Latest / Morning Medical with Dr. Chow / Lupus Research, Cancer Risk Reduction, and Health Risks in Menstrual Products

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Lupus Research, Cancer Risk Reduction, and Health Risks in Menstrual Products · Morning Medical with Dr. Chow

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Good morning, everyone, and welcome to another episode of Morning Medical with Dr.
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Chow.
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I am your host, Dr.
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Chi-Ming Chow, and today we have some groundbreaking news to share with you in the
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field of autoimmune diseases.
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Let's dive right in!
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Scientists may have pinpointed a primary cause of lupus, a chronic autoimmune disease that
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affects millions of people worldwide.
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Researchers from Northwestern Medicine in Chicago and Brigham and Women’s Hospital in
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Boston have identified a "molecular defect" that leads to systemic lupus erythematosus,
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commonly known as lupus.
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These findings were published in the prestigious journal Nature.
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Dr.
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Deepak Rao, an assistant professor of medicine at Harvard Medical School and a rheumatologist
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at Brigham and Women’s Hospital, explained that lupus fundamentally involves abnormal B cell
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activation and antibody production.
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This process requires help from T cells, which are white blood cells integral to immune system
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activity.
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In lupus patients, there's a dramatic imbalance in the types of T cells they generate, leading
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to too many harmful T cells that cause cellular damage and too few helpful T cells needed for
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cell repair.
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The research team tested the blood of 19 lupus patients and compared it to a control group of
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healthy individuals.
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They discovered that the lupus patients shared certain molecular changes that resulted in this
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imbalance.
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A key protein called interferon was found to promote the excess accumulation of harmful T
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cells.
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While it has been known for years that lupus patients produce too much interferon, this
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study clarifies how interferon contributes to the disease.
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One of the most exciting findings of this research is the identification of a protein,
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the aryl hydrocarbon receptor, or AHR, which can prevent T cells from developing into
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disease-causing cells.
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The researchers propose using small molecule activators of AHR directed specifically toward
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T cells as a treatment to suppress the pathological T cell response in lupus and
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reprogram those T cells toward benign or protective functions.
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This approach could potentially be safer and more effective than current broad
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immunosuppressive therapies because it targets the disease-causing cells.
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Dr.
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Jaehyuk Choi, an associate professor of dermatology and a Northwestern Medicine
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dermatologist, mentioned that while it is not yet clear which patients would benefit the most
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from this treatment, the data suggests it could potentially be broadly useful for all lupus
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patients.
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Dr.
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Mara Lennard Richard from the Lupus Research Alliance in New York City, which partially
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funded the research, expressed hope that these findings may pave the way to a potential new
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treatment.
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Dr.
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Brooke Goldner, a board-certified physician and creator of the Hyper-Nourishing Nutrition
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Protocol for Lupus Reversal, also weighed in, saying that targeted immune therapy using T
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cells and B cells is a "new and exciting focus" in lupus research.
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However, she emphasized that lupus is a highly complex disease with many contributing factors,
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and more research is needed to confirm these results.
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She also highlighted the importance of lifestyle modifications in managing lupus
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symptoms.
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Lupus is more common among women between the ages of 15 and 44, and it disproportionately
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affects people who are African American, Asian American, Hispanic or Latino, Native American,
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or Pacific Islander.
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The Lupus Foundation of America reports that around 1.5 million Americans are living with
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lupus, with about 16,000 new cases each year.
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Common symptoms include joint pain, extreme fatigue, and a distinctive butterfly-shaped
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rash on the face.
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In addition to medication, lupus patients can manage their illness with certain lifestyle
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behaviors, such as eating an anti-inflammatory diet and managing emotional stress.
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Dr.
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Goldner pointed out that lifestyle medicine has shown that symptoms can be reversed long-term
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through lifestyle modification.
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She suggested that it would be extremely interesting to evaluate the activity of
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abnormal immune cells before and after lifestyle changes to see if there is a similar
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reversal of the activity of these cells without using more invasive medical treatments.
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This study marks a significant milestone in our understanding of lupus and brings new hope for
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better treatment options in the future.
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We will continue to follow this story closely and bring you updates as they become available.
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Nearly half of adult cancer deaths in the United States could be prevented by making
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lifestyle changes, according to a new study from the American Cancer Society.
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The study found that approximately 40 percent of new cancer cases among adults aged 30 and
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older in the United States, and nearly 50 percent of deaths, could be attributed to
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preventable risk factors.
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Dr.
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Arif Kamal, the chief patient officer with the American Cancer Society, stated, “These are
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things that people can practically change how they live every single day to reduce their risk
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of cancer.”
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Smoking was identified as the leading risk factor by far, contributing to nearly one in
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five cancer cases and nearly a third of cancer deaths.
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Other significant risk factors included excess body weight, alcohol consumption, physical
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inactivity, diet, and infections such as human papillomavirus, or HPV.
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The researchers analyzed 18 modifiable risk factors across 30 types of cancer.
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In 2019, these lifestyle factors were linked to more than 700,000 new cancer cases and over
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262,000 deaths.
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Cancer grows because of DNA damage or because it has a fuel source, Kamal explained.
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While genetics or environmental factors can also create these biological conditions,
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modifiable risks explain a significantly larger share of cancer cases and deaths than any other
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known factors.
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Exposure to sunlight, for example, can damage DNA and lead to skin cancer, while fat cells
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produce hormones that can feed certain cancers.
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“With cancer, it oftentimes feels like you have no control,” Kamal said.
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“People think about bad luck or bad genetics, but people need to feel a sense of control and
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agency.”
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Certain cancers are more preventable than others, according to the study.
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Modifiable risk factors contributed to more than half of new cases for 19 of the 30 types
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of cancer evaluated.
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There were ten types of cancer where modifiable risk factors could be attributed to at least 80
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percent of new cases, including more than 90 percent of melanoma cases linked to ultraviolet
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radiation and nearly all cases of cervical cancer linked to HPV infection, which can be
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prevented with a vaccine.
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Lung cancer had the largest number of cases attributable to modifiable risk factors—more
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than 104,000 cases among men and 97,000 among women—with the vast majority linked to smoking.
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After smoking, excess body weight was the second largest contributor to cancer cases,
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linked to about five percent of new cases in men and nearly eleven percent of cases in
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women.
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It was associated with more than a third of deaths from cancer of the endometrium,
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gallbladder, esophagus, liver, and kidney.
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Another recent study found that the risk for certain cancers was significantly reduced for
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people taking popular weight-loss and diabetes medications such as Ozempic and Wegovy.
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“Obesity is emerging, in some ways, as just as potent of a risk for people as smoking is,”
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said Dr.
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Marcus Plescia, chief medical officer for the Association of State and Territorial Health
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Officials.
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Dr.
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Plescia was not involved in the new study but has prior experience working on cancer
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prevention initiatives.
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Intervening on a set of “core behavioral risk factors”—quitting smoking, eating well, and
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exercising, for example—can make a “dramatic difference in the rates and outcomes of chronic
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diseases,” Plescia said.
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And cancer is one of those chronic diseases, just like heart disease or diabetes.
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Policymakers and health officials should work to “create environments where it’s easier for
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people, where the healthy choice is the easy choice,” he added.
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This is particularly important for people living in historically disadvantaged
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neighborhoods, where it might not be safe to exercise or easy to get to a store with healthy
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food.
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As rates of early-onset cancer rise in the United States, it is especially important to
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create healthy habits early, experts say.
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It is harder to quit smoking once you have started or lose weight that you have gained.
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But “it is never too late to make these changes,” Plescia said.
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“Turning health behaviors around later in life can make a profound difference.”
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Making lifestyle changes to minimize exposure to certain factors can reduce cancer risk
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relatively quickly, experts say.
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“Cancer is something your body fights every single day as your cells divide,” Kamal said.
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“It is a risk that you face every day, and that also means that the reduction of the risks can
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benefit you every day as well.”
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A small pilot study has detected lead in both organic and non-organic tampons, raising
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concerns about the potential health impact of heavy metals in these products.
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While the presence of these metals was found to be minimal, the study underscores the need for
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further research to determine whether these heavy metals might leach into the body and
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impact health.
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The average menstruating person will spend about five years of their total reproductive
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lifespan using an estimated eleven thousand tampons, sanitary pads, panty liners, and other
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menstrual products, experts say.
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What if some of those menstrual aids contain heavy metals or potentially toxic chemicals
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linked to chronic diseases and reproductive and developmental problems?
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Past research has found that tampons and other menstrual products may contain chemicals such
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as perfluoroalkyl and polyfluoroalkyl substances, known as PFAS; plasticizers, also
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known as phthalates; and volatile organic compounds, or VOCs, emitted as gas or
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fragrances from many consumer products.
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All these chemical groups have been shown to disrupt the body’s endocrine system, which
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regulates sexual development, metabolism, blood sugar, mood, sleep, and more.
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Recently, a small pilot study found arsenic and lead in both organic and non-organic tampons.
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While the levels were small, there is no safe level of exposure to lead, according to the
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United States Environmental Protection Agency.
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However, the study was unable to determine whether heavy metals might leach from tampons
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into the body, making any potential health impact unknown, said senior study author
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Kathrin Schilling, assistant professor of environmental health sciences at Columbia
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University’s Mailman School of Public Health in New York City.
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"I do not want people to panic, but to be aware that heavy metals have been found in these
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menstrual products," Schilling said.
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"Obviously, the next step is to do research that would show if the metals leach from the
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tampon into the body."
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The study was also unable to determine whether any metal, even if released into the body, can
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be absorbed into the vaginal lining and subsequently into the bloodstream, said Amanda
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Hils, a spokesperson for the United States Food and Drug Administration, which regulates
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tampons and other menstrual products as medical devices.
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"We plan to evaluate the study closely, and take any action warranted to safeguard the
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health of consumers who use these products," Hils said in an email.
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Vaginal tissue is more permeable than other parts of the body, so if studies were to find
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that heavy metals—or worrisome chemicals—do leach from menstrual products into the body, it
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could be a significant problem, said Anna Pollack, associate professor of global and
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community health at George Mason University in Fairfax, Virginia.
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She was not involved in the pilot study.
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"I am most concerned with menstrual products that are used inside the body," said Pollack,
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who coauthored a review of ten years of studies on contaminants in tampons, sanitary pads,
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menstrual cups, and other products.
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"However, there is no reason for people to be afraid to use menstrual products at this time,"
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she added.
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"I would just be aware of the issue and monitor any research that develops."
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Schilling and her team tested thirty tampons from fourteen brands purchased from major
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online retailers and stores in the United States, United Kingdom, and Greece.
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The researchers conducted a blinded study, so they did not know the brands.
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The team ran tests for sixteen heavy metals: arsenic, barium, calcium, cadmium, cobalt,
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chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium,
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and zinc.
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"We found an average of one hundred nanograms per gram of lead, and two nanograms per gram of
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arsenic in the tampons," Schilling said.
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"But there was no detectable level of chromium and no detectable level of mercury, which is
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very good." Organic tampons contained higher levels of arsenic, while non-organic tampons
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had higher levels of lead, the study found.
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"The average lead concentration in tampons was about ten times higher than the maximum levels
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currently allowed in drinking water," Schilling said, adding that arsenic levels were five
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times lower than current limits for drinking water.
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"It’s important to note that arsenic should not be present in tampons at all, and we do not yet
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understand the effects of vaginal exposure since it has not been studied," she said.
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"There is no safe level of lead exposure, and it has been shown to cause reproductive health
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issues in women."
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How did detectable levels of these heavy metals get into tampons in the first place?
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Most tampons are made of cotton or a mixture of cotton and rayon, a semi-synthetic fiber made
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from wood pulp.
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Arsenic is a natural element found in soil, water, and air, while lead and other heavy
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metals are a natural part of Earth’s crust—so plants can easily absorb metals as they
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develop.
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The soil and water of the United States and other parts of the world are also heavily
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contaminated with both metals and chemicals used to produce plastic products, experts say.
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Heavy metals can be byproducts of manufacturing plants, mining facilities, and smelting
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processes, while PFAS and other chemicals enter the air, soil, and groundwater from human
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waste, consumer products discarded in landfills, and byproducts from fluorochemical
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manufacturing plants.
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Nearly half of the drinking water in the United States is contaminated with some of the twelve
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thousand types of PFAS, according to an August 2023 study by the United States Geological
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Survey.
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Chemicals called phthalates have been discovered in sanitary pads, panty liners, and
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tampons, according to Pollack’s review.
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Phthalates are in consumer products such as shampoo, makeup, perfume, and children’s toys
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and have been linked to reproductive problems, such as genital malformations and undescended
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testes in baby boys and lower sperm counts and testosterone levels in adult males.
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Both phthalates and PFAS have also been linked to the rise in early menarche in teens and
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preteens.
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In 2022, advocacy groups Mamavation and Environmental Health News, in collaboration
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with the Institute for Green Science at Carnegie Mellon University in Pittsburgh,
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looked at levels of PFAS in menstrual products.
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The investigation found forty-eight percent of sanitary pads, incontinence pads and tested
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panty liners contained PFAS, as did twenty-two percent of tampons and sixty-five percent of
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period underwear.
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Manufacturers use PFAS, often called “forever chemicals” because they do not easily break
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down in the environment, in food packaging to prevent grease and water from soaking through
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food wrappers and beverage cups.
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The chemicals are also used to make carpeting, clothing, and furniture resistant to stains,
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water, and grease damage.
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A February 2023 study found PFAS may alter hormonal and metabolic pathways needed for
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growth and development in young children, teens, and young adults.
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PFAS chemicals have also been linked to an increased risk of adult kidney cancer and
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abnormally high cholesterol levels and decreased antibody response to vaccines in both
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adults and children.
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However, the mere presence of a chemical is not an indication of risk or adverse effect,
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according to the American Chemistry Council, an industry association.
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"As the Centers for Disease Control and Prevention emphasizes, ‘The measurement of an
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environmental chemical in a person’s blood or urine is a measure of exposure; it does not by
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itself mean that the chemical causes disease or an adverse effect,’" a spokesperson for the
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council told CNN.
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Tampon makers and the FDA recommend that tampons not be used at night or for longer than
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eight hours due to a greater risk of toxic shock syndrome, a deadly bacterial infection
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that can cause organ failure and death if not treated.
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That advice also applies to anyone concerned about heavy metals or chemicals in their
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menstrual products, said Nancy King Reame, professor emerita of health promotion and risk
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reduction at the School of Nursing at Columbia University Medical Center.
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"But because the vaginal microbiome, including menstrual fluid, is the least understood organ
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system in the body, real-world advice on the use of period products based on these findings
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is premature to say the least," said Reame, who assisted on the tampon study.
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Other recommendations include washing your hands before and after inserting or removing a
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tampon to reduce bacterial spread, changing tampons every four to eight hours, and using
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the lowest absorbency possible.
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"If you can wear one tampon up to eight hours without changing it, the absorbency may be too
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high," the FDA noted on its website.
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Signs of toxic shock, which include a sudden high fever, diarrhea, dizziness, vomiting, or a
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rash that looks like a sunburn, need immediate medical attention.
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In addition, "if you have discomfort, pain, or other unexpected symptoms like unusual
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discharge when trying to insert or wear a tampon, or if you have an allergic reaction,
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stop using tampons and contact your provider," the FDA said.
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The federal government has finally responded to the longstanding calls from doctors and nurses
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to tally and study the number of health workers in Canada.
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A funding announcement of forty-seven million dollars has been made to address this issue.
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This funding will be divided among various research groups with the aim of collecting and
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studying data on Canada’s health workforce, a task that has proven difficult due to the
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fragmented nature of provincial health systems.
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The largest portion of this funding, twenty-two and a half million dollars, will be allocated
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to an arm of the Canadian Institute for Health Information.
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Their mission will be to identify where the gaps are in the workforce.
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In addition, thirteen million dollars will be given to the Medical Council of Canada to
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expand a national physician database.
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This registry will include doctors’ credentials, specialties, and locations and
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aims to make physician credentials portable within Canada.
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The urgency for federal leadership on the health workforce has been highlighted since the
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COVID-19 pandemic.
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Shortages in health professionals have led to long waitlists, emergency room closures, and
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significant stress for those on the job.
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Doctors and nurses have been advocating for this kind of federal intervention, noting that
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the pandemic exposed severe vulnerabilities in the healthcare system.
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The new funding is seen as a step in the right direction to address these issues.
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Our final topic for today's episode is a significant update from the United Nations
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regarding global population trends.
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According to a new report released on World Population Day, the world's population is
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projected to grow from the current 8.2 billion to a peak of 10.3 billion in the 2080s.
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John Wilmoth, head of the United Nations Population Division, explained that the
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probability of the world’s population peaking within this century is quite high—around 80
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percent.
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This marks a major shift from a decade ago when the estimated probability of such an occurrence
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was only about 30 percent.
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The World Population Prospects 2024 report attributes the earlier-than-anticipated peak to
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several factors, including lower fertility levels in some of the world's largest
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countries.
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For instance, China's population is projected to drop dramatically from 1.4 billion in 2024
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to 633 million by the year 2100.
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Globally, women are having an average of one fewer child than they did in 1990.
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In more than half of all countries and territories, the average number of live births
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per woman is below 2.1, which is the level needed for a country’s population to maintain
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its size without migration.
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Nearly 20 percent of the world, including countries like China, Italy, South Korea, and
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Spain, have 'ultra-low' fertility rates, with women having fewer than 1.4 live births.
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The report also notes that population has already peaked in 63 countries and territories,
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including China, Germany, Japan, and Russia, and is projected to decline by 14 percent over
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the next 30 years in these regions.
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In another 48 countries and territories, including Brazil, Iran, Turkey, and Vietnam,
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the population is expected to peak between 2025 and 2054.
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For the remaining 126 countries, including the United States, India, Indonesia, Nigeria, and
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Pakistan, the population is expected to increase through 2054 and potentially peak in
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the second half of the century or later.
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Interestingly, nine countries, including Angola, the Central African Republic, Congo,
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Nigeria, and Somalia, are projected to see very rapid growth, with their populations doubling
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between 2024 and 2054.
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Despite these differences, Wilmoth pointed out that all populations are following a similar
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path, with variations arising from different stages of the demographic transition toward
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longer lives and smaller families.
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Following the COVID-19 pandemic, global life expectancy is rising again, and by the 2080s,
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people aged 65 and older will outnumber children under 18 years of age.
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In some countries, immigration will become the main driver of future growth.
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Furthermore, gender equality and women’s empowerment are highlighted as key factors that
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can help counter population growth.
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The world’s population has grown dramatically in the last 75 years, from an estimated 2.6
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billion in 1950 to 8 billion in November 2022.
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Since then, it has increased by roughly 2.5 percent to 8.2 billion.
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Kathleen Mogelgaard, president and CEO of the Washington-based Population Institute, noted
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that the new estimates underscore an increasing demographic divide around the world.
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While over 100 countries and territories have already peaked or will do so in the next 30
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years, many others, particularly among the world’s poorest nations, will continue to grow.
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Rapid population growth is likely to magnify the scale of investments and efforts required
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to eradicate poverty and hunger and ensure universal health care and education in
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countries facing severe economic, social, and environmental challenges.
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Conversely, countries with low fertility rates that face rapid population declines may need
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innovative policies to deal with labor market, social protection, and national security
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ramifications.
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Looking ahead, the report compares the world’s 10 most populous countries today with
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projections for 2100.
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India tops both lists, followed by China, though with a much smaller population by the
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end of the century.
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The United States, currently the third most populous country, is expected to be replaced by
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Pakistan in 2100 and will drop to sixth place.
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Nigeria, Congo, Ethiopia, Indonesia, Tanzania, and Bangladesh are projected to follow.
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Brazil, which is the seventh most populous country today, is expected to drop to 12th
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place by the end of the century.
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Wilmoth emphasized that while population numbers are important, they are just one part
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of the equation.
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'What really matters is our behaviors and the choices we make,' he said.
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That concludes today's episode of Morning Medical with Dr.
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Chow.
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Thank you for joining us as we explored these significant updates in the medical and health
26:38
world.
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Make sure to tune in tomorrow for more insights and news.
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Have a great day!