Day: 01/12/2024

The cliff descending method to facilitate parallel view during endoscopic submucosal dissection in the gastric fornix.

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Abbreviations:

ESD (endoscopic submucosal dissection), GEJ (gastroesophageal junction)

Introduction

Endoscopic submucosal dissection (ESD) has become standard of care for treatment of early gastric cancers worldwide. As procedural expertise grows, the locations and types of lesions that can be endoscopically resected have expanded. The gastric fornix is considered one of the most challenging locations because of the pooling of fluid and blood over the lesion, poor maneuverability of the endoscope, and en face position of the muscle wall during dissection in retroflexion. Dissection in a forward view is often impossible because of the severe angulation at the gastroesophageal junction (GEJ). As the endoscope is advanced from the esophagus, a cliff-like downward angle is encountered on the way to the fundus. We present the novel “cliff descending” method combining multi-bending endoscopes and traction to create a safe and manageable dissection plane for these difficult lesions (Video 1, available online at www.videogie.org).

A patient in their 70s was referred to our department for management of an early gastric cancer detected on screening. The location was in the gastric fornix. Dissection was started in retroflexion. This proved to be challenging, as the muscle was completely perpendicular to the knife. To complete the circumferential incision, a multi-bending endoscope was required, but the procedure remained technically difficult. It was decided to change to an anterior approach, facilitated by a line-and-sheath-type traction device (Figs. 1 and 2). This combination maintained a parallel orientation of the muscle layer throughout dissection, even down the cliff-like angulation at the GEJ (Fig. 3). The total procedure time was 151 minutes, with 68 minutes spent after starting the cliff descending method. A final inspection was performed, and the defect was left open given the limited evidence for closure in the stomach and lack of high-risk features. No antibiotics were required. Final histologic review confirmed a 15-mm early gastric adenocarcinoma (pT1a) with clear vertical and horizontal margins and no lymphovascular invasion (Fig. 4). Given the curative resection, a follow-up endoscopy will be performed in 1 year. The patient was discharged without issue, and no delayed adverse events have arisen.

Figure thumbnail gr1
Figure 1A, Illustration of conventional approach using a regular endoscope in retroflexion. The muscle layer remains en face during dissection. B, Multi-bending endoscope, with multi-bend portion highlighted in green. Full tip-down angulation is used to remain parallel to the muscle. C, Application of a line-and-sheath traction device more easily exposes the submucosal plane.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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Figure 2A, Lesion located in the gastric fornix. B and C, Retroflexed views rendered the muscle layer en face during resection. D, Switching to the multi-bending scope allowed for a parallel plane of dissection. E and F, The application of line-and-sheath traction further improved the views.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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Figure 3A, Lesion viewed in retroflexion. B, Illustration of the severe angle at the gastroesophageal junction, which required maintaining a parallel dissection plane in forward view. C, Comparison of the angle to an image of the authors sitting on a cliff face.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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Figure 4A, Specimen after resection. B, Neoplastic areas of the specimen. C (H&E, orig. mag. ×0.4) and D (H&E, orig. mag. ×5), Histopathology showing adenocarcinoma without muscular invasion.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

We present this novel technique as another tool when performing ESD in this difficult location. Usually, the cliff-like angulation from the GEJ into the fundus prevents a forward-viewing approach. By using full down-angulation with a multi-bending scope (Fig. 5), the plane can be kept parallel to the knife in forward view, creating a safe dissection environment. A line-and-sheath-type traction device can provide adequate counter-traction using the “crane” effect, which can further help lift the tissue away from the muscle layer.

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The traction device has a premade lasso at the end, which can be fastened to an endoscopic clip and secured by tightening the line, which closes the loop. The device is then brought outside the scope and attached to the mucosal flap. By adjusting the direction of traction via manipulation of the plastic sheath and changing the degree of tension by relaxing or tightening the line, the submucosa can be exposed even when traversing a sharp angle and descending the “cliff face.”

Figure thumbnail gr5
Figure 5A, Full upward angulation of the multi-bending scope (bottom) and conventional gastroscope (top). B, Full downward angulation of multi-bending scope (bottom) and conventional gastroscope (top). C and D, Full downward angulation, plus usage of the extra bending segment in the multi-bending scope (bottom).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Because it is challenging to perform ESD in this location, various strategies have been developed. Multi-bending endoscopes appear to have been helpful in multiple cases,

usually used in retroflexion. However, it is acknowledged that not all centers have access to this type of specialty endoscope. Procedures in this location have also been completed with conventional endoscopes with the assistance of an insulated-tip knife (IT-2 knife; Olympus, Tokyo, Japan),

a change in the patient position to right lateral decubitus,

and usage of the pocket-creation method.

Some centers have also used loop traction in lieu of line-and-sheath traction, although with this method, the ability to easily adjust the direction of traction is lost.

Thus, the cliff descending method remains an attractive option to safely complete ESD in a forward view for lesions in the gastric fornix.

The cliff descending method to facilitate parallel view during endoscopic submucosal dissection in the gastric fornix

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This is a case of early gastric cancer in the fundus of the stomach. Treatment was provided with endoscopic submucosal dissection (ESD), which is typically quite challenging in this location.

We used a combination of a multi-bending scope and line-and-sheath traction to create safe and efficient views. Dissection progressed in the forward view, and the lesion was ultimately resected en bloc. Final histology showed an R0 resection of an early gastric adenocarcinoma (pT1a).

Often, attempts are made to perform ESD in this location in retroflexion, but this usually causes the muscle to be directly perpendicular to the knife, risking deep injury. This method allowed us to create safer views parallel to the muscle layer. Moreover, the procedure was completed in forward view, which some find to be a more natural scope orientation.

During ESD in the fundus, similar to other difficult locations, it is important to know what tools and techniques one has at their disposal to facilitate the procedure. The most effective technique likely differs with patient factors, exact lesion location, and endoscopist preference. Nonetheless, we think the cliff descending method can be a strong candidate when planning for ESD in the gastric fundus.

We thank VideoGIE for the opportunity to present this video case.

Motomura_Takao_figure

A, Specimen after resection. B, Neoplastic areas of the specimen. C (H&E, orig. mag. ×0.4) and D (H&E, orig. mag. ×5), Histopathology showing adenocarcinoma without muscular invasion.

Top Studies in Neurology From 2023

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New Drugs in Alzheimer’s and ALS

Number one: monoclonal antibodies against beta amyloid for the treatment of early Alzheimer’s disease. For two monoclonal antibodies, lecanemab and donanemab, there was efficacy in slowing the disease progression. In practical terms, these two treatments pose significant problems. First, for diagnosis, you need PET-CT. The therapy has to be done via IV regularly, every 2 weeks or every 4 weeks. There are a number of side effects, which need MRI control, and the treatment is very expensive. We have, at present, no infrastructure for treating these patients. We also have a number of monoclonal antibodies that were not effective.

Number two: amyotrophic lateral sclerosis. There is a small subgroup, 1%-2% of patients, who have mutations in the SOD1 gene. There is now a new antisense oligonucleotide called tofersen, which reduces the concentration of SOD1 [protein] in the cerebrospinal fluid. There is a clinical phase 2 trial ongoing for efficacy.

Epilepsy, MS, and Gliomas

Number three: modern antiepileptic drugs taken during pregnancy in females with epilepsy. There is a study that showed that modern antiepileptic drugs like lamotrigine and levetiracetam have no effect on cognitive function in children aged 3 years. Remember, valproic acid and topiramate are clearly contraindicated in females with epilepsy during pregnancy.

Number four: There is an interesting disease called radiologically isolated syndrome. These are patients who get an MRI for whatever reason and they have signs of multiple sclerosis. We have two placebo-controlled studies for dimethyl fumarate and teriflunomide showing that you can delay the onset of the first episode of the disease compared with placebo.

The fifth study is a study in low-grade gliomas. There is a dual inhibitor of the mutated enzymes, IDH1 and IDH2, and this is called vorasidenib. This drug clearly improves the prognosis of patients with low-grade gliomas, and this is the first time that there is an effective treatment.

Migraine, Back Pain, and Stroke Treatments

Number six is the issue of triptan nonresponders in acute migraine attacks. The companies that produce the gepants and lasmiditan claim that up to 30% or 40% of patients are nonresponders to triptans. A study from the German Migraine Registry showed that triptan nonresponders do not exist if patients are given the opportunity to try three different triptans.

Number seven: We have very effective monoclonal antibodies against CGRP for the prevention of migraine, but 30% of patients will not respond. There is hope because there is another molecule involved in migraine, which is called PACAP. At the International Headache Congress, there was a placebo-controlled study that showed that a monoclonal antibody against PACAP is superior to placebo. We hope that this might be effective in people who do not respond to monoclonal antibodies against CGRP.

Number eight: acute back and neck pain. A large study from Australia clearly showed that opioids are not superior to placebo, and they should not be used also to avoid addiction.

Number nine: thrombectomy for large ischemic strokes. We were afraid to treat these patients out of fear of an increased risk for intracerebral hemorrhage, but this is not the case. There is a tension study with 253 patients that clearly shows that thrombectomy is superior to standard of care. We now have three studies showing that thrombectomy is also effective for large ischemic strokes, with only a small increase in intracerebral hemorrhage.

Remote Ischemic Conditioning

Finally, in 2022, there was a large study from China showing that remote ischemic conditioning in acute stroke might be effective. This is done by intermittent ischemia in the upper extremities. Now there is a new study in Europe with 1500 patients, which showed no benefit of remote ischemic conditioning, even if the treatment was started on the way to the hospital.

Dear colleagues, I’ve discussed 10 important publications and studies from 2023 which have impact for the treatment of our patients in neurology. I’m Christoph Diener from the medical faculty of University Duisburg-Essen.

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Stress During Fertility Treatments Leads to Higher Glucose

Women with increased levels of preconception stress during fertility treatments show increases in pregnancy glucose levels, particularly when conceiving using intrauterine insemination (IUI).

“We found that maternal stress, evaluated before pregnancy, is negatively associated with cardiovascular health, measured as glucose levels during pregnancy,” said Lidia Mínguez-Alarcón, PhD, of Harvard Medical School, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health in Boston, Massachusetts, in a press statement for the study published on January 4, 2024, in the Journal of the Endocrine Society.

“Our results highlight the importance of considering preconception as a sensitive window of stress in relation to cardiovascular health during pregnancy,” she said.

Conception with the use of assisted reproductive techniques is known to be associated with an increased risk for adverse metabolic conditions and glucose dysregulation in pregnancy.

With some studies further showing stress can affect glucose metabolism, Mínguez-Alarcón and her colleagues conducted the Environment and Reproductive Health (EARTH) Study, a prospective cohort study investigating stress levels among women enrolled in the Massachusetts General Hospital Fertility Center, in Boston, between 2004 and 2019.

The women’s self-reported preconception stress levels were compared with blood glucose levels in late pregnancy, assessed as part of screening for gestational diabetes.

In the analysis of 398 women, participants had a median age of 35 years at study entry and a median body mass index (BMI) of 23.4 kg/m2.

Psychological assessment was conducted with the short version of the validated Perceived Stress Scale 4 (PSS-4) psychological stress survey, and the women had a median PSS-4 score of 5, ranging from 0 to 14 on a scale of 0-16, with 16 representing the highest stress. Questions on the survey include “How often have you felt difficulties were piling up so high that you could not overcome them?” with responses including never, almost never, sometimes, fairly often, and very often.

Their mean pregnancy blood glucose level (mg/dL), assessed at a median of 26 weeks of pregnancy with a 1-hour nonfasting, 50-g glucose load test, was 119 mg/dL.

Overall, 82 women (21%) had abnormal gestational glucose levels (≥ 140 mg/dL) post glucose load.

After adjustment for multiple factors including age, BMI, race, smoking status, physical activity, and other factors, the levels of stress in the first (lowest), second, and third tertiles had corresponding mean glucose levels of 115, 119, and 124 mg/dL, respectively (P for trend = .007).

Compared with women in the first tertile of psychological stress those with higher levels in the second and third tertiles had 4% and 13% higher probabilities of having abnormal glucose, respectively (P trend = .01).

An analysis of patients according to the mode of conception showed the link between stress and abnormal glucose levels was stronger among women conceiving with IUI than with natural or in vitro fertilization (IVF) methods (risk ratio, 1.45); however, the authors caution that the lower number of women in the IUI group, just 65, vs 98 in the natural conception group and 235 receiving IVF is a caveat.

Of note, IVF cycles resulted in more live births than with IUI, and IVF is currently the preferred treatment for infertility couples trying to conceive.

The link between stress and blood glucose abnormalities was also stronger among women with a college degree vs those with lower education levels and among those with higher vs lower incomes.

Chronic Stress a Key Mechanism?

In terms of mechanisms, chronic stress, in particular, may drive the abnormalities in glucose production, the authors explained.

“Stress is known to initiate a physiological response that results in the activation of the hypothalamic-pituitary-adrenal (HPA) axis, which stimulates the production of glucocorticoids in the adrenal cortex,” they wrote.

Glucocorticoids, including cortisol, can impede the transport of glucose into skeletal muscle and adipose tissue and stimulate the gluconeogenesis pathway in the liver, they added.

“While the resulting high blood glucose level ensures that there is adequate energy supply during the fight or flight response, repeated activation of the HPA under chronic stress can lead to insulin resistance and hyperglycemia.”

That mechanism may explain the stronger glucose abnormalities among women with higher education and income levels, who could be expected to experience more chronic stress, the authors speculated.

“One possible explanation for the stronger associations seen in women with higher incomes and attained education levels is that many of these individuals may be employed in demanding, time-intensive jobs,” they wrote.

“It has previously been shown that those with a higher education level experience greater levels of job stress, with stronger associations found in women than in men.”

Overall, the findings are notable in that most studies evaluating stress and glucose levels in pregnancy have focused on gestational stress and not stress during the preconception window, Mínguez-Alarcón told Medscape Medical News.

“Higher blood sugar levels are a predictor of worse current and long-term maternal and offspring health,” she said.

In addition, “stress during pregnancy can negatively affect cardiovascular health, but we are showing that [stress] also before conception can affect pregnancy health.”

The results underscore the need for clinicians to consider patients’ stress levels early in the pregnancy planning process,” Mínguez-Alarcón noted.

“Recommendations for clinicians are to reduce stress levels before pregnancy, as soon as women are planning to become pregnant in the coming months, for example, when they stop contraceptive medications,” she said.

Common Diabetes Pills Also Protect Kidneys

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Medication people with type 2 diabetes use to manage their blood sugar also appear to protect their hearts and kidneys, according to a new study in JAMA Network Open. 

These pills, known as sodium-glucose cotransport protein 2 (SGLT2) inhibitors, reduce the amount of blood sugar in a kidney by causing more glucose to be excreted in urine.

Chronic kidney disease (CKD) cannot be cured and often leads to renal failure. SGLT2 inhibitor drugs can help stave off this possibility. Acute kidney disease (AKD), on the other hand, is potentially reversible. It typically occurs after an acute kidney injury, lasts for up to 90 days, and can progress to CKD if left unchecked. 

“T here has been a notable absence of targeted pharmacotherapy to offer protection to these patients,” said Vin-Cent Wu, MD, PhD, a nephrologist at National Taiwan University Hospital in Taipei, and an author of the study. 

For the retrospective analysis, Wu and his colleagues looked at data from more than 230,000 adults with type 2 diabetes whose health records were gathered into a research tool called the TriNetX, a global research database. Patients had been treated for AKD between 2002 and 2022. Major adverse kidney events were noted for 5 years after discharge, which were defined as events which required regular dialysis, major adverse cardiovascular events such as a heart attack or stroke, or death. 

To determine the effects of SGLT2 inhibitors, Wu and colleagues compared outcomes among 5317 patients with AKD who received the drugs with 5317 similar patients who did not. Members of both groups had lived for at least 90 days after being discharged from the hospital and did not require dialysis during that period. 

After a median follow-up of 2.3 years, more patients who did not receive an SGLT2 inhibitor had died (994 compared with 481) or had endured major stress to their kidneys (1119 compared with 504) or heart (612 compared with 295). The relative reduction in mortality risk for people in the SGLT2-inhibitor arm was 31% (adjusted hazard ratio, 0.69; 95% CI, 0.62-0.77).

Only 2.3% of patients with AKD in the study were prescribed an SGLT2 inhibitor. 

In the United States, approximately 20% of people with type 2 diabetes and CKD receive a SGLT2 inhibitor, according to 2023 research.

“Our study reveals that the prescription rate of SGLT2 inhibitors remains relatively low in clinical practice among patients with type 2 diabetes and AKD,” Wu told Medscape Medical News. “This underscores the need for increased awareness and greater consideration of this critical issue in clinical decision-making.” 

Wu said that AKD management tends to be conservative and relies on symptom monitoring. He acknowledged that confounders may have influenced the results, and that the use of SGLT2 inhibitors might only be correlated with better results instead of producing a causation effect.

This point was raised by Ayodele Odutayo, MD, DPhil, a nephrologist at the University of Toronto, who was not involved in the study. But despite that caution, Odutayo said that he found the study to be encouraging overall and broadly in line with known benefits of SGLT2 inhibitors in CKD. 

“The findings are reassuring that the medications work even in people who’ve already had some kidney injury beforehand,” but who are not yet diagnosed with CKD, Odutayo said. 

“There is vast underuse of these medications in people for whom they are indicated,” perhaps due to clinician concern that the drugs will cause side effects such as low blood pressure or loss of salt and fluid, Odutayo said. Though those concerns are valid, the benefits of these drugs exceed the risks for most patients with CKD.

Food an Effective Medicine in Diabetes?

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Despite boosting engagement with preventive healthcare, an intensive food-as-medicine program did not improve glycemic control in patients with uncontrolled type 2 diabetes (T2D) and self-reported food insecurity any better than usual medical care.

METHODOLOGY:

  • A randomized clinical trial tested if an intensive food-as-medicine program improved glycemic control and affected healthcare use in patients with diabetes and food insecurity.
  • The trial included 500 patients (81% White, 55% women, mean age, 55 years) with T2D, glycated hemoglobin (A1c) levels of ≥ 8%, food insecurity, and residence within the service area of the participating clinics.
  • Patients were randomly assigned to either participate in the food-as-medicine program immediately (treatment group) or after 6 months (control group receiving usual care).
  • The food-as-medicine program provided healthy groceries for 10 meals/week for the entire household, along with dietitian consultations, nurse evaluations, health coaching, and diabetes education.
  • The primary outcome was participants’ A1c levels at 6 months, and secondary outcomes included healthcare use, self-reported diet, and healthy behaviors at both 6 months and 12 months.

TAKEAWAY:

  • After 6 months, both the treatment and control groups reported a substantial decline in A1c levels (1.5 and 1.3 percentage points, respectively), with a nonsignificant adjusted mean difference of −0.10 (P = .57).
  • Patients in the treatment group, as opposed to the control group, showed higher engagement with preventive healthcare at 6 months, making more visits to the program clinic (13.00 vs 0.72) and dietitians (2.7 vs 0.6).
  • The number of outpatient visits, reflecting healthcare usage, was also significantly higher in the treatment vs control group at 6 months (P = .007).
  • There was no detectable impact on total claims, with an insignificant reduction in inpatient or emergency department claims offset by an insignificant increase in outpatient claims.

IN PRACTICE:

“Programs targeted to individuals with elevated biomarkers require a control group to demonstrate effectiveness to account for improvements that occur without the intervention. Additional research is needed to design food-as-medicine programs that improve health,” the authors wrote.

Beyond Minoxidil: Pumpkin Seed Oil Restores Female Hair Loss

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Could  humble pumpkin seed oil really be just as effective as pharmaceuticals at restoring female pattern hair loss? See what the research has to say.

Female pattern hair loss (FPHL) is a distressing issue for many women. While topical minoxidil foam is effective, alternative options remain desirable due to treatment burden, irritation potential and undesirable facial hair growth [1]. Researchers recently explored whether pumpkin seed oil could provide similar rejuvenating effects on thinning hair without minoxidil’s downsides [1].

In this novel trial, women applied either pumpkin seed oil or 5% minoxidil foam daily for 12 weeks [1]. Remarkably, while minoxidil performed slightly better, over 60% reported significant hair regrowth with pumpkin seed oil alone using validated scoring systems [1].

Outcomes like decreased miniaturized “vellus” hairs and improved caliber of regrowing hair shafts indicate pumpkin seeds influence factors promoting fuller, normalized tresses [1].

Researchers suggest anti-androgenic effects underlie efficacy, as pumpkin seeds contain chemicals inhibiting 5-alpha reductase required for converting testosterone into dihydrotestosterone attacking hair follicles [1]. Less biochemical assault combined with improved blood flow nourishes weak follicles.

Beyond halting hair loss progression, 60% of women improved sufficiently to detect significant new growth [1]. And without minoxidil’s drawbacks like rapid shedding or heart effects such as rapid heartbeats or chest pains. 

As the first human data, this high-quality evidence demonstrates clinically-meaningfulResponses that position pumpkin seed oil as a novel, natural FPHL therapy [1]. Women bothered by hair thinning or genetic alopecia can feel empowered deploying gentle phytotherapy before resorting to daily medications.  

Easy incorporation into oils or shampoos provides accessibility, bypassing healthcare gatekeepers for initial support. For those experiencing no improvement, prescription options remain available as usual care.

This research opens integrative doors for women struggling with a huge yet neglected psychosocial burden, using science to validate traditional medicine. While larger studies over longer periods with standardized formulations are ideal, these results offer real hope today for non-invasive hair loss reversal. That alone is a tremendous gift despite remaining questions.

Reason Behind Disturbed Sleep Found in 60% of Pineal Glands

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Is your pineal gland, the “seat of the soul” that controls sleep rhythms, turning to stone? Over 60% of people unknowingly suffer from this condition.

A recent analysis found over 60% of people have calcification of the pineal gland, which produces the hormone melatonin regulating sleep-wake cycles. Calcification associates with melatonin decline, health issues.

The Calcifying Effects of Fluoride on the Pineal Gland

The pineal gland has been referred to as the “seat of the soul” for hundreds of years due to its light-sensitive nature and production of the spiritual hormone melatonin[1]. But could fluoride, a ubiquitous modern-day toxicant, be calcifying this gland and literally turning our spiritual center to stone?[2] Emerging research suggests the answer is yes.

In a 2001 study on fluoride distribution, pineal gland fluoride levels were measured in aged cadavers. Researchers found that:

“There was a positive correlation between pineal F[luoride] and pineal Ca[lcium] (r = 0.73, p<0.02) but no correlation between pineal F and bone F. By old age, the pineal gland has readily accumulated F and its F/Ca ratio is higher than bone.”[3]

They concluded that over time through regular fluoride exposure, “the pineal accumulates fluoride and that this accumulation may be implicated in the pathogenesis of pineal calcification.”[3] Given the essential role of the pineal gland and melatonin in regulating wake/sleep patterns and spiritual health[4], these findings have profound implications. 

The pineal gland produces the vital spiritual hormone melatonin, which regulates healthy sleep-wake cycles[5]. Studies reveal calcification is associated with decreased nighttime melatonin production[6]:

“Calcification of the pineal gland is shown to be closely related to defective melatonin secretion, which enhances oxidative stress.”[7]

Decreased melatonin is subsequently linked with various sleep cycle disturbances including daytime tiredness:

“[Calcification] is associated with decreased REM sleep percentage, decreased total sleep time, poorer sleep efficiency, greater sleep disturbance and greater daytime tiredness.”[8]

Animal studies also demonstrate that pineal gland removal results in loss of response to the anti-depressant Prozac[9], suggesting disturbing effects on mood regulation as well: 

“The mechanism behind mood stabilization and antidepressant effect of fluoxetine may be abolished in pinealectomized rats due to loss of circadian rhythm of plasma melatonin levels.”[10]

Pineal gland fluoride can also contribute to free radical damage and inflammation, thereby inflaming conditions like depression and other disorders:

“Fluoride leads to generation of free radicals and enhanced lipid peroxidation in animals and humans through oxidative mechanisms.”[7]

Meanwhile melatonin has direct antioxidant effects offering protection. But with enough accumulated fluoride, the pineal gland’s essential detoxifying and regulatory roles are hindered, which undoubtedly impacts the soul.

So how exactly does fluoride infiltrate the seat of the soul? The pineal gland protrudes from the center of the brain and uniquely lacks the blood-brain barrier protecting most of the brain from bloodstream toxins like fluoride[2]. Pineal gland tissue also contains high levels of hydroxyapatite, which attracts circulating fluoride like a magnet and causes it to accumulate over time[2,11]:

“Fluoride has a great affinity toward hydroxyapatite crystals, so the pineal (which calcifies early in life) accumulates fluoride over time.”[12]

Animal studies reveal eliminating fluoride exposure for as little as 5 weeks stimulates significant pineal gland repair and reverses accumulated damage, underscoring the importance of reducing sources of toxic fluoride[13]. Similar healing would likely occur in human glands as well.

Beyond avoiding sources like fluoridated water, fluoride dental products, non-stick pans, and certain drugs, increasing intake of iodine, magnesium, selenium, vitamin K2, and antioxidants like melatonin helps mitigate pineal gland accumulation and promote healthy de-calcification[14]. With wise prevention and periodic detox from this ubiquitous toxicant, we can sustain the seat of the soul for future spiritual connection.

Recent Systematic Review Finds High Global Prevalence of Pineal Gland Calcification

A 2023 systematic review and meta-analysis published in Systematic Reviews aimed to assess the pooled global prevalence of pineal gland calcification (Pineal Res. 2023; 12:32). The authors conducted a comprehensive literature search and analysis of population-based studies reporting prevalence rates.

From 30 studies screened, 8 cross-sectional studies representing over 5,500 patients were included in the final quantitative analysis. The pooled prevalence of pineal gland calcification was found to be 61.65% (95% CI: 52.81-70.49%) with high heterogeneity between studies (I2 = 97.7%).

Reported prevalence rates ranged widely from 26.88% to 76.7% between countries. Qualitative review revealed pineal calcification consistently increased with age, was more common in males versus females, and was higher among white ethnicity.

While specific causes remain unclear, contributors likely include genetic, environmental, lifestyle and neurodegenerative factors. Potential mechanisms span accumulating hydroxyapatite deposits or cellular debris within the gland’s unique physiology alongside calcifying processes seen in bone and vasculature.

Given the pineal gland’s role regulating sleep-wake cycles and other rhythms via spiritual hormone melatonin, these high rates of calcification have profound clinical implications. Pineal concretions associate dose-dependently with melatonin decline, circadian dysfunction, sleep disturbances and psychiatric symptoms.

Future studies must clarify specific causes and impacts of rising pineal gland calcium accrual both globally and in vulnerable subpopulations. Since pineal physiology remains incompletely understood, the prevalence, predictors and clinical sequela of pineal calcification deserve fuller investigation.

In summary, this systematic analysis established significantly high worldwide prevalence of pineal gland calcification using the largest dataset to date. These findings highlight an urgent need to elucidate the drivers and consequences of pineal concretions given the essential spiritual and homeostatic functions governed by this unique neuroendocrine organ.

Decalcifying Soft Tissue & Supporting Pineal Health

Since calcification may contribute to conditions like Alzheimer’s disease and pineal gland dysfunction, evidence-based natural interventions to remove excess calcium deposits deserve exploration. The research database GreenMedInfo.com contains research on over 95 natural substances studied to reduce soft tissue calcification, with top evidence for magnesium, garlic and vitamin K2.[16]

Reducing intake of inorganic calcium supplements could also mitigate risk, as excessive supplementation associates with pineal calcification and lesions in the brain.[17] The use of inorganic calcium supplements, even at low doses, correlates with greater volume brain lesions compared to non-users.[18]

Considering the pineal gland’s melatonin-producing effects on sleep-wake and antioxidant activity, supporting its structural health aligns with evidence-based natural healing. Beyond moderate sun exposure for optimal melatonin, dietary sources like walnuts, oranges and kiwi support healthy circadian rhythms and sleep quality.[19] Herbs including lavender, passionflower and valerian root as well as supplemental melatonin also promote sound sleep and brain health through the aging process.

19 Ayurvedic Tips for Insomnia

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If you’re tossing and turning or just can’t get a restful night’s sleep, Ayurveda may have just the wisdom you need.

Insomnia is unfortunately very common. A report published by the American Academy of Sleep Medicine (AASM) featured more than 2,000 Americans and discovered that almost 3 in 10 people are negatively impacted by insomnia on a daily basis. Chronic insomnia, which is when sleep difficulties occur at least three times a week for three months or longer, affects at least 10 percent of Americans.

What Are the Different Types of Insomnia?

Insomnia that lasts from a single night to a few weeks is called transient insomnia. But chronic insomnia, as mentioned before, occurs at least three nights a week over three months or more. Chronic insomnia is either primary or secondary: primary insomnia is not related to any other health problem, while secondary insomnia can be caused by a medical condition (such as cancer, asthma, or arthritis), drugs, stress, mental health concerns (such as depression), or a poor sleep environment (such as too much light or noise, or a bed partner who snores).

How Does Ayurveda Define Insomnia?

According to Ayurveda, insomnia (known as nidranasha or anidra) is a disease of the channels of the mind (or manovaha srotas). The manovaha srotas are the channels that carry thoughts, feelings, sensations, emotions, and the components of other mental processes.

Insomnia is the condition of insufficient sleep, interrupted sleep, or poor-quality sleep. This might look like having trouble falling asleep or waking up frequently during the night. Some people find it difficult to return to sleep once they are up at odd hours.

According to Ayurveda, waking up early in the morning and then staying awake is also considered insomnia. Experiencing a compromised quality of sleep where you wake up feeling unrefreshed and unrested despite sleeping seven to eight hours would be identified as insomnia, as well.

Ayurveda teaches us that insomnia is not just an illness, but a symptom of an underlying doshic imbalance and a sign of many other chronic physical, behavioral, cognitive, and mental issues that may appear in the future if not addressed.

What Causes Insomnia?

Ayurveda has a great deal to say about how to support balanced sleep in general. According to Ayurveda, there are two main models that explain the mechanism of insomnia: cognitive and physiological. According to the cognitive model, what prevents a person from falling asleep is rumination and hyperarousal—for example, overthinking, mind chatter, and stress.

Physiological conditions that can contribute to insomnia include sleep apnea, hormonal fluctuations, chronic pain, congestive heart failure, hyperthyroidism, GERD or heartburn, restless leg syndrome, menopause, certain medications, and substances such as caffeine, nicotine, and alcohol.

How the Doshas Influence Insomnia

A person with Vata imbalance has difficulty falling asleep at first. This is particularly common during Vata time of the night, which occurs between 2-6 a.m. Vata’s light and mobile qualities make it difficult for the mind to rest and the chatter to stop.

Imbalanced Pitta individuals experience broken sleep during the night. Their obsessive-compulsive thoughts keep them stimulated between the hours of 12-4 a.m.

For those dealing with Kapha dosha aggravation, sleep terminates at a very early hour in the morning. They can’t go back to sleep once awake.

Ayurvedic Remedies for Insomnia

It’s always best to work with an Ayurvedic doctor or practitioner to figure out which dosha is causing the insomnia and to receive customized treatments. We know that sleep is crucial to optimal health: it aids the body in repairing, regenerating, and recovering. Sleep flushes out toxins, boosts our memory, increases our focus, and much more. Simple adjustments to our routine, exercise, diet, and lifestyle habits can have a profound impact on our sleep.

Here are tips to use Ayurveda to manage insomnia:

1. Stick to a consistent sleep routine.
2. Eat nutritious meals appropriate for your dosha.
3. Have an early, light dinner, preferably three hours before you go to bed.
4. Don’t drink caffeinated beverages after 2 p.m.
5. Turn off your phone and tablets at least an hour before bed.
6. Avoid consuming news and conversations that lead to sensory overload.
7. Go for nature walks.
8. Exercise regularly but refrain from movement that is too stimulating in the evening.
9. Take a warm bath with dosha-specific essential oils, like lavender, chamomile, or ylang ylang.
10. Apply warm sesame oil to the feet to sedate the nervous system. It will help ease stress, calm the mind, and soothe the body.
11. Cultivate a daily meditation practice to lower stress and promote sleep.
12. Try self-reflection and gratitude journaling.
13. Minimize any contentious conversations in the evening.
14. Practice alternate nostril breathing and Bhramari pranayama to calm the mind.
15. Make sure your bedroom is dark and quiet, with the head of your bed facing any direction but north (as energy from that direction can be stimulating).
16. Wind down your evening with yoga asanas like Big Toe Pose, Bridge Pose, Cat Pose, Corpse Pose, Cow Pose, Dolphin Pose, Downward-Facing Dog, and Easy Pose.
17. Herbs helpful for Vata and Kapha types of insomnia include Ashwagandha, Tulsi, Indian valerian root, Bola (Indian myrrh), Shallaki (frankincense) and Brahmi. Drinking warm milk with nutmeg before bed also works.
18. Pitta-based insomnia, which shows up as body heat and mental agitation, can be treated with cooling nervines, such as chamomile, Mandukaparni (gotu kola), Chandan (sandalwood), and Hypericum (St. John’s wort).
19. Shirodhara and Picchu treatments (herbal oil applied to the crown of the head) are extremely useful in the treatment of insomnia.

Omics Study Suggests Long COVID Involves Viral Persistence

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Bacterium, virus, coronavirus, covid-19, sars background

People with long COVID are likely to have immune cells showing signs of chronic inflammation and other unusual characteristics, according to a new study by scientists at the Gladstone Institutes and the University of California San Francisco (UCSF). Their findings, which appear in Nature Immunology, support the hypothesis that long COVID may involve a low-level viral persistence.

“Not every person with long COVID had these pro-inflammatory cells, but we only saw them in the long COVID group,” said Kailin Yin, PhD, postdoctoral fellow in the Roan lab and co-first author of the study. “It underscores the idea that there isn’t just one uniform thing that characterizes all individuals with long COVID.”

The team analyzed immune cells from the blood of 43 people with and without long COVID, focusing particularly on T cells. They used omic assays and serology to “deeply characterize the global and SARS-CoV-2-specific immunity in the blood of individuals with clear LC and non-LC clinical trajectories, eight months post infection.”

“Our results are an essential first step to understanding what’s going on with T cells in long COVID,” said senior author Nadia Roan, PhD, a senior investigator at Gladstone and a professor at UCSF. “This paves a path toward answering ongoing questions about the different types of long COVID, the mechanisms that cause it, and how to treat and prevent it.”

Long COVID, also known as “post-acute sequelae of COVID” (PASC), is broadly defined as symptoms that continue or emerge after an initial infection with the SARS-CoV-2 virus. The symptoms and trajectory of this condition can vary between individuals. In addition, vaccination status and subsequent infections can impact a person’s long COVID risk and disease progression.

“This is a very heterogeneous condition,” Roan says. “There’s a diverse mix of long COVID cases, which makes it difficult to work out what’s really going on. That’s why it was so important to eliminate some of this variability. We analyzed and compared a set of pristine samples not complicated by the effects of vaccination or re-infection, which can affect T-cell and other immune responses.”

Roan’s group worked with researchers at UCSF who are part of a multidisciplinary team running an observational COVID study called LIINC, or Long-term Impact of Infection With Novel Coronavirus, which follows a cohort of people who were infected one time with COVID. For this study, patients were classified as having long COVID if they consistently had symptoms during the entire study period. Those who had no symptoms following their initial infection were in the control group.

In this study, Roan and her team used six different technologies, including CyTOF (Cytometry by Time-of-Flight), serology, RNA sequencing, single‐cell RNA-seq, and plasma proteomics. CyTOF can measure levels of specific molecules on or within T cells. 

Notably, they found CD4 T cells were in a more inflammatory state in people with long COVID. Meanwhile, CD8 T cells, which normally kill cells infected by viruses or bacteria, showed signs of exhaustion preferentially in people with long COVID. These signs were observed only in T cells that recognize the SARS-CoV-2 virus, not in the broader population of CD8 T cells.

“Such exhaustion is typically seen in chronic viral infections such as HIV, and means the T cell branch of the immune system stops responding to a virus and no longer kills infected cells,” said Micheal Peluso, MD, assistant professor in the UCSF Department of Medicine and co-first author of this study.

In their conclusion, the researchers write, “Our analysis suggested an improper crosstalk between the cellular and humoral adaptive immunity in LC [long COVID], which can lead to immune dysregulation, inflammation and clinical symptoms associated with this debilitating condition.”