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Slow Down the Fasting Talk

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July 15, 2021

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Published July 15, 2021

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Slow Down the Fasting Talk

Fasting is no new kid on the block, but recent years have seen what used to be a dietary practice reserved for religious rituals or intensive cleanses become a mainstream diet. As you may have noticed, the masses have jumped on the bandwagon with the promise of a novel way to lose a few pounds. The real draw is being able to mention it every time someone offers you food before 11 am.

But are the benefits really from “fasting” or from simply eating less food? 

In a randomized controlled trial, researchers in the United Kingdom examined the effect of a 24-hour fasting window alternating with 150% of baseline caloric intake every other day for three weeks in healthy, lean individuals (n=12). The control groups were either restricting calories daily to 75% (n=12) or alternating fasting days without a net calorie restriction (200% every other day; n=12).

After three weeks, the group that restricted caloric intake daily showed a reduction in body mass primarily by fat loss (average of -1.91 kg). Fasting decreased body mass as well (average of -1.60 kg) but only when combined with caloric restriction. In the group that did not restrict total calories, no significant reduction in fat or body mass was seen (average of -0.52 kg). Additionally, no statistically significant difference was found between the groups’ postprandial indices of cardiometabolic health and gut hormones or expression of key genes in the adipose tissue. Not exactly worth skipping breakfast over.

While this study is small and brief, these findings suggest that daily energy restriction is just as beneficial for weight loss as alternate-day fasting in normal weight adults. Fasting may be a great thing to brag about, but it likely does not possess magical powers for weight loss. It simply means you’re eating less food.

Another Blow for This COVID-19 Vaccine

And the hits just keep on comin’ for Johnson & Johnson’s COVID-19 vaccine. This week, the CDC found a link between the J&J vaccine and Guillain-Barré syndrome (GBS), and the FDA updated its label to include an increased risk of GBS during the 42 days following vaccination. So far, 100 cases have been reported and 12.8 million doses have been administered, which puts the ratio at around 0.0008%. Despite the many zeroes east of the decimal, patients will naturally be concerned.

Let’s put this in perspective for patients

The National Institutes of Health (NIH) reports that the annual risk of developing GBS in the general population is around 1 per 100,000.

How about in people who develop COVID-19? While one study showed no increase in GBS after a COVID-19 diagnosis in comparison with the general population, another study showed a risk of 11/72,000. Given this, 100 out of 12.8 million doesn’t seem as concerning.

The moral of the story: the vaccine is still safe, and the benefits greatly outweigh the risks. If an association with GBS exists, it is extremely rare. Vaccinate on!


Healthcare Humor

How many pathologists does it take to diagnose a malignancy?

Ten... because one fewer would be benign. 


“I’m Allergic to Penicillin,” You Say?

You probably hear that response frequently from patients. It’s about as common as “You’re on mute” these days. But in the case of the former, it may not be true

Approximately 10% of all US patients report having a penicillin allergy, but <1% of the US population have a penicillin allergy. Check our math, but these numbers don’t add up. And we’re not pointing fingers at patients—they’re simply working off the best information they have. You know, like when Ross truly believed he and Rachel “were on a break.”

Can a simple tool predict a TRUE penicillin allergy?

Researchers say most likely. Several studies have tackled this theory, but most recently a study derived and validated the PEN-FAST rule for determining true penicillin allergy. This acronym accordions out to “penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment,” which pretty much sums up the rule.

Investigators established this point system for predicting penicillin allergy risk:

  • Allergy event occurring five or fewer years ago (2 points)
  • Anaphylaxis/angioedema or severe cutaneous adverse reaction (2 points)
  • Treatment required for the episode (1 point)

They stratified the point totals as follows to estimate the risk of a positive result on allergy testing:

  • Very low (0 points): 0.6% risk
  • Low (1 or 2 points): 5% risk
  • Moderate (3 points): 19% risk
  • High (4 or 5 points): 53% risk

With a cutoff score of <3 points, the sensitivity was 70.7% and the specificity was 78.5%. In fact, the likelihood of a true allergy among those who scored <3 is similar to a negative result on skin testing. Not too shabby! Like skin testing, it’s important to keep in mind that while this tool may be helpful in identifying type 1 hypersensitivity reactions, it may not be able to uncover type 3 hypersensitivity reactions. Despite limitations, we see the PEN-FAST rule as a helpful decision tool when it comes to immediate antibiotic treatment or referral for allergy testing. Keep this rule in your back pocket—or maybe even your front pocket. It’s THAT good!

Not Your Grandmother’s Gene Therapy

Just when you thought gene therapy couldn’t get any cooler, along comes optogenetic therapy, a gene therapy of biblical significance: it literally “gives sight to the blind” (Psalm 146:8). At least it did for one 58-year-old man with retinitis pigmentosa, who now wears the banner of “first person with partial functional recovery in a neurodegenerative disease after optogenetic therapy.” It’s a long banner.

Before treatment, the man could scarcely detect light, but after treatment and with the help of special goggles, he could locate, count, and touch objects. He’s not ready to umpire the Wimbledon final, but his transformation has been astounding.

So, what’s optogenetic treatment all about?

Essentially, it rewires nerve cells in the eye, or more specifically, it harnesses a light-sensitive protein that, when hit with a specific wavelength of light, makes nerve cells send signals to the brain. Here’s the article if you want to get into the scientific weeds—just be sure to check for ticks later.

How does it compare with traditional gene therapy?

Traditional gene therapy and gene editing can slow or stop degenerative eye disease but can’t restore vision. And they can target only a specific gene. Optogenetic therapy, however, may help patients who have lost their vision from diseases, no matter the gene changes that led to those diseases. We’re talking about diseases like macular degeneration, which could be huge for millions of people. We see the future and it looks bright!

Choosing Wisely: Five COVID-19 Best Practices for Clinicians

The past year and a half has ushered in a fire hose of data and publications on COVID-19. As we move forward, how can we apply the best practices gleaned from all this information to our day to day with patients? As always, Choosing Wisely comes to the rescue with five evidence-based recommendations for healthcare professionals treating patients with COVID-19.

  • Do not use treatments without evidence: You can find the National Institutes of Health COVID-19 treatment guidelines here.
  • Use specific therapies as indicated: Remdesivir and tocilizumab should only be used in specific scenarios as supported by evidence. In some trials, remdesivir shortens recovery in those needing oxygen, but in other trials it does not, nor does it decrease mortality. Tocilizumab isn’t useful and is potentially harmful outside of those who are severely ill, on steroids, have inflammation, or have a rapid increase in oxygen requirements.
  • Use caution with steroids: Only use steroids in patients with hypoxia. Monitor and control blood glucose levels in patients who are using steroids.
  • Avoid unnecessary testing: Data do not support the routine use of CT scans, CT scores, or inflammatory biomarkers to grade COVID-19 severity or guide treatment.  
  • Do not stop routine care! Multiple studies show that neglecting chronic care such as for cancer, cardiovascular disease, and mental health is disastrous for patients.

Choosing Wisely didn’t forget about the general public either. Those recommendations are the tried-and-true best practices: social distancing, masking, getting tested, watching for breathing trouble, and getting vaccinated.

Thanks for the advice, Choosing Wisely! Now if only you could tell us how to lose our “Quarantine 15” (lbs) and make small talk again.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

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Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!

Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.