The Magic Sweetener?

Dental researchers have known something most of us don’t know – that the natural sweetener xylitol can prevent cavities.  It may be about as good as fluoride.   Dr. Peter Milgrom, who teaches, researches and practices dentistry at the University of Washington, has become a big fan of xylitol.   Earlier this week, I reported on his latest study, showing a benefit to babies.

Here are some additional xylitol facts from Dr. Milgrom that I couldn’t shoe-horn into the story:

  • The shortcomings of xylitol:   It has “cool” taste, similar to mint, so works best in cold foods or mint flavors. And it’s a little more expensive than other sweeteners.
  • Most studies so far have shown you need to get at least two, often three, doses of xylitol per day to get a benefit.  And if it’s in a gum or toothpaste, for example, it needs to be the number one ingredient, not diluted with other sweeteners.
  • But, if you get too much xylitol (admittedly rare), you might get stomach upset and diarrhea.
  • There were some suggestive studies from Finland, using very small samples, saying xylitol also might prevent ear infections.   Weird, and not verified.   Milgrom has applied for funding to investigate that.
Birch trees in Finland (Flickr photo by Slider5)

Birch trees in Finland (Flickr photo by Slider5)

Finland, by the way, is like the World Capitol for xylitol.  The Finns have been building up a xylitol industry, presumably because they can grow big crops of birch trees, which are the main source of the substance.

Milgrom’s research is mostly government funded, but he does get free xylitol for his experiments from a Danish company called Danisco.   If you’re intrigued, he says Danisco runs a credible website for basic facts about xylitol.

(What does xylitol do?  Basically, it blocks the bacteria that form dental plaques, interfering with their ability to feed and to stick to teeth.)

More about that “slow earthquake”

I wrote about “deep tremors” (also nicknamed “slow earthquakes”) last January, both in this blog and for KPLU.  You didn’t feel it, no matter where you live, but the quake happened under western Washington during April and May.  That was a couple months earlier than scientists expected.  So, they didn’t get their instruments in the ground in time to record it.  No matter — the deep tremors come back approximately every 15 months.

There’s a nice write-up by Sandy Doughton in The Seattle Times today.  She went on the scene, in Sequim, as the researchers lay down their seismometers in the Olympic forest (great photos, too), and she gives a lengthier explanation of the science behind (or beneath) these episodic tremors.

Findings I like, this month

These bits of research failed to make headlines, but you might enjoy them, as I did (disclaimer: I didn’t look into the quality of any of these studies):

  • “Parents Influence on Children’s Eating Habits is Small.” Really?  How could that be?  Apparently, the community, peers, television viewing, and the “food environment” are more important.   I don’t think they were able to separate out young children from teenagers, for this study from Johns Hopkins University.  It claims to be the first-ever study to look at parental influence on eating habits.  (The news release is here.)
  • Autism Medication is Ineffective for Repetitive Behaviors. This is from Seattle Children’s Hospital.  They compared a common anti-depressant (citalopram) that is used to control repetitive behavior in children with autism against a placebo, and found no benefit.  The children wring their hands, or rock back and forth.  The drug was prescribed because some clinician thought that there was a common problem with the brain chemical serotonin.  (The news release is here. )
  • A New Material to Use Inside the Body — Blending Crustaceans and Polyester. Some University of Washington researchers are bio-engineering a substance that can blend two important qualities, stickiness and sturdiness.  You want a severed nerve to be able to grow back in the right direction, so you need some scaffolding that it can grab onto, like a wisteria in your garden.  And you need something that won’t dissolve too easily inside the body. This is an interesting blend, of shells and polyester.  They claim it has prospects for muscle and tendon repairs, too. (The news release is here.)

Chitosan and polyester fibers, at the nano scale.

Chitosan and polyester fibers, at the nano scale. (UW)

  • A Faustian Bargain, for Our Brains? This theory — and it’s more like a hunch — says our evolutionary history is a two-sided coin.  In exchange for evolving bigger, intelligent brains, we may have also been cursed with cancer.  Apparently, humans are more cancer-prone than other primates, and it may be related to a gene that kills off potentially bad cells.  By being more lax, our bodies are able to grow bigger brains.   (The news release is here.)

A concussion is a brain injury

Concussions are scary, the more you learn about them.  I like the way Brian Adler summarizes the underlying message:  “All concussions are brain injuries, and all brain injuries are serious.”  (Adler is an attorney who represents accident victims, not a doctor, but he seemed to get a lot of nodding heads at a  sports medicine conference in Seattle.)

The biggest danger is getting a second injury.

There’s been a lot of discussion among scientists and neurologists about concussions and athletics.  The most common system for many years makes a distinction between people who lose consciousness and people who don’t.  But, the latest guidelines, published this month as the “Zurich concussion statement,” says you don’t have to lose consciousness to have a serious concussion.  (I can’t find a free accessible version online.)

The new guidelines say youth athletes should never return to action on the same day as the injury (and adults should only take that risk after a medical evaluation).

Washington’s new youth concussion law (reported on KPLU) is perhaps the most advanced in the world, because one of its architects also served on the Zurich panel.  That’s Dr. Stan Herring of the UW/Harborview.  One big change is simply recognizing that each individual and each injury is different.  You can’t simplify by saying, it’s only minor because he never lost consciousness.  Instead, someone trained to evaluate head injuries needs to run the  victim through a series of tests, similar to a neurological exam.  If there are any problems with balance or coordination, for example, then the brain needs time to heal.

Technically, a concussion is less severe than a “mild traumatic brain injury.” But it can be hard to tell where one stops and the other starts.  A head injury can lead to internal bleeding, which damages brain cells by creating pressure inside the skull.  And a lot of damage happens when the “wiring” of the brain, the long axons that connect one brain cell to another, get severed.  There are bundles of axons, and a jolt to the head can rip them in clusters.  Such damage may not show up in x-rays.

Helmets?  Surprisingly, the international panel can’t agree on whether they’re a good thing in many sports, since they may encourage athletes to take bigger risks and hit things with their heads.  Helmets are definitely recommended for bicycling, skiing and snowboarding.

Oh yeah, one bit of good news.  Most concussions heal within a week and leave no lasting damage.

Flash-forward, the flu of December 09

Here are four interesting items I learned yesterday from King County’s chief epidemiologist, Jeff Duchin, MD.

  1. Lesson learned:  Closing individual schools is not effective for limiting flu transmission in a community.  Next time — if the virus appears to be more deadly — the health department will close all schools in the county, perhaps for 8 weeks or longer.
  2. Lesson learned #2: This virus spread far more rapidly than planning scenarios had predicted.  Basically, flu virus can be widespread before we know what’s hit us.
  3. Who’s first in line for a vaccine, if there’s a limited supply? Heavy-duty planning is underway for how to distribute an A-H1N1 (swine flu) vaccine next winter, assuming it’ll be available.  This will be in addition to the normal, annual flu shots.   First-responders, and most medical workers, are clearly at the top of the list.  Pregnant women, and people with compromised immune systems.  After that, it might be all children under 18, given signs that they’re being hardest hit so far.  (Normally, the elderly are considered most at risk, but not in this case.)
  4. If the virus remains less severe?  Expect simply a lot of people to be out sick, especially in schools, as everyone who didn’t get sick this spring, gets it on the second pass.   But, it wouldn’t be much different from what we’ve seen this past month.

And one note to the King County Board of Health:    Anyone watching (the meeting was recorded by King County TV) might be disappointed at the level of questioning by board members, as Dr. Duchin and other staff testified.  They asked thoughtful questions to clarify the facts.  But, nobody on the Board asked the simple questions, What parts of the “pandemic plan” did not work?  What surprises did the staff face? What needs to be improved before we face a severe pandemic?   (The lessons learned above came from a private interview, after the meeting.)

Flu reflections and questions

On Thursday afternoon, we’ll get the official “swine flu de-brief” from Public Health-Seattle & King County.  What will be the lessons learned?  Dr. David Fleming, the agency’s director, offered a possible preview back on May 4th, at a panel in Seattle hosted by the Washington Global Health Alliance (and televised by TVW).

It seems everyone involved with pandemic flu planning has been praising the response to this outbreak. Fleming said, “Boy, planning is really paying off.”  He was comparing the government reaction to anthrax and SARS outbreaks few years back, and noting that this time there was more “rational communication.”

But I don’t think the public perception is quite so triumphal.  People were confused and they see officials as being confused.  While the response may be much better than it would have been a decade ago, does it live up to the expectations of today?  After millions of dollars have been spent on pandemic flu planning, was this response good enough?

Here are a few points from the panel that struck me:

  • At the peak of concern, supplies of Tamiflu were depleted at some health care centers in King County, and Public Health had to distribute some doses from the national strategic stockpile — and this was a mild strain of flu.
  • Fleming acknowledged, “We planned for the wrong disease, a global pandemic of great severity,” or a high death rate. But it turned out to be a milder strain of flu.
  • This strain of H1N1 spread much faster than anyone anticipated.  That means the information communicated to the public has been way behind what’s actually happening in the community.  On the other hand, officials are trying not to speculate in public, and offer assurances before they’re certain about what’s happening.
  • Children and schools were a major source of transmission for this outbreak — which may have lessons for vaccinations next fall.  (A point made by Dr. Kathy Neuzil, of PATH and U.W.)
  • Agricultural workers may be a weak-link in the global surveillance system, since flu viruses can jump more easily than many realize from poultry or swine to people.  There’s now system for tracking illness among these workers. (From Ann Marie Kimball, an epidemiologist at U.W.)

Swine flu and school closures – how much longer?

Wondering if you child’s school will be next?

The top public health officials in King County — Dr David Fleming, Director, and Dr. Jeff Duchin, Chief Epidemiologist — have been hinting that school closures may not be a tactic for much longer.

As my KPLU colleague Liam Moriarty reported this morning (Friday),  “So far, none of the folks in King County with the H-1-N-1 (swine) virus have gotten any sicker than they might from any of the old familiar flu viruses. Dr. Fleming says if that trend holds in the coming days – and this bug proves to not be particularly nasty – some of the precautions such as closing schools could be relaxed ….”

On the other hand, three students at Lakes High School, south of Tacoma, were taken to Madigan Army Hospital with severe flu-like symptoms, and as of Friday morning, two of them were in intensive care units, in serious condition.  That led to closing the school, as a precaution.

Seems sensible and prudent.   If tests show that they indeed are suffering from the swine flu H1N1, then we might see school closures  as a good tactic that should continue.

I have to say, the top officials in public health agencies and school districts have seemed remarkably indifferent to the hardship the closures cause.  In particular, for single parents and parents working jobs that offer little or no sick/vacation leave, this is a whole separate crisis.

When will a leader (the Governor? a Health Director?) stand up and say to employers, “We are in an emergency situation, and I’m asking all employers in the state to give extra sick days to anyone whose child’s school has been closed for a week?”

[UPDATE, Friday afternoon: Seattle Mayor Greg Nickels deserves a prize for being the first to address the work issue.  He told a news conference today that the city is offering extra flexibility to its employees … and he called on other employers to do the same. ]

In case you missed it, in King County, four schools have been closed (as of noon Friday)(five schools as of Friday 4 pm)  because they each have a student who probably has swine flu.  (The reason for closures is to slow down the spread of the virus — to prevent a situation where lots of people are getting sick at once.  But, once the virus is confirmed to be widespread in the community, then there’s not much benefit from closing individual schools.)

If you’re like me, keep crossing your fingers that your child’s school doesn’t have a “probable” case during the next week, and maybe after that we’ll be beyond school closures.

Washington’s “Swine Flu Six”

I’ll offer a few posts here, shortly. First, for those of you craving detail during these anxious times, here is full text of the radio stories for KPLU:

Version one:  Six Local Cases of Swine Flu Called “Probable”

The swine flu outbreak has officially reached Washington state. Last night, the state health department announced it’s identified six people as probable cases. They’re in Seattle, Snohomish County and Spokane. More from KPLU science and health reporter Keith Seinfeld:

We have the most details about the three from Seattle. They include:

A 33-year-old female doctor, whose husband and two children are also likely infected. They’re being treated at home.

A 27-year-old single man is at home.

And an 11-year-old boy has been hospitalized but is recovering. The boy’s school is Madrona, and it is staying open because the boy did not come to school at all after he became sick over the weekend.closed for a week. UPDATE – The decision was made early Thursday morning, after public health officials determined the boy may have been contagious last Friday when he was in School.   Washington Secretary of Health Mary Selecky says this all sounds alarming:

“The reason we’re being very cautious is because this is a brand new virus, and as a result there really isn’t any immunity in the population. So, we want to prevent it from spreading.”

Public health is especially on the lookout for how easily the virus spreads, and how severe the flu is once people get it. Dozens more possible cases are in early testing stages. The best way to keep it from transferring the flu, she says, is to stay home if you’re sick, cover your cough, and wash your hands. If you don’t have enough sick days? That policy, she says, is up to each employer. Keith Seinfeld, KPLU news.

More:

  • In Snohomish County, the public health department wasn’t able to get any details, as of Wednesday night, about a 6-year-old 3-year-old boy or a 34-year-old woman who are probable cases.
  • None of Washington’s six probable cases appears to have involved travel to Mexico.
  • So far, about 95-percent of the cases labeled probable by different states have proven positive at the federal labs in Atlanta. But it may take several days to get results for Washington.

Version Two: Probable cases of Swine flu in Washington

Six people in Washington are now considered to “probably” have swine flu, according to the state Department of Health. All six are recovering. Also one woman in Victoria, B.C., has confirmed she caught the swine flu while on vacation in Mexico. More details now from KPLU science and health reporter Keith Seinfeld:

Just a few hours after saying there’s no sign of any swine flu in Washington, the state health department got results from a new batch of tests. Six people have a strain of flu that is probably the new strain of swine flu – and their samples have been flown to the federal laboratory in Atlanta for confirmation.

Of the six, three are from Seattle, two from Snohomish County and one from Spokane. An 11-year-old boy in Seattle and a six-year-old boy in Snohomish were the only children. The Seattle boy’s mother is being praised for keeping him home – so his school, Madrona, won’t have to be closed. UPDATE – But Madrona was closed Thursday, for a week, because it turns out he may have been contagious last Friday when he was in School.  Dr. Jeff Duchin, chief epidemiologist for King County, spoke at a Wednesday evening news conference televised on northwest cable news.

“You shouldn’t go to school when you are sick.  You shouldn’t go to school if you have a fever or are coughing, all around the community, because if this virus has made its way to Washington state, the way to prevent it from spreading is by keeping away from one another when we’re ill.”

The Seattle boy has been hospitalized since Tuesday, with a fever and shortness of breath, but now is in good condition. None of the others required hospitalization. One case is a 33-year-old doctor from Seattle. She and her famly are being treated, but it’s not clear yet if she may have exposed others.

Public health officials say, you should expect to see more cases in Seattle and all over Washington, as more people are tested. Results from the federal labs may take several days. Keith Seinfeld, KPLU news.

More:

  • A shipment of anti-viral medicines is en route to Washington, to add to the state’s stockpile, in case the outbreak becomes an epidemic.
  • Seattle has activated its Emergency Operations Center, at the lowest alert level, to be ready should the situation change suddenly.
  • The advice to the public remains, stay home if you’re sick, wash your hands and cover your cough.

Swine flu, without Mexico

I may be gloriously wrong on this.  But, Ill go out on a limb and suggest the possibility that this H1N1 swine flu has been in Washington state, and other states as well, for quite a while.  I won’t be surprised if it turns out that many people who suffered a flu or flu-like illness over the past month actually had this strain.

And last night’s announcement of Washington’s first six “probable” cases (see this post) added some support.  I was told by both the state Department of Health and King County’s public health officials that none of the six people who harbor the suspected virus has any connection to Mexico. They didn’t travel there, nor did they contact anyone who recently did.

In fact, in King County, the three cases only came to light because they bypassed the health department.  Why?  Because the health department was only agreeing to test samples that met the criteria of severe flu symptoms PLUS some connection to Mexico.  These three, then, were tested by independent clinical laboratories, and then forwarded to the state when they proved to be a Type-A influenza virus.

(One of those labs was at the University of Washington, and I’m still trying to learn about the other two, as well as the cases in Snohomish and Spokane.)

If they had no connection to Mexico, and they caught it locally, then this suggests that there was a good-sized reservoir of infected people in Seattle by the end of last week.  It still may have come from Mexico, but perhaps  a month ago, or longer.

Swine flu, the mystery

Everyone’s talking about swine flu. Every major news organization has done a decent job covering the basics. Here are a few extras, based on what I’ve learned so far:

  • We won’t know for a week or longer if this is indeed a serious pandemic or not. The information from Mexico is still too incomplete to tell us if the flu there is killing an unusual number of healthy young adults. It appears to be unusal, and that’s what has public health leaders around the world worried. But that appearance may prove false, once we get more data. They’re handling it with “an abundance of caution,” says King County’s chief epidemiologist Jeff Duchin. (For example, they may not be getting an accurate measure of how many people are infected with mild cases of swine flu, and that number is key to telling you what percentage are severe cases.)
  • In British Columbia, two cases of swine flu were confirmed over the weekend. Both were men who were returning from Mexico. Both cases were considered “mild” (in which case, I’m not sure how they were detected).
  • It would take six months or longer to create a vaccine. In the meantime, for those who do get sick, a drug called Tamiflu can effectively treat the disease. A stockpile is on hand, in King County and elsewhere, to deliver Tamiflu in the event this does become a major epidemic. The stockpile would be used primarily for police, fire and medical workers.
  • “What should I do?” In most cases, nothing. Public health officials say, if you are sick enough that you think you need medical attention, then call your doctor’s office. But, don’t just show up. And if you’re mildly ill and wouldn’t normally seek medical attention, then don’t seek it now. (But do take the usual precautions, such as covering your coughs, handwashing, etc.)