February 2022

Discovering the science behind the recommendations

Q: I’m wondering about a tip that you had about migraines and something called the LIFE diet that was published in something called BMJ Case Reports. Was it a reliable study and what is BMJ anyway? -- Fred G., Urbana, Illinois A: Thanks for asking that question, Fred. I want to take the opportunity to let you know how we prepare my columns and how science-based the opinions and ideas are. But first -- BMJ stands for British Medical Journal. Like JAMA (the Journal of the American Medical Association), they decided to go with initials a few years ago, and it become their official name. Case Reports is a related journal they put out that offers interesting case studies -- they may just be one-offs, but their implications are useful. In the case of the migraine case study, the remedy offered -- the Low Inflammatory Foods Everyday (LIFE) diet -- is clearly healthful. Eating lots of fresh vegetables and fruits and avoiding red meats and dairy is something that is beneficial for heart health and to quell inflammation. And because it is simply a case study, the column makes it clear it “may” help with migraines. For the 40 million folks in the U.S. who are desperate to find relief from the pain and the life-interfering intrusions of migraines, it accurately says it “might” be worth a try. As for the overall approach to the columns, let me assure you that, as they are developed, they are carefully researched and footnoted for references -- virtually all of which are primary sources. We identify studies (as much as possible given the column wordlength restrictions) as clinical, randomized, double blind, lab-based -- whatever is the fact. And I am delighted to tell you that on the website that is launching in the early fall, www.GreatAgeReboot.com, we will be posting the columns along with their references/footnotes/sources so that you can see, firsthand, where the info came from. * * *

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It’s best to monitor liver enzymes when starting this MS med

DEAR DR. ROACH: I am 69 years old and have multiple sclerosis, for which I have been taking Aubagio (teriflunomide) for five months. My monthly liver tests have been negative so far. I am concerned about the long-term effects of this drug on my liver. Can the drug damage the liver permanently over time? Also, what are the symptoms of a damaged liver? What is the liver’s function? Thank you for your help. -- C.D.S. ANSWER: Multiple sclerosis is a disease in which the coating of nerve cells, called myelin, is destroyed by the body’s immune and inflammatory systems. Symptoms of this nerve damage include numbness, weakness and vision changes. Most people with MS have symptoms that relapse and then remit. Teriflunomide blocks some of the actions of T lymphocytes, and this has been shown to reduce the relapse rate by about 30% and decrease the progression of disability. As you point out, teriflunomide can adversely affect the liver. While 10% to 13% of people will show abnormal liver enzymes on a blood test, damage to the liver is uncommon. Most cases occur in the first six months after beginning treatment, so blood testing is recommended to evaluate any adverse effects on the liver. Initially there are no symptoms, which is why blood testing is recommended. By the time symptoms have developed, there is usually extensive liver damage. Most people will not experience any ill effects of the liver, which is good, because the liver has countless functions related to making proteins that regulate most body functions, as well as detoxifying drugs and metabolic byproducts. Stopping teriflunomine caused improvement in the reported cases of liver toxicity. DEAR DR. ROACH: I have had several incidents over the past year or two of nocturnal colon incontinence. Can you please explain why this happens and what I can do about it? -- T.O.H. ANSWER: Losing control of one’s bowels is a common problem, but one that patients are sometimes reluctant to discuss, even with their doctors. Fecal incontinence requires a thorough evaluation to determine the possible cause. There are many, often related to underlying diseases. In some cases, it is changes in physiology of the rectum due to aging, often accompanied by additional issues, such as trauma during childbirth. Probably the most important factor in patients I see with fecal incontinence is loose or watery stools. It is much more difficult for the bowel when stool is liquid compared with when it’s solid, so often the first treatment is preventing or treating diarrhea. This includes a review of foods likely to cause diarrhea. Excess caffeine, fructose and lactose should be avoided, as they are common causes. A fiber supplement can be extremely helpful in people who have diarrhea and incontinence due to loose stools. Antidiarrheal medicine like loperamide (Imodium) may also be helpful. Conversely, stool impaction may lead to incontinence, which is why a thorough history and exam is so critical. Evaluation by a gastroenterologist, including more sophisticated testing, is appropriate if a primary care doctor’s treatment plan isn’t effective.

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John Franklin Winters

John Franklin Winters was born on March 25, 1941 in Princeton, Kansas. Died on January 25,2022 in Denver, Colorado. John was preceded in death by his parents Howard & Edith Winters, Sister Nina Boyer & Nephew Ronnie Boyer.

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Randy L. Briar

Randy L. Briar of Emporia died on Thursday, January 27, 2022 at his home. He was 54. Randy was born on December 10, 1967 in Newton, Kansas, the son of Gary and Donnia Baucom Briar. He married Debbie Gerety on October 8, 1993 in Emporia, Kansas. Randy and Debbie made their home on an acreage between Emporia and Lebo.

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Frankie Jane Derhammer

Frankie Jane Derhammer, 75, of Wellsville, Kansas, passed away at her home on Friday, January 28, 2022. Family will meet with friends from 3:00 P.M. to 5:00 P.M., Saturday, February 12, 2022, at Dengel & Son Mortuary, Ottawa.

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Ralph Dana “Bud” Gage Jr.

Ralph Dana “Bud” Gage Jr., 80, a longtime newspaper executive with the Lawrence Journal- World and a member of the Kansas Newspaper Hall of Fame, died suddenly Jan. 30, 2022, at home. Private family burial will be in Highland Cemetery, Ottawa, Kan. A public memorial service and reception for friends are pending.

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