CT Scan Decisions: Key Questions for Patients

A UC San Francisco study published in JAMA Internal Medicine examined the cancer risks associated with CT scans.  Key Findings from the UC San Francisco Study:^[2] 

• Projected Cancer Cases: The study estimates that CT scans conducted in 2023 could result in approximately 103,000 future cancer cases, based on radiation exposure data.
• Scope of Study: Researchers analyzed 121,212 exams across 143 hospitals, using National Cancer Institute models to project risks.
• Most At-Risk Group: Children under one year are the most vulnerable to radiation-induced cancer.

Criticism & Counterarguments

The study reinforces concerns about radiation exposure, prompting discussions on limiting unnecessary scans and optimizing doses.  However, critics highlight the nuances in risk modeling, cautioning against overestimations in vulnerable patient groups.

• Overestimation of Risks: Experts from the Mayo Clinic and the American College of Radiology argue the estimates may be exaggerated, particularly for patients with severe illnesses who may not live long enough for radiation-induced cancers to develop.
• Importance of LDCT Screening: The American Lung Association (ALA) strongly supports low-dose CT (LDCT) for lung cancer screening in high-risk individuals, emphasizing that its life-saving benefits outweigh the small radiation risks, especially with technological advancements reducing exposure.^[2]

LDCT vs. Regular CT: Making an Informed Choice

What Are LDCT and Regular CT Scans?

• LDCT (Low-Dose CT): A CT scan that uses a reduced radiation dose, often employed for screening purposes like lung cancer detection in high-risk individuals (e.g., long-term smokers). The web result from cancercenter.com notes that an LDCT delivers about 1.4 millisieverts (mSv) of radiation, roughly one-fifth of a regular CT scan’s dose (around 7 mSv).
• Regular CT Scan: A standard diagnostic CT scan that uses a higher radiation dose to produce detailed images, typically for diagnosing specific conditions like trauma, tumors, or infections.

CT Scan Decisions: Key Questions for Patients

Before undergoing a CT scan, experts recommend asking key questions: 

• Is the scan necessary? 
• Are there safer alternatives? 
• Has the radiation dose been optimized, especially for children? 
• Would an LDCT be a better option for screening?

If screening for conditions like lung cancer, opting for an LDCT can help minimize radiation exposure. For diagnosing specific issues, a regular CT may provide more detailed imaging, but it's crucial to discuss the risks and benefits with a doctor, particularly if multiple scans are needed. Ultimately, the best choice depends on the medical context—LDCT is ideal for screenings with lower radiation, while regular CT offers superior detail for complex diagnoses.

References

1. Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
2. American Lung Association Addresses Recent Study About Radiation in CT Scans
3. Popular CT Scans Could Account for 5% of All Cancer Cases A Year
4. What's the difference between a low-dose CT scan and a regular CT scan?

Crafting Your Happiness: Shaping Your Path, Choosing Your People

In life, there’s a delicate balance 

between embracing others as they are and intentionally shaping the world around you. 

It’s about recognizing that 

every person carries their own unique quirks, struggles, and perspectives—and accepting them without judgment. 

Yet, at the same time, you hold the power to 

curate your surroundings, making thoughtful choices about who you allow into your orbit. 

Your happiness isn’t just a matter of chance; 

it’s something you actively cultivate by surrounding yourself with people who uplift, support, and align with your aspirations. 

The journey is 

yours to walk, and deciding who accompanies you along the way is one of the most important choices you can make.

Untangling the Causes of Eye Bags: Why a Precise Diagnosis is Key

Eye Doctor Explains How to Get Rid of Under EYE BAGS (YouTube link)

Under-eye bags are a common cosmetic concern that can stem from a variety of underlying anatomical changes. The factors listed in the statement are all recognized contributors:

• Orbital Fat Prolapse: As we age, the septum (a fibrous membrane) that holds the fat pads around the eyes in place can weaken. This allows the fat to bulge forward, creating the appearance of puffiness or bags under the eyes. This is a primary and well-established cause.
• Orbital Bone Resorption: The bones of the skull, including the orbital rim (the bone around the eye socket), undergo resorption or loss of volume over time. This can lead to a sunken appearance and reduced structural support for the overlying tissues, making eye bags appear more prominent and contributing to a hollowed look.
• Skin Laxity: The skin around the eyes is thin and delicate. With age, and due to factors like sun exposure and genetics, the skin loses collagen and elastin, leading to decreased elasticity and sagging. This loose skin can contribute to the formation and appearance of eye bags.
• Ligamentous Laxity: The supporting ligaments in the face, including those around the eye area, can stretch and weaken with age. This loss of support can cause the tissues to droop, exacerbating the appearance of eye bags and contributing to an overall aged look.

The Importance of Precise Diagnosis

Because eye bags can result from one or a combination of these factors, a "one-size-fits-all" treatment approach is often ineffective.  An accurate diagnosis by a qualified medical professional is essential to:

• Identify the Primary Cause(s): A thorough examination can help determine the dominant factors contributing to an individual's eye bags. For instance, if fat prolapse is the main issue, treatments will differ from those primarily addressing skin laxity or volume loss due to bone resorption.
• Rule Out Other Medical Conditions: In some cases, puffiness under the eyes can be a symptom of underlying medical conditions such as thyroid problems, allergies, infections, connective tissue diseases, or fluid retention due to other health issues. A proper diagnosis can help identify and address these if present.
• Tailor the Treatment Plan: Different causes necessitate different treatment strategies. Options can range from lifestyle changes and topical treatments for mild cases to non-surgical interventions like dermal fillers (to address volume loss) or laser resurfacing (to improve skin texture and tightness), and surgical procedures such as blepharoplasty (eyelid surgery) to remove or reposition fat and excise excess skin. Festoons or malar mounds, which are distinct from typical eye bags, require specific treatment approaches.
• Manage Expectations: Understanding the specific cause helps in setting realistic expectations for treatment outcomes.

In conclusion, the formation of eye bags is a complex interplay of factors including fat prolapse, bone resorption, skin laxity, and ligamentous weakness. A precise diagnosis is paramount for developing an effective and targeted treatment plan to address this common aesthetic concern.

See Also:

1. Bags under eyes

Beyond Hemorrhoids: Key Colon Cancer Symptoms and Why Early Detection Matters

Top 5 WARNING Signs of Colon Cancer You MUST KNOW! (YouTube link)

Rising Prevalence: 

• Colon cancer is increasingly common, now affecting younger people (30s and 40s), not just those over 50. It's one of the most common and deadly cancers.

Top 5 Warning Signs:

• Blood in Stool: Can be visible (bright red or dark) or hidden (occult). Often mistaken for hemorrhoids, but testing is crucial as it may indicate deeper bleeding.
• Change in Bowel Habits: Includes diarrhea, constipation, gas, or IBS-like symptoms. Thin or small stools ("goat poop") may suggest a tumor affecting bowel shape.
• Unexplained Weight Loss: Losing fat and muscle unintentionally is a red flag, as cancer consumes energy and triggers inflammation.
• Persistent Abdominal Discomfort: Bloating, cramps, or pain, often misdiagnosed as IBS, can signal a tumor affecting the colon.
• Fatigue or Anemia: Chronic bleeding leads to iron deficiency, causing paleness, tiredness, or dizziness. Doctors may prescribe iron without screening for cancer.

Screening Importance: 

Over half of colon cancer deaths could be prevented with proper screening. Tests include:

• Colonoscopy: Gold standard, examines the entire colon.
• Sigmoidoscopy: Less invasive, checks only the lower colon.
• Fecal Tests: Fecal occult blood test (FOBT) or stool DNA tests (e.g., Cologuard) detect blood or cancer-related DNA.
• CT Colonography: Virtual colonoscopy, less invasive but requires prep.
• Liquid Biopsy: Emerging blood test for cancer DNA, not yet widely available.

Personal Experience: Dr. Brewer shared his colonoscopy results, revealing diverticuli (outward pouches in the colon) and a polyp (inward growth, potential cancer precursor). Both are linked to pressure in the sigmoid colon and require monitoring. His doctor recommended a high-fiber diet, though the speakers noted fiber’s role is debated in carnivore diets.

Risk Factors and Prevention:

• Environmental Changes: Increased colon cancer in younger people may be linked to diet, particularly high fructose consumption (e.g., high fructose corn syrup), which promotes inflammation and possibly cancer growth.
• Metabolic Disease: Type 2 diabetes and inflammation are significant risk factors, suppressing immunity and fueling cancer.
• Diet Debate: Processed meats (nitrosamines) carry some risk, but evidence linking unprocessed meats to colon cancer is weak. Carnivore and low-carb diets may improve gut health for some, but fiber can support a healthy gut biome.

Key Takeaway: Don’t ignore symptoms or assume they’re benign (e.g., hemorrhoids or IBS). Test, don’t guess, especially with a family history or symptoms. Lifestyle changes (e.g., reducing sugar, managing metabolic health) and regular screening are critical for prevention.

Additional Notes:

• Dr. Brewer’s colonoscopy experience highlighted the procedure’s discomfort but emphasized its necessity. He had a polyp and diverticuli, underscoring the importance of follow-up.
• The discussion touched on the gut biome, noting that both carnivore and plant-based diets can foster beneficial bacteria, but fiber may enhance gut health for some.

For more details on colon cancer screening or metabolic health, visit Cleveland Clinic website or focusing on personalized dietary and lifestyle choices, alongside regular check-ups for metabolic health. Always consult a doctor for personalized advice.

Boosting NAD+: Strategies for a Healthier Lifespan

NAD+ (Nicotinamide Adenine Dinucleotide) is a critical coenzyme in every cell, supporting numerous biological processes. Here are the key benefits of maintaining healthy NAD+ levels:

• Energy Production: NAD+ is essential for cellular metabolism, facilitating the conversion of nutrients into ATP, the cell's primary energy source, through processes like glycolysis, the citric acid cycle, and oxidative phosphorylation.
• DNA Repair: NAD+ activates enzymes like PARP-1, which repair DNA damage caused by oxidative stress or aging. This helps maintain genomic stability, reducing the risk of mutations and age-related diseases.
• Cellular Defense and Longevity: NAD+ supports sirtuins, proteins that regulate cellular health, stress resistance, and lifespan. Sirtuins promote anti-aging effects by enhancing DNA repair, reducing inflammation, and improving metabolic efficiency.
• Improved Mitochondrial Function: NAD+ enhances mitochondrial health, ensuring efficient energy production and reducing oxidative stress, which is linked to aging and chronic diseases.
• Neuroprotection: NAD+ supports brain health by protecting neurons from oxidative damage and inflammation, potentially reducing the risk of neurodegenerative diseases like Alzheimer’s and Parkinson’s.
• Cardiovascular Health: NAD+ promotes blood vessel function and heart health by supporting sirtuins and reducing oxidative stress, potentially lowering the risk of cardiovascular diseases.
• Metabolic Health: NAD+ regulates insulin sensitivity, glucose metabolism, and fat storage, helping prevent obesity, type 2 diabetes, and metabolic syndrome.
• Reduced Inflammation: NAD+ modulates immune responses and inhibits enzymes like CD38, which are linked to chronic inflammation ("inflammaging"), a driver of age-related decline.
• Enhanced Muscle Function: NAD+ supports muscle repair and maintenance by improving mitochondrial function and reducing oxidative damage, aiding physical performance and recovery.
• Cognitive and Physical Resilience: Higher NAD+ levels are associated with improved cognitive function, memory, and physical endurance, supporting overall vitality during aging.

Maintaining NAD+ levels through diet (e.g., flavonoid-rich foods), lifestyle (e.g., calorie restriction), or supplements (e.g., nicotinamide riboside) may enhance these benefits, potentially improving healthspan and lifespan. However, consult a healthcare professional before making changes to boost NAD+.

The Third Way to Boost NAD+ (YouTube link)

In the video, it discusses three strategies to boost NAD+ levels, which are crucial for cellular health and longevity:

• Increasing NAD+ Precursors: Supplying more precursors to produce NAD+.
• Enhancing NAD+ Synthesis: Activating enzymes that synthesize NAD+ to increase production.
• Reducing NAD+ Consumption: Conserving NAD+ by minimizing its use by enzymes like PARP-1 and CD38.

PARP-1 is an enzyme that consumes NAD+ to repair DNA damage. Excessive oxidative stress, such as from a high-fat diet, increases DNA damage, activating PARP-1 and depleting NAD+. This can be mitigated by reducing oxidative stress through diet, like consuming purple sweet potatoes rich in anthocyanin pigments, which restore NAD+ levels. While PARP-1 blockers could preserve NAD+, preventing DNA damage is preferable. Higher PARP-1 activity correlates with longer lifespans, but overactivation can deplete NAD+ and cause cell death.

CD38, another NAD+ consumer, is linked to inflammation and increases with age due to "inflammaging." Blocking CD38 in old mice restores NAD+ to youthful levels. Conditions like obesity, characterized by oxidative stress and inflammation, reduce protective sirtuin activity, which relies on NAD+. Calorie or protein restriction can boost sirtuin expression and NAD+ levels by reducing oxidative stress.

Dietary Interventions: Antioxidant and anti-inflammatory flavonoids in plant foods inhibit PARP-1 and CD38, boosting NAD+ and sirtuin activity. 

Effective compounds include:

• Cyanidin (red cabbage, blackberries)
• Quercetagetin (marigold tea)
• Luteolin (oregano, radicchio, chrysanthemum tea)
• Kuromanin (blackberries, purple corn, hibiscus tea)
• Luteolinidin (red sorghum)
• Apigenin (parsley, chamomile tea)
• Proanthocyanidins (apples, plums, wild blueberries, cinnamon, cocoa powder)
• Quercetin (onions)

These compounds, found in fruits, vegetables, and spices, can achieve NAD+-boosting effects at dietary levels. For example, one apple or two plums provide enough proanthocyanidins to lower PARP-1 and CD38 expression, while two onions can raise quercetin levels sufficiently. High-dose flavonoid supplements lack long-term safety data, so a balanced vegetarian diet is recommended to safely increase NAD+ levels.

Dr. Greger's Plant-Based Prescription for Health and Longevity

Nutrition Expert: These are The Best Foods to Eat to Live Longer | Dr. Michael Greger (YouTube link)

Dr. Michael Greger, a renowned advocate for evidence-based nutrition, emphasizes the critical role of diet in health and longevity, highlighting that poor diet is the leading cause of death globally, surpassing smoking. He argues that most chronic diseases, including heart disease (evident in nearly all Americans by age 10), stem from "diseases of excess" — too much sodium, saturated fat, and sugar. A plant-based diet, centered on whole, unprocessed plant foods like fruits, vegetables, legumes, whole grains, nuts, seeds, and spices, is the healthiest approach to prevent and even reverse these conditions.

Key Points:

• Diet as the Top Risk Factor: The Global Burden of Disease study identifies diet as the number one killer, with the American diet causing more deaths than smoking. Heart disease, the leading cause of death, is preventable through dietary changes.
• Plant-Based Diet Defined: A plant-based diet prioritizes whole plant foods, minimizing meat, dairy, eggs, salt, and sugar. It’s not necessarily vegetarian but focuses on maximizing healthy choices, avoiding processed foods like soda or chips, which can technically be plant-based but are unhealthy.
• Health Benefits: Centering diets around whole plant foods reduces the risk of chronic diseases, improves energy, digestion, and quality of life, and can extend lifespan. For example, switching to a healthier diet at age 20 can add 11–13 years to life, and even at age 80, it can add 3 years.
• Actionable Swaps: Nutrition is about "instead of what." Replace unhealthy foods with healthier alternatives (e.g., water instead of soda, oatmeal instead of eggs if comparing health impacts). Dr. Greger’s Daily Dozen app recommends incorporating specific healthy foods like berries, dark leafy greens, legumes, and spices daily.
• Top Foods to Add: 
• Berries (healthiest fruits)
• Dark green leafy and cruciferous vegetables (e.g., kale, collards)
• Legumes (beans, chickpeas, lentils) as primary protein sources in Blue Zones.
• Top Foods to Remove: 
• Trans fats (hydrogenated oils)
• Processed meats (bacon, hot dogs, classified as Class 1 carcinogens)
• Sugary beverages (soda).
• Taste Bud Reset: A plant-based diet can recalibrate taste buds in about three weeks, making healthy foods like unsalted corn or sweet potatoes taste delicious as the palate adjusts away from hyper-salty, sweet, or fatty processed foods.
• Supplements Caution: The supplement industry is poorly regulated, with many products not containing what’s claimed or being contaminated. Choose USP-certified brands or whole food sources (e.g., turmeric spice over curcumin pills). Supplements like B12 (for plant-based eaters), vitamin D (for low sun exposure), and algae-based DHA (for cognitive health) may be necessary in specific cases, but most people should focus on diet over pills.
• Behavioral Change: Small, incremental dietary changes compound over time. A two-week plant-based trial can yield noticeable improvements in energy and digestion, encouraging long-term adherence. The goal is to make healthy eating enjoyable, not restrictive, by “loving the food that loves you back.”

Takeaways for Listeners:

• Try Plant-Based for Two Weeks: Expect better energy, digestion, and a recalibrated palate that enjoys whole foods.
• Focus on Whole Plant Foods: Prioritize berries, greens, and legumes while cutting trans fats, processed meats, and soda.
• Start Small, Think Long-Term: Small dietary changes compound to improve health and longevity, and it’s never too late to start.