Explore the growing concerns about plastics in our environment, their entry into our bodies through food, water, and air, and the potential health risks, from hormone disruption to cancer. Read Article, Take Test , Get FREE 🎓 CME Certificate with Valid Email We’ll send you occasional updates. Your email stays private—never sold or shared.  😇 The Effects of Plastics on Human Health By Stuart M. Caplen, MD   last updated 6/22/2025 Plastic was invented in the 1860s, and an initial use was in making combs.  Improved plastic formulations became commercially available in the 1940s, and production and sale of plastics rapidly increased after World War II.[1]  Plastics are now in use all over the world, and humans are ingesting or inhaling plastics in ever-increasing amounts.  This article will discuss some of the sources of plastics and their known effects on human health.  While there can be specific negative health effects for the workers who manufacture plastics, this article will only discuss some of the risks to the general population. Plastics Global production of plastics is an exponentially increasing phenomenon that increased from 2 million metric tons in 1950 to 380 million metric tons in 2015.  It is estimated that much of the plastic that was ever produced has been released into the environment and remains there in some form.  As of 2015, an estimated 6,300 million metric tons of plastic waste had been generated, with about 9% recycled, 12% incinerated, and 79% deposited in landfills, or disposed of into the natural environment such as into rivers, seas or oceans.[2,3]   99% of plastics produced today are from fossil fuels and contain numerous potentially harmful substances, both chemicals which can leach out of the plastic and plastic particles.  The term plastic refers to various types of polymers which are synthesized from monomers and formed into macromolecular chains.[2]  Polyethylene is the most widely used plastic in the world, found in bottles, plastic wrap, grocery bags, as well as many other products. Chemicals, some of which are known to be hazardous, can leach from plastics.  Some, which are linked to cancer, can be found in polyurethanes (flexible foam in furniture, bedding, and carpet backing), polyvinyl chloride (pipes, packaging, wire, and cable coatings), epoxy resins (coatings, adhesives, and composites, such as carbon fiber and fiberglass), and polystyrene (food packaging, hard plastic in consumer products).[2]  Plastics may also contain potentially harmful additives such as brominated flame retardants, lead heat stabilizers, and plasticizers (which make plastic more flexible and durable), such as phthalates.  In addition, the hormone-disrupting plasticizer Bisphenol A (BPA) can leach from plastic in water bottles and epoxy beverage can liners.[2] Chemicals commonly migrate from packaging into food.  Some plastic polymers used for food packaging can degrade into toxic monomers when they come into contact with acidic or alkaline foods, ultraviolet light, and heat.  Migration of plastics from food and beverage packaging into food products is thought to be one of the highest sources of human exposure.[2] Plastic particles that are concerning to human health are categorized as microplastics (particles 1000 nanometers to 5 millimeters (mm) in size) and nanoplastics (particles smaller than 1000 nanometers).[4]  For reference, a human hair is 50,000 to 100,000 nanometers (0.05mm to 0.1mm) in width.[5] How Do Plastics Get into the Human Body?  Microplastics and chemical additives enter the human body through drinking water, food, and from the air.  In studies of microplastics, some investigators actually test the materials detected to ensure they are plastics, while others report finding anthropogenic (resulting from the influence of human beings on nature) debris that is consistent with microplastics, without actually testing the materials.   A study of globally sourced tap water found anthropogenic fiber particles consistent with microplastics in 81% of the samples.[6]  In other studies, there was great variation in the amount of microplastics found in tap water, depending on the location.  For example, no plastics were detected in a study of Norwegian drinking water, while 100% of the samples in a study of Mexico City drinking water contained microplastics.[7,8]  Another study of 11 brands of globally sourced bottled water found microplastic contamination in 93% of the bottles.  As polypropylene was the most common polymer found, it was theorized that some of the microplastic found could be from the bottlecap, with some entering the water when the bottle was opened.  Some glass water bottles were also found to have plastic microparticles which might indicate contamination from the bottling process or from the water itself.[9]  A number of studies in the literature from different geographic sites have reported that bottled water typically contains more microplastics than tap water.[10] A study of school meals packed in aluminum dishes for children aged 3 to 10 found that levels of the phthalates di(2-ethylhexyl)phthalate (DEHP) and di-n-butylphthalate (DBP) in the food increased by more than 100% compared to the initial baseline levels in the food.  Aluminum used in food storage is not infrequently coated with plastic.  Aluminum cans may also be coated with a plastic epoxy coating.[11] Polypropylene infant feeding bottles from 48 geographic regions were tested, and it was estimated that the average daily consumption for a 1-year-old feeding from them was 1,580,000 polypropylene microparticles, with a range of 14,600–4,550,000 microparticles per day.  The numbers were higher in developed countries.[12]  In another study, 76% of breast milk tested (26 out of 34 samples) contained plastic microparticles, mostly consisting of polyethylene, polyvinyl chloride, and polypropylene.[13]  An Australian study found that 95% of tested rice samples had plastic contamination.  There was no difference between rice packed in plastic or paper.  Instant rice, on average contained four times the plastic content of non-pre-cooked rice.[14]  An Italian study looked at apples, pears, broccoli, potatoes, and carrots, and found plastic particles in all of them, with apples and pears containing the most.[15]  Plastics can be absorbed by plant roots if there is plastic in the water supply or soil.[16]  A study testing 16 different types of protein, including chicken, shrimp, fish, steak, tofu, and plant-based ground beef, found microplastics in all the foods tested at varying levels.  The highest levels were found in highly processed foods such as breaded shrimp and fish sticks.[17]  Chemical polymer fibers were found in 100% of 19 honey samples from five different countries, and five sugar samples.[18]  A study of plastic release from plastic triangular tea bags found that one plastic teabag released approximately 11.6 billion microplastics and 3.1 billion nanoplastics into a single cup of tea.  However, while the billion numbers are huge, it should be noted that one source calculated that the total amount of plastic released is about 60 millionths of a gram.[19,20]  Microplastics have been found in varying percentages in fish and other seafood around the world which potentially may be ingested by humans.[21,21A]  Multiple studies have found varying percentages of microplastics in sea salts.[6,22]  Annual plastic flows to the ocean are expected to increase from 11 million metric tons in 2016 to 29 million metric tons in 2040.[23]  One dire estimate is that if the use of plastic and management of refuse remains unchanged there could be more plastic by weight in the oceans than fish by 2050.[24]  While there are many sources of ocean plastic, one surprising estimate is that about 8.6% of microplastics in the oceans come from tire dust.[23]  In addition to plastic waste products and dust entering water, sunlight can break down plastics and further contribute to smaller plastic particles being released into the water.[25]   Types of microplastics in the surface water and sediments off the coast of Southern China (a) pellets, (b) fibers, (c) fragments, (d) films [26] Plastic cutting boards can also be source of plastic in food, and also when washed off, a source of plastic in waste water.[27] Organic food may also contain substances from plastic.  Organic fertilizer has frequently been found to contain plastic particles.[28,29]  In 2024, Consumer Reports tested for and found phthalates in both organic and nonorganic food products.[30]  Phthalates were used in the past in the U.S. in many enteric-coated medications to help control drug release, and in 2012 the FDA recommended they no longer be used.[31,32]  In 2022 the FDA removed 23 phthalates no longer being used in the food industry from food contact situations, such as tubing or packaging, but in a controversial decision, left nine still available for use.[33,34]  Phthalates have been associated with increased insulin resistance[35,36,37], arteriosclerosis[37], hypertension[36], fertility problems[38,39], behavioral disorders and impaired motor skills in children[40,41], pregnancy loss[42,43], endometriosis[43A,43B], male infant genital abnormalities[42], and cancers.[31,44]  Plastics in the Human Body When searched for, plastic compounds have been found nearly everywhere in the human body. In a recent study, asymptomatic patients who required a carotid endarterectomy had their carotid plaques excised and tested for embedded plastics.  58% of those plaques had detectable amounts of polyethylene, and 12% had polyvinyl chloride.  Electron microscopy demonstrated jagged foreign particles among plaque macrophages and also scattered in the plaque itself.  Subjects who had plastic particles in their carotid plaques had 4.5 times the risk of having a stroke, myocardial infarction, or death in the next 34 months compared to those that did not.  The majority of the particles found were nanoparticles, as it has been suggested that larger particles may not be absorbed as easily into the blood from the gastrointestinal (GI) tract.[4]  Other researchers looked at arterial thrombi removed after emergency surgery of the lower extremities or aorta.  It was reported that microplastics were found in 61.5% of the 26 thrombi they examined.[45] Cardiac tissue samples were taken during surgery in another study, and although not in 100% of the samples, microplastics were found in some of the pericardial and epicardial fat, myocardial and pericardial tissue, and in the left atrial appendage.  As another part of the study, microplastics were noted in the blood of patients prior to surgery.  After surgery, the patients’ blood samples revealed two additional types of microplastic particles and also smaller sized microplastics compared to pre-surgical blood samples. This suggests that medical procedures might be another way plastic enters the body.[46]  Human lung tissue samples containing A) polyethylene terephthalate and B) polyurethane [47] In another study, lung tissue removed during thoracic surgery was examined, and microplastic particles were found in 85% (11 out of 13 tissue samples).[47]  Inhalation of plastic particles can occur after burning plastics in waste disposal, exhaust from plastic production, or plastic particles floating in the air.  A large source of plastic particles in the air comes from automobile and truck tires as they wear down from road friction.  Plastic textile fibers can also be released into the air.[2]  Extended respiratory exposure to microplastics such as polypropylene can potentially cause asthma and pneumoconiosis (lung disease caused by the lung's reaction to inhaling certain dusts).[48] A study of human and canine testicular tissue found microplastics in all samples, with the levels in human testes three times higher than in the dog testes.[49]  In an Italian study, microplastics were found in 60% of ten samples of human semen, while a Chinese study found microplastics in 100% of 36 semen samples tested.[50,51]  There has been a world-wide decrease in fertility and it is suspected that microplastics could be a factor.  (Other substances, such as herbicides, have also been found in semen samples suggesting the etiology of the infertility problem may be multifactorial.[52])  In a study looking at six human post-partum placentas, microplastics were found in four of the samples or 66.7%.[53]  Scientists looking at human post-mortem liver, kidney, and frontal cortex brain samples found micro- and nanoplastics in the brain at 7 to 30 times the concentrations measured in the livers or kidneys.  They also compared results from 2024 to similar samples from 2016 and found significantly more plastic material in the 2024 liver and brain tissue than in the 2016 samples. The most common plastic found was polyethylene.[54] Most ingested plastic is eliminated from the body in feces.  The first report of researchers documenting microplastics in the stool was in 2018, when microplastics were found in all eight of the subjects who lived in various places in Europe and Asia.  The median amount of plastic discovered in those subjects was 20 microplastic particles in 10 grams of stool (0.35 ounces).[55]  A study comparing microplastics in infant stools to adult stools, found that the infants’ stool contained up to 14 times the amount of microplastics per gram of stool than the adults, indicating higher infant exposure to microplastics.  All six infant and ten adult stool specimens tested were positive for microplastics.[56]  In vitro  studies with simulated human intestinal models have found that ingestion of plastics can change the gut microbiome, with potentially negative effects on health.[57]  A study comparing patients with irritable bowel syndrome (IBS) to controls found higher levels of microplastics in the patients’ feces who had IBS, suggesting that higher levels of plastic exposure might possibly contribute to the development of the disease.[58]  Another study examined colon tissue removed during surgery and found microplastics embedded in normal colonic tissue as well as higher amounts of microplastics embedded in colonic adenocarcinoma tissue samples.[58A] Although not proven, researchers are looking into the connection between microplastic ingestion and the noted increase in colorectal cancers in young adults.[59] In vitro  experiments have demonstrated impaired lipid digestion and metabolism when microplastics are present.  It was found that microplastics could cause smaller lipid particles to aggregate, creating larger, less absorbable lipid particles.  Microplastics also changed the structure of lipase which decreased its activity and impaired fat digestion.[60,61] The chemical additive BPA, in some studies, has been found in the urine of up to 86% of adults and over 90% of children.[62]  BPA migrates out of polycarbonate water or beverage bottles into the water at levels that increase with heat.  Migration of BPA in liquids also occurs with epoxy-coated beverage cans.  BPA has been found in either animal or human studies to have a number of adverse effects.  BPA has been shown to increase the chance of having insulin resistance and contracting type 2 diabetes.  There is also some data that BPA may interfere with thyroid hormone metabolism.[63]  BPA has weak binding affinity to estrogen receptors, and exposure is hypothesized to lead to accelerated puberty and may also worsen estrogen-sensitive tumor growth.  BPA has been found to potentially damage DNA.  It may also alter immune responses.  Elevated BPA levels in pregnant women may be a risk factor for male autism.[64]  Finally, in vitro  studies demonstrated BPA may increase a cancer’s resistance to some chemotherapeutic drugs.[65] Addendum : Two recent studies have discovered microplastics in additional parts of the body.  Microplastics were found in 100% of bone marrow samples in one study[65A].  Another study, found the widespread presence of microplastics in the synovium (membrane lining) of hip and knee joints in patients undergoing arthroplasty.[65B]      Animal Studies  Microplastics have been reported in animals to migrate from the GI tract and have been found in the lungs, liver, kidneys, muscles, intestines, and brain[60,66]. The effects of microplastics depends on the size, shape, quantity, and probably individual variation of the response to plastics.  Animal experiments indicate that microplastics can cause dysfunction in the liver and intestines.  Animal studies have shown that exposure to microplastics may increase oxidative stress.[67]  Oxidative stress may cause inflammation, which can have numerous deleterious effects on the body.[22]  Microplastics have been shown to induce an immune response in animals.  In some animal studies, microplastics have been demonstrated to inhibit acetylcholinesterase activity, which led to neurotoxicity.[60]  Chronic exposure to polystyrene in mice damaged the blood brain barrier, deposited microplastics in brain tissue, and led to learning and memory dysfunction.[68]  Mouse studies have shown microplastics can reduce the quality of oocytes as well as sperm quality.[60]  An experiment using a rat model of induced rheumatoid arthritis, reported that microplastics could increase inflammation and potentially worsen cartilage damage in rheumatoid arthritis.[69]  Discussion As a byproduct of plastic manufacturing and use, unfortunately humans now breathe or ingest micro- and nanoplastics daily.  Some scientists have labeled this time period as the "Plasticene era"[70] due to the abundant amount of plastics on the earth.  Microplastics are in the oceans, soil, air, drinking water, and food. They can be released from food packaging, clothing, carpets, tires and many other manufactured products. Some chemicals contained in plastics are potentially carcinogenic, some are endocrine disruptors, and some can increase oxidative stress and inflammation.  They may increase the chance of miscarriage and may adversely affect brain development in children.   Most ingested plastic is removed in feces, nevertheless, microplastics have been found inside the body almost everywhere researchers have looked.  One study reported that plastic embedded in arteriosclerotic plaque increased negative clinical outcomes.[4]  A study found plastics in human brain tissue, in increased amounts, compared to specimens from eight years ago.[54]  With respect to infants, microplastics have been found in placental tissue, breast milk, in polypropylene infant feeding bottles, and in infant feces, so potentially humans may be exposed for their entire lives.  Microplastics can negatively affect the intestinal biome, and also may be playing a part in the world-wide decrease in fertility.  Plastics appear to have many other potentially negative effects and scientists are still trying to discover all the connections between plastic ingestion or inhalation and deleterious health effects.  Not all human subjects were found to have plastic particles in the various tissues or organs examined.  This may represent an area for further study.  It may simply represent a difference in the amount of plastic intake.  It also may possibly be due to genetic or other factors that impede plastic absorption into the blood stream from the GI tract or lung, which might lead to therapies that can decrease plastic deposition in the body.  The ubiquitous use of plastic in modern societies is evidenced just by looking in a refrigerator and realizing how much food is packaged in plastic, plastic-coated metal, or plastic-lined paper cartons.  In addition, most, if not all, the food and liquid in the refrigerator probably already contained microplastics before being packed in their containers. On an individual level, it is currently nearly impossible to avoid ingesting microplastics and plasticizers.  Some suggested methods of reducing plastic intake are decreasing intake of water or beverages bottled in plastic, using food-grade silicon, or glass food storage containers instead of plastic, not using cutting boards made of plastic, and not microwaving food in plastic containers.  Fresh, minimally processed foods have been found to contain fewer plasticizers than fast food.  It has been suggested that the vinyl gloves worn in the preparation of fast foods may possibly further increase plasticizer levels in the food.[71,72]  Filtering drinking water has been shown to reduce microplastic levels, but performance can vary greatly between models.  One study reported that water filters that incorporated microfiltration or membrane filtration removed more plastic, than those that did not use that technology.[73] Solving the world-wide problem of reducing human exposure to plastics would be an immense task, requiring an enormous change in the way modern societies function. 🎓  Want Free CME Credit for This Article? Take the quiz now at www.FibonacciMD.app . It only takes a few minutes! Your certificate will be emailed to you after you pass the quiz and complete a short evaluation We’ll send you occasional updates. Your email stays private—never sold or shared.  😇 References ✅ Earn Free CME Credit for Reading This Article Eligible for 0.5 PRA Category 1 Credit Click the button below to take a short quiz. A valid email is required to send your certificate. We’ll send you occasional updates. Your email stays private—never sold or shared.  😇

Understanding Cancer Antigens CA 125 and CA 19-9: Key Biomarkers in Cancer Detection Tumor markers, or cancer antigens, are substances found in the blood, urine, or tissue of some cancer patients. This article will provide an introductory overview of two key tumor markers: CA 125 , often used in the management of ovarian cancer, and CA 19-9 , a biomarker primarily associated with gastrointestinal cancers like pancreatic cancer. We will explore their clinical significance and applications i n monitoring these diseases. by Cheng-Hung Tai, MD, Michelle Boyar, MD, and Nancy E. Mills Edited by Rich Strongwater, MD Cancer Antigen 125 AKA CA 125 CA 125 II CA-125 CA-125 II carbohydrate antigen 125 carcinoma antigen 125 MUC16 Mucin 16 Cancer antigen 125 (CA125) is an antigenic tumor marker expressed by epithelial ovarian neoplasms and cells lining various organs such as the endometrium, fallopian tubes, pleura, peritoneum, and pericardium. [1] Cancer antigen 125 (CA-125) is a human protein that is now used as a biomarker but was first discovered in the early 1980’s as a potential treatment for ovarian cancer.  Levels are often elevated in patients with ovarian cancer. The lack of sensitivity and specificity makes the use of CA-125 for early detection of ovarian cancer controversial. However, levels are often examined to assess response of ovarian cancer patients to treatment. Many benign conditions can result in an elevation of CA-125 levels, including normal menstruation, pregnancy, endometriosis, uterine fibroids, pelvic inflammatory disease, and liver disease. In addition, elevated CA-125 levels may be seen in other malignancies, such as those affecting the fallopian tubes, endometrium, breast, lung, pancreas, and gastrointestinal tract. Any tumor causing peritoneal disease or carcinomatosis can cause elevated CA-125 levels. Diagnostic Tests The original CA-125 test has been used since the 1980s. The more recent CA-125 II test is more specific, but there is no statistical advantage in using one test over the other. Normal laboratory values of each test generally vary depending upon individual laboratory ranges: CA-125: ≤ 35 U/mL CA-125 II: < 20 U/mL The CA-125 II test is more useful in postmenopausal women with adnexal masses suspicious for malignancy. In premenopausal women, CA-125 values fluctuate with menstruation, which results in its decreased sensitivity and specificity in this population. The American College of Obstetricians and Gynecologists has stated that serum CA-125 levels > 200 U/mL is a criterion for referral to a gynecologist or even a gynecologic oncologist. In the 2011 guidelines, this threshold was removed, and no specific numerical value was assigned; a very elevated CA-125 level and clinical evaluation should dictate further work up by a gynecologist or gynecologic oncologist. Specimen Requirements and Procedure When the CA125 assay is used for cancer diagnosis, sampling should not be conducted immediately before or during menstruation because the physiological elevation of the CA125 levels may provide false-positive results. [9][20]  The serum samples for CA125 should not be collected within 2 weeks of surgery, as the levels may become falsely elevated secondary to tissue damage. CA125 levels have a half-life of 6 days and may require a few weeks to return to normal levels after surgery. A pre-treatment sample should be used as a reference for evaluating CA125 levels postoperatively. [1]   [12] Clinical Significance CA125 plays a significant role as a tumor marker, particularly in the preoperative assessment of patients with an adnexal mass and suspected to have an ovarian malignancy. [13]  Around 80% of the patients diagnosed with ovarian epithelial carcinoma show elevated CA125 levels, and levels are monitored post-treatment to assess the progression of the disease. [14]  The use of CA125 for preoperative assessment is more valuable among postmenopausal women compared to its use among premenopausal women. [4]     CA125 is successfully used for disease monitoring after treatment (chemotherapy or chemotherapy and surgery) and evaluating the progression of the disease. A significant correlation exists between the disease progression and serum CA125 levels, with doubling or halving serum values considered clinically significant. [8]   Most patients with CA125 levels greater than 35 U/mL demonstrate disease recurrence on second-look surgery. [1]   [8]   Prognosis Preoperative and postoperative CA125 concentrations may be of prognostic significance. [15]  After primary surgery and chemotherapy, persistent elevations of CA125 concentrations are associated with poor prognosis. Patients with preoperative CA125 concentrations greater than 65 U/mL are reported to have a lower 5-year survival rate and a 6.37-fold risk of death compared to patients with CA125 levels less than 65 U/mL. [12]   Normalization of CA125 levels after 3 cycles of combination therapy also correlates with improved survival. Importantly, CA125 concentration is not elevated in 10% to 20% of patients with advanced ovarian cancer. For these patients, using radiological imaging techniques and monitoring other tumor markers are necessary. [1][16] For more information- see National Institutes of Health.  Cancer Antigen 125- StatPearls by T Gandhi 2024 https://www.ncbi.nlm.nih.gov  › books › NBK562245 Cancer Antigin 19-9 AKA CA 19-9 CA 19-9 CA19-9 cancer antigen 19-9 carbohydrate antigen 19-9 Cancer antigen 19-9 (CA19-9) is a biomarker that is often elevated in malignancies of the gastrointestinal system, including pancreatic, neuroendocrine, colorectal, gastric, esophageal, and hepatocellular tumors. However, this antigen is also found in normal pancreatic fluid and bile and various benign conditions. Originally discovered as a monoclonal antibody for treatment of colorectal cancer, the current clinical significance of serum CA 19-9 is its usefulness in managing pancreatic cancer. Clinical Usefulness The following table depicts the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CA 19-9 with respect to the diagnosis of pancreatic malignancies. In one study, the 37 U/mL cutoff for CA 19-9 was the best value for discriminating pancreatic from other malignancies, with relatively low sensitivity (77%) but better specificity (87%). In general, CA 19-9 should not be used as a screening tool for pancreatic cancer. Serum CA 19-9 levels are useful to evaluate treatment response and determine a prognosis. Recently, higher cutoffs have been used, as this increases specificity at the cost of sensitivity. High levels of CA 19-9 often correlate with unresectable or advanced malignancies, whereas decreasing levels indicate a longer patient overall survival. As per American Society of Clinical Oncology (ASCO) guidelines, serial monitoring of CA 19-9 levels can be used to assess tumor response to treatment (surgery, chemotherapy, radiation therapy, or targeted therapy). Levels are checked once every 1-3 months. Decreasing levels suggest efficacy of a therapeutic regimen, whereas a rising (or unchanged) level may indicate disease progression and the need for further imaging and/or biopsy. Treatment decisions are not made solely on the basis of a rising or falling CA 19-9 level. Other Serological Biomarkers for Pancreatic Cancer  One “marker” under further evaluation for its clinical usefulness is the NLR.   An elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR) has been reported to be a negative prognostic marker in many types of cancer, including pancreatic ductal adenocarcinoma (PDAC). [17]   Ongoing research will analyze a multitude of potential biomarkers (including genetic) for pancreatic and other gastrointestinal malignancies.  Serologic panels will be further developed. These studies will be critical for identifying prognostic biomarkers and potential therapeutic targets. Courtesy of the National Library of Medicine References “Courtesy of the National Library of Medicine” or “Source: National Library of Medicine.” Bast RC Jr, Xu FJ, Yu YH, Barnhill S, Zhang Z, Mills GB. CA 125: the past and the future.  Int J Biol Markers.  1998;13:179-187. Eltabbakh GH, Gupta MK, Belinson JL, Kennedy AW, Webster K, Paraiso MF. Comparison between Centcor CA-125 and CA-125 II assays.  Eur J Gynaecol Oncol.  1996;17:504-506. 4.  American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016 Nov;128(5):e210-e226. [ PubMed ] Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen.  Am J Gastroenterol . 1990;85:350-355. Kim HJ, Kim MH, Myung SJ, et al. A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve.  Am J Gastroenterol.  1999;94:1941-1946. Locker GY1, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol.  2006;22:5313-5327. Kenemans P, Yedema CA, Bon GG, von Mensdorff-Pouilly S. CA 125 in gynecological pathology--a review. Eur J Obstet Gynecol Reprod Biol. 1993 Apr;49(1-2):115-24. [ PubMed ] Grover S, Koh H, Weideman P, Quinn MA. The effect of the menstrual cycle on serum CA 125 levels: a population study. Am J Obstet Gynecol. 1992 Nov;167(5):1379-81. [ PubMed ] American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer.  Obstet Gynecol . 2011;117:742-746. Balachandran A, Nayak SR. An Observational Study of Factors affecting CA125 Levels in Premenopausal Women. Adv Biomed Res. 2023;12:235. [ PMC free article ] [ PubMed ]  Meyer T, Rustin GJ. Role of tumour markers in monitoring epithelial ovarian cancer. Br J Cancer. 2000 May;82(9):1535-8. [ PMC free article ] [ PubMed ] Dodge JE, Covens AL, Lacchetti C, Elit LM, Le T, Devries-Aboud M, Fung-Kee-Fung M., Gynecology Cancer Disease Site Group. Preoperative identification of a suspicious adnexal mass: a systematic review and meta-analysis. Gynecol Oncol. 2012 Jul;126(1):157-66. [ PubMed ] Prat J., FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2014 Jan;124(1):1-5. [ PubMed ] Cooper BC, Sood AK, Davis CS, Ritchie JM, Sorosky JI, Anderson B, Buller RE. Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol. 2002 Jul;100(1):59-64. [ PubMed ] Lee M, Chang MY, Yoo H, Lee KE, Chay DB, Cho H, Kim S, Kim YT, Kim JH. Clinical Significance of CA125 Level after the First Cycle of Chemotherapy on Survival of Patients with Advanced Ovarian Cancer. Yonsei Med J. 2016 May;57(3):580-7. [ PMC free article ] [ PubMed ] Li J, Wang J, Li Y, Jiang W, Zuo D, Zhang X, Xiao J, Inamura K, Giovannetti E, Ren, L. Peripheral blood neutrophil-to-lymphocyte ratio as a prognostic marker and its association with the tumor-immune microenvironment in pancreatic cancer: a retrospective cohort study.   J Gastrointest Oncol.   2025 Jun 25;16(3):1248–1257. doi:  10.21037/jgo-2025-283

Zucchini Banana Muffins make the most of overripe bananas and extra zucchini, delivering a flavorful, healthy snack that’s low in calories and fat. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES  | Culinary Medicine   Low-Calorie | Low-Fat | Low-Cholesterol by Mary B Grosvenor, MS, RD Start your day off right with this nutritious breakfast treat. It’s a tasty way to use some extra fresh zucchini and provides a boost to your fruit, vegetable, nut and grain intake. I ngredients 1 cup enriched flour 1 tsp baking soda 1 tsp ground cinnamon ¼ tsp ground cloves ¼ tsp ground nutmeg ½ tsp salt 1 c zucchini , shredded ½ c banana, mashed 1/3 cup canola oil ¼ cup brown sugar ½ c white sugar 1 egg ¼ chopped walnuts Instructions Preheat the oven to 425 degrees. Combine dry ingredients – flour, baking soda, salt, nutmeg, cloves, and cinnamon. Whisk together the brown sugar, white sugar and canola oil. Once combined add slightly beaten egg.. Stir the zucchini and banana into the sugar mixture. Add the dry ingredients and stir until combined. Mix in the walnuts. Spoon into lined muffin tins, 2/3 full Place muffins in 425 degree oven. After 5 minutes reduce heat to 350. Bake 10-12 minutes or until toothpick inserted comes out clean. Makes 12 muffins Nutrition information per serving muffin  Calories 165, Fat 8g, Saturated fat 0.8g, Cholesterol 16mg, Carbohydrate 22g, Fiber 1.2g, Protein 2.2g, Sodium 210mg, Potassium 90mg Nutrition Chef Authors: Mary B Grosvenor, MS, RD Medically Reviewed by FibonacciMD editors. Editor’s Note - Appropriate for low-calorie, low cholesterol, low saturated fat dietary regimen. Read more about the health benefits of zucchini in our post " Keen on Zucchini " More healthy recipes with zucchini: Zesty Zucchini with Pesto Pasta Recipe Shrimp Scampi with Zucchini Noodles Recipe Chicken Noodle Soup with Zoodles Recipe

Adding chia seeds to your oatmeal gives a nutritional boost to an already healthy morning meal. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES  | Culinary Medicine   Low-Calorie | Low-Fat | Low-Cholesterol | High-Fiber This recipe combines oats, flax, and chia to provide a hearty high-fiber nutrient-dense breakfast option. Including yogurt increases the protein and the banana adds just enough sweetness. Finish this breakfast with fresh blueberries or raspberries or add an extra nutritional kick with sliced almonds or walnuts.  Ingredients ¼ cup rolled oats 1 Tbsp raw chia seeds 1 Tbsp ground flax seeds ½ ripe banana, thinly sliced ¾ cup water 1/3 cup nonfat vanilla skyr or Greek yogurt  1/3 cup blueberries Instructions Combine oats, chia seeds, flax seeds, and banana in a microwavable cereal bowl. Add water and mix well to wet all ingredients. Microwave on high for 2 minutes. Mash the banana pieces.  Stir in yogurt and top with blueberries. Makes one serving Nutrition information per serving Calories 340, Fat 10g, Saturated fat 1.1, Cholesterol 2mg, Carbohydrate 50g, Fiber 11g, Protein 16g, Sodium 39mg, Potassium 565mg Nutrition Chef Authors: Mary B Grosvenor, MS, RD Lori A Smolin, PhD Medically Reviewed by FibonacciMD editors. Notes This recipe works best with a very ripe, even mushy, banana. The nutrient calculations here use high-protein skyr. Greek yogurt has a similar protein content but any yogurt will work.  Editor’s Note- This recipe is appropriate for a low-calorie, low saturated fat, low cholesterol, high fiber, lacto-vegetarian dietary regimen. Learn more about the nutritional benefits of chia seeds in our article " Chia Seeds: An Ancient Superfood "

Learn how chia seeds went from being a staple of ancient civilizations to a modern-day superfood, and how to incorporate them into your diet. Culinary Medicine by Lori A Smolin, PhD   and Mary B Grosvenor, MS, RD   Chia seeds are small but mighty. These miniscule seeds pack a monumental nutritional punch. It is no wonder they have become one of social media’s latest viral health trends.  They are promoted as a source of fiber and healthy fats and to support digestive health. The current popularity of chia seeds has caused their market size to grow to $1.72 billion in the US, but their benefits are not a new discovery.   [1] Since 3500 B.C.E. chia seeds have been considered a nutritional powerhouse.[2] But are they everything modern promoters and ancient wisdom claim them to be?  Chia Origins and Reemergence Chia means strength in the language of the Mayans of early Mesoamerica where ancient runners and warriors used them to boost energy and increase stamina. [2]  These diminutive seeds were an important part of this early culture.  Along with corn, beans, and amaranth, they were a dietary staple. [3] They symbolized fertility, life, and sustenance and were often used as offerings to the gods for a good harvest. Chia seeds were even used medicinally to dress wounds and settle stomachs. [3]  However, when Spain colonized this region, the indigenous people were forced to grow European crops such as barley and wheat, and the use of this native plant diminished.   [3] It was not until the 1980s that there was a resurgence of interest in chia seeds, ironically, not for their health benefits, but for their ability to quickly sprout thick green “fur” on trendy terracotta figurines called “Chia Pets”. [3]  It took two more decades for chia seeds to reassert their rightful place as a modern, as well as ancient, superfood.  Seeds of Health Chia seeds have been called a superfood. Although the term “superfood” is technically a marketing term with no scientific definition, foods that are given this label are typically high in essential nutrients and offer potential health benefits. [4]  The nutrients and phytochemicals in chia seeds have been shown to reduce inflammation, improve blood lipid profiles and weight management, lower blood pressure and  blood glucose, and enhance gut health.[5] Although meta-analyses have not consistently found that adding chia seeds to the diet provides all of these benefits, as part of a healthy dietary pattern they contribute to overall health and help reduce the risk of chronic disease. [6,7,8]       Chia seeds are a good source of protein and healthy fats. A two-tablespoon serving provides about 4 grams of high-quality protein and 7 grams of fat. [5]  About 60% of the fat in chia seeds is from omega-3 fatty acids and 20% is from omega-6 fatty acids,   both of which are important for the structure of cell membranes. [9] While omega-6 fatty acids, which are found in vegetable oils, nuts, and seeds, are prevalent in the modern diet, omega-3s are harder to come by.[10]  Fatty fish are a common source, but chia seeds are one of the best plant sources. Chia seeds contain alpha-linolenic acid, an omega-3 that can be used to synthesize two other omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA is needed to form regulatory molecules that reduce inflammation, blood pressure, and blood clotting, and DHA is important for the structure and function of the retina of the eye.  Chia seeds provide plenty of dietary fiber; two tablespoons provide 40% of the amount recommended for an entire day. Most of the fiber in chia is mucilage, a type of soluble fiber that absorbs water. When soaked, the seeds swell, absorbing 10 to 12 times their weight in water, forming a gel around the seed [5].  This ability to form a gel gives this superfood a superpower: chia seeds slow absorption. This makes you feel full more quickly so it is beneficial when trying to cut back on calories. It also slows glucose absorption, reducing the postprandial rise in blood glucose, which can help reduce the risk of diabetes.[8,11]  This gel-forming soluble fiber also traps cholesterol and bile acids in the GI tract, helping to lower LDL cholesterol in the blood. [11] The soluble fiber in chia seeds also feeds the healthy bacteria in your gut and can help soften stool, making elimination easier and preventing constipation. [11]   Chia seeds are plentiful in the B vitamins thiamin and niacin and the minerals calcium, phosphorus, and magnesium needed for bone health, iron and copper for healthy blood levels, and manganese and selenium, which have antioxidant roles. Chia seeds also contain phytic acid, or phytate, which is a benefit and a risk: It is an antioxidant, but it can bind minerals, particularly calcium, iron, and zinc, in the digestive tract, reducing their absorption.  Soaking or cooking the seeds reduces the phytate content.  The phytochemicals in chia seeds include phenolics, carotenoids, and phytosterols, all of which have antioxidant and anti-inflammatory properties, which can reduce the risk of diabetes, heart disease, and cancer. [12] Phytosterols can also help lower blood cholesterol levels by competing with cholesterol for absorption in the intestines. Choosing Chia Adding chia seeds gives a slightly nutty flavor and a bit of a crunch to your meals. You can sprinkle them onto your morning yogurt, blend them into your smoothie, or add them to your oatmeal. They also make a healthy sweet treat when made into pudding or baked into bread, cookies, and granola bars. It is unlikely that chia seeds will become a staple of your diet, but they are a simple, tasty way to boost nutrient and phytochemical intake. Check out our "Chia Flax Oatmeal Recipe" References [1] Chia Seeds Market | Growth, Trends and Forecast | 2019-2024. https://www.mordorintelligence.com/industry-reports/chia-seeds-market ‌ [2] Chia Seed History and Origin | Grand Teton Ancient Grains. Grand Teton Ancient Grains. Published January 19, 2025. Accessed August 13, 2025. https://www.ancientgrains.com/black-chia-seeds/chia-seed-history-and-origin?srsltid=AfmBOoombkJQ3ieUyoVYVrFpxe1KWgFrn-CSVQa4jCD9FL104d_a5-Mz ‌ [3] Almoselhy, RIM, Usmani, A, and Siddiqui, MA. Evolution of chi seeds from ancient times to modern superfood. Food Sci & Nutri Tech 10 (1), February 14, 2025. doi: https://doi.org/10.23880/fsnt-16000360 [4] Staab J. What makes superfood so super? UC Davis. Published March 10, 2021. https://www.ucdavis.edu/food/news/what-makes-superfood-so-super ‌ [5] Agarwal A, Rizwana, Tripathi AD, Kumar T, Sharma KP, Patel SKS. Nutritional and Functional New Perspectives and Potential Health Benefits of Quinoa and Chia Seeds. Antioxidants (Basel). 2023;12(7):1413. Published 2023 Jul 12. doi:10.3390/antiox12071413 [6] Fateh HL, Ahmed DH, Najafabadi MS, Moludi J. The impact of chia seeds on diabetes, blood pressure, lipid profile, and obesity indicators: Systematic review and meta-regression analysis of 14 randomized controlled trials. Prostaglandins Other Lipid Mediat. 2024;175:106907. doi:10.1016/j.prostaglandins.2024.106907 [7] Silva LA, Verneque BJF, Mota APL, Duarte CK. Chia seed (Salvia hispanica L.) consumption and lipid profile: a systematic review and meta-analysis. Food Funct. 2021;12(19):8835-8849. Published 2021 Oct 4. doi:10.1039/d1fo01287h [8] Karimi M, Pirzad S, Shirsalimi N, et al. Effects of chia seed (Salvia hispanica L.) supplementation on cardiometabolic health in overweight subjects: a systematic review and meta-analysis of RCTs. Nutr Metab (Lond). 2024;21(1):74. Published 2024 Sep 16. doi:10.1186/s12986-024-00847-3 [9]National Institutes of Health. Omega-3 Fatty Acids. Nih.gov . Published February 15, 2023. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/ ‌ [10] McRorie JW, McKeown NM. Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. Journal of the Academy of Nutrition and Dietetics. 2017;117(2):251-264. doi: https://doi.org/10.1016/j.jand.2016.09.021 [11] Restivo J. Chia seed benefits: What you need to know. Harvard Health. Published February 21, 2024. https://www.health.harvard.edu/nutrition/chia-seed-benefits-what-you-need-to-know

Test your knowledge of epidemic typhus, its symptoms, and how to fight this disease. “ Epidemic typhus has also been called camp fever, jail fever, and war fever, names that suggest overcrowding, underwashing, and lowered standards of living. It is caused by the bacterium Rickettsia prowazekii and is conveyed from person to person by the body louse, Pediculus humanus humanus. ”  CDC  July 19, 2024 Medical Trivia A Multiple-Choice Quiz Which of the following statements about typhus is false? a) “It could only be the body louse. It was the louse” said the scientist who discovered how typhus spreads. b) Typhus is a disease named after the Greek word "typhos," which means "smoky" or "hazy." One of the main symptoms of typhus is a state of confusion or stupor. c) Epidemic typhus is caused by the Salmonella bacteria (Salmonella typhi) d) Typhoid fever is caused by the Salmonella bacteria (Salmonella typhi) ANSWER:  The answer is C.  Salmonella typhi causes typhoid fever not typhus, two distinctly different diseases. Salmonella typhi is spread by contaminated food, not by lice. The following expands upon the typhus trivia mentioned in the Q&A. Charles Nicolle: A Pioneer in Public Health Charles Nicolle, a French physician, made a groundbreaking discovery in 1910 that would forever change our understanding of Epidemic typhus. Through meticulous research, Nicolle identified the body louse as the primary vector responsible for spreading the disease. His findings were instrumental in developing effective prevention and control measures. Nicolle's work was recognized with the prestigious Nobel Prize in Physiology or Medicine in 1928. His statement, " It could only be the body louse. It was the louse, " succinctly captured the significance of his discovery. Typhus: A Hazy Illness Typhus, a serious bacterial infection, gets its name from the Greek word "typhos," meaning "smoky" or "hazy." This is a nod to the mental confusion or stupor that often accompanies the disease. Symptoms of typhus can also include fever,rash, and headache. Typhus vs. Typhoid Fever While both typhus and typhoid fever are bacterial infections, they have distinct differences. Typhus is caused by Rickettsia bacteria and is transmitted by insects like lice, ticks, or fleas. Typhoid fever, on the other hand, is caused by Salmonella typhi bacteria and is spread through contaminated food or water. Key differences include their mode of transmission and some of their symptoms. While both can cause fever and headache, typhus often involves a rash, while typhoid fever may lead to diarrhea or constipation. If you suspect you may have either illness, consult a healthcare professional for diagnosis and treatment. CONCLUSION: Understanding typhus, its transmission, and its historical significance helps us appreciate the advances in medicine that have saved millions of lives. Figures like Charles Nicolle made pivotal discoveries that helped control typhus, reducing its once-devastating impact. As you reflect on the differences between typhus and other diseases like typhoid fever, it’s a reminder of how critical medical knowledge is in preventing and combating infectious diseases. initially posted 9/2024

This delicious Peach Compote recipe is perfect for topping pancakes, waffles, or ice cream. Peach Season: In the USA, peach season typically runs from May to September, with specific timing varying depending on the region. Florida kicks off the season in late March, followed by Georgia, South Carolina, North Carolina, and Texas. California, Idaho, New Jersey, and Colorado come in later, with their seasons lasting through September. By knowing when peaches are in season, you can ensure you're getting the freshest and juiciest fruit for your recipes. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine Low-Calorie | Low-Cholesterol | Low-Fat Healthy Peach Compote Recipe This recipe is appropriate for low-calorie, low-cholesterol, and low-fat diet regimens with the added bonus of 2 grams of fiber per serving. This peach compote can be eaten on its own or added as a topping for desserts, breakfast foods like waffles, pancakes, and French Toast, or add to meats such as pork chops or pork loin. Ingredients: 1/4 cup sugar (can adjust to your liking) 8 ripe peaches 1 T lemon juice Directions: download the Peach Compote Recipe PDF Peel peaches and cut into rough chunks. Place peaches in small saucepan and heat on medium low/heat for around 5 minutes until they begin to soften and release some liquid. Mash peaches and add 1 T lemon juice. Add ¼ cup of sugar and stir until dissolved. Set the heat to med/high and bring mixture to a boil, stirring constantly for 5 minutes. Turn heat back to medium/low and let simmer for 10-15 minutes, stirring occasionally to prevent burning. Use an immersion blender or masher to bring compote to desired consistency. Transfer to a heat safe container and let cool. Nutritional Information Servings 10 Nutrition Facts Per servong Calories: 85 Total fat: 0.3 g Saturated fat: 0 g Cholesterol: 0 mg Sodium: 0 mg Potassium: 230 mg Total carbohydrates: 21.2 g Dietary fiber: 1.9 g Sugars: 21.2 g Chef and Author : Justin Gillette Medically Reviewed by FibonacciMD editors. Check out our Sweet and Smoky Grilled Peaches Recipe Read more about the The Health Benefits of Peaches: Unveiling the Good and Handling the Bad (Peach Fuzz Allergies) Check out our article " The Health Benefits of Peaches: Unveiling the Good and Handling the Bad (Peach Fuzz Allergies) " Initially published Aug 2023

Peaches in Culinary Medicine: Nutrition & Peach Fuzz Allergies This culinary medicine ingredient explainer highlights peaches as a nutrient-rich fruit that supports wellness while addressing peach fuzz allergies. Culinary Medicine Peaches, the vibrant, juicy fruits of summer, not only delight the taste buds but also offer a long list of health benefits that make them a must-have addition to your diet. Packed with essential nutrients, antioxidants, and fiber, peaches provide a sweet way to boost your well-being. In this article, we delve into the remarkable health benefits of peaches while addressing concerns about allergies and aversions to their fuzzy skin. The Health Benefits of Peaches Nutrient Powerhouse Peaches are a nutrient-rich fruit that supports overall health. They are a fantastic source of vitamins, including vitamin C, A, and E. Vitamin C, a powerful antioxidant, aids in collagen production, promoting skin health and boosting the immune system. Vitamin A supports vision and immune function, while vitamin E contributes to skin health and offers protective antioxidant properties. Fiber for Digestive Health Dietary fiber is crucial for maintaining a healthy digestive system, and peaches are an excellent source of this essential nutrient. A single medium-sized peach contains about 2 grams of fiber, which aids in regulating digestion, preventing constipation, and promoting a feeling of fullness. Antioxidant Protection Peaches contain an array of antioxidants, including flavonoids and phenolic compounds. These antioxidants help combat oxidative stress, which is linked to chronic diseases and aging. Regular consumption of peaches can aid in reducing the risk of various diseases and promoting long-term health. Heart Health The combination of fiber, antioxidants, and potassium found in peaches contributes to heart health. Potassium helps regulate blood pressure and maintain proper heart function. Additionally, the fiber content of peaches can help manage cholesterol levels, reducing the risk of cardiovascular diseases. Aiding Weight Management Peaches are naturally low in calories, making them an ideal snack for those looking to manage their weight. The fiber in peaches helps control appetite and helps prevent overeating, promoting a healthy approach to weight management. Addressing Peach Fuzz Allergies and Aversions While peaches offer a bounty of health benefits, some individuals may experience allergies or aversions to the fuzzy skin. This condition is known as "oral allergy syndrome" or "pollen-food syndrome." It occurs due to cross-reactivity between proteins in certain fruits, including peaches, and pollen allergens. Individuals allergic to birch pollen, for example, may experience itching or swelling in the mouth and throat when consuming peaches. If you suspect you have peach fuzz allergies, consult an allergist for proper diagnosis and guidance. In many cases, the allergist may recommend cooking or peeling the peaches before consumption, as this can help break down the proteins responsible for the allergic reaction. Canned peaches may also be better tolerated, as the canning process alters the protein structure. For those with an aversion to the fuzzy texture of peach skin, there are ways to enjoy peaches without discomfort. Thoroughly washing the peach and gently rubbing the skin with a soft cloth can help remove some of the fuzz, making it more palatable. Alternatively, opting for nectarines, a smooth-skinned cousin of peaches, can provide a similar flavor and nutritional profile without the fuzz. Conclusion In conclusion, the health benefits of peaches are as diverse and delightful as their taste. From supporting heart health to aiding digestion and providing a wide array of essential nutrients, peaches are a welcome addition to a balanced diet. While concerns about peach fuzz allergies and aversions are valid, there are strategies to overcome these challenges and enjoy the juicy goodness of peaches. So, whether you bite into their fuzzy skin or savor their flesh, peaches are undoubtedly a summertime treat that nourishes both body and soul. Ingredient Explainer: Peaches Healthy Peach Compote Recipe Sweet and Smoky Grilled Peaches Recipe medically reviewed by Richard Strongwater, MD

Grilled peaches enhance their natural sweetness for a delicious, healthy treat. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES  | Culinary Medicine   Low-Calorie | Low-Carb | Low-Fat | Lacto-Vegetarian Recipe When you are craving something sweet, a summer peach is hard to beat! They are delicious served fresh, baked in a pie, and even grilled. Grilled peaches can be a versatile addition to your next barbeque. Include them plain as a side dish, top them with goat cheese as an appetizer or make them a dessert by pairing them with a scoop of ice cream. Hearty enough to handle the heat of a barbeque, peaches are a healthy and delicious addition to any summer cookout.  Ingredients 2 peaches 2 tsp slivered almonds 1 ounce soft goat cheese 1 tsp honey ½ tsp butter, softened Mint leaves Instructions Mix together the goat cheese and honey Wash the peaches and cut them in half, remove the pit Brush each half with softened butter Place cut side down on grill, Cook for 2 minutes Turn over and grill for 1 minute (use tongs to prevent breaking)  Remove from grill and add a dollop of honey goat cheese to the center of each half Top with slivered almonds and mint leaves Makes 1 servings Nutrition information per 6 serving Calories 70, Fat 3g, Saturated fat 1.3, Cholesterol 4mg, Carbohydrate 9g, Fiber 1.5g, Protein 3g, Sodium 35mg, Potassium 170mg Nutrition Chef Authors: Mary B Grosvenor, MS, RD Medically Reviewed by FibonacciMD editors. Editor’s Notes: Be sure to clean grill between uses to avoid contaminating your peaches Appropriate for low-calorie, low-carb and low-fat lacto-vegetarian dietary regimen Check out our Peach Compote Recipe Read more about the The Health Benefits of Peaches: Unveiling the Good and Handling the Bad (Peach Fuzz Allergies)   more health-conscious recipes

Think you know the truth about Chagas disease? Test your knowledge with this quick trivia challenge—can you spot the false statement? After the quiz, explore more about Chagas disease, including its impact, the dangers it poses, the acute and chronic stages, how it’s diagnosed, and the latest approaches to treatment and prevention. Medical Realities Chagas Trivia & Facts Which of the following A-D statements is false ? A) Both African and American trypanosomiasis are caused by a parasitic nematode infection. B) Chagas’ disease AKA American trypanosomiasis is transmitted by the kissing bug. C) An estimated six to eight million people in Central and South America are infected with Chagas disease, with 700,000 new cases in 1990 but only 28,000 new cases in 2023. D) Thirty percent of patients infected with Chagas disease will develop cardiac damage. 12,000 people die each year. Source- Pan American Health Organization Answer A is false.   Both African and American trypanosomiasis are caused by a parasitic protozoan infection.  African trypanosomiasis AKA African sleeping sickness is transmitted by the tsetse fly.  Protozoan infections also cause malaria, amoebic dysentery, and babesiosis. Chagas disease is a serious parasitic illness transmitted by the kissing bug, which can lead to severe and life-threatening heart and digestive issues if left untreated. The Kissing Bug: A Hidden Danger Why is it called the kissing bug? The kissing bug has earned its name due to its habit of biting its human hosts on the face, often near the lips or mouth, during the night. This nocturnal behavior, combined with its preference for biting exposed skin, has led to the moniker "kissing bug." Where are kissing bugs common? Kissing bugs are primarily found in the Americas, particularly in Central and South America. However, their range has been expanding, and cases have been reported in the southern United States, including Texas, California, and Arizona. These insects thrive in rural areas with poor housing conditions, where they can find shelter in cracks and crevices in walls and roofs. Understanding Chagas Disease and Its Impact The dangers of Chagas disease Chagas disease, also known as American trypanosomiasis, is a parasitic infection transmitted by the kissing bug. The parasite, Trypanosoma cruzi, is found in the insect's feces and is transmitted to humans through a bite. While many people infected with Chagas disease initially experience no symptoms or only mild ones, the infection can lead to serious health problems, including heart disease, digestive disorders, and neurological complications. In severe cases, Chagas disease can be fatal. Two Stages Chagas disease has two stages. The first stage, called the acute phase, happens shortly after infection. The second stage, known as the chronic phase, occurs over a long time. In both stages, some people might not feel sick at all, while others can have serious health problems. Acute phase:  This early stage happens in the first weeks or months after getting infected. Symptoms are often mild or not there at all and can include: Fever Feeling tired Body aches Headache Enlarged glands (enlarged lymph nodes) Rash Loss of appetite Diarrhea Vomiting Eyelid swelling (Romaña's sign).  A symptom of Chagas disease is Romaña's sign—when the eyelid swells up. This happens when the  Trypanosoma cruzi  parasite gets into the eyelid, usually by accidentally rubbing the bug feces (poop) into your eye or into a bug bite near your eye. 1) Romana’s sign 2) American triatom bug 3) Trypanosoma Cruz (a parasitic protozoan) Chronic phase : This stage can last many years or even a lifetime. Most people have no symptoms during this time. However, about 20 – 30% of those infected develop serious problems. These include: Heart issues, such as an enlarged heart, heart failure, altered heart rate or rhythm, or sudden death. Digestive problems, such as an enlarged esophagus or colon, leading to trouble eating or going to the bathroom. Clinical Testing and Diagnosis for Chagas Disease Acute Chagas disease can be identified by spotting parasites in blood using microscopy. For chronic Chagas , look for specific antibodies against the parasite. Since 2006, the FDA has approved tests for screening blood donations for specific antibodies against the  T. cruzi  parasite . Diagnosing Acute Chagas Infections: Healthcare providers diagnose acute Chagas infections by identifying trypomastigotes in blood using microscopy. Trypanosoma Cruzi under the microscope Parasite levels in the blood decrease rapidly within a few months and become undetectable by most diagnostic methods during the chronic phase. Diagnosing Chronic Chagas Disease: For chronic Chagas disease, healthcare providers detect antibodies against the parasite using serologic tests. Testing protocol: No single test is sufficiently sensitive and specific for diagnosis. Use two or more tests that detect antibodies to different antigens. Common techniques include enzyme-linked immunosorbent assay (ELISA) and immunofluorescent antibody test (IFA). Treatment and prevention As healthcare professionals, it's crucial to be aware of the subtle signs and symptoms of Chagas disease, especially in regions where the kissing bug is prevalent. Early detection and treatment can prevent serious complications and improve patient outcomes. If diagnosed early, Chagas disease can be treated with antiparasitic medications. However, once the infection has progressed, treatment options are limited. Preventing Chagas disease involves avoiding contact with kissing bugs. This can be achieved by using insecticide-treated bed nets, improving housing conditions, and wearing long sleeves and pants when sleeping in areas where kissing bugs are prevalent. Antiparasitic treatment  Antiparasitic treatment works best when started early but can be used at any stage of the disease. In the United States, there are two treatments available: Benznidazole is FDA approved for use in children 2 – 12 years of age and is commercially available at  http://www.benznidazoletablets.com . Lampit® (nifurtimox) is FDA approved for treatment of children from birth to age younger than 18 years and is commercially available for pharmacies to purchase from several drug wholesalers. Source:  CDC September 4, 2024 and National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

Don't let cholesterol confusion scramble your diet. Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A Smolin, PhD   In 1953, researcher Ancel Keys hypothesized that high intakes of saturated fat and cholesterol raised blood cholesterol levels, which contributed to cholesterol buildup in the artery walls, a condition known as atherosclerosis.[1,2] As a result of his studies, in the 1960s the American Heart Association began to recommend limiting our cholesterol intake to no more than 300 mg/day to reduce the risk of heart disease.[3] Eggs were a focus of these recommendations because one egg contains about 200 mg of cholesterol, more than any other individual food. This recommendation held for over 50 years until newer data challenged the restrictions on cholesterol and eggs.[4,5] After years of avoiding them, many of us are wondering how eggs, and the cholesterol they contain, fit into a healthy diet.  The Nutritional Benefits of Eggs Eggs are nutrient dense, meaning they are high in nutrients relative to the number of calories they provide.[6]  An average chicken egg has 70 Calories, 7 grams of protein, less than a gram of carbohydrate, and about 5 grams of fat, most of which is healthy poly- or monounsaturated fat. The high-quality, readily digestible protein in eggs makes them a valuable protein source; they have been shown to reduce malnutrition in children in developing countries and to support the protein needs of athletes trying to build muscle and of older adults trying to prevent muscle loss.[7] The high-protein, low-carbohydrate profile of eggs also makes them more filling than foods higher in carbohydrate. Eating eggs for breakfast has been shown to increase satiety, helping maintain a calorie deficit throughout the day and therefore supporting weight loss.[7,8] Although eggs are high in cholesterol, unlike other sources of cholesterol, such as fatty meats and full-fat dairy products, eggs are not high in saturated fat.  Eggs are a source of the fat-soluble vitamins A, D, E, and K; the B vitamins folate and vitamin B 12 ; and the minerals zinc, iron, and selenium. Eggs are also a primary source of choline in the US diet. Choline, although not a vitamin, is needed to form cell membranes and support brain and nervous system function. Diets high in choline have been associated with a lower risk of cardiovascular disease, especially stroke.[9] The golden color of the egg yolk is due to the carotenoids, lutein, and zeaxanthin, which have antioxidant and anti-inflammatory properties. Lutein and zeaxanthin have been found to help prevent the eye diseases macular degeneration and cataracts; they may also reduce cognitive decline in older adults.[10] Clarifying Cholesterol  The cholesterol in our bodies comes from what we consume in food and from cholesterol synthesized by our liver. Dietary cholesterol is only found in food from animal sources such as eggs, meat, and dairy products. So, if you eat a vegan diet, and thus do not eat any cholesterol, your liver will make all you need.  Cholesterol is used by the body to synthesize steroid hormones, such as estrogen, testosterone, and cortisol. It is also needed to form cell membranes; it is particularly important in brain and other nervous tissue where it is a component of myelin, an insulating layer around nerve cells. Cholesterol circulates in the blood in several types of transport particles, including LDLs (low-density lipoproteins), which carry cholesterol from the liver to cells throughout the body, and HDLs (high-density lipoproteins), which carry cholesterol back to the liver for elimination from the body. Elevated levels of LDL cholesterol can lead to plaque buildup in artery walls, restricting blood flow and increasing the risk of a heart attack or stroke. [11] Higher HDL cholesterol levels reduce the risk of cardiovascular disease.  Sorting out whether cholesterol intake correlates with blood cholesterol levels has been challenging.  Studies of the relationships between dietary cholesterol, blood cholesterol, and heart disease risk have had mixed results: a few show a positive correlation, but most do not.[12,13]  These differing results may be due in part to the fact that the ability to regulate blood cholesterol in response to changes in dietary cholesterol varies among individuals.[5] Also dietary components other than cholesterol can affect blood cholesterol levels. Of particular significance is saturated fat, which increases LDL cholesterol in the blood.[14] Foods high in cholesterol are usually also high in saturated fat or consumed alongside foods high in saturated fat, making it difficult to distinguish the effect of dietary cholesterol from that of saturated fat.[13] A review of currently available data concluded that there is not sufficient evidence to support an association between cholesterol intake and blood cholesterol levels or cardiovascular risk.[5]  In accordance with this conclusion, the American Heart Association now    suggests that rather than keeping cholesterol intake to a specific limit, we concentrate on consuming a healthy dietary pattern.   [13]  A Healthy Dietary Pattern  A healthy dietary pattern emphasizes fruits, vegetables, and whole grains, which are high in fiber, and limits saturated fat, sodium, and added sugars. Eggs can be included in this pattern, but the number of eggs that is healthy for an individual depends on their genetics and health history. For example, healthy adults with no family history of heart disease, normal blood cholesterol levels, and no heart disease risk factors can consume up to 2 eggs per day as part of a heart-healthy dietary pattern.   [13,15]. But individuals with heart disease risk factors such as high blood cholesterol, diabetes, obesity, or high blood pressure should be more cautious with their egg intake, limiting it to no more than 4 to 5 eggs per week [13,15].   Whether you like your eggs poached, scrambled, fried, or boiled be careful of what you pair them with. A meal of eggs with sausage, bacon, buttery biscuits, or cheese is high in saturated fat and low in fiber so would have to be a rare treat. However, eggs scrambled with mushrooms, peppers, spinach, and tomatoes served with fresh berries and whole grain toast contains little saturated fat and plenty of fiber from fruits, vegetables, and whole grains so it fits easily into a healthy dietary pattern.  Enjoy Some Eggs Eggs are a convenient, relatively inexpensive, easily digestible source of high-quality protein. They provide a variety of vitamins, minerals, and carotenoids and have a lower environmental impact than most animal products.[16] Although they are high in cholesterol, they contain almost no saturated fat and so do not raise unhealthy LDL cholesterol levels. If you choose to include eggs as part of your healthy dietary pattern enjoy them within the context of your individual health history.  References [1] Keys A. Prediction and Possible Prevention of Coronary Disease. American Journal of Public Health and the Nations Health. 1953;43(11):1399-1407. doi: https://doi.org/10.2105/ajph.43.11.1399 [2] Menotti A, Puddu PE. Ancel Keys, the Mediterranean Diet, and the Seven Countries Study: A Review. Journal of Cardiovascular Development and Disease. 2025;12(4):141. doi: https://doi.org/10.3390/jcdd12040141  [3] Carter S, Elizabeth Sanchia Connole, Hill AM, Buckley JD, Coates AM. Eggs and Cardiovascular Disease Risk: An Update of Recent Evidence. Current Atherosclerosis Reports. 2023;25(7):373-380. doi: https://doi.org/10.1007/s11883-023-01109-y  [4]American Heart Association. New federal guidelines may lift dietary cholesterol limits. www.heart.org . Published November 13, 2017. https://www.heart.org/en/news/2018/07/18/new-federal-guidelines-may-lift-dietary-cholesterol-limits [5] Fernandez ML, Murillo AG. Is There a Correlation between Dietary and Blood Cholesterol? Evidence from Epidemiological Data and Clinical Interventions. Nutrients. 2022;14(10):2168. doi: https://doi.org/10.3390/nu14102168 [6] Griffin BA. Eggs: good or bad? Proceedings of the Nutrition Society. 2016;75(3):259-264. doi: https://doi.org/10.1017/S0029665116000215 [7] Puglisi MJ, Fernandez ML. The Health Benefits of Egg Protein. Nutrients. 2022;14(14):2904. doi: https://doi.org/10.3390/nu14142904 [8] Keogh J, Clifton P. Energy Intake and Satiety Responses of Eggs for Breakfast in Overweight and Obese Adults—A Crossover Study. International Journal of Environmental Research and Public Health. 2020;17(15):5583. doi: https://doi.org/10.3390/ijerph17155583 [9] Zhou R, Yang M, Yue C, et al. Association between Dietary Choline Intake and Cardiovascular Diseases: National Health and Nutrition Examination Survey 2011–2016. Nutrients. 2023;15(18):4036. doi: https://doi.org/10.3390/nu15184036 [10] Jia YP, Sun L, Yu HS, et al. The Pharmacological Effects of Lutein and Zeaxanthin on Visual Disorders and Cognition Diseases. Molecules : A Journal of Synthetic Chemistry and Natural Product Chemistry. 2017;22(4). doi: https://doi.org/10.3390/molecules22040610 [11] Merschel M. Here’s the latest on dietary cholesterol and how it fits in with a healthy diet. www.heart.org . Published August 25, 2023. https://www.heart.org/en/news/2023/08/25/heres-the-latest-on-dietary-cholesterol-and-how-it-fits-in-with-a-healthy-diet [12] Zhong VW, Van Horn L, Cornelis MC, et al. Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality. JAMA. 2019;321(11):1081. doi: https://doi.org/10.1001/jama.2019.1572 [13] Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation. 2020;141(3):39-53. doi: https://doi.org/10.1161/cir.0000000000000743 [14] Flock, M. R., and Kris-Etherton, P. M. Diverse physiological effects of long-chain fatty acids: Implications for cardiovascular disease. Curr Opin Clin Nutr Metab Care 16:133–140, 2013. [15] Gunnars K. Eggs and Cholesterol — How Many Eggs Can You Safely Eat? Healthline. Published August 23, 2018. https://www.healthline.com/nutrition/how-many-eggs-should-you-eat [16] Myers M, Ruxton S. Eggs: Healthy or Risky? A Review of Evidence from High Quality Studies on Hen’s Eggs. Nutrients. 2023;15(12):2657-2657. doi: https://doi.org/10.3390/nu15122657

In this Continuing Medical Education article, discover how mirror therapy can ease phantom limb pain and aid stroke recovery through brain reprogramming. Read Article, Take Test , Get FREE 🎓 CME Certificate with Valid Email We’ll send you occasional updates. Your email stays private—never sold or shared.  😇 Normal Right Hand with Left Hand Seen as a Mirror Image in Mirror Therapy By Stuart M. Caplen, MD  After a limb amputation, a patient may feel as if the limb is still attached.  This can be a source of severe pain and is known as phantom limb syndrome.  It occurs in up to 90% of people with limb loss.[1]  Mirror therapy has been shown to decrease the false perception of having the limb attached, as well as reducing the subsequent pain that can occur.  The process by which mirror therapy is theorized to work illustrates both the complexity and plasticity of the human brain. What is Phantom Limb Pain?  Phantom limb syndrome patients can experience movement, pain, and muscle spasms that feel as if they are coming from the amputated limb.  Perceived movements can be complex, such as waving goodbye, or the phantom limb may feel as if it is frozen in place. Theoretically, it is postulated that the motor cortex does not “realize” that the limb is missing and continues to try to move it.  The motor cortex of the brain continues to send messages to the muscles in the amputated extremity that it still “believes” are there.  These signals can get amplified when the motor cortex does not receive feedback that the movement has occurred.[2]  Movement directives for the limbs are monitored by the parietal lobes, which are involved with body image.  The parietal lobe may be where an amputee’s perception of movement in the phantom limb is generated.  It may be due to the contradictory processes of the brain “thinking” the limb is still attached and sending out increasingly amplified messages to the limb, while the visual system “sees” there is no limb, which leads to phantom limb pain.[2]  Another theory is that pathological remapping of the brain after an amputation may lead to chaotic, abnormal outputs that lead to a perception of pain in the phantom limb.[3]  Mirror therapy appears to work by creating the illusion that both limbs are moving normally, which reduces the conflict between proprioceptive and visual inputs (the feeling that the limb is there and moving, but not visualizing the limb or seeing it move) and reprograms the brain.  In mirror therapy, the person puts the uninjured limb in either an open box with a mirror in it, designed for that purpose, or simply uses a mirror placed on a table or floor.  Moving the unaffected arm or leg and viewing it in the mirror creates the illusion that both limbs are present and moving, thus reducing the incompatibility of the visual and proprioceptive brain inputs, and potentially decreasing troubling phantom limb symptoms.[2] What Observation Led to Mirror Therapy? Interestingly, patients who had paralysis in a limb before amputation typically feel as if the phantom limb is also paralyzed (called learned paralysis), while those whose limb was not paralyzed can “feel” the limb move for some time until eventually, due to lack of sensory feedback, they may lose that ability.  It was this observation that led to the creation of mirror therapy.[2] In patients who previously had paralysis of a limb prior to its amputation, each time the message to use the paretic limb went from the motor cortex to the arm, the brain received visual feedback that the arm was not moving. This appears to get incorporated into the neural circuitry of the parietal lobes so that the brain “learns” that the paralyzed arm is fixed in that position.  After an amputation of a paralyzed limb, the brain already “knows” the arm does not move, and the phantom limb does not move either.  The concept that the brain can “learn” and be “rewired” by the use of visual stimuli to accept that the paretic limb was paralyzed, was considered central to the concept of mirror therapy by its creators. Their theory was that as the brain had demonstrated that it could be “rewired”, if they created a visual message to the brain that a task the motor cortex wanted to be performed by a phantom limb was in fact performed, it might possibly reduce phantom limb pain.[2] To accomplish that, a mirror box was used to create the illusion that the amputated limb was actually moving, using a mirror image of the intact limb.  This was done to provide visual feedback in hopes of reprogramming the brain.  In one of Ramachandran’s and Rogers-Ramachandran’s early experiments, a patient who had a left arm amputation nine years earlier and could not “move” his phantom left limb, initially tried to move both his right arm and phantom left arm while in the mirror box with his eyes closed.  While his normal right arm moved, his left arm felt “frozen as if in a cement block.”  However, when he opened his eyes and viewed the mirror image of what now appeared to be a normal left arm, he experienced vivid sensations of movement in his phantom limb.  The authors felt that the ability to feel movement in a previously frozen phantom arm, after visualizing a normal mirror image, implied that new neural pathways could be created in the adult brain.  It also implied that areas of the brain concerned with vision and proprioception must interact to a great extent, with visual feedback exerting a modulating effect.[2,3] Does Mirror Therapy Work ?  In 1996, Ramachandran and Rogers-Ramachandran published an article titled “Synesthesia in Phantom Limbs Induced with Mirrors”.  (Synesthesia is the production of a sensation to one sense or part of the body by stimulation of another sense or part of the body.)  They studied ten subjects who had phantom limb syndrome after an amputation and felt either pain or spasms in their absent limbs. They then had them use a mirror box, which presented the visual illusion of having two normal limbs.  In six of the subjects, moving the normal limb, which when seen in the mirror looked like the subject had two normal limbs, caused the subjects to “feel” movement in the phantom arm.  Four out of five patients who had experienced recurrent painful clenching spasms of their phantom hands experienced relief from those spasms when the normal hand was opened. and they could see that the mirror image hand was also open.  It was not possible for those subjects to get pain relief without viewing the mirror image of the normal, unclenched hand in place of the amputated limb.  In total, eight of the ten subjects were able to get pain relief from the use of mirror therapy.  In three patients, touching the normal hand, which when viewed as a mirror image, induced precisely localized touch sensations in the phantom hand.  In another subject who had symptoms for ten years, three hours of visual input using a mirror box over three weeks permanently altered his body image.  His phantom arm disappeared, and all he felt after therapy was part of the palm and fingers dangling from his shoulder.  He also eliminated his chronic phantom elbow pain, and the therapy allowed him to “move” his phantom fingers rather than feeling them painfully clenched and fixed in position.  In another experiment, they asked subjects to attempt to place their phantom hand in the mirror box palm down.  The examiner then put his gloved hand in the box palm up, which could be seen in the mirror.  When the examiner flexed his fingers, the subjects complained that their phantom hand was painful and felt the fingers were being hyperextended into anatomically impossible positions.[2]  In support of their theory of brain neuroplasticity, Ramachandran and Altschuler discussed a case where three weeks after a traumatic amputation, a patient felt sensation in his phantom hand when certain areas of his contralateral face were touched.  In the brain architecture, the motor and sensory areas of the hand are located next to the face.  It has been shown that in some patients with phantom limbs there is an extension of the brain’s face area into the hand area, which implies neuroplasticity.[3]   A different, well-known example of brain plasticity is that some blind musicians process auditory inputs in both the auditory and optical brain cortices.[4]  Homunculus Illustrating Hand Sensory Region Near Facial Region in the Brain More Mirror Therapy Studies Ramachandran’s work was repeated by others, and in one experiment by Chan et al.,  22 subjects with leg amputations and phantom limb pain were separated into three groups.  One group was treated with a mirror box and attempted to use both limbs while viewing the mirror; one group used a mirror box with the mirror covered up; and one group used just mental imagery to pretend to move both limbs.  They performed these tasks for 15 minutes a day for four weeks.  At the end of that time, 100% of the mirror-treated patients reported a decrease in pain versus 17% in the covered mirror group and 33% in the mental-visualization group.  After the initial experimental endpoint, 89% of those in the covered mirror and mental-visualization groups who switched to mirror therapy reported decreased pain after a second 4-week period.   The authors stated that, “Pain relief associated with mirror therapy may be due to the activation of neurons in the hemisphere of the brain that is contralateral to the amputated limb.  These neurons fire when a person either performs an action or observes another person performing an action.  Alternatively, visual input of what appears to be movement of the amputated limb might reduce the activity of systems that perceive protopathic pain.”*[1] * (Protopathic pain is a type of sensory perception characterized by a generalized, non-discriminating response to stimuli like pain or temperature.) Ramadugu et al. studied 60 amputees with mirror therapy using a control group where the mirror was covered up.  They reported significant decreases in pain in the mirror therapy group versus the control group.  When the control group was crossed over to mirror therapy, they also had significantly decreased phantom limb pain up to 12 weeks after starting therapy.[5] Finn et al. tested 15 male upper extremity amputees and compared mirror therapy, to either covered mirrors or mental-visualization therapy, as the control groups.  Therapy was performed five days a week for four weeks.  89% of subjects in the mirror therapy group had a significant decrease in pain scores.  The mean amount of time spent daily by the group experiencing pain also significantly decreased over the controls.  The control groups did not experience a significant diminishment of pain, nor a decreased overall time experiencing pain. After four weeks, five out of six of the control group subjects switched over to mirror therapy and all experienced decreased pain and reduced daily time spent in pain.[6] Another study by Yildirim and Kanan reported that mirror therapy significantly decreased phantom limb pain in 15 amputees, with pain decreasing each week over four weeks of treatment.[7] A meta-analysis of mirror therapy for phantom limb pain reported that there was a significant decrease in phantom limb pain after one month with mirror therapy, with those subjects who had the pain for more than a year getting the most benefit.  There was no evidence of long-term benefit of mirror therapy, but the authors stated this might be due to limited data from the literature available at the time they authored the article.[8] A systematic review found that mirror therapy worked to reduce phantom limb pain, but there was limited scientific data supporting its effectiveness.[9]  Another systematic review reported that the level of evidence was insufficient based on the data reviewed to recommend mirror therapy, and more studies were needed.[10] Mirror Therapy for Stroke Victims  In 1999, Altschuler et al. performed a pilot study of mirror therapy on nine stroke patients with post-stroke hemiparesis.  Among these subjects, three showed moderate recovery, three exhibited mild recovery, and three experienced no change.  Their theory was that there is a temporary interruption of brain signals after a stroke, which leads to a form of “learned paralysis” similar to that seen in phantom limb. This may persist even after the post-stroke swelling and edema subside, at which point mirror therapy might help recovery.[3,11] Movement, as seen using mirrors, has been found to add additional activation of the hemisphere contralateral to the affected limb, which might also help stroke victims.  The mirror imagery is thought to increase cortico-muscular excitability, which might directly improve motor functioning.  It is also hypothesized that mirror therapy may normalize central sensory processing by providing a visual image of the affected limb as having normal movement, which may help reduce pain after a stroke.[12] A Cochrane review looked at the use of mirror therapy to improve limb motor function after a stroke.  They included 62 studies with a total of 1,982 subjects who had suffered a stroke and concluded that there was moderate‐quality evidence that mirror therapy has a significant positive effect on motor function and motor impairment and may improve the ability to do activities of daily living.  There was low-quality evidence for a significant positive effect on reducing pain. They also reported there was no clear effect on improvement of visuospatial neglect symptoms (failing to notice, respond to, or report stimuli on the side opposite their brain lesion).  The improvement in pain was noted mostly in individuals with complex regional pain syndrome.  The authors noted that there were limitations on the use of data from the current literature on mirror therapy after stroke due to small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.[12] Summary An intuitive leap led to the creation of mirror therapy, based on the observation that previously paralyzed phantom limb patients did not feel movement, but those who had normal functioning limbs before amputation could feel the missing limb still move.  This “learned paralysis” indicated the brain could be “rewired.”  Ramachandran thought that phantom limb pain was due to discoordination between the motor cortex and visual inputs, and the brain could be “tricked” into thinking the limb was still there by use of a mirror.  Using a mirror to create normalized limb visual input has been shown to reduce phantom limb symptoms in many patients and should be considered when recommending therapy for patients who suffer from this condition.  Mirror therapy may also be helpful in rehabilitating stroke victims who have limb paresis.  The fact that this relatively simple, but ingenious therapy appears to work is an indication of both the complexity and the plasticity of the human brain.  Note:  There is also some literature evidence, not discussed in this article, that motor imagery (where patients imagine the limb is moving normally) and virtual reality visual feedback of normal limb movement (similar to mirror therapy) may also be helpful in some stroke or phantom limb patients.[1,9,13] Author’s Note: Thank you to Dr. Theodor Feigelman for editing this article.  References ✅ Earn Free CME Credit for Reading This Article Eligible for 0.5 PRA Category 1 Credit Click the button below to take a short quiz. 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