Ramsay Hunt Syndrome (The Stated Cause Of Justin Beiber’s Facial Paralysis) Is Caused By Chicken Pox Virus Reactivation

I enjoyed listening to this doctor, Andrew Mester MD, describe Ramsay Hunt syndrome, similar to Bell’s Palsy but usually accompanied by rashes. Ramsay Hunt syndrome and Bell’s Palsy are one-sided facial paralysis involving the 7th cranial nerve or facial nerve. The facial nerve has a cervical branch which reaches down into the neck area. Both syndromes are caused by reactivation of a virus, varicella zoster virus (VZV) for Ramsay Hunt (that’s the virus that causes chicken pox) and herpes simplex virus (HSV) for Bell’s Palsy. The two conditions may present as indistinguishable.*

11 June 2022

What causes reactivation of chicken pox virus?

VZV reactivation frequently arises under immune-exhaustion, such as aging, or immunocompromised conditions caused by immunosuppressive drugs, HIV infection, or malignancies.
Persistent Varicella Zoster Virus Infection Following mRNA Covid-19 Vaccination Was Associated With The Presence Of Encoded Spike Protein In The Lesion, Cutaneous Immunology and Allergy, 25 August 2022

Could the COVID-19 vaccine suppress the immune response? Yes, if this paper is anything to go by:
Innate immune suppression by SARS-CoV-2 mRNA vaccinations: The role of G-quadruplexes, exosomes, and MicroRNAs, Food and Chemical Toxicology, June 2022

I talked about that here: Paper: mRNA Vaccine Suppresses Immune Response: Increasing Risk For Infections, Bell’s Palsy, Shingles, Cancer.

A case study:
Ramsay Hunt Syndrome Following COVID-19 Vaccination, BMJ Postgraduate Medical Journal, 5 January 2022

* Ramsay Hunt Syndrome, BMJ Journal of Neurology, Neurosurgery, and Psychology, 1 August 2001

Canadian singer Justin Beiber was diagnosed with Ramsay Hunt syndrome in June 2022:

Institute Of Medicine Set “Arbitrary” Value For Vitamin D Blood Levels

I happened to see something in that New York Times article about the vitamin D study. The article…

Study Finds Another Condition That Vitamin D Pills Do Not Help, New York Times, 27 July 2022

Said this…

Dr. Rosen said those concerns led him and the other members of the National Academy of Medicine’s expert group to set* what he called an “arbitrary value” of 20 nanograms per milliliter of blood as the goal for vitamin D levels and to advise people to get 600 to 800 international units of vitamin D supplements to achieve that goal.

*Here’s that report:
The 2011 Report On Dietary Reference Intakes For Calcium And Vitamin D From The Institute Of Medicine: What Clinicians Need To Know, The Journal of Clinical Endocrinology and Metabolism, January 2011

Which also says…

The Committee finds that the prevalence of vitamin D inadequacy in the North American population has been overestimated by some groups due to the use of inappropriate cut-points that greatly exceed the levels identified in this report.

Back to the NYTs article:

Labs in the United States then arbitrarily set 30 nanograms per milliliter as the cutoff point for normal vitamin D levels, a reading so high that almost everyone in the population would be considered vitamin D deficient.

All this “arbitrary.”

There are real problems with taking too much vitamin D, as I’ve posted about:

The problems don’t end with bone. Vitamin D is a hormone after all, with far-reaching effects. I used to trust people in the health heirarchy.

Big Study Finds Vitamin D Doesn’t Lower Risk Of Fractures

This came out over the summer and I was meaning to get to it. It used the big VITAL cohort. (VITAL was studying vitamin D3 and omega-3 for cancer and heart disease. They found them not useful for those conditions.)

Here’s the fracture study:
Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults, New England Journal of Medicine, 28 July 2022

Background: Vitamin D supplements are widely recommended for bone health in the general population, but data on whether they prevent fractures have been inconsistent.

Results: Among 25,871 participants (50.6% women [13,085 of 25,871] and 20.2% Black [5106 of 25,304]), we confirmed 1991 incident fractures in 1551 participants over a median follow-up of 5.3 years. Supplemental vitamin D3, as compared with placebo, did not have a significant effect on total fractures (which occurred in 769 of 12,927 participants in the vitamin D group and in 782 of 12,944 participants in the placebo group; hazard ratio, 0.98; 95% confidence interval [CI], 0.89 to 1.08; P=0.70), nonvertebral fractures (hazard ratio, 0.97; 95% CI, 0.87 to 1.07; P=0.50), or hip fractures (hazard ratio, 1.01; 95% CI, 0.70 to 1.47; P=0.96).

Supplementing with vitamin D3 at 2000 IU per day for about 5 years did not result in a lower risk of fractures.

From media articles:
Study Finds Another Condition That Vitamin D Pills Do Not Help, New York Times, 27 July 2022

The results, published Thursday in The New England Journal of Medicine, hold for people with osteoporosis and even those whose blood tests deemed them vitamin D deficient.

Dr. Manson [lead researcher on VITAL study] said. “But we seem to need only small-to-moderate amounts of the vitamin for bone health. Larger amounts do not confer greater benefits.”

Vitamin D Supplements Fail To Lower Risk Of Fractures In Healthy Adults, Study Says, UPI, 27 July 2022

“Overall, the results from this large clinical trial do not support the use of vitamin D supplements to reduce fractures in generally healthy U.S. men and women,” Dr. Meryl LeBoff, the study’s lead author, said in the release.

I still hear doctors recommending vitamin D for bone health. It’s going to be hard to change people’s minds about this.

James Burke, 1986

This gives me chills. He seems to be foretelling an internet, or a computerized “open society, tolerant of every view, aware there is no single privileged way of doing things.” He also said, though, that this “new instrument” or “new system”, could “make conformity more rigid, more totalitarian than ever before in history.”

He’s still alive. I wonder what he thinks about how things turned out.

Wikipedia:

James Burke (born 22 December 1936) is a British broadcaster, science historian, author, and television producer. He was one of the main presenters of the BBC1 science series Tomorrow’s World from 1965 to 1971 and created and presented the television series Connections (1978), and its more philosophical sequel The Day the Universe Changed (1985), about the history of science and technology. The Washington Post has called him “one of the most intriguing minds in the Western world”.

An Iodine Supplement?

I can’t let go of this iodine issue. Just saw:

Vegans, Vegetarians and Pescatarians Are at Risk of Iodine Deficiency in Norway, Nutrients, November 2020

Vegans, vegetarians and possibly pescatarians [vegetarian + seafood] in Norway, are unable to reach the recommended iodine intake merely from food and are dependent on iodine supplements.

Norway doesn’t add much iodine to table salt:

The iodization of table salt in Norway is voluntary with only 5 micrograms per gram.

We add a lot more:

Iodized salt in the U.S. contains 45 micrograms of iodine per gram of salt. The recommended daily intake for adults is 150 micrograms, which can be obtained from about one-half to three-quarters of a teaspoon of table salt.
Mayo Clinic Q and A: Sea salt and sufficient iodine intake

But … The American Heart Association recommends no more than 2,300 milligrams sodium a day, ideally no more than 1,500.

There are about 1,725 mg sodium in 3/4 teaspoon of table salt. That doesn’t account for the other sodium-containing foods we eat in a day… prepared soups, pasta sauces, dressings, cheeses, pretzels and chips are all high in sodium. Just one slice of bread contains 100-200 mg. And manufacturers aren’t using iodized salt in those foods. Depending on table salt for iodine is clearly not the answer. (Also, iodized salt loses its iodine over time: “An opened package of table salt with iodide may rapidly lose its iodine content in high temperature and high relative humidity conditions through the process of oxidation and iodine sublimation.”)

Where are vegans getting iodine? You could use low-sodium iodized salt. (I talked about that here.) But do we want to get into the habit of salting our food? Many foods taste wonderful without added salt, if we would allow ourselves to get used to it.

You know where I’m going with this. A supplement. I just don’t see any other way. Do you?

Dr. Greger’s thoughts on iodine:

My related posts:

Iodine. It’s Important.
120 Countries Fortify All Food-Grade Salt With Iodine. The US Does Not.
Low-Sodium Salt … For The Iodine
Salt

The Tea Porters Of Western China

Porters in western China — sometimes including women and children — lugged crushing burdens of tea along trails to Tibet for centuries until trucks replaced them by the mid-1900s.

People were more economical than packhorses.

250 Pounds of Grief, by Paul Salopek for National Geographic, 14 October 2022
Following The Forgotten Trails Of China’s Vanished Tea Porters.

This story is part of journalist Paul Salopek’s multiyear, 24,000-mile walk across the world.

One Physician’s Thoughts On That Colonoscopy Study, And The Debate That Ensued

Many people took umbrage with the study I posted this week that found, essentially, screening colonoscopies don’t save lives. They HAVE to, right? Early detection, right? That’s not what science is finding. Here’s an east coast physician addressing the study and the debate that ensued.

Great Colonoscopy Debate – A Listener Responds, Sensible Medicine, 13 October 2022

After watching the great debate last night, I had 5 thoughts.

(1) The point Dr. Mandrola made about the actual numbers of the per-protocol analysis got obscured. I don’t think people who hadn’t read the article realized that the risk of colon cancer-related mortality was 0.30% in the usual-care group and 0.15% in the intervention group. All-cause mortality wasn’t even reported for the per-protocol analysis.

Even those who embrace per protocol analysis are making a losing argument. We’re talking about an absolute risk reduction for cancer-related mortality of 0.15% even in the best-case scenario (per-protocol analysis). I’ve shown it here visually against the backdrop mortality.

The 2 tall bars on the left show the 10 year risk of dying seen in the study. The third bar assumes 100% compliance with screening, and the short bars are rates of colon cancer death observed (4 and 5), or rates of death assuming 100% compliance (6 and 7). Simply put: colon cancer death is dwarfed by dying for any reason, and the benefits are tiny.

(2) Where are people getting the number 50% reduction from for the per-protocol analysis with regard to cancer-related mortality? This is being parroted by all the national GI organizations. It’s from this 0.30% and 0.15%. Dr. Mandrola was also trying to make this point, but it got slightly obscured in the discussion. Relative risk obscures the very low absolute benefit.

Here’s the kicker: All the hot-take commentators, of which there are many out there, don’t realize: they are parroting the NEJM editorial which quoted the 50% reduction in cancer-related mortality in the per-protocol analysis.

I am very certain the editorialists wrote it like this in the editorial rather than provide the actual raw numbers published in the paper because they knew this could become a defensive talking point for people who wouldn’t bother to read or understand the whole paper.

Yes, I am that cynical about academic medicine.

And yes, I am fairly certain this framing was intentional.

(3) The description of the trial in the Methods was that they expected a 50% participation rate in the intervention arm. 42% is lower than this, but it’s not dramatically off from what they had expected. This has not been mentioned.

(4) If the issue of colonoscopy saving lives is settled already, why was this trial even done? We are not doing trials to determine if the Earth is round because that is considered settled knowledge. We do trials to help with clinical issues which are not settled. If the trial had happened to show a positive finding, the same people getting worked up about methodological issues now would be championing the study — I am very sure of this. The truth is there are 3 more ongoing trials precisely because this is not settled science. We have no idea which colorectal cancer screening is best in 2022.

(5) I have never observed so many trainees (GI fellows and IM residents who want to do GI) get so worked up over a scientific issue on Twitter. I am sure that >80% of them don’t even understand the nuances of the discussion. Some are doing it just to demonstrate they are on the “right team” and advocating for the right cause (let alone the obvious COI that their salaries are highly dependent upon this approach to medicine).

Their ability to analyze unemotionally is entirely gone. They know the answer they want to arrive at and see no nuance whatsoever.

Good points.

First Big Randomized Control Trial Of Colonoscopy Found That It Doesn’t Reduce Deaths

Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death, New England Journal of Medicine, 9 October 2022

Over 10 years of follow-up, colonoscopy did not reduce the risk of dying from colon cancer, or from any cause. From the abstract:

Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear.

We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014.

Follow-up data were available for 84,585 participants.

Related:
Screening Colonoscopy Misses the Mark in its First Real Test, Sensible Medicine, 9 October 2022

Over 10 years of follow-up, an invitation to screening colonoscopy modestly reduced the risk of being diagnosed with colorectal cancer, but it did not significantly reduce the risk of dying from colorectal cancer. Survival from cancer was nearly identical in both groups. And all-cause mortality was the same.

What do you think? Overscreening, overdiagnosis, overtreatment? I think that.