San Antonio Express-News (Sunday)
CDC affirm swearing masks is effective
Dear Dr. Roach: A recent column advised readers to wear masks. Please print a study that shows masks work. I can show you 10 studies from the CDC that say they don’t. You should not encourage your readers to do something without proof.
C.W. A: Although some authorities were hesitant to recommend masks at the beginning of the pandemic, the evidence has become strong that masks are effective at protecting both the wearer and (especially) others from getting sick. A study in
July showing masks to be ineffective was retracted by the authors, noting their experimental data were unreliable and, therefore, “our findings are uninterpretable.” The best type of study, a clinical trial, is not yet available, although at least two are ongoing, despite concerns about the ethics of such a trial.
The Centers for Disease Control and Prevention affirmed shortly thereafter that “cloth face coverings are a critical tool in the fight against COVID-19 that could reduce the spread of the disease, particularly when used universally within communities.” Because medical face masks, particularly the high-quality N95 masks, remain in short supply to health care providers in some parts of the country, members of the public are encouraged to use cloth masks, particularly those with two or more layers of washable, breathable fabric.
I am posting links to a few studies and editorials about mask effectiveness on my page at Facebook.com/keithroachmd.
Dear Dr. Roach: I have a brain aneurysm and am wondering if it could be affected by wearing a mask. I just seem to get a bit off kilter when wearing one. I have a coil in my head.
J.H. A: An aneurysm is an enlargement of a blood vessel. They are particularly dangerous in the brain, where a rupture leads to bleeding that can cause a stroke. A coil (a platinum wire) is placed into the aneurysm, causing a clot to form and reducing the risk of artery rupture.
A mask should have no effect on a brain aneurysm. Neither oxygen levels nor CO2 levels in the blood are significantly affected. Many people feel a bit off kilter when using a mask at first, but they become easier with continued use.
Masks should not be worn by someone who could not take it off without assistance. There are very few other reasons NOT to wear masks when in a public setting.
Dear Dr. Roach: My doctor said that an ultrasound and blood tests show that I have fatty liver. I drink wine and a beer occasionally. What is fatty liver? How did I get it and what can I do about it?
E.M.
A: Fatty liver is a catchall term for abnormal fat depositions in the liver. These can come about in people with heavy alcohol use: Only about 1 percent of people who have two to four drinks per day will develop alcoholic fatty liver disease, but 6 percent of those who have eight drinks per day will.
For nondrinkers, or people who drink only occasionally, the major risks are older age, diabetes, being male and being overweight or obese, especially when the weight is predominantly around the abdomen.
Nonalcoholic fatty liver disease is extremely prevalent in the United States: 10 to 46 percent of people have it. It is now among the leading causes of cirrhosis in the U.S.
The major treatments for nonalcoholic fatty liver disease are lifestyle changes. Alcohol abstinence is recommended, even modest alcohol use like you. If you are overweight, weight loss is the primary treatment. One authority recommends a goal of 5 to 7 percent of body weight (so, 10-14 pounds if you weigh 200 pounds, for example). Regular physical activity was found to reduce overall mortality rates in people with NAFLD as well, independent of the effect on body weight.
Because viral hepatitis can be much more severe in a person with fatty liver, you should be sure you are immune to hepatitis A and hepatitis B (your doctor can do blood tests to be certain, and can give the appropriate vaccines if you are not immune).
If you have diabetes, careful control of diabetes is essential. Because people with NAFLD are at increased risk of heart disease, other risk factors, especially blood pressure and cholesterol levels, should be more aggressively treated, including with medication therapy if lifestyle changes are not enough.
Dear Dr. Roach: I have been using turmeric on my food for quite a while. I’ve noticed I’ve started having bouts of diarrhea. I found others’ reports of this when searching on the internet. I might quit taking it to see if the diarrhea ceases. Do you have any other information on contracting diarrhea with turmeric?
W.T. A: Yes, I have seen this before. It has been welldocumented.
Turmeric is used by many people just as a spice, but it’s also taken for the medicinal properties of curcumin, which is an anti-inflammatory used by many people for arthritis and other conditions.
Curcumin is the key substance for the reported health benefits of turmeric. It needs to be taken with other substances, such as piperine found in black pepper, to be absorbed well.
The reports on diarrhea with turmeric or curcumin are conflicting. Some authorities say it is dose-dependent, meaning it’s more likely with higher doses; others say the opposite. Some say it goes away in a few days, but my clinical experience is that some people do not get better.
Staying off of the turmeric for a while to see if the diarrhea goes away is a scientific way of determining whether the turmeric is the likely cause. A careful record of how often you had diarrhea before and after the turmeric is useful. If the answer isn’t clear, you can restart and see what happens to the frequency afterward.
Dear Dr. Roach: Can you please tell me why I have bubbles in my urine when I pee? My doctors don’t seem to worry about it. There must be a reason.
A.L. A: Bubbles in the toilet bowl after voiding can be normal. In the normal situation, there are few bubbles, which dissipate (”pop”) quickly. However, bubbly or foamy urine is a key indicator for the presence of protein in the urine. Proteins have properties similar to soap, which allow them to form bubbles. Losing excess protein in the urine can therefore cause excess bubbles, and a simple dipstick test for protein is appropriate in people who notice excess bubbles in the urine.
Many kidney conditions can cause excess protein excretion, but one we consider most often is called nephrotic syndrome, where very large amounts of protein can be lost in the urine. This is often associated with swelling of the legs and very high cholesterol levels.
If there is no protein in the urine, it is unlikely the bubbles represent anything to worry about.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGood Health@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.