Day: 01/03/2015

How Exercise Changes Our DNA .

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We all know that exercise can make us fitter and reduce our risk for illnesses such as diabetes and heart disease. But just how, from start to finish, a run or a bike ride might translate into a healthier life has remained baffling.

Now new research reports that the answer may lie, in part, in our DNA. Exercise, a new study finds, changes the shape and functioning of our genes, an important stop on the way to improved health and fitness.

The human genome is astonishingly complex and dynamic, with genes constantly turning on or off, depending on what biochemical signals they receive from the body. When genes are turned on, they express proteins that prompt physiological responses elsewhere in the body.

Scientists know that certain genes become active or quieter as a result of exercise. But they hadn’t understood how those genes know how to respond to exercise.

Enter epigenetics, a process by which the operation of genes is changed, but not the DNA itself. Epigenetic changes occur on the outside of the gene, mainly through a process called methylation. In methylation, clusters of atoms, called methyl groups, attach to the outside of a gene like microscopic mollusks and make the gene more or less able to receive and respond to biochemical signals from the body.

Scientists know that methylation patterns change in response to lifestyle. Eating certain diets or being exposed to pollutants, for instance, can change methylation patterns on some of the genes in our DNA and affect what proteins those genes express. Depending on which genes are involved, it may also affect our health and risk for disease.

Far less has been known about exercise and methylation. A few small studies have found that a single bout of exercise leads to immediate changes in the methylation patterns of certain genes in muscle cells. But whether longer-term, regular physical training affects methylation, or how it does, has been unclear.

So for a study published this month in Epigenetics, scientists at the Karolinska Institute in Stockholm recruited 23 young and healthy men and women, brought them to the lab for a series of physical performance and medical tests, including a muscle biopsy, and then asked them to exercise half of their lower bodies for three months.

One of the obstacles in the past to precisely studying epigenetic changes has been that so many aspects of our lives affect our methylation patterns, making it difficult to isolate the effects of exercise from those of diet or other behaviors.

The Karolinska scientists overturned that obstacle by the simple expedient of having their volunteers bicycle using only one leg, leaving the other unexercised. In effect, each person became his or her own control group. Both legs would undergo methylation patterns influenced by his or her entire life; but only the pedaling leg would show changes related to exercise.

The volunteers pedaled one-legged at a moderate pace for 45 minutes, four times per week for three months. Then the scientists repeated the muscle biopsies and other tests with each volunteer.

Not surprisingly, the volunteers’ exercised leg was more powerful now than the other, showing that the exercise had resulted in physical improvements.

But the changes within the muscle cells’ DNA were more intriguing. Using sophisticated genomic analysis, the researchers determined that more than 5,000 sites on the genome of muscle cells from the exercised leg now featured new methylation patterns. Some showed more methyl groups; some fewer. But the changes were significant and not found in the unexercised leg.

Interestingly, many of the methylation changes were on portions of the genome known as enhancers that can amplify the expression of proteins by genes. And gene expression was noticeably increased or changed in thousands of the muscle-cell genes that the researchers studied.

Most of the genes in question are known to play a role in energy metabolism, insulin response and inflammation within muscles. In other words, they affect how healthy and fit our muscles — and bodies — become.

They were not changed in the unexercised leg.

The upshot is that scientists now better understand one more step in the complicated, multifaceted processes that make exercise so good for us.

Many mysteries still remain, though, said Malene Lindholm, a graduate student at the Karolinska Institute, who led the study. It’s unknown, for example, whether the genetic changes she and her colleagues observed would linger if someone quits exercising and how different amounts or different types of exercise might affect methylation patterns and gene expression. She and her colleagues hope to examine those questions in future studies.

But the message of this study is unambiguous. “Through endurance training — a lifestyle change that is easily available for most people and doesn’t cost much money,” Ms. Lindholm said, “we can induce changes that affect how we use our genes and, through that, get healthier and more functional muscles that ultimately improve our quality of life.”

Prick-free Blood Tester from India

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Many of us are terrified of blood tests, where skin is pricked with a needle to get the blood for testing. A solution to this problem has come in the form of ToucHb – a prick-free blood testing device


The inside of ToucHb

Say hello to ToucHb—a prick-free blood testing device brought to you by Biosense Technologies. ToucHb can measure your blood hae-moglobin, oxygen saturation, temperature and pulse rate all without pricking for blood. A team of three—engineer Myshkin Ingawale and doctors Abhishek Sen and Yogesh Patil—was behind making this product from the ground up.

What led the team to come up with this idea? Myshkin narrates, “In 2009, I had gone to visit my friend Abhishek in Parol—a two-hour drive from Mumbai. He was interning at the place and when I reached Parol, I had to wait for him as he was busy helping deliver a baby. Afterwards, he came out ashen-faced and informed me that both the mother and baby had died of something called post-partum haemorrhage, which is basically uncontrollable bleeding. What was shocking was that it was caused by undiagnosed anaemia.”

The news that someone could die of anaemia—a completely diagnosable and curable disease—shocked Myshkin and made him look for a solution. He asked his mother, a paediatrician, and found that testing for anaemia involves sending a blood sample through a Coulter counter. But the nearest such machine was in Mumbai and it wasn’t a viable solution to keep using the machine to have every person tested for anaemia. He contacted his two friends and started searching for practical designs for the device.

Photoplethysmography basics
Photoplethysmography (PPG) is a simple and low-cost optical technique that can be used to detect blood volume changes in the microvascular bed of tissue. It is often used non-invasively to make measurements at the skin surface. The PPG waveform comprises a pulsatile (AC) physiological waveform attributed to cardiac synchronous changes in the blood volume with each heart beat, and is superimposed on a slowly varying (DC) baseline with various lower-frequency components attributed to respiration, sympathetic nervous system activity and thermoregulation.
PPG technology is used in a wide range of commercially available medical devices to measure oxygen saturation, blood pressure and cardiac output, assess autonomic function and also detect peripheral vascular disease.


Dr Sen says, “In India, public healthcare runs on the ASHA worker and not on the doctor. So when our team convened to design a solution for this problem, we knew that whatever we created had to be prickless (to avoid medical waste), simple enough for the ASHA worker to operate and small enough for her to carry in her kit.”

ToucHb features
ToucHb is a handheld battery-operated device. Total blood haemoglobin is used for the diagnosis of anaemia. (The WHO qualifies any pregnant woman with Hb level of less than 11 grams per decilitre of blood as anaemic.)

TouchHb works on the principle of ‘photoplethysmography.’ Basically, it works by radiating light of three different wavelengths onto the finger, and through the tissue of the patient’s finger. Once this is done, based on the amount of light transmitted, absorbed and scattered, one can figure out the amount of haemoglobin in blood. Haemoglobin has a characteristic absorbance. For estimation of oxygen saturation, the technique is similar to the one used in pulse oximeters. While a pulse oximeter is not able to measure total haemoglobin, ToucHb is designed to do that.

Obstacles
Since non-invasive procedures for the masses is still a field in its infancy, developing the device was not without its share of challenges.


ToucHb device

Dr Abhijeet says, ”We often joke that we failed 32 times but in reality we probably failed many more times—maybe many times each day! First, the basic science—the core R&D itself—was a challenge. All this ‘optical’ stuff for a bunch of relatively inexperienced doctors and engineer meant that we were walking in the dark.”

Dr Yogesh adds, “There were small nitty gritties related to production and assembly lines—a millimetre here and a rupee difference there—and suddenly we were struggling both on the technical and costing sides! We had to learn as we went along—how to identify signs of error, rectify and make the hardware reliable. We learnt the best way—by being wrong!”

Roadmap
ToucHb is being produced and sold directly to clinics, which then use it for screening and monitoring of anaemia in their patients. But the team has a bigger plan—to scale up the production from 30-40 a batch to more than 1000 a batch. This will involve putting in place a quality management system, something which will take time.

“Apart from scaling up the production, one of the big steps for us is to partner with different international and national health agencies to under-stand the best way to create an impact with this device. The healthcare ecosystem is a complex thing—protocols are designed for good reasons, and we need to work jointly with experienced public health experts to modify the existing system and make small incremental tweaks in the way point-of-care community health works,” says Dr Patil.

The ToucHb Version 1 has already been released. So what next?

Myshkin shares, “As with any technology, you have to keep upgrading, making it better to avoid obsolescence. So watch out for even more feature-rich Version 2, a few months down the road! I would love to tell you about the features we are planning to introduce in subsequent versions, but we ourselves are not sure about which ones will make the cut.”

Is It Possible to Recover from Autism?

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When I was training to be a clinical psychologist, telling parents that their child had autism was a regular part of my job. Now that I’m a parent, I understand better the pained expression that came over their faces as they contemplated this news. Among the many questions taking shape in their minds, I can imagine the one looming largest: Could their child ever be like other children?

A recent study, published in February in theJournal of Child Psychology and Psychiatry, suggests that for some people, the answer is yes. The researchers found that some individuals who had been diagnosed with autism as young children no longer had symptoms—such as difficulty interacting and communicating with others, rigid adherence to rituals and routines, and repetitive movements of their bodies and objects—when they were older.

This finding is not the first to suggest that some young adults with autism lose their symptoms. A 2008 literature review reported that 3 to 25 percent of affected people eventually recover. But the recent study was especially rigorous. The researchers recruited three groups of eight- to 21-year old subjects: 34 of them had apparently recovered from autism, 44 had high-functioning autism, and another 34 were control subjects with no developmental issues.

An expert diagnostician thoroughly reviewed the early records of all recovered participants to confirm that they truly had autism when they were younger, and she correctly rejected 24 reports from kids with nonautism diagnoses (such as language disorders) that had been slipped in as foils, verifying that her diagnostic technique was sound. These measures made researchers confident that the now typically functioning children had not initially been misdiagnosed. The team also set a relatively high bar for recovery: participants not only had to be free of autism symptoms, as indicated by a battery of tests—they also had to have typically developing friends and be fully included in regular education classrooms.

The study’s findings were encouraging: those who recovered were on a par with the typically developing individuals and better than the group with high-functioning autism in their social and communication skills and in their ability to go about daily life, such as taking care of themselves and doing housework. These findings, according to some experts, represent a watershed moment in autism research, “clearly demonstrating the possibility of leaving behind the symptoms of [autism] and emerging into a state of healthy functioning,” writes University of California, Davis, psychologist Sally Ozonoff, who was not involved in the study.

Not Autistic, Not Quite Typical

As exciting as these results might be, I believe we should interpret them with caution. For one thing, about 20 percent of those in the recovered group still showed mild difficulties with eye contact, gestures and facial expressions. According to the study authors, “these difficulties were judged … not to have an autistic quality.” But those doing the judging were not “blind,” as researchers are in rigorous clinical trials—they knew if a participant was typically developing, had autism or had supposedly recovered.

It is easy to imagine how this knowledge could have colored their interpretations of participants’ behaviors. Even if those in the recovered group did actually lose their symptoms, “the majority still have serious issues,” including depression, anxiety and inattention, notes Elizabeth Kelley, a psychologist at Queen’s University in Ontario and one of the study’s authors.

Kelley points out another limitation of the study: it looked back at recovery after it had happened. The retrospective design cannot reveal what proportion of kids will shed their diagnosis or why. Parents often try a variety of interventions, including behavioral treatment, speech and occupational therapy, and medication—and they do not always keep detailed records. Until researchers report on the outcomes of children they starting following very early in life, “we have no idea why some people recover,” Kelley says.

Fortunately, scientists are starting to do those studies. For example, Catherine Lord, director of the Center for Autism and the Developing Brain at Weill Cornell Medical College, has been following a group of about 100 people with autism from the time they were diagnosed at age two through their early 20s. Study participants completed a large battery of tests every few years as children and again at age 18, and parents have been filling out questionnaires every year.

Like Kelley and her colleagues, Lord has found that a handful of participants lose their autism symptoms. Moreover, she says, “their eye contact, gestures, the way they hold their body, the way they talk about their friends”—behaviors that have long been thought to be difficult to improve on—are indistinguishable from those of typically developing adults. They are also functioning well in daily life, holding down part-time jobs while attending college. The researchers fittingly refer to this group as having a “very positive outcome.” A more sizable group is considered “more able” than the remaining adults in the sample—they have no cognitive impairment and are generally doing well academically, although they still have clear autism symptoms. A paper presenting these results is currently under consideration at a peer-reviewed journal.

Who Recovers and How?

Although Lord’s study has not resolved the question of why some people with autism improve radically, it has found early signs that may help identify those who will. For example, at a very young age, individuals in the “very positive outcome” group had rapid gains in verbal skills and decreases in restricted and repetitive behaviors, such as flapping their hands and lining up toys. Parents whose children show these early improvements have reason to be hopeful about prognosis.

Interestingly, neither Lord nor Kelley found that those with the best outcomes received more behavioral treatment than the others, as one might expect. This finding does not mean that behavioral treatment is ineffective for autism—in fact, many studies suggest the opposite is true. Researchers simply do not yet know how the amount and type of treatment relate to prognosis. For example, applied behavioral analysis, which focuses on using reinforcement to help children learn and attend to another person, could be especially effective for some youngsters, whereas social skills training, which emphasizes capabilities such as holding a conversation and turn taking, might help others. Similarly, some children might require much more intensive intervention to make gains. The unpredictable effect of treatment could be related to underlying genetic differences; autism most likely has many variations, rather than a single genetic cause.

Until there are more definitive answers, Kelley says, “parents should do as much as they can for their individual child,” within their means. She firmly cautions parents against bankrupting themselves or running themselves emotionally ragged trying to get help for their child, because there may be factors leading to better outcomes that are completely outside parental control. “It may be a genetic variant—who knows?” Kelley remarks.

As exciting as these positive outcomes are, we do not yet know if they will last. As people with autism begin to face the challenges of adulthood, old symptoms might recur and new ones could surface. Studies of adults with autism have consistently found that many struggle to live independently, get and keep a job, and form friendships and romantic relationships. Lord and her colleagues want to keep following study participants to see if those in the “very positive outcome” group continue to flourish.

Of course, people with autism can thrive even if they don’t recover. Lord recalls an adult with autism who put it well: “If I’m independent, have a good job and have relationships with other people, why am I not as good as someone else?” Researchers and clinicians alike should keep working to understand how all people who have autism can achieve the best possible outcome: a happy, fulfilling life.

Alzheimer’s & Aluminum Link Can No Longer Be Ignored

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Aluminum has been long known to be neurotoxic, with mounting evidence that chronic exposure is a factor in many neurological diseases, including dementia, autism, and Parkinson’s disease.

However, definitive scientific proof is difficult to establish due to the the lack of longitudinal studies, as well as pushback from industries that use aluminum in their products. Despite the shortage of conclusive studies, mounting scientific evidence leaves little room for doubt.

Case in point: a new case study from Keele University in the UK unequivocally shows high levels of aluminum in the brain of an individual exposed to aluminum at work, who later died from Alzheimer’s disease.

While aluminum exposure has been implicated in Alzheimer’s and a number of other neurological diseases, this case claims to be “the first direct link” between Alzheimer’s disease and elevated brain aluminum following occupational exposure.

The Aluminum-Alzheimer’s Link

The 66 year-old Caucasian man developed an aggressive form of early onset Alzheimer’s disease after eight years of occupational exposure to aluminum dust, which scientists conclude “suggests a prominent role for the olfactory system and lungs in the accumulation of aluminum in the brain.”

This is not the first time high aluminum levels have been found in the tissues of someone who died from Alzheimer’s disease. For example, in 2004, high aluminum levels were found in the tissues of a British womanwho died of early-onset Alzheimer’s.

This was 16 years after an industrial accident dumped 20 metric tons of aluminum sulphate into her local drinking water. And there are many studies showing elevated aluminum levels in living individuals displaying a wide range of neurological symptoms.

Aluminum Can Be an Occupational Hazard

Exposure to aluminum is unfortunately an occupational hazard for those who work in industries like mining, factory work, welding, and agriculture. Not to mention that you ingest aluminum vapors every time your nose catches cigarette smoke wafting by.

Inhaling aluminum dust or vapors sends aluminum particles directly into your lungs in a highly absorbable form, where they pass into your bloodstream and are distributed throughout your body, including your bones and brain. Aluminum powder has been known to cause pulmonary fibrosis, and aluminum factory workers are prone toasthma. Studies of the health effects of aluminum vapors have been grim, pointing to high levels ofneurotoxicity.

So why are most government regulators and physicians so resistant to looking at the health and environmental effects of aluminum? One filmmaker is shining a light on this issue by way of a documentary.

The ‘Dark Side’ of Aluminum Exposed

The featured documentary, The Age of Aluminum, reveals the “dark side” of this toxic metal, exploring the scientific links between aluminum and diseases such as breast cancer and neurological disorders. Also exposed is how aluminum mining and manufacturing have created acute ecological problems across the globe, leading to environmental disasters in Hungary, South Africa, and the UK. In the film, neuroscientist Christopher Shaw reports:

“Many researchers are beginning to accept that aluminum has some sort of role to play in neurodegenerative diseases such as Alzheimer’s. Whether it does in others is still an open question, but Alzheimer’s is really coming into focus and it’s fairly clear that the body burden of aluminum from all the sources to which humans are exposed may be contributing to Alzheimer’s disease.”

Aluminum Is Everywhere

Although aluminum occurs naturally in soil, water, and air, we are contributing to the load with the mining and processing of aluminum ores, manufacturing of aluminum products, and the operation of coal-fired power plants and incinerators. Aluminum can’t be destroyed in the environment—it only changes its form by attaching or separating from other particles.

Rain washes aluminum particles out of the air and into our water supply, where they tend to accumulate rather than degrade. If you live in an industrial area, your exposure is undoubtedly higher than average.

According to CDC, the average adult in the US consumes about seven to nine mg of aluminum per day in food, and a lesser amount from air and water. Only about one percent of the aluminum you ingest orally gets absorbed into your body—the rest is moved out by your digestive tract, provided it’s functioning well.

When tested in a lab, aluminum contamination has been found in a vast number of products on the market, from foods and beverages to pharmaceuticals, which suggests the manufacturing process itself is a significant part of the problem. Aluminum is found in a shocking number of foods and consumer products, including:

-Foods such as baking powder, self rising flour, salt, baby formula, coffee creamers, baked goods and processed foods, coloring and caking agents

-Drugs, such as antacids, analgesics, anti-diarrheals, and others; additives such as magnesium stearate

-Vaccines—Hepatitis A and B, Hib, DTaP (diphtheria, tetanus, pertussis), pneumococcal vaccine, Gardasil (HPV), and others

-Cosmetics and personal care products such as antiperspirants, deodorants (including salt crystals, made of alum), lotions, sunscreens, and shampoos

-Aluminum products, including foil, cans, juice pouches, tins, and water bottles

Does Your Frozen Dinner Come with a Side of Aluminum?

Aluminum contamination in our food supply is a more significant problem than you may think. In a study published in the journal Environmental Sciences Europe, researchers analyzed 1,431 non-animal foods and beverages for aluminum content. This is what they found:

-77.8 percent had an aluminum concentration of up to 10 mg/kg

-17.5 percent had aluminum concentrations between 10 and 100 mg\kg

-4.6 percent of the samples had aluminum concentrations in excess of 100 mg/kg

Aluminum compounds are often used as additives in foodstuffs. Additional contamination occurs when food comes into contact with aluminum equipment and other items because aluminum is unstable in the presence of acids and bases. Aluminum equipment has a protective oxide film, but this can be damaged as fine fissures develop from normal wear and tear.In the study, Table 3 shows the aluminum content of everything from flour and baking mixes to soup, chocolate, beer and wine, and herbal teas. Some products show a wide range of contamination levels, and others are more homogenous. Baked goods are very high because of the common practice of baking and storing foods on aluminum trays. The report has numerous other tables that demonstrate how prevalent this toxin is in your food.

If you cook your food in aluminum foil, you are introducing your own contamination. One investigation found that cooking meats in aluminum foil increases their aluminum concentration. Researchers concluded, “eating meals prepared in aluminum foil may carry a health risk by adding to other aluminum sources.” As with many toxins, it isn’t one exposure here and there that is so concerning—it’s the cumulative effect of many smaller exposures over time that can lead to a toxic metal overload and erosion of your health. According to a 2006 study, cooking meat in aluminum foil increased aluminum levels as follows:

-Red meats cooked in aluminum foil showed an increase in aluminum by 89 to 378 percent

-Poultry increased by 76 to 214 percent

-Aluminum levels increased with higher cooking temperatures and longer cooking times

Aluminum Heads Straight to Your Brain

Aluminum is to your central nervous system as cigarette smoke is to your lungs. Scientists are clear that toxic metals damage brain tissue and lead to degenerative disease by producing oxidative stress—and aluminum is one of the worst offenders. With Alzheimer’s rates skyrocketing, today’s multiple avenues of aluminum exposure are of great concern. Just as with particles in the environment, once aluminum is in your tissues, your body has a difficult time releasing it. This toxic metal serves absolutely no biological purpose, so the less of it you ingest, the better.

Once in your body, it travels around easily, unimpeded, piggybacking on your iron transport system. It crosses biological barriers that normally keep other types of toxins out, such as your blood-brain barrier. Over time, aluminum can accumulate in your brain and do serious damage your neurological health—regardless of your age. Aluminum toxicity may be doing as much damage to our children as to our seniors.

Brain Inflammation in Both Children and Adults

Vaccines present a particularly problematic source of toxic metal exposure. Aluminum is the most commonly used vaccine adjuvant and is considered “safe” even though research shows it may induce serious immunological disorders and neurological complications in humans.

In the video above, Dr. David Ayoub discusses how the aluminum in vaccines may be even more dangerous than mercury. The number of aluminum-containing vaccines children receive today has quadrupled over the past 30 years. In the 1970s, children got only four aluminum-containing vaccines in their first 18 months of life, but now they typically receive 17. And as children’s aluminum burden has increased, so has the prevalence of childhood neurological disorders. In one school, 90 percent of the children developed ADHD during the course of a single school year, and their toxicity profiles all revealed massive amounts of aluminum.

Aluminum is also in vaccines and is used as an adjuvant. If you go by the aluminum content on vaccine labels, the amount kids are getting is excessive, but if you add in the aluminum NOT listed on the labels—”accidental exposure” due to contamination—it’s a much more serious problem. Dr. Ayoub cites one study that found five to six times more aluminum in vaccines than what was actually listed on the labels.

When you review the signs and symptoms of aluminum toxicity, they are shockingly similar to the symptoms of autism, ADHD, Alzheimer’s, Parkinson’s, and other neurological diseases. Vaccine adjuvants can cause serious chronic brain inflammation. Aluminum targets your cerebellum and autonomic nervous system—the part responsible for biological processes over which you have no conscious control (breathing, blood pressure, balance, coordination, etc.). When you look at the MSDS sheet for aluminum, you will see symptoms strikingly similar to those in common neurological diseases, including memory problems, speech impairments and aphasia, dementia, depression, muscle weakness, motor disturbances, and other neurological difficulties. The list goes on and on.

Researchers Claim New Blood Test May Predict Alzheimer’s

There has never been a way to accurately predict who will get Alzheimer’s, but that may be changing. Researchers at Georgetown University and University of Rochester claim they have found a blood test that predicts this with 90 percent accuracy—and incredibly, with NO false negatives. If further research confirms what researchers expect, this is a medical breakthrough of epic proportions.

The test involves measuring the patterns of 10 specific lipids (fat-like compounds) associated with the plaques found in the brains of people with Alzheimer’s disease. These 10 lipids are highly predictive of whether or not you will become cognitively impaired. All of the people in the study were in their 70s, so the next step is to determine if the test is accurate earlier, say in your 40s and 50s. Researchers say they are still several years away from implementing the test, but they all feel very hopeful.

Biomarkers such as lipids are tricky for Alzheimer’s because they change during the course of the illness. Some occur in high levels during the early phase of the disease and then actually decrease after symptoms appear—so they are stage dependent. There is clearly much more research that needs to be done before we have a grasp of this disease. Even with a test that can predict whether or not you are in the process of developing dementia, there are no good treatments once you have it—so you should be doing everything in your power to prevent it. One of the strategies is helping your body detoxify from metals, such as aluminum.

Aluminum Impairs Your Body’s Ability to Detoxify

Removing mercury from vaccines and replacing it with aluminum may be increasing the problems from BOTH toxins in your body. The reason for this is because aluminum impairs your body’s ability to excrete mercury by impeding your glutathione production. Glutathione is your most important intracellular detoxifier, required for reversing oxidative stress. So, if your aluminum load is high, your body will potentially become more toxic from the mercury from, say, flu shots and fish because you are now on “aluminum overload” and your detoxification system no longer functions well.

Your body requires sulfur to manufacture glutathione, making sulfur an extremely important dietary nutrient when it comes to metal detoxification, which can be optimized through dietary sources. Onions and garlic are good if they are grown in sulfur rich soils, but most soils are unfortunately sulfur deficient. Therefore, animal-based proteins seem to be one of your best bets. Whey protein concentrate is particularly high in cysteine, one of the two sulfur-bearing amino acids that are direct precursors to glutathione.

Please note that if you avoid consuming animal proteins, it is VERY easy to become sulfur deficient, and this may be one of the most significant risk factors for choosing an animal protein-free diet. That doesn’t mean you should go overboard on meat, however! Most people need only about one gram of protein per kilogram of lean body weight, or about half a gram of protein per pound of lean body mass. Also make sure to buy grass-fed and finished meats, as most factory farmed meat is of inferior quality and contaminated with a whole host of veterinary drugs, including antibiotics and growth hormones.

How to Detoxify Aluminum

There are a number of potent chelators you can use to detoxify aluminum. Clearly, your first step would be to avoid further exposure to aluminum. This means avoiding products such as:

–Toothpaste containing aluminium oxyhydroxide

-Antiperspirants containing aluminum chloride, aluminum chlorohydrate, or aluminum-zirconium compounds

-Aluminum laminated pouch drinks

-Aluminum cookware

-Aluminum espresso makers

For serious Alzheimer’s disease, the following chelating agents can be helpful:

-Silica-rich water, such as Fiji water, which contains 83 Mg of silica per liter. Research published in 2013 showed that drinking up to one liter of a silicon-rich mineral water daily for 12 weeks effectively excreted aluminum via the urine, without detrimental effects on essential metals such as iron and copper. According to the authors: “We have provided preliminary evidence that over 12 weeks of silicon-rich mineral water therapy the body burden of aluminum fell in individuals with Alzheimer’s disease and, concomitantly, cognitive performance showed clinically relevant improvements in at least 3 out of 15 individuals.”

-Melatonin: Research [source, source, source] shows that melatonin has a metal binding role and is a useful supplement in the treatment of neurological disorders in which oxidative stress is involved, which includes Alzheimer’s. Melatonin can travel freely across all cellular barriers, facilitating the removal of toxic metals such as aluminum. It also appears to suppress the oxidative activity of aluminum in your brain.

-Anything that raises your glutathione. Your body synthesizes glutathione from three amino acids: cysteine, glutamate, and glycine. Raw fruits and vegetables, particularly avocado, asparagus, grapefruit, strawberries, orange, tomato, cantaloupe, broccoli, okra, peach, zucchini, and spinach are rich in the precursors glutamate and glycine. Dietary sources of cysteine include eggs, meat, red peppers, garlic, onions, Brussels sprouts, whey protein, and wheat germ. Other helpful treatments for improved glutathione metabolism include:

-Exercise: Exercise affects your adenosine triphosphate (ATP) levels needed to help produce glutathione

-Optimizing your vitamin D levels through sun exposure: There’s some evidence vitamin D increases intracellular glutathione levels

-Epsom salt baths

-MSM supplementation

-The supplement N-acetyl L-cysteine (NAC) may also be useful. NAC is the rate-limiting nutrient for the formation of the intracellular antioxidant glutathione

–Curcumin: Research suggests that curcumin has a protective effect against aluminum-induced damage by modulating the extent of oxidative stress. It also decreases beta-amyloid plaques associated with Alzheimer’s, delays neuron degradation, chelates metals, decreases microglia formation, and has an overall anti-inflammatory, antioxidant effect. Studies have shown that curcumin can help improve memory in Alzheimer’s patients. There are some contraindications that curcumin is not recommended if you have biliary tract obstruction (as it stimulates bile secretion), gallstones, obstructive jaundice, or acute biliary colic.

In Summary

It can no longer be argued that aluminum does not have a role in neurodegenerative diseases like Alzheimer’s—the evidence is very clear and growing. It really should not be surprising that people with aluminum toxicity display many of the same symptoms as those with dementia, Parkinson’s, ADHD, autism, and other neurological diseases, because aluminum targets exactly these areas of your brain and nervous system.

The best way to protect yourself is to be careful about your choices in food and personal products, and minimize your use of vaccines and other drugs that are often contaminated with aluminum.

Optimizing your dietary sulfur is also essential, as your body needs sulfur to manufacture its number one weapon against aluminum overload: glutathione. By taking a few steps to protect yourself, you’ll minimize your exposure while maximizing your body’s ability to rid itself of this toxic metal, which will move you toward a long and healthy life well into your senior years.

Ladies, Ditch the Bra.

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I realize it may feel some combination of uncomfortable, unprofessional, or unnecessarily provocative. Societal convention has most of us trussing up before going out.

If you are reading this at home, do me a favor and unhook. Then keep reading.

Ladies, Ditch the Bra

There’s Some Evidence of a Relationship Between Bras and Breast Cancer.

Yes, seriously.

Dressed To Kill: The Link Between Breast Cancer and Bras

Sydney Ross Singer and Soma Grismaijer authored a book called Dressed To Kill. They interviewed 4,000+ women in five major U.S. cities over two years. Half the women had been diagnosed withbreast cancer. They found:

  • 75% of women who slept in their bras developed breast cancer
  • 1 in 7 who wore their bras 12+ hours per day developed breast cancer
  • 1 in 168 who did not wear a bra developed breast cancer
  • Within one month of ditching their bras, women with cysts, breast pain, or tenderness found their symptoms disappeared.

Breast Size, Handedness, and Breast Cancer Risk

A 1991 article in the European Journal of Cancer found that premenopausal women who do not wear bras had half the risk of breast cancer compared with bra users. The data also suggest that bra cup size (and breast size) may be a risk factor for breast cancer.

Cancer Is Not a Disease

Andreas Moritz revealed that Japanese, Fijians, and women from other cultures were found to have a significantly higher likelihood of developing breast cancer when they began wearing bras. His book explains how cancer is an adaptive healing mechanism, arguing that people would die more quickly if the body did not form cancer cells.

Bras and Girdles Can Reduce Melatonin Levels

Japanese researchers found they can lower melatonin by 60%. Melatonin has anti-cancer properties. And Spanish researchers wrote about the use of melanonin in breast cancer prevention and treatment.

There’s No Downside to Being Cautious.

Am I suggesting this scanty fact base offers definitive proof of a causal relationship? No.

Am I suggesting you should be comforted that the National Cancer Institute, the American Cancer Society, and the New York Times all believe it to be bunk? No.

That’s a longer discussion, but it’s sufficient to say that politics and economics create active bedfellows and the absence of a commercial imperative might have something to do with the dearth of research.

Many of us don’t need to wait in order to do something that intuitively seems to make a lot of sense. Frankly, in view of the alarming rate of breast cancer prevalence in this country (12.3% of women) and the growing trend to remove body parts in an attempt to improve our odds, it seems we might be receptive to a bit of behavior modification.

Go braless as much as possible.

It actually gets easier. When these muscles and ligaments are forced to bear the weight of our breasts, muscle tone returns. The more you wear a bra, the more you need to wear a bra. Chest muscles and breast ligaments atrophy, which then makes it feel uncomfortable to go braless.

A 15 year French study conducted by Besancon CHU professor Jean-Denis Rouillon found that “medically, phyisiologically, and anatomically, breasts gained no benefit from their weight being supported in a bra.” There was some evidence that eliminating bra use helped ease back pain. He described bra wearing as a “false need.”

Remove your bra when you get home. Don’t wear a bra to bed. And if you’re self-conscious when going out, try wearing camisoles, thicker material, or nipple pads. It does make sense to wear a support bra while exercising.

Wear Loose Bras in Softer Materials and Avoid Underwires.

Tight bras and underwires restrict lymphatic drainage, promoting congestion and stagnation of toxic waste materials that are supposed to be flowing out for excretion. Further, the closing of lymphatic vessels reduces the delivery of oxygen and nutrients to the cells.

Michael Schachter, MD, FACAM wrote that bras and tight clothing can impede lymph flow and contribute to the development of breast cancer.

John MacDougall, MD wrote in The Lancet that repeated inflammation from constricting bras are implicated in painful breast cysts and lumps, scar tissue develops, and milk ducts become plugged, all of which is associated with a higher risk of breast cancer.

The metal in underwire bras can create an “Antenna Effect” according to the father of Applied Kinesiology, George Goodheart, DC. Repeated pressing of metal over an acupuncture point can cause longer-term stimulation of neuro-lymphatic reflex points corresponding to the liver, gallbladder, and stomach. “It will likely make her sick; slowly and quietly,” said John Andre, ND, DC.

Here’s a list of no-underwire bras recommended by Donna Eden, Vicki Mathews, and Titanya Dahlin. Donna adds that plastic underwires have the same negative impact as metal underwires.

Slide the Wires Out!

There’s no need to toss your expensive underwire bras. If you cut a small opening at one end of the wire, you can manually remove it from each cup. You’ll probably find that your bra supports you nearly as well without them. Oh, and don’t be fooled. They make look like plastic, but they’re actually plastic-coated metal. If you find you still need the support, you can buy and insert plastic wires. Andre explains how.

Using Water As Medicine: Drinking Water On Empty Stomach

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It is popular in Japan today to drink water immediately after waking up every morning. Furthermore, scientific tests have proven its value. We publish below a description of use of water for our readers. For old and serious diseases as well as modern illnesses the water treatment had been found successful by a Japanese medical society as a 100% cure for the following diseases: Headache, body ache, heart system, arthritis, fast heart beat, epilepsy, excess fatness, bronchitis asthma, TB ***(verify from a consultant)***, meningitis, kidney and urine diseases, vomiting, gastritis, diarrhea, piles, diabetes, constipation, all eye diseases, womb, cancer and menstrual disorders, ear nose and throat diseases. METHOD OF TREATMENT As you wake up in the morning before brushing teeth, drink 4 x 160ml glasses of water Brush and clean the mouth but do not eat or drink anything for 45 minute After 45 minutes you may eat and drink as normal. After 15 minutes of breakfast, lunch and dinner do not eat or drink anything for 2 hours Those who are old or sick and are unable to drink 4 glasses of water at the beginning may commence by taking little water and gradually increase it to 4 glasses per day. The above method of treatment will cure diseases of the sick and others can enjoy a healthy life. The following list gives the number of days of treatment required to cure/control/reduce main diseases: High Blood Pressure (30 days) Gastric (10 days) Diabetes (30 days) Constipation (10 days) Cancer (180 days) TB (90 days) ***(verify from a consultant)*** Arthritis patients should follow the above treatment only for 3 days in the 1st week, and from 2nd week onwards – daily. This treatment method has no side effects, however at the commencement of treatment you may have to urinate a few times. It is better if we continue this and make this procedure as a routine work in our life. Drink Water and Stay healthy and Active. This makes sense .. The Chinese and Japanese drink hot tea with their meals not cold water. Maybe it is time we adopt their drinking habit while eating!!! Nothing to lose, everything to gain… For those who like to drink cold water, this article is applicable to you. It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this ‘sludge’ reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal. A serious note about heart attacks Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms. 60% of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let’s be careful and be aware. The more we know, the better chance we could survive. A cardiologist says if everyone who gets this mail sends it to everyone they know, you can be sure that we’ll save at least one life. Please be a true friend and send this article to all your friends you care about.

The Oldest Man In Recorded History?!

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What is the longest a person has ever lived for? Meet Li Ching Yuen, a man who lived an astonishing 256 years! And no, this is not a myth or a fictional tale. According to a 1930 New York Times article, Wu Chung-chieh, a professor of the Chengdu University, discovered Imperial Chinese government records from 1827 congratulating Li Ching-Yuen on his 150th birthday, and further documents later congratulating him on his 200th birthday in 1877. In 1928, a New York Times correspondent wrote that many of the old men in Li’s neighborhood asserted that their grandfathers knew him when they were boys, and that he at that time was a grown man. Li Ching Yuen reportedly began his herbalist career at the age of 10, where he gathered herbs in mountain ranges and learned of their potency for longevity. For almost 40 years, he survived on a diet of herbs such as lingzhi, goji berry, wild ginseng, he shoo wu and gotu kola and rice wine. In 1749, at the age of 71, he joined the Chinese armies as teacher of martial arts. Li was said to be a much-loved figure in his community, marrying 23 times and fathering over 200 children. According to the generally accepted tales told in his province, Li was able to read and write as a child, and by his tenth birthday had traveled in Kansu, Shansi, Tibet, Annam, Siam and Manchuria gathering herbs. For the first hundred years he continued at this occupation. Then he switched to selling herbs gathered by others. He sold lingzhi, goji berry, wild ginseng, he shou wu and gotu kola along with other Chinese herbs, and lived off a diet of these herbs and rice wine. He Wasn’t The Only One Li was asked what his secret was to longevity. This was his reply: “Keep a quiet heart, sit like a tortoise, walk sprightly like a pigeon and sleep like a dog.” These were the words of advice Li gave to Wu Pei-fu, the warlord, who took Li into his house to learn the secret of extremely long life. Li maintained that inward calm and peace of mind combined with breathing techniques were the secrets to incredible longevity. Obviously, his diet would have played a large role. But its fascinating that the old living person in recorded history attributes his long life to his state of mind. Why Is This So Hard To Believe? With the average lifespan for the Western world currently sitting between 70-85 years, the thought of someone living over 100 years old seems like quite the stretch. The thought of someone living over 200 years old seems extremely suspicious. But why don’t we believe that people can live this long? We have to keep in mind that some people in this world don’t live a grueling 9-5 lifestyle, they don’t have to deal with the stresses of debt, they aren’t breathing polluted city air, and they exercise regularly. They don’t eat refined sugars or flour, or any foods that have had pesticides sprayed on them. They aren’t eating fatty meats, sugary deserts, and genetically modified foods. No antibiotics. No alcohol and no tobacco. Their diets not only exclude junk foods that we so often indulge in, they also include superfoods and herbs which are like steroids for our organs and immune system. They also spend their spare time in nature practicing breathing techniques and meditating which have been proven to improve mental, physical, and emotional health. I do not doubt for a minute that if we all did the things we knew we were supposed to do, that living to be 100 years old would be commonplace. When we treat our bodies right, who knows how long we can live for?

Depression doesn’t make you sad all the time .

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When I’m having a depressive episode, I’m not walking around in tattered black clothes, weeping and wailing. I go out with friends and I crack jokes (especially sardonic ones) A young woman cycling on a beach, smiling
‘Look at the woman joyously cycling on a beach, hair fluttering in the breeze. You can’t judge her emotional state or her larger mental health picture, nor should you.’ 

One of the most popular, enduring, and irritating myths about depression is that it means depressed people are sad all the time – and that by extension, people who are happy can’t be experiencing depression, even if they say they are. It is a skewed and horrible version of depression, and it’s one that further stigmatises the condition and isolates people with depression and related mental health conditions. This is because, put bluntly, depression doesn’t make you sad all the time – though the level of sadness a patient experiences can of course vary depending on the individual and the severity of depression.

When I’m having a depressive episode, I’m not walking around in tattered black clothes, weeping and wailing. I go out with friends. I crack jokes (especially sardonic ones). I keep working, and have friendly chats with the people I work with. I often manage to feed and clothe myself, I read books. Above all, I experience moments of happiness: a flash of delight as I’m walking on the beach with a friend and the sun is perfect and the breeze is just right; a surge somewhere deep inside when I’m surrounded by beautiful trees and it’s raining and I feel my heart swelling to encompass the whole world; a warm, friendly, affectionate sensation at the touch of a friend, a hug at the end of an evening or a hand placed over mine as we lean forward to see something better.

Yet I feel a strange conflicting pressure. On the one hand, I feel like I need to engage in a sort of relentless performative sadness to be taken seriously, for people to understand that I really am depressed and that each day – each moment of each day – is a struggle for me, that even when I am happy, I am still fighting the monster. I feel like I need to darken everything around me, to stop communicating with the world, to stop publishing anything, to just stop. Because that way I will appear suitably, certifiably sad, and thus, depressed – and then maybe people will recognise that I’m depressed and perhaps they’ll even offer support and assistance. The jokes die in my throat, the smile never reaches my lips, I don’t share that moment of happiness on the beach by turning to my friend and expressing joy.

I don’t, in other words, do the things that can help ameliorate depression, encourage people to reach out, and help depressed people with functioning, completing daily tasks of life, and finding a reason to live again. I don’t find and build a rich community of people who can offer support (and whom I can support in turn), because I have to be so wrapped up in performing my sadness at all times to prove that I’m depressed enough – even as I want to scream that this is a reinforcement of stereotypes that hurt people, that by doing this I am hurting not just myself but others.

On the other, I feel an extreme pressure to perform just the opposite, because sad depressed people are boring and no fun, as I am continually reminded every time I speak openly about depression or express feelings of sadness and frustration. I’m caught in a trap where if I don’t perform sadness, I’m not really depressed, but if I express sadness at all to any degree, I’m annoying and boring and should stop being so self-centred. Thus I’m effectively pushed into fronting, putting a face on it even when I am depressed and deeply sad – when I feel like I am choking on my own misery, I put up a cheeky Tweet. When I hate myself and I want to die, I post a link to something fun, or I write up something silly to run somewhere – even though as I write it, I am drawn deeper and deeper into my unhappiness.

Depression is an asshole, and it can become your master, but you can slip out from under it occasionally. And many depressed people in the midst of an episode don’t actually spend it fainting dramatically on the couch and talking about how miserable they are. Some are high-functioning (bolstered by the need to put a face on it), others are into morbid jokes, others try to reach out for help (isn’t that what we’re “supposed” to do?) from friends and try to make their depression less scary. Depression isn’t an all-or-nothing deal – seeing a person who identifies with depression cracking a joke or having fun or dancing with a friend isn’t evidence that the person is faking it, whether the person is experiencing a moment of genuine happiness, or fronting. Conversely, jollying up people with depression to demand that they start being more fun is equally revolting, a refusal to acknowledge that people experiencing a rough day, or a rough week, or a rough few hours aren’t going to be your trained monkeys.

Depression manifests differently in everyone and at different times. Various behaviours are not proof positive that someone is or isn’t depressed, and, as with any armchair diagnosis, insisting that someone is not actually depressed just because of a show of something other than deep, entrenched sadness is actively harmful.

Look at the woman above, joyously cycling on a beach, hair fluttering in the breeze. You can’t judge her emotional state or her larger mental health picture, nor should you.

Sugar molecule kinks red meat consumption and elevated cancer risk .

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Neu5Gc, a non-human sugar found in red meat, promotes inflammation and cancer progression in rodents.

While people who eat a lot of red meat are known to be at higher risk for certain cancers, other carnivores are not, prompting researchers at the University of California, San Diego School of Medicine to investigate the possible tumor-forming role of a sugar called Neu5Gc, which is naturally found in most mammals but not in humans.

In a study published in the Dec. 29 online early edition of the Proceedings of the National Academy of Sciences, the scientists found that feeding Neu5Gc to mice engineered to be deficient in the sugar (like humans) significantly promoted spontaneous cancers. The study did not involve exposure to carcinogens or artificially inducing cancers, further implicating Neu5Gc as a key link between red meat consumption and cancer.

“Until now, all of our evidence linking Neu5Gc to cancer was circumstantial or indirectly predicted from somewhat artificial experimental setups,” said principal investigator Ajit Varki, MD, Distinguished Professor of Medicine and Cellular and Molecular Medicine and member of the UC San Diego Moores Cancer Center. “This is the first time we have directly shown that mimicking the exact situation in humans — feeding non-human Neu5Gc and inducing anti-Neu5Gc antibodies — increases spontaneous cancers in mice.”

Varki’s team first conducted a systematic survey of common foods. They found that red meats (beef, pork and lamb) are rich in Neu5Gc, affirming that foods of mammalian origin such as these are the primary sources of Neu5Gc in the human diet. The molecule was found to be bio-available, too, meaning it can be distributed to tissues throughout the body via the bloodstream.

The researchers had previously discovered that animal Neu5Gc can be absorbed into human tissues. In this study, they hypothesized that eating red meat could lead to inflammation if the body’s immune system is constantly generating antibodies against consumed animal Neu5Gc, a foreign molecule. Chronic inflammation is known to promote tumor formation.

To test this hypothesis, the team engineered mice to mimic humans in that they lacked their own Neu5Gc and produced antibodies against it. When these mice were fed Neu5Gc, they developed systemic inflammation. Spontaneous tumor formation increased fivefold and Neu5Gc accumulated in the tumors.

“The final proof in humans will be much harder to come by,” Varki said. “But on a more general note, this work may also help explain potential connections of red meat consumption to other diseases exacerbated by chronic inflammation, such as atherosclerosis and type 2 diabetes.

“Of course, moderate amounts of red meat can be a source of good nutrition for young people. We hope that our work will eventually lead the way to practical solutions for this catch-22.”

Study co-authors include Annie N. Samraj, Oliver M. T. Pearce, Heinz Läubli, Alyssa N. Crittenden, Anne K. Bergfeld, Kalyan Banda, Christopher J. Gregg, Andrea E. Bingman, Patrick Secrest, Sandra L. Diaz and Nissi M. Varki, all at UC San Diego School of Medicine.

This research was funded, in part, by the Ellison Medical Foundation, the National Cancer Institute (grant R01CA38701), a Samuel and Ruth Engelberg Fellowship from the Cancer Research Institute and a Swiss National Science Foundation Fellowship.

 

A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor

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Abstract

Background: The purpose of this prospective, double-blinded, parallel-arm, randomized trial was to examine the effects of epidural bupivacaine on the length of the second stage of labor in nulliparous women.

Methods: The authors assessed length of second-stage labor, degree of motor blockade, mode of delivery, and visual analog scores in 310 nulliparous women with labor epidurals randomized to receive either: (1) 0.125% bupivacaine and fentanyl 2 μg/ml or (2) fentanyl 10 μg/ml alone via epidural using double blinding.

Results: The median duration of the second stage was 75 min (41, 128) in the bupivacaine/fentanyl group versus 73 min (42, 120) in the fentanyl-only group (P = 0.17) with a median difference of 6.0 (95% CI, −6.0 to 18.0). Furthermore, there was no difference in degree of motor blockade, incidence of operative delivery, visual analog scores, or neonatal outcomes between the two groups. No adverse events were reported.

Conclusions: Use of epidural bupivacaine/fentanyl or a fentanyl-only infusion during the second stage of labor did not affect the duration of the second stage of labor, degree of motor blockade, mode of delivery, pain relief, and maternal or neonatal outcomes. However, in the fentanyl-only infusion group, there was a fivefold increase in opioid exposure to the fetus with unknown effects on neurobehavior, an outcome not assessed beyond the immediate postnatal period in this study.

What We Already Know about This Topic

  • Epidural analgesia through the second stage of labor is associated in some studies with prolonged second-stage duration and increased instrumental deliveries

  • Whether providing epidural analgesia without local anesthetics alters these outcomes is unknown

What This Article Tells Us That Is New

  • In 310 nulliparous women with epidural analgesia randomized at the onset of second stage to receive epidural fentanyl alone or with bupivacaine, there was no difference in duration of second stage, degree of motor block, or instrumental delivery

  • To achieve similar degrees of analgesia, women receiving epidural fentanyl without bupivacaine required a fivefold increased dose of fentanyl.

Discussion
Historically, when high concentrations of local anesthetic were used in labor epidural infusions, motor blockade was significant during the second stage of labor and often resulted in epidural infusions being turned down or completely off to improve maternal expulsive efforts.11  We highlight three clinical observations from our study of paramount interest and importance that address the aforementioned practices.
First, lower-dose epidural bupivacaine infusions such as that used in this trial moderately impeded lower extremity motor function during childbirth. In fact, all women were able to lift their legs against gravity (motor strength score: 3 or higher), further indication that no woman had an extensive motor block. This counters a previously described theory of epidural local anesthetics resulting in poor maternal expulsive efforts, thought to be a cause of increased operative deliveries.12 
Second, several investigators have reported that a major disadvantage to lowering or discontinuing the epidural infusion during the second stage of labor is the potential for inadequate analgesia.13–16  In two separate studies, Chestnut et al.13,14  randomized women to either bupivacaine-containing solutions or placebo infusion of saline during the second stage. Women randomized to the saline groups reported higher pain scores. Alternatively, Lindow et al.16  infused epidural opioid in lieu of saline in comparison with epidural bupivacaine/fentanyl. Again, results were similar with women reporting higher pain scores and a greater need for “rescue” analgesia of nitrous oxide and/or perineal infiltration of lidocaine in the fentanyl-only group. Of note, these studies had sample sizes of less than 100 women.
A meta-analysis was performed analyzing the possible consequences of discontinuing epidural analgesia late in labor.17  The only significant finding was an increase in pain. In contrast, our study found that pain scores were equally satisfactory among both groups. This is likely due to the higher concentration of fentanyl (10 μg/ml) used in our studyversus saline and a fentanyl concentration of 1.6 μg/ml used in the study by Lindow et al.16 
Last, substituting epidural bupivacaine with fentanyl-only (10 μg/ml) during the second stage of labor was not associated with deleterious maternal or neonatal effects. Although there was a negligible amount of intravenous meperidine given in both study arms, epidural fentanyl administration was five times greater in the fentanyl-only group. This increase in fetal opioid exposure is because epidural fentanyl is rapidly absorbed systemically. Although the bioavailability is unknown in laboring women, transplacental transfer is approximately 90%.18 
We report three limitations to our study. First, to estimate sample size, from our database, we included women of parity 0 and 1, which would explain the shorter median duration of the second stage at 28 min (15, 58) than what was observed in this study. Our study consisted of all nulliparous women. Second, having a third arm, with subjects that had a placebo infusion started after randomization, would have allowed us to evaluate the effects of discontinuing the epidural entirely on the outcomes of interest. But such a design would have raised ethical concerns regarding the withholding of effective analgesia. Last, parental opioids are known to induce neurobehavioral depression. The literature regarding the effects of epidural opioids remains unclear.19 However, we did not assess the newborn beyond the routine 1- and 5-min Apgar scores, so, there exists the possibility that this exposure could have resulted in neurobehavioral changes, even subtle ones.
In summary, we found that the use of epidural bupivacaine/fentanylversus fentanyl-only neither did lengthen the second stage of labor nor did affect the degree of motor blockade, mode of delivery, satisfaction with pain analgesia, and maternal or neonatal outcomes. However, the use of epidural fentanyl-only resulted in a fivefold increase in fetal opioid exposure. Although not assessed, this exposure could result in neonatal neurobehavioral depression, both short and long term, and should be an outcome of interest in future studies. Therefore, anesthetic management should be tailored to the individual needs of the obstetrical patient, balancing the risks and benefits to the mother and her newborn.