Archive for the ‘News’ Category

Skimmed milk ‘doesn’t stop toddlers getting fat’

Tuesday, April 9th, 2013

Skimmed milk ‘doesn’t stop toddlers getting fat’

Jenny Hope Medical Correspondent

The Daily Mail 19 March 2013

 

 

Parents who give their toddlers skimmed milk to prevent them from gaining weight may be wasting their time. A study found that two year olds who drank full fat milk put on fewer pounds than those on low fat. Academics believe this is because full fat keeps them fuller for longer, and they eat less as a result.

The US study concluded that the type of milk given to children ‘may not matter that much’ despite fears the obesity epidemic is being fuelled by diets high in fat.

Researchers at the University Of Virginia School Of Medicine found two-year-olds who drank mainly low-fat and skimmed milk were 57 per cent more likely to become overweight by the age of four. But the average weight of children drinking full-fat milk was lower over the same period.

Professor Mark DeBoer, who led the research, said: ‘We assumed the study would show that children drinking low-fat and skimmed milk would be helped to keep their weight down, but this was not the case.

‘If you are going to drink milk, and we strongly back the importance of drinking milk at a young age, it doesn’t seem to matter that much which type it is.’

In the US, the American Academy of Pediatrics and the American Heart Association recommend all children drink low-fat or skimmed milk after the age of two to ward off obesity.In contrast, British children under five are not advised to drink skimmed milk – which has virtually all the fat removed – because they need the extra energy for growth.The US study asked 11,000 parents what type of milk their children drank at aged two and four: skimmed; one per cent semi-skimmed; two per cent milk fat; full-fat, or soy.

Heavier children were more likely to drink skimmed and semi-skimmed milk, with 14 per cent of heavy two-year-olds and 16 per cent of heavy four-year-olds drinking it, compared with nine per cent of normal weight two-year-olds and 13 per cent of normal weight four-year-olds.

Professor DeBoer said parents may be acting from the best motives by choosing low-fat milks, but milk fat may increase a feeling of fullness so reduce the appetite for other high calorie foods. He said: ‘Physicians don’t have much time to advise parents worried about their children putting on weight, so they may be better off sticking to advice we know works.

 

Gerry Gajadharsingh writes: When are the powers to be going to come clean and advise patients that following low fat diets are NOT what you need to do? Actually the title should be eating low fat makes you put on weight!

Sugary Drinks May Explain 180,000 Deaths Worldwide Each Year

Tuesday, April 9th, 2013

Sugary Drinks May Explain 180,000 Deaths Worldwide Each Year

Marlene Busko

Mar 20, 2013

 

NEW ORLEANS — A large, international epidemiologic study reports that slurping back large amounts of sugary beverages was associated with an increased body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, cardiovascular disease (CVD), and cancer.

Specifically, the researchers found that in 2010, 132,000 deaths from diabetes, 44,000 deaths from CVD, and 6000 deaths from cancer in the world could be attributed to drinking sugar-sweetened soft drinks, fruit juice, or sports beverages.

The study byGitanjali Singh, PhD, from Harvard School of Public Health, Boston, Massachusetts, and colleagues was reported at EPI|NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

“It is a [surprisingly] large number of deaths — tens of thousands of deaths — that are being caused by consuming sugary beverages,” Dr. Singh commented to Medscape Medical News. Three quarters of these BMI-related deaths were from diabetes, which “suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths,” she noted.

“Uphill Battle” to Change Patient Habits, Public Policy

The study reinforces the need for clinicians to encourage patients to drink fewer sugary beverages, Dr. Singh said. In addition, even though “it’s certainly an uphill battle [to change public policy] — it’s one that…physicians, cardiologists, public-health scientists, [and] policy makers…really need to advocate for and show support for,” she noted.

As part of the Global Burden of Disease study, the researchers obtained data from 114 national dietary surveys, representing more than 60% of the world’s population.

Based on data from large prospective cohort studies, they determined how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected CVD, diabetes, and 7 obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer). Using data from the World Health Organization, they calculated the number of deaths from BMI-related CVD, diabetes, and cancer for men and for women aged 20 to 44, 45 to 64, and 65 years and older.

Average sugary-drink consumption varied tremendously — from less than 1 drink (8 oz) a day in elderly Chinese women to more than 5 drinks (40 oz) a day in younger Cuban men.

Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.

Mexico, which has one of the world’s highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.

In contrast, Japan, with one of the lowest per-capita rates of imbibing these beverages, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.

In 2010, drinking sugar-sweetened beverages was associated with about:

  • 38,000 deaths from diabetes in Latin American and Caribbean countries.
  • 11,000 deaths from CVD in Eastern- and Central-Eurasian countries.
  • 25,000 deaths in the United States.

“Sugar-sweetened beverages are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but also in low and middle-income countries,” the group concludes.

Bottom Line: Advise Patients to Avoid Sugary Drinks

“The evidence base that sugar-sweetened beverages are associated with excess weight gain is well established; what these investigators have done is to take it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, CVD, and cancer,” American Heart Association(AHA) spokesperson Rachel K. Johnson, PhD, from the University of Vermont, Burlington, commented.

Study strengths include its large scope, but since it was an epidemiologic study, it does not demonstrate cause and effect, Johnson noted. Nevertheless, “it is certainly a [biologically] plausible association, and we should take it seriously,” she added.

According to Dr. Johnson, “The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it’s not a good choice.”

 

It is “particularly problematic” that satiety mechanisms don’t kick in with beverages in the same way as with solid foods. “If you have a sugary drink at 4 o’clock, you’re not as likely to cut back on what you eat for dinner in the same way you would if you’d had a snack of solid food at 4 o’clock,” she said.

The AHA recommends that adults don’t exceed 450 calories a day or 36 oz a week from sugar-sweetened beverages. In a 2012 statement position statement, the AHA and American Diabetes Association stated that nonnutritive artificial sweeteners can be a tool to help people lower their added sugar and calorie intake, as long as they don’t eat extra calories to compensate for the lower calories in the diet drinks.

The authors have disclosed no relevant financial relationships.

EPI|NPAM 2013. March 19–22, 2013. Abstract MP22.

 

Gerry Gajadharsingh writes:

Note this research includes fruit juices, whilst a little fruit is good for you, that means the whole fruit including the fibre which helps to slow down the fructose (fruit sugar) release, drinking fruit juices and smoothies is not what we recommend!

Multivitamins May Lower Cancer Risk in Men

Thursday, November 1st, 2012

Multivitamins May Lower Cancer Risk in Men

Medscape Today News

17th October 2012

11th Annual American Association for Cancer Research (AACR) International Conference on Frontiers in Cancer Prevention Research

 

The daily use of multivitamins may reduce the risk for cancer in men, according to the results of a very large randomized trial.

After about 11 years, multivitamin use resulted in a modest but statistically significant reduction — specifically, an 8% reduction in total cancer incidence.

In an analysis that separated prostate cancer from all other cancers, “we did not see an effect for prostate cancer, but there was a 12% reduction in total cancers which was significant,” said lead author John Michael Gaziano, MD, MPH. He was speaking at a press briefing ahead of a presentation at the Annual American Association for Cancer Research (AACR) Frontiers in Cancer Prevention Research meeting.

The study has also been published early online in the Journal of the American Medical Association to coincide with the meeting.

“Cancer mortality also went in the right direction — a 12% reduction which wasn’t quite statistically significant but certainly a consistent finding,” said Dr. Gaziano, a researcher at Brigham and Women’s Hospital, Center for Older Adult Health, Boston, Massachusetts.

“Our main message is that the main reason to take a multivitamin is for nutritional deficiencies but it certainly appears that there may be a modest benefit in preventing cancer in men over the age of 50,” he said.

A number of trials of individual vitamins, administered at high doses, have not shown any effect at preventing cancer, Dr. Gaziano explained.

Observational studies have also not provided evidence of an association between multivitamin use and a reduction in cancer incidence or mortality.

However, the current study is unique in a number of ways, the first being that it is the only large-scale placebo-controlled trial evaluating a multivitamin in the prevention of cancer.

It is also of long duration, he said. “This effort was 17 years in the making, from the time we wrote the first protocol and we have 11 years of follow up, with up to 14 years of treatment for some of the participants.”

In addition, Dr. Gaziano pointed out that this study was well controlled. The participants who were randomized to the multivitamin arm were all taking the exact same brand and formulation (Centrum Silver), which has not necessarily been the case in other studies.

Conflicting Results

Previous studies have reported conflicting results. As reported by Medscape Medical News, 2 studies evaluating the association of multivitamins and breast cancer found opposite results — one study found an increased risk while the other found that multivitamins decreased the risk.

Another study reported more neutral results, in that multivitamin use had no influence on the risk for common cancers, cardiovascular disease, or overall mortality.

The lead author of that study, Marian L Neuhouser, MD, commented at that time that the “main message of our study is that postmenopausal women who take a multivitamin don’t increase their risk for cancer or cardiovascular disease, but they don’t decrease it either.

“These multivitamins are having no effect with regard to these particular disease outcomes,” said Dr. Neuhouser, who is from the Fred Hutchinson Cancer Research Center, Seattle, Washington.

Reduction in Total Cancers

The data in the current study was drawn from the Physicians’ Health Study II, a large-scale, randomized, double-blind, placebo-controlled trial that included 14, 641 male US physicians who were 50 years or older when the study began. The cohort included 1312 men with a history of cancer. The multivitamin study began in 1997, with treatment and follow-up that continued through June 1, 2011.

The cohort included a large proportion of former smokers (40.0%) and a very low proportion of current smokers (3.6%) with a high rate of current aspirin use (77.4%).

“This was a population of healthy physicians,” Dr. Gaziano said. “Over two thirds of them exercised regularly and only 4% smoked.”

Adherence to the protocol was high in both the multivitamin and placebo group. At 4 years, it was 76.8% (vitamin) and 77.1% (placebo), P = .71; and at 8 years, adherence was 72.3% (vitamin) and 70.7% (placebo), P = .15. It remained high even at the end of the follow-up period, at 67.5% and 67.1%, respectively (P = .70).

During the study period, a total of 2669 men developed cancer, including 1373 cases of prostate cancer and 210 cases of colorectal cancer. A total of 2757 participants (18.8%) died during follow-up, and this included 859 (5.9%) from cancer.

Their results showed that men taking a daily multivitamin had a statistically significant reduction in the incidence of total cancer, as compared with placebo (17.0 and 18.3 events, respectively, per 1000 person-years; hazard ratio [HR], 0.92; P = .04).

However, when the cancers were considered separately, there was no significant effect. There was no effect of the daily multivitamin on prostate cancer (multivitamin and placebo groups, 9.1 and 9.2 events per 1000 person-years; HR, 0.98; P = .76), colorectal cancer (1.2 and 1.4 events per 1000 person years; HR, 0.89; P = .39), or any other site-specific cancers.

Dr. Gaziano and colleagues noted that the total cancer rates in this cohort were probably influenced by the increased surveillance for prostate-specific antigen (PSA) and subsequent diagnoses of prostate cancer during the last 1990s.

“We had included participants with a prior history of cancer and we had prespecified an analysis that we would do, and there is an appearance of a stronger effect in those with a prior cancer,” he said.

Among men with a baseline history of cancer, daily multivitamin use was associated with a reduction in total cancer (HR, 0.73; P = .02). However, this reduction was not significantly different from the cohort without a cancer history (HR, 0.94; P = .15; P for interaction = .07).

“We are continuing more analyses, looking at the nutritional status of the individuals,” Dr. Gaziano said. “We hope to be able to continue following this cohort, some of whom we have been following for 30 years, so we can see the long term effects.”

Researchers from the Linus Pauling Institute at Oregon State University, Corvallis, who have been studying related issues, commented that this data “conclusively shows that multivitamins are safe to take, help fill important nutritional gaps, reduce cancer risk and in turn will help cut health care costs.”

“An 8 percent drop in overall cancer rates is not small,” said Balz Frei, PhD, professor and director of the Linus Pauling Institute, in a statement.

“Given that more than 1.6 million new cancer cases are diagnosed in the U.S. each year, this translates into about 130,000 cancers prevented every year, and with it all the health care costs and human suffering,” commented Dr. Frei, who was not involved in the study.

Dr. Frei also pointed out that the effect might be even higher in other population groups than seen in this study. “And it’s worth noting that the research was done with 14,600 physicians,” Dr. Frei said. “This highly-educated group has a better diet, knowledge base and health habits than the average person, so it’s reasonable to believe that the impact of multivitamin use in the general population will be even greater.”

11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, Presented October 17, 2012.

The study was supported by grants from the National Institutes of Health and the BASF Corporation. Dr. Gaziano reports investigator-initiated research funding from the NIH, the Veterans Administration, and the BASF Corporation; assistance with study agents and packaging from BASF Corporation and Pfizer (formerly Wyeth, American Home Products, and Lederle); and assistance with study packaging provided by DSM Nutritional Products Inc. (formerly Roche Vitamins). Several other coauthors also report relationships with industry as noted in the paper.

JAMA. 2012. Published online October 17, 2012.

 

Gerry Gajadharsingh writes:

 

So you see the problems of research! Sometimes conflicting research comes up. The American Physicians Health Study is a study following a very large group of American Physicians over many years, I also present some of this research to back up the science behind Metabolic Balance. Interestingly the multivitamin /mineral complex used was a standard OTC low dose following Recommended Daily Allowance (RDA), for example Vitamin C at 60mg (100% RDA), Magnesium (13% RDA) and Zinc (73% RDA), amongst others.

 

RDA was developed to ward of deficiency disease, if you take in less than 60mg of Vitamin C a day eventually you will develop scurvy, the plague of sailors in times gone by. This is vastly different to saying that 60mg is all you need! I am amazed that even at this low dose the reduction in overall male cancer (>50 years) was 12% (excluding prostate cancer). I expect that in years to come research will become more convincing with the use of optimal levels of nutritional supplementation (not just vitamins and minerals) in decreasing the incidence of diseases, not just cancer. Of course the main stay of keeping healthy should be great nutrition, with supplements doing just that, supplementing your diet.

Simvastatin: updated advice on drug interactions – updated contraindications

Wednesday, October 17th, 2012

The Medicines and Healthcare products Regulatory Agency (MHRA)

 Drug Safety Update

 Simvastatin: updated advice on drug interactions – updated contraindications

 

Article date: August 2012

 

We have previously communicated on the increased risk of myopathy associated with use of high-dose simvastatin (80 mg daily) – see Drug Safety Update May 2010.

Considering the risk of myopathy associated with simvastatin, recent analysis of clinical trial data, spontaneously reported cases and drug- drug interaction studies has resulted in further changes to the simvastatin prescribing information.

The changes include contraindications to concomitant use with certain medicines and maximum dose recommendations when simvastatin is taken with a number of other medicines, as these interactions may increase plasma concentrations of simvastatin which is associated with an increased risk of myopathy and/or rhabdomyolysis. Key points to note are that:

  • Simvastatin is now contraindicated with ciclosporine, danazol and gemfibrozil
  • The maximum recommended dose for simvastatin in conjunction with amlodipine or diltiazem is now 20 mg/day

A full updated listing of all the interactions is provided in the table below.

Drug interactions associated with increased risk of myopathy/rhabdomyolysis

Interacting agents Prescribing recommendations
Itraconazole

Ketoconazole

Posaconazole

Erythromycin

Clarithromycin

Telithromycin

HIV protease inhibitors (eg, nelfinavir)

Nefazodone

Ciclosporin

Danazol

Gemfibrozil

Contraindicated with simvastatin
Other fibrates (except fenofibrate) Do not exceed 10 mg simvastatin daily
Amiodarone

Amlodipine

Verapamil

Diltiazem

Do not exceed 20 mg simvastatin daily
Fusidic acid Patients should be closely monitored. Temporary suspension of simvastatin treatment may be considered.
Grapefruit juice Avoid grapefruit juice when taking simvastatin

 

 

Gerry Gajadharsingh writes:

 

This is slightly worrying, Many of my male musculoskeletal patients concurrently take statins. It is difficult to know sometimes if the statin they are taking contributes to their pain, certainly elevation of the muscle enzyme creatine kinase (CK) requested as a blood test may be helpful. However data is now emerging that this common statin is causing increasing problems, hence the guidance to make sure you are not taking more than 20mg especially if you are taking other medications for blood pressure and even common antibiotics such as Erythromycin. Patients also find it amazing that even grapefruit is contraindicated!

 

Sitting down increases risk of Type 11 Diabetes, CVS events and death

Wednesday, October 17th, 2012

Sitting down increases risk of Type 11 Diabetes, CVS events and death

Medscape News

October 15, 2012 (Leicester United Kingdom) — The more time people spend sitting, the greater their risk of diabetes, cardiovascular events, and death, a new meta-analysis has shown [1]. This is the first research to systematically quantify the strength of association between sedentary behavior–beyond just TV viewing–and health outcomes and shows a particularly consistent relationship for diabetes, say Dr Emma G Wilmot (University of Leicester, UK) and colleagues in their paper in the November 2012 issue of Diabetologia.

Wilmot says that a number of important messages have emerged from the research. “People don’t think about sitting as being dangerous, and it’s quite a change, having to think, ‘how can I reduce my sitting?’ rather than just ‘how much exercise can I do?’ We’ve traditionally been focused on making sure we meet the physical-activity guidelines of 30 minutes per day, but with that approach we’ve overlooked what we do with the other 23 and a half hours in the day. If you sit for the rest of the day, that is going to have an impact on health, and that’s essentially what our meta-analysis shows,” she told heartwire .

She stresses, however, that this does not mean that exercise is not important. “That’s obviously not the case. There’s a wealth of data showing that physical activity is important, but if people are spending a large percentage of their time sitting, they need to start thinking about how they can reduce this.”

And this message applies across the world, says Wilmot, who says she has had journalists calling her from as far afield as Canada, Chile, India, Russia, South Africa, and the US.

She and her colleagues add that much more research is needed to figure out how best to quantify and standardize measures of sedentary behavior and to formulate guidelines. “At the moment, we don’t have enough of an evidence base to be able to give very specific recommendations about how much to reduce sitting time by. We need intervention studies to give us some guidance on what approach we should take.” She and her colleagues are now running a study in 200 young people at increased risk of diabetes, which they expect to report next year and which they hope will add to this evidence base.

Greatest vs Least Sedentary Time Doubles Risk of Diabetes

Wilmot and colleagues say the hazards of high levels of sitting were first highlighted in the 1950s, when a twofold increase in the risk of an MI was identified in London bus drivers compared with active bus conductors. But since then, the “potentially important distinction” between sedentary (sitting) and light-intensity physical activity has been “largely overlooked” in research, they observe.

“The opportunities for sedentary behavior in modern society, such as watching television, sitting in a car, or using the computer, are ubiquitous,” they add, stating that estimates have put the time the average adult spends in sedentary pursuits at around 50% to 60% of their day.

For their review, the researchers searched for terms related to sedentary time and health outcomes. They combined the results of 18 studies including a total of 794 577 participants. The data were adjusted for baseline event rate and pooled using a random-effects model.

The greatest sedentary time compared with the lowest was associated with a doubling of diabetes (relative risk 2.12), around a 2.5-fold increase in the risk of cardiovascular events (RR 2.47), a 90% rise in risk of cardiovascular death (hazard ratio 1.90) and a 49% higher risk of all-cause mortality (HR 1.49). Based on the pooled effects, all of these findings were significant.

Further statistical analysis showed that the predictive effects were significant only for diabetes, which means the reproducibility of the diabetes finding was greater, suggesting this is the “most robust” result, Wilmot noted.

“People don’t realize that doing just small amounts of activity–it doesn’t even need to be a proper walk–are important,” she says. “If you are having a chat with a friend at your desk or the phone rings, stand up and chat. Just these small changes could make a big difference.”

Specific Reasons Why Sitting Ups Risk of Diabetes

Wilmot explained to heartwire that there appear to be specific reasons why sitting too long can be particularly deleterious in terms of diabetes. “Sitting seems to have an immediate effect on how our bodies metabolize glucose. When we sit, our muscles are not used, and we quickly become more insulin resistant.” Studies have shown that people who sit after eating have 24% higher glucose levels than people who walk very slowly after a meal, she says.

It is also known that there are some individuals who are genetically predisposed to the adverse effects of sitting, including those who are susceptible to diabetes, “so it might be especially important for these people to avoid prolonged sitting,” she observes. The exact metabolic pathways involved are not known, “but what we do know is that when rats have their hind legs immobilized, there is a reduction in lipoprotein lipase, a key regulator of metabolic health.”

Further studies in this area are required, she says, and future diabetes-prevention programs should consider promoting reduced sedentary behavior–including environmental restructuring to promote less sitting–alongside more traditional lifestyle behaviors such as increased physical activity and dietary change.

Also needed is research on how best to quantify sitting using devices called accelerators–which can calculate how long people sit for–as well as work on how to standardize measures of sedentary time. This will include looking at the feasibility of reducing sitting time too, by employing simple concepts such as standing or “walking” desks with treadmills or gadgets that people wear on their waist and that vibrate when the user has been sitting continuously for 40 minutes.

 

Gerry Gajadharsingh writes:

Here’s a good tip, do 5 minutes of resistance based exercise to activate your glucose receptors before eating followed by a short (gentle and slow) walk after eating. Be aware that lots of cardio exercise may also counter productive as it keeps us in carb burning energy pathways and pushes up our insulin response.

 

Use of Complementary & Alternative Medicine (CAM) in Cancer Patients

Wednesday, October 17th, 2012

Use of Complementary & Alternative Medicine (CAM) in Cancer Patients

October 16, 2012 (Albuquerque, New Mexico) — A large percentage of cancer patients use complementary and alternative medicine (CAM) for a wide variety of reasons. Because some of these therapies can interfere with conventional treatments, such as chemotherapy, it is imperative that healthcare providers know everything their patients are using.

Oncology nurses tend to underestimate their patients’ use of CAM, according to a study presented here at the 9th International Conference of the Society for Integrative Oncology.

“From multiple surveys, we know that the primary reason that patients aren’t sharing information about CAM use is because nobody has asked them,” said Lorenzo Cohen, PhD, professor and director of the integrative medicine program at the University of Texas M.D. Anderson Cancer Center in Houston.

Dr. Cohen presented the results of a study designed to evaluate the effect of a brief intervention for nurses on communication about CAM. The primary aim of the study was to make nurses aware of the importance of asking their patients about CAM. A secondary aim was to assess the use of CAM in community settings; most research to date has been done in academic settings,” he explained.

Concern About Interactions

Cancer patients often use over-the-counter medications and are increasingly using CAM, as previously reported by Medscape Medical News. This is particularly true in older adults, who make up the largest population of cancer patients and have high rates of polypharmacy.

Interactions between drugs and CAM are a real concern, William Douglas Figg Sr., PharmD, MBA, senior scientist and head of the clinical pharmacology program and molecular pharmacology section at the Center for Cancer Research, National Cancer Institute (NCI), in Bethesda, Maryland, previously explained. “We know that some [CAM] agents can increase metabolism or decrease metabolism,” he said. “Some can alter absorption. These might alter the anticancer agents we are giving.”

Patient and Nurse Perspectives

Dr. Cohen and colleagues conducted their multisite randomized trial through the Community Clinical Oncology Program (CCOP) Research Base at the M.D. Anderson Cancer Center. This NCI-funded program prepares cancer control and prevention trials, which are then made available to a national network of CCOP sites and independent Main Member sites.

Initially, 175 nurses were recruited to the trial, as were 699 patients who completed a questionnaire about CAM use, communication, and knowledge (preintervention patients). Two months later, another 650 patients were recruited and completed the questionnaire (postintervention patients).

Nurses in the intervention group viewed a weekly 20-minute video that discussed the definitions of CAM, issues of patient use, the importance of discussing CAM, and the legal ramifications of not doing so. A resource list on how to access information about CAM was provided to the nurses in the intervention group and to those in the control group.

About 40% of patients reported that they used some type of CAM (excluding spiritual practices such as prayer) after their cancer diagnosis. “This number is somewhat low,” Dr. Cohen noted. “We are still doing analyses to really be sure about it, but it does seem that in community settings and in the regions where the study was conducted, it is somewhat lower.”

The main reasons patients gave for using CAM was that they found it beneficial (70%) and it addressed emotional and spiritual aspects (62%) related to their disease. Some patients also reported that it helped their immune system and alleviated adverse effects.

The main reasons patients gave for not using CAM given were a lack of information about it and skepticism about its benefits.

At 2-month follow-up, more nurses in the intervention group reported asking about CAM use than nurses in the control group (odds ratio [OR], 4.2; P < .005), and reported asking more of their last 5 patients about CAM use (P =.003).

However, when preintervention and postintervention patients reported on being asked about CAM use, there was no significant difference (OR, 1.6; P > .010)

Underestimation of CAM Use

There was a huge misperception when nurses were asked what percentage of their patients used CAM. “The majority thought that it was 1% to 25%, so no more than a quarter. In fact, we know that close to one half of patients reported using some type of CAM,” Dr. Cohen noted.

Interestingly, the researchers found that there was a high degree of personal CAM use among nurses.

CAM use in community-based oncology patients is relatively high, but there was an underestimation of its use by the oncology nurses, he concluded. Although more nurses in the intervention group reported asking about CAM use than in the control group, when the same element was assessed in patients, the effect was more modest, Dr. Cohen reported.

This is something that needs to be better understood, he added, and future studies should include other members of the healthcare team, including physicians.

9th International Conference of the Society for Integrative Oncology (SIO). Presented October 10, 2012.

 

Gerry Gajadharsingh writes:

 

A diagnosis of cancer is always traumatic for patients and their families. It is good to know that of almost 50% of all cancer patients using CAM, 70% found it beneficial, with 62% finding the emotional support offered by CAM very useful. The diagnostic procedures necessary to confirm cancer can sometimes be painful and traumatic to some patients, especially biopsy, receiving the dreaded diagnosis traumatic enough, never mind the treatment offered which may include surgery, radiotherapy or chemotherapy. CAM clinicians experienced in helping patients as an adjunct to their medical intervention can often help with the “non-medical factors”, nutritional, management of anxiety, overall well-being, pain control and general support. Many oncology centres are welcoming adjunct therapies but I think it only sensible that patients inform their cancer specialists of CAM treatment they are receiving, especially OTC nutritional and herbal supplements which may effect any potential medical interventions. Lifestyle factor modification, such as alcohol, smoking, caffeine, high glycaemic load carbohydrate diets, stress management etc., can sometimes play its part in cancer care and preventive strategies.

Pushy Parents are told to Slow down and let children thrive

Wednesday, October 17th, 2012

Pushy Parents are told to Slow down and let children thrive

Eton Master warns pressure can be damaging

Greg Hurst Education Editor. The Times Saturday October 13th 2012

Pushy parents, “tiger” mothers, turbo charged fathers- prepare to meet your nemesis. Eton College is in the vanguard of a new movement seeking to tell teachers, teenagers and especially their parents to slow down, even to embrace a little idleness.

The message is aimed at families so preoccupied with theirs child’s development that they micromanage free time, ferrying them from super selective schools to tutors, music teachers and sports clubs. Yet the result, says Mike Grenier, a house master at Eton, may be to demotivate a child and even cause psychological damage. Such “hyper parenting is at its most extreme in London, where a rise in the birth-rate has heightened competition for places at private pre prep schools.

Mr Grenier say: “We know that for a lot of pre schools in some of the more affluent areas- Knightsbridge, Kensington, Battersea- the perception is that there are not enough places and that is it is only in a private school that you are going to get the quality starting from the age of 3 or 4 that will see you pass to the next stage through the private sector. So the reality is that there are children who are being given interview coaching at the age of 3 or 4”. He has heard worse from New York: children doing an hour or more music practice or tutoring before school, two or three hours of one to one tuition afterwards then a physically demanding activity such as swimming or ballet.

Ironically, Mr Grenier says, such parents may be holding their children back by not allowing them to take risks, make mistakes and learn from them. “Not only are they in danger of demotivating children because they feel they are a passive project being constructed rather against their will but it could lead people to feel very anxious when confronted by new difficulties.”

Moreover, he says, parents ought to be role models for their children, and living with pressure and anxiety is not a good example. Mr Grenier is an advocate of how slow education, a concept adapted from a culinary movement begun in Italy as an antidote to fast food.

With other teachers, in private and state schools, he is spearheading a campaign to infuse this approach into education, and will speak at the London Festival of Education next month. But isn’t Eaton itself a hothouse? There is a tremendous amount of pressure, he concedes: working hard is the norm here. “Peer group pressure is important and in some ways is a tremendously positive and motivating force. The boys want to do well, they want to keep up and boys are competitive.”

He identifies three spheres for learning at Eaton. First is the curriculum, in which, slow, schooling means more independent research, project work, collaboration, reflection. Second come its many extracurricular activities: the housemaster’s sitting room looks out on playing fields where Eaton’s first XV rugby team is practicing drills in the rain. Third area is activity lead by the boys themselves. “The experience there is so successful, in particular with teenagers because so much of it is self-motivated.” He says. “Boys are choosing to direct their own plays, to enter creative pries, volunteer for mentoring programmes.”

The role of a teacher or parent, he says, is to provide a safety net as a child walks a tightrope, and to raise or lower it. “The danger of hyper- parenting,”Mr Grenier says, “Is that it is intrusive and they don’t even let them get on the high rope at all.”

 

Gerry Gajadharsingh writes:

It’s great to see top schools like Eaton realising that over stimulation of children is often not helpful in their overall development. We seem in such a rush to pack so many things into our children’s lives that we often fail to understand that “less is sometimes more”. Giving time and space i.e. “slowing down” allows certain parts of the brain to develop properly and minimises the risk of turning our children into “stressed” individuals, which may come back to haunt them in adult life. Don’t forget that 95% of our brain activity is subconscious and it’s our subconscious brain that allows our bodies to run smoothly in the background without having to think too much about it. Time and space allows ideas to happen and helps with our creativity.

 

Omega 3 supplements reduces aging

Thursday, October 11th, 2012

Omega 3 supplements reduces aging

 Science Daily (Oct. 1, 2012) — Taking enough omega-3 fatty acid supplements to change the balance of oils in the diet could slow a key biological process linked to ageing, new research suggests.

The study showed that most overweight but healthy middle-aged and older adults who took omega-3 supplements for four months altered a ratio of their fatty acid consumption in a way that helped preserve tiny segments of DNA in their white blood cells.

These segments, called telomeres, are known to shorten over time in many types of cells as a consequence of ageing. In the study, lengthening of telomeres in immune system cells was more prevalent in people who substantially improved the ratio of omega-3s to other fatty acids in their diet.

Omega-3 supplementation also reduced oxidative stress, caused by excessive free radicals in the blood, by about 15 percent compared to effects seen in the placebo group.

“The telomere finding is provocative in that it suggests the possibility that a nutritional supplement might actually make a difference in aging,” said Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State and lead author of the study.

In another recent publication from this study, Kiecolt-Glaser and colleagues reported that omega-3 fatty acid supplements lowered inflammation in this same group of adults.

“Inflammation in particular is at the heart of so many health problems. Anything that reduces inflammation has a lot of potentially good spinoffs among older adults,” she said.

 

Study participants took either 2.5 grams or 1.25 grams of active omega-3 polyunsaturated fatty acids, which are considered “good fats” that, when consumed in proper quantities, are associated with a variety of health benefits. Participants on the placebo took pills containing a mix of oils representing a typical American’s daily intake.

The researchers say this combination of effects suggests that omega-3 supplements could represent a rare single nutritional intervention that has potential to lower the risk for a host of diseases associated with aging, such as coronary heart disease, Type 2 diabetes, arthritis and Alzheimer’s disease.

The study is published online and scheduled for later print publication in the journal Brain, Behavior, and Immunity.

Participants received either the placebo or one of the two different doses of omega-3 fatty acids. The supplements were calibrated to contain a ratio of the two cold-water fish oil fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), of seven to one. Previous research has suggested that EPA has more anti-inflammatory properties than DHA.

In the case of fatty acids, omega-3 supplementation alone doesn’t tell the whole story of how this dietary change can affect health, explained Martha Belury, professor of human nutrition at Ohio State and a co-author of the study. Also important is the ratio of omega-6 fatty acids to omega-3 fatty acids that are present in a person’s blood.

Omega-6 fatty acids come from vegetable oils, and since the 1960s, research has suggested that these oils, too, can help protect the cardiovascular system. However, the typical American diet tends to be heavy on omega-6 fatty acids and comparatively low in omega-3s that are naturally found in cold-water fish such as salmon and tuna. While the ratio of omega-6 to omega-3 fatty acids averages about 15-to-1, researchers tend to agree that for maximum benefit, this ratio should be lowered to 4-to-1, or even 2-to-1.

The long chains — or bigger molecules — that make up EPA and DHA fatty acids are believed to be the secret to their effectiveness, Belury said.

Both groups of participants who took omega-3 supplements showed, on average, lengthening of telomeres compared to overall telomere effects in the placebo group, but the relationship could have been attributed to chance. However, when the researchers analyzed the participants’ omega-6 to omega-3 ratio in relationship to telomere lengthening, a lower ratio was clearly associated with lengthened telomeres.

“The idea we were looking at with the ratio of omega-6 to omega-3 fatty acids was an increase in the denominator to make the ratio smaller. In the United States, we need to focus on the omega-3 part because we don’t get enough of those,” Belury said.

The researchers also measured levels of compounds called F2-isoprostanes to determine levels of oxidative stress, which is linked to a number of conditions that include heart disease and neurodegenerative disorders. Both omega-3 groups together showed an average overall 15 percent reduction in oxidative stress compared to effects seen in the placebo group.

When the scientists revisited their earlier inflammation findings, they also found that decreases in an inflammatory marker in the blood called interleukin-6 (IL-6) were associated with telomere lengthening. In their earlier paper on omega-3s and inflammation, they reported that omega-3 supplements lowered IL-6 by 10 to 12 percent, depending on the dose. By comparison, those taking a placebo saw an overall 36 percent increase in IL-6 by the end of the study.

“This finding strongly suggests that inflammation is what’s driving the changes in the telomeres,” Kiecolt-Glaser said.

Telomeres are a hot topic in science, and their tendency to shorten is associated with such age-related problems as heart disease and early mortality. These short fragments of DNA act as caps at the end of chromosomes, and can be likened to the protective plastic at the end of a shoelace.

“If that plastic comes off, the shoelace unravels and it doesn’t work anymore,” said study co-author Ron Glaser, professor of molecular virology, immunology and medical genetics and director of the Institute for Behavioral Medicine Research (IBMR) at Ohio State. “In the same way, every time a cell divides, it loses a little bit of its DNA at the ends, and over time, that can cause significant problems.”

Kiecolt-Glaser noted that this population was disease-free and reported very little stress. The study included 106 adults, average age 51 years, who were either overweight or obese and lived sedentary lives. The researchers excluded people taking medications to control mood, cholesterol and blood pressure as well as vegetarians, patients with diabetes, smokers, those routinely taking fish oil, people who got more than two hours of vigorous exercise each week and those whose body mass index was either below 22.5 or above 40.

“People who are less healthy than this group, and especially those who experience chronic stress, may gain even more benefits from omega-3 supplementation,” she said.

Gerry Gajadharsingh writes: So again more research backing up a few key points. Many western diets are low in Omega 3 compared to Omega 6, incidentally some of the Omega 6’s can also be low in many patients especially GLA (important in skin health). Inflammation drives many of the key disease processes in the body and low Omega 3 can cause inflammation. TDL, the pathology lab that I use already offers a test, for clinicians, measuring the Omega 6 (arachidonic acid) : Omega 3 (EPA) ratio. More excitingly TDL are just about to launch a test to measure the telomere length, I’m off the launch party in a few weeks and hope to be able to offer this test to patients soon. The answer: Metabolic Balance and Omega 3 supplementation, all MB patients are required to take additional essential fats in phase 3 and 4 of their plan, we simply don’t get enough in our diets. Coupled with optimum breathing behavior, great stress management, a good functioning musculoskeletal system and exercise strategy, what more could a person ask for to reduce the process of aging!

It’s not what you eat, it’s when you eat.

Wednesday, September 26th, 2012

It’s not what you eat, it’s when you eat.

The Daily Telegraph Friday September 14th 2012 Nick Collins

Curry, chips and burgers are the scourge of most dieters, but now they can go back on the menu if they are eaten at set times of the day. People who snack on healthy food may consume only a small amount of fat. However, their haphazard eating patterns means they can put on weight, a study suggests. In contrast, sticking to strict meal times is good for the metabolism and helps the body burn off fat, allowing a more liberal choice of food. The findings indicate that adopting a fixed timetable for meals could be more effective method of dieting than trying to cut out fatty foods and might help prevent obesity, researchers said. Previous studies have shown that both a high fat diet and eating patterns that disrupt the natural body clock can interfere with our metabolism and raise the risk of obesity. Scientists from the Hebrew University of Jerusalem tested the effects of timing and fat intake on four groups of mice over an 18 week period to determine whether careful scheduling of meals could lower the effects of a high fat diet. Half were given a high fat diet that would normally be expected to make them obese. Of this, a quarter were fed at the same time each day and another quarter could eat as much as they liked, whenever they liked. The other half were fed a diet that was lower in fat. Again, one quarter had fixed feeding times, the other had not. All four of the groups gained weight over the course of the trial, with the group that ate a high fat diet at irregular intervals unsurprisingly gaining the most weight, while those on a low fat, scheduled diet gained the least. But more surprisingly, the mice that had been fed a high fat diet at regular intervals finished the trial in a better condition than those who ate low fat foods whenever they wanted, despite both groups consuming the same amount of calories overall. The mice in the scheduled high fat group had 12 per cent lower cholesterol and 1.4 times higher sensitivity to insulin than the unscheduled, low fat group. The diet also changed their metabolism so they burnt off the fats they ingested to produce energy in between meal times, rather than storing the fat in their bodies. The study was published in the journal of the federation of American societies for experimental biology.

Prof Oren Froy, who led the experiment said: “The timing of food consumption takes precedence over the amount of fat in the diet, leading to improved metabolism. Improving metabolism through careful scheduling of meals, without limiting the content of the daily menu, could be useful as a therapeutic tool to prevent obesity in humans.”

 

Gerry Gajadharsingh writes:

Metabolic Balance has been saying this for years, glad to see more research backing this up. Many of my patients who do the Metabolic Balance programme know this to be true, but you can only go without snacking if you have a proper breakfast, lunch and dinner!

New Clinical Guidelines for Treating, Screening Hypertriglyceridemia

Wednesday, September 26th, 2012

New Clinical Guidelines for Treating, Screening Hypertriglyceridemia

Michael O’Riordan

Medscape Today News

 

September 10, 2012 (Chevy Chase, Maryland) — Adults should be screened for high triglyceride levels once every five years because of the potential risk of cardiovascular disease and pancreatitis associated with hypertriglyceridemia, according to new clinical-practice guidelines from the Endocrine Society [1]. Individuals with high triglyceride levels should undergo further assessment of other cardiovascular risk factors, such as obesity, hypertension, abnormal glucose metabolism, and liver dysfunction.

The new recommendations, led by task-force chair Dr Lars Berglund (University of California, Davis), are published in the September 2012 issue of the Journal of Clinical Endocrinology and Metabolism. In the review, the expert panel notes that while there is robust evidence supporting the association between LDL-cholesterol levels and cardiovascular disease, the association between triglyceride levels and cardiovascular disease is more uncertain. However, they recommend screening adults for high triglycerides as part of a fasting lipid panel.

In addition to these recommendations, Berglund and colleagues recommend that:

  • The diagnosis of hypertriglyceridemia be made on fasting triglyceride levels and not nonfasting levels.
  • Individuals with high fasting triglyceride levels be evaluated for secondary causes of hyperlipidemia, including endocrine conditions and medications, and that treatment be focused on secondary causes.
  • Patients with primary hypertriglyceridemia be screened for other cardiovascular risk factors.
  • Patients with primary hypertriglyceridemia be evaluated for a family history of dyslipidemia and cardiovascular disease in order to assess future cardiovascular risk.
  • Obese and overweight patients with mild to moderate hypertriglyceridemia be treated with lifestyle therapy, including dietary counseling, and physical-activity programs to achieve weight reduction.
  • Dietary fat and simple-carbohydrate consumption be reduced in combination with drug therapy to lower the risk of pancreatitis for patients with severe and very severe hypertriglyceridemia.
  • The treatment goal for patients with mild hypertriglyceridemia be a non–HDL-cholesterol level in agreement with the National Cholesterol Education Panel Adult Treatment Panel (NCEP ATP III) guidelines.
  • Fibrates be used as a first-line drug to reduce triglycerides in patients at risk of triglyceride-induced pancreatitis.
  • Fibrates, niacin, or omega-3 fatty acids be used alone or in combination with statins in patients with moderate to severe hypertriglyceridemia.
  • And finally, statins not be used as monotherapy in patients with severe or very severe hypertriglyceridemia, although statins can be used to modify the risk of cardiovascular disease.

“Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, while mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease,” according to the authors of the clinical-practice guidelines. “Therefore, similar to the NCEP ATP III guidelines committee’s recommendations, we recommend screening adults for hypertriglyceridemia as part of a fasting lipid panel at least every five years.”

 

Gerry Gajadharsingh writes: Glad to see that researchers are flagging up the issue of over consumption of simple carbohydrates and not just fat. Think of “Foie Gras”, the fatty liver from duck, how do they get the duck to have a fatty liver? They force feed them with grain! I use this example not just to flag up animal welfare issues but to emphasize that elevated lipids (triglycerides and cholesterol) are not just to do with eating fatty foods but may have as much, if not more to do with eating too many simple carbohydrates.

 

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