Face Masks and Exercise; Dosing Psilocybin: It’s TTHealthWatch! Leave a comment


TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.

This week’s topics include cloth masks and exercise, psilocybin and depression, exercise and COVID severity, and inflammatory diets.

Program notes:

0:49 Pause of J&J vaccine

1:12 Cloth face masks

2:12 Felt somewhat claustrophobic

3:01 Psilocybin in treating depression

4:03 Dosing psilocybin

5:01 Used to treat depression historically

6:01 Uncertainty regarding dose

6:35 Exercise and COVID-19

7:35 Direct correlation

8:35 Proxy for chronic disease?

9:15 Inflammation and diet

10:15 Associations with dietary patterns and microbial clusters

11:35 Red wine, coffee and tea helpful

12:58 End

Transcript:

Elizabeth Tracey: Does what you eat affect your gut microbiome and inflammation?

Rick Lange, MD: Does physical inactivity put you at a higher risk for severe COVID outcomes?

Elizabeth: How does psilocybin compare to an antidepressant in the treatment of depression?

Rick: And what happens when you wear a cloth face mask and you’re on an exercise stress test?

Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, this week, of course, a paucity of things related to COVID-19. But before we start recording, we should mention that we have heard that the U.S. has decided to pause using the J&J vaccine.

Rick: There are issues regarding some complications, some hematologic or blood-borne complications, and also some concerns about the safety of it related to production, so stay tuned. We’ll provide more information as it becomes available.

Elizabeth: Since it’s peripherally related then, why don’t we first turn to one of your studies in the BMJ? That’s taking a look at the impact of cloth face masks.

Rick: In terms of sporting events and exercise it’s not possible, sometimes, to social distance, but it is possible to wear a face mask. When you wear a cloth face mask, and that’s the most common type worn — they looked at 31 adults, the mean age of about 23, and about half men and half women, then did two stress tests, one with a cloth face mask and one without. Then they measured how well they did.

What they determined was — and by the way, they did a maximal exercise stress test — the cloth face mask reduced the exercise time by 14% and the maximal oxygen consumption by 29%. That’s a pretty significant decline. Furthermore, they assessed how the individuals felt during this time.

Compared with no mask, participants reported feeling increasingly short of breath and even claustrophobic at the higher exercise intensities while they were wearing the cloth masks. That may be one of the reasons why they terminated exercise earlier, because it looked like they had still plenty of oxygen in their blood, but they just felt like they couldn’t catch their breath and felt somewhat claustrophobic.

Elizabeth: I think that this is a fine study and my concern is that people are going to extrapolate the findings from this study into general use of cloth face masks and resist — even more than some populations are already — wearing them.

Rick: Elizabeth, I’m glad you brought that up because this wasn’t to convince people not to wear a face mask. That’s really not the issue at all. It was really to quantify how much it affects exercise, so that when people are involved in athletics they just need to consider how they would modify their exercise — either the frequency of it, or the intensity of it, or the type — just so that they get the benefit of activity, at the same time remaining safe. Let’s alter our exercise patterns or expectations so we can do so safely.

Elizabeth: Okay. Since we’re talking about things that are peripherally related to the COVID-19 pandemic, let’s turn now to the New England Journal of Medicine. We’ve reported many times that there’s a huge concern — that’s the increase in mental health issues relative to the pandemic, especially things like anxiety and depression. This study takes a look at psilocybin and compares it with an antidepressant, escitalopram, in relieving moderate to severe depression, actually, in a group of patients.

Interestingly, this study takes place at one of the centers worldwide that’s really looking at psilocybin and other drugs of that ilk in their ability to alleviate a lot of issues like anxiety about death, long-term depression in cancer patients, cigarette smoking cessation and so on.

In this study, they had 59 patients who were enrolled; 30 were assigned to the psilocybin group and 29 to the escitalopram group. They had 2 separate doses of 25 mg of psilocybin 3 weeks apart and 6 weeks of daily placebo — that was in the psilocybin group — or 2 separate doses of 1 mg of psilocybin 3 weeks apart, plus 6 weeks of daily oral escitalopram.

I also thought that the roll-in to this study required some pretty courageous people, because they already had moderate depression and they had to have a run-in period where they were free of any drugs before they were able to become a part of this study.

They had a number of outcomes that they were looking at, and the long and short of it is that there was really no significant difference between the two groups with regard to this primary outcome of relief of depressive symptoms, although there were trends among the psilocybin group that seemed to indicate that it might be helpful.

Rick: Elizabeth, as you’ve mentioned, these people had chronic moderate to severe depression. These people have had it for 15 to 22 years. The use of what are now called psychedelic drugs dates back decades, and in fact, in the 40s, 50s, and 60s, the psychoactive properties of these were used to treat depression and other things, and there are thousands of papers written about it. Unfortunately, their recreational use, especially LSD and psilocybin, put a big damper on using them. They’ve actually resurged — especially we’ve talked before about the use of ketamine for treating depression, and now this study using psilocybin.

What are its exact effects? We know it has serotonin effects, but there are other drugs that have serotonin-like effects that aren’t as good in terms of antidepressant capabilities. This is a relatively small study, a relatively short period of time.

It really was no more effective than escitalopram but there was no placebo group, and usually escitalopram takes months for it to be most effective, so if we had continued this on for not 6 weeks, but for much longer, would we have seen a better benefit with the escitalopram? It’s really unknown, so there’s still a lot of studies that need to be done.

Elizabeth: I would note that the editorialist says that one of the major issues here is that there’s uncertainty regarding the appropriate therapeutic dose range and the frequency of the administration of psilocybin, and I would say that yeah, that’s probably true that maybe we haven’t optimized that either.

Rick: An early study, so suggesting it’s at least as effective as escitalopram. So you might say, “Well, maybe in people that are not responsive to escitalopram, would this be a more effective therapy?” As you suggested, we need to look more about long-term administration and also whether this was the optimal dosing, but I’m glad it’s being done in a very rigorous and methodic way.

Elizabeth: Yes, absolutely. Let’s turn back to The BMJ. This is our frank relationship with COVID-19 piece for this week. This is physical inactivity and its association with severe COVID-19 disease.

Rick: We talk about using masks during exercise, but really nobody’s looked at the effect of exercise or activity — or, more importantly, inactivity — with regard to severity of COVID outcomes. This was a retrospective study done in the Kaiser Permanente system and the nice thing about that system is every time a patient’s examined they asked them what level of physical activity. Are they meeting the guidelines, over 150 minutes per week? Are they completely inactive, less than 10 minutes of exercise per week, or somewhere in the middle?

About 14% of their patients are completely inactive. Only about 6% meet their recommendations of over 150 minutes of moderate to vigorous exercise per week, and the rest of them sit in the middle, and when they looked at outcomes of hospitalization and, “How did people do with COVID infection?,” they identified over 48,000 adult individuals that had a COVID diagnosis, and what they discovered was there was a direct correlation between how they did with regard to hospitalization, ICU hospitalization, and also mortality.

Individuals that were inactive had about a twofold increased risk of all of those, by the way, compared to those that were the most active, and those that had in-between activity were somewhere in between. This shows clearly that the activity or inactivity affects outcome. In fact, other than age and having an organ transplant, in this particular study it was the most important risk factor.

Elizabeth: Couple of things about this, of course. We have seen this dose-response relative to physical activity with lots of different diseases, so it’s not at all surprising that this would be the case.

Of course, there’s not a lot of people can do about it if they’ve had this long history of physical inactivity right now to stave off their risk for developing COVID or severe COVID. That would still be, “Get vaccinated.” Then the other thing is I’m wondering how much of a proxy inactivity is for chronic disease.

Rick: Well, Elizabeth, that’s a good thing. I failed to mention is that they corrected for all the other risk factors. Even after correction for all of those things, activity fell out as being more important than those other things in this particular study.

You know, Americans, on average, have 4 to 6 hours of leisure time a day, and most of that’s spent in front of a computer or a TV, so spending 30 minutes of a day doing some activity, even if it’s not moderate or vigorous, to improve one’s health and also to prevent the severity of COVID seems like a worthwhile time investment.

Elizabeth: Oh, I would absolutely agree with you, as an active proponent of that myself. Staying in the BMJ, let’s turn to our final one for this week, and that’s taking a look at long-term dietary patterns and their association with pro-inflammatory and anti-inflammatory features of the gut microbiome. Again, something that we’ve talked about so many times, this really tantalizing and so far incompletely characterized relationship between our gut flora and the multitude of things that go on in our bodies.

In this study, they investigated the relationship between 173 dietary factors and the microbiomes of 1,425 people, and they divided those people into four cohorts: those with Crohn’s disease; those with ulcerative colitis; irritable bowel syndrome; and then the general population.

They got a fecal sample from these folks, and they actually did a sequencing and analysis, and they took a look also at their dietary intake, and that was with food frequency questionnaires. They ended up with 38 associations between dietary patterns and microbial clusters, and these were associated with various inflammatory markers and with these different conditions.

Ultimately what they find out, and again, not surprising, is that processed foods and animal-derived foods definitely are positively associated with gut flora that may not be the best ones that we could possibly have, and also those that synthesized endotoxins, which we know are not a good thing.

The opposite was found for plant foods and fish. They induced gut flora that helped produce short-chain fatty acids, and they actually seemed like they were assistive in reducing inflammation.

A big study. Of course, we have lots of questions, “If you modify your diet, can you modify your gut flora significantly, and does that really help with inflammation anywhere other than in the gut?” That’s what I’d like to know.

Rick: This study was well done with a large number of individuals, basically to really illustrate the point that if you have a high intake of animal foods, and processed foods, and alcohol and sugar, that corresponds to a gut microbial environment that really is characteristic of inflammation, and the other foods and legumes, breads, fish, and nuts, basically the type of bacteria that are anti-inflammatory.

A couple of other things that came out of it and you didn’t mention. One is that red wine, the phenols in red wine seem to be anti-inflammatory and also, coffee, tea, also polyphenol-rich foods that are associated with lower rates of inflammation as well.

Most of us don’t correlate with what we put in our mouth with the degrees of inflammation, and that inflammation is responsible for increased obesity, hypertension, cardiovascular disease, and autoimmune disease, but it looks like what you put in your mouth really does influence your overall health.

That should prompt us to change our diet, although at this particular time we don’t know how long it will take to change the microbiome when that’s done, but it still seems to be the right thing to do.

Elizabeth: Yeah. The question is can you change it and how long does it take to change it if you’ve got the establishment of some of these things already in your gut?

Rick: I think that’s an interesting study, to follow the gut microbiome over that time, but it appears in people that weren’t taking a Mediterranean diet, when they do so it does improve their overall outcome. I’m going to extrapolate and say that part of that is decreasing metabolic risk, but also decreasing inflammation, so does changing diet help? I think the answer to that is, “Overwhelmingly, yes.”

Elizabeth: On that note, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up make healthy choices.



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