Food choices...should we be made to feel wrong?

An interesting weekend and interesting observations...

There is such a strange phenomenon around food sensitivity and the individuals who have them. I am sensitive to a few things and am therefore very aware of what I eat and how I feel after eating certain foods. It is more challenging for me to go and attend parties and other social events where food is served as I need to be careful. I do not like to feel uncomfortable and icky in  my own body and therefore tend to either take my own food or not eat at all.
I am lead to believe that this makes others feel very uncomfortable and this has my mind boggled?

The choices I make to keep my body healthy and to feel good are for my own health benefits and I cannot see how anyone should be uncomfortable about that. I do not expect others to cater to my weird food sensitivities and I have no problem not eating where I am uncertain of the ingredients in the food served. This is not a reflection on the host and their food but just self preservation.

It is uncomfortable enough to have multiple unusual food sensitivities and I chose not to make a scene and rather just decline food. Please do not make me feel even worse by suggesting that I send the message that peoples food choices are wrong or that I judge anyone for the food they serve...I DO NOT. I just know that I will suffer if I eat anything that does not agree with my system.

Don't make me wrong for my food choices and for me making my health a priority. Eating is a necessity for nutrients and energy and I eat to serve my body and unfortunately do not get to indulge in the sweet treats and other decadent and comfort foods of this beautiful country. I do not make you wrong for eating what you like, please do not make me wrong for eating what my body likes....

Antibiotic resistant bacteria, a major problem...

Antibiotic-Resistant 'Nightmare' Bacteria a Growing US Threat

Health departments working with the Centers for Disease Control and Prevention (CDC) Antibiotic Resistance Lab Network (ARLN) found more than 220 instances of germs with "unusual" antibiotic resistance genes in the United States last year, according to a Vital Signs report released Tuesday, April 3, 2018.

The report also shows that the CDC's "containment" strategy put forth in 2017 is helping to stop the spread of new and unusual types of antibiotic resistance that have yet to spread widely.

"The bottom line is that resistance genes with the capacity to turn regular germs into nightmare bacteria have been introduced into many states, but with an aggressive response we have been able to stomp them out promptly and stop their spread between people, between facilities and between other germs," CDC Principal Deputy Director Anne Schuchat, MD, reported during a media briefing.

Each year, 2 million Americans develop antibiotic-resistant infections and 23,000 die of these infections. "Today, we are talking about tackling a less common but highly important piece of the antibiotic resistance problem — using CDC's containment strategy to stop new and unusual resistance from spreading," said Schuchat.

"These unusual threats are the uncommon or highly resistant germs that have yet to spread throughout the US. We are working to get in front of these germs before they do become common. We have data showing that an aggressive approach works," she noted.

Putting Out Sparks Before They Start Fires

The CDC's containment strategy calls for rapid detection of unusual resistance in patients, assessing infection control in the facility if unusual resistance is found, screening of exposed contacts to identify asymptomatic colonization, coordinating the response with other facilities, and continuing these interventions until transmission is controlled.

The Vital Signs report summarizes the CDC's experience over the first several months of improved lab testing by the ARLN.  From January to September 2017, health departments in the ARLN tested 4442 carbapenem-resistant Enterobacteriaceae (CRE) isolates and 1334 carbapenem-resistant Pseudomonas aeruginosa  isolates; 32% and 1.9%, respectively, were carbapenemase producers.

Notably, 221 isolates with non–Klebsiella pneumoniae carbapenemases were identified. "These rare forms of resistance have the potential to add to the US CRE burden and represent an important opportunity to prevent the spread of novel resistance at its earliest stage," the authors say.

These results prompted an aggressive response, including infection control assessments and colonization screening of 1489 contacts to identify asymptomatic carriers. "The screenings showed that about 1 in 10 tests were also positive — meaning the unusual resistance had spread to other patients and could have continued spreading if left undetected. When screening tests were positive, vigilant infection control and additional screenings continued until the spread was stopped," Schuchat noted.

The Vital Signs report also details changes in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (extended-spectrum β-lactamase [ESBL] phenotype) or resistant to carbapenems (CRE), using infection data from the National Healthcare Safety Network from 2006 to 2015.

The results show that the percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year, while the CRE percentage decreased by 15% per year.  This difference may be due in part to the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains, Schuchat explained.

For CRE alone, the CDC estimates that the containment strategy would prevent as many as 1600 new infections in 3 years in a single state, a 76% reduction. "The containment strategy will let us bend the curve, or slow the spread of rising resistance," Schuchat said.

Limiting the spread of emerging forms of antibiotic resistance is a public health priority, and a timely and coordinated effort among healthcare facilities, local and state health departments, and the CDC is needed to accomplish this goal, she noted.  And the improved detection and response capacities from the newly established ARLN and stronger state-based antibiotic resistance response efforts are having an impact.

"Germs do more than spread and cause infections in people. They can also share their resistance with other germs, making some untreatable. Much like a fire, finding and stopping unusual resistance early when it's just a spark protects people. The new lab capacity allows us to detect smaller resistance fires and in some cases even resistance sparks so that they can be extinguished immediately," said Schuchat.

Vital Signs. Published online April 3, 2018.

Gut bacteria and cognitive performance

Does Baby’s Gut Bacteria Predict Cognitive Performance?

by Bianca Garilli, ND and Ashley Jordan Ferira, PhD, RDN

During the first years of life, an infant’s gut microbiota undergoes rapid colonization, and the microbial diversity of the growing infant results from exposure to a variety of sources.1 These microbiota sources are impacted by a variety of factors, including but not limited to: genetic underpinnings, the mother’s microbiota composition, method of delivery (vaginal vs. cesarean section), hospital and birthing environment, feeding sources (breast vs. bottle), sanitation of environments exposed to, and antibiotic use.1 By 2-5 years of age, a child’s gut microbiota closely resembles that of an adult in terms of composition and diversity and is nearing its final unique microbiome fingerprint.1 Evidence indicates that this early life gut bacterial population will set the stage for influencing health and development throughout the child’s life.1

The first years of a child’s life are also considered part of the foundational period for brain development, when neural networks growth and myelination are occurring rapidly and dynamically. It is logical to think that the child’s developing gut microbiota could play a significant role in the child’s long-term neurodevelopment. Therefore, supporting a healthy and diverse gut microbiota composition during the first years of life would be critical.

A recent study in Biological Psychiatry conducted by a team of researchers from The University of North Carolina, Chapel Hill aimed to better understand how differences in gut microbial composition and diversity in infants impacted neurodevelopmental outcomes and cognitive performance 1 year later.2 Researchers gathered fecal samples from 89 infants aged 1 year. This was followed by an assessment of their cognitive abilities through a variety of methods at 2 years of age, along with brain imaging, which was conducted during unsedated natural sleep at both 1 and 2 years of age.2

Based on the results of the study, the researchers categorized the children into 3 distinct categories (C1, C2, C3) differentiated by the bacterial composition/clustering of their stool samples. An inverse relationship was revealed:  the infant’s whose stool samples contained a higher alpha diversity at 1 year of age (where higher alpha diversity indicates a high number of different species present in the sample)3 was associated with lower cognitive performances scores on the overall composite score, the visual receptions scale, and the expressive language scale.2 This was perhaps a surprising finding, since high alpha diversity is considered a more “mature” microbial composition and has been associated with positive health outcomes in adults.2

Bacterial clusters at 1 year of age predicted cognitive performance at 2 years of age. Specifically:2

C2 (high levels of Bacteroides) had the lowest alpha diversity and demonstrated the highest level of cognitive performance (90th percentile). C2 infants were more likely to be birthed vaginally and be breastfed, and are considered to have a less mature microbiome

C1 (high levels of Faecalibacterium) had the highest alpha diversity and demonstrated the lowest level of cognitive performance (72nd percentile)

C2 > C3 > C1 was the cluster pattern observed for the visual reception scale

A high alpha diversity indicates a more mature, adult-like community, but the concept of high vs. low alpha diversity being positive vs. negative is certainly still an active area of debate and ongoing research. This is the first study to demonstrate an association between the human gut microbiome and cognition in developing infants; the majority of studies to date in this area have been conducted in animals.2

Future studies would benefit from incorporating multiple measurement time points for microbiota sampling and longer-term follow-up. Incorporating data on broad-spectrum metabolomics or transcriptomics would yield mechanistic insights.2 This future research is critical to understand the associations between gut bacterial composition in infants and long-term neurodevelopment and cognitive health, so that targeted interventions can be informed for future investigations.

Why is this Clinically Relevant?

It is important to establish a healthy gut microbiota in the newborn and developing infant via:

Exposure to maternal vaginal flora during delivery if possible

Limiting antibiotic use in early years

Breastfeeding and maternal skin to skin contact in early months of life

Evidence shows that composition of gut microbiota in infants impacts cognitive performance and neurodevelopment in the growing child

Various routes of exposure in the antenatal and postnatal period of life influence the long-term, individualized microbiota signature

Further research will be important in creating targeted microbiota interventions to support healthy neurodevelopmental outcomes in children

Citations

Rodriguez JM, Murphy K, Stanton C, et al. The composition of the gut microbiota throughout life, with an emphasis on early life. Microb Ecol Health Dis. 2015;26:26050.

Carlson A, Xia K, Azcarate-Peril MA, et al. Infant gut microbiome associated with cognitive development. Biological Psychiatry. 2018;83(2):148–159.

Research Gate. https://www.researchgate.net/post/What_is_the_difference_between_alpha-diversity_and_beta-diversity_in_microbial_ecology. Accessed February 17, 2018.

Depression and Vitamind D3

Vitamin D Supplementation May Help Ease Depression

NEW YORK — Vitamin D supplementation may help reduce depressive symptoms, new results of an updated meta-analysis show.

"People who were vitamin D deficient and depressed seemed to respond best to supplementation, but there was some evidence that supplementation improved depressive symptoms in people who had a normal level of vitamin D," Marissa Flaherty, MD, of the Department of Psychiatry, University of Maryland School of Medicine in Baltimore, told Medscape Medical News.

Globally, more than 300 million people suffer from depression. It's the number one cause of years lost to disability worldwide. In the United States, the overall prevalence of vitamin D deficiency hovers around 42%, with the highest rate seen in blacks.

"In my third year of residency, I noticed that a lot of my depressed patients had very low vitamin D levels, and when I supplemented their vitamin D, their depressive symptoms, particularly their fatigue and energy levels, would improve," Flaherty said.

To investigate further, Flaherty and her colleagues conducted a systematic review and meta-analysis of five randomized controlled trials published from 2011 to 2016 that examined the effect of vitamin D supplementation (vs no supplementation) on depressive symptoms, as measured by the Beck Depression Inventory and Hamilton Depression Rating Scale.

The number of participants in these studies ranged from 40 to 746. The type and route of vitamin D supplementation varied, as did the study length (from 3 to 52 weeks) and the results. For example:

• A 6-week study published in 2011 found no effect of daily supplementation with 5000 IU cholecalciferol on ratings of depression in a group of young healthy adults.
• An 8-week study published in 2013 found that daily supplemention with 1500 IU vitamin D3 plus 20 mg fluoxetine was superior to fluoxetine alone in controlling depressive symptoms in patients with major depressive disorder (MDD).
• A 3-month study found that two single intramuscular injections of 150,000 or 300,000 IU vitamin D improved depression ratings in depressed adults with vitamin D deficiency.
• An 8-week study found that weekly supplementation with 50,000 IU oral vitamin D improved depression scores in patients with MDD.
• A 52-week study found that weekly supplementation with 50,000 IU vitamin D3 did not significantly lower depressive symptoms in depressed dialysis patients.

In the pooled data analysis, Flaherty and her colleagues found that vitamin D supplementation improved depressive symptoms, with a medium overall effect size (SMD, 0.495; 95% confidence interval [CI], 0.190 - 0.801; P = 0001).

"I think all doctors should check vitamin D levels and supplement when needed."Dr Marissa Flaherty

"There was some heterogeneity in some of the studies, but overall, the effect was there," Flaherty told Medscape Medical News. "I think all doctors should check vitamin D levels and supplement when needed. There is no harm in supplementing vitamin D, and most people have low vitamin D," she said.

Flaherty presented the results here May 6 at the American Psychiatric Association (APA) annual meeting.

Harmful on Many Fronts

Reached for comment, Gregory Dalack, MD, chair of the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, said this is a "good update of the literature. In general, having low vitamin D is not helpful, not just for depression but for bones and all sorts of things.”

Dalack emphasized the importance of looking at the big picture for patients with depression.

"The way that I think about is, when I am looking to treat someone's depression and trying to optimize their response, if they are not sufficient on their vitamin D level, if they are not taking their meds, if they are not active physically, those are all problems which would undermine their depression," said Dalack.

He also noted that in most of the studies included in this analysis, vitamin D supplementation was not used as a primary treatment but rather to augment therapy with antidepressants, "which is important, because the evidence is not there that you could just use vitamin D as monotherapy and expect them to feel better.”

The study had no commercial funding. The authors and Dr Dalack have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2018. Poster P3-096, presented May 6, 2018.

A challenging mothers day....

Today I find it myself really examining this day of celebrating my mother. I have recently done even more healing around my feelings of anger, loss and longing around my mother.

She was never a loving and nurturing mother and my memories of my arrival upon this planet were clouded by shock. It was strangely shocking to discover that coming from peace and love, I arrived to a place where I was not really welcomed. My mother was in her own special place of pain and unhappiness and she did not welcome a little girl. These are the memories I have locked onto for too long. How is it that I only remember the disappointment I was to her for all her days? How can it be that all I remember are the negative emotions, the negative moments?

My healing challenges have been to release the anger and pain and know that she did the best she could and that my arrival really caused her more pain than joy. I needed to say sorry for causing her pain and for adding to her distress. I have spent time with my body and all the discomfort locked within my stomach caused by my pent up feelings towards my mother. It hurts and I have carried that pain around for long enough.

What a strange experience to apologize to her for causing her pain and to thank her for being my mom and for the lessons I learned from her. I chose not to have children because I did not wish to perpetuate the circle of pain and inadequacies I had experienced as a child. I did not wish to inflict my wounds and pain unto another little being and I did not feel healed enough to be a mother and love unconditionally. I have no idea how to do so with myself and is this not an indicator of my ability to do so with a child?

I'm not sure I made the right decision and now I must live with this choice without any anger towards my mother for the part she played in my decision. She was not the best example of a loving and nurturing mother and I guess I must be grateful as I was always clothed and fed and I always had a roof over my head even if I didn't always feel safe around her. Gratitude for she taught me how not to be yet I falter in this too.

I struggle with the emotional turmoil of loving her regardless of my pain and anger and disappointment. I struggle with total acceptance of the lack of love and nurturing I got from her. I am in the process of letting all those emotions flow through me for I must heal to move forward in power and love.

I am willing to be thankful for having her as my mother and for the gifts that brought. The clarity of that has not yet presented itself to me fully, yet I am willing to surrender because the weight of carrying all this anger and hurt and disappointment and longing around has become to heavy a burden to bear.

I must let go to gain strength and courage to move beyond the limitations of my mother.

So, as the world celebrates their mothers and most are thankful and swimming in a sea of joy and love, I slowly move towards acceptance and know that in this I will find the joy and love and finally release the pain I hold deep within my body.

Growth and expansion of self is rarely comfortable...

I love this...self growth and expansion is usually uncomfortable and many give up before realizing the benefits and getting that prize at the end of struggle.... Expanding Your Comfort Zone

BY MADISYN TAYLOR Your current comfort zone has served you, but it represents your behaviors and patterns from your past. None of us are born with a guidebook that provides explicit rules for thought and behavior that will enable us to navigate life successfully. To cope with the myriad of complexities to which all of humanity is subject, we each develop a set of habits and routines that ground us, their continuity assuring us that life is progressing normally. Most of us know, whether instinctively or by experience, that transformations can be uncomfortable, but we always learn and gain so much. Any initial discomfort we experience when expanding our comfort zones diminishes gradually as we both become accustomed to change and begin to understand that temporary discomfort is a small price to pay for the evolution of our soul. Your current comfort zone did, at one time, serve a purpose in your life. But it is representative of behaviors and patterns of thought that empowered you to cope with challenges of days past. Now, this comfort zone does little to facilitate the growth you wish to achieve in the present. Leaving your comfort zone behind through personal expansion of any kind can prepare you to take the larger leaps of faith that will, in time, help you refine your purpose. Work your way outward at your own pace, and try not to let your discomfort interfere with your resolve. With the passage of each well-earned triumph, you will have grown and your comfort zone will have expanded to accommodate this evolution. Whether your comfort zone is living with your parents, or perhaps being too shy to socialize, or maybe it's not realizing your spirit self--whatever it is, start small, and you will discover that venturing beyond the limited comfort zone you now cling to is not as stressful an experience as you imagined it might be. And the joy you feel upon challenging yourself in this way will nearly always outweigh your discomfort. As you continue to expand your comfort zone to include new ideas, activities, goals, and experiences, you will see that you are capable of stimulating change and coping with the fresh challenges that accompany it.