AstraZeneca’s Tezepelumab Fails to Meet its Primary Endpoint in P-III SOURCE Study for Asthma

Shots:

  • The P-III SOURCE study involves assessing Tezepelumab (210mg, q4w) vs PBO in 150 adult patients as add-on therapy with patients maintained on their currently prescribed ICS + LABA, with/ out other asthma controller therapy for 48wks.
  • The trial did not meet its 1EPs i.e., reduction in the daily OCS dose, without loss of asthma control, the safety profile was consistent with previous trials. The therapy’s other efficacy parameters were similar to those observed in previous trials, including the P-III NAVIGATOR trial
  • Tezepelumab is a human mAb targeting TSLP, being developed in collaboration with AstraZeneca and Amgen

Click here ­to­ read full press release/ article | Ref: AstraZeneca  | Image: Physicians Practice

The post AstraZeneca’s Tezepelumab Fails to Meet its Primary Endpoint in P-III SOURCE Study for Asthma first appeared on PharmaShots.

Study: Asthma Patients Maintain High Medication Adherence Using Propeller Health’s Platform

Propeller Health, Novartis Co-Package Asthma Medication in Europe for Prescription Propeller

What You Should Know:

– New study out from Propeller and Chicago’s NorthShore
University HealthSystem shows that asthma patients maintain higher medication
adherence and decrease their rescue inhaler use when using a digital health
platform.

– The study looked at 100 patients recruited from
NorthShore practices, half of whom used Propeller to manage their condition and
half of whom did not.

– The treatment group maintained their high medication adherence at 68%, while the control group experienced a 17% decline in adherence over the course of the study. The treatment group also increased days without needing their rescue inhaler by 19%, 13% more than in the control group.


Patients using Propeller
Health’s
digital
health
platform to manage their asthma experienced a significant decline in
rescue inhaler use and higher medication adherence rates compared to patients
not using the platform, according to a new
randomized controlled trial
 published in The Journal of Allergy and Clinical
Immunology
: In Practice by researchers from Propeller and NorthShore University HealthSystem. The study
reveals maintained their high medication adherence at 68%, while the control
group experienced a 17% decline in adherence over the course of the study

Poor adherence to asthma medication and overuse of rescue
inhalers have both been associated with increased asthma morbidity in previous
research. Studies reveal that patients often overestimate their level of
adherence to their clinician, leading to costly treatments that may not be
appropriate or necessary to curb symptoms.

Randomized Clinical Trial Details

The published study features a randomized controlled trial
that enrolled 100 patients with uncontrolled asthma, 25 to 65 years of age.
Patients were recruited between April 2018 and 2019 from allergist and
pulmonologist practices at NorthShore University HealthSystem in Chicago. Treatment
and control group participants were both attached a small sensor to their
controller and rescue inhalers. The treatment group received insights on their
medication use in the Propeller app, including reminders to take missed or late
doses and reports on their usage and possible triggers.

Utilizing Propeller’s digital health platform, clinicians
had had access to the treatment patients’ controller and rescue medication
data. If patient utilization indicated poor adherence or worsening control,
patients were contacted to address adherence and review asthma control status. The
control group’s medication use was remotely monitored, but they did not receive
insights in the app or outreach from providers.

Clinical Trial Outcomes/Results

The study’s treatment group maintained its high medication adherence at 68%, while the control group experienced a 17% decline in adherence over the course of the study. In addition, Propeller users’ days without needing their rescue inhaler increased 19% in the treatment group, 13% more than in the control group.

“Increasing adherence and reducing rescue use are critical to improving the health and well-being of asthma patients,” said Giselle Monsaim, MD, lead author of the study and attending physician in the Departments of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunology at NorthShore University HealthSystem. “We’re pleased to add to the body of research that shows digital health can play an important role in maintaining high adherence rates and increasing days without symptoms for people with asthma.”

Health Innovators: David Van Sickle on digital innovation in respiratory medicine

In the first episode of our Health Innovators series, Paul Tunnah speaks to David Van Sickle, CEO of Propeller Health about how digital technologies are revolutionising the field of respiratory medicine.

The post Health Innovators: David Van Sickle on digital innovation in respiratory medicine appeared first on .

AstraZeneca and Amgen Report Results of Tezepelumab in P-III NAVIGATOR for Asthma

Shots:

  • The P-III NAVIGATOR study involves assessing Tezepelumab + SOC vs pbo + SOC in adults (18–80yrs.) & adolescents (12–17yrs.) with severe, uncontrolled asthma, who were receiving treatment with medium/high dose ICS + at least 1 additional controller medication with or without OCS
  • Trial met its 1EPs i.e. reduction in AAER @52wks. in the overall population. The study also met 1EPs in patients with low levels of eosinophils i.e. <300 & 150 cells/microlitre
  • Tezepelumab is mAb that inhibits the action of TSLP and has received US FDA’s BT designation in Sept’2018 for patients with severe asthma, without an eosinophilic phenotype

Click here ­to­ read full press release/ article | Ref: AstraZeneca | Image: The Indian Express

The post AstraZeneca and Amgen Report Results of Tezepelumab in P-III NAVIGATOR for Asthma first appeared on PharmaShots.

Aptar Pharma Acquires the Assets of Respiratory Startup Cohero Health

Aptar Pharma Acquires the Assets of Cohero Health

What You Should Know:

– Apstar Pharma acquires the assets of respiratory health company Cohero Health to expands its digital portfolio with a focus on respiratory disease management.

– Cohero Health develops digital tools and technologies to improve respiratory care, reduce avoidable costs, and optimize medication utilization.


AptarGroup, Inc., a global leader in consumer dispensing, active packaging, drug delivery solutions, and services, announces that it has acquired all operating assets and the proprietary portfolio of Cohero Health, Inc. (“Cohero Health”), a digital therapeutics company transforming respiratory disease management for asthma and chronic obstructive pulmonary disorder (COPD). Financial details of the acquisition were not disclosed.

Start breathing smarter

Founded in 2013, New York-based Cohero Health develops innovative digital tools and technologies to improve respiratory care, reduce avoidable costs, and optimize medication utilization. With this transaction, Aptar Pharma acquires Cohero Health’s turnkey digital health platform and device assets including:

· BreatheSmart Connect digital health platform – care coordination and HIPAA-compliant SaaS cloud service which captures and securely stores data from Cohero Health’s devices and BreatheSmart® software for remote monitoring and patient communications to help manage patient therapy;

· BreatheSmart® App – designed for patient habit creating and behavior change, driving appropriate medication utilization. Provides real-time tracking of medication adherence and lung function, along with reminders, educational materials, and symptom/trigger recording;

·
HeroTracker® Sensors
– Bluetooth enabled medication smart inhaler sensors
designed for both control and rescue medications. Attaches to respiratory
medications to automatically record time and date of doses taken

· mSpirometer™ and cSpirometer™lung function diagnostic sensors – enable comprehensive pulmonary lung function testing in a handheld wireless device.

Acquisition Expands Aptar’s Digital Portfolio

“Cohero Health further strengthens and expands Aptar’s digital portfolio, in this case, with a focus in respiratory disease management,” commented Sai Shankar, Aptar Pharma’s Vice President, Global Digital Healthcare Systems. “Aptar has made previous investments in digital respiratory company Sonmol in China and digital health company Navia Life Care in India. With this strategic bolt on, Aptar now has global capabilities to deploy digital respiratory health, utilizing either the Cohero or Aptar device portfolio/platform. The investment will also facilitate Aptar’s ability to provide diagnostic solutions in respiratory and a significant number of other disease categories.”

AstraZenca Reports Results of Fasenra (benralizumab) in P-lllb PONENTE Trial for Asthma

Shots:

  • It is based on P-lllb PONENTE trial assessing Fasenra (benralizumab, 30mg) in adult patients with severe Asthma on high-dose ICS + LABA and long-term use of OCS therapy with or without additional asthma controller. This study included approx. 600 patients in EU, North America, South America, and Taiwan
  • Results: 62% of patients achieved complete elimination of daily OCS use on 1EP and on the 2EP, 81% of patients achieved complete elimination or were able to reduce their daily OCS dose to 5mg or less when further reduction was not possible due to adrenal insufficiency
  • Fasenra is mAb that binds directly to IL-5 receptor alpha on eosinophils and attracts natural killer cells to induce rapid and near-complete depletion of eosinophils via apoptosis. It is currently approved as an add-on maintenance treatment for severe eosinophilic asthma and is approved for self-administration in the US, EU and other countries

Click here to­ read full press release/ article | Ref: AstraZeneca | Image: Fox News

The post AstraZenca Reports Results of Fasenra (benralizumab) in P-lllb PONENTE Trial for Asthma first appeared on PharmaShots.

What White Blood Cell Count Should We Shoot for?

At the start of my video What Does a Low White Blood Cell Count Mean?, you can see what it looks like when you take a drop of blood, smear it between two pieces of glass, and view at it under a microscope: a whole bunch of little, round, red blood cells and a few big, white blood cells. Red blood cells carry oxygen, while white blood cells are our immune system’s foot soldiers. We may churn out 50 billion new white blood cells a day. In response to inflammation or infection, that number can shoot up to a 100 billion or more. In fact, pus is largely composed of: millions and millions of white blood cells.

Testing to find out how many white blood cells we have at any given time is one of the most common laboratory tests doctors order. It’s ordered it hundreds of millions of times a year. If, for example, you end up in the emergency room with abdominal pain, having a white blood cell count above about 10 billion per quart of blood may be a sign you have appendicitis. Most Americans fall between 4.5 and 10, but most Americans are unhealthy. Just because 4.5 to 10 is typical doesn’t mean it’s ideal. It’s like having a “normal” cholesterol level in a society where it’s normal to die of heart disease, our number-one killer. The average American is overweight, so if your weight is “normal,” that’s actually a bad thing.

In fact, having excess fat itself causes inflammation within the body, so it’s no surprise that those who are obese walk around with two billion more white cells per quart of blood. Given that, perhaps obese individuals should have their own “normal” values. As you can see at 2:06 in my video, if someone with a 47-inch waist walks into the ER with a white blood cell count of 12, 13, or even 14, they may not have appendicitis or an infection. That may just be their normal baseline level, given all the inflammation they have in their body from the excess fat. So, normal levels are not necessarily healthy levels.

It’s like smoking. As you can see at 2:31 in my video, if you test identical twins and one smokes but the other doesn’t, the smoker is going to end up with a significantly higher white cell count. In Japan, for example, as smoking rates have steadily dropped, so has the normal white count range. In fact, it’s dropped such that about 8 percent of men who have never smoked would now be flagged as having abnormally low white counts if you used a cut-off of 4. But, when that cut-off of 4 was set, most people were smoking. So, maybe 3 would be a better lower limit. The inflammation caused by smoking may actually be one of the reasons cigarettes increase the risk of heart attacks, strokes, and other inflammatory diseases. So, do people who have lower white counts have less heart disease, cancer, and overall mortality? Yes, yes, and yes. People with lower white blood cell counts live longer. Even within the normal range, every one point drop may be associated with a 20 percent drop in the risk of premature death.

As you can see at 3:39 in my video, there is an exponential increase in risk in men as white count goes up, even within the so-called normal range, and the same is found for women. The white blood cell count is a “stable, well-standardized, widely available and inexpensive measure of systemic inflammation.” In one study, half of the women around 85 years of age who had started out with white counts under 5.6 were still alive, whereas 80 percent of those who started out over 7 were dead, as you can see at 4:05 in my video—and white blood cell counts of 7, 8, 9, or even 10 would be considered normal. Being at the high end of the normal range may place one at three times the risk of dying from heart disease compared to being at the lower end.

The same link has been found for African-American men and women, found for those in middle age, found at age 75, found at age 85, and found even in our 20s and 30s: a 17 percent increase in coronary artery disease incidence for each single point higher.

As you can see at 5:00 in my video, the higher your white count, the worse your arterial function may be and the stiffer your arteries may be, so it’s no wonder white blood cell count is a useful predictor of high blood pressure and artery disease in your heart, brain, legs, and neck. Even diabetes? Yes, even diabetes, based on a compilation of 20 different studies. In fact, it may be associated with everything from fatty liver disease to having an enlarged prostate. And, having a higher white blood cell count is also associated with an increased risk of dying from cancer. So, what would the ideal range be? I cover that in my video What Is the Ideal White Blood Cell Count?.

A higher white blood cell count may be an important predictor for cardiovascular disease incidence and mortality, decline in lung function, cancer mortality, all-cause mortality, heart attacks, strokes, and premature death in general. This is no surprise, as the number of white blood cells we have circulating in our bloodstreams are a marker of systemic inflammation. Our bodies produce more white blood cells day to day in response to inflammatory insults.

We’ve known about this link between higher white counts and heart attacks since the 1970s, when we found that higher heart attack risk was associated with higher white blood cell counts, higher cholesterol levels, and higher blood pressures, as you can see at 0:53 in my video What Is the Ideal White Blood Cell Count?. This has been found in nearly every study done since then. There are decades of studies involving hundreds of thousands of patients showing dramatically higher mortality rates in those with higher white counts. But why? Why does white blood cell count predict mortality? It may be because it’s a marker of inflammation and oxidation in the body. In fact, it may even be a biomarker for how fast we are aging. It may be more than just an indicator of inflammation—it may also be an active player, contributing directly to disease via a variety of mechanisms, including the actual obstruction of blood flow.

The average diameter of a white blood cell is about seven and a half micrometers, whereas our tiniest vessels are only about five micrometers wide, so the white blood cell has to squish down into a sausage shape in order to squeeze through. When there’s inflammation present, these cells can get sticky. As you can see at 2:20 in my video, a white blood cell may plug up a vessel as it exits a small artery and tries to squeeze into a capillary, slowing down or even momentarily stopping blood flow. And, if it gets stuck there, it can end up releasing all of its internal weaponry, which is normally reserved for microbial invaders, and damage our blood vessels. This may be why in the days leading up to a stroke or heart attack, you may find a spike in the white cell count.

Whether white count is just a marker of inflammation or an active participant, it’s better to be on the low side. How can we reduce the level of inflammation in our body? Staying away from even second-hand smoke can help drop your white count about half of a point. Those who exercise also appear to have an advantage, but you don’t know if it’s cause and effect unless you put it to the test. In one study, two months of Zumba classes—just one or two hours a week—led to about a point and a half drop in white count. In fact, that may be one of the reasons exercise is so protective. But is that just because they lost weight?

Fitness and fatness both appear to play a role. More than half of obese persons with low fitness—51.5 percent—have white counts above 6.6, but those who are more fit or who have less fat are less likely to have counts that high, as you can see at 3:47 in my video. Of course, that could just be because exercisers and leaner individuals are eating healthier, less inflammatory diets. How do we know excess body fat itself increases inflammation, increases the white count? You’d have to find some way to get people to lose weight without changing their diet or exercise habit. How’s that possible? Liposuction. If you suck about a quart of fat out of people, you can significantly drop their white count by about a point. Perhaps this should get us to rethink the so-called normal reference range for white blood cell counts. Indeed, maybe we should revise it downward, like we’ve done for cholesterol and triglycerides.

Until now, we’ve based normal values on people who might be harboring significant background inflammatory disease. But, if we restrict it to those with normal C-reactive protein, another indicator of inflammation, then instead of “normal” being 4.5 to 10, perhaps we should revise it closer to 3 to 9.

Where do the healthiest populations fall, those not suffering from the ravages of chronic inflammatory diseases, like heart disease and common cancers? Populations eating diets centered around whole plant foods average about 5, whereas it was closer to 7 or 8 in the United States at the time. How do we know it isn’t just genetic? As you can see at 5:38 in my video, if you take those living on traditional rural African diets, who have white blood cell counts down around 4 or 5, and move them to Britain, they end up closer to 6, 7, or even 8. Ironically, the researchers thought this was a good thing, referring to the lower white counts on the “uncivilized” diet as neutropenic, meaning having too few white blood cells. They noted that during an infection or pregnancy, when more white cells are needed, the white count came right up to wherever was necessary. So, the bone marrow of those eating traditional plant-based diets had the capacity to create as many white cells as needed but “suffers from understimulation.”

As you can see at 6:26 in my video, similar findings were reported in Western plant eaters, with an apparent stepwise drop in white count as diets got more and more plant based, but could there be non-dietary factors, such as lower smoking rates, in those eating more healthfully? What we need is an interventional trial to put it to the test, and we got one: Just 21 days of removing meat, eggs, dairy, alcohol, and junk affected a significant drop in white count, even in people who started out down at 5.7.

What about patients with rheumatoid arthritis who started out even higher, up around 7? As you can see at 7:03 in my video, there was no change in the control group who didn’t change their diet, but there was a 1.5 point drop within one month on whole food plant-based nutrition. That’s a 20 percent drop. That’s more than the drop-in inflammation one might get quitting a 28-year pack-a-day smoking habit. The most extraordinary drop I’ve seen was in a study of 35 asthmatics. After four months of a whole food plant-based diet, their average white count dropped nearly 60 percent, from around 12 down to 5, though there was no control group nor enough patients to achieve statistical significance.

If white blood cell count is such a clear predictor of mortality and is so inexpensive, reliable, and available, why isn’t it used more often for diagnosis and prognosis? Maybe it’s a little too inexpensive. The industry seems more interested in fancy new risk factors it can bill for.

I touch on the health of the rural Africans I discussed in How Not to Die from Heart Disease.


For more on fighting inflammation, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

CareLinx, Doctor on Demand Partner to Bring In-Home Virtual Care to Seniors

CareLinx, Doctor on Demand Partner to Bring In-Home Virtual Care to Seniors

What You Should Know: 

– Doctor On Demand and CareLinx, one of the largest professional networks for in-home care, have announced a collaboration to bring in-home virtual care services to CareLinx clients. 

– At a time when seniors have been encouraged to stay home to avoid exposure to COVID, Doctor On Demand’s partnership with CareLinx will vastly improve their opportunity to receive comprehensive healthcare while remaining safe. 


After being the first and only telemedicine provider to roll out medical care for Medicare Part B beneficiaries, Doctor On Demand is doubling down on their efforts to support seniors in their homes. Doctor On Demand, the nation’s leading virtual care provider, and CareLinx, a nationwide, professional network for in-home care, today announced a partnership to bring in-home virtual care services to CareLinx clients. 

Supporting High-Risk Patients at Home

The partnership aims to expand CareLinx’s in-home care offerings and improve health outcomes for their clients, geriatric and high-risk patients who need support at home. Today, CareLinx tech-enabled caregivers have digital care plans on their smartphones — enabling quality delivery of everyday care services such as bathing and meal prep, as well as direct communication to a patient’s family. 

Doctor On Demand will augment these existing services by connecting CareLinx clients with virtual care providers in real-time. CareLinx caregivers will support the Doctor On Demand registration process and assist with in-home follow-ups and care coordination recommended by Doctor On Demand’s board-certified physicians as well. 

CareLinx Clients Receive Access to Virtual Visits, Powered by Doctor on Demand

Eligible CareLinx clients will receive initial visits with board-certified physicians through Doctor On Demand at no cost. These virtual visits can be used to treat a spectrum of health issues, including diagnosis and testing of COVID-19, typical ailments like infections, rashes, cold and flu, and ongoing chronic diseases like asthma, diabetes, high blood pressure, and thyroid issues. Doctor On Demand physicians can also fill prescriptions and order lab work, and patients can see the same physician time and time again, building a trusted, personal relationship via video.

Why It Matters

“Now more than ever, finding high-quality, in-home care is pivotal during a time when seniors and high-risk patients are being encouraged to stay at home to minimize risk and exposure to COVID-19. Our partnership with Doctor On Demand enables CareLinx to continue equipping caregivers with digital tools and technologies to make caregiving easier, more transparent, and higher quality,” said Sherwin Sheik, CEO, CareLinx. “Additionally, this partnership is helping to supplement in-home activities of daily living with a telehealth option for our clients, who may not otherwise realize they have the option to see a provider virtually for medical ailments.  Combined with the in-home care they are receiving, these services can help provide an expanded continuum of care to help them stay healthy and safe where they want to be — at home.”

Innovaccer, CareSignal Partner to Enable Deviceless Remote Patient Monitoring


Innovaccer, CareSignal Partner to Enable Deviceless Remote Patient Monitoring

What You Should Know:

– Innovaccer has recently partnered with CareSignal to
address healthcare’s urgent need amidst the COVID-19 pandemic: to create and
maintain solid, clinically actionable relationships with patients in a new set
of predominantly virtual care.

– CareSignal offers evidence-based end-to-end support services for chronic medical conditions such as asthma, CHF, COPD, diabetes, depression, hypertension, and hospital discharge support, and maternal health monitoring.


Innovaccer, Inc., and CareSignal today announce a partnership to address healthcare’s urgent need amidst the COVID-19 pandemic: to create and maintain solid, clinically actionable relationships with patients in a new setting of predominantly virtual care.

Partnership Details

The partnership combines more than two dozen
condition-specific patient monitoring programs with population
health
data insights for a more integrated care and improved clinical
outcomes with industry-leading financial returns.

CareSignal offers evidence-based end-to-end support services for chronic medical conditions such as asthma, CHF, COPD, diabetes, depression, hypertension and hospital discharge support, and maternal health monitoring. With a focus on prevention and addressing the social determinants of health, each program offers personalized clinically-validated features to deliver even more value from Innovaccer’s population health, care management, and organization-specific offerings. 

“Innovaccer has always stayed on top of delivering on promises to our customers, and our partnerships with leading organizations have been instrumental in achieving 100% client satisfaction,” says Abhinav Shashank, CEO at Innovaccer. “Working with CareSignal supports our mission to help healthcare care as one. With CareSignal as our partner, we will strengthen our approach towards better patient engagement and enable smart deviceless remote patient monitoring.”

Lemonaid Health Raises $33M to Expand On-Demand Consumer Telehealth Platform

Lemonaid Health Closes oversubscribed $33M Series B to expand telehealth services

– Lemonaid Health, a direct to consumer telehealth company
raises $33M in Series B funding to expand the company’s medical team and number
of services being offered to patients.

– To date, the company has treated more than a million patients
online for a variety of medical conditions ranging from erectile dysfunction to sinus infections
to depression and anxiety for roughly $25/visit (less than a typical co-pay).


Lemonaid Health,
a convenient, affordable, on-demand platform for telehealth, has raised a $33
million Series B round of funding, bringing total financing to $55 million. The
oversubscribed round was led by Olive Tree
Ventures
with participation from Artis
Ventures
, Correlation Ventures, Hikma Ventures, Sierra Ventures and others.

COVID-19 Driving Telehealth Adoption

The coronavirus pandemic has accelerated the integration of
telehealth and transformed the way consumers interact with their healthcare
providers. Providers are seeing 50 to 175 times the number of patients via
telehealth platforms than they were before the outbreak, according to a McKinsey COVID-19 Consumer Survey.

Online Doctor’s Office & Medicine Delivery

Founded in 2013 by Co-Founders Ian Van Every and Paul
Johnson, Lemonaid Health offers patients direct access to the care they need,
from consultation through treatment nationally across the U.S. The company
leverages evidence-based guidelines and the most up-to-date clinical protocols
to provide quality care for less than typical co-pays. In just a few minutes,
patients are able to interact with a U.S.-licensed doctor or nurse practitioner
for conditions like anxiety and depression, urinary tract infections (UTIs),
birth control, hair loss, hypothyroidism, erectile dysfunction, genital herpes
and sinus infections. Patients are also offered free and fast delivery of
prescription medications through the platform to speed treatment.

For $25 per visit, patients can request prescriptions by
filling out a questionnaire and attaching a picture for the doctor to write out
the prescription, and then have it automatically sent to a locally preferred
pharmacy within a 2-hour turnaround time. The visit cost is much cheaper than a
co-pay, and an email summary of the care provided is sent for the
patient’s primary care doctor.

Expansion Plans

Lemonaid Health has seen a surge in demand for its services
and interest from prospective partners during the COVID-19 pandemic. Although
initially a direct-to-consumer provider, the company is starting to work with
partners within the existing healthcare system to further expand reach.

With the investment, Lemonaid Health will expand its team of
medical professionals and increase the number of services being offered to
patients, including treatment for asthma, hypertension, Type 2 diabetes and
more mental health services.

“The U.S. healthcare system has struggled to deliver
the services patients need in a way that is convenient and effective. The challenges
of providing routine care has been exacerbated recently as the majority of
health resources have been focused on responding to the coronavirus
pandemic,” said Paul Johnson, co-founder and CEO of Lemonaid Health.
“We founded Lemonaid Health with a vision to increase access to
affordable, high-quality healthcare. As more consumers have turned to
telehealth in the last six months, we’ve seen significant growth in demand for
our online services. With the additional financing, we will be able to help even
more patients get the care they deserve and expand our services in partnership
with other healthcare providers.”

Combating Air Pollution Effects with Food

There is a food that offers the best of both worlds—significantly improving our ability to detox carcinogens like diesel fumes and decreasing inflammation in our airways—all while improving our respiratory defenses against infections.

Outdoor air pollution may be the ninth leading cause of death and disability in the world, responsible for millions of deaths from lung cancer, emphysema, heart disease, stroke, and respiratory infection. In the United States, living in a polluted city was associated with 16, 27, and 28 percent increases in total, cardiovascular, and lung cancer deaths, compared to living in a city with cleaner air. As well, living in a city with polluted air may lead to up to a 75 percent increase in the risk of a heart attack. “Additionally, the possibility of dying in a traffic jam is two and a half times greater in a polluted city.” No one wants to be living in a traffic jam, but it’s better than dying in one.

In addition to causing deaths, air pollution is also the cause of a number of health problems. It may not only exacerbate asthma but also increase the risk of developing asthma in the first place. These pollutants may trigger liver disease and even increase the risk of diabetes. Indeed, “even when atmospheric pollutants are within legally established limits, they can be harmful to health.” So, what can we do about it?

Paper after paper have described all the terrible things air pollution can do to us, but “most…failed to mention public policy. Therefore, while science is making great strides in demonstrating the harmful effects of atmospheric pollution on human health, public authorities are not using these data” to reduce emissions, as such measures might inconvenience the population “and, therefore, might not be politically acceptable.” We need better vehicle inspections, efficient public transport, bus lanes, bicycle lanes, and even urban tolls to help clean up the air, but, while we’re waiting for all of that, is there anything we can do to protect ourselves?

As I discuss in my video Best Food to Counter the Effects of Air Pollution, our body naturally has detoxifying enzymes, not only in our liver, but also lining our airways. Studies show that people born with less effective detox enzymes have an exaggerated allergic response to diesel exhaust, suggesting that these enzymes actively combat the inflammation caused by pollutants in the air. A significant part of the population has these substandard forms of the enzyme, but, either way, what can we do to boost the activity of whichever detoxification enzymes we do have?

One of my previous videos Prolonged Liver Function Enhancement from Broccoli investigated how broccoli can dramatically boost the activity of the detox enzymes in our liver, but what about our lungs? Researchers fed some smokers a large stalk of broccoli every day for ten days to see if it would affect the level of inflammation within their bodies. Why smokers? Smoking is so inflammatory that you can have elevated C-reactive protein (CRP) levels for up to 30 years after quitting, and that inflammation can start almost immediately after you start smoking, so it’s critical to never start in the first place. If you do, though, you can cut your level of that inflammation biomarker CRP nearly in half after just ten days eating a lot of broccoli. Broccoli appears to cut inflammation in nonsmokers as well, which may explain in part why eating more than two cups of broccoli, cabbage, cauliflower, kale, or other cruciferous veggies a day is associated with a 20 percent reduced risk of dying, compared to eating a third of a cup a day or less, as you can see at 3:41 in my video.

What about air pollution? We know that the cruciferous compound “is the most potent known inducer” of our detox enzymes, so most of the research has been on its ability to fight cancer. But, for the first time, researchers tried to see if it could combat the pro-inflammatory impact of pollutants, such as diesel exhaust. They put some human lung lining cells in a petri dish, and, as you can see at 4:11 in my video, the number of detox enzymes produced after dripping on some broccoli goodness skyrocketed. Yes, but we don’t inhale broccoli or snort it. We eat it. Can it still get into our lungs and help? Yes. After two days of broccoli sprout consumption, researchers took some cells out of the subjects’ noses and found up to 100 times more detox enzyme expression compared to eating a non-cruciferous vegetable, alfalfa sprouts. If only we could squirt some diesel exhaust up people’s noses. That’s just what some UCLA researchers did, at an amount equal to daily rush hour exposure on a Los Angeles freeway. Within six hours, the number of inflammatory cells in their nose shot up and continued to rise. But, in the group who had been getting a broccoli sprout extract, the inflammation went down and stayed down, as you can see at 4:58 in my video

Since the dose in those studies is equivalent to the consumption of one or two cups of broccoli, their study “demonstrates the potential preventive and therapeutic potential of broccoli or broccoli sprouts,” but if broccoli is so powerful at suppressing this inflammatory immune response, might it interfere with normal immune function? After all, the battle with viruses like influenza can happen in the nose. So what happens when some flu viruses are dripped into the nostrils of broccoli-sprout eaters compared with people consuming non-cruciferous alfalfa sprouts? After eating broccoli sprouts, we get the best of both worlds—less inflammation and an improved immune response. As you can see at 5:55 in my video, after eating alfalfa sprouts, there is a viral spike in their nose. After eating a package of broccoli sprouts every day, however, our body is able to keep the virus in check, potentially offering “a safe, low-cost strategy for reducing influenza risk among smokers and other at risk populations.”

So, better immune function, yet less inflammation, potentially reducing the impact of pollution on allergic disease and asthma, at least for an “enthusiastic broccoli consumer.” But what about cancer and detoxifying air pollutants throughout the rest of our body? We didn’t know, until now. Off to China, where “levels of outdoor air pollution…are among the highest in the world.” By day one, those getting broccoli sprouts were able to get rid of 60 percent more benzene from their bodies. “The key finding…was the observed rapid and highly durable elevation of the detoxification of… a known human carcinogen.” Now, this was using broccoli sprouts, which are highly concentrated, equivalent to about five cups of broccoli a day, so we don’t know how well more modest doses would work. But if they do, eating broccoli could “provide a frugal means to attenuate…the long-term health risks” of air pollution. More on air pollution here.

I’ve been reading about the terrible effects of air pollution for a long time and I am thrilled there’s something we can do other than uprooting our families and moving out to the countryside.


For more on cruciferocity, see my videos Lung Cancer Metastases and Broccoli and Breast Cancer Survival Vegetable.

There’s a secret to maximizing broccoli’s benefits. See Flashback Friday:Second Strategy to Cooking Broccoli.

For more on Cooking Greens: How to Cook Greens and Best Way to Cook Vegetables.

What about broccoli sprout pills? See Broccoli: Sprouts vs. Supplements.

Speaking of respiratory inflammation, what about dietary approaches to asthma? Learn more:

There are sources of indoor pollution, too. See Throw Household Products Off the Scent.

There is one way what we eat can directly impact air pollution, beyond just personal protection. Check out Flashback Friday: Diet and Climate Change: Cooking Up a Storm.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Teva launches digital asthma and COPD rescue inhaler in US

Teva has launched new digital inhaler and drug combination in the US, containing built-in sensors that connect to a phone to help manage asthma and COPD symptoms. 

Israel-based Teva said the system conveys information to patients, who can use the product branded as ProAir Digihaler (albuterol sulfate) for patients with asthma and chronic obstructive pulmonary disease (COPD). 

Teva noted it is the first and only digital rescue inhaler indicated in patients four years or older for the treatment or prevention of bronchospasm who have reversible obstructive airway disease, and for prevention of exercise-induced bronchospasm (EIB). 

The inhaler detects, records and stores objective inhaler event data, including timestamp and inhalation characteristics such as peak inspiratory flow. 

Patients are then able to view this data on the app, which informs patients if their inhaler technique may need improvement. 

The patients can choose to share these data with their healthcare providers to help facilitate dialogue around the assessment and management of their condition and discuss if their inhaler technique may need improvement. 

Teva is developing a suite of digital inhaler products in the US – AirDuo Digihaler (fluticasone propionate and salmeterol) and ArmonAir Digihaler (fluticasone) are both used for maintenance of asthma in patients. 

Both products are expected to become commercially available to patients in the coming months. 

Last year saw a key development in the US respiratory diseases market when Mylan finally launched its generic version of GlaxoSmithKline’s blockbuster inhaler Advair (fluticasone+salmeterol). 

The competition for the product approved in asthma and COPD had been delayed for years because of the FDA’s stringent approach to copies of drug-device combination products. 

The main patent on Advair had expired as long ago as 2010, while the patent on GSK’s Diskus inhaler ran out in 2016. 

Mylan launched its Advair generic at a 70% discount compared with GSK’s original drug and was the first of a group of potential generics, although a rival from Hikma has hit trouble with the FDA and was refiled late last year. 

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Philips and BioIntelliSense Integrate to Enhance Remote Patient Monitoring

Philips and BioIntelliSense Integrate to Enhance Remote Patient Monitoring

What You Should Know:

– Philips integrates the BioIntelliSense FDA-cleared
BioSticker™ sensor as part of its remote patient monitoring solutions for
patients outside the hospital.

– Multi-parameter sensors aid monitoring across multiple chronic conditions with medical-grade vital signs for physicians to remotely track core symptoms, including COVID-19.

– Healthcare Highways is the first to leverage the BioSticker sensor as a part of Philips’ RPM program in the U.S.


Philips, today announced it has formed a strategic collaboration with BioIntelliSense, a continuous health monitoring, and clinical intelligence company, to integrate its BioSticker™ medical device into Philips’ remote patient monitoring (RPM) offering to help monitor at-risk patients from the hospital into the home.  With the addition of multi-parameter sensors, Philips’ solutions can enhance how clinicians monitor patient populations living with chronic conditions – including diabetes, cancer, congestive heart failure and more –  in their homes with passive monitoring of key vital signs, physiological biometrics, and symptomatic events via a discreet wearable patch for monitoring up to 30 days.

COVID-19 Pandemic Underscores Need for Remote Patient Monitoring

Remote patient monitoring and telehealth-enabled clinical programs offer care teams a sustainable and scalable way to manage patient populations with chronic or complex conditions at home and plays a key role in supporting care for COVID-19 patients who do not require hospitalization. By regularly transmitting patient data that can provide critical insights into a patient’s condition, the collaboration will empower care teams in the U.S. with a more holistic patient view and the ability to intervene earlier before adverse events occur.  With single-use sensors and patient-owned technology supporting remote monitoring, care teams can also help reduce the need for clinicians and patients to interact in person.

“With more patients interacting with their doctors from home and more hospitals developing strategies to virtually engage with their patients, remote patient monitoring is now, more than ever, an essential tool,” said Roy Jakobs, Chief Business Leader Connected Care, member of the Executive Committee at Royal Philips. “Building on Philips’ global leadership in patient monitoring, which includes an extensive suite of advanced monitoring solutions, platforms, and sensors, this is the latest example of our capability to allow more seamless, cloud-based data collection across multiple settings from the home to the hospital and back into the home. Patient data, coupled with our clinically differentiated and leading AI-powered technology, quantifies the data into relevant actionable insights to help detect deterioration trends and support care interventions – all while outside the walls of the hospital.”

Wireless, Secure Data Transfer of Key Vital Signs

The
BioSticker is a single-use, FDA-cleared 510k class II wearable medical device
to enable at-home continuous passive monitoring with minute level data across a
broad set of vital signs, physiological biometrics and symptomatic events (skin
temperature, resting heart rate, resting respiratory rate, body position,
activity levels, cough frequency) on a single device for thirty-days. Symptoms,
including those directly associated with COVID-19 such as temperature and
respiratory rate, can be remotely monitored in confirmed cases of Coronavirus
and also for those patients not sick enough to be hospitalized, or those
suspected of having COVID-19.

In
addition to COVID-19, the BioSticker device will help transform the way
clinicians monitor and manage patients living with chronic conditions from the
home. 

“Multi-parameter
sensors are the natural next phase for remote monitoring, especially at a time
when more patients are engaging with their physicians from home,” said James
Mault, MD, Founder and Chief Executive Officer of BioIntelliSense. “Clinicians
need medical grade monitoring and algorithmic clinical insights for COVID-19
exposure, symptoms and management. Accelerated by the COVID-19 crisis, the
practice of medicine has been irreversibly enlightened as to the safety and
efficacy of virtual care. Philips is a demonstrated leader in remote patient
monitoring, and we look forward to BioIntelliSense’s technology  playing
an integral role in simplifying and enhancing outcomes for patients and their
doctors.”

Healthcare Highways first to leverage BioSticker as a part of
Philips’ RPM solutions

Healthcare Highways, a provider of health plans, high-performance provider networks, pharmacy benefit management, population health management, and benefit plan administration, is the first to leverage the BioSticker sensor as a part of Philips’ RPM program in the U.S. Out of the seven programs that will be deployed with Healthcare Highways, one will focus specifically on monitoring patients with COVID-19. The remaining six will focus on conditions across the acuity spectrum, including patients with congestive heart failure, hypertension, diabetes, total joint replacement, cancer and asthma. The program will help Healthcare Highways improve insights to patient health status across its provider network.

“Healthcare Highways was built on the idea of delivering measurable value and access to quality care to our members. We work in partnership with our providers to innovate on the care model, and look at Remote Patient Monitoring as the next frontier of how providers will connect with patients,” said Creagh Milford, DO, MPH, Chief Medical Officer of Healthcare Highways and Chief Executive Officer of HighCare Health. “COVID-19 has underscored the need for proactive care management. Resources are strained and by integrating an RPM program with biosensor technology, we’ll be able to drive further value for our unique member base, providers and employers to establish a new way of care delivery.”

Propeller Health, Novartis Co-Package Asthma Medication in Europe for Prescription

Propeller Health, Novartis Co-Package Asthma Medication in Europe for Prescription

What You Should Know:

– Propeller Health announced
it will co-package a new asthma medication from Novartis, which was
approved by the European Commission this week for use in the EU.

– Enerzair®
Breezhaler® plus Propeller Health sensor is the first asthma medication to be
co-packaged and co-prescribed with a digital health platform.

– Propeller’s solution
works by attaching a sensor to the Enerzair® Breezhaler® inhaler, which then
delivers objective data on medication use to the Propeller app on the patient’s
smartphone


Propeller Health today announced a collaboration with Novartis to co-packaged the Propeller digital health platform with Enerzair® Breezhaler® (QVM149; indacaterol acetate, glycopyrronium bromide and mometasone furoate [IND/GLY/MF]), a recently approved Novartis medication developed to treat uncontrolled asthma. Propeller previously announced a collaboration with Novartis to develop a custom add-on sensor for the Breezhaler® inhaler, a device used for the company’s portfolio of COPD treatments (Ultibro® Breezhaler®, Onbrez® Breezhaler®, and Seebri® Breezhaler®), connecting these medications to Propeller’s digital health platform. The same sensor will be co-packaged with Enerzair® Breezhaler®.

Why It Matters

This collaboration marks the first time a digital health tool will be packaged and prescribed alongside an inhaled asthma medication. Enerzair® Breezhaler® and Propeller sensor and app received approval from the European Commission in July and will launch across Europe starting in 2020. Healthcare professionals in Europe will have the option to prescribe Enerzair® Breezhaler® with or without the companion digital health platform. The medication is not available in the U.S.

Enerzair® Breezhaler® was approved as a maintenance treatment of
asthma in adult patients not adequately controlled with a maintenance
combination of a long-acting beta2-agonist
(LABA) and a high dose of an inhaled corticosteroid (ICS) who experienced one
or more asthma exacerbations in the previous year.

Impact of Uncontrolled Asthma

Asthma affects an estimated 358 million people worldwide and can cause a significant personal, health, and financial burden when not adequately controlled. Despite current therapy, over 40% of patients with asthma at Global Initiative for Asthma (GINA) Step 3, and over 45% at GINA Steps 4 and 5 remain uncontrolled. Patients with uncontrolled asthma may downplay or underestimate the severity of their disease and are at a higher risk of exacerbation, hospitalization, or death. Barriers, such as less than optimal adherence, incorrect inhaler technique, treatment mismatch, safety issues with oral corticosteroids, and ineligibility for biologics, have created an unmet medical need in asthma.

Enerzair Breezhaler 

Enerzair Breezhaler is provided in a transparent capsule that allows patients to see that they have taken their medication and will be administered via the dose-confirming Breezhaler® device, which enables once-daily inhalation using a single inhaler. The digital companion includes a sensor that attaches to the Breezhaler device and can be linked to the Propeller Health smartphone app, providing patients with inhalation confirmation, medication reminders, and access to objective data that can be shared with their physician in order to help them make better therapeutic decisions.

Propeller’s solution works by attaching a sensor to the
Enerzair® Breezhaler® inhaler, which then delivers objective data on medication
use to the Propeller app on the patient’s smartphone. The app also sends the
patient reminders to take their prescribed dose and keeps a record of adherence
data over time. The patient can share that data with their clinician to help
inform the patient’s treatment plan.

In previous clinical studies unrelated to this collaboration, the Propeller platform has been shown to increase asthma control by up to 63 percent, increase medication adherence by up to 58 percent, and reduce asthma-related emergency department visits and hospitalizations by as much as 57 percent.

“Our collaboration with Novartis to co-package Propeller with Enerzair® Breezhaler® is the first time a pharmaceutical company and digital health company have worked together to package a digital health platform with an asthma medication,” said David Van Sickle, co-founder and CEO of Propeller Health. “The ability to prescribe a maintenance medication with Propeller will make it easier for healthcare professionals to engage their patients in self-management.”

One Way to Treat Asthma and Autoimmune Diseases with Diet

Cutting two teaspoons of salt’s worth of sodium from one’s daily diet can significantly improve lung function in asthmatics

In the 1960s and 1970s, a mystery was emerging. Why were childhood asthma rates between 2 to 5 percent in the developed world but as low as 0.007 percent in the developing world? For example, in the developing world, instead of 1 in 20 kids affected, or even 1 in 50 kids, it could be more like 1 in 10,000 kids—extremely rare. And, when kids moved from a low-risk area to a high-risk area, their risk went up. What was going on? Were they exposed to something new? Did they leave some protective factor behind?

As I discuss in my video How to Treat Asthma with a Low-Salt Diet, all the way back in 1938, scientists showed they could stop asthma attacks by lowering children’s sodium levels. That was done with a diuretic drug, but subsequent dietary experiments showed that diets high in salt seemed to increase asthmatic symptoms, while “lowering the salt decreased the asthmatic symptoms…” This body of evidence was apparently forgotten…until it was picked up again in the 1980s as a possible explanation for why Western countries had higher asthma rates.

Maybe it was the salt.

As you can see at 1:34 in my video, researchers graphed out childhood death from asthma versus family salt purchases, and it seemed more salt meant more death. Just because a family buys more salt doesn’t necessarily mean the kids are eating more, though. The way to find out how much salt someone is eating is to collect their urine over a 24-hour period and measure the amount of sodium, since how much salt we eat is pretty much how much salt we excrete. The way to test for asthma, called a bronchial challenge test, is to look for an exaggerated response to an inhaled chemical. And, indeed, there was a strong correlation between how their lungs reacted and how much sodium they were taking in. However, there are all sorts of food additives, like preservatives, that can trigger these so-called hypersensitivity reactions, so maybe high sodium intake was just a marker for high processed food intake. Maybe it wasn’t the salt at all.

Or maybe it was other components of the diet. For example, the reason sodium may be a risk factor for another inflammatory disease, rheumatoid arthritis, may be that sodium intake is just a marker for increased fish and other meat intake or decreased fruit and vegetable intake. We needed a study where researchers would take asthmatics, change the amount of salt in their diets, and see what happened—and that’s just what came next.

As you can see at 3:16 in my video, researchers doubled the salt intake of ten asthmatics, and lung sensitivity worsened in nine out of ten. There was no control group, though. Is it possible the subjects would have gotten worse anyway?

In a randomized, double-blind, placebo-controlled trial, researchers put everyone on a low-salt diet, but then gave half of the subjects sustained-release sodium pills to bring their salt intake back up to a more normal level and the other half a placebo. After five weeks, the groups switched regimes for another five weeks. That’s how you can randomize people to a true low-sodium diet without them even realizing it. Genius! So what happened? Asthmatics on the salt got worse. Their lung function got worse, their asthma symptoms got worse, and they had to take more puffs on their inhalers. This study compared asthmatics consuming about three teaspoons’ worth of salt a day to those consuming less than one, so they were effectively able to drop their sodium intake by two teaspoons’ worth of salt, as you can see at 4:04 in my video. If you do a more “pragmatic” trial and only effectively reduce people’s salt intake by a half a teaspoon a day, it doesn’t work.

Even if you are able to cut down your sodium intake enough to get a therapeutic effect, though, it should be considered an adjunct treatment. Do not stop your asthma medications without your doctor’s approval.

Millions suffer from asthma attacks triggered by exercise. Within five minutes of starting to exercise, people can get short of breath and start coughing and wheezing such that lung function significantly drops, as you can see at 0:19 in my video Sodium and Autoimmune Disease: Rubbing Salt in the Wound?. On a high-salt diet, however, the attack is even worse, whereas on a low-salt diet, there’s hardly a significant drop in function at all. To figure out why, researchers had the subjects cough up sputum from their lungs and found that those on the high-salt diet had triple the inflammatory cells and up to double the concentration of inflammatory mediators, as you can see at 0:43 in my video. But why? What does salt intake have to do with inflammation? We didn’t know…until now.

“The ‘Western diet,’ high in saturated fatty acids and salt, has long been postulated as one potential…cause for the increasing incidence of autoimmune diseases in developed countries…” The rapidly increasing incidence of autoimmune diseases may be due to an overactivation of immune cells called T helper 17 (Th17) cells. “The development of…multiple sclerosis, psoriasis, type I diabetes, Sjögren’s syndrome, asthma, and rheumatoid arthritis are all shown to involve Th17-driven inflammation,” and one trigger for the activation of those Th17 cells may be elevated levels of salt in our bloodstream. “The sodium content of processed foods and ‘fast foods’…can be more than 100 times higher in comparison to similar homemade meals.”

And, sodium chloride—salt—appears to drive autoimmune disease by the induction of these disease-causing Th17 cells. It turns out there is a salt-sensing enzyme responsible for triggering the formation of these Th17 cells, as you can see at 2:07 in my video.

Organ damage caused by high-salt diets may also activate another type of inflammatory immune cell. A high-salt diet can overwork the kidneys, starving them of oxygen and triggering inflammation, as you can see at 2:17 in my video. The more salt researchers gave people, the more activation of inflammatory monocyte cells, associated with high-salt intake induced kidney oxygen deficiency. But that study only lasted two weeks. What happens over the long term?

One of the difficulties in doing sodium experiments is that it’s hard to get free-living folks to maintain a specific salt intake. You can do so-called metabolic ward studies, where people are essentially locked in a hospital ward for a few days and their food intake is controlled, but you can’t do that long term—unless you can lock people in a space capsule. Mars520 was a 520-day space flight simulation to see how people might do on the way to Mars and back. As you can see at 3:17 in my video, the researchers found that those on a high-salt diet “displayed a markedly higher number of monocytes,” which are a type of immune cell you often see increased in settings of chronic inflammation and autoimmune disorders. This may “reveal one of the consequences of excess salt consumption in our everyday lives,” since that so-called high-salt intake may actually just be the average-salt intake. Furthermore, there was an increase in the levels of pro-inflammatory mediators and a decrease in the level of anti-inflammatory mediators, suggesting that a “high-salt diet had a potential to bring about an excessive immune response,” which may damage the immune balance, “resulting in either difficulties on getting rid of inflammation or even an increased risk of autoimmune disease.”

What if you already have an autoimmune disease? In the study titled “Sodium intake is associated with increased disease activity in multiple sclerosis,” researchers followed MS patients for a few years and found that those patients eating more salt had three to four times the exacerbation rate, were three times more likely to develop new MS lesions in their brains, and, on average, had 8 more lesions in their brain—14 lesions compared to 6 in the low-salt group. The next step is to try treating patients with salt reduction to see if they get better. But, since reducing our salt intake is a healthy thing to do anyway, I don’t see why we have to wait.


What else can we do for asthma? See:

Have you heard that salt reduction was controversial? That’s what the processed food industry wants you to think. Check out the science in:

What are some of the most powerful dietary interventions we have for autoimmune disease? See, for example:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

The Benefits of Slow Breathing

There are all manner of purported hiccup “cures,” which include everything from chewing on a lemon, inhaling pepper, or, our dog’s favorite, eating a spoonful of peanut butter. In my video How to Strengthen the Mind-Body Connection, I talk about the technique I’m excited to try the next time I get hiccups: “supra-supramaximal inspiration,” where you take a very deep breath, hold for ten seconds, then, without exhaling, breathe in even more and hold for another five seconds, and then take one final, tiny breath in and hold for five last seconds to achieve “an immediate and permanent termination to hiccups…”

When I was a kid, I taught myself to control my own hiccups using slow-paced breathing, and, as an adult, was so excited to see there was finally a case report written up on it.

There’s a nerve—the vagus nerve—that goes directly from our brain, to our chest, and to our stomach, connecting our brain back and forth to our heart and our gut, and even to our immune system. The vagus nerve is like the “‘hard-wired’ connection” that allows our brain to turn down inflammation within our body. When you hear about the mind-body connection, that’s what the vagus nerve is and does. “There has been increasing interest in treating a wide range of disorders with implanted pacemaker-like devices for stimulating the vagal afferent [vagus nerve] pathways,” but certain Eastern traditions like Yoga, QiGong, and Zen figured a way to do it without having electrodes implanted into your body.  

“A healthy heart is not a metronome,” as a study titled exactly that explains. “Your heart rate goes up and down with your breathing. When you breathe in, your heart rate tends to go up. When you breathe out, your heart rate tends to go down.” Test this out on yourself right now by feeling your pulse change as you breathe in and out.

Isn’t that remarkable?

That heart-rate variability is a measure of vagal tone—the activity of your vagus nerve. Next time you’re bored, try to make your heart rate speed up and slow down as much as possible within each breath. This can be done because there’s an entirely other oscillating cycle going on at the same time, as you can see at 2:08 in my video, which is the speeding up and then slowing down of your heart rate, based on moment-to-moment changes in your blood pressure. And, as any physics student can tell you, “all oscillating feedback systems with a constant delay have the characteristic of resonance,” meaning you can boost the amplitude if you get the cycles in sync. It’s like pushing your kid on a swing: If you get the timing just right, you can boost them higher and higher. Similarly, if you breathe in and out at just the right frequency, you can force the cycles in sync and boost your heart rate variability, as you can see at 2:36 in my video.

And what’s the benefit again? According to the neurophysiologic model postulation it allows us to affect the function of our autonomic nervous system via vagal afferents to brainstem nuclei like the locus coeruleus, activating hypothalamic vigilance areas.

Huh?

In other words, it’s not just about curing hiccups. Practicing slow breathing a few minutes a day may have lasting beneficial effects on a number of medical and emotional disorders, including asthma, irritable bowel syndrome, fibromyalgia, and depression. In the United States, we’ve also put it to use to improve batting performance in baseball.

To date, most studies have lacked proper controls and have used fancy biofeedback machines to determine each person’s resonant frequency, but, for most people, it comes out to be about five and a half breaths per minute, which is a full breath in and out about every 11 seconds. You can see the graph at 3:34 in my video. When musicians were randomized into slow-breathing groups with or without biofeedback, slow breathing helped regardless. It’s the same with high blood pressure. As you can see at 3:52 in my video, you can use this technique to significantly drop your blood pressure within minutes. The hope is if you practice this a few minutes every day, you can have long-lasting effects the rest of the day breathing normally.

Practice what exactly? Slow breathing—taking five or six breaths per minute, split equally between breathing in and breathing out. So, that’s five seconds in, then five seconds out, all the while breathing “shallowly and naturally.” You don’t want to hyperventilate, so just take natural, shallow breaths, but be sure to simply breathe really slowly. Try it the next time you get hiccups. Works for me every time!


For more tips, watch my video on How to Stop Hiccups.

And, because slowing down our pulse in general may also have beneficial effects, I encourage you to check out:

Every time I’m amazed by ancient wisdom, I have to remind myself of the video I did on toxic heavy metals—Get the Lead Out. So, though traditional healing methods may offer a plethora of insights, they still need to be put to the test.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: