Making Lebanon a Safer Place!

2000px-Skull_and_crossbones.svgWhat does arsenic, cyanide and polonium have in common? Yes, you guessed it they all are poisons and pretty lethal ones. Now what does perfume, rubbing alcohol and acetone have in common? Well from the point of view of a toxicologist, it’s the same thing… they are poisons.

The dose makes the poison. 
Paracelsus the “father of toxicology”

Therefore, if introduced in your body beyond their safety cut-point doses, even the things that we think are safe are in reality poisonous. Hence, everything around you is trying to poison you; Households (Javel water, bleach, dishsoap…) plants (Belladonna, foxglove…) animals (snakes, spiders, wasps…)  and the list goes on to even include your Ex!

Basically we live in a poison-full world, but what should we do if we got poisoned? What if your kid swallows pills from that bottle you hide from your wife? Or what if you drink from the empty water bottle you filled with turpentine and were sure you wouldn’t forget? What if you accepted that stupid bet and drank that bottle of dish soap? …

Illustration By Marc Freiha, great friend and our blog’s artwork designer.

The answer is pretty simple… call the poison center!
(contact number for the USJ Poison Center is provided at the end of this post)

When I decided to write about what to do in case of intoxication, the first person that came to my head is definitely Pr. Hayat Azouri. Among other qualifications she is:

  • A pharmacist
  • A toxicology specialist
  • Faculty member in Université Saint Joseph de Beyrouth (USJ) school of pharmacy
  • Chief of the toxicology laboratory and the manager of the USJ poison center.

In addition, she was my Master’s program coordinator at USJ, so I picked up the phone, called her and set up an appointment to visit her on campus.

The conversation between us was extremely interesting… It turns out that the USJ poison center is a personal project of hers, she’s actually the one who came up the idea and proposed it to the university. She accepts phone calls anywhere and anytime 24/7, even when she’s out of the country, and yes it’s pro bono! She’s well known by her sharp, fast and accurate answers; so here’s are the highlights from our ChitChat:

Chris: What’s the scope of the USJ poison center and who is the team behind it?

Pr. Azouri: The center provides phone assistance in case of poisoning. I accept phone calls from the community or the healthcare professionals. Along with Dr. Diane Antonios (immuno-toxicology specialist and USJ faculty member) and the database provided by the university, we can give fast and life saving assistance to the caller. The fast response is always key, because such cases are extremely time sensitive.

Chris: Who should call the poison center?

download.jpegPr. Azouri: Although we accept calls from anyone, being called by healthcare professionals (Medical Doctor, Pharmacist…) makes it easier to communicate the assistance, antidotes and interventions, because they are somehow familiar with the process. On the other hand, the latter should not stop anyone from calling the center, because the least we can do is assess the situation and evaluate whether the intoxicated patient needs hospitalization or can be managed at home.

Chris: What are the main complaints that you receive?

Pr. Azouri: The main complaints in Lebanon are the same worldwide and mainly are related to kids accidentally swallowing medications, alcohol or any other toxin.

Chris: Now talking about the specifics, how do you manage snakebites, knowing that anti-venom is not available in most of the country’s hospitals?snake-155258_960_720

Pr. Azouri: The Lebanese ministry of health is the one providing the anti-venom. So when we are contacted with snakebite cases, we provide the first-aid instructions and then we give the directives to obtain the anti-venom from the Lebanese Ministry of Health.

Chris: Knowing that all these services are free with no personal monetary revenue, why did you do it and still doing it?

Pr. Azouri: The answer again is pretty simple, and might come as a shocker to you. This is my way of giving back to the community… even the thought of me saving just one kid from dying because of an intoxication gives me the push and the alibi to continue doing what I’m doing.

I left the campus after this ChitChat, not only informed about the USJ poison center, but also learning a lesson about how to give back to the community, which can be by putting your knowledge and what you know into practice of helping others with only moral satisfaction in return… and most importantly, making a difference!

You can contact the USJ Poison Center by calling: 03-332246

Giving is not just about making a donation. It is about making a difference.
Kathy Calvin – president and CEO of UN Foundation.

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And You Thought Love Bites Were The worst!

spideyIf you think that humans are the most dangerous animals these days with their guns, tanks and chemical warfare … think again! Although Spiderman won’t agree with me, but if a venomous insect stings someone, it will at least ruin their day; even if they’re an army commando and it’s a needle-tip sized insect. So what do we know about these insects’ venoms? And how do these toxins work?

Elia: First, what’s the difference between poisons and venoms?

Chris: As a toxicology fanatic, I cringe every time someone mixes-up these two terms. Although both are toxins but they diverge in the route of access to the body.

Poison must be inhaled, ingested, or delivered via touch, while venom is injected into a wound.
Via Today I Found OutFunny Snake Smoking

In other words, if a venom is ingested it won’t be toxic, but you can read any Agatha Christie book and you will have an idea of what might happen if a poison is ingested.

An easy way to remember the difference is:

VENOM starts with a V like Vampire. It needs  a way in, being fangs or a wound.

POISON starts with  a P like Passive. You only need to touch, or ingest, nothing too violent.

E: So how does venoms work?

C: Mechanism of action of venoms is dependent on its biochemical composition, affecting either the bite wound or the whole body.
According to Toxinology, the snake venoms classification are mainly as follows:

Toxin activity type

Clinical effects


Systemic skeletal muscle damagewrist.jpg

Haemostatic system toxins

Interfere with normal haemostasis, causing either bleeding or thrombosisZMvtSWZ.gif


Damage vascular wall, causing bleeding460px-Survive-Being-Bitten-by-a-Venomous-Snake-Step-6


Direct renal damage0102


Direct cardiotoxicitynrd4083-i1


Direct tissue injury at the bite site/bitten limbimages

(The above classification can be generalised to other venoms also)

E: So what to do if I got bitten or stung by a venomous animal ?

C: The two most common bites are snakes and spiders.
If it’s a snake bite, the main issue is to prevent the spread of the venom outside the bite wound. By combining the recommendations of First Aid EverywhereWebMD  and MayoClinc the following are the Do and Don’ts of a snake bite:

  • Call medical help as soon as possible.
  • If possible put the affected area/limb bellow the level of the heart, to prevent it’s spread in your body.
  • Stay clam and do not agitate, excessive movement will lead to the spread of the venom in your body.


  • If a limb is bitten, remove any bracelet, shoe, watch, ring … from the affected limb because it will swell.
  • Softly apply pressure to the area, without restricting breath or any blood vessels.


  • Do not use any tourniquet! it will cut blood to the affected area and will cause more necrosis in the bitten limb.


  • Use a bandage instead, without restricting blood. In addition, you can restrict movement by using a solid object (i.e. wooden stick) to immobilize the joint; but again the bandage should not be tight!

images (1).jpeg

  • NO aspirin, NO alcohol and No caffeine ! All of the latter will cause either the spread of the venom or worsening of the symptoms.
  • Never open the bite wound with a knife, and most importantly, never suck the venom out ! No evidence exist yet that the latter will enhance the outcomes.


  • Do not wash the bite wound.
  • Do not try to catch the snake; just remember its colour and how it looks like; and with nowadays phones you can take a photo of the snake (but not a selfie ! )


On the other hand, when it comes to spider bites, it’s slightly easier to manage:


  • Wash the affected area.
  • Apply ice packs.
  • Do not apply a tourniquet.
  • Get medical attention.

PS: Some spider bites will cause extensive allergic reactions that can lead to anaphylactic shock. If any signs of rashes on the body, difficulty in breathing and/or drop in blood pressure show up, you should get medical attention right away as these types of allergies can be fatal.

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Cocktail’s Ingredients:

Making the Flowers count..Literally!

It’s officially a week since Valentine’s day. Many of you received gifts among which are flowers. Chris was wondering why would I even bring this matter up to the blog, why do we even want to talk about flowers. Here’s what happened:

Chris: We get it, people like receiving flowers. Why are we talking about it here?

Elia: The nature-loving biologist in me stumbled upon a curious botanist by the name of Charles de l’Ecluse (Carolus Clusius). He was born 490 years ago this month and is credited to introducing tulips to the Netherlands. It was the first booming interest in plants for something other than their medicinal value. If you hadn’t known yet, tulips in Holland are MAJOR:

  • About 93 percent of all bulbs in the world come from the Netherlands.

  • There are over 52,000 acres of bulbs produced there by about 2,700 growers, with about 20,000 employees.

  • Over nine billion bulbs are produced annually, one third of which are tulips. These three billion tulips, if planted four inches apart, would circle the globe at the equator seven times! Via UVM.

International events and tours are anchored around those bulbs. The economics of the business has always been impressive, in places more than others.

C: That all sounds fine, but what’s this really all about?

E: Those once-living flowers are not just there for our pleasure. Plant biology is a fascinating stand alone world that keeps getting more interesting. Recent reports shared on social media are describing how the Venus flytrap can count. As DNews put it, this carnivorous plant can count how often it’s been touched, particularly up to 5 to feed itself:

One: The plant’s trap enters a “ready to go” mode, noting the stimulation.

Two: The trap begins to close around the source of the stimulation.

Three: The trap closes tightly.

Four: The plant produces a hormone associated with the feeding process.

Five: Glands on the inner surface of the trap produce digestive enzymes and transporters that help to take up nutrients. At this point, if the stimulation were a real insect or other victim, it would be dinner.

C: That’s pretty  neat, and good for the plant. I still don’t see why I should care..

E: This brings me to how people are harnessing the power of plants and other cells to perform calculations of their own. Well, not just calculation but actual coding. Welcome to the world of cellular computing!

Coding and computing are ways to solves problems relying on the power of a machine and its software. Those systems do exist in nature, and one of the smallest machines are cells themselves. Coding at this level allows researcher to go beyond silicon circuits, embed computing capabilities into cells and ultimately get those cells to be “smarter” sensors and respondents to both internal changes their environments.

One example of that would be when cells are over-replicating, like with cancer, they would automatically detect over-expressed proteins and code for a cure, by expressing the appropriate genes.

In coding terms, this looks like:

If A>50 AND B>150 then code for protein C.

On the molecular level, getting to “If” “And” “Or” terminology requires control over regulatory regions in the DNA. What basically allows a gene to be expressed is binding of protein expression machinery to its promoter region. These promoters are analogous to transistors in electricity, allowing the machinery to flow and code for instructions. Using molecular scissors, scientists have been able to modulate this machinery:


This gif (Via NPR) shows how the presence of both conditions allows for instructions to be made.

C: That’s pretty impressive. What do these scissors respond to?

E: These molecular scissors are players in a technique called DNA Strand Displacement (DSD). It’s been successfully adopted by Microsoft itself as an upcoming coding challenge. These scissors can respond to internal (over-expressed proteins) or external stimuli (drug). More recently, scientists have demonstrated that the concept works inside mammalian cells.

The fact that we can now code inside living cells is pretty darn impressive. If that doesn’t make those flowers you got on Valentine count, I’m not sure what will.

[Signature drink by E.]

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Is Your Speaker On?!

If you Skype, Facetime, use web-conferencing or just live with your grandpa, you know we’re eventually going back to this:


Appreciating your ears is natural after the frustration/failed communication. But how bad is noise to our health, and could we ever power back those sensors?

Christian: How do we define noise in the first place?

Elia: Noise has many definitions; Merriam Webster‘s definition of a noise (sound) is “one that lacks agreeable musical quality or is noticeably unpleasant”. Noise and any other sound are measured in decibels, a quality relating to its pressure. The sound waves move through the ear bones, to the cochlear liquid, then moving the hair cells. Different sounds move the population of hair cells in a different way, enabling the generation of unique nerve impulses. Over time, hearing loss occurs because of damage to those hairs, which do not regenerate. Hearing loss can be due to two factors, noise-level and duration. As stated on DangerousDecibels.Org:

  • A typical conversation occurs at 60 dB – not loud enough to cause damage.

  • A bulldozer that is idling (note that this is idling, not actively bulldozing) is loud enough at 85 dB that it can cause permanent damage after only 1 work day (8 hours).

  • When listening to a personal music system with stock earphones at a maximum volume, the sound generated can reach a level of over 100 dBA, loud enough to begin causing permanent damage after just 15 minutes per day!


C: Is hearing loss a common condition?

E: According to the NIH, “One in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing loss in both ears, based on standard hearing examinations.” Despite damage being permanent and cumulative, Noise-Induced Hearing Loss (NIHL) is the only preventable hearing loss condition. People should be more aware of their surroundings as this can be a very limiting condition. Noise pollution has been recognized as a hazard by several environmental protection agencies, where people are assigned hot lines to register complaints. As the US National Park Services put it: “Noise Knows no Boundaries”, warning visitors from its effect on both wildlife and their experience of the environment. This is especially concerning for animals using sonar and vocalisation to hunt, mate, forage and other important activities.


C: But noise is such a big part of our culture now. Some people even need it to sleep! What does science have to say about that?

E: This kind of noise is referred to as “White Noise”. As elegantly explained on HowStuffWorks:

The adjective “white” is used to describe this type of noise because of the way white light works. White light is light that is made up of all of the different colors (frequencies) of light combined together (a prism or a rainbow separates white light back into its component colors). In the same way, white noise is acombination of all of the different frequencies of sound. You can think of white noise as 20,000 tones all playing at the same time.

The concept is to essentially create enough noise frequencies to confuse and dull your brain, rendering any new “sudden” noise ineffective in waking you up. Some people also make use of noise generators to mask Tinnitus, a condition where you have constant ringing in your ears. Silence is very much appreciated in some cultures, leading germans to invent the first earplugs.

C: I’m guessing the more modern alternative to those are noise-cancelling headphones. Any idea how those work?

E: As we mentioned earlier, sounds travel as waves. Blocking access of those waves to your ears can be done either passively or actively. The passive way is equivalent to adding more roadblocks, like earplugs, wearing headphones to cover the whole ear instead of earphones. Sophistication in the material used for isolation goes a long way in these scenarios. But for more serious isolation, active blocking is designed to counter the effect of incoming waves.

By detecting incoming noise waves, active-blockers are able to generate similar ones, but with an 180 degree (out of phase) quality. The generated sounds will cancel out incoming noise, in a phenomenon known as destructive interference. Imagine armwrestling with equal forces. At that balance moment, no single force wins and slams the other on the table. It’s as silent as can be.


I have recently received noise-cancelling headphones and got to try them on a long Cross-Antlantic business trip. They are worth every penny, given how loud a plane can be, and how sensitive I now recognise ears to be. Moreover, a recent discussion showed that noise is making us oblivious to the sounds of nature. The idea is we are so used to high levels of noise, that we tune them out. This coping mechanism, or “learned deafness”, may be leading us to stop listening to the natural choruses present in our cities and parks, such as bird chirping and others. You might want to save your ears for that instead of full blast music on your iPod.

[Signature drink by E.]

The Invincible Pill

It’s seems like every week or so we read about Captagon in the headlines, and how smuggling it is becoming more and more prevalent and specially in the Middle East.

Elia: What’s Captagon and how does it affect the body?

Captagon-pills-seized-in--009 (1)Chris: Captagon is the street name of the chemical compound Fenethylline; it’s a psycho-
stimulant drug that “excites” the brain and central nervous system, which increases the mental state of alertness of its users.

E: How would it do that?

C: Captagon is the result of linking Amphetamine and Theophylline molecules via an alkyl chain. The drug is not an active molecule by itself; it undergoes several chemical reactions in the liver and kidneys until it releases Amphetamine and Theophylline.

Amphetamine is a derivative of the natural stimulant Adrenaline , the latter is released normally when we are in stress and increases the heart and respiratory rate and causes pupil dilatation.


Theophylline is an alkaloid derivative that causes a dilatation in the respiratory system and it’s pharmacologically related to caffeine, hence it makes respiration easier and of course increases concentration and alertness.

E: What was its initial medical use? And why did it become illegal?

C: It was first synthesized in 1961 by the German pharmaceutical company “Degussa” most famous for their production of the lethal gas “Zyklon B” used in the Second World War.

Amphetamine_fullSize_1.2810715.1245847339The synthesis of Captagon was initially a project in the testing of Theophylline’s effect on the lungs and cardiovascular system. After undergoing several tests, they discovered its effects on the level of alertness; it ended up being sold over the counter for the treatment of ADHD (attention deficit) and Narcolepsy (spontaneous sleep).

In 1981, after several testing, the FDA listed Captagon as a controlled substance (schedule 1) and became illegal in most countries. The latter was made on the basis that the drug causes these side effects and at very high rates:

  • Stroke
  • Cardiac toxicities including myocardial infarctions and hypertrophy
  • Seizures
  • Dependence with a highly addictive profile
  • Serious withdrawal symptoms when stopped abruptly

E: Why is it so much prevalent in the Middle East at this moment?

C: Captagon started in Eastern Germany, after the fall of Berlin wall the production was moved to Eastern Europe, finally and after the fall of the Soviet Union and the establishment of peace in Europe, the production was shifted to the Middle East. What do all these areas have in common? You guessed it … Wars.

foreign_troops_depressed_after_war_ptsdCaptagon gives the sensation of being invincible and gives a big boost of energy and false confidence that all soldiers need especially on the front lines. In addition, it is believed that Captagon traffics finances wars and its weapons. Consequently, being very cheap and easy to produce, Captagon became the drug of choice in wars.

Finally, a fun fact; forensic reports in 2005 were made on several seizure of Captagon smuggles and turned out that the trafficked pills do not contain Fenethylline at all… talk about placebo effects !


Cocktail’s Ingredients:

Juicy, Charbroiled & Cancer Free!

UntitledRed meat” and “cancer risk” in one sentence is a barbecue lover’s worst nightmare. In October 2015, the “International Agency for Research on Cancer” (IARC) published an article classifying red meat and processed meat as carcinogen. Consequently, The topic became trending worldwide on social media. Everyone is talking about it, and some became very concerned and decided to remove red meat from their diet.

Elia: Who is the IARC?

Chris: IARC is a specialized cancer agency and part of the World Health Organization (WHO); its main mission is to conduct and to collect studies on cancer and its culprits. IARC is classified as one of the best and most reliable global references in cancer information.

E: How does the IARC classify the chemicals according to their carcinogenicity?



E: What did the IARC really say about red meat and cancer?

C: The IARC study team worked on 800 studies on meat consumption and the causality of multiple cancers, and the result came from large cohort studies over 20 years.

They came to the conclusion that processed meat is a Group 1 carcinogenic to humans, and the red meat is classified as Group 2 A carcinogenic for humans, causing mainly colon cancer. You can access the full IARC article by clicking on this link.

E: What are the actual differences between red meat and processed meat?

C: Red meat is defined as all types of mammalian muscle meat, such as beef, veal, pork, lamb, mutton, horse, and goat.

Processed meat is defined as meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation.

E: What’s in the red meat that makes it questionable when it comes to cancer?

111C: Muscle tissues contain amino acids, sugars and creatinine that react together when the red meat is cooked under high temperature (i.e. deep-frying) and especially on open flames (i.e. Barbecue). These cooking techniques will cause the formation of what we call heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons (PAH). The two latter compounds are known to have mutagenic activity and react with the DNA in the cell lining of the gastro-intestinal tract predisposing to colon cancer.

E: Why is processed meat more carcinogenic than red meat?

C: Pre-cooking, smoking and curing red meat (i.e. bacon) increases drastically the kinetics of the reactions causing the formation of HCAs and PAHs in meat when cooked. On the other hand, all processed meats are treated with nitrites in order to prevent Clostridium Botulinum colonization and to extend the shelf life of the meat products. Nitrite, in treated food, will cause additional reactions in the meat causing the formation of N-nitroso compounds.

454 The latter has an extremely important role in meat manufacturing because it doesn’t only extend the shelf life of the meat but it gives a pink color that helps the product be more appealing and increase its sales (i.e. hot dogs, pink mortadella, pink ham…). Unfortunately, N-nitroso products are highly carcinogenic and using it with red meat is just adding insult to injury. Ultimately, this explains why the results of the IARC studies classified the processed meat as more carcinogenic than red meat, and they explicitly said “…each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%”.

E: Should meat be removed from our diets?

C: The answer is definitely no, for two main reasons; Firstly, meat is the major source of protein and vitamin B with no clean-cut alternative yet in our diet. The second reason is that the IARC classifies the products causality of cancer in humans but at the same time they do not define the intensity of this causality, which will need further studies to come up with accurate and more statistical significant frequencies. In other words, the group 1 carcinogenics includes tobacco smoking and alcohol use also, which is an example of how the intensity is not expressed in their classification knowing that tobacco smoking causes way more cancer than alcohol drinking.

E: Any final tips on how to decrease the risk of cancer and still enjoy a good barbecue?

C: Here are a few tips on how to flip some burgers and enjoy its juicy texture without worrying about the cancer risk:

  • 235253Do not leave the meat on an open flames for a long time; hence, avoid causing black bites on meat by burning it.
  • Avoid eating processed meat and specially the smoked and pink meat.
  • Avoid deep fried red meat.
  • Eat more chicken and fish, where PAHs and HCAs still can form but in very small quantities compared to red meat.
  • Eat more cooked vegetables with your barbecue especially broccoli that contains glutathione that aids the liver in the clearance of the toxins caused by the meat.
  • Skip eating red meat one or two days per week.



Cocktail’s Ingredients:





Intimacy 101

Stem cell therapy presents itself as somehow alien to most people. The idea of using living units to repair/remedy diseases is so powerfully intimate, borderline intimidating. Additionally, the field is evolving so fast, that I had much reading to do before we could sit down for this conversation:


Chris: Let’s start with basics, what are stem cells? And are there different types?

Elia: As we’re all familiar with, our tissues are composed of cells. What makes each tissue or organ different is the type of cells composing it. This programming is termed differentiation, whereby cells express certain proteins to make them look like skin tissue, as opposed to those expressed in the liver. Stem cells are a subset that have 3 main characteristics:

  • Capable of dividing and renewing themselves for long periods
  • Unspecialised: They are not committed to a specific cell type/tissue.
  • They have the potential to become any other cell type/tissue.

Consider them as a Transformer toy.


These toys have been characterised in 3 different settings:

  • Embryonic stem cells: As their name suggests, they are found in early development, where their successive division promotes the establishment of the different tissue linages. They are typically obtained from blastocysts resulting from In Vitro Fertilization where they are no longer needed.
  • Adult (somatic): In some adult tissues, such as bone marrow, muscle, and brain, populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease. They are more specialised than their embryonic counterpart and can generate different cell types for the specific tissue or organ in which they live
  • iPSC (induced Pluripotent Stem Cells): Differentiated cells that can be reprogrammed to become stem cells. They are coaxed into being stem cells by scientists in vitro using viral vectors; forcing them to express genes they wouldn’t otherwise express.

Among those, the first are the only ones that are truly pluripotent, able to differentiate into any other type. The adult ones are too scarce in the body but worth the attention due to the low chance of rejection in therapy.

C: So you mention therapy. How would undifferentiated cells be helpful in therapy?

E: Physicians would opt into cell therapy in cases of tissue damage that cannot be remedied by the body itself. Blood stem cell transplant is the most widely known form of cell therapy. The bone marrow is the location where most of your blood cells originate. This factory, an example of adult stem cells, may be disturbed due to an auto-immune disease, post-chemotherapy or other instances. Over 26,000 people make use of this technique on a yearly basis in Europe alone. As you can guess, the main challenge is for those new cells to properly adapt and function in their new host.

As an equally important aspect, stem cells are carefully “differentiated” in labs for the purpose of drug screening. It’s sort of like on demand tissue, allowing scientists to produce and test, before moving into in vivo  systems.


C: But as you said, stem cells can differentiate into any other sort, not just blood. Has there been any progress on other fronts?

E: Scientists continuously use these cells to better understand normal human development and figure out gateways to cell therapy. Over 5000 studies are currently listed in featuring stem cells. Patients can sign up provided the option has been discussed with their physician. However, as with all clinical trials, there are things to know. These were beautifully summarised by below:

  1. Currently, very few stem cell treatments have been proven safe and effective

  2. There is something to lose when you try an unproven treatment
  3. Different types of stem cells serve different purposes in the body

  4. The same stem cell treatment is unlikely to work for different diseases or conditions
  5. The science behind a disease should match the science behind the treatment
  6. Cells from your own body are not automatically safe when used in treatments
  7. Patient testimonials and other marketing provided by clinics may be misleading
  8. An experimental treatment offered for sale is not the same as a clinical trial
  9. The process by which science becomes medicine is designed to minimize harm and maximize effectiveness


Cocktail ingredients:

[Signature drink by E.]

Antibiotics 101

I m gonna start by saying it is important to consult your healthcare provider before taking any antibiotic for any given reason. Besides, when you are prescribed an antibiotic, it is important to follow the instructions in order to optimize the outcomes of your treatment.


Elia: Can I stop taking my antibiotic if I’m feeling better?

Chris: Few days after starting the antibiotic course you will definitely feel way better, especially when it comes to Strep throat infection. What’s happening is that big bulks of bacteria are wiped by the first few doses of antibiotic. Consequently, you will end up having the bothering side effect of the antibiotic (most commonly nausea & diarrhea) and no sign of the original symptoms you were complaining about; as a result, you are tempted to stop the drug.


What occurred really is a huge number of bacteria are either dead or not functional, but a relatively small amount has survived the first few days of antibiotic but not enough to cause the symptoms. If you stop the antibiotic at this point, you will give the chance to those who already are stronger and didn’t die to multiply and cause the reappearance of the symptoms few days after stopping the drug; the chances are that they will develop stronger and resistant to the antibiotic you already took.

E: What should I do if I accidentally skip a dose?

C: The rule in antibiotics is you take the dose as soon as you remember, but if it’s nearly the time for the next dose just skip it. In case of multiple consecutive dose skips, you should consult your doctor or pharmacist.

E: Can I drink Alcohol when I’m on antibiotics?

C: Alcohol drinking is the most asked question when it comes to antibiotics. Although it doesn’t affect the outcome of almost all the community prescribed antibiotics, but drinking alcohol is never a good idea when you are sick. The latter will worsen all your symptoms in general.

To check the list of the less commonly used antibiotics and affected by alcohol drinking check this Link.


In addition, if you are taking Metronidazole (an antibiotic used for gastro-intestinal, genital, skin and other infections) and you drink alcohol it will cause what we call the Disulfuram-like effect, which is basically a very bad hangover: flushing, headache, nausea, vomiting, cold sweat, accelerated heart rate…

E: Any last tips or things to avoid while on an antibiotic?

C: here are few tips that will enhance the course of treatment and make it as smooth as possible:

  • Never crush or chew on your antibiotic tablets and always take it with a big glass of water, because any residues in the mouth might lead to oral fungal infections.
  • The most common complaint when taking an antibiotic is diarrhea; so to avoid it you can either eat some yoghurt or take any probiotic tablets daily while taking the drug and at least one week after finishing it.

PS: You should space any dairy product for at least two hours from any antibiotic that has an active ingredient and ends with one of these suffixes: “floxacin” or “cycline”. If calcium comes in contact with any of these drugs the absorption of the antibiotic by your body will decrease.

  • Always tell your doctor or pharmacist if you are taking any other medications, this way you will make sure no drug-drug interaction is available.


Cocktail’s Ingredients:



There’s a Gene For That

Almost 500,000,000 search results show up on googling the word “Diet”, and a 250,000,000 for “Weight Loss”. With so many people interested in the topic, actively dieting or offering advice, research behind the reasons for obesity is growing. Through one’s own experience of having trouble achieving similar success to their peers, one can guess that it might be genetic. Research has confirmed the link, and we will try and expose it:

Chris: Obesity is characterised by an accumulation of body fat. How does that happen at the organism level?

Elia: To start off, a really nice definition:

A consequence of an imbalance between energy intake and energy expenditure . The energy balance represents a conglomerate of traits, each one influenced by numerous variables such as behaviour, diet, environment, social structures, metabolic factors and genetics.

Unfortunately, if this energy balance is unchecked, it could lead to a number of diseases including type 2 diabetes, cardiovascular and metabolic problems.

C: What causes obesity and what has been shown so far to link it to genetics?

E: One example that is popular is that of Leptin. This protein is coded and expressed by the adipose tissue to resist weight change in either direction. By being made in proportion to fat mass, a loss of weight will diminish its quantity, signalling to the brain to increase food intake. Weight gain will produce too much of the protein, signalling for satiety. There’s a really nice intro on the topic by the lab who first characterised it.

Mutations in this gene have shown how it can lead to obesity early in life. This is the case for a monogenic case, a singly gene attributable to a phenotype (around 5% of the cases). It becomes trickier with polygenic inheritance.

C: How so? What’s the status on that?

E: In that case, multiple genes contribute, introducing high variability and degrees of susceptibility. Associations with different areas in the genome have been made possible through new technologies. But again, these are coding for genetic predispositions, nothing like the causality seen in monogenic cases. Interestingly;

The fact that the prevalence of obesity in many countries has increased threefold over the last three decades seems difficult to conjugate with the notion that genetics are the primary cause of obesity as revealed by twin and adoption studies.

It is thought that polygenic obesity is always the result of a predisposition aggravated by an “obsegenic” environment.


C: It’s already known that diet is a big influencer. People are more sedentary, have easier access to fatty and sugary food. But, that still doesn’t explain the variety of phenotypes we see..

E: This has been the focus of several research groups. One of the articles that made headlines recently was one measuring post-meal glucose levels. Blood sugar has been associated with prediabetes, affecting 37% of the US population alone. The group had noted a dissatisfaction with correlating carbohydrate content to blood sugar, especially given interpersonal variability. In other words, my blood sugar may react differently to an apple depending on the time of day, so ascribing a value to food may not be the best option. They were able to positively associate types of gut microbiomes to specific responses. Moreover, they were also able to harness this knowledge to design an algorithm and tailor each person’s diet; this successfully lowered their post-meal glucose levels.

In other words, we are moving from viewing obesity as something we’re born and stuck with, to a series of linked elements we can control and manoeuvre to our benefit.

Cocktail Ingredients:

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[Signature drink by E.]

A New Appreciation for POOP!

The microbiome traditionally refers to the community of microorganisms living in a particular environment. In  humans, bacterial cells outnumber their mammal counterpart with a ratio of 10:1.

The recent enthusiasm for microbiomes has sprouted new journals and an interest in how we can harness their potential for human health.

Out of which, a very intimate conversation was bound to happen.


Chris: What is fecal transplant?

Elia: Bacteriotherapy or Fecal microbiota transplantation (FMT) is the transfer of fecal matter from a healthy donor, mixed with saline solution, into a recipient’s gastrointestinal (GI) tract.

C: How is this performed?

E: The most common way is the introduction of the sample during a colonoscopy. Others includes enemas or infusions through the nasal tube. This has been practiced as early 4th century in China, where the “yellow soup” was administered orally.

C: How does it modify the microbiome in the intestinal flora?

E: The whole premise of introducing such a sample is to allow for the repopulation of bacteria. This is usually indicated after recurrent courses of antibiotics.

One prominent example is the treatment of C. diff.  

The CDC reports that approximately 347,000 people in the U.S. alone were diagnosed with this infection in 2012. Of those, at least 14,000 died.

This bacteria is normally outcompeted by a healthy individual’s microbiome. Other bacteria just don’t allow it to thrive. This is not the case for when the patient has had antibiotics. A harsh regimen cleans out most of the commensal helpful population, leaving the individual vulnerable to contracting this infection. Interestingly, the current treatment for C. diff is even more antibiotics, plunging both physicians and patients into a possibly frustrating vicious circle. Recurrence rate is close to 20% after the first round and up to 60% after the second. Hence, the interest in repopulating the GI with healthy bacteria as an alternative to fight off the infection.


C: Has this method shown any worth clinically? Isn’t the same as altering your food to enhance your microbiome, be it probiotics or others?

E: This method surely works more efficiently than dietary supplements, with respect to bacterial repopulation rates. However, controlled clinical research studies looking at fecal transplant success rates have yet to be completed, but case reports are piling up indicating an efficacy of 83%–90%. The FDA has classified it as an investigational new drug in 2013. A lot of DIY websites are instructing people on how to perform one themselves, but please note that even not all physicians are allowed to perform it. Recent reports show FMT being applied to patients with other conditions with deregulated microbiota, such as autoimmune conditions, multiple sclerosis and others.

C: And how are people responding to this trend?

E: Resistance is surprisingly low. Even if the procedure might sound icky, it is very much preferable to their current state. Donors are screened and are most of the time a patient’s relative. This might look very promising to some, given how it’s not as invasive or plagued with side effects as other courses of treatment. The regulating authorities are still cautious about it. Is this a drug or an tissue donation? Should people get paid for this? etc. It would be very interesting to see this one unfold.


Cocktail Ingredients:


[Signature drink by E.]