Published March 2, 2024

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Welcome to March—the month that ushers in Match Day, March Madness, and the lesser known “Vas Madness.” The term refers to the annual onslaught of vasectomy requests for the beginning of March. Why then? Because nothing pairs better with frozen peas and days of sofa-lounging than a marathon of college basketball.

A 2018 study shows that March and December consistently post up the greatest number of vasectomies, hinting that both watching the NCAA tournament and meeting year-end deductibles may inform men’s timing decisions. And urologists support the Vas Madness phenomenon. Dr. Alexander Rozanski of UT Health San Antonio says, “Sometimes it’s hard to get guys to follow post-vasectomy recovery instructions.... March Madness gives them a good excuse to lay low and recover.”

Digging Deeper into the Link Between Nose-Picking and Alzheimer Disease

NEURO NEWS

The book was right—all you really need to know you learned in kindergarten. While we all grasped the social perils of nose-picking long ago, we likely didn’t predict the potential health repercussions. Now a study draws a line between nose-picking and an increased risk of Alzheimer disease (AD). But the science is still out on whether lying sets your pants on fire.

Follow the pathogens

Can nose-picking (or “rhinotillexomania,” as practiced by highly evolved pickers) legitimately increase the risk of AD? It sounds like a reach, but a new narrative review dug into the emerging research and advanced the hypothesis that this uncouth act may indirectly ignite neuroinflammation—a driver of AD risk. How? The theory is twofold: (1) An unwashed finger may cart pathogens from the nasal cavity to the nearby brain, triggering the increased production of beta-amyloid. (2) Clawing particles back down the nasal cavity may disturb the microbiome balance.

Picking apart the theory

We still need to know “what comes first, the chicken (AD) or the egg (infection).” Does a compromised immune system allow for infection-induced neuroinflammation and AD, or do aging and subclinical AD spur inflammation and immune weaknesses, opening the door to olfactory pathogens?

Key takeaways

The link between nose-picking and AD risk is gaining traction in medical literature, but more research remains before nose-picking reaches AD-risk-factor status. In the meantime, it doesn’t hurt to reinforce the pearls of kindergarten: (1) Flush, (2) wash your hands, and (3) keep fingers (and other objects) out of your nose. But for the Alfred E. Neumans out there who struggle with rule number three, rule number two may help mitigate the concern.

FDA …

• Expands use of asthma med Xolair to treat food allergies

• Approves budesonide oral suspension (Eohilia) for eosinophilic esophagitis

• Approves drug to reduce accidental food allergies

Two Kiwis a Day Keep Depressed Mood Away?

DIETARY DIGEST

Scientists may have identified a nonpharmacologic option capable of boosting your mood faster than a Dow Jones spike or a “check-in” tweet from Elmo. According to a placebo-controlled dietary intervention trial, kiwifruit may be a mood magician—with vitamin C its wand.

The kiwi effect

Investigators from New Zealand—a team of Kiwis, if you will—assigned 155 healthy adults (18-35 years) with low vitamin C levels to either two SunGold kiwifruit, a vitamin C tablet (250 mg), or a placebo daily for eight weeks. Participants self-reported via daily smartphone surveys their mood as well as their vitality, sleep, and exercise. Both the kiwis and the tablet correlated with a mood boost, but in a whole food flex, the fuzzy fruit elevated mood by a more substantial margin and for a longer duration. The kiwi consumers noticed a mood jump within four days, and that wave of contentment crested at 14 and 28 days. Of note, those days corresponded with in-clinic visits—aka “paydays” for the participants, prompting the question, “Was it the vitamin C or the C note that spiked their mood?”  

Key takeaways 

Vitamin C is a known purveyor of that “peaceful, easy feeling,” but this study offers the first controlled trial to explore daily mood fluctuations in response to a vitamin C tablet or kiwi intervention. The results suggest a compelling case for incorporating two kiwis into the daily regimen of individuals with low vitamin C levels seeking a swift mood boost. But the authors call out the benefits of the specific kiwi brand SunGold (think yellow flesh, not green). On the vitamin-C fruit pecking order, this variety sits well above oranges, strawberries, and the standard green kiwi. But kiwi is more than just its vitamin C content; it also boasts abundant fiber, vitamin B9, and potassium—all of which are known to promote mental well-being.

New Risk Factor for Cardiovascular Disease—Beware B3

CARDIO CORNER

Can you have too much of a good thing? When it comes to Elmo, Larry David says, “Definitely yes.” And when it comes to vitamin B3, or niacin, researchers say, “Likely yes.”

The pendulum swing…

In the 1940s, US scientists discovered a population-wide deficiency in the essential nutrient niacin, prompting a mandate of niacin fortification in common foods, like flour and cereal. Problem solved! But thanks to those efforts, Americans now consume three times the recommended amount of niacin (16 mg for men, 14 mg for women). And emerging research suggests that excess niacin may be a new risk factor for cardiovascular disease (CVD).

Examining a research trifecta of clinical, genetic, and mouse data, scientists found a notable correlation: higher levels of the compound 4PY (N1-methyl-4-pyridone-3-carboxamide) in the bloodstream significantly raised the likelihood of experiencing a myocardial infarction, stroke, or other cardiac event. What is 4PY? You guessed it—it’s a byproduct of the breakdown of excess niacin. And it can trigger vascular inflammation, potentially resulting in atherosclerosis.

Key takeaways

Few of us likely had niacin on our proinflammatory bingo card, but the research shows that an overabundance of the nutrient can stimulate cardiovascular inflammation. On the plus side, the revelation of a new pathway to CVD holds the promise of developing medications that could alleviate blood vessel inflammation. In the meantime, what’s the safety threshold for niacin intake? Researchers aren’t sure. They need more data to determine the sweet spot between beneficial and harmful niacin levels. Clinicians, patients, policymakers, and Big Cereal await the answer. For now, study authors advise the public to avoid niacin supplements, given the emerging evidence linking excessive niacin intake with heightened cardiovascular risks.

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

• Cefepime–taniborbactam in complicated urinary tract infection

• Effect of tai chi vs aerobic exercise on blood pressure in patients with prehypertension: A randomized clinical trial

• Flu vaccine makers plan switch to trivalent shots, removing vanished B virus

• $15 billion win for physicians on prior authorization

• Study: 90-fold increase in pickleball-related fractures in past 20 years

• Decoding glycomics with a suite of methods for differential expression analysis

• Effect of a salt substitute on incidence of hypertension and hypotension among normotensive adults

• Abstract 16592: Cancer as a New Risk Factor for Major Adverse Cardiovascular Events in Secondary Prevention

• New guidelines: Start PSA screening earlier in black men

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

Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.

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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