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What are the treatments for addiction?

Addictive disorders are a group of disorders that can cause physical and psychological damage. Receiving treatment is essential for breaking the cycle of addiction.

However, as a chronic disease, addiction is difficult to treat and requires on-going care.

In the United States, around 8.1 percent of the population, or 21.7 million people, either need or regularly receive treatment for substance use disorders, according to the National Survey on Drug Use and Health.

 

First steps

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The first step to recovery is acknowledging the presence of an addiction and its effects on daily life.

The first step towards recovery is acknowledging that substance use has become a problem in the person’s life which is disrupting the quality of their life. This can result from impairment in school, work, social, recreational or other important areas of function.

Once an individual recognizes the negative impact of a substance on their life, a wide range of treatment options is available.

A person with an addictive disorder requires access to treatment. For most people, treatment may last for the rest of their life. They will need to abstain from the substance on a life-long basis, which can be difficult. Treatment plans for addictive disorders will often change to meet the needs of the patient.

Treatment options for addiction depend on several factors, including the type of addictive disorder, the length and severity of use, and its effects on the individual. A doctor will also treat or refer for treatment any physical complications that have developed, such as liver disease in a person with alcohol use disorder or respiratory issues in people with an addiction to substances which have been smoked.

Several treatment options are available, and most people experiencing addiction will receive a combination of approaches. None of the treatments for addictive disorders work for every person.

Common interventions might involve a combination of inpatient and outpatient programs, psychological counseling, self-help groups, and medication.

 

Detoxification

Detoxification is normally the first step in treatment. This involves clearing a substance from the body and limiting withdrawal reactions.

In 80 percent of cases, a treatment clinic will use medications to reduce withdrawal symptoms, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

If a person is addicted to more than one substance, they will often need medications to reduce withdrawal symptoms for each.

In 2017, an electronic device called the NSS-2 Bridge became available to reduce opiate withdrawal. The device sits behind the ear and gives off electrical pulses to trigger certain nerves that might provide relief from withdrawal symptoms.

 

 

Counseling and behavioral therapies

Therapy might be one-to-one or a group session.

 

This is the most common form of treatment following detoxification.

Therapy might occur on a one-to-one, group, or family basis depending on the needs of the individual. It is usually intensive at the outset of treatment with the number of sessions gradually reducing over time as symptoms improve.

Different types of therapy include:

  • cognitive-behavioral therapy, which helps people recognize and change ways of thinking that have associations with substance use.
  • multi-dimensional family therapy, designed to help improve family function around an adolescent or teen with a substance-related disorder
  • motivational interviewing, which maximizes an individuals willingness to change and make adjustments to behaviors
  • motivational incentives that encourage abstinence through positive reinforcement

Counseling for addiction aims to help people change behaviors and attitudes around using a substance, as well as strengthening life skills and supporting other treatments.

In 2017, the United States Food and Drug Administration (FDA) approved the first-ever mobile application, reSET®, as effective for use alongside outpatient management for marijuana, cocaine, alcohol, and stimulant use disorders.

Some forms of treatment for addictive disorders focuses on the underlying cause of the addictive disorder in addition to behaviors characteristic of the addiction.

 

Rehabilitation programs

Group therapy and long-term rehabilitation can help a person with a substance use disorder feel less isolated.

Longer-term treatment programs for substance-related and addictive disorders can be highly effective and typically focus on remaining drug-free and resuming function within social, professional, and family responsibilities.

Fully licensed residential facilities are available to structure a 24-hour care program, provide a safe housing environment, and supply any necessary medical interventions or assistance.

A few types of facility can provide a therapeutic environment, including:

  • Short-term residential treatment: This focuses on detoxification and preparing an individual for a longer period within a therapeutic community through intensive counseling.
  • Therapeutic communities: A person seeking long-term treatment for severe forms of addictive disorder would live in a residence for between 6 and 12 months with on-site staff and others in recovery. The community and staff serve as key factors in recovery from and changes in attitudes and behaviors toward drug use.
  • Recovery housing: This provides a supervised, short-term stay in housing to help people engage with responsibilities and adapt to a new, independent life without on-going substance use. Recovery housing includes advice on handling finances and finding work, as well as providing the connection between a person during the final stages of recovery and community support services.

 

Self-help groups

These may help the recovering individual meet others with the same addictive disorder which often boosts motivation and reduces feelings of isolation. They can also serve as a useful source of education, community, and information.

Examples include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

People who are struggle with other types of addiction can find out about self-help groups in their community either by an internet search or by asking a doctor or nurse for information.

 

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CBD

Cannabidiol is a chemical in the Cannabis sativa plant, also known as marijuana or hemp. Over 80 chemicals, known as cannabinoids, have been identified in the Cannabis sativa plant. While delta-9-tetrahydrocannabinol (THC) is the major active ingredient in marijuana, cannabidiol is also obtained from hemp, which contains only very small amounts of THC.

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FDA Authorizes First Standalone At-Home Sample Collection Kit

Coronavirus (COVID-19) Update: FDA Authorizes First Standalone At-Home Sample Collection Kit That Can Be Used With Certain Authorized Tests

For Immediate Release:

The U.S. Food and Drug Administration has authorized an at-home sample collection kit that can then be sent to specified laboratories for COVID-19 diagnostic testing. Specifically, the FDA issued an emergency use authorization (EUA) to Everlywell, Inc. for the Everlywell COVID-19 Test Home Collection Kit. Everlywell’s kit is authorized to be used by individuals at home who have been screened using an online questionnaire that is reviewed by a health care provider. This allows an individual to self-collect a nasal sample at home using Everlywell’s authorized kit. The FDA has also authorized two COVID-19 diagnostic tests, performed at specific laboratories, for use with samples collected using the Everlywell COVID-19 Test Home Collection Kit. These tests have been authorized under separate, individual EUAs. Additional tests may be authorized for use with the Everlywell at-home collection kit in the future, provided data are submitted in an EUA request that demonstrate the accuracy of each test when used with the Everlywell at-home collection kit.

“The authorization of a COVID-19 at-home collection kit that can be used with multiple tests at multiple labs not only provides increased patient access to tests, but also protects others from potential exposure,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Today’s action is also another great example of public-private partnerships in which data from a privately funded study was used by industry to support an EUA request, saving precious time as we continue our fight against this pandemic.”

Today’s EUA for the Everlywell COVID-19 Test Home Collection Kit permits testing of a sample collected from inside the patient’s nose using the authorized self-collection kit that contains nasal swabs to collect a sample and a tube filled with saline to transport the sample back to a specified lab. Once patients self-swab to collect their nasal sample, they will ship the sample overnight to a specific CLIA-certified lab that is running one of the in vitro diagnostic molecular tests authorized under a separate EUA for use with the Everlywell at-home sample collection kit. The labs authorized to test specimens collected using the Everlywell at-home collection kit are Fulgent Therapeutics and Assurance Scientific Laboratories.  Results will be returned to the patient through Everlywell’s independent physician network and their online portal.

This announcement follows two recent EUAs for diagnostic tests that also use at-home specimen collection: one that uses a sample collected from the patient’s nose with a nasal swab and transported in saline and another that permits testing of a saliva sample collected by the patient at home. Everlywell’s EUA request leveraged data from studies supported by The Bill and Melinda Gates Foundation and UnitedHealth Group to demonstrate stability of specimens during shipping. The data from these studies are freely available to support other EUA requests, alleviating each test developer of the burden of recreating the same study.

The Everlywell home-collection kit is currently the only authorized COVID-19 at-home sample collection kit for use with multiple authorized COVID-19 diagnostic tests. The kit and associated tests are available by prescription only.

Today’s authorization is limited to the Everlywell COVID-19 test for at-home collection of nasal swab specimens for analysis by COVID-19 diagnostic tests specifically authorized under separate EUAs for use with specimens collected with the Everlywell at-home collection kit. It is important to note that this is not a general authorization for at-home collection of patient samples using other collection kits, swabs, media, or tests, or for tests fully conducted at home.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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Vitamin Pills May Be Bad for You

Why Vitamin Pills Don’t Work, and May Be Bad for You

We dose up on antioxidants as if they are the elixir of life. At best, they are probably ineffective. At worse, they may just send you to an early grave.

For Linus Pauling, it all started to go wrong when he changed his breakfast routine. In 1964, at the age of 65, he started adding vitamin C to his orange juice in the morning. It was like adding sugar to Coca Cola, and he believed – wholeheartedly, sometimes vehemently – that it was a good thing.

Before this, his breakfasts were nothing to write about. Just that they happened early every morning before going to work at California Institute of Technology, even on weekends. He was indefatigable, and his work was fruitful.

At the age of 30, for instance, he proposed a third fundamental way that atoms are held together in molecules, melding ideas from both chemistry and quantum mechanics. Twenty years later, his work into how proteins (the building blocks of all life) are structured helped Francis Crick and James Watson decode the structure of DNA (the code of said building blocks) in 1953.

The next year, Pauling was awarded a Nobel Prize in Chemistry for his insights into how molecules are held together. As Nick Lane, a biochemist from University College London, writes in his 2001 book Oxygen, “Pauling… was a colossus of 20th Century science, whose work laid the foundations of modern chemistry.”

Linus Pauling was one of our most influential scientists, yet his belief in the power of antioxidants may have set us down a dangerous path. Credit: Getty Images.

But then came the vitamin C days. In his 1970 bestselling book, How To Live Longer and Feel Better, Pauling argued that such supplementation could cure the common cold. He consumed 18,000 milligrams (18 grams) of the stuff per day, 50 times the recommended daily allowance.

In the book’s second edition, he added flu to the list of easy fixes. When HIV spread in the US during the 1980s, he claimed that vitamin C could cure that, too.

In 1992, his ideas were featured on the cover of Time Magazine under the headline: “The Real Power of Vitamins”. They were touted as treatments for cardiovascular diseases, cataracts, and even cancer. “Even more provocative are glimmerings that vitamins can stave off the normal ravages of ageing,” the article claimed.

Sales in multivitamins and other dietary supplements boomed, as did Pauling’s fame.

But his academic reputation went the other way. Over the years, vitamin C, and many other dietary supplements, have found little backing from scientific study. In fact, with every spoonful of supplement he added to his orange juice, Pauling was more likely harming rather than helping his body. His ideas have not just proven to be wrong, but ultimately dangerous.

Antioxidants were meant to delay the ravages of ageing, but there’s little evidence that supplements bring any noticeable benefits. Credit: Getty Images.

Pauling was basing his theories on the fact that vitamin C is an antioxidant, a breed of molecules that includes vitamin E, beta-carotene, and folic acid. Their benefits are thought to arise from the fact that they neutralise highly reactive molecules called free-radicals.

In 1954, Rebeca Gerschman then at the University of Rochester, New York, first identified these molecules as a possible danger – ideas expanded upon by Denham Harman, from the Donner Laboratory of Medical Physics at UC Berkeley in 1956, who argued that free radicals can lead to cellular deterioration, disease and, ultimately, ageing.

Throughout the 20th Century, scientists steadily built on his ideas and they soon became widely accepted.

Here’s how it works. The process starts with mitochondria, those tiny combustion engines that sit within our cells. Inside their internal membranes food and oxygen are converted into water, carbon dioxide, and energy. This is respiration, a mechanism that fuels all complex life.

‘Leaky Watermills’

But it isn’t so simple. In addition to food and oxygen, a continuous flow of negatively charged particles called electrons is also required. Like a subcellular stream downhill powering a series of watermills, this flow is maintained across four proteins, each embedded in the internal membrane of the mitochondria, powering the production of the end product: energy.

This reaction fuels everything we do, but it is an imperfect process. There is some leakage of electrons from three of the cellular watermills, each able to react with oxygen molecules nearby. The result is a free radical, a radically reactive molecule with a free electron.

In order to regain stability, free radicals wreak havoc on the structures around them, ripping electrons from vital molecules such as DNA and proteins in order to balance its own charge. Although inconceivably small in scale, the production of free radicals, Harman and many others posited, would gradually take its toll on our entire bodies, causing mutations that can lead to ageing and age-related diseases such as cancer.

In short, oxygen is the breath of life, but it also holds the potential to make us old, decrepit, and then dead.

Clinical trials are the only ways to reveal the effects of a drug – and investigations into antioxidants have produced some shocking results. Credit: Alamy.

Shortly after free radicals were linked to ageing and disease, they were seen as enemies that should be purged from our bodies. In 1972, for example, Harman wrote, “Decreasing [free radicals] in an organism might be expected to result in a decreased rate of biological degradation with an accompanying increase in the years of useful, healthy life. It is hoped that [this theory] will lead to fruitful experiments directed toward increasing the healthy human lifespan.”

He was talking about antioxidants, molecules that accept electrons from free radicals thereby diffusing the threat. And the experiments he hoped for were sown, nurtured, and replicated over the next few decades. But they bore little fruit.

In the 1970s and into the 80s, for example, many mice – our go-to laboratory animal – were prescribed a variety of supplementary antioxidants in their diet or via an injection straight into the bloodstream. Some were even genetically modified so that the genes coding for certain antioxidants were more active than non-modified lab mice.

Although different in method, the results were the largely the same: an excess of antioxidants didn’t quell the ravages of ageing, nor stop the onset of disease.

“They never really proved that they were extending lifespan, or improving it,” says Antonio Enriquez from the Spanish National Centre for Cardiovascular Research in Madrid. “Mice don’t care for [supplements] very much.”

Far from protecting us from disease, one study found that vitamin supplements increased the incidence of lung cancer among smokers. Credit: Alamy.

What about humans? Unlike our smaller mammalian kin, scientists can’t take members of society into labs and monitor their health over their lifetime, while controlling for any extraneous factors that could bias the results at the end. But what they can do is set up long-term clinical trials.

The premise is pretty simple. First, find a group of people similar in age, location, and lifestyle. Second, split them into two subgroups. One half receives the supplement you’re interested in testing, while the other receives a blank – a sugar pill, a placebo. Third, and crucially to avoid unintentional bias, no one knows who was given which until after the trial; not even those administering the treatment.

Known as a double-blind control trial, this is the gold standard of pharmaceutical research. Since the 1970s, there have been many trials like this trying to figure out what antioxidant supplementation does for our health and survival. The results are far from heartening.

In 1994, for example, one trial followed the lives of 29,133 Finish people in their 50s. All smoked, but only some were given beta-carotene supplements. Within this group, the incidence of lung cancer increased by 16 percent.

A similar result was found in postmenopausal women in the U.S. After 10 years of taking folic acid (a variety of B vitamin) every day their risk of breast cancer increased by 20 percent relative to those women who didn’t take the supplement.

It gets worse. One study of more than 1,000 heavy smokers published in 1996 had to be terminated nearly two years early. After just four years of beta-carotene and vitamin A supplementation, there was a 28 percent increase in lung cancer rates and a 17 percent increase in those who died.

These aren’t trivial numbers. Compared to placebo, 20 more people were dying every year when taking these two supplements. Over the four years of the trial, that equates to 80 more deaths. As the authors wrote at the time, “The present findings provide ample grounds to discourage use of supplemental beta-carotene and the combination of beta-carotene and vitamin A.”

Fatal Ideas

Of course, these notable studies don’t tell the full story. There are some studies that do show benefits of taking antioxidants, especially when the population sampled doesn’t have access to a healthy diet.

But, according a review from 2012 that noted the conclusions of 27 clinical trials assessing the efficacy of a variety of antioxidants, the weight of evidence does not fall in its favour.

Just seven studies reported that supplementation led to some sort of health benefit from antioxidant supplements, including reduced risk of coronary heart disease and pancreatic cancer. Ten studies didn’t see any benefit at all – it was as if all patients were given the sugar pill also (but, of course, they weren’t). That left another 10 studies that found many patients to be in a measurably worse state after being administered antioxidants than before, including an increased incidence of diseases such as lung and breast cancer.

“The idea that antioxidant [supplementation] is a miracle cure is completely redundant,” says Enriquez. Linus Pauling was largely unaware of the fact that his own ideas could be fatal. In 1994, before the publication of many of the large-scale clinical trials, he died of prostate cancer. Vitamin C certainly wasn’t the cure-all that he cantankerously claimed it was up until his last breath. But did it contribute to a heightened risk?

Dosing up on vitamin C does not even help us fight the common cold. Credit: Alamy.

We’ll never know for sure. But given that multiple studies have linked excess antioxidants to cancer, it certainly isn’t out of the question. A study published in 2007 from the US National Cancer Institute, for instance, found that men that took multivitamins were twice as likely to die from prostate cancer compared to those who didn’t. And in 2011, a similar study on 35,533 healthy men found that vitamin E and selenium supplementation increased prostate cancer by 17 percent.

Ever since Harman proposed his great theory of free radicals and ageing, the neat separation of antioxidants and free radicals (oxidants) has been deteriorating. It has aged.

Antioxidant is only a name, not a fixed definition of nature. Take vitamin C, Pauling’s preferred supplement. At the correct dose, vitamin C neutralises highly charged free radicals by accepting their free electron. It’s a molecular martyr, taking the hit upon itself to protect the cellular neighbourhood.

But by accepting an electron, the vitamin C becomes a free radical itself, able to damage cell membranes, proteins and DNA. As the food chemist William Porter wrote in 1993, “[vitamin C] is truly a two-headed Janus, a Dr Jekyll-Mr Hyde, an oxymoron of antioxidants.”

Thankfully, in normal circumstances, the enzyme vitamin C reductase can return vitamin C’s antioxidant persona. But what if there’s so much vitamin C that it simply can’t keep up with supply? Although such simplifying of complex biochemistry is in itself problematic, the clinical trials above provide some possible outcomes.

Divide and Conquer

Antioxidants have a dark side. And, with increasing evidence that free radicals themselves are essential for our health, even their good side isn’t always helpful.

We now know that free radicals are often used as molecular messengers that send signals from one region of the cell to another. In this role, they have been shown to modulate when a cell grows, when it divides in two, and when it dies. At every stage of a cell’s life, free radicals are vital.

Without them, cells would continue to grow and divide uncontrollably. There’s a word for this: cancer.

We would also be more prone to infections from outside. When under stress from an unwanted bacterium or virus, free radicals are naturally produced in higher numbers, acting as silent klaxons to our immune system. In response, those cells at the vanguard of our immune defense – macrophages and lymphocytes – start to divide and scout out the problem. If it is a bacterium, they will engulf it like Pac-Man eating a blue ghost.

It is trapped, but it is not yet dead. To change that, free radicals are once again called into action. Inside the immune cell, they are used for what they are infamous for: to damage and to kill. The intruder is torn apart.

From start to finish, a healthy immune response depends on free radicals being there for us, within us. As geneticists Joao Pedro Magalhaes and George Church wrote in 2006: “In the same way that fire is dangerous and nonetheless humans learned how to use it, it now appears that cells evolved mechanisms to control and use [free radicals].”

Put another way, freeing ourselves of free radicals with antioxidants is not a good idea. “You would leave the body helpless against some infections,” says Enriquez.

Few would dispute that a balanced diet is essential for good health, but most of us don’t need supplements to meet our nutritional needs. Credit: Getty Images.

Thankfully, your body has systems in place to keep a your inner biochemistry as stable as possible. For antioxidants, this generally involves filtering any excess out of the bloodstream into urine for disposal. “They go in the toilet,” says Cleva Villanueva from Instituto Politécnico Nacional, Mexico City, in an email.

“We’re very good at balancing things out so that the affect [of supplementation] is moderate whatever you do, which we should be grateful for,” says Lane. Our bodies have been selected to balance the risk of oxygen ever since the first microbes started to breathe this toxic gas. We can’t change billions of years of evolution with a simple pill.

No one would deny that vitamin C is vital to a healthy lifestyle, as are all antioxidants, but unless you are following doctor’s orders, these supplements are rarely going to be the answer for a longer life when a healthy diet is also an option. “Administration of antioxidants is justified only when it is evident that there is a real deficiency of a specific antioxidant,” says Villanueva. “The best option is to get antioxidants from food because it contains a mixture of antioxidants that work together.”

“Diets rich in fruits and vegetables have been shown generally to be good for you,” says Lane. “Not invariably, but generally that’s agreed to be the case.” Although often attributed to antioxidants, the benefits of such a diet, he says, might also hail from a healthy balance of pro-oxidants and other compounds whose roles aren’t yet fully understood.

After decades of unlocking the baroque biochemistry of free radicals and antioxidants, hundreds of thousands of volunteers, and millions of pounds spent on clinical trials, the best conclusion that 21st Century science has to offer is also found within a child’s classroom – eat your five-a-day.

courtesy BBC Health & GetPocket

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What to know about leaky gut syndrome

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Leaky gut syndrome is a digestive condition that affects the lining of the intestines. In leaky gut syndrome, gaps in the intestinal walls allow bacteria and other toxins to pass into the bloodstream.

Many doctors and healthcare professionals do not recognize leaky gut syndrome (LGS) as a diagnosable condition. However, current scientific evidence suggests leaky gut may contribute to a range of medical conditions.

In this article, we discuss LGS, as well as its symptoms, causes, and risk factors. We also examine what current research says about leaky gut and autism. Finally, we cover potential treatments for leaky gut and provide tips for improving overall gut health.

What is leaky gut syndrome?

a woman with Leaky gut syndrome

Leaky gut syndrome causes bacteria to pass into the bloodstream through gaps in the intestinal walls.

The gastrointestinal (GI) tract is a tube of connected organs that runs from the mouth to the anus. The organs of the GI tract include::

  • the esophagus
  • the stomach
  • the small and large intestines

Digestive enzymes in the stomach and small intestine break down nutrients in food and drink into smaller molecules that the body uses for energy, growth, and repair.

The intestines also play an essential role in protecting the body from harmful bacteria and toxins.

Tight openings in the intestinal walls allow water and nutrients to pass through into the bloodstream while keeping harmful substances inside. In LGS, these openings become wider, allowing food particles, bacteria, and toxins to enter directly into the bloodstream.

Gut microbiota and leaky gut syndrome

The intestines are also home to a wide range of bacteria called gut microbiota. These bacteria aid digestion, protect the intestinal wall and support normal immune function. LGS may involve imbalances in gut microbiota.

According to a 2016 article, imbalances in the gut microbiota can trigger the body’s immune response. This results in gut inflammation and increased intestinal permeability (IP). IP describes how easily substances can leak out of the intestines and into the bloodstream.

The link between LGS and other health conditions

Leaky gut may contribute to several health conditions. Examples include:

  • irritable bowel syndrome (IBS)
  • Crohn’s disease
  • celiac disease
  • chronic liver disease
  • food allergies and sensitivities
  • It is still not clear whether LGS is a cause or a symptom of these conditions.

    However, a 2015 review article suggests that increased IP may contribute to the development of inflammatory bowel disease (IBD). A separate 2019 review shows evidence of IP occurring before the onset of type 1 diabetes.

    Scientists have also been investigating the gut-brain axis. This is the relationship between the GI tract and the brain. A 2017 review suggests that leaky gut may contribute to mental health conditions, such as anxiety and However, scientists need to carry out further research to support this claim.

    Symptoms

    man with headache as part of stroke symptoms

    A person with the condition may experience headaches, bloating, and difficulty concentrating.

    Leaky gut shares many of its symptoms with other health conditions. This can make the condition difficult for doctors to identify.

    Leaky gut may cause or contribute to the following symptoms:

    • chronic diarrhea, constipation, or bloating
    • nutritional deficiencies
    • fatigue
    • headaches
    • confusion
    • difficulty concentrating
    • skin problems, such as acne, rashes, or eczema
    • joint pain
    • widespread inflammation

    Causes and risk factors

    Experts do not yet know exactly what causes leaky gut syndrome. However, various risk factors can disrupt the gut microbiota and contribute to increased IP. Examples include:

    • poor nutrition
    • alcohol consumption
    • infections
    • autoimmune disorders, such as lupus
    • diabetes
    • stress

    Is there any link with autism?

    Experts still do not know exactly why autism develops. However, scientists have suggested that various genetic, biological, and environmental factors may play a role.

    Recently, scientists have begun investigating a possible link between gut microbiota, IP, and autism.

    Gut microbiota and autism

    According to a 2016 review, autistic children often develop significant digestive problems, such as constipation, diarrhea, and vomiting.

    In a small 2017 study, researchers compared stool samples from two groups of children — autistic children with GI symptoms, and those without autism or GI symptoms. The researchers identified significantly higher amounts of Clostridium perfringens bacteria in samples collected from autistic children with GI symptoms.

    Intestinal permeability and autism

    In a 2019 review, researchers confirmed an association between gut microbiota imbalances and autism.

    A 2010 study observed increased IP in autistic people and their first-degree relatives. However, a 2013 study reported no significant differences in the IP of autistic children.

    Scientists must carry out more research to establish whether IP plays a role in autism.

    Treatment and improving gut health

    a woman running along aside a cliff side walk.

    Exercising regularly can help improve digestion.

    Since many doctors do not consider leaky gut to be a legitimate medical condition, there is no standard treatment.

    However, certain dietary and lifestyle changes may help people to improve their gut health. This, in turn, may alleviate leaky gut symptoms.

    The following dietary tips may help to improve gut health:

    • eating more probiotics to boost beneficial gut bacteria
    • eating foods rich in prebiotic fiber, such as vegetables and whole grains
    • eating less meat, dairy, and eggs
    • avoiding added sugar and artificial sweeteners

    The following lifestyle changes can improve digestion and support a healthy gut:

    • exercising regularly
    • getting enough sleep every night
    • reducing stress
    • avoiding unnecessary use of antibiotics
    • quitting smoking

    Summary

    LGS creates gaps in the intestinal walls that allow harmful bacteria and toxic substances to escape into the bloodstream.

    Researchers have found significant evidence to support the existence of leaky gut. Research also indicates that leaky gut may contribute to a range of health conditions.

    However, scientists have yet to uncover how leaky gut directly contributes to the progression of these diseases.

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What is Crohn’s disease?

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Crohn’s disease is a chronic, or long-term, condition that causes inflammation of the digestive tract. It is a type of inflammatory bowel disease. Crohn’s disease can be painful, debilitating, and, sometimes, life-threatening.

Crohn’s disease, also called ileitis or enteritis, can affect any part of the gut, from the mouth all the way down to the anus. In the majority of cases, however, the lower part of the small intestine – the ileum – is affected.

Symptoms can be unpleasant. They include intestinal ulcers, discomfort, and pain.

According to the Centers for Disease Control and Prevention, Crohn’s disease affects 26-199 people per 100,000. Although Crohn’s disease typically starts between the ages of 15 to 40, it can start at any age.

Having a support system that understands the experience of having Crohn’s is important. IBD Healthline is a free app for people with a Crohn’s diagnosis. The app is available on the AppStore and Google Play.

Symptoms

woman holding her stomach in pain

Pain is commonly felt on the lower right side of the abdomen, but can affect many areas of the gut.

Crohn’s disease symptoms vary depending on which part of the gut is affected. Symptoms often include:

  • Pain: The level of pain varies between individuals and depends on where the inflammation is in the gut. Most commonly, pain will be felt at the lower-right side of the abdomen.
  • Ulcers in the gut: Ulcers are raw areas in the gut that may bleed. If they do bleed, the patient might notice blood in their stools.
  • Mouth ulcers: These are a common symptom.
  • Diarrhea: This can range from mild to severe. Sometimes there may be mucus, blood, or pus. The patient may get the urge to go but find nothing comes out.
  • Fatigue: Individuals often feel extremely tired. Fever is also possible during fatigue.
  • Altered appetite: There may be time when the appetite is very low.
  • Weight loss: This can result from a loss of appetite.
  • Anemia: A loss of blood can lead to anemia.
  • Rectal bleeding and anal fissures: The skin of the anus becomes cracked, leading to pain and bleeding.

Other possible symptoms:

  • arthritis
  • uveitis (eye inflammation)
  • skin rash and inflammation
  • liver or bile duct inflammation
  • delayed growth or sexual development, in children

Ulcerative colitis vs. Crohn’s disease

While ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine, all layers of the intestine may be inflamed and with ulcers in Crohn’s disease.

Also, inflammation occurs in Crohn’s disease anywhere along the gut; in ulcerative colitis, it only appears in the large intestine (colon and rectum).

The Crohn’s disease patient’s bowels can have normal healthy sections in between the diseased parts, whereas, in ulcerative colitis, the damage appears in a continuous pattern.

Diet

Children with Crohn’s disease might need high-calorie liquid formulas, especially if their growth is being affected.

Most patients with Crohn’s disease say that the following foods can increase diarrhea and cramping:

  • bulky grains
  • dairy products
  • spicy foods
  • alcohol

Some people do not feel like eating. In severe cases, they may need to feed intravenously for a short period.

Treatment

person refusing wholegrain bread

Bulky grains, like those contained in bread, can worsen Crohn’s disease.

Treatment may involve medication, surgery, and nutritional supplements.

The aim is to control inflammation, correct nutritional problems, and relieve symptoms.

There is no cure for Crohn’s disease, but some treatments can help by reducing the number of times a patient experiences recurrences.

Crohn’s disease treatment depends on:

  • where the inflammation is situated
  • the severity of the disease
  • complications
  • the patient’s response to previous treatment for recurring symptoms

Some people can have long periods, even years, without any symptoms. This is known as remission. However, there will usually be recurrences.

As periods of remission vary so much, it can be hard to know how effective treatment has been. It is impossible to predict how long a period of remission is going to be. Best foods for a Crohn’s disease flare-upEating the right foods can help people to manage the symptoms of Crohn’s disease. Find out more.Read now

Medication for Crohn’s disease

  • Anti-inflammation drugs – the doctor will most likely start with mesalamine (Sulfasalazine), which helps control inflammation.
  • Cortisone or steroids – corticosteroids are drugs containing cortisone and steroids.
  • Antibiotics – fistulas, strictures, or prior surgery may cause bacterial overgrowth. Doctors will generally treat this by prescribing ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
  • Anti-diarrheal and fluid replacements – when the inflammation subsides, diarrhea usually becomes less of a problem. However, sometimes the patient may need something for diarrhea and abdominal pain.

Biologics

Biologics are a new type of drug that scientists have developed from a living organism. They reduce the body’s immune response by targeting proteins that lead to inflammation.

Biologics appear to help people with Crohn’s disease.

Examples of biologics for Crohn’s include:

  • infliximab (Remicade)
  • adalimumab (Humira)
  • 6-mercaptopurine (Purinethol)
  • methotrexate
  • imuran (Azathioprine)
  • certolizumab pegol (Cimzia)

Biologic treatments can have side effects, include vomiting, nausea, and a weaker resistance to infection.

Some studies suggest that the use of biologics can reduce the chance that a person will need abdominal surgery within 10 years to 30 percent. Before the introduction of biologics, researchers put this figure at 40–55 percent.

Biologics also appear to reduce the risk of adverse effects that can arise when a person uses corticosteroids.

There are different types of biologic drugs, and individuals react differently to them. A doctor will recommend a suitable option, and they may suggest trying an alternative or a combination of drugs if the first one does not work.

Surgery

The majority of Crohn’s disease patients may need surgery at some point. When medications no longer control symptoms, the only solution is to operate. Surgery can relieve symptoms that did not respond to medication, or to correct complications, such as abscess, perforation, bleeding, and blockage.

Removing part of the intestine can help, but it does not cure Crohn’s disease. Inflammation often returns to the area next to where the affected part of the gut was removed. Some Crohn’s disease patients may require more than one operation during their lives.

In some cases, a colectomy is needed, in which the whole colon is removed. The surgeon will make a small opening in front of the abdominal wall, and the tip of the ileum is brought to the skin’s surface to form an opening called a stoma. Feces exit the body through the stoma. A pouch collects the feces. Doctors say that a patient who has a stoma can carry on leading a normal and active life.

If the surgeon can remove the diseased section of the intestine and then connect the intestine again, no stoma is needed.

The patient and their doctor need to consider surgery very carefully. It is not appropriate for everyone. The patient has to bear in mind that after the operation, the disease will recur.

Most people with Crohn’s disease can live normal and active lives, hold jobs, raise families, and function successfully.

Causes

Smoking may increase the risk of developing Crohn's disease.

Smoking may increase the risk of developing Crohn’s disease.

The exact cause of Crohn’s disease is unclear, but it is thought to stem from an abnormal reaction in the immune system.

The theory is that the immune system attacks foods, good bacteria, and beneficial substances as if they are unwanted substances.

During the attack, white blood cells build up in the lining of the gut, and this buildup triggers inflammation. The inflammation leads to ulcerations and bowel injury.

However, it is unclear whether the abnormal immune system causes Crohn’s disease or results from it.

Factors that may increase the risk of inflammation include:

  • genetic factors
  • the individual’s immune system
  • environmental factors

Around 3 in 20 people with Crohn’s have a close relative with the condition. If an identical twin has Crohn’s disease, the other twin has a 70 percent chance of having it, too.

A bacterium or virus may play a role. E. coli bacteria has been linked to Crohn’s disease, for instance.

Smoking is another risk factor.

Diagnosis

A doctor will ask the person about any signs and symptoms. A physical examination may reveal a lump in the abdomen, caused when loops of inflamed bowels become stuck together.

The following tests may help in the diagnosis:

  • stool and blood tests
  • biopsy
  • sigmoidoscopy, where a short, flexible tube (sigmoidoscope) is used to investigate the lower bowel
  • colonoscopy, where a long, flexible tube (colonoscope) is used to investigate the colon
  • endoscopy, if symptoms occur in the upper part of the gut. A long, thin, flexible telescope (endoscope) goes down through the esophagus into the stomach.
  • CT scan or barium enema X-ray to reveal changes inside the bowel

Complications

If symptoms are severe and frequent, the likelihood of complications is higher. The following complications may require surgery:

  • internal bleeding
  • stricture, where a part of the gut narrows, causing build up of scar tissue, and partial or complete blockage of the intestine
  • perforation, when a small hole develops in the wall of the gut, from which contents can leak, cause infections or abscesses
  • fistulas, when a channel forms between two parts of the gut

There may also be:

  • a persistent iron deficiency.
  • food absorption problems.
  • slightly higher risk of developing bowel cancer.
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Everything you need to know about cirrhosis

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Cirrhosis of the liver describes a condition where scar tissue gradually replaces healthy liver cells.

It is a progressive disease, developing slowly over many years. If it is allowed to continue, the buildup of scar tissue can eventually stop liver function.

For cirrhosis to develop, long-term, continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and replaced by scar tissue, the condition becomes serious, because it can start blocking the flow of blood through the liver.

This MNT Knowledge Center article explains the symptoms, causes, and treatments of liver cirrhosis, including information about complications.

Symptoms

One of the primary methods of diagnosis is through a blood test.

Symptoms are not common during the early stages of cirrhosis.

However, as scar tissue accumulates, the ability of the liver to function properly is undermined. The following signs and symptoms may occur:

  • blood capillaries become visible on the skin on the upper abdomen.
  • fatigue
  • insomnia
  • itchy skin
  • loss of appetite
  • loss of bodyweight
  • nausea
  • pain or tenderness in the area where the liver is located
  • red or blotchy palms
  • weakness

The following signs and symptoms may appear as liver cirrhosis progresses:

  • accelerated heartbeat
  • personality changes
  • bleeding gums
  • lost mass in the body and upper arms
  • difficulties processing drugs and alcohol
  • confusion
  • dizziness
  • fluid buildup on ankles, feet, and legs, known as edema
  • hair loss
  • higher susceptibility to bruising
  • jaundice, or yellowing of the skin, whites of the eyes, and tongue
  • loss of sex drive
  • memory problems
  • more frequent fevers and increased risk of infection
  • muscle cramps
  • nosebleeds
  • pain in the right shoulder
  • breathlessness
  • stools become black and tarry, or very pale.
  • urine becomes darker.
  • vomiting blood
  • problems with walking and mobility

The liver tissue is replaced by fibrous scar tissue. Regenerative nodules may also form. These are lumps that appear as the liver tries to heal the damage.

Treatment

If the cirrhosis is diagnosed early enough, damage can be minimized by treating the underlying cause or the various complications that arise.

Treatment for alcohol dependency: It is important for the patient to stop drinking if their cirrhosis was caused by long-term, regular heavy alcohol consumption. In many cases, the doctor will recommend a treatment program for treating alcohol dependency.

Medications: The patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C.

Controlling pressure in the portal vein: Blood can “back up” in the portal vein that supplies the liver with blood, causing high blood pressure in the portal vein. Drugs are usually prescribed to control the increasing pressure in other blood vessels. The aim is to prevent severe bleeding. Signs of bleeding can be detected via an endoscopy.

If the patient vomits blood or passes bloody stools, they probably have esophageal varices. Urgent medical attention is required. The following procedures may help:

Banding: A small band is placed around the base of the varices to control bleeding.

Injection sclerotherapy: After an endoscopy, a substance is injected into the varices, which triggers a blood clot and scar tissue to form. This helps stem the bleeding.

A Sengstaken-Blakemore tube with a balloon: A balloon is placed at the end of the tube. If endoscopy does not stop the bleeding, the tube goes down the patient’s throat and into their stomach. The balloon is inflated. This places pressure on the varices and stops the bleeding.

Transjugular intrahepatic portosystemic stent shunt (TIPSS): If the therapies mentioned above do not stem the bleeding, a metal tube is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces the pressure that was causing the varices.

Other complications are handled in different ways:

Infections: The patient will be given antibiotics for any infections that arise.

Screening for liver cancer: Patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.

Hepatic encephalopathy, or high blood toxin levels: Drugs can help treat excessive blood toxin levels.

In some cases, the damage caused by cirrhosis covers most of the liver and cannot be reversed. In these cases, the person may need a new, transplanted liver. It can take time to find a suitable donor, and this procedure is often advised only as a last resort.

Outlook

The survival rate of a person with liver cirrhosis depends on the severity of the scarring.

A 15-year follow-up study of 100 people in Norway with severe alcoholic cirrhosis showed that 71 percent of the people in the study lived for 5 years after diagnosis, and 90 percent lived for 15 years.

Continued alcohol consumption and advanced age were linked to a higher mortality rate in people with cirrhosis.

This is a limited study, but it shows that cirrhosis is a serious condition that severely reduces life expectancy and impairs quality of living.

Cirrhosis is responsible for 12 deaths in every 100,000 members of the United States population.

Stages

Cirrhosis is graded on a scale called the Childs-Pugh score as follows:

  • A: Relatively mild
  • B: Moderate
  • C: Severe

Doctors also classify cirrhosis as either compensated or decompensated. Compensated cirrhosis means that the liver can function normally despite the damage. A liver with decompensated cirrhosis cannot perform its functions correctly and usually causes severe symptoms.

Rather than being viewed in terms of its own stages, cirrhosis is often seen as a final stage of liver disease.

Causes

Frequent heavy drinking is a cause of cirrhosis.

Common causes of cirrhosis are:

  • long-term alcohol abuse
  • hepatitis B and C infection
  • fatty liver disease
  • toxic metals
  • genetic diseases

Hepatitis B and C together are said to be the leading causes of cirrhosis. Other causes include:

Regularly drinking too much alcohol

Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too high, the liver will be overworked, and liver cells can eventually become damaged.

Heavy, regular, long-term drinkers are much more likely to develop cirrhosis, compared with other, healthy people. Typically, heavy drinking needs to be sustained for at least 10 years for cirrhosis to develop.

There are generally three stages of alcohol-induced liver disease:

  1. Fatty liver: This involves a build-up of fat in the liver.
  2. Alcoholic hepatitis: This occurs when the cells of the liver swell.
  3. Approximately 10 to 15 percent of heavy drinkers will subsequently develop cirrhosis.

Hepatitis

Hepatitis C, a blood-borne infection, can damage the liver and eventually lead to cirrhosis. Hepatitis C is a common cause of cirrhosis in Western Europe, North America, and many other parts of the world. Cirrhosis can also be caused by hepatitis B and D.

Non-alcoholic steatohepatitis (NASH)

NASH, in its early stages, begins with the accumulation of too much fat in the liver. The fat causes inflammation and scarring, resulting in possible cirrhosis later on.

NASH is more likely to occur in people who are obese, diabetes patients, those with high fat levels in the blood, and people with high blood pressure.

Autoimmune hepatitis

The person’s own immune system attacks healthy organs in the body as though they were foreign substances. Sometimes the liver is attacked. Eventually, the patient can develop cirrhosis.

Some genetic conditions

There are some inherited conditions that can lead to cirrhosis, including:

  • Hemochromatosis: Iron accumulates in the liver and other parts of the body.
  • Wilson’s disease: Copper accumulates in the liver and other parts of the body.

Blockage of the bile ducts

Some conditions and diseases, such as cancer of the bile ducts, or cancer of the pancreas, can block the bile ducts, increasing the risk of cirrhosis.

Budd-Chiari syndrome

This condition causes blood clots in the hepatic vein, the blood vessel that carries blood from the liver. This leads to liver enlargement and the development of collateral vessels.

Other diseases and conditions that can contribute to cirrhosis include:

  • cystic fibrosis
  • primary sclerosing cholangitis, or hardening and scarring of the bile ducts
  • galactosemia, or inability to process sugars in milk.
  • schistosomiasis, a parasite commonly found in some developing countries
  • biliary atresia, or badly formed bile ducts in babies
  • glycogen storage disease, or problems in the storage and energy release vital for cell function

Diagnosis

Because there are rarely symptoms early on in the condition, cirrhosis is often diagnosed when the patient is being tested for some other condition or disease.

Anybody who has the following symptoms should see their doctor immediately:

  • fever with shivering
  • shortness of breath
  • vomiting blood
  • dark or tarry stools
  • episodes of drowsiness or confusion

A doctor will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about their medical history and lifestyle, including drinking.

The following tests may also be ordered:

  • Blood test: These measure how well the liver is functioning. If levels of alanine transaminase (ALT) and aspartate transaminase (AST) are high, the patient may have hepatitis.
  • Imaging tests: Ultrasound, CT, or MRI scans can be used to see whether the liver is enlarged and detect any scarring or nodules.
  • Biopsy: A small sample of liver cells is extracted and examined under a microscope. The biopsy can confirm cirrhosis and its cause.
  • Endoscopy: The doctor inserts a long, thin tube with a light and video camera at the end goes through the esophagus and into the stomach. The doctor looks out for swollen blood vessels called varices than can be a sign of cirrhosis.

Complications

Cirrhosis can lead to several other conditions, some of which are life-threatening. These include:

Ascites or edema: Ascites is a buildup of fluid in the abdomen, and edema is a buildup of fluid in the legs. They can be treated with a low-salt diet and water pills. In severe cases, the fluid may have to be drained repeatedly. Surgery is sometimes needed.

Varices and portal hypertension: These are large, swollen veins in the esophagus and stomach. They can increase pressure in a blood vessel called the portal vein that carries blood from the spleen and bowel to the liver. Varices can rupture, causing severe blood loss and clots.

Hepatic encephalopathy: This refers to high levels of toxins in the blood where the liver is no longer successfully filtering them all.

Hepatocellular carcinoma: This is the most common type of liver cancer. It is the third-leading cause of cancer mortality across the globe.

Hepatopulmonary syndrome (HPS): Doctors define HPS as a combination of liver disease, dilated blood vessels in the lungs, and abnormalities in the exchange of gases. It is linked to an increase in the mortality rate of people waiting for a liver transplant.

Coagulation disorders: Cirrhosis can cause problems with blood clotting, leading to potentially fatal bleeds and clots.

Prevention

Staying within recommended daily and weekly alcohol limits is highly recommended to avoid cirrhosis. Please refer to the following helpful information from the Centers for Disease Control and Prevention (CDC) about drinking in moderation.

Individuals who have cirrhosis should avoid alcohol completely. Alcohol accelerates the progression of the disease.

To avoid contracting hepatitis B and C, be sure to take the following precautions:

  • Use a condom when having sex.
  • Do not share needles when injecting drugs.
  • People at risk of becoming infected with hepatitis B, such as healthcare workers, social care workers, and police personnel, can be vaccinated

As cirrhosis cannot be reversed or repaired once it reaches a certain stage, prevention is often considered the best form of treatment.

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