceeds."

Still, even under the best circumstances, there is a risk of leaving a person severely disabled if even a small area of the brain becomes unintentionally damaged.

Even Marsh wrote, "Despite all this technology neurosurgery is still dangerous, skill and experience are still required as my instruments sink into the brain or spinal cord, and I must know when to stop … And then there is luck, both good luck and bad luck, and as I become more and more experienced it seems that luck becomes ever more important."¹¹

Benefits of Being Awake During Brain Surgery

There are practical benefits to being awake during brain surgery, including cost. "The total inpatient costs for awake craniotomies were lower than surgery under GA [general anesthesia]," researchers wrote in the journal Neurosurgery.¹² While total inpatient expenses per patient for awake craniotomy came in at $34,804, this rose to $46,798 for surgery under general anesthesia.

Further, the incremental cost per quality-adjusted life years for the awake craniotomy group was $82,720 less than the general anesthesia group. Awake brain surgery also required fewer days in the hospital — 4.12 days for the awake craniotomy group compared to 7.61 days for the general anesthesia surgery group.

"This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas," the researchers noted.¹³ Another of the primary benefits is avoiding the risks that come along with general anesthesia, which can be significant.

Research published in the journal Anesthesiology compared the effectiveness of local versus general anesthesia for hip fracture surgery and found the local anesthesia was associated with better outcomes, with researchers writing, "Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia."¹⁴

Awake Brain Surgery Outcomes and Shortcomings

Research into outcomes of awake brain surgery have also suggested positive outcomes. In a review of medical records for 35 patients who had awake right hemisphere brain operations, 68.7% of those with seizures became seizure-free and 77.7% of those with moderate to severe headaches improved significantly.

"There were also improvements in speech and language functions in all patients who presented with speech difficulties," the researchers noted, adding, "When combined with intraoperative cortical mapping, both speech and motor function can be well preserved."¹⁵

That being said, most research into awake brain surgery has focused on preserving language and motor function, while the monitoring of other cognitive functions has been less explored.

In a systematic review of 360 studies, tests to assess memory, calculation, emotions and other cognitive functions were reported in only a minority of cases, as were tests for visuospatial domain and motor and sensory functions. On the contrary, tests to assess language functions were widely reported.

"There is a need for development of tests or paradigms for assessment of other cognitive functions so that the broad spectrum of cognition can be monitored during awake brain surgery," researchers explained¹⁶ and, indeed, there remains much to be learned about the human brain as a whole, let alone how it responds to interventions like surgery. As with all surgery, there remain risks for awake brain surgery, which include:¹⁷

Changes in vision	Seizures	Difficulty with speech or learning
Loss of memory	Impaired coordination and balance	Stroke
Swelling of the brain	Too much fluid in the brain	Meningitis
Leaking spinal fluid	Weak muscles

Brain Tumor Signs and Symptoms

In the U.S., an estimated 700,000 people are living with a primary brain tumor and 87,000 more will be diagnosed with one in 2020.¹⁸ Common symptoms of a brain tumor include:

Loss of balance	Memory loss and language issues
Mood and/or behavior changes	Nausea and vomiting
One-sided weakness or numbness	Persistent headaches
Seizures	Vision changes

EMF exposure, including cellphone use, contributes to chronic illness including brain tumors, and you'd be wise to reduce your exposure to cell towers, cellphones, microwaves, "smart" products, Wi-Fi and wireless products. Increased peroxynitrites from cellphone exposure will damage your mitochondria, and your brain is the most mitochondrial-dense organ in your body.

This is but one risk factor for brain tumors, which often occur without a known cause. Other risk factors may include radiation exposure, family history and a weakened immune system, as well as potentially infection with certain viruses or exposure to certain chemicals such as vinyl chloride, pesticides and petroleum products.¹⁹

As much as possible, be proactive in using a healthy lifestyle to support and protect your health and remember, too, that even your brain is capable of being regenerated.

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Research overwhelmingly supports the notion that ditching the “three square meals a day” approach in favor of time-restricted eating (also referred to as intermittent fasting) can do wonders for your health, as your body simply cannot function optimally when there’s a continuous supply of calories coming in. 

The cycling of feasting (feeding) and famine (fasting) mimics the eating habits of our ancestors and restores your body to a more natural state that allows a whole host of biochemical benefits to occur.

It’s a powerful approach that not only facilitates weight loss, but also helps reduce your risk of chronic diseases like Type 2 diabetes, heart disease, cancer and Alzheimer’s.

While there are many variations, time-restricted eating typically involves not eating for at least 14 consecutive hours a day. However, not eating for 16 to 20 hours is likely closer to a metabolic ideal. This means you eat all of your meals for the day within a four- to eight-hour window.

Among the many benefits of time-restricted eating is the upregulation of autophagy and mitophagy — natural cleansing processes necessary for optimal cellular renewal and function. In a January 2020 review paper,¹ researchers explain how caloric restriction helps combat Alzheimer’s specifically, through these autophagy pathways.

Preventing Alzheimer’s Through Time-Restricted Eating

As explained in “The Effects of Caloric Restriction and Its Mimetics in Alzheimer’s Disease Through Autophagy Pathways,”² two of the pathology hallmarks of Alzheimer’s are amyloid beta plaques and neurofibrillary tangles formed by aggregates of tau protein.

“The aberrant accumulation of these misfolded and aggregated proteins results in neurotoxicity, and AD is therefore recognized as a proteinopathy,” the paper states. Other pathological events frequently seen in the brains of Alzheimer’s patients include:³

• Synaptic deficits and axonal degeneration
• Mitochondrial dysfunction
• Abnormal metal homeostasis
• Oxidative stress
• Neuroinflammation

Many of these occur as a result of “insufficient elimination of neurotoxic proteins or damaged intracellular organelles,” the paper notes. In other words, they occur when there’s insufficient autophagy occurring in your body. The good news is you can upregulate autophagy, and one of the simplest ways is by implementing time-restricted eating. As explained in this review:⁴

“Autophagy is a catabolic mechanism that ensures the removal of misfolded or aggregated proteins and maintains the turnover of cytoplasmic components.

Under conditions of starvation or energy deficiency, phagophores are synthesized de novo in the cytoplasm from newly synthesized lipids or from intracellular organelles with membrane structures, such as the endoplasmic reticulum.

Phagophores elongate and curve to form double-membrane autophagosomes, which then encapsulate cytosolic materials, misfolded proteins, or long-lived proteins.

After fusion with lysosomes, any cargo is degraded by lysosomal enzymes. The autophagic process provides a strategy for clearing misfolded or aggregated proteins in proteinopathic disorders. Failure of autophagy leads to the accumulation of aggregates, which results in neurotoxicity and disease progression.”

Autophagy Dysfunction in Neurodegenerative Disorders

Autophagy dysfunction has been identified in several neurodegenerative and neuropsychiatric disorders and diseases, including Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis (ALS), Huntington’s disease, ischemic stroke, schizophrenia and even drug addiction.⁵

Hence, it is believed that autophagy activation has an important role to play in the prevention and treatment of these conditions. Importantly though, using autophagy stimulators such as drugs, gene therapy or supplements can have undesirable side effects in some people, and may not be ideal.

Time-restricted eating, or calorie restriction, the authors note, is a safer and likely more effective strategy for most. So, just how does calorie restriction or intermittent fasting induce autophagy?

There are several mechanisms at play, but two important ones are activation of monophosphate-activated protein kinase (AMPK) and inhibition of the mammalian target of rapamycin (mTOR) pathway.⁶

Calorie restriction also helps ameliorate Alzheimer’s and other degenerative conditions by lowering inflammation and improving insulin sensitivity, mitochondrial function and oxidative stress.

The Benefits of AMPK Activation

AMPK is an enzyme essential for maintaining energy balance. It consists of three proteins (called sub-units) that together create a functional enzyme. AMPK is expressed in various tissues, including the brain, liver, skeletal muscle and fat cells, and is essential for activating autophagy.

It’s sometimes referred to as a "metabolic master switch" because it plays an important role in regulating metabolism.⁷ It shifts energy toward cellular repair and maintenance, thus helping your body return to homeostasis (balance).

Low AMPK has been linked to insulin resistance, mitochondrial dysfunction, obesity, neurodegeneration and chronic inflammation. Activating AMPK produces many of the same benefits as exercise, dieting and weight loss,⁸ all of which are known to benefit a range of chronic diseases and ill health.

AMPK is also an important neuroprotector,⁹ thus making it particularly relevant in Alzheimer’s prevention and treatment. In addition, AMPK stimulates cellular and mitochondrial autophagy (mitophagy) and mitochondrial biogenesis, as well as five other critically important pathways:

• Insulin
• Leptin
• mTOR
• Insulin-like growth factor 1 (IGF-1)
• Proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α)

Benefits of mTOR Inhibition

MTOR is also an important pathway responsible for controlling autophagy. When you inhibit mTOR — which you can do through time-restricted eating — you activate autophagy. MTOR is basically a nutrient sensor. While insulin primarily senses your intake of carbohydrates, mTOR primarily senses protein.

That said, other nutrients can also activate or inhibit mTOR. Nutrients that activate mTOR include branched-chain amino acids, glutamine, methyl folate and vitamin B12.

Nutrients that inhibit mTOR include polyphenols like curcumin, fisetin, quercetin, resveratrol (found in wine) and epigallocatechin gallate (EGCG, found in green tea). Organic coffee and dark chocolate also contain high amounts of mTOR inhibiting polyphenols.

Why Cycling in and Out of Autophagy Is so Important

One of the reasons time-restricted eating works so well is because you’re cycling through autophagy on a daily basis (opposed to only occasionally, were you to do longer fasts once a month or quarterly, for example).

This cycling is really crucial. You don’t want to inhibit mTOR and activate autophagy all the time. There needs to be a balance between breaking down and building back up.

When you eat, your insulin goes up, mTOR is activated and autophagy is inhibited, thus allowing for cellular rebuilding and growth. Then, when you fast, insulin goes down, mTOR is inhibited and autophagy activated, thus allowing for the breakdown and elimination of dysfunctional cellular components. The next time you eat, the cycle of rebuilding begins anew, and so on.

When you’re continuously eating, autophagy will be severely inhibited. As a result, damage continues to build up as damaged cells cannot be efficiently eliminated and regenerated. Many hormonal shifts also occur during fasting, including growth hormone.

Opinions about how long one should fast each day varies. As a general rule, the recommended range is between 12 and 18 hours of fasting each day. I’m of the opinion that 16 to 18 hours of fasting might be the sweet spot, as this allows your body to deplete the glycogen stores in your liver more and suppress mTOR and activate autophagy better.

Time-Restricted Feeding Improves Brain Function

As noted in “The Effects of Caloric Restriction and Its Mimetics in Alzheimer’s Disease Through Autophagy Pathways,” a number of animal studies have demonstrated that time-restricted eating helps prevent memory loss and improve cognition. The authors state, in part:¹⁰

“[Intermittent fasting] has been reported to optimize brain function and increase neuronal resistance to injury and disease … Behavioral improvements in AD mice that undergo IF might occur because of the effects of IF on balancing hippocampal excitability.

In addition, IF prevents memory loss in ovariectomized rats infused with amyloid beta in hippocampal regions … short-term fasting (24 or 48 hours) was capable of enhancing neuronal autophagy in 5xFAD mice, which is a severe AD model …”

The Case for Eating Less, Period

Both animal and human studies also suggest people with a low calorie intake overall have a reduced risk for Alzheimer’s compared to those eating a high-calorie diet.¹¹

In one animal study, animals whose diet was 30% lower in calories than normal restored memory performance after 10 months. High-calorie diets were also shown to result in autophagic failure in the hippocampus.¹²

Animal studies have further demonstrated that low-calorie diets reduce the amount of amyloid beta and tau in the brain, while high-calorie diets increase them.¹³

The beautiful characteristic of time-restricted eating is that it appears to replicate most of the metabolic benefits of calorie restriction without actually restricting calories. Additionally, because it is such a restricted eating window and a person’s appetite is reduced, they typically wind up eating fewer calories anyway without any feeling of deprivation.

Siim Land does a great job on expanding on the differences between these two as they relate to longevity in the video at the top of the article. Even though the comparison is to longevity, the same pathways are also active in Alzheimer’s, such as sirtuins, AMPK and NAD+.

Calorie Restriction Mimetics

“The Effects of Caloric Restriction and Its Mimetics in Alzheimer’s Disease Through Autophagy Pathways” also addresses the use of calorie restriction mimetics, compounds that mimic the effects of calorie restriction. The most thoroughly studied and well-recognized mimetic is resveratrol, a polyphenol found in grape skins and certain berries, including blueberries and cranberries. According to the authors:¹⁴

“Several studies have revealed the potential efficacy of resveratrol supplementation for the prevention and treatment of AD. For example, treatment with resveratrol prevents neurotoxicity in cultured cells exposed to amyloid beta.

In addition, in a rodent model of AD, resveratrol alleviated memory deficits, maintained the integrity of the blood-brain-barrier, ameliorated the plaque burden, in habited tau pathology, and suppressed microglial activation …

The anti-amyloidogenic and neuroprotective effects of resveratrol in AD appear to be strongly associated with enhanced autophagic activity. Resveratrol activates SIRT1-dependent autophagy, which contributes to an attenuation of the neurotoxicity caused by amyloid beta. Moreover, resveratrol represses mTOR signaling and induces autophagy by activating the AMPK signaling pathway.”

Other Alzheimer’s Prevention Guidelines

Aside from time-restricted eating, there are many other strategies that will help prevent (and in some cases, treat) Alzheimer’s. Here’s a rundown of what I believe are some of the most important:

Avoid trans fat and industrially processed vegetable oils — While diets high in healthy fats and antioxidants can go a long way toward warding off dementia, diets high in trans fats and processed omega-6 oils will promote it. Research15 published in the October 2019 issue of Neurology found a strong link between trans fat consumption and incidence of dementia and its various subtypes, including Alzheimer’s. The worst dietary culprits were pastries, margarine, candy, caramels, croissants, nondairy creamers, ice cream and rice crackers.16 Similarly, the oxidized omega-6 fat found in processed vegetable oils can cause significant harm to your brain when consumed in excess.

Avoid sugar and refined fructose — Ideally, you’ll want to keep your sugar levels to a minimum and your total fructose below 25 grams per day, or as low as 15 grams per day if you have insulin resistance or any related disorders.

Increase consumption of healthy fats, including marine-based omega-3 — Beneficial health-promoting fats that your brain needs for optimal function include coconut oil, organic butter from raw milk, ghee, grass fed raw butter, olives, organic virgin olive oil, nuts like pecans and macadamia, free-range eggs, wild Alaskan salmon and avocado.  Also make sure you’re getting enough animal-based omega-3 fats from small fatty fish such as anchovies and sardines, or take a phospholipid-based supplement such as krill oil. High intake of the omega-3 fats EPA and DHA help prevent cell damage caused by Alzheimer's disease, thereby slowing down its progression, and lowering your risk of developing the disorder.

Avoid gluten and casein (primarily wheat and pasteurized dairy, but not dairy fat, such as butter) — Research shows your blood-brain barrier is negatively affected by gluten.17 Gluten also makes your gut more permeable, which allows proteins to get into your bloodstream, where they don’t belong. That then sensitizes your immune system and promotes inflammation and autoimmunity, both of which play a role in the development of Alzheimer’s.

Optimize your gut flora by regularly eating fermented foods or taking a high potency and high quality probiotic supplement.

Improve your magnesium level — Magnesium threonate appears promising for supporting cognition and may be superior to other forms. To learn more, see “Cognitive Benefits of Magnesium L-Threonate.”

Optimize your vitamin D levels with safe sun exposure — Researchers believe optimal vitamin D levels may enhance the amount of important chemicals in your brain and protect brain cells by increasing the effectiveness of the glial cells in nursing damaged neurons back to health. Vitamin D may also exert some of its beneficial effects on Alzheimer's through its anti-inflammatory and immune-boosting properties. Sufficient vitamin D is imperative for proper functioning of your immune system to combat inflammation that is also associated with Alzheimer's. For more information, see “Link Between Vitamin D Deficiency and Dementia Confirmed.”

Avoid and eliminate mercury from your body — Dental amalgam fillings, which are 50% mercury by weight, are one of the major sources of heavy metal toxicity. However, you should be healthy before having them removed. Once you have adjusted to following the diet described in my optimized nutrition plan, you can follow the mercury detox protocol and then find a biological dentist to have your amalgams removed. Also avoid flu vaccinations as most contain mercury, aka thimerosal, a well-known neurotoxic and immunotoxic agent.

Avoid and eliminate aluminum from your body — Sources of aluminum include antiperspirants, nonstick cookware and vaccine adjuvants. For detox guidance, see “The Three Pillars of Heavy Metal Detoxification.”

Exercise regularly — It's been suggested that exercise can trigger a change in the way the amyloid precursor protein is metabolized,18 thus slowing down the onset and progression of Alzheimer's. Exercise also increases levels of the protein PGC-1alpha. Research has shown that people with Alzheimer's have less PGC-1alpha in their brains and cells that contain more of the protein produce less of the toxic amyloid protein associated with Alzheimer's.

Avoid anticholinergics and statin drugs — As detailed in “Common OTC Drugs Can Cause Dementia,” drugs that block acetylcholine, a nervous system neurotransmitter, have been shown to increase your risk of dementia. These drugs include certain nighttime pain relievers, antihistamines, sleep aids, certain antidepressants, medications to control incontinence, and certain narcotic pain relievers. Statin drugs are also problematic as they suppress the synthesis of cholesterol, deplete your brain of coenzyme Q10 and neurotransmitter precursors, and prevent adequate delivery of essential fatty acids and fat-soluble antioxidants to your brain by inhibiting the production of the indispensable carrier biomolecule known as low-density lipoprotein.

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Self-isolation is one of the key measures suggested by authorities to prevent the further spread of coronavirus, or COVID-19. Here's how to do it right, and exactly what's involved (byeeeee, flatmates). 

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We know that coronavirus is transmitted via contact with infected people, but you can also catch it from an unexpected object you use every day. 

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The World Health Organization has officially declared Covid-19 a pandemic.

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From rye to sourdough, brown to wholegrain, dietitian Melissa Meier picks her healthiest bread varieties on your local supermarket shelf. 

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From rye to sourdough, brown to wholegrain, dietitian Melissa Meier picks her healthiest bread varieties on your local supermarket shelf. 

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A novel structure of a so-called 'neurotransmitter: sodium symporter' has been mapped. The discovery adds to the researchers' knowledge of neurotransmitters in the brain and may lead to better drugs for, for example, ADHD, depression and epilepsy.

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As people become more aware of privacy concerns and the ways in which genomic database companies are profiting from their data, their expectations for compensation and control may increase, according to researchers at Penn State and Cornell University.

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How individuals respond to government advice on preventing the spread of COVID-19 will be at least as important, if not more important, than government action, according to a recent commentary.

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A team of researchers recently proved the ability to grow human-derived blood vessels in a pig -- a novel approach that has the potential for providing unlimited human vessels for transplant purposes.

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The FDA-approved drug liraglutide has been shown to help obese patients lose weight by suppressing their appetite. However, where and how the drug acts in the brain was not fully understood, until now. A new preclinical study shows how liraglutide crosses the brain's blood barrier to engage with a region of the brainstem known as the nucleus tractus solitarius, which is responsible for balancing food intake and energy expenditure.

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Of all food allergies, which affect between 5% and 8% of US children, peanut allergy is the one most likely to cause anaphylaxis, a serious type of allergic reaction. For a child with a peanut allergy, eating one peanut can literally be fatal.

“When you have an allergy,” says Andrew MacGinnitie, MD, PhD, clinical director of the division of immunology at Boston Children’s Hospital, “your body sees the thing you are allergic to as dangerous. So your immune system tries to protect you by causing hives, vomiting, and other symptoms.”

The body does this by releasing histamine and other chemicals that are designed to help your body get rid of whatever is causing the allergic reaction. Hives increase blood flow to an area so that your immune system can get to work. Sneezing helps you get rid of pollen or cat hair in your nose. And vomiting helps get rid of whatever is in your stomach. The problem is that when the reaction is severe, with an outpouring of more of these chemicals than is needed, it can lead to trouble breathing and a dangerous drop in blood pressure. If untreated, this can lead to death.

Re-educating the immune system to lessen the danger

“What we’d like to do,” says MacGinnitie, “is re-educate your immune system so that it doesn’t see peanuts as dangerous. For patients with severe environmental allergies, or severe allergies to insect stings, we can give a series of shots that decrease the symptoms. However, when this was tried to treat peanut allergies, it was too dangerous.”

Instead, a different approach — feeding children who have peanut allergies small amounts of peanut to build tolerance — shows promise. In a series of studies, including one published in The Lancet in September 2019, researchers found that when they gave people with peanut allergies small yet gradually increasing amounts of peanut flour every day, 85% of them were ultimately able to eat 300 mg of peanut protein. That’s about the equivalent of one peanut.

That may not seem like much, but it’s a big deal, says MacGinnitie. “Kids with peanut allergy typically don’t want to eat lots of peanut. They just want to be protected so that accidental small exposures — like eating a donut from Dunkin’ that was next to one with peanuts — won’t trigger severe reactions.”

New medicine for peanut allergy approved

This research led to FDA approval of a new medication to treat peanut allergy. It is called Palforzia, and is made from peanut flour. It is approved for children ages 4 to 17. After an initial dose, 11 increasing doses are given over several months. The first time a higher dose is given it’s done in a healthcare setting, but the other doses at that level are given at home, one dose daily. When a patient can tolerate all the dosage levels, they take a dose of 300 mg peanut protein every day at home as a maintenance treatment.

That’s one of the downsides: this treatment is not a cure. When people stop taking the peanut flour, the vast majority of them lose protection.

There are other downsides too, says MacGinnitie. “About 20% to 25% of kids have anaphylaxis during the protocol. That’s about three times more than would have it if they just stayed away from peanuts.” This alone may keep many families away. He also points out that about 10% drop out because of chronic gastrointestinal complaints during treatment, such as stomachaches, vomiting, or diarrhea.

There are other treatments on the way, such as a patch with peanut protein that has fewer side effects, although it may not work as well as oral treatment.

If your child has a peanut allergy, talk with your doctor. Definitely don’t try eating peanut flour without talking to your doctor! Every patient and every situation is different. Working with your doctor, you can figure what’s best for your child and your family.

Follow me on Twitter @drClaire

The post Peanut allergy: A new medicine for children may offer protection appeared first on Harvard Health Blog.

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Many health problems in the developed world stem from the disruption of a delicate metabolic balance between glucose production and energy utilization in the liver. Now scientists report that they have discovered the molecular mechanisms that trigger metabolic imbalance between these two distinct but linked processes, a finding with implications for the treatment of diabetes and non-alcoholic fatty liver disease.

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Balance is a skill you don’t think about until you really need it — like when you lose your footing and have to perform an exotic improv dance to keep from hitting the ground. But don’t wait until your sense of balance fails before you give it proper attention. As we age, balance can sharply decline, often with little warning. An exercise program called BEEP can help.

How you keep your balance

While keeping proper balance may seem simple, it involves a complex system with many moveable parts. Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.

Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.

Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries.

“Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system,” says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife.

There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.

For instance, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (called BEEP for short) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces, and increased their walking speed and overall confidence.

Focus on three exercises to improve balance

The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. “These types of exercises increase both the physical and cognition skills needed for better balance,” says Dr. Manor. “Plus, they mimic movements of everyday life.”

He recommends adding these to your regular workouts or doing them daily on their own.

Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable. Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.

Heel and calf raises. Stand with your arms crossed over your chest and lift your heels, so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.

One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg, so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Go back and forth three to five times.

You also can perform these exercises with your eyes closed to work on coordination and concentration. Another option is to “distract” yourself by doing unrelated cognitive tasks — count backward, name words that begin with the same letter, or make a mental supermarket list.

“Balance is definitely a use-it-or-lose-it skill,” says Dr. Manor. “But if you work on your balance continuously, you are almost guaranteed to see improvements.”

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A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report.

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Being of an older age, showing signs of sepsis, and having blood clotting issues when admitted to hospital are key risk factors associated with higher risk of death from the new coronavirus (COVID-19), according to a new observational study of 191 patients with confirmed COVID-19 from two hospitals in Wuhan, China.

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