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In the Rear View

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Published August 14, 2025

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Good morning! Let’s rewind to 1912, when physicians were debating not AI but nomenclature. Biochemist Casimir Funk coined the term “vitamines” to capture the vital role and supposed amine chemistry of these micronutrients. But critics pounced, noting not all vitamines contain amines. Funk lopped off the “e,” and the name stuck, despite grumbling dissent. His retort: “A badly chosen catchword, like a folksong without feeling, can never become popular.”

But then the real trouble began. After vitamins A through E took their alphabetical assignment, disorder set in. Vitamin B ballooned to 12 subtypes before settling on a numerically scrambled eight. Vitamin K ignored the alphabet and borrowed its letter from the German koagulation. The rest? A parade of reclassified or phantom vitamins—F through J, plus M, P, and the punchline “PP.” It was the messiest rollout until the two-letter state abbreviation (see Gary Gulman’s blistering account).

New Colonoscopy Prep Guidelines—A Movement in the Right Direction?

GI GIST

Colonoscopy attendance rivals that of a high school reunion—plenty of “I’ll be there!” before only the yearbook committee and the guy recalling his 40-yard-dash time show up. Between dread, logistics, and the urban legend of bowel prep, nearly half of eligible adults skip the procedure. But fresh guidelines try to lure them back by shifting the prep ordeal from survival-show challenge to a mildly inconvenient Tuesday.

Task force puts punishing bowel prep in the rear view—for some

The American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy banded together to deliver their first overhaul of colonoscopy prep guidelines since 2014. And average-risk patients are going to like it. Dietary changes now start only the day before—low-fiber or clear-liquid meals for breakfast and lunch, capped with a clear-liquid dinner. And the dreaded 4-liter chug has been downsized to a 2-liter split dose (night before, then morning of)—so the taste will haunt patients for only half as long. Patients with afternoon appointments can tackle the entire prep in a single day. Additionally, the task force suggests adding oral simethicone to give doctors a clearer view.

Patients at higher risk for inadequate prep—including those with chronic constipation, slowed gut motility, or conditions such as cirrhosis, Parkinson disease, dementia, or diabetes—still face a stricter routine. Their regimen starts three days in advance, with tighter dietary limits, larger prep volumes, and boosters like bisacodyl to thoroughly flush the colon.

Key takeaways

The task force insists the new regimen goes down easier for average-risk patients without sacrificing colon clarity. The guideline authors wager that the looser rules will push prep success rates higher—ideally to 90% (up from 85% in 2014). They’re calling on GIs to track adequate and inadequate prep, along with “no shows.” For the GIs’ tallying purposes, “adequate” means a colon clear enough for them to confidently decide when the patient needs their next screening—a “you’ll know it when you see it” thing.

For more education on colorectal cancer, check out this CME activity: Don’t Miss the Red Flags for Early-Onset Colorectal Cancer - Frankly Speaking Ep 411

Guideline Updates and FDA Approvals

Lithium Delivers an Element of Surprise in Dementia Research

NEURO NEWS

For decades, lithium has been the darling of grunge anthems and psychiatric prescriptions—but now, researchers suggest it may hold a missing piece of the Alzheimer disease puzzle. They’ve shown this trace element is naturally present in the body and very much needed—like iron, vitamin C, and validation from internet strangers. And when levels run low, brain aging and neurodegeneration may accelerate.

Of mice and metals

In a series of mouse studies with more cognitive swings than Flowers for Algernon, researchers found that lowering dietary lithium triggered inflammation, plaque buildup, and memory decline—especially in Alzheimer-model mice. In contrast, maintaining normal lithium levels steadied brain aging and protected against many of these hallmark changes.

But how does it work? The team found that β-amyloid plaques in the brain bind lithium and pull it from surrounding cells. Without enough available lithium, microglia—the brain’s cleanup crew—falter and toxic proteins build up. When the researchers compared different compounds, standard forms of lithium stuck to plaques, while lithium orotate avoided this problem, cut down plaques and tangles, and restored memory in Alzheimer-model mice.

Key takeaways

The potential role of lithium in cognitive protection is one of the most intriguing Alzheimer discoveries in recent memory. While the evidence looks shiny, it’s still early days. The results come only from mice, and lithium at higher doses can be toxic, making human trials essential before practice changes. For now, most lithium slips in through the diet—leafy greens, nuts, legumes, and some mineral waters. Many of these foods already link to lower dementia risk, and lithium may be one hidden reason why. Looking ahead, Dr. Kostas Lyketsos of Johns Hopkins speculates, “Is there a future in which lithium at a very low dose could supplement what seems to have been lost? Possibly… That will be the work of future studies.”

For more education on Alzheimer disease, check out this CME activity: Managing MCI and Alzheimer’s Disease in Primary Care

Have a Cup of Tea: Reducing Blood Pressure Without Medication—Flavan-3-Ols

SPECIAL CONTRIBUTOR—FRANK DOMINO, MD

In an age where common medical interventions are being constantly called into question, you might be wondering, “Should I try to get this patient on an ARB for their blood pressure or offer them something else?”

Jumping into this fray is the use of flavan-3-ols. These are a subclass of flavonoids and are found in cocoa products, tea, grape extract, and apples. A recently publishedsystematic review and meta-analysissays increasing these in your diet may help lower blood pressure (BP). But like relative risk reductions, the real question is, “By how much?”

Increasing these flavonoids in your diet by, on average, 586 mg/day led to a decreased office systolic BP of -2.8 mm Hg (95% CI, -3.9 to -1.7) and a decreased diastolic BP of -2.0 mm Hg (95% CI, -2.6 to -1.3), with improved 24-hour ambulatory BP (systolic -3.7 mm Hg [95% CI, -5.8 to -1.6]; diastolic -2.6 mm Hg [95% CI, -4.5 to -0.8]) with chronic consumption. The influence of flavan-3-ols was larger in those with elevated baseline BP or confirmed essential hypertension (office: -5.9 mm Hg [95% CI, -10.0 to -1.8] / -2.7 mm Hg [95% CI, -4.4 to -1.0]; 24-hour ambulatory BP: -6.8 mm Hg [95% CI, -16.3 to 2.8] / -5.1 mm Hg [95% CI, -12.5 to 2.2]). For comparison, most BP medications lower systolic BP by 7 to 10 mm Hg and diastolic BP by ~4 mm Hg.

So, for those with hypertension or elevated BP, a change in diet might be a good first line of treatment (combined with 150 minutes of moderate exercise per week). But what to eat? And how much? This table might help:

Frankly Speaking Table
Key takeaways

To save time and energy, drink two 8-ounce cups of green tea per day (yuck) or 2.5 cups of black tea and you are good to go. Or eat a dozen apples.

For me, the bottom line is to start with the exercise and add tea. Don’t forget, alcohol and NSAIDs are leading causes of secondary hypertension. If you don’t ask, they might not tell. And finally, while this is a very cool meta-analysis, it was funded by an “unrestricted grant from Lipton Tea.” No, I didn’t make that up.

To learn more about this study, check out this Frankly Speaking about Family Medicine podcast.

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

Morning Report is written by:

Alissa Scott, Author
Aylin Madore, MD, MEd, Editor
Margaret Oliverio, MD, Editor
Ariel Reinish, MD, MEd, Editor
Emily Ruge, Editor

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