Health Connection - September 2021

Mood and the Microbiome: The Gut / Brain Axis

By Claire Mogelvang, RD

You have a “gut feeling” something isn’t right. You “can’t stomach” your colleague’s bad attitude. You have “butterflies in your stomach” before your big interview. Expressions like these highlight a phenomenon we’re all familiar with on a visceral level: the gut/brain axis.

The term “gut” refers to your digestive tract, including the mouth, esophagus, stomach, intestines, and colon. The gut/brain axis is the connection between the central nervous system (brain) and the enteric nervous system (gut). The gut and brain communicate through the longest nerve in the body, the vagus nerve, which runs from the brain all the way down to the intestines. The brain communicates with the gut to control motility, stimulate the release of secretions and enzymes, and deliver nutrients. Meanwhile, the gut affects neurotransmitters, stress and anxiety, mood, and behavior. This two-way communication loop has trillions of influencers: the dizzying variety of bacteria, fungi, viruses, and protozoa, known as the microbiotia, that live in the gut.

We tend to think about microorganisms as potential threats to our health, but research shows that certain bacteria have a symbiotic relationship with our bodies and help us stay well. They aid digestion, detoxify chemicals, prevent pathogen growth, reduce inflammation, and help us sustain a healthy metabolism and immune system. Humans don’t produce enough enzymes to break down all the fiber in a healthy diet, but the bacteria in our gut do. These bacteria turn carbohydrates into beneficial substances such as thiamine, folate, biotin, riboflavin, panthothenic acid, and vitamin K. Most remarkably, gut bacteria secrete neurotransmitters, including serotonin, dopamine, and GABA, that communicate and regulate mood. In fact, the gut produces 90-95% of our body’s serotonin, the neurotransmitter thought to regulate mood, happiness, and anxiety! Certain bacteria also produce short chain fatty acids that influence memory and learning.

Mental Health and the Microbiotia

Scientists have long been intrigued by the connection between gut and brain disorders. For example, many people with irritable bowel syndrome also suffer from depression, while people with autism often have digestive problems, and those suffering from Parkinson’s Disease tend to experience constipation. We don’t yet understand how the gut/brain connection works, but several theories are being investigated:

• Some microbes may secrete substances that infiltrate blood vessels and hitch a ride to the brain
• Microbes may prompt certain cells in the gut lining to stimulate the vagus nerve, which connects directly to the brain
• Microbes impact enteroendocrine cells in the lining of the gut, which affect hormone production
• Gut microbes have an impact on the immune system and inflammation, which can affect the brain

While the gut has an effect on our mood, stress in turn impacts the gut. When the hypothalamus secretes stress hormones, digestion slows, intestinal blood flow decreases, and body sensations are heightened as we go into fight or flight mode. Some people may experience severe belly pain and intestinal contractions. Stress also impacts the intestinal permeability of the gut lining, triggering an immune response that leads to inflammation.

Feeding Your Microbiota

Your microbiotia is as unique to you as your fingerprints. During pregnancy, a woman’s microbiotia shifts, to produce an optimum mix of microorganisms for the baby. Babies born by vaginal delivery also get a dose of microbes on their way to the outside world. The gut microbiome changes a lot during a child’s first two years of life, shaped by microbes in breast milk, the environment, and the foods the child eats. By the time a child is around three, the microbiotia stabilizes. However, throughout our life factors such as diet, stress, cigarette smoking, alcohol consumption, low stomach acid, pathogens, food allergens, and medication have an ongoing impact on our gut fauna.

The key to a healthy microbiota starts with the way you feed your body:

• Eat a Mediterranean diet to increase your gut’s biodiversity, promote good digestion, and help protect against heart disease, stroke, cancer, and diabetes
• Make sure your diet includes plenty of fiber for good bacteria to feed on
• Increase the quantity and diversity of the microbes in your gut by eating fermented foods such as yogurt, sauerkraut, kefir, kimchi, natto, miso, and kombucha
• Take probiotics but look at the contents: you want multiple strains of bacteria, at a strength of 50 billion colony forming units (CFUs) or higher
• Eliminate inflammation triggers like sugar, saturated fats, and processed food, all of which can kill beneficial bacteria

If you think your diet may be affecting your mood, it may be time to take a closer look at your nutritional choices. The team of Registered Dietitian Nutritionists at MarinHealth can help. Learn more about our nutrition counseling services.

Claire Mogelvang, RD, is a clinical adult dietitian at MarinHealth Medical Center and UCSF Health.

Prostate Questions, Answered

By Patrick Bennett, MD

September is Prostate Health Awareness Month, so we’re answering a few questions about the prostate, a part of the male body that doesn’t get a lot of attention from men until they hit their 50s.

What is the prostate and what does it do?

The prostate is a walnut-sized organ located below the bladder. It it comprises the first segment of the urethra, the channel that carries urine to the tip of the penis. The prostate and adjacent organs called the seminal vesicles produce semen, which during ejaculation mixes with sperm created in the testicles and transported through the vas deferens. Contraction of the prostate and muscles surrounding the urethra account for the expression of semen during ejaculation.

How does the prostate impact urinary symptoms?

The prostate continues to grow throughout a man’s life—this growth is often called benign prostatic hyperplasia, or BPH. Given the location of the prostate surrounding the urethra, this growth can gradually block the flow of urine, ultimately contributing to the sort of symptoms many men notice as they get older. These may include:

• Difficulty starting to urinate
• A weak urinary stream
• Instances of strong or sudden urgency to urinate
• A need to urinate frequently or a sensation of emptying incompletely
• Waking more frequently during the night to urinate

How is BPH treated?

The urinary symptoms that men develop can be impacted by a number of factors in addition to the growth of the prostate. These include age-related changes in bladder function (its capacity to hold urine and the strength of contractions), constipation or other bowel symptoms, difficulties with sleeping (such as sleep apnea or back pain), alcohol or caffeine consumption, and other medications. My partners and I work with patients to identify these factors to see if lifestyle, diet or medication changes might resolve mild symptoms. For patients with persistent, bothersome symptoms, there are a number of very effective treatment options.

• Medication
  There are several types of medication that can relieve urinary symptoms related to BPH. The most commonly used—and the most effective and safe—are alpha blockers. These drugs relax the smooth muscle within the prostate and reduce the blockage of flow. A second family of medications, 5-alpha reductase inhibitors, work over many months to gradually reduce the size of the prostate. A third class, anticholinergics, relax the bladder muscle itself and can reduce urgency and frequency. Each of these drugs can cause side effects, and not all men respond adequately to medications. Fortunately, there are a number of very effective surgical treatments for symptoms of BPH.

• Surgical Interventions
  • Minimally-invasive surgical technology (MIST) procedures are all performed through small cystoscopes without skin incisions. They may be performed with light levels of anesthesia in outpatient facilities.
    • The Urolift procedure involves placement of small titanium tacks that retracts the lobes of the prostate to improve flow and other symptoms.
    • The Rezum procedure involves super-heating prostate tissue, which ultimately reduces the prostate size and constriction of the urethra.
    • Trans-urethral resection of the prostate (TURP) involves removing prostate tissue with a small devices using an electrical current.
  • Robotic-assisted laparoscopic prostatectomy: for patients who have an exceptionally large prostate, the BPH tissue can be removed through an elegant procedure with the DaVinci robotic system.
  • Prostatic Artery Embolization is a relatively new option where an interventional radiologist uses small arterial catheters (similar to angioplasty) to block the blood flow to the prostate. Many men find their symptoms alleviated by this technique.

What about prostate cancer?

Aside from skin cancer, prostate cancer is the most common cancer diagnosis among men. The statistics about prostate cancer are often confusing, however, because many prostate cancers are very slow growing and have no impact on a man’s health or lifespan. Over the past 30 years, there have been many tremendous advances in the diagnosis and treatment of prostate cancer, providing reassurance to those men who have slow growing tumors and providing effective treatments for men with the more aggressive, potentially lethal cancers. Physicians at MarinHealth Urology | A UCSF Health Clinic collaborate with oncologists, radiation oncologists, and other specialists to ensure that our patients receive the most state-of-the-art cancer treatment available.

How is prostate cancer diagnosed?

Most cancers are initially detected on the basis of an elevation of the blood test Prostate Specific Antigen (PSA). Physical examination, the ‘digital rectal examination,’ can also detect some tumors that may not be evident by PSA alone. Currently it is recommended that men age 55-69 consider annual prostate cancer screening, though many other factors such as a family history of prostate cancer, ethnicity, and life expectancy may influence when and if a man elects to have this blood test performed. Decision making about prostate cancer screening can be confusing for many patients, and we recommend that men discuss their options with their primary care providers.

The evaluation of an elevated PSA or abnormal physical examination has been transformed by advances in MRI imaging. A 3-Tesla MRI is able to detect 95% of clinically significant prostate cancers. This technology has dramatically reduced the need for a man at low risk for prostate cancer to have a biopsy. At the same time, the “3T MRI” has greatly improved the accuracy of biopsies so that now even small but potentially lethal tumors can be found earlier. Other new imaging technology, such as PET scans, are improving the staging of prostate cancer so that treatments can be more appropriately tailored to a specific man’s diagnosis.

Prostate cancer diagnosis has also improved tremendously due to genomic tests that allow us to predict more accurately the prognosis for prostate cancers. Knowing whether a specific cancer is likely to grow rapidly or slowly based on the mutations that can be identified in the biopsy tissue enables physicians and patients to select the most effective treatment with the fewest risks or side effects.

How is prostate cancer treated?

Men who undergo prostate biopsy and are found to have prostate cancer will generally meet with a team of physicians to discuss an array of management options that might be appropriate. Some of the most common options are as follow:

• Active surveillance: if a tumor has characteristics suggesting that it might grow slowly, a man might elect active surveillance; typically, he will be examined and have the PSA checked regularly, and may undergo MRI or repeat biopsy one or two years after his initial diagnosis.
• Surgery: robotic assisted laparoscopic prostatectomy, performed by a specially-trained urologist with the DaVinci surgical system, can achieve outstanding results measured by cancer cure rates and quality of life. Patients typically are in the hospital just overnight after undergoing this several hour procedure.
• Radiation therapy: similar to surgery, radiation therapy for prostate cancer has advanced tremendously in the last decade. New imaging modalities, techniques to improve targeting and protect adjacent organs, and the combination of radiation with medical therapy have all led to greater cure rates and few complications.
• Treatment for advanced disease: if at the time of diagnosis a prostate cancer is no longer confined to the prostate itself, medical treatments may be more appropriate than surgery or radiation. The mainstay of treatment is androgen deprivation therapy—medications that reduce the production of testosterone which in turn will cause prostate tumors to regress. While this very effective approach has been available to patients for more than 70 years, there are now a broad array of additional therapies that a medical oncologist can employ to keep a patient symptom free for many years.
• Emerging technologies: the treatments for prostate cancer continue to evolve steadily. Therapy such as high intensity focused ultrasound are being investigated presently as alternatives to surgery and radiation. MarinHealth physicians specializing in prostate cancer—urologists, radiation oncologists, medical oncologists, radiologists and pathologists—collaborate with one another and with colleagues at UCSF Health to ensure that every patient has access to the most advanced treatment options.

Need a urologist? Find a MarinHealth doctor near you.

Patrick Bennett, MD is a urologist practicing at MarinHealth Urology | A UCSF Health Clinic.

Master Disaster: Keeping Your Family Safe in Wildfires and Other Emergency Situations

By Julie Lavezzo

More than 72,000 communities across the country are now at risk for sudden, catastrophic wildfires. This is particularly concerning on the West Coast, where years of drought have turned our traditional “fire season” into a year-long hazard. That’s why it’s critical to do all you can to safeguard your home and, more importantly, protect your life and the lives of your loved ones.

Your Home

To reduce your home’s flammability:

• Clear leaves and dead vegetation from your gutters, roof, and deck and in a 10-foot radius around your home.
• Keep flammable materials such as firewood or propane tanks at least 30 feet from your home’s foundation, barns, garages, and sheds.
• Prune trees so the lowest branches are 6 to 10 feet from the ground.
• Hydrate and maintain your lawn. Investigate landscaping options for outdoor areas that are both drought and fire resistant.
• Prevent flying embers from entering your home. Inspect shingles and roof tiles, cover exterior attic vents with metal wire mesh no larger than 1/8 inch, enclose vents, screens, or eaves with metal mesh.
• Dispose of grass clippings, branches, weeds, and other garden debris promptly.

To learn more about how to protect your home and property, visit FIRESafeMarin.org.

Be informed and prepared

Contact your local planning/zoning office to find out whether your home is in a high-risk area, or click here for a map of Marin County and be sure to follow local ordinances. Talk to your local fire department for tips on how to prepare and get advice on when to evacuate. Develop an emergency evacuation plan that includes TWO ways out of your neighborhood. Designate a safe place to meet after your family has escaped. Keep a “Go Bag” packed and at the ready, with emergency and healthcare items, critical paperwork, and irreplaceable items including:

• Prescription medications and other critical healthcare items
• Papers you can’t afford to lose such as passports, deeds/titles to home and car, bank information, insurance policies, birth certificates, health records
• Pen/pencil and notebook
• Family photos
• Cash
• N-95 masks
• Spare eyeglasses
• First aid kit
• Phone charger

If you live in an isolated area, you may want to pack a second bag containing items such as:

• A 3-5 day supply of non-perishable food and water, including food for your pet
• Mylar blankets
• Expanded first aid kit and hygiene supplies
• Waterproof matches and/or flint and steel
• Communication devices such as a radio, walkie-talkie, HAM radio, air horn, or whistle
• A tent, blankets or sleeping bags, extra clothing
• Basic tools including a good Swiss Army knife, can opener, and hammer
• Plastic sheeting and duct tape
• Light: flashlight with extra batteries, head lamp, solar light etc.

When a Wildfire Threatens Your Area

Sign up for text alerts with AlertMarin, which will let you know when to take action in an emergency, and Nixle, which provides police alerts based on ZIP codes. If there is a fire near you:

• Gas up and pack the car. Place your go bag and other valuables in your vehicle and keep pets and kids close to home and ready to evacuate. Park your car in your driveway, not your garage. If possible, back in so you’ll be able to drive out quickly.
• Move patio or deck furniture, wooden containers for plants, and other flammable objects indoors or as far from your home, garage, or shed as possible
• Close all windows, doors, vents, garage doors, dog doors—any openings that could permit embers from entering your home
• Connect garden hoses and fill pools, hot tubs, garbage cans, and other large containers with water—firefighters may need to use these water sources to put out flames
• Don’t wait to evacuate. You don’t want to get caught in a traffic jam and leaving early clears the roads for firefighters to get equipment to your area.
• If you are asked to evacuate, listen for news updates and don’t return home until your area is declared safe.

Planning for a Power Outage

When hazardous weather conditions cause a heightened risk of fire, PG&E is prepared to enact Public Safety Power Shutoffs (PSPS). In the event of a power shutoff, do not call PG&E. To prepare, have an evacuation plan in place, keep mobile devices charged and vehicles gassed up and have 5-7 days-worth of food and water on hand. If you prefer to go stay in a hotel outside the outage zone, plan for that in advance because others will have the same idea!

Whether or not you plan to leave home during a planned power outage, unplug appliances and electronics and turn off air conditioners. This will prevent a potentially damaging power surge when the electricity comes back on. If you have advanced warning of a brown out, freeze leftovers, milk, and fresh meat and poultry to keep them at a safe temperature longer and stock your freezer with ice. Food is safe to eat if the refrigerator temperature is lower than 40° degrees and the freezer temperature is below zero.

Keeping Life Support Devices Working During a Power Outage

It’s essential to plan for your life support needs. Keep emergency numbers on hand and have a back-up phone that does not use electricity and a battery powered radio to get outage updates. Purchase a backup generator or plan on spending time with a friend who lives outside the blackout zone so you can use your medical device.

For additional advice on how to stay safe and comfortable during a power outage, click here.

If you rely on electricity for medical devices, be sure to sign up for PG&E’s Medical Baseline program to receive extra notifications and support before a PSPS.

Earthquake Safety

Earthquakes are a fact of life here in Northern California. While many of the safety measures are similar to fire evacuation preparations, there are some additional tips to help prevent injuries in the event of a major quake:

• Have escape routes and meeting places worked out in advance, but keep in mind that while a wildfire may require you to evacuate, a major earthquake might mean the opposite: you may need to shelter in place if roads or bridges are heavily damaged.
• Bolt bookcases to the wall and move heavy books and other items to the lowest shelves
• Secure and latch filling cabinets and use child safety latches to secure regular cabinets
• Use Velcro tabs to secure aquariums, computers, TV equipment, and fragile vases and decorative objects to surfaces
• Secure TVs, pianos, refrigerators, and other heavy objects that could roll in an earthquake. Secure the water heater with plumber’s tape.
• Teach your kids to “duck and cover” and have a family drill several times a year
• Keep a 5-7 day supply of nonperishable food on hand, as well as drinking water
• Store flashlights, a radio, extra batteries, heavy gloves, trash bags, and tools in an easily accessible location
• Familiarize yourself with the earthquake safety plan at your children’s school, including the location of a planned evacuation site, procedures for reuniting parents and children, and phone trees or other methods of emergency communication
• Fill your bathtub(s) with water immediately after an earthquake occurs so you have an emergency water supply on hand

For additional disaster preparation checklists, refer to these links:

• National Fire Protection Association Wildfire Safety Tips
• American Red Cross Family Disaster Plan
• Diabetes Patient Preparedness Plan
• Emergency Preparedness for Older Adults and People with Disabilities
• Emergency Power Planning for People with use Electricity and Battery-Dependent Assistive Technology and Medical Devices
• How to Prepare for an Emergency of Disaster When You Have Lung Disease
• Medical Information Wallet Card
• Oxygen Users Disaster Evacuation Planning Guide
• Ready Marin Build a Kit Checklist
• Ventilator Respiratory Disaster Planning Guide

Julie Lavezzo is MarinHealth Medical Center’s Director of Safety, Security and Transportation.

Breastfeeding for a Great Beginning

By Julie Moxley, RN, BSN, IBCLC

The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months, with continued breastfeeding—in addition to appropriate complimentary foods—for one year or longer. Some of the benefits to both mother and baby are:

• Breast milk provides balanced nutrition and includes maternal antibodies that strengthen the baby’s immune system.
• Breastfeeding enhances mother/child bonding.
• Mothers who breastfeed have added protection against breast and ovarian cancer, anemia, and osteoporosis.
• Because breastfeeding burns calories, it can help mothers lose pregnancy weight.

MarinHealth® Medical Center is one of less than 600 hospitals in the United States to earn the prestigious Baby-Friendly® Designation. Sponsored by the United Nations International Children’s Fund and the World Health Organization, the International Baby-Friendly Hospital Initiative recognizes hospitals and birth centers that offer an optimal level of breastfeeding care and support.

We use the latest evidence-based data to implement our breastfeeding policy. Because babies don’t regulate their body temperature at birth and are subject to stress and cold, we delay bathing for 12 hours. Instead, we gently wipe newborns down and place them on their mother’s breast for skin-to-skin bonding. This keeps babies warm, encourages nursing, stimulates milk production, and regulates their blood sugar. We also delay weighing, measuring, and the administration of Vitamin K and eye ointment. Our nurses work with new moms to initiate breastfeeding within the first hour after birth. We also teach mothers how to pump and maintain lactation when they are away from their babies.

Resources and Tips for Breastfeeding Success

Breastfeeding is a natural experience, but it doesn’t always come naturally. Our team guides you every step of the way. After you bring your little bundle home, these tips should help with breastfeeding success:

• Create a comfortable space just for breastfeeding. A comfy rocking chair is ideal. Have pillows, burp cloths, nursing pads, and water within reach.
• Wear a comfy top that is easily unbuttoned or pulled up.
• Let your baby set the schedule. Newborns tend to eat every few hours. You will soon learn your baby’s signals, such as opening and closing their mouth, making sucking noises, turning inward in search of a breast, drooling, fidgeting, whimpering, or crying.
• Nurse baby on one side until your breast feels soft or no longer full. Then take a break to burp the baby, and try to feed from the other breast. If the baby doesn’t show any interest or latch on, they are probably satisfied. Start your next feeding with the full breast.
• Treat your nipples gently. Pat them dry after feeding and change pads if you leak milk. Sore nipples can be soothed with pure lanolin but consult a lactation consultant if breastfeeding is painful.
• Don’t stress over length or frequency of feedings. Each baby has a unique schedule. If your baby is growing well and meeting developmental milestones, you’re doing just fine.
• Don’t give up—get help. In the early weeks, some women need extra help with breastfeeding. Call MarinHealth’s Lactation Center at 1-415-925-7522 or talk to your doctor.
• Get support from other new mothers. MarinHealth offers a free, virtual, weekly support group for new mothers. This is an ideal forum for discussing breastfeeding, newborn care, and general parenting questions. You might even make some new friends! Learn more.

To speak with one of our lactation consultants or make an in-person appointment, call: 1-415-925-7522.

Learn more about the benefits of breastfeeding and how a Baby-Friendly hospital can help you getting started and have a positive experience after giving birth by listening to this short podcast. If you’re pregnant or planning a pregnancy, sign up for MarinHealth’s maternity email series.

Julie Moxley, RN, BSN, IBCLC, is a lactation consultant at MarinHealth Medical Center.