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The Results Are In...

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Published February 7, 2024

Morning Report — Not Your Typical Medical Newsletter

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Stop us if you’ve heard this one: “The patient says, “Doc, it hurts when I do this.” The doctor replies, “Then don’t do that!”

So, what do you do when a rapid headache manifests every time you drink red wine? You could swear off Merlot à la Paul Giamatti in Sideways. Or you could continue imbibing but conduct a lab study to pinpoint the cause of the headaches.

Neurologist and red wine enthusiast Morris Levin opted for the latter, and that’s how he and coinvestigators uncorked a new theory: Red wine headaches may be caused by the flavonol quercetin that naturally occurs in wine—especially red varieties. How? When the compound hits the bloodstream, it becomes quercetin glucuronide, which inhibits alcohol metabolism, causing a buildup of toxins and potentially triggering head pain. Selecting wine with lower quercetin levels, like white wine and even cheaper red wines (it has to do with levels of sunlight during production), may sidestep the condition. Next up—human trials to prove the theory. We predict an overflow of volunteers.

The Sounds of Silence and Increased Mortality Risk

LIFESTYLE LEARNINGS

“In the operating room during surgery, sometimes if someone talked to me on the left side when there was a lot of background noise, I usually wouldn’t respond.” That’s otolaryngologist Janet Choi recalling the moment she realized her lifelong hearing impairment necessitated hearing aids. As with the wine-aficionado-turned-investigator above, Choi’s personal challenges sparked a broader research question. Building on the known benefits of hearing aid use on cognition, Choi asked, Does hearing aid use affect mortality risk as well?

Hear today, live tomorrow

Using data from the National Health and Nutrition Examination Survey, Choi and colleagues led a cross-sectional study of nearly 2,000 adults (mean age of 50 years) with hearing loss. All completed questionnaires on hearing aid use. The follow-up period spanned approximately 10 years. Predictably, the findings bore out an association between hearing aid use and lower mortality risk, echoing studies linking hearing aid use with a lower risk of frailty, dementia, and cognitive decline. But it was the magnitude of benefit—a 24% relative reduction in mortality risk—that astonished the team.

Key takeaways

This study highlights a significant correlation between hearing aid use and a lower risk of mortality. But of the 40 million US adults with hearing loss, only 12% regularly use a hearing aid, presumably due to stigma, discomfort, and expense. And regular use is key—those in the study who owned hearing aids but left them in the drawer most days were as likely to die prematurely as those who never used them. While the study indicates correlation and not causation, plausible reasons for greater longevity exist, including staving off isolation and increasing activity. Also, auditory deprivation itself may disrupt brain structures. Choi offers this sound advice to new users: Wear your hearing aid daily for 30 consecutive days to acclimate. As for the financial barrier—fortunately, technological advances have caused the price of hearing aids to drop like the cost of Merlot post-Sideways.

New Guidelines/Recommendations

New Discovery May Soon Cut the Cord Between Pregnant Women and Hyperemesis

PREGNANCY PERSPECTIVES

If you’ve read this far, you know it’s becoming a cliché to turn your own ailment into a research project, but when life gives you lemons, you enroll participants to drink lemonade. After geneticist Marlena Fejzo battled hyperemesis and a callous OB/GYN during her pregnancy in 1999, she began a lifelong quest to identify the cause of nausea and vomiting in pregnancy.

A consequential stop on Fejzo’s journey was 23andMe—the popular company that tells you everything you did and did not want to know about your gene pool. She persuaded the genetics giant to add questions about hyperemesis to customer surveys. Fejzo and colleagues’ subsequent 2018 paper called out a link between customers with hyperemesis and a variant in a gene for the hormone GDF15. Next stop—establish evidence of causation.

Now, a recent paper from Fejzo and a new team of researchers seemingly has accomplished that task. The team assessed GDF15 levels in pregnant women’s blood and examined genetic risk factors for hyperemesis. They discovered that women with hyperemesis had markedly elevated GDF15 levels during pregnancy relative to women without symptoms. But there’s a twist: The greater a woman’s pre-pregnancy exposure to the hormone, the milder her “morning” sickness.

Key takeaways

This latest study supports the causal relationship between GDF15 and the nausea and vomiting that saddle two-thirds of women in pregnancy. And the findings offer biologic validation to the >2% of pregnant women grappling with hyperemesis, many of whom face skepticism over the severity of their condition, despite A-listers Princess Kate and Amy Schumer raising awareness. While still in its embryonic stage, the discovery could give birth to novel treatments, presumably involving exposure to GDF15 before pregnancy or impeding the hormone’s effect on the brain. We can conceive of a future when these distressing pregnancy symptoms become as antiquated as “twilight sleep” births.

FDA …

Innovative Blood Test for Alzheimer Disease on the Horizon

NEURO NEWS

The availability of blood-based screening and diagnostic tests is surging like the rollout of AI products. Noninvasive prenatal testing, liquid biopsy cancer testing, and commercially available Alzheimer disease (AD) testing have ascended the list. Why? Because these tests typically understand the assignment—be minimally invasive and cost-effective. Now, another commercially available blood-based AD test hopes to continue the trend, but is it reliable?

The results are in …

This new assay may detect AD even before symptom onset. That’s according to a recent cohort study of nearly 800 people (with and without cognitive impairment) that revealed that the blood test performed as well as costly cerebrospinal fluid tests and brain scans in detecting AD pathology. The test checks the bloodstream for phosphorylated tau (p-tau), which rises in tandem with known AD culprits beta amyloid and tau. Study results showcased an impressive 96% accuracy rate in spotting elevated beta-amyloid levels and 97% accuracy in identifying tau. The test manufacturer—only too happy to provide free materials for the study—expects the test (costing $200 to $500) to reach consumers’ veins next month.

Key takeaways

The burgeoning wave of commercially accessible AD blood-based tests may hold promise for patients, particularly those with limited access to advanced testing. But placing an AD test directly in consumers’ hands also invites scrutiny and debate. Patients must recognize that a positive result does not conclusively predict the development of AD. Nor does a negative result exclude non-AD conditions like vascular dementia or Lewy body dementia. Nevertheless, some experts optimistically foresee the test evolving into a routine screening tool—like cholesterol testing—that facilitates risk stratification. And what patients do with the AD test results could parallel their response to cholesterol test results—use them to make informed health decisions and gain early access to disease-modifying interventions. Like our foray into AI, we’re still entering the Wild West of these blood-based AD tests. More to come.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

Alissa Scott, author
Aylin Madore, MD, MEd, editor
Margaret Oliverio, MD, editor
Ariel Reinish, MD, MEd, editor
Emily Ruge, Author, editor

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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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