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TOXINS IN FOOD

TOXINS IN FOOD

You can’t reach for a fork these days without hearing about one toxic food trouble or another. In order to take a significant bite out of the potential dangers lurking on our dinner plates and avoiding the toxins found in some foods, it is important to read labels, understand the sources of where our food comes from, and keep the kitchen clear of certain unsavory ingredients. Below are some of the most common toxins to avoid:

PESTICIDES

Used to raise and treat plants, these poisons often leave behind a residue. They’ve been linked to everything from cancer to birth defects.

BHA (BUTYLATED HYDROXYANISOLE) & BHT (BUTYLATED HYDROXYTOLUENE)

These common processed food preservatives have been declared carcinogens by the International Agency for Research on Cancer. They’re also accused of disrupting hormones and impacting male fertility.

RECOMBINANT BOVINE GROWTH HORMONE (RBGH/RBST)

Given to cows to increase milk production, rGBH produces elevated levels of insulin-like growth factor-1 (IGF-1) in dairy products. IGF-1 is a significant risk for breast, prostate and colon cancers.

SODIUM ALUMINUM SULPHATE AND POTASSIUM ALUMINUM SULPHATE

Used in processed cheese products, baked goods, and microwavable popcorn, among other packaged goods, these ingredients are linked to adverse reproductive, neurological, behavioural, and developmental effects.

BISPHENOL-A (BPA)

Found in food and beverage can linings, this hormone-mimicker is suspected of increasing the risk of breast and prostate cancers, reproductive and behavioural problems, obesity, and diabetes.

What are the solutions?

  1. Reduce your intake of animal-derived products (meat, fish, egg, poultry and dairy) and include more plant-based foods in your diet (nuts, seeds, legumes, plant-based milk, etc)
  2. Wash and scrub all fresh fruits and vegetables thoroughly under running water. Running water has an abrasive effect that soaking does not have. This will help remove bacteria and traces of chemicals from the surface of fruits and vegetables, and dirt from crevices. Not all pesticide residues can be removed by washing. Before washing with water, products can be soaked in white vinegar
  3. Peel fruits and vegetables when possible to reduce dirt, bacteria, and pesticide residue. Discard the outer leaves of leafy vegetables. Trim fat from meat and skin from poultry and fish because some pesticides residues collect in fat
  4. Eat a variety of foods, from a variety of sources. This will provide you with a better mix of nutrients and reduce your likelihood of exposure to a single pesticide
  5. Choose organic products whenever possible
  6. Avoid canned and processed foods
  7. Stop using plastic: say no to straws and plastic bottles. Invest in your own BPA-free bottle
  8. Always read the label and ingredients list to avoid those toxins
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TOP 10 REASONS FOR WHY YOU FEEL SO TIRED

TOP 10 REASONS FOR WHY YOU FEEL SO TIRED

Tiredness (also known as fatigue) is an extremely common problem. In fact, “why am I so tired?” was one of the most frequently searched questions of the last 2 years at Google. The answers can vary, since tiredness can come from a physiological or psychological condition. In this article we’ll discuss 10 of the main causes of fatigue.   

3. ANEMIA

Anemia is a condition characterized by a low number or abnormal shape of red blood cells. In some countries up to 10% of the population is at risk of developing some kind of anemia, mostly due to low levels of iron. Pregnant women are especially vulnerable to it. There are several types of anemia; however, the one caused by iron deficiency is the most commonly related to fatigue.

Iron deficiency is related to fatigue mainly because this ion is essential for oxygen transportation, ATP production (the main energy currency of the cell) and muscle function. People with this condition usually experience dizziness and get tired easily.

4. SLEEP APNEA

This condition involves blocking of the upper airways during sleep which leads to short periods where the person is not able to breathe. This can be caused by a number of factors like obesity, genetic disorders, kidney failure, etc.   

The lack of sleep and sudden shortage of oxygen eventually lead to general sleepiness and fatigue in most cases. So far, women have proved to be more vulnerable to this condition.

5. UNDERACTIVE THYROID

The condition is also known as Hypothyroidism. It is characterized by a low production of important hormones. Since early symptoms are very common for many other diseases, people can spend many years without being diagnosed.

Usually, the symptoms include weight gain, depression, muscle ache, sensitivity to cold, dry skin and hair and of course, fatigue.

This condition can be treated with hormone therapy.

9. GLANDULAR FEVER

Also known as infectious mononucleosis, this infection is mostly seen in adolescents or adults who haven’t been infected with the Epstein-Barr virus before, people can be infected and show no symptoms for nearly 2 months. 

Although fever is the main symptom, fatigue is the one that lasts the longest (up to 6 months after the infection).

10. DEPRESSION

Depression is the term usually used when someone feels sad or anxious for an extended period of time. People that have been depressed for a long period of time (over 2 years) can develop feelings of tiredness as part of a particular form of depression called dysthymia.

However, in literature, is common to see depression as the consequence of chronic fatigue syndrome. People who live with the syndrome often spend very long periods of their lives without effective treatment of diagnosis, which leads to feelings of hopelessness and eventually depression.

There are plenty of other reasons for why you may feel tired all the time, for example, if you are fighting an infection, it often triggers what some call “sickness behavior”, which sometimes includes fatigue. Overall, any condition related to chronic inflammation has the potential to cause tiredness. Or it simply could be that you need to make dietary changes. Whatever the case, if you If you experience long periods of fatigue and are concerned, talk to your doctor.  

Hector Osorio 29 Jan 2019

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HIGH CHOLESTEROL WHAT IT IS, AND 5 WAYS TO CONTROL IT

HIGH CHOLESTEROL WHAT IT IS, AND 5 WAYS TO CONTROL IT

Cholesterol is a fat molecule synthesized by the body to serve various vital and structural functions. Your body produces these molecules on its own, and also absorbs it from foods you eat, especially animal sources like meat, dairy, and eggs.

High levels of cholesterol in your blood is known to cause heart and blood vessel diseases. Cholesterol can bind to other substances in your bloodstream and clog up your arteries which can lead to a heart attack or a stroke.

You’ve probably heard of LDL, HDL, and VLDL cholesterol, which are different types of cholesterol, and that some are “bad” and some are “good”. In general, LDL cholesterol is termed “bad” cholesterol for its tendency to build up in vessel walls damaging them. HDL cholesterol is termed “good” cholesterol for its counteractive effect, where it transports cholesterol from your bloodstream back into the liver, preventing its buildup in your vessels. Having too much bad cholesterol (LDL), and/or very little good cholesterol (HDL) is dangerous, and can lead to the mentioned conditions.

WHAT CAUSES HIGH CHOLESTEROL?

Several factors could contribute to high cholesterol levels, and they all have to do with your lifestyle:

  • An unhealthy diet: eating processed, fried, and fast foods that are rich in saturated and trans fats is a major source of bad (LDL) cholesterol. These fats are also found in different sweets, fatty meat, dairy foods, and pastry.
  • A sedentary lifestyle: moderate and intense physical activity is needed to lower your LDL cholesterol and elevate the protective HDL cholesterol.
  • Smoking: like in many other diseases, smoking is a cause. Smoking raises your LDL cholesterol levels and reduces the HDL cholesterol level, tipping the balance towards more problems.

The good news is, there are many medications in use today that can help you manage your high cholesterol level and protect your body against its dire effects. Moreover, there are several diet and lifestyle changes that you can adopt to reduce your cholesterol level naturally without needing medications:

1. Take control of your diet

The thing is, a high cholesterol level is largely a dietary problem. The importance of controlling what and how much you eat cannot be stressed enough.

  • Avoid saturated fats: These fats are found in many of the things we eat, especially meat products. Processed and fast foods contain higher proportions of saturated fats, and hence it’s best if you avoid these altogether. These fats mainly increase your bad (LDL) cholesterol levels and are not a healthy choice.
  • No more trans fats: The FDA is working on banning trans fats from food products for the ill effects they cause. These fats are usually found in fried foods and some forms of pastry. You can check the label on the product you’re buying and search for the ones containing “partially hydrogenated oil”, which is a more complex way of saying trans fats.
  • Choose foods with good cholesterol: As already mentioned, HDL cholesterol is considered a good type of cholesterol, one that protects your vessels and prevents them from clogging up. Foods like avocado,  olive oil, fresh nuts, fish, and some fruits are good HDL sources and would be a great substitute for unhealthy foods in your diet.
  • Opt for foods high in fiber: These foods can help reduce the amount of cholesterol absorbed by your guts, and hence would help drop your LDL. Foods like oatmeal, beans, fruits, vegetables, and seeds are rich in fiber, and you would be smart to incorporate them into your diet.
  • Try foods rich in Omega-3: These are a special type of fatty acids that you’ve probably already heard of. Many studies claim that Omega-3 protects your heart and improves your health. The most famous source of this nutrient is fish. You can try to replace red meat in your diet for fish to take the full benefit.

2. Exercise more

As already said, having a sedentary lifestyle puts you at a higher risk of having high cholesterol. You can work out around 30 minutes, 3 to 5 times a week to stay within the recommended physical activity level. Staying active can raise your good cholesterol (HDL) levels and protect you against various metabolic disorders.

Now, you don’t have to start running marathons right away, but you can start by choosing to walk more often rather than drive. Maybe invest in a bicycle and take it to work twice a week. With time, your body will be more used to moving and you can start doing higher intensity exercises like jogging or swimming.

3. No more smoking

As with most other medical conditions, smoking is one of the causes. It is well known that smoking harms your heart and blood vessels, and can cause many types of cancer. Stopping smoking can help raise the level of HDL cholesterol, enhancing its protective effects on your body.

4. Lose those extra pounds

If you’re overweight or obese, you should consider losing some weight through diet and exercise. Extra weight is an important cause of metabolic disturbances which include high cholesterol. Moreover, obesity can lead to many diseases like hypertensiondiabetes, and heart problems.

You can lose weight by adjusting your diet and exercising a little more. Seeking the help of a healthcare professional to set a comprehensive diet and training program can be worthwhile.

5. If you drink, do so in moderation

Some studies have shown that moderate consumption of alcohol may increase HDL cholesterol, which is a good thing. Nevertheless, data is still inconsistent in this regard, but if you do indeed drink alcohol, make sure you do so in moderation. This translates to a maximum of one alcoholic drink per day for women or two drinks for men.

High cholesterol is harmful to your health and is usually a result of unhealthy life habits. The most important controllable factor contributing to high blood cholesterol is your diet. By getting your diet in check, and maybe exercising a little more and quitting some bad habits, you will probably be able to control your cholesterol levels and gain numerous other health benefits.

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HEART DISEASE - FACT VS FICTION

HEART DISEASE - FACT VS FICTION

World Heart Day takes place on 29th September every year and is the World Heart Federation‘s and the world’s biggest platform for raising awareness about cardiovascular disease, including heart disease and stroke.

According to the World Heart Federation, “cardiovascular disease is one of the leading causes of death and disability across the world, killing 17.5 million a year. This accounts to the third leading cause of death on the planet and half of all non-communicable disease-related deaths.

In this article we look at some of the common myths regarding heart disease, and some practical steps you can take to improve your heart health.

COMMON CARDIOVASCULAR DISEASES

One misunderstanding about cardiovascular disease is that it is only one disease; there are actually many diseases that fall into this category. According to Mayo Clinic, heart diseases may consist of coronary artery disease, arrhythmias, congenital heart defects, and conditions that relate to narrowed or blocked blood vessels and other conditions that involve irregularities in the heart’s muscle, valves, or rhythm. As claimed by the American Heart Association, heart disease can lead to a number of additional health issues, some of which include myocardial infarction (heart attack), ischemic attack (the most common type of stroke), heart failure, hemorrhagic attack (a less common, but sometimes more serious type of stroke), and more.

COMMON MYTHS

As stated by Harvard Health Publishing, some common myths about heart disease are as follows: 

  • Cardiovascular disease sufferers need to take it easy
  • As long as a cholesterol-lowering drug is being utilized, sufferers can eat anything they want
  • It’s normal to have higher blood pressure at an older age
  • Diabetes cannot cause cardiovascular disease if a diabetes medication is being taken
  • Vitamins and supplements are acceptable ways to lower the risk for heart disease,
  • Chronic smokers can reduce their risk of cardiovascular disease the moment they quit smoking. 
  • Heart diseases mostly only affects men,
  • Sufferers should eat as little fat as possible
  • A small heart attack is nothing to worry about

All of these statements are false and should be further researched by heart disease sufferers to gain a better understanding of how and why.

GENETICS

One common misconception regarding heart disease is that it is strictly hereditary. Although cardiovascular diseases can leave a person predisposed, it does not guarantee nor exclude the chances of an individual acquiring the ailment. Risk factors for heart disease can be majorly influenced by lifestyle choices, regardless of genetics.

AGE

Although heart disease is generally more prevalent in older adults, anyone of any age can suffer from cardiovascular diseases. When the blood vessels in the heart get clogged with plaque, it makes it more difficult for blood to circulate to the rest of the body, including the legs. This often causes pain due to the type of heart disease, which often leads to heart attacks. Leg pain can be a sign that one may be suffering from cardiovascular disease and potentially lead up to a heart attack.

GENDER

Many believe that men and women have the same symptoms when it comes to heart attacks and in some instances, it is true, but not always. In a study, WebMD found that both men and women reported symptoms of pain, shortness of breath, and fatigue, but men were more likely to experience right-side chest discomfort, dull ache, discomfort, and indigestion. Women, on the other hand, were more likely to experience throat discomfort, pressing on the chest, and vomiting.

According to the American Heart Association, high blood pressure does not clearly display any signs or symptoms and must be routinely monitored in order to be kept under control.

DIET

It is commonly believed that fats are bad for your health and should be avoided; this is not necessarily true, as there are good and bad types of fat and are both a dietary necessity, in proportion. As with fats, there are good and bad types of cholesterol and once the good kind (High-density lipoprotein) is elevated, it allows the bad kind (Low-density lipoprotein) to be decreased.

LDL cholesterol levels can be  lowered through an appropriate diet with increased amounts of whole grains, beans, nuts, citrus fruits, and many other foods. Superfoods that have been proven to help prevent heart diseases are beans, berries, dark greens, nuts, seeds, oats, salmon, and other foods that contain good fats.

WAYS TO IMPROVE HEART HEALTH

EAT BETTER

The food that we eat has a direct connection with our heart. For instance, if you drink caffeine, the heart speeds up. And, if we eat too many saturated fats, our heart ends up being encased in fat. Obesity is the leading cause of heart disease, followed by high blood pressure and diabetes.

There are various heart healthy diets that you can research. For example, the Mediterranean diet is immensely popular globally when it comes to heart health. Its beneficial effect on heart health has made it deserves all the hype. According to the research in Nutrition Journal, Mediterranean diet plays a major role in managing and balancing the levels of fat in the blood.

STOP SMOKING 

Both smoking and exposure to secondhand smoke is harmful to your heart’s health. The nicotine from cigarettes causes your blood vessels to contract, but it also boosts up your blood pressure. This, in turn, can become the leading cause of cardiovascular disease. It also increases the risk of metabolic syndrome.

Metabolic syndrome is an amalgamation of many risk factors that increase the possibility of succumbing to heart disease. These risk factors include diabetes or stroke. In accordance with the recent study from Diabetology and Metabolic Syndrome, it was found that inflammation increased due to smoking; thus, in turn, increasing the risk of heart diseases.

MOVE MORE 

Rapid urbanization and hectic work schedules means people are much more inactive than they were in the past.  People generally move less than they used to.  Even taking small steps such as walking for 30 mins a day can help improve heart health. 

Above all, in order to sustain good cardiovascular health and healthy life, consider our diet, lifestyle and the surrounding environment. Don’t be negligent, make sure to give your heart the care it deserves. Few simple lifestyle changes such as eating healthy food, being more active and quitting smoking can improve heart health as well as overall well being.

The information provided is not intended to replace the care or advice of a qualified health care professional. Always consult your doctor for all diagnoses, treatments and cures for any diseases or conditions, as well as before changing your health care regimen.

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MOH: Vaccines in Malaysia are halal and must be administered to children

MOH: Vaccines in Malaysia are halal and must be administered to children

A two-year-old child passed away in Miri Hospital, Sarawak, from diphtheria in March 2018. An investigation by the Ministry of Health (MOH) Malaysia revealed that the parents chose to not have her immunised against diphtheria due to concerns about the halal nature of vaccine.

According to the MOH, there were 32 cases of diphtheria – including seven deaths – reported throughout the country last year. Out of those cases, 75% were unvaccinated, most of them children.

Health Director-General Datuk Dr Noor Hisham Abdullah advised that children should be administered with the ‘five-in-one’ injection at two, three and five months, including a booster at 18 months.

Vaccines are Halal

The technical committee chairman of vaccine advocacy programme Immunise4Life, Datuk Dr Zulkifli Ismail, said the anti-vaccine sentiment has created confusion and distrust towards vaccination. “There is nothing in Islam or any other religion that says you cannot give vaccinations to children. The only reason we are seeing diphtheria cases is not because vaccine has failed, but because parents do not want their children to take the vaccine.”

The MOH urged Muslim parents to not doubt the halal status of vaccines.


The National Fatwa Council has also issued a statement that vaccines provided by the government are all halal. Health Deputy Minister Datuk Seri Dr Hilmi Yahaya advised Muslim parents to trust the data provided by experts instead of false information circulated on social media.

“In Malaysia, there is only one vaccine which contains porcine DNA – the rotavirus vaccine. The government does not buy this vaccine. It is only available in private clinics to treat severe diarrhoea,” he added.

Dr Zulkifli encouraged the use of reliable resources to retrieve information on immunisation, such as Immunise4Life website (www.ifl.my) and MYVaksinBaby app.

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Herb-drug interactions that patients need to know

Herb-drug interactions that patients need to know

Doctors in Singapore are on alert regarding herb-drug interactions following an incident last year, when a 58-year old woman died after surgical removal of a benign brain tumour.

The woman failed to inform doctors that she took cordyceps, a herbal medication, a week before her operation. This was believed to have led to extensive bleeding in her brain.

Patients need to understand that herbal medications are not completely safe, and that these preparations, when taken with other drugs, can alter the way that the drug is processed and excreted by the body, enhance a drug’s side effects, or block the intended therapeutic effect of the drug.

It is important that patients consult first with a physician before taking any herbal supplements, or inform their physician if they are taking herbal preparations if they are prescribed with medications.

Below are some of the most common herbs used as supplements, together with some of their known interactions with drugs:

1. Black Cohosh
Black cohosh is often used for menopausal disorders. It could be toxic to the liver and could have an increased toxic effect to liver when used together with other drugs that can also cause liver toxicity. Drugs that depend on the liver for their excretion may accumulate and lead to toxicity when used with black cohosh.

2. Coenzyme Q10
Coenzyme Q10 protects the heart from damage from cancer medications. The use of coenzyme Q10 with warfarin decreases its blood thinning effects and may increase the risk for a blood clot.

3. Echinacea
Echinacea is used to enhance the body’s immune system and helps in the management of the common cold. Echinacea affects the metabolism of drugs by the CYP450 system. This could lead to complicated drug interactions, enhancement of side effects and reduction of the drug’s therapeutic effects. It can also slow down the metabolism of caffeine which can lead to insomnia, jitteriness and headache.


4. St. John’s Wort supplements
Supplements containing St. John’s Wort are commonly used to treat symptoms of depression. This should not be used concomitantly with other antidepressants, migraine medications, dextromethorphan, warfarin, birth control pills, and certain antiretroviral medications due to seriousness of drug interactions.

5. Ginseng
Ginseng is commonly used to improve the body’s resistance and vitality. There are four known types of ginseng, namely American, Korean, Siberian and Brazillian. Of these, American ginseng is known to decrease the effects of warfarin and should not be used together with other anticoagulants, though this cannot be conclusively said for the other three types. Ginseng also has an effect in blood pressure and blood sugar medications.


6. Ginkgo biloba
Gingkgo biloba is used to enhance memory, and in improving symptoms of Alzheimer’s and Parkinson’s diseases. It can decrease effects of certain HIV medications, and alter the actions of drugs metabolized by the liver.

Cecille Anthony Adams, 09 Jul 2018

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Addressing the Concerns of a Pregnant Patient with Hepatitis B

Addressing the Concerns of a Pregnant Patient with Hepatitis B

Hepatitis B is a silent infection which is often taken lightly and under-diagnosed and can be transmitted through infected blood and body fluids, as well as from mothers to babies during pregnancy and delivery. Dr Nurhazinat bt Mohd Yunus, Consultant Obstetrician and Gynaecologist, shares some important points about hepatitis B in pregnancy.

Questions

1. What are the most common concerns for pregnant patients regarding hepatitis B?

Patients are usually concerned about three things – their baby, their partner and lastly themselves.

Firstly, they are concerned whether their baby will be ok, and whether the virus will cause abnormalities to their baby. We need to reassure these patients that although their baby can be infected with the virus, it will not cause any abnormalities. There are viruses that are known to cause foetal abnormalities such as chicken pox, but not HBV.

Secondly, it involves their partner. Sometimes, patients do not know that they have hepatitis, so when they are found to be positive, a lot of questions arise. Have they always been a carrier? Did they get it from their side of the family, through blood transfusion, or from their husband? The list goes on. If their husband is tested negative, part of the management involves counselling the couple to use condom, get vaccinated, inform them about the possible risk of getting infected, and so on. We will try to find the cause and have them alert their family members as well. It is well worth to get their whole family screened and vaccinated.

The third concern revolves around the patients themselves and their future. Can they get pregnant again? Will they get sick in the future? Do they need to limit the number of children to bear? There are no straight answers to this as we need to check the patients’ viral load and liver function to see how aggressive the infection is.

2. Can patients with hepatitis B breastfeed their babies?

Most disease control committees have declared that there are no issues for mothers with hepatitis B to breastfeed. Of course, the risk is still there and there is no 100% guarantee that breast milk-transmitted infection will not occur. Most doctors recommend breastfeeding but there are also doctors who disagree. They feel that there is no point in exposing a baby to the smallest risk of contracting an infection and recommend feeding by formula milk instead, especially in well-developed countries where they have good infant formulas with low contamination rate. In the end, we can only counsel patients and provide the information, but patients will have to make the decision themselves.

3. What about antivirals? Are they safe to use during pregnancy and breastfeeding?

There are a few types of antivirals that are deemed relatively safe to use during pregnancy and breastfeeding. Usually pregnant women with hepatitis will be jointly managed by medical and obstetrics and gynaecology specialists. Most of the time, attending physicians will decide if their patients need to be on antivirals as they will continue to manage these patients even after delivery. These patients need more care, so their viral load and liver function must be closely monitored.

 

4. How can babies be protected if their mother has hepatitis? Is there any special care for babies who are infected?

Malaysia has a national vaccination programme where hepatitis B vaccination is given at birth. As such, the younger generation is better protected against the disease.

If a mother is tested positive for HBV infection, her baby will be given the vaccine and Hepatitis B immune globulin (HBIG), which is effective in preventing the development of the virus. If the vaccine is given together with the HBIG within 12 hours, it will reduce the rate of contracting the virus by 90%.

These babies will then undergo paediatrics follow-up and more tests will be done to confirm their hepatitis B status. Sometimes the infection will clear off, and sometimes the initial blood drawn for testing is actually the mother’s blood. There are a lot of possibilities but it is certain that these babies will need special care and probably lifelong follow-up.

5. How can doctors reassure patients regarding their disease?


If patients are pregnant and have hepatitis B, remind them that they can live a normal life with a normal life expectancy. They can still have as many children as they want, and we as doctors will not limit their childbirth choices just because they have hepatitis B. In between pregnancies, they need to undergo check-ups to assess if they are healthy, if their liver is ok, or if they need any medications. Even if all is well, remind them that they still need to continue their follow-ups for long-term monitoring.

Dr. Nor Anisa Hanan, 11 Jul 2018
Consultant Obstetrician and Gynaecologist
Tropicana Medical Centre

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COVID-19: Higher Risk for Smokers and Vapers

COVID-19: Higher Risk for Smokers and Vapers

When someone’s lungs are exposed to flu or other infections the adverse effects of smoking or vaping are much more serious than among people who do not smoke or vape.

Smoking makes COVID worse if you get it and smoking — and vaping — increase the risk of being infected and developing COVID-19.

As of April 28, 2020 there were 19 peer reviewed papers that had data on smoking and COVID disease progression, 17 from China, 1 from Korea, and 1 from the US.  Our peer reviewed meta-analysis of these 19 papers found that smoking was associated with more than a doubling of odds of disease progression in people who had already developed COVID. 

There have been several reports, mostly in non-peer reviewed preprints, reporting lower levels of COVID-19 infections among smokers than nonsmokers. This is a surprising finding because, based on what we know about the effects of smoking and vaping on immune function of the respiratory system, one would expect that smoking and vaping would increase risks of COVID infection.  A big problem with all the studies to date has been that they have been based on people who were tested, rather than samples drawn from the population as a whole.  Because of limited availability of tests in many places, the resulting samples are biased toward people who may already have symptoms.

On August 11, 2020, Shivani Mathur Gaiha and Bonnie Halpern-Felsher from Stanford and Jing Cheng from UCSF addressed this problem in a study that used a population-based sample of youth and young adults, “Association between youth smoking, electronic cigarette use and Coronavirus Disease 2019.  Among young people (ages 13-24) COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only, seven times more likely among ever-dual-users, and 6.8 times more likely among past 30-day dual-users.

These findings are particularly important as the case mix of people getting COVID is moving to younger people, perhaps reflecting increased exposures due to reduced social distancing and a lack of understanding about factors exacerbating COVID-related risk in this age group.

 

Why?

Smoking is associated with increased development of acute respiratory distress syndrome (ARDS) in people with a risk factor like severe infection, non-pulmonary sepsis (blood infection), or blunt trauma.   People who have any cotinine (a metabolite of nicotine) in their bodies – even at the low levels associated with secondhand smoke – have substantially increased risk of acute respiratory failure from ARDS. 

The recent excellent summary of the evidence on the pulmonary effects of e-cigarettes reported multiple ways that e-cigarettes impair lungs’ ability to fight off infections:

Effects on immunity

Reporting of respiratory symptoms by e-cigarette users suggests increased susceptibility to and/or delayed recovery from respiratory infections. A study of 30 healthy non-smokers exposed to e-cigarette aerosol found decreased cough sensitivity. If human ciliary dysfunction is also negatively affected, as suggested by animal and cellular studies, the combination of reduced coughing and impaired mucociliary clearance may predispose users to increased rates of pneumonia. Exposure to e-cigarettes may also broadly suppress important capacities of the innate immune system. Nasal scrape biopsies from non-smokers, smokers, and vapers showed extensive immunosuppression at the gene level with e-cigarette use. Healthy non-smokers were exposed to e-cigarette aerosol, and bronchoalveolar lavage was obtained to study alveolar macrophages. The expression of more than 60 genes was altered in e-cigarette users’ alveolar macrophages two hours after just 20 puffs, including genes involved in inflammation. Neutrophil extracellular trap (NET) formation, or NETosis, is a mode of innate defense whereby neutrophils lyse DNA and release it into the extracellular environment to help to immobilize bacteria, a process that can also injure the lung. Neutrophils from chronic vapers have been found to have a greater propensity for NET formation than those from cigarette smokers or non-smokers. Given that e-cigarettes may also impair neutrophil phagocytosis, these data suggest that neutrophil function may be impaired in e-cigarette users. [emphasis added]

Studies in animals reinforce and help explain these human effects:

Two weeks of exposure to e-cigarette aerosol in mice decreased survival and increased pathogen load following inoculation with either Streptococcus pneumoniae or influenza A, two leading causes of pneumonia in humans. Furthermore, the aerosol exposure may lead to enhanced upper airway colonization with pathogens and to virulent changes in pathogen phenotype, as shown with Staphylococcus aureus. Thus, although more studies are needed, the animal data suggesting that vaping leads to an increased susceptibility to infection would seem to correlate with the population level data in young adult humans, whereby vapers have increased rates of symptoms of chronic bronchitis. [emphasis added]

A meta-analysis of the relationship between smoking and influenza found that smokers were more likely to be hospialized and admitted to the ICU.

The WHO has also concluded that, ” smokers are more likely to develop severe disease with COVID-19, compared to non-smokers” and provides a nice discussion of how smoking increases risk of COVID-19 by increasing the risk of heart, lung, and other diseases.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, posted an article on her blog “COVID-19: Potential Implications for Individuals with Substance Use Disorders,” that stared off by saying

As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape.

She goes on to address other drug use and how COVID-19 could interact with them, including noting that

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

In addition, an article in Scientific American, “Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection,” summarizes how smoking and vaping affect the lungs and the immune system that is consistent with the view that using these products increases the risk of infection and worse outcomes.  CNN also has a good story, “How smoking, vaping and drug use might increase risks from Covid-19.”  KQED/NPR reports on a young man who developed COVID that may have been aggrevated by his vaping.  Fortunately, he recovered and has now stopped vaping.

 

The New York Times has a good story reporting that the Massachusetts AG put out an advisory urging people to stop smoking and vaping and pointed to resources to quit.

CDC, FDA, the Surgeon General, state health departments and everyone (including comedians, such as John Oliver who spent his whole show on the issue last weekend) working to educate the public on how to lower risk of serious complications from covid-19 should add stopping smoking, vaping, and avoiding secondhand exposure to their list of important preventive measures.

This would also be a good time for cities, states private employers and even individual families to strengthen their smokefree laws and policies – including e-cigarettes — to protect nonsmokers from the effects of secondhand smoke and aerosol on their lungs and to create an environment that will help smokers quit.

The California Department of Public Health has information on smoking, vaping and COVID here, as does the California Smokers’ Helpline.  Trinity Health is also urging people to stop smoking to protect against COVID-19.  FDA has said that vaping and smoking could increased COVID risks.  CDC lists smoking as one of the risk factors for COVID-19 because smoking depresses immune function.

UCSF has added smoking and vaping nicotine and cannabis to COVID-19 triage protocol.  Doing so will both improve patient care and, over the longer term, provide important information needed to quantfy how smoking and vaping impact COVID risks. 

 

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