Blood transfusion in cardiac surgery: The less the better?

There are no advantages to liberal use of red blood cell (RBC) transfusion over restrictive use in moderate to high-risk patients undergoing cardiac surgery, the multicentre randomized noninferiority TRICS-III* trial has shown.

Liberal use refers to transfusion if haemoglobin level drops to <9.5 g/dL in the operating room or the intensive care unit and to <8.5 g/dL subsequently on the ward, restrictive use to transfusion if haemoglobin is <7.5 g/dL intraoperatively and postoperatively.

“Apparently, the restrictive approach was noninferior to the liberal approach,” said Dr Christopher Granger, director of the Cardiac Care Unit, Duke University Medical Center in Durham, North Carolina, US who is unaffiliated with the study. “Interestingly, the result was more favourable to the restrictive strategy – it was not statistically significant but was nonetheless reassuring. I think this will have impact on the guidelines.”

The primary composite outcome of hospital death, stroke, new renal failure requiring dialysis or new focal neurological deficit occurred in 11.4 percent of patients treated using the restrictive strategy vs 12.5 percent in those treated with the liberal strategy (p<0.001 for noninferiority). Mortality rates were no different between groups at 3 percent and 3.6 percent, respectively. [N Engl J Med 2017;doi:10.1056/NEJMoa1711818]

TRICS-III involved cardiac surgery patients from 19 countries with a preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE I) of ≥6, randomized to restrictive or liberal strategy and followed through day 28. Secondary outcomes included duration of hospital stay and mechanical ventilation; and individual perioperative adverse events including MI, stroke, delirium, infection, acute kidney injury, gut infarction, prolonged low cardiac output state, and platelets and plasma transfusion.

Of patients in the restrictive arm, 52.3 percent received allogeneic RBC transfusion vs 72.6 percent in the liberal arm (odds ratio [OR], 0.41; 95 percent CI, 0.37—0.47). There were no significant differences in the secondary outcomes between groups.

Optimal threshold for transfusion

“Current guidelines recommend transfusion for severe anaemia and recommend against it at haemoglobin level of >10 mg/dL,” said lead author Dr C David Mazer from the University of Toronto and St Michael’s Hospital in Toronto, Ontario, Canada. “In between, they don’t provide good guidance.”

In the setting of cardiac surgery, there is considerable uncertainty on the optimal threshold for transfusion. Observational studies suggest harm from the liberal transfusion approach, but there are very limited randomized controlled trials to confirm this. The TITRe trial, on the other hand, found no significant difference between the liberal and restrictive transfusion strategies in terms of morbidity or total costs postoperatively. [N Engl J Med 2015; 372:997-1008]

“In TRICS-III, we’ve shown that we can transfuse more sparingly and maintain patient safety and patient outcomes, while saving blood [which is a scarce resource] and its associated costs. There was remarkable consistency of results through various subgroups and sensitivity analyses, and I think that strengthens the message.”

Age does matter

Interestingly, in the subgroup analysis of the TRICS-III trial, patients 75 years and older did better with the restrictive strategy, suggesting that this group may be more susceptible to some of the harmful effects of transfusion (eg, infection and mortality).

“I find this very counterintuitive as most surgeons have a lesser threshold for transfusion in the elderly patients, those 75 and 80 years old. I was baffled by the results. This is extremely important and the long-term outcomes should be evaluated,” said discussant Dr Frank Sellke, Karl Karlson & Gloria Karlson professor and chief, Division of Cardiothoracic Surgery and director, Lifespan Cardiovascular Institute, Brown Medical School and Rhode Island Hospital in Providence, Rhode Island, US.

“Many people believe that the older you are, the higher your haemoglobin should be or the more liberally you should transfuse. The outcome that we saw was opposite to that,” Mazer said. “Restrictive transfusion is safe in these patients.”

Implication to practice

Two in three patients undergoing surgery receive blood transfusion. However, blood transfusion is not safe in some countries. “Blood is not only expensive, it is also toxic [in certain cases]. You don’t want to give more than what is necessary. With TRICS-III, there is now compelling evidence that less is better,” commented Dr Daniel Sessler from the Cleveland Clinic in Ohio, Canada, who is unaffiliated with the study. “So, with rare exceptions, we shouldn’t be transfusing above a haemoglobin of 7 [g/dL] and that applies to sicker and older patients, and even critical-care patients.”

Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery.


In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5.


A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups.


Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass.


UK first in heart failure operation.

Sevket Gocer,
Sevket Gocer, right, was the first patient in the UK

A pioneering operation to improve the function of failing hearts while they are still beating has taken place in the UK for the first time.

Patients with heart failure struggle to pump blood around the body and mild exercise can leave them breathless.

Surgeons used a form of “cardiac sewing” to remove scar tissue and reduce the size of the heart so it pumps more efficiently.

The operation took place at King’s College Hospital in London.

One common cause of heart failure is when the arteries which nourish the organ become blocked, leading to a heart attack. Heart muscle dies and is replaced by hard scar tissue which does not beat.

Over time, the scar tissue can stretch so chambers of the heart become larger, meaning the organ has more blood to force out with each heartbeat.

The overall effect is a weaker heart, less able to do its job, transforming simple day-to-day tasks like climbing stairs into extreme exertions.

In the operation, surgeons used a wire with anchors at both ends to pierce two sections of heart muscle. When the wire was tightened, the walls of the heart were “remodelled”.

Before and after surgery
Scar tissue, in grey, is “sewn out”

The scar tissue was effectively removed and the volume of one of the chambers of the heart was reduced by a quarter.

Sevket Gocer, 58 and from Bromley in south-east London, was the first patient to be treated in the UK. His heart function is said to have “improved significantly” after the operation.

A similar procedure used to be performed by opening up the chest and stopping the heart, but it was a very risky operation and fell out of medical practice.

Surgeons hope the less invasive operation, which can be performed while the heart is still pumping, will be a better option for patients.

Mr Olaf Wendler, a professor of cardiac surgery at King’s College Hospital, told the BBC: “In the technique we have now used for the first time in the UK, one does not need to stop the heart, one does not even necessarily need to place the patient on a heart-lung machine.

“It’s a less traumatic and less invasive type of procedure.”

He said the operation was being tested in a trial at hospitals across Europe and that the procedure could make a difference to patients’ lives.

He said: “[If successful] it’s bringing them on to an exercise level where they’re able to look after themselves properly including going to do the shopping and having a social life.”

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “The results of this trial will determine if this experimental procedure is safe.

“If the trial is successful, there will be further use of the technology as surgeons gain expertise in the technique. As more people are treated with this procedure, it will become fully clear whether it will have a real benefit for patients.”

Can a drug make you tell the truth?

In movies and TV dramas, sodium thiopental is shown as a sinister truth serum used to get information out of captured people. Michael Mosley tried it out.

One of the great challenges of living in our society is knowing when people are telling the truth or not. We lie all the time and are remarkably bad at detecting when other people are deliberately deceiving us.

There are lots of urban myths about lie detecting, such as the claim that liars tend to look away, twitch their feet or touch their noses when lying (the so-called Pinocchio effect).

In study after study, it has been shown that professionals such as policemen are no more reliable at detecting liars than the rest of us. So it’s not surprising that for many years scientists have been working to develop “truth drugs” – drugs that will make you open up and tell all you know to an interrogator.

One of the oldest and best known of these truth drugs is sodium thiopental. Although it was first developed in the 1930s, it is still used today in a range of settings, including, in some countries, by the police and the military.

I was intrigued but also extremely sceptical about the claims that sodium thiopental, originally developed as an anaesthetic, could make people speak the truth if they chose not to. So I decided, as part of a series I’ve been making on the extraordinary history of pharmaceuticals, to try it out.

Sodium thiopental is part of a group of drugs called barbiturates, drugs widely used in the 1950s and 60s to help people sleep better. They are no longer used for that purpose because they are extremely addictive and potentially lethal – Marilyn Monroe famously died from a barbiturate overdose.

I decided to take a low dose of sodium thiopental under proper medical supervision, with anaesthetist Dr Austin Leach monitoring my vital signs throughout. Barbiturates work by slowing down the rate at which messages travel through the brain and spinal column. The more barbiturates there are, the harder it is for chemical messages to cross the gaps between one neuron and the next.

Your whole thinking process slows down until you fall asleep. With thiopental, that happens very quickly indeed.

Although it was originally developed as an anaesthetic, it was soon noticed that when patients were in that twilight zone halfway between consciousness and unconsciousness, they became more chatty and disinhibited. After the drug had worn off, the patients forgot what they had been talking about.

It was decided that sodium thiopental might form the basis for a truth drug, an interrogation tool. But does it really work?

I decided that I would have a go at trying to maintain the fiction that rather than being Michael Mosley, science journalist, I would be Michael Mosley, famous heart surgeon. We started with a very low dose. Immediately I felt extremely light-headed, intoxicated. But would this make me more inclined to speak the truth?

There is an expression, “in vino veritas” (in wine there is truth). Alcohol is an anaesthetic and it depresses some of our higher centres, areas like the cerebral cortex where a lot of thought processing occurs. It reduces inhibitions but also slows thought processes, making it difficult to think clearly. The Roman historian Tacitus claimed that Germanic tribes held their important councils while drunk, as they thought it made effective lying harder.

One theory about sodium thiopental is that it works in much the same way. Because lying is generally more difficult and complicated than telling the truth, if you suppress higher cortical functions you are more likely to speak the truth, simply because it’s easier.

I’m not sure if I lied effectively while under the influence of low dose thiopental, but I found that I could still lie.

“I am a cardiac – ha ha ha! – cardiac surgeon, a world famous cardiac surgeon,” I shouted out when Dr Leach asked me what I did for a living.

“Would you like to tell me what the last operation you carried out was?” he enquired, politely.

“It was a heart bypass,” I improvised. “They survived, yeah, I was awesome.”

Not convincing, but I had just about managed to stick to my fictional story. But what would happen when the dose was upped?

Truth drug experiment, 1945
Truth drug experiment, Britain 1945

At this point I felt some trepidation. There was a risk that I might say something that I really didn’t want the world to know, but, confident in my ability to keep on lying, I told Dr Leach to go ahead.

I was given another slightly larger dose of sodium thiopental and this time I actually felt more sober, more in control. So what happened next was a complete surprise.

Again Dr Leech asked me my name and my profession. This time there was no hesitation.

“I’m a television producer. Well, executive producer, well, presenter, some, mix of the three of them.”

“So you don’t have any history of performing cardiac surgery?” he asked gently.

“None whatsoever. None whatsoever”

I’m still confused about what happened because one effect of the drug is to distort short-term memory. But I think the reason that I spoke the truth on this occasion is because the thought of lying never occurred to me.

So does it work? Well my conclusion after trying it out and speaking to experts is that it will certainly make you more inclined to talk, but that when you are under the influence you are also in an extremely suggestible state. The reason you become more suggestible is probably because the drug is interfering with your higher centres, like your cortex, where a lot of decision making goes on. There is a serious risk you will say what your interrogator wants to hear rather than the truth.

The truth is we don’t have a reliable truth drug yet. Or if there is one out there, nobody’s telling.

Hydroxyethyl Starch Solutions Get Boxed Warning.

Hydroxyethyl starch solutions should not be used in critically ill patients, including those with sepsis and those admitted to the ICU, because they pose an increased risk for mortality and severe renal injury, the FDA has announced. A boxed warning will be added to the solutions’ labels to emphasize these risks.

Providers are also advised to avoid using HES solutions in patients with preexisting renal dysfunction. Treatment should be stopped at the first sign of renal injury; renal function should be monitored in all patients for 90 days after treatment.

In addition, the FDA says, HES solutions should be avoided in patients undergoing open heart surgery in association with cardiopulmonary bypass, given an increased risk for excessive bleeding. A separate warning about this risk will be added to the Warnings and Precautions section of the label.

Source: FDA


Underlying Factor in Most Chronic Disease?

For thousands of years, Eastern civilizations have used forms of energy medicine to unblock and regulate energy channels in the body. For example, acupuncture has a long history of success in Traditional Chinese Medicine

The West has been slow to embrace energy medicine, holding a more biochemical view of the human body, as opposed to “the body electric.”

Hold a stethoscope to your body and you’ll hear a lot of electrical chatter. Your nervous system communicates using electricity (i.e., movement of electrons), receiving and transmitting electrical signals throughout your body. Most of your biological processes are electrical.

Most people in the medical world have no background whatsoever in the electrical world, which is why Clint Ober is so uniquely qualified to offer this fresh perspective, which is brilliantly simple and intuitive, given how our ancestors lived.

Ober spent three decades working in the cable television industry prior to changing course to investigate how Earth’s electrical energy influences health. While struggling to recover from his own healing challenges, he received the following internal whisper:

“Become an opposite charge. Status quo is the enemy.”

This inspiration was the beginning of what could end up being a discovery as groundbreaking as germ theory. What he has discovered could be a major underlying thread in all chronic disease, a phenomenon he calls “electron deficiency syndrome.” The premise is simple. If you are deficient in electrons, your body is unable to effectively combat inflammation.

When inflammation runs rampant, as you probably know, you are vulnerable to a plethora of chronic diseases, including cancer, cardiovascular disease,rheumatoid arthritis, and many other illnesses that are appearing at alarmingly high rates today.

The Earth is the natural antidote for electron deficiency and can provide you with an infinite flow of electrons through grounding, also known as “Earthing.” And I will spend a large part of this article explaining how this works. But here’s the rub. You can’t benefit from this electron flow unless you are directly connected to the Earth. And today, people in industrialized countries are anything BUT connected.

Humankind’s Disconnect from a Healing Source: Mother Earth

Industrialization and the introduction of plastics and other synthetic materials have disconnected us from the Earth and her energy. Whereas we once walked barefoot across the grass and slept on the cool dirt floors of a cave, we now live ABOVE the ground, separated from the Earth by raised wooden floors, rubber-soled shoes, and sometimes hundreds of feet of air, if you live (or work) in a high-rise building.

We are ungrounded—literally!

Have you ever noticed how good it feels to walk barefoot on a sandy beach, or in a forest? There is a reason for that—it’s called the grounding effect. The reason you feel so good on that sandy beach is you are receiving a surge of healing electrons from the ground. The Earth is a relatively infinite source of electrons, having a slightly negative charge. But the Earth’s electrons are free to move. So, when you stand barefoot on that sand, electrons from the Earth flow into your body, a virtual “transfusion” of healing power. This occurs until you equalize with the Earth. Meaning, you cannot get too much—the process simply stops when your charge (your voltage) returns to zero. It’s completely safe and natural.

The Earth is the biggest electrical object, and we are part of it. When you are grounded (i.e., in contact with the Earth), it’s impossible for your body to carry a charge.

Humans used to be naturally grounded. First, we were barefoot, and then we donned leather-soled shoes, which are stillmoderately conductive. When you wear a shoe with a leather sole, your feet sweat and permeate the leather with moisture and body salts, so the shoe becomes a semiconductor permitting you to receive some electrons.

But, for the past 50 years or so, we’ve added carpets, plastics, synthetic-soled shoes, and athletic sneakers, all serving as non-conductive barriers between the Earth and us. During that same period of time, we’ve seen an explosion of inflammation-based diseases. Our immune systems are struggling.

Pets are designed to be in contact with the Earth as well, but now they live above ground in houses, as we do. Anecdotal evidence shows they are suffering the same effects of electron deficiency as humans. Animals that live in the wild are not bothered with inflammation, cardiovascular disease, diabetes, arthritis, or even plaque on their teeth. This is why your dog or cat will crawl under the porch and lie on the bare earth if he isn’t feeling well.

What animals have always known, “modern science” is just now figuring out.

Even water is influenced by the Earth’s electrical energy. Water in contact with the Earth has a structure that makes it conducive to healing. When you are grounded to the Earth, it is thought that the negatively charged electrons you are receiving may help increase the structure of the water in your cells—just as water increases in structure when a negative charge is introduced by an electrode. By going outside, barefoot, touching the earth, and allowing the excess positive charge in your body to discharge into the earth, you can alleviate some of the stress on your system. So how does this grounding effect work?

You Are An Earthly Antenna

Your body is a conductor. You are an antenna for the Earth. When you are ungrounded, electric fields are attracted to your body and create a surface charge—a voltage. You know this to be true if you’ve ever shocked yourself after walking across a carpeted floor.

When living above Earth, your charge is positive; when connected to the Earth, your charge is negative—in other words, you become an opposite charge. You accumulate this surface charge any time you’re not grounded. When your charge reaches 3,000 to 5,000 volts and you touch a metal object, ZAP… this is static discharge, the sudden outflow of built-up electrical energy from your body.

This static electricity is the reason workers in microchip factories must be grounded—so they don’t blow the chips. The same goes for operating rooms. Everyone involved in a surgical procedure must be grounded—the patient as well as the medical personnel. Your skin offers some protection from static electricity, but when it’s open (as in surgery), that protection disappears. In fact, in the early days of open-heart surgery, this lesson was learned the hard way when many patients died from static electricity because patients weren’t grounded.

The higher the conductivity between you and the Earth, the more likely you’re going to be grounded. Proximity is key.

The more distance there is between you and the Earth, the greater the charge on your body. In fact, this has been precisely calculated. For every meter you are above the ground, 300 volts of charge will build up in your body. (See The Feynman Lectures on Physics) So, if you are in a second story bedroom, your charge would be 1000 volts, on average. Do you think your risk for illness could be higher living on the second floor? How about the 5th floor, or the 25th? Indeed, a study in 2009 from the University of Iowa revealed a 40 percent increase in stroke risk among people living in multistory homes.

Besides living and working above ground, invisible electromagnetic fields from devices such as cellular and cordless phones, computers, tablets and other technology assault us around the clock. You are bathed in background electricity from ordinary household wiring in the walls of your home, which contributes to your positive electrical charge and therefore increases the stress on your immune system. And if you are on the computer several hours a day, combined with several calls on your cell phone followed by an hour or two of television, you are getting several more hefty exposures to these unnatural electrical fields. If you want an in-depth discussion about Earth’s electrical surface potential, read this article by Gaetan Chavalier, PhD.

Playing with a Voltmeter

If you need convincing, you can watch your own body’s electrical charge wax and wane by availing yourself of a voltmeter, as Clint Ober demonstrates in the above interview. What you need is a low voltage field detector; one that reads in millivolts. Play with this, as it will show you that grounding works!

Measure your body’s charge when you are at varying distances from electrical devices, power cords, your computer, your phone, your refrigerator, etc. You will see that moving away from these objects drops the charge—and grounding zeros you out. This way, you can witness firsthand the effect of these devices on your body, in a very concrete way. You will see that you receive far more electrical noise from devices that are plugged in than from those running on battery power. This is why I recommend NOT using electronic devices while they are charging.

If you’re going to experiment with a voltmeter, make sure you do it safely, using conventional cord that has resistors built into it.

Although grounding does not eliminate dangerous exposure to EMFs, your risk for adverse health effects from them is drastically reduced. Still, I don’t recommend holding your cell phone right next to your head, even if you’re grounded. But grounding is the least expensive, most basic strategy that will allow you to resist that type of biological damage and decrease your body’s risk for developing prolonged inflammation.

Electron Deficiency Syndrome and Inflammation

If you Google the word “inflammation,” you’ll come up with more than 62 million links. This is indicative of just how much of a problem inflammation is. Inflammation is the root of virtually ALL of our chronic diseases. So, the question you should ask next is, what’s CAUSING all of this inflammation? It may very well be a deficiency of electrons—at least, this may be one of the most significant factors.

Electricity is as important for powering your body as for powering your computer and household appliances. We are beginning to understand, with the help of scientists like Clint Ober and James Oschman, that the Earth is our greatest source of healing because it supplies us with an unlimited flow of electrons. These electrons act like little antioxidants—cleaning up the free radicals and toxins that are byproducts of everyday human metabolism and environmental exposure.

Free radicals are primarily produced via metabolic processes, although you also get them from the foods you eat, the water you drink and the air you breathe. Your immune system is the main generator of free radicals, and it’s in operation 24 hours a day. In the process of oxidizing invading pathogens and disposing of damaged cells, your immune system generates reactive oxygen species (ROS), which are molecules short an electron or with an electron imbalance—they take away electrons from the cell or pathogen.

This creates the need for a “mop” to absorb or give up electrons so that electrical stability can be maintained within your body. Grounding to the Earth fulfills this role—and it’s nearly instantaneous.

Many of these metabolic/electric processes are occurring at the speed of light, just like the electrical current in a wire flows immediately to a light bulb when you flip the switch. When grounding to the Earth, electrons flow instantly into your body, much faster than waiting for particles to travel around in your bloodstream.

How Earthing Affects Your Blood

An important discovery is that Earthing thins your blood, making it less viscous. This has huge implications for cardiovascular disease because virtually every aspect of that disease has been correlated with elevated blood viscosity.

Dr. Stephen Sinatra, cardiologist and Earthing expert, discussed the zeta potential of RBC’s that decreases blood viscosity, when exposed to an electrical field. Within minutes of grounding to the Earth, your zeta potential quickly rises, meaning your blood cells have a greater charge and actually repel each other. This action causes your blood to flow more easily and your blood pressure to drop. When your zeta potential is lower, your blood cells tend to clump together, which is unfortunately what most people’s blood looks like when they are not grounded.

For a visual aid, the difference between grounded and ungrounded blood is like comparing red wine to catsup—thin and flowing with ease, versus thick and sticky and stagnant. Getting back to the increased risk of stroke for folks living in multilevel dwellings, it makes sense when you consider your blood cells being in a perpetual state of “clumping,” which increases the risk of clot formation.

Earth’s Gift to Athletes

The scientific research related to Earthing is really still in its infancy. Nevertheless, studies so far are very promising for a variety of heath benefits. Clint has been involved in more than 30 Earthing studies over the past decade, which have gradually verified that his inspiration to “become an opposite charge” was right on.

I first met Clint Ober about seven years ago through a chiropractor Jeff Spencer. One of the foundational elements he integrates into his training is Earthing. In fact, 200 to 300 of the world’s most elite athletes have been using Earthing as part of their training regimen for the last five years because they feel it offers them a competitive edge, including many professional football players.

Since the athletes were showing such great benefit, researchers at the University of Oregon conducted a study, referred to as theDOMS study (Delayed Onset Muscle Soreness). Researchers induced inflammation by repetitive and intensive use of a muscle group, and then measured both subjective pain experience and objective markers of inflammation in study participants. The participants were divided into two groups, one grounded and one not. The muscle soreness was essentially the same as what you experience after your first weekend of yard work in the spring—when you wake up a couple days later extremely sore and barely able to hobble out of bed. The results of this study were remarkable:

  • White blood cell count was extremely elevated in the ungrounded group, but not elevated at all in the grounded group.
  • Bilirubin dropped 40 percent in the ungrounded group but only 5 percent in the grounded. Bilirubin is one of your body’s primary antioxidants.
  • The grounded group experienced less pain than the ungrounded group.

Researchers concluded that all signs point to grounding having the effect of markedly decreasing inflammatory response. And this is HUGE as inflammation is key in just about every chronic disease you can name. Reduce inflammation, and you reduce disease. But Earthing has benefits that reach far beyond preventing sore muscles.

Pain Reduction, Better Adrenal Function and Improved Tolerance to Cold

In addition to decreased inflammation, two studies have shown that grounding can stabilize your autonomic nervous system (ANS). Oftentimes, the inflammatory cycle starts with an illness or injury that fails to heal. Besides pain and inflammation, your body’s inability to “restabilize” results in chronic stress. Why is this important? This ongoing stress can lead to adrenal fatigue, which is epidemic today. If your ANS can be stabilized, your chronic stress level will decrease. Grounding appears to be able to do this.

Grounding was found to regulate cortisol levels, according to one small study involving 12 subjects. The 12 were grounded over the course of eight weeks, during which time their saliva levels were monitored for cortisol, DHEA, and other stress-related hormones. All subjects with abnormal cortisol levels normalized, indicating the grounding reduced the stress in their bodies. This has huge implications for public health since the majority of all visits to healthcare practitioners are for stress related disorders.

The new study by Sokal provides even more good news about Earthing’s effects on inflammation. Researchers attempted to answer the question of whether or not Earthing affects human physiologic processes. So, they grounded people and tested their blood and urine chemistry. Just like the prior study, researchers found a significant reduction of inflammation indicators in the grounded test subjects. Specifically, in the group that slept Earthed, they found the following:

  • Reduced renal excretion of calcium and phosphorus during a 7- to 8-hour period of sleeping grounded (which reflects a reduced risk of osteoporosis)
  • Decreased blood glucose levels (reducing risk for diabetes)
  • Decreased free tri-iodothyronine, and increased free thyroxin and TSH (meaning better thyroid function)
  • Accelerated immune response following vaccination (as evidenced by gamma globulin concentration), which would suggest a more robust immune system

Having a simple, natural way to reduce stress and inflammation would have benefits for a wide array of medical problems, such as cardiovascular disease, arthritis, diabetes, as well as for issues like carpal tunnel (repetitive stress syndrome). Grounding also appears to help with Raynaud’s syndrome, which involves cold peripheral extremities. Although it isn’t understood exactly how grounding improves temperature regulation, it may be due to the thinning of your blood and improved circulation. It’s interesting that chickens that are allowed to live outside in the pasture don’t freeze, but those in chicken coops need artificial heat to keep from freezing on cold nights. Perhaps chickens grounded in the pasture share similar thermoregulation benefits with people who have Raynaud’s syndrome.

Unearthing the Fountain of Youth

Earthing may actually slow down the aging process. One of the dominant theories on aging is the free radical theory, which is that aging occurs as a result of cumulative damage to your body by free radicals. While you don’t want to completely eliminate ALL free radicals, you do want to maintain a good balance of antioxidant electrons in your body to ensure the damage from free radicals doesn’t’ get out of hand. Earthing can provide this continuous supply of electrons. According to Dr. James Oschman, biophysicist and coauthor of Earthing: The Most Important Health Discovery Ever?:

“It looks to me, from my study of biophysics and cell biology, like the body is designed with a semi-conductive fabric that connects everything in the body, including inside of every cell. I refer to this system as the living matrix. Those electrons that enter the bottom of your foot can move anywhere in your body. Any place where a free radical forms, there are electrons nearby that can neutralize that free radical and prevent any of those processes: mitochondrial damage, cross linking of proteins, and mutation or genetic damage. So the whole fabric is basically an antioxidant defense system that is in every part of your body.

We have this material called ground substance, which is part of the connective tissue. It goes everywhere in the body. It’s a gel material and it stores electrons. So that if you go barefoot, you will take in electrons and your body will store them, and they will be available at any point where you might have an injury, or any point where a free radical might form.”

So, to summarize then, Earthing offers many potential health benefits from better sleep, to less pain and inflammation, to reducing your risk for diabetes, cancer, heart disease, and I suspect this is just the tip of the iceberg as research in this area is just getting going. So, how do you basically “get grounded”? Let’s take a look at some practical approaches for introducing more Earth energy into your life.

Plugging into the Earth

The best way to gain the benefits of these healing electrons is to simply put your bare feet in contact with the Earth, especially damp Earth, as often as possible. Because water is such a great conductor, seawater is the absolute best. Swimming in seawater, dangling your feet in it, or walking on a sandy beach are all great ways to ground yourself. If you don’t have access to a shoreline, damp grass is a good substitute.

Concrete will work to a degree, but better if it’s got some moisture to it. Sealed or painted concrete, wood, asphalt, and typical insulators like plastic or rubber soles will not allow electrons to pass through.

As I said earlier, the closer you can get to being grounded 24 hours a day, the more benefits you’ll see. Unless you are sleeping in a cave or living on an island somewhere, chances are your domicile isn’t allowing you to be grounded all day every day, and so the most practical alternative is making use of new technology… Which brings me to the grounding mat.

Grounding Mats, Sheets and Patches

Necessity is the mother of invention, and this is certainly true for grounding science. Technology now offers us ways to stay grounded while in buildings, cars, and even airplanes.

There are a variety of mats, pads, sheets and patches that you can put in contact with your bare skin to restore this much-needed connection to the Earth. The grounding device is connected to a cord that plugs into the ground of an ordinary household electrical outlet. The grounding devices have resistors incorporated into them, so they are completely safe to use—you are protected from unexpected electrical currents.

For a grounding mat to work, your outlet must be grounded. In the United States, about 40 percent of houses do not have a ground in the bedroom, particularly homes built before 1970. Even if the outlets have been replaced, they are not necessarily connected to any ground wire, and the only way you can tell is to test them. If your outlet isn’t grounded, then you can have someone install a ground to those outlets. There are a number of ways to do this.

The most important time to be grounded is while you’re sleeping. There are two reasons for this.

First, the average bedroom typically contains more electrical noise than any other room in a house, especially near where your head rests on your bed. You’ve probably got a tangle of wires behind the wall, as well as wires running under the floor if you’re in an upstairs bedroom. Second, you spend a third of your life lying there. This is the time when your body should be repairing and regenerating, and electrical noise interferes with this process, potentially causing chronic stress and inflammation.

I recommend using a grounding sheet on your bed. Earthing happens to be very helpful for sleep. In fact, many people fall asleep within 5 to 10 minutes of becoming grounded. Better sleep and less pain are probably the most immediately appreciated benefits when people begin Earthing.

A Few Medical Precautions

Earthing is so effective that some people have had to decrease their medication dosage. Having to make changes in your meds is not a bad thing, but rather a sign that your body is working better. If you are taking any of the following three types of medications when you begin Earthing, you should be especially careful to observe how you feel and be diligent about monitoring your blood levels:

  • Blood Thinners: If you take Coumadin (warfarin) or other blood thinners, your blood is going to get even thinner when you’re grounded, as described previously. You will want to be very diligent about monitoring your blood levels and watching for warning signs, such as bleeding or bruising.
  • Oral Hypoglycemics: Grounding is shown to reduce blood glucose levels. A study of rats showed that grounding decreased their blood glucose levels, as well as lowering their triglycerides and body weight by 10 percent. So if you take oral hypoglycemics, you will want to monitor your blood sugar carefully.
  • Thyroid: Many people who are on thyroid replacement for hypothyroidism started having heart palpitations within the first few days of Earthing, a sign of thyroid excess, which was confirmed by blood tests. These individuals had to decrease their thyroid dose. Lack of free electrons may be the most unrecognized cause of thyroid dysfunction.
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Featured in Journal Watch: More Studies from the San Francisco Cardiology Sessions.

Journal Watch Cardiology summarizes three New England Journal of Medicine studies that were presented at the American College of Cardiology conference:

Nonemergency PCI seems safe to perform at hospitals without on-site cardiac surgery facilities, according to a randomized study that included some 3700 patients. Three fourths underwent PCI at hospitals without on-site cardiac surgery, and the rest were transferred to hospitals with on-site facilities. The rate of a composite outcome (death, MI, repeat revascularization, or stroke) did not differ between the groups at either 30 days or 12 months.

In two studies of relatively high-risk patients undergoing CABG, use or nonuse of cardiopulmonary bypass had no significant effect on the rate of composite outcomes that included death, MI, stroke, repeat revascularization, or renal failure. Joel M. Gore comments that the choice regarding cardiopulmonary bypass “thus depends chiefly on operator expertise and individual patient characteristics and preferences.”

Source: Journal Watch Cardiology

Tight Glycemic Control Doesn’t Improve Outcomes After Kids’ Cardiac Surgery.

Tight glucose control in pediatric ICU patients following cardiac surgery does not reduce morbidity or mortality, according to a study in the New England Journal of Medicine.

Nearly 1000 children (up to age 36 months) who were admitted to the cardiac ICU after undergoing cardiopulmonary bypass were randomized to receive either tight glycemic control with insulin or standard care. Those with diabetes were excluded.

Overall, the number of healthcare-associated infections (e.g., pneumonia, bloodstream infections) did not differ significantly between the groups. There were also no differences in 30-day or in-hospital mortality; length of ICU or hospital stay; or duration of mechanical ventilation or vasoactive support.

An NEJM editorialist argues why these findings should supersede those from a 2009 study showing a benefit with tight glycemic control. He concludes that the door “should be closed on the routine normalization of plasma glucose in critically ill adults and children.”

Source: NEJM

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