Concussions, Sub-concussive Impacts and long-term Neurological Impairment
Hey Peter, I'm curious if you have thoughts related to the literature you have previously covered on the podcast related to Alzheimer's disease risk reduction and how it might be applied in the world of athletics? I am a Performance Dietitian who works with athletes that regularly experience concussions and repetitive sub-concussive impacts. The literature in this area is more limited than I think most people realize, especially in the United States due to the media surrounding American Football and CTE. Acutely, interventions like DHA, creatine and curcumin have been suggested to reduce the severity/duration/damage of concussions, however this evidence is primarily from animal models (since we cannot ethically give humans concussions...) or pulled from small case studies on TBI. With all this in mind, I've started delving more into the literature on Alzheimer's disease risk reduction, and would love to hear your thoughts, or someone like Richard Isaacson's or Francisco Gonzalez-Lima's thoughts on if or how some of this literature may be applied to athletes both during their career and once they've retired.
Elevated D-Dimer
After a very mild case of Covid & hearing how Covid could cause D-Dimer levels to increase, I decided on a test. About 1 month post Covid, D-Dimer came back @ 1.04. On a 6 month follow up it was still .98 (about 2x the upper bound). Since this is a bit of a needle in the haystack approach, what diagnostics would you look to do if all other blood work so far has come back "normal"?
Daily Low-Dose Aspirin as Cancer Preventative
Years ago The Economist magazine presented an article (https://www.economist.com/science-and-technology/2010/12/09/wonder-drug) suggesting that daily low dose aspirin, taken over a span of years, might reduce the risk of cancer by as much as 20%. This fell into the ‘too good to be true’ category, so I read the source paper and a few other published papers. What I read seemed promising, but I am not qualified to assess medical literature. One thing seems clear, even if aspirin were a safe and effective treatment, as an off-patent drug, it may be trapped in a market failure. There is little incentive for pharmaceutical companies assess its viability and bring it to market. A cynic would say the incentives are against bringing it to market. Could you weigh in on the prospect of using aspirin as a cancer prophylactic?
Metabolic and performance impacts of Meldonium (Mildronate)
What are Peter's thoughts on the metabolic and performance impacts of Meldonium? In 2015-2016 it rose to prominence when it came to light that hundreds of athletes from primarily Eastern Europe were using the drug as a performance enhancer. That aside, it's on-label use as an anti-ischemia medication, and studies (albeit funded by the manufacturers) seem to suggest a general set of cardio-protective, and mitochondrial health benefits. I am surprised this has never come up on the podcast before.