Lack of Sleep and Breast Cancer

Adequate restful sleep is more and more being recognized as an important factor for maintaining good health. A recent study published in the August issue of Breast Cancer Research and Treatment found that a lack of sleep is associated with more aggressive breast cancers. The study was conducted on 101 women with estrogen receptor positive breast cancer. Having fewer than 7 hours of sleep a night during the 2 years before the diagnosis was associated with a greater risk for recurrence. This association was really only strong in post-menopausal women. Although the study was small, it does add to other literature supporting the importance of enough sleep in preventing serious illness. 

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Chocolate and Nobel Laureates

You can't have enough chocolate articles! A note in the October 10 edition of the New England Journal of Medicine found an association between how much chocolate a country's inhabitants consume and the number of Nobel laureates is produces: the more chocolate consumed, the more Nobel prizes awarded. Some research has shown chocolate to improve cognitive functioning. So now we have even more reason to eat chocolate!

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Lifestyle Changes and Cancer

A presentation by Graham Colditz, PD, DrPH, from the Washington University School of Medicine in St. Louis, Missouri at the Union for International Cancer Control World Cancer Congress 2012 emphasized that lifestyle changes could prevent many cancers. 1/3 of cancer in high-income countries is caused by smoking. If smoking rates could be reduced to the current levels in Utah (11%), the US could see a 75% reduction in smoking-related cancers in 10-20 years. If people could maintain a healthy body mass index (BMI), in the case of cancer it is between 21-23 kg/m2, the incidence of cancer could be reduced by about 50% in 2 to 20 years. He estimated that poor diet and lack of exercise are each associated with about 5% of all cancers. He said that improvement in diet could reduce cancer incidence by 50% and increases in physical activity could reduce cancer incidence by as much as 85% in 5 - 20 years. 

If pills could have this kind of effectiveness, imagine the marketing campaign!

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Tomatoes and Stroke

A study published in the October 9 issue of Neurology found that a diet high in lycopene, found in high amounts in tomatoes, was associated with a lower risk of stroke in Finnish men. Associations are not causes and there are many reasons that a diet high in tomatoes would prevent stroke. People who eat a lot of tomatoes may also be eating a lot of fruits and vegetables in general, rather than meats. That aside, lycopene, which gives the tomato its red color, is a terrific antioxidant and therefore can keep the blood vessels healthy. 

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Sitting and Diabetes Risk

 A new meta-analysis by researchers in the UK and published in the November 2012 issue of Diabetologia found a strong relationship between sitting and diabetes. Prolonged sitting was also shown to increase the risk for cardiovascular disease and all-cause mortality, but the relationship was most robust with diabetes. It is not enough to just get in your 30 minutes of exercise a day. Continued sitting throughout the day appears to have an effect on how our bodies metabolize glucose. We are not using our muscles enough to use the glucose in our system. The pancreas secretes more insulin, and the cells start becoming insulin resistant. Health problems arise both from high glucose levels and from high insulin levels. 

Another aspect of all of this is that people who sit after eating have a 24% higher glucose level than people who walk very slowly after a meal. This is certainly something to think about after Thanksgiving!

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NSAIDs and Hearing Loss in Women

A study published recently in American Journal of Epidemiology found that consuming ibuprofen or acetaminophen, but not aspirin, more than twice a week chronically increases the risk for hearing loss in women. Other studies have found this association in men. It has also long been known that acute high doses of aspirin may cause tinnitus, or ringing in the ears. Rather than chronically ingesting ibuprofen or acetaminophen, it would be wise to figure out what is causing the inflammation and/or pain and deal with that. There are also several nutritional ways to lower inflammation, without resorting to drugs. A diet high in plant-based foods and fish and low in sugar, trans- and saturated- fats, and animals products is considered and anti-inflammatory diet.

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Food and Cancer

Medscape reports on a paper presented at the August 29 Union for International cancer Control World Cancer Congress 2012 by Richard Beliveau, Ph D, from the University of Montreal, University of Quebec at Montreal, and McGill University in Quebec. He stated that not all fruits and vegetables protect against cancer, but rather specific fruits and vegetables protect against specific cancers. He mentioned turmeric the spice as being a powerful anti-inflammatory that could prevent cancer from developing. Inflammation is a risk factor for cancer, as seen in inflammatory bowel disease or with infections such as H. pylori. He highlighted epigallocatechin gallate, which is found in green tea. It targets tumor invasion and metastasis, as well as prevents the formation of blood vessels. Resveratrol from grapes also has anti-tumor effects as does broccoli. Tomatoes have been found to reduce the risk of prostate cancer, and leafy green vegetables reduce the risk for pancreatic cancer.

He also mentioned obesity, which is associated with cancers. He pointed out that people over 40 are tumor carriers, but the tumors start in adolescence. We can either feed those tumors or prevent those tumors.

The 5 "golden rules" of chronic disease prevention also apply to cancer: (1) don't smoke; (2) maintain a BMI between 21 and 23 kg/m2; (3) eat an abundance of plant products (fruits, vegetables, grains); (4) exercise at least 30 minutes a day; (5) stay away from industrially prepared (junk) food. I would probably add in the importance of 6-8 hours of sleep at night, healthy social relationships, and ways to de-stress (meditation, listening to quiet music, reading).

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Risks for Type 2 Diabetes

A study performed at the University of Texas Southwestern Medical Center in Dallas and published in the September 19 issue of JAMA followed 732 obese participants for 7 years. Those who were more likely to develop diabetes had at baseline impaired fasting glucose, a family history of diabetes, hypertension, metabolic syndrome (waist circumference greater than 35 inches for women, greater than 40 inches for men, low HDL cholesterol, high triglycerides, high fasting glucose), and a higher concentration of VLDL cholesterol. The incidence was less likely if someone had more muscle mass. 

Interestingly there was no direct association between body mass index (BMI) and diabetes. The crucial criteria are central obesity (or big belly), and lower muscle mass. 

Type 2 diabetes can be avoided with a good diet and exercise program, which is something I offer my patients. 

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Poor Food Choices and Sedentary Activities

A European study published online September 3 in Archives of Pediatric & Adolescent Medicine found that adolescents between 12.5 and 17.5 years who spent more time in front of the computer or television were less likely to make good food choices. This does not come as a surprise to me at all. Generally spending more time in front of the computer means less time being physically active. When you're physically active, you usually crave better foods, as your body wants the nutrition. Some of this can be overcome by parents having readily available healthier snack foods around, such as "baby" carrots and fruit. 

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Cherries and Gout

A study published in the recent Arthritis and Rheumatism journal found as association between eating cherries and or cherry extract and a reduced incidence of gout attacks. While I find the study problematic for any number of reasons, I do find it interesting in that earlier studies have found that black cherry juice can reduce delayed onset muscle soreness after exercise. We'll see if this gout data can hold up with more rigorous research. In the meantime, if you do have gout, including cherries in your diet would not be a bad idea. Of course they're only in season for a relatively short time, so cherry extract may be the way to go for the rest of the year.

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BPA and Obese Children

The September 19 issue of JAMA contained a study that showed that obese children and adolescents have a higher concentration of bisphenol A (BPA) in their urine. BPA, a known endocrine disruptor (messes up your hormones), is found in canned foods, liquids packaged in plastic bottles, and other consumer products, mainly those associated with softer plastics. This study was cross-sectional, so we can't conclude that BPA causes obesity. It could be that obese children eat more canned food, or have more sodas and energy drinks out of plastic bottles. Sodas and energy drinks are also associated with obesity.

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Foods to Lower Blood Pressure

Medscape reports on studies presented at the American Heart Association High Blood Pressure Research 2012 Scientific Sessions during the week of September 20. Research done at Tufts University looking at over 2000 adults in the Framingham Heart Study Offspring Cohort found that those who ate more than 2% or their total calories from yogurt (equivalent to one six-ounce cup of low-fat yogurt every three days had a 30% lower risk of hypertension than non-yogurt eaters and a 0.19 mmHg smaller annualized elevation of systolic blood pressure. While yogurt is a healthy food, it is better to have unsweetened yogurt, as many of the fruit yogurts contain a lot of sugar. I enjoy mixing up plain low-fat yogurt with fresh fruit and cinnamon.
A small study done at the US Department of Agriculture found that adding low-calorie cranberry juice or cranberries to the diet resulted in lower diastolic blood pressure and systolic blood pressure trending lower.
A Japanese study conducted in India that used a blend of sesame and rice-bran oil found significant drops in blood pressure. The oil was helpful by itself and augmented the effect of a calcium-channel blocker, nifedipine. The oil is not available yet commercially.

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Obesity and Cognitive Decline

A study published in the August 21, 2012 issue of Neurology reported on the cognitive changes occurring over a 10 year period for the 6404 participants (67% men) in the Whitehall II Study ongoing since 1985. Obesity is associated with a more rapid decline with age. These researchers wanted to see if metabolical function affected the outcomes. They noted the findings associated with metabolic syndrome: blood pressure, glucose levels, triglyceride levels, and high-density lipoprotein (HDL) levels. They did not measure other markers of inflammation such as hsCRP, IL-6, and TNF-alpha. They are did not take exercise into consideration. However, we know that exercise reduces one's risk for metabolic syndrome greatly. Overall they found that the decline in cognitive function was less so for  metabolically normal individuals, regardless of weight. However, the metabolically normal but obese group did decline a bit more than the normal weight individuals. In the metabolically abnormal group, for everyone the decline was more marked, but especially so in the obese individuals. 

The take-home message here is that even metabolically normal obese people would be well-served by losing some weight to reduce their risk of cognitive decline. 

One problem I have with this study is that individuals who were metabolically normal, but only through the use of drugs, were considered normal. The drugs do not get to the underlying problems, especially nutritional and exercise problems. So the findings might have been more dramatic if the drugged people were not included in the normal group. 

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DHA for Children with Reading Problems

An interesting study published online on PLoS One showed that supplementing children's diets with 600 mg/day docosahexaenoic acid (DHA) improved reading and behavior in children who were in the bottom fifth of readers. DHA did not make a difference in reading score in children who were not in the bottom quintile. Behavior changes were noticed by the parents more than by the teachers. This study was don in England with healthy children aged 7-9. It was a randomized, double-blind, placebo-controlled trial. The placebo was corn/soybean oil and the DHA was derived from algae. Other studies have shown a benefit of DHA in children with autism, hyperactivity, or developmental coordination disorder (DCD).

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Strokes and Red Meat

A meta-analysis published online on July 31 in Stroke found that red meat consumption is associated with an increase in all strokes and in ischemic strokes in particular. Increasing one's intake of fresh, processed, and total red meat consumption by one serving per day resulted in an 11% increase in risk for stroke. This association, however, was not very strong. One of the studies included, a Japanese study, found no association between red meat and stroke. It could be that eating a significant amount of red meat is also associated with other things, and all together they lead to an increase in stroke. Other studies have shown red meat to be associated with certain cancers and with atherosclerosis. It seems like it certainly is something that could be kept to a minimum in one's diet. If you consume red meat, it should be not very often and should preferably be organic and grass fed beef or bison or whatever meat it is. 

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Exercise and Heart Disease

The headline to this blogpost is somewhat misleading, in that the study in question did not look at heart disease but at lipoproteins as risk factors for heart disease. Most people are familiar with the concept of high cholesterol being a risk factor for heart disease. The real story is far more complex. Total cholesterol as a risk factor is nearly meaningless in most cases. Even knowing one's low density lipoprotein (LDL) and high density lipoprotein (HDL) values is next to meaningless. What is meaningful is the amount of LDL and HDL particles and their sizes. A recent study published in the American Heart Journal found that putting sedentary middle-aged individuals on an exercise program effected their LDL and HDL particle numbers and sizes in a beneficial way, regardless of how closely they adhered to the diet recommended by the American Heart Association. Now this could also be a statement about the effectiveness of the AHA diet. This study does show that the biggest favor you could do yourself is to be physically active on a consistent basis.

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Acupuncture for Chronic Pain

In interesting meta-anlysis published online September 10, 2012 found acupuncture to be helpful for chronic pain. About 50% of patients who get acupuncture have some improvement in their pain. About 42% of patients have an improvement in their pain with sham acupuncture, which is quite a lot. Still, the result is that acupuncture is helpful for about half the people with chronic pain. 

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Is Your iPad Keeping You Up at Night?

A study published online July 31 in Applied Ergonomics found that the light emitted from an iPad on the brightest setting and used for two hours suppresses the production of melatonin. Normally melatonin is secreted starting about 2 hours before bedtime. If the onset of melatonin is suppressed at that time, it can delay the normal sleep pattern. In previous research, these researchers did not find that computer use or watching television suppressed melatonin in any significant amounts. However, tablet computers are typically viewed from a closer distance. The effect would probably be less pronounced if the brightness setting is turned down. The new iPad also has a nighttime setting where the background is dark and the letters white. This setting emits a lot less light. 

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An Apple A Day Keeps Cancer Away?

A recent Italian study published in the Annals of Oncology found that a diet high in flavonoids, in particular a group called the proanthocyanidins, and glycans reduced the risk of developing pancreatic cancer by more than 25%. Proanthocyanidins are found in apples, pears, grapes, cocoa, tea, and many other foods. The highest amount of proanthocyanidins were found in Red Delicious and Granny Smith apples, even more so than in grapes and wine. The study was a case control study of 350 patients with pancreatic cancer and 650 case-control patients. A very detailed food frequency questionnaire was used to evaluate their diets.
In Functional Medicine we look at food as information. There are many chemicals found in foods, in particular many fruits and vegetables, that can inhibit the growth of cancer by effecting the gene expression in the cells. Other foods such as tomatoes, strawberries and other berries, broccoli, and other cruciferous vegetables have all been found to reduce the risk of various cancers.

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Healthy Habits Reduce Hypertension

A presentation at the August 2012 European Society of Cardiology showed that a healthy lifestyle reduced the risk for high blood pressure by two thirds. This large prospective population-based cohort study looked at 9,637 Finnish men and 11,430 Finnish women between 25 and 74 years of age and free of hypertension at baseline. They were followed for an average of 16 years. Healthy behavior included:

1. not smoking
2. less than 50 g of alcohol per week (roughly 3.5 drinks per week)
3. leisure time physical activity at least 3 times per week
4. daily consumption of vegetables
5. BMI less than 25 kg/m2

Smoking was not associated with an increase in blood pressure, although it is associated with heart disease in general.

The researchers found that healthy alcohol consumption, leisure time physical activity, daily vegetables, and healthy weight resulted in an approximately 60% reduction in risk for hypertension. There is no downside to a healthy lifestyle.

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BPA linked to Severe Heart Disease

Bisphenol A (BPA) is banned in much of Europe but not in the US. It is found in many plastics and resins. Most cans are lined with a resin that contains BPA. Plastics with the recycle code of  3 or 7 may contain BPA. It is also found in credit card and cash register receipts, water pipes, and food packaging. It has been found in human breast milk as well. A new study in the United Kingdrom, the Metabonomics and Genomics in Coronary Artery Disease study found a link between coronary artery disease (heart disease) and BPA, especially in severe heart disease. The mechanism is still unknown.

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Chronic Stress and Stroke

New research published online in the Journal of Neurology Neurosurgery and Psychiatry found that experiencing a major life event in the last year increased the risk for a stroke 4 times. A high score on a stressful event scale doubled the risk for stroke, as did a current or previous history of smoking. Interestingly, the intake of two or more energy drinks per day also doubled the risk for stroke. In this case I think you'd also have to examine why people would be consuming two energy drinks a day. There are probably other issues going on that contribute to the risk of stroke, and not necessarily the energy drink alone. In a June 23, 2012 post I wrote about another study linking chronic stress and stroke. Ways to deal with chronic stress include working in some downtime daily. This may be sitting quietly listening to music, or mediation. Exercise is also very helpful in dealing with chronic stress.

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Chocolate and Stroke

Good news! More research showing that consuming chocolate is good for you! At least in preventing strokes. An article published online in the August 29 edition of Neurology found that men who consume the most chocolate have a 17% lower risk for stroke than men who consume the least amount of chocolate. When women are included in an analysis of several studies, the overall decrease in stroke risk was 17% with chocolate consumption. No information was available on the types of chocolate that was consumed. The study was done in Sweden where about 90% of the chocolate is milk chocolate with 30% cocoa solids. Chocolate is high in flavonoids that have a cardio-protective effect. They are anti-oxidants, anti-inflammatory, lower blood pressure, increase high-density cholesterol, and improve the health of the blood vessels. 

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Depression and Inflammation

In Functional Medicine and Chiropractic we've long looked at the whole body as an integrated whole, and not independent body parts. Depression is not something that just happens to the mind and in the mind. The physical body is intimately linked to the mind and vice versa. An unhealthy body can lead to depression. The mainstream medical world is now coming around, although in their own way. An article in the September 3, 2012 Archives of General Psychiatry states that prolonged or excessive inflammation can damage many parts of the body, including the brain. Rather than using diet and nutritional supplements known to reduce inflammation, they used a biologic drug, infliximab, a drug known to block an inflammatory pathway in the body. This drug reduced depression in those patients with the highest level of inflammation. I would wager that an anti-inflammatory diet, one high in fruits and vegetables, low in processed and simple carbohydrates, with healthy fats, would also have an anti-depressant effect on those with higher levels of inflammation.

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Walnuts Improve Quality of Sperm

Most fertility interventions are focused on the woman and not the man. A new study published August 15, 21012 online in Biology of Reproduction found that consuming 75 g of whole-shelled walnuts daily for 12 weeks has a positive effect on sperm in healthy young men consuming a Western diet. There were improvements in vitality, morphology, and motility of the sperm. There were also fewer incidences where the sperm was missing a sex chromosome. 120 healthy men between 21 and 35 years of age who normally ate a Western diet were recruited for the study. An additional health benefit of adding the walnuts, was an improvement in their omega-3 and omega-6 blood levels. Many couples choose to clean up their diets before trying to conceive. It makes sense.

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Apples and Cholesterol

A study published online in the Journal of the Academy of Nutrition and Dietetics found that women who eat dried apple every day for a year see a decrease in their cholesterol levels. Women who ate prunes daily did not see a decrease, but did see their cholesterol levels remain steady. This study was done without a control group and all the women had gone through menopause, a time when cholesterol levels generally rise. The women were encouraged to eat about 75 grams (about 2 apples' worth) of dried apple each day or 100 grams of prunes daily for a year. After 6 months the apple group saw a 13% drop in total cholesterol and a 24% drop in LDL cholesterol. Those numbers compare favorably with statins. It would be nice to see this study replicated with a control group. 

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Exercise and Smoking

A study out of the University of Exeter in the UK found that exercise reduced the craving for cigarettes. I found this interesting, as it seems that exercise can be used to help people quit smoking. Many people don't start exercising until they've quit smoking, but this study shows that there is a benefit to starting an exercise program and then quitting smoking.

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Fitness in Middle Age Protects Your Health

Recent research out of the Cooper Institute at the University of Texas Southwestern Medical Center in Dallas and published in the August 27 Archives of Internal Medicine showed that staying fit during middle age is associated with a decreased risk of developing chronic diseases, such as Alzheimer's disease, diabetes, and heart disease. As I've mentioned before, there is no downside to becoming more fit and eating well.

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Fat and Fit

The September 5, 2012 European Heart Journal has a Swedish study that showed that obese individuals with high levels of cardiorespiratory fitness and a healthy cardio-metabolic profile (such as normal glucose, hemoglobin A1c, hsCRP, triglycerides, uric acid) have a lower risk of death than obese individuals with poor fitness and poor cardio-metabolic profiles. Interesting, as far as cardiovascular mortality and cardiovascular events were concerned fit, metabolically healthy obese individuals had the same risk as normal weight individuals. It is only in the last few years that researchers have distinguished fit and fat people from unfit and fat people. Most fat people are not fit, but that does not mean that all are unfit.

Fitness helps prevent type 2 diabetes and metabolic syndrome, both associated with obesity. Becoming fit is a very pro-active way to begin to turn your life around it weight is an issue. Often people who exercise will crave healthier foods.

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Lifestyle Changes Could Prevent 50% of Cancers

Medscape reports on the findings of Graham Colditz, PhD, DrPH who presented a paper at the Union for INternational Cancer Control World Cancer Congress 2012 who stated that more than 50% of cancer could be avoided by using preventative lifestyle strategies. 1/3 of cancer in high-income countries is due to smoking, so obviously not smoking is a good idea. About 20% of cancers can be attributed to being overweight or obese. A healthy body mass index  (BMI) to prevent cancer is considered between 21 to 23 kg/m2, so slightly less than 24.9 considered normal weight. Poor diet and lack of exercise each are associated with about 5% of all cancers. He speculated that improvement in diet could reduce cancer incidence by 50% and an increase in physical activity could reduce cancer incidence by up to 85% in 5-20 years.
Other non-lifestyle factors included tamoxifen in reducing recurrences of breast cancer, raloxifene in reducing the risk for invasive breast cancer, bilateral oophorectomy in women carrying the BRCA1 or BRCA2 gene, aspirin for colorectal cancer prevention, and use of colonoscopy and sigmoidoscopy as screening tools. Three viruses have been associated with cancers so far: human papillomavirus, hepatitis B an C. Vaccinations and treatment against these viruses could eradicate those cancers.
The reductions seen with the lifestyle changes are quite impressive and there are no downsides to implementing them. There can be unwanted consequences from any of the drug treatments. It seems safest to implement the lifestyle changes.

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Cancer and Exercise

Medscape describes 2 newly published reviews in the August 15 edition of the Cochrane Database of Systematic Reviews. Both reviews found that exercise has a positive effect on health-related quality of life issues: cancer-specific concerns, body image, emotional wellbeing, sexuality, sleep, and social functioning. Exercise also reduced anxiety, fatigue, and pain.

Previous research has found that exercise:
(1) improves survival
(2) prevents decline in fitness, or avoids deconditioning syndrome
(3) improves treatment outcomes
(4) reduces the risk for certain cancers such as colorectal, prostate, and breast cancer.

In general, some exercise was better than no exercise. Moderate and vigorous exercise improved physical functioning, and reduced anxiety, fatigue, and sleep disturbances better than mild exercise.

Although the article did not mention it, the most important thing is to listen to your body. If you don't have a history of exercising, or even if you do, I would advise seeking the council of someone who can give you some guidance, such as a good chiropractor or physical therapist.

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Exercise and Alzheimer's Disease

A Japanese study published in the Journal of Biological Chemistry showed that exercise reduced beta-amyloid plaque in the mouse model. The study was partially based on the fact that high fat diets are a risk factor for Alzheimer's disease. In this study the researchers compared the effects of diet control with voluntary exercise and both diet control and voluntary exercise in mice. Exercise was shown to be more beneficial than diet control in reducing beta-amyloid formation (a characteristic of Alzheimer's disease) and restoring memory loss induced by a high-fat diet. Diet control plus exercise was significantly different than exercise alone. 

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Omega-3s and Risk for Heart Failure

A new meta-analysis published in Clinical Nutrition found that an increased intake of omega-3 fatty acids are associated with a 15% decrease in the risk of heart failure. Seven prospective studies with a total of 176,441 subjects and 5,480 incidents of heart failure showed that people with the highest levels of EPA and DHA has a 14% lower risk of heart failure compared to those with the lowest levels. Put another way, for every 15 grams per day increase in fish consumption, the risk of heart failure was reduced by 5%, and for every 125 mg per day increase in EPA and DHA omega-3 fatty acids the risk was reduced by 3%. Fish and omega-3 fatty acids should be part of most people's diet or supplement regime, as heart disease is not uncommon.

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Vitamin C and Exercise

A recent study published in the journal Nutrition showed that vitamin C intake may decrease heart rate during exercise and reduce the perception of fatigue and exertion. This study was performed at Arizona State University and involved 20 obese adults (BMI of 34.3 kg/m2) with an average age of 35. The participants were given a calorie-controlled diet for four weeks with or without a daily vitamin C supplement of 500 mg. They were tested before and after the study doing 60 minutes of exercise at an intensity of 50% of predicted maximal oxygen consumption. Those taking 500 mg vitamin C daily had a reduced heart rate and reduced perceived exertion by about 10%. It is difficult to know what to make of these results. Do they apply to normal weight fit individuals? It certainly points out that in this population vitamin C may make exercise more enjoyable and certainly won't hurt. 

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Cocoa Boosts Brain Function

A randomized controlled study published online on August 14, 2012 in Hypertension and funded by Mars Inc, found that in otherwise healthy elderly individuals with mild cognitive impairment, regular consumption of a flavonol-rich cocoa drink improves cognitive functions, most likely by improving their glucose/insulin metabolism. The cocoa intervention was for a 2 month period, and consisted of either a low-, a medium-, or a high-flavonol cocoa drink, or a placebo. Both the high- and the medium-flavonol drinks conferred some benefits to cognition, insulin resistance, and blood pressure. The subjects' cognitive functions were evaluated using standardized tests. Other research has found the cocoa has positive effect on brain function. Including dark chocolate in a healthy diet, rich in vegetables and fruits, as well as regular physical and mental exercise are perhaps the easiest and most effective ways to prevent mental decline.

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Chocolate and Blood Pressure

A recent meta-anlysis of the effects of chocolate and cocoa on blood pressure was published in the August 14, 2012 edition of the Cochrane Database of Systemic Reviews. Healthy individuals who consume about 100 grams of chocolate or cocoa everyday may see an average of 2.77 mmHg drop in systolic blood pressure and 2.20 mmHg drop in diastolic blood pressure. While this is not a lot, it can contribute to normalizing blood pressure. The flavonols in chocolate are theorized to be responsible for the effects of relaxing the blood vessels. In general, dark chocolate is more effective than milk chocolate. Dark chocolate in previous studies has also shown to improve insulin resistance, total cholesterol, LDL cholesterol, triglycerides, and lower BMI.

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Blood Type and Coronary Heart Disease

In the early 90s Dr. Peter D'Adamo popularized the idea of eating right for your blood type. The research backing his ideas were mainly done by him and his father on blood cells and also based on clinical observation. There has not been a lot of strong research duplicating his work. For some people following the diet prescribed for their blood type worked very well for them, for others it made no difference. Now an interesting study has been done through the Harvard School of Public Health using data from 62,073 women from the Nurses' Health Study and 27,428 men from the Health Professionals Follow-up Study and published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology. They found that individuals with blood groups A, B, or AB were 5% to 23% more likely to develop coronary heart disease compared with subjects with O blood type individuals. Those with non-O blood have higher levels of factor VIII-von Willebrand factor (vWF), a factor involved with thrombosis and platelet adhesion, which has previously been identified as a risk factor for coronary heart disease. Also, the A blood group generally has higher levels of LDL cholesterol. 

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Exercise Improves Reading and Math

Recent research presented at the American Psychological Association's 120th Annual Convention showed that cardiorespiratory fitness was the only factor that consistently was shown to have an impact on reading and math tests in middle school children. This study was done in Texas. Data was gathered from 1,211 Texas middle school students with an average age of 12. The group was 54% female, 57% white, 24% Mexican-American, 9 % African American. Across the board reading and math skills were associated with better physical fitness. Social support was related to better reading scores among boys. For girls having a larger body mass index was the only other factor aside from cardiorespiratory fitness that was related to performance on math tests. Physical fitness was assessed with a standardized fitness assessment administered by the physical education teachers. Other studies have also found that physical fitness is very important for learning. A book that I highly recommend is Spark: Exercise and the Brain. 

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Looking at Green is Beneficial

In an earlier post on my old web site, I mentioned a study that found looking at green vegetation had a positive effect on one's psyche. A new study published in the journal Environment, Science, and Technology found that even looking at a green environment while cycling resulted in lower total mood disturbance and ratings of perceived exertion than looking at the same scenery when it was tinted red. Feelings of anger were higher after looking at the red scenery. It would be interesting to see if manipulating the color of a swimming pool or a gym would affect performance. Or perhaps it is not the color alone, but that we affiliate the green color with greenery in nature. When it is red instead, we don't get that same association. Perhaps this study needs to be done with looking at green squares and red squares, imagery that is not associated with colors.

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The Importance of Selenium

Selenium has long been known as a mineral that is associated with a lower risk of cancer, especially bladder, prostate, and thyroid. It is an essential part of many proteins found in the body. A recent review paper by McCann and Ames from the Nutrition and Metabolism Center at children's Hospital in Oakland indicated that a moderate selenium deficiency may have several long-term detrimental effects (FASEB Journal, 2011, Vol. 25, pp 1793-1814), including heart disease, cancer, and immune dysfunction. A recent study published in Diabetes Care looking at data from two US cohorts found that those with the highest level of selenium in their toe nails had a 24% reduction in the risk of diabetes. Selenium is abundant in Brazil nuts. Otherwise, the selenium content in food varies greatly, depending on where it is grown.

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Cinnamon Improves Blood Sugar in Diabetics

A Chinese study published in the recent edition of Nutrition Research found that cinnamon supplementation was associated with improvements in blood sugar levels and reduction in triglyceride levels. 66 type-2 diabetics were randomly assigned to either a high dose (360 mg/day) cinnamon, a low dose (120 mg/day) cinnamon, or placebo. All were taking gliclazide (a sulfonylurea drug not marketed in the US) during the study. After 3 months both cinnamon groups showed lowered blood glucose levels (1.01 mml/L in the low dose, 1.62 mmol/L in the high-dose group), with no changes seen in the placebo group. Interestingly, triglycerides were lowered only in the low dose group, and not in the high dose or the placebo group.

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Spinal Manipulation and Lower Back Pain

An article published in the recent Evidence Based Medicine found that spinal manipulation alone is effective, and as effective as physical therapy and exercise, in the treatment of chronic lower back pain. They found the effect more short-term. In practice, many chiropractors, myself included, do not just use spinal manipulation to treat chronic lower back pain. While I do use manipulation, I also emphasize rehabilitation exercises, with a particular emphasis on core and spinal stabilization exercises. Where necessary I'll also use soft tissue work and modalities such as interferential current and ultrasound, especially for acute exacerbations. I spend time discussing activities of daily living and how they can effect the lower back. With any chronic problem, there usually is no magic bullet, but rather an approach that uses many options. 

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High Carb Diets and Breast Cancer

An interesting study published in the July 3 issue of the American Journal of Clinical Nutrition found an association between high carbohydrate/high glycemic index diets and estrogen receptor negative breast cancer. High glycemic diets would be a diet with many simple carbs such as white bread, white potatoes, sugars, candies, and cakes. While this study does not say that eating these things leads to cancer, it is suggesting a connection between the two. High glycemic diets are more inflammatory. High glycemic diets are high in glucose. Cancers thrive on glucose and mainly use glucose for energy. A high glycemic diet is unhealthy and puts one also at risk for diabetes and other chronic illnesses. Eating a diet high in vegetables and fruits, whole grains, legumes, and lean organic animal products is much healthier. 

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Athletes and Travel

A study published in the August 8 British Journal of Sports Medicine looked at rugby players traveling across different time zones for competition and found in increase in illness during travel if they're traveling across more than 5 time zones. Most of the illnesses were infections, with about a third being upper respiratory and a third being digestive. Once the athletes returned home, there was no more incidence of illness than before travel. The reason for the increase therefore probably has to do not only with resetting one's biological clock, but also with the stress of travel. 

I wrote an article on travel and competition and it can be read here. 

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Best Exercise for Type 2 Diabetics

A Danish study published in the August 6 edition of Archives of Internal Medicine found that weight training and aerobic exercise are each associated with a significantly lower risk for type 2 diabetes in men. The risk is further reduced when the two activities are combined. Other research has shown that regular moderate exercise reduces the risk of mortality in diabetics by 38%. This study here used data from the Health Professionals Follow-up Study, an ongoing prospective cohort study of 51,529 male health professionals who were aged 40-75 years in 1986. Interestingly, but not surprising, men who performed at least 150 minutes/week of weight training also did more aerobic exercise, had a healthier diet, drank less alcohol, were less likely to smoke, and watched less television. Healthy behaviors tend to go hand in hand. Exercise is often a good first intervention, as you're doing something, not being deprived of something.

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Exercise Reduces Mortality in Diabetics

A large, well-designed German study published in the August 6 Archives of Internal Medicine found that moderate physical activity performed on a regular basis can reduce the risk of mortality by 38% in diabetics. There is no pill that can do that. In non-diabetics moderate exercise is said to reduce the risk of of overall mortality by 33% and cardiovascular mortality by 35%. Moderate exercise or activity is usually equated with at least 30 minutes of brisk walking 5 days a week. The key here is that the exercise needs to be done regularly. 

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Honey Best for Treating Coughs in Children

A study published in the August 6 edition of Pediatrics reports that honey is more effective than placebo in controlling nighttime cough in children with upper respiratory infections. The authors conducted a randomized double blind placebo controlled study using 3 different kinds of honey. The end results showed all three honeys to be equally effective and more effective than the placebo. 300 children between the ages of 1 and 5 were recruited for the study. The parents were asked to evaluated the children before and after the intervention. Children with asthma and pneumonia were excluded. Previous studies have also shown honey to be effective. 

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Treatment for Depression

An article published recently on PLoS One was a systematic review of treatments for depression. The authors concluded that psychotherapy with antidepressants offered a slight advantage over psychotherapy alone or antidepressants alone. Psychotherapy and antidepressants alone did not differe from each other, or offer any better results than alternative therapies. The researchers concluded that their data suggested that "the type of treatment offered is less important than getting depressed patients involved in an active therapeutic program."

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Fiber and Adolescents at Risk For Metabolic Syndrome

A recent study published on PLoS Medicine looked at the effect of fiber in adolescent males aged 15-16 years at risk for metabolic syndrome. The youths were recruited from secondary schools in lower socio-economic areas with high rates of obesity. Participants were given 6 grams of psyllium per day in capsule form or placebo for 6 weeks, then a two week wash-out period, and then another 6 weeks either psyllium or placebo. The researchers found that 6 weeks of 6 g/day of psyllium resulted in improved fat distribution and an improved lipid profile, both markers for metabolic syndrome. Eating a diet high in fruits and vegetables, so high in fiber, is part of a comprehensive plan to reduce the risk of metabolic syndrome. It is probably easier in this population to just give them a pill with fiber than change a whole diet, although both would be optimal. 

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Fatty Acids and You

What we know about fatty acids is constantly evolving and complex. By now most of us know how important omega-3 fatty acids and fish oil are in reducing inflammation and preventing heart disease. We also know that saturated fats, those fats found primarily in meats, are associated with heart disease. A recent study published on PLoS Medicine found a strong association between omega-6 polyunsaturated fatty acids and a reduction in heart disease. Omega-6 fatty acids are found in most vegetables oils, such as sunflower oil, soybean oil, borage and blackcurrant seed oil, as well as as in avocados, nuts, eggs, and poultry. While omega-6 fatty acids are precursors to inflammatory prostaglandins, they are nevertheless important, even in the prevention of heart disease. No fatty acid is all bad or all good. Interestingly, this study did not find an association with omega-3 fatty acids and heart disease. The bottom line is that it is important to balance omega-3 and omega-6 fatty acids. 

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Black Tea Is Good For You

A study published in the May 2012 edition of Preventive Medicine showed that black tea is associated with a decrease in triglyceride levels, and improvement in cholesterol markers, and a decrease in fasting blood sugar. The researchers recruited 87 people between 25 and 60 years old. The subjects were randomized so that half were told to drink three cups of black tea per day, while the other half was told to drink the same volume of hot water throughout the day. The study went on for 12 weeks. At the end of the 12 weeks there were significant improvements in triglyceride levels, cholesterol markers, and fasting glucose. All of these are important for cardiovascular health.

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Traffic Noise and Heart Attacks

A Danish study published online in PLoS One found an association with traffic noise and risk of myocardial infarction. Previous studies have found an association between air pollution and MI.  Not a lot of research has been published on the effect that noise has on the body and on subsequent risk. Noise in general induces a stress response in the body and is followed by elevated blood pressure, heart rate, and contraction of the arteries. Noise also leads to an increase in cortisol, a hormone associated with stress. While more research needs to be done, trying to maintain a quiet environment may be good for your health. I would like to see a study on the health effects of having the television on throughout the day with that constant noise and chatter. 

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Green Tea Extract and Hypertension

A Polish study published in the June issue of Nutrition Research found that supplementation with a green tea extract can lead to significant reductions in C-reactive protein (CRP), an inflammatory marker, as well as decreases in systolic and diastolic blood pressure in obese people with hypertension. Green teach contains several polyphenols, one of which is epigallocatechin gallate (EGCG). This study used a daily dose of green tea extract of 379 mg, which provided 208 mg of EGCG. The subjects consumed either the extract or a placebo for three months. AFter three month those consuming the green tea extract saw a drop in their blood pressure of 4.9 (systolic) and 4.7 (diastolic). CRP dropped by 0.9 mg/L in the green tea extract group, but increased by 0.11 mg/L in the placebo group. Significant improvements in LDL and HDL cholesterol levels were also noted in the green tea extract group.

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Omega-3 Fatty Acids and Inflammation

A recent study conducted at Ohio State University and scheduled to published in Brain, Behavior and Immunity,  found that 1250 mg or 2500 mg of omega-3 polyunsaturated fatty acids reduced significant inflammatory markers, IL-6 and TNF-alpha. The scientists recruited 138 overweight or obese men and women who were otherwise in good health for the study. Overweight and obese individuals have higher inflammatory markers than normal weight individuals. Visceral or abdominal fat is inflammatory. The participants were divided into three groups: 1250 mg omega-3 per day, 2500 omega-3 per day, or usual diet with placebo. Including fish oil in one's daily regime as a supplement is one way to lower inflammation. In addition, a healthy low-glycemic index diet and regular exercise would lower inflammation even more. Omega-3 fatty acids have been associated with reducing cardiac arrhythmias, improving arterial health, decreasing depression, decreasing chronic pain, and many other health benefits. 

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Healthy Habits that Prevent Disease

The June issue of the American Journal of Medicine had articles on disease prevention.
1. Eating fish is associated with a lower risk for colorectal cancer. This Chinese study showed that regular consumption of fish reduces the risk for colon cancer by 4%, but reduces the risk for rectal cancer by a whopping 21%. Colon cancers are more diverse on a molecular level than are rectal cancers, and this may explain the difference.
2. Smokers who used hypnotherapy to help them quit smoking were 4.55 times more likely to quit than those who didn't. Smokers who underwent acupuncture were 3.53 times more likely to quit.
3. Regular tooth scaling (deep cleaning) is a associated with a decreased risk for future cardiovascular events.
4. Physicians can be as effective as weight loss centers in getting patients to lose weight. The physicians  in this study done at East Carolina University found that physicians using behavioral modification sessions and a diet plan partially or fully supplemented by meal replacements were as successful as weight loss clinics, and were more successful at reducing body fat.
5. Low dose aspirin has been associated with reducing cancer deaths. It would be interesting to see how low dose aspirin compares with an anti-inflammatory diet and a control group. An anti-inflammatory diet would not have the adverse effect of increasing the risk for major bleeds, including hemorrhagic stroke.

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New Swimming Stroke Information

A recent Reuters article by Sharon Begley says it better than I could say it:

Olympics: Faster Swimmers Paddle Like a Duck
By Sharon Begley
NEW YORK (Reuters) Jul 18 - Olympic swimmers need to ignore their intuition when it comes to the best ways to propel themselves through the water to glory next week.
Scientists have made several discoveries about the mechanics of swimming since the last summer Games four years ago, refuting some seemingly obvious assumptions.
Take freestyle swimming. It seems that forming each hand into a tight cup maximizes the force it exerts on the water, while keeping the fingers apart produces a wimpier stroke.
Not so, explains Adrian Bejan, professor of mechanical engineering at Duke University in Durham, N.C. Inspired by animal locomotion, he and colleagues analyzed the force that fingers and toes generate when pulled through the water.
When the digits are separated by between one-fifth and two-fifths of their diameter, the force exerted is 50 percent greater than when they are pressed together with no spaces in between, Bejan and his team will report in an upcoming issue of the Journal of Theoretical Biology.
The reason involves something called a boundary layer. When fingers move through water, viscosity causes a thin stream of fluid to stick to (and move with) them rather than flow between them. As a result, slightly separating the fingers creates a wider surface than keeping them close together. Just as a wider oar pulls with greater force than a narrower one, so does a wider hand.
The greater force pulls the swimmer both forward and, on the down stroke, upward. The higher the body is above the water, the faster forward it can go, since air resistance is less than water resistance.
In addition, the higher you are, the faster forward you fall. Since the swimmer's fall from above the water's surface has a horizontal component as well as a vertical one, the greater height achieved with a more powerful stroke translates into greater forward velocity.
PADDLES OR PROPELLERS?
When it comes to arm positioning, coaches and swimmers spent decades debating the best technique for freestyle and backstroke. Conventional wisdom views the propeller-like "sculling" motion as superior, but new studies show that a paddle- like "deep catch" stroke is the quicker route to the medals podium.
In the sculling stroke, the elbow of a freestyle swimmer is raised high as the hand enters the water as vertically as possible. The arm moves inward toward the body and then outward, making an S shape.
"The arm stays bent, the hand enters the water in line with the shoulder, and after moving to the center of the body it moves out again," explained Rajat Mittal, professor of mechanical engineering at Johns Hopkins University in Baltimore.
Whether in a boat or a plane, a propeller also moves perpendicular to the direction of motion - that is, right and left. Perpendicular motion creates a lift force that pushes the boat forward.
The sculling stroke was popularized in the 1960s by the late James "Doc" Counsilman, an American Olympic and college swimming coach who was among the first to apply science to the mechanics of swimming. Counsilman reasoned that just as a propeller-driven boat can move faster than a paddle boat by generating lift, so the sculling stroke can produce lift that is more effective than the paddle stroke, in which the swimmer simply drives the hand into the water and pulls it back as hard as possible.

To see whether the sculling stroke deserved its popularity, USA Swimming provided Mittal and his graduate student, Alfred von Loebbecke, with underwater videos of America's elite swimmers using either the sculling or paddle stroke. The scientists used animation software to scan the swimmers' arms, from which they created computer simulations.
From the simulations, the scientists determined the lift forces and drag forces the swimmers' strokes produced. They describe the findings in a paper scheduled for publication in the Journal of Biomechanical Engineering.
Bottom line? "The deep catch stroke is more efficient and effective than the sculling stroke," said Mittal. In the backstroke, the deep catch stroke produced 18 percent more thrust than the sculling stroke. How much extra speed a swimmer can get from the extra thrust depends on factors such as a swimmer's shape and technique.
That is not to say the sculling stroke should be retired. Long-distance swimmers prefer it because it's easier to maintain for long periods.
Sprinters, however, generally favor the deep catch stroke, as can be seen in American Michael Phelps, who won a record eight gold medals in Beijing. He employs a modified version, keeping his elbow slightly bent as it pulls against the water. The straighter the arm, the greater the shoulder strength required to drag it back through the water. A slight elbow bend conserves energy for a last-yards power sprint.
Mittal also analyzed the dolphin kick, performed at the start and after each turn in the freestyle, backstroke, butterfly and breast stroke.
Contrary to expectations that the largest leg muscles would be the source of the kick's power, it turns out that 90 percent of the thrust in a dolphin kick comes from the ankles and feet. "The more you can make the lower part of your leg floppy like a dolphin fluke, the better your thrust," Mittal said.
SOURCES: http://bit.ly/Mt0zLf J Theor Biol 2012. http://bit.ly/MwNKU0
J Biomech Eng 2012.
Reuters Health Information © 2012 

Blood Pressure and 10 Minute Walks

A study published in the July 2012 issue of Medicine and Science in Sports and Exercise found that in individuals with pre-hypertension, breaking aerobic exercise up into several sessions throughout the day reduced their risk for hypertension and other cardiovascular disease. As an example, 3 ten-minute aerobic sessions, such as brisk walking, had a greater effect than a single 30-minute exercise session on maintaining a lower ambulatory blood pressure. Other studies have pointed out the ill effects of sitting for prolonged periods of time. Seems like more and more studies are indicating that we need to get up and move around throughout the day. 


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Dim Light and Depression

The July 24 issue of Molecular Psychiatry contains an animal study that showed that hamsters exposed to dim light at night for 4 weeks showed signs of depression, changes to their hippocampus found in depression, and an increase in the inflammatory marker tumor necrosis factor (TNF). Previous research has shown an association between dim light at night and breast cancer and obesity. Both of these conditions, along with depression, are associated with an increase in inflammation. The good news here is that the symptoms of depression were reversible when the animals were returned to a normal light-dark cycle. 


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How Protein Suppresses Appetite

High protein diets are successful, at least in the short term. Recent research published in the July 5 issue of Cell proposes a mechanism showing how protein suppresses appetite. When protein is ingested, it is broken down into peptides, or chains of amino acids. As an aside, stomach acid is necessary for this to occur optimally. People on acid-blocking or proton-pump inhibitor drugs do not break down proteins well. These peptides are also referred to as oligo-peptides. These oligo-peptides travel through the intestinal cells to the portal vein. There they act upon u (mu) receptors found in the portal vein nervous system at the intestinal outlet. Messages are sent to the brain, which in turn sends messages that trigger messages to begin gluconeogenesis, or the conversion of protein to glucose. This process itself causes an appetite suppressing message to be sent to the brain. 
I recommend that my patients eat some protein with every meal, including breakfast. It does help suppress the appetite, so that by the time the next meal comes along, you're not so ravenous and likely to overeat. 


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Cranberries

Cranberries are often recommended in order to prevent or help treat urinary tract infections. They are also known for their high flavonoid content (anthocyanin and proanthocyanidin). A recent study published in the July issue of the Journal of Food Science compared anthocyanin and proanthocyanidin content of processed and whole cranberries. Freeze drying resulted in loss of flavonoid content. Flavonoids were nearly twice as high in whole fruit juice than in juice made from concentrate. Homemade cranberry sauce contained far higher levels of flavonoids than did canned cranberry juice. It is easy to make and doesn't need to be eaten only at Thanksgiving. Sweetened-dried cranberries were low in anthocyanins but did retain proanthocyanidins. Bottom line: better to consume fresh or freeze-dried cranberries than processed. Juice from whole cranberries superior to juice made from concentrate. 


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Improving Your Memory

Recent research suggests that in order to retain new information, a period of wakeful rest after learning the information is optimal. Research published in the recent Psychological Science by psychological scientist Michaela Dewar showed that new information was retained much better when subjects rested after learning the new information, rather than play a computer game. It seems that consolidating memories is a several stage process that requires peace and quiet. While this isn't always possible, you can optimize retention at seminars by walking and relaxing in the breaks rather than play with your phone or pick up e-mails. 


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Weight Training and Walking Improve Cognition

Four new randomized trials were presented at the Alzheimer's Association International Conference that showed that physical activity such as resistance training and walking, can increase cognitive functioning in various types of elderly adults, including those already diagnosed with mild cognitive impairment. Both resistance and aerobic training improved different types of memory. To improve executive function and functional plasticity, a higher level of aerobic exercise was required. Even a program of moderate walking in older people without demential showed an increased growth in memory brain regions as well as increased levels of brain-derived neurotrophic factor (BDNF). 


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Strawberries are a Superfruit

The term super fruit is usually linked with exotic fruit, not strawberries. Recent research out of the University of Warwick has found that strawberries impact so many aspects of our metabolism that affects good health, that they should be considered a super fruit. Most recently they found that strawberry extracts activate a protein in our bodies called Nrf2 that has been shown to increase antioxidant and other protective activities. This protein also helps decrease blood lipids (fats) and cholesterol. Strawberries have been shown to decrease the rise in post-meal glucose and LDL cholesterol (the "bad" cholesterol). So let's hear it for strawberries for dessert!


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Organic Tomatoes Are Healthier

Not only do organic tomatoes taste better, they are healthier and contain more anti-oxidants than conventionally grown tomatoes. This research was published in the recent Journal of Agricultural and Food Chemistry and the studies were conducted in Spain. Organic tomatoes contain more phenols than conventionally grown tomatoes. Phenols are anti-oxidants that the plant produced under more stressed conditions. The more the plant is stressed, the more phenols. Various phenols and polyphenols have been shown to prevent cardiovascular and degenerative diseases, as well as some forms of cancer. Tomatoes also contain lycopene and other carotenoids, and vitamin C, so overall they pack a healthy punch. 


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Sitting Too Much Reduces Lifespan

A new study published online in the journal BMJ Open examined data from the National Health and Nutrition Examination Survey (NHANES) and found that more sitting is associated with an earlier death. In particular cutting television time to less than two hours every day might extend life by almost 1.4 years. Keeping "down time" to less than three hours a day might make us live an extra two years. Something to think about while walking!


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Food Journal Important for Weight Loss

A study published online July 13 in the Journal of the Academy of Nutrition and Dietetics found that keeping a food journal improved weight loss over a 12 month period on post-menopausal women. Weight loss was also helped by preparing meals at home and eating meals at regular intervals. There are several online programs and apps that can help you keep a journal. Calorie King and Livestrong.com are two that come to mind. 


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Revisiting HDL Cholesterol

A recent study published in the July 11, 2012 edition of the Journal of the American college of Cardiology confirmed that the way HDL, the "good cholesterol," is evaluated in clinical practice is not that meaningful. Currently most doctors evaluate how much cholesterol each HDL protein is carrying. It is more significant to measure the number of HDL protein particles and sizes than the amount of cholesterol these particles contain. These tests currently can be done by specialty labs such as Spectracell and Berkeley Heart Lab. At the end of May I attended the 2012 Institute for Functional Medicine's annual symposium. This year the topic was on Cardiometabolic diseases, which include heart disease and diabetes. The way HDL and LDL are measured and evaluated was discussed in detail, with the recommendation to evaluate particle size and number. 


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Soy and Breast Cancer

Soy contains very weak estrogens and has therefore been discussed a great deal in regards to breast cancer. The results of early Chinese studies were not relevant to American women in the same way, as American women, at least at that time, were generally not raised eating an abundance of soy products. A new study looking at these issue was published online May 30 in the American Journal of Clinical Nutrition. The researchers found by pooling both American and Chinese data that soy seems to have a protective role as far as breast cancer is concerned. And it seems the more the better, and especially so for women with estrogen receptor negative cancers. Women with estrogen receptor positive cancers also had a decreased risk of recurrence with increased soy intake if they were also on Tamoxifen. It would be interesting to know if these results would be changed in any way looking at organic versus non-organic soy. 


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Non-Aspirin NSAID Use and Kidney Cancer

The September 12 issue of the Archives of Internal Medicine have a study that showed that long-term use of non aspirin anti-inflammatory drugs (NSAIDs) are linked to an increased risk of kidney cancer, or renal cell cancer. The data was gathered from the Nurses' Health Study (77,525 nurses followed up to 16 years) and the Health Professionals Follow-up Study (49,403 men followed for 20 years). The study also suggests that the longer one uses these NSAIDs, the higher the risk. These drugs include ibuprofen (Advil, Motrin, etc.), naproxen, cox-2 inhibitors, etc. 


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Exercise Reduces Neuropathic Pain

The June issue of Anesthesia & Analgesia has an animal study that shows that exercise can reduce neuropathic pain. The study was performed on rats that were given an injury to their sciatic nerve.  A group was then progressively trained to either swam or run on the treadmill. Compared with non-exercising rats, the exercising rats experienced less pain. Exercise also reduced the expression of inflammation-promoting cytokines in the sciatic nerve tissue. Other studies have shown that inflammatory cytokines contribute to pain. For years exercise has been recommended for people with chronic pain. This was the first study that looked at neuropathic pain. 


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Vitamin D and Fractures

A new paper published in the July 5 edition of the New England Journal of Medicine examined the data from a dozen large double-blind, randomized controlled studies and found that an average daily intake of at least 800 IU per day reduced the risk of a fracture significantly, and specifically a 30% reduction in the risk of hip fracture. Lower doses of vitamin D do not have this effect. In the adult population it is difficult to get enough vitamin D through the diet--you can only eat so much oily fish--and adults have less direct sun exposure. The authors recommend 1000 to 2000 IU of vitamin D per day, as adults sometimes forget their supplements, and this amount would ensure adequacy. Other studies have shown vitamin D3 (cholecalciferol) to be superior vitamin D2 (ergocalciferol). 


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Long Working Hours and Pre-Diabetes

A study published in the May BMC Public Health journal found that 10-hour working days in Japanese men over 40 years old was associated with metabolic syndrome, or pre-diabetes. This is no big surprise, as consistently working 10 hour days does not leave a lot of time for exercise and down-time. Also, working those kind of hours requires more vigilance in order to eat right. Eating right, moderate consistent exercise, 7-8 hours of sleep per night, and some down-time are essential for optimal health. 


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Meditation and Multitasking in the Workplace

Some interesting research is being done at the University of Washington on the effects of a mindfulness meditation practice and real-world multitasking at work. Three groups of 12-15 human resource managers were recruited for this study. One group was enrolled in an 8-week mindfulness meditation training, another in a relaxation training, and the third was not enrolled in anything. The third, or control group, was enrolled in the mindfulness meditation group after the first 8 weeks of the study. Before and after each 8-week period participants were given a stressful test of their multitasking abilities, requiring them to use email, calendars, instant messaging, telephone, and word-processing tools. The researchers measured their speed, accuracy, and the extent to which they switched tasks. The also noted self-reported levels of stress and memory while performing the tasks. The mindfulness meditation group reported lower levels of stress, tended to stay on task longer, but completed the job in the same amount of time as the other groups. The relaxation training did not have a reduction in stress but did, as did the meditation group, have an improvement in memory. When the control group was finally trained in mindfulness meditation, it, too, enjoyed all the same benefits noted above. 


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Stress and the Immune System

Researchers at Stanford University have been studying acute stress and the immune system's response. The body responds to acute stress by mobilizing the immune system in order to prepare for healing a possible injury. This is a good thing and short term stress, minutes or a few hours, is good for the body and can boost the immune system. this is perhaps one way exercise helps prevent infections. Chronic, unrelenting stress has the opposite effect. A wonderful book on the effects of chronic stress is Why Zebras Don't Get Ulcers by Robert Sapolsky. He is also on the faculty at Stanford. 


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Popeye Was Right

Popeye was right: spinach does make you stronger--as do beets and chard. These foods are high in nitrates, which have been associated with stronger muscles. A recent study published in the Journal of Physiology found that mice given the mouse equivalent of a 200-300 gram serving of spinach a day had considerably stronger muscles than mice not fed spinach. The mice with the higher nitrate levels also had higher levels of two particular proteins, CASQ1 and DHPR, that are crucial in calcium balance and ultimately muscle contraction.  The researchers now want to apply what they've learned in mice and apply it to people. Spinach, beet, and chard have so many health benefits, that it wouldn't hurt to include them in your diet one way or another. 


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Depressing Fact

Researchers writing in PLoS Medicine have found "there is significant penetration by multinational processed food manufacturers such as Nestle, Kraft, PepsiCo, and Danone into food environments in low-and-middle income countries, where consumption of unhealthy commodities is reaching--and in some cases exceeding--a level presently observed in high income countries." The authors from the UK, US, and India also found that higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales. Think of the chronic diseases of the Western world that are soon to follow....


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Low Carb Diets and Cardiovascular Risk

The recent British Medical Journal published an international study conducted on 44,000 Swedish women between 30 and 49 years old from 1991-1992 with an average 15 year follow-up. Diet was assessed using an extensive dietary and lifestyle questionnaire. The researchers found that those on high protein, low carbohydrate diets for an extended period of time had more cardiovascular incidents. It is difficult to know what to make of this study. What was the quality of the carbohydrates (whole grains or white flour), the quality of the protein (animal, vegetable, organic), how much did each person's diet vary over the time period? Were the people eating the most carb health-conscious vegetarians, which would certainly make them look better than meat eaters? I am a firm believer in moderation. If you have a blood sugar issue or are at risk for having one, you need to cut down on your carbs. That doesn't mean no carbs, just fewer than what you're eating and make them healthy, whole grain, or starchy vegetable or non-starchy vegetable carbs. Also increasing your legume intake gives you healthier carbs and more protein. People who are doing a lot of endurance exercise need more carbs than people doing primarily resistance training. Everyone needs protein, be it from an animal or vegetable source. Healthy fats are also crucial. 


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Meditation, Exercise, and Cold Symptoms

The July/August issue of the Annals of Family Medicine has an interesting study looking at 149 adults older than 50 following either an 8-week mindfulness meditation practice or moderately intense exercise program, or neither. Those in the exercise and meditation groups had half the number of acute respiratory infections than those in the control group during the 8 week intervention: 257 days of illness in the meditation group, 241 days of illness in the exercise group, and 453 days of illness in the control group. The severity of the infections were least in the meditation group and worst in the control group, with the exercise group falling somewhere in-between. The meditation group also lost the least days of work. 


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Sleep Deprivation and the Immune System

Previous studies have shown that sleep deprivation is associated with diseases such as obesity, diabetes, and hypertension. A new study looked at how sleep deprivation affects the immune system, in particular white blood cells. 15 healthy young men had their blood drawn under normal and severely sleep deprived conditions. Normal circumstances were 8 hours of sleep every night, exposure to at least 15 minutes of outdoor light within the first 90 minutes of waking, and no caffeine, alcohol, or medication during the final three days. All of this was in order to stabilize their circadian clocks. A particular type of white blood cell, granulocytes, reacted immediately and were increased. This response is much the same as had these young men been under physical stress. 


The study, "Diurnal Rhythms in Blood Cell Populations and the Effect of Acute Sleep Deprivation in Healthy Young Men," was a collaborative effort between the Department of Forensic Molecular Biology at Erasmus MC University Medical Center Rotterdam and Chronobiology, Faculty of Health and Medical Sciences at the University of Surrey, United Kingdom. The laboratory study was conducted at the University of Surrey Clinical Research Centre.


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Cancer Cells Need Sugar to Thrive

If cancer cells need sugar to thrive, it would seem that a low sugar diet would inhibit cancer cells. Recent research performed at UCLA showed that cells that require glucose to function, which cancer cells do, die when deprived of glucose. Diet recommendations for people living with cancer include low sugar/low glycemic index diets. 
Mol Syst Biol. 2012 Jun 26;8:589. doi: 10.1038/msb.2012.20.


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Calorie Restriction and Longevity

New research published in the July 3 edition of Cell Metabolism shows that, at least in the fruit fly, a restricted calorie diet only prolongs life if there is physical activity as well. There has been a lot of research on how calorie restriction can prolong life, a sacrifice that most people do not want to make. This research points out that calorie restriction alone is not enough. Movement is also necessary. They speculated that part of the reason could have to do with fat metabolism, and that enhanced fat metabolism could slow aging. 


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Not All Calories the Same

In an earlier article I pointed out that diets with 15% or 25% protein resulted in the least amount of loss of lean muscle mass while dieting. An article published June 27, 2012 in the Journal of the American Medical Association showed that the optimal diet for weight loss is a low-glycemic load diet. The study itself was quite interesting. Between June 2006 and June 2010 21 overweight and obese young adults were put on a diet so that they would lose 10-15% of their body weight. This run-in phase primed them: once a heavy person loses weight, they are much more likely to gain weight than someone of the same weight who was never heavy. So it truly takes less for them to gain weight. The participants were than randomly put on one of three diets for 4 weeks and then moved onto the next diet for another 4 weeks and so on. One diet was typical low fat diet (20% fat, 60% carbohydrate, 20% protein), another was very low carbohydrate (10% carbohydrate, 60% fat, and 30% protein), and the third was the high glycemic index diet (20-30% protein, 40-50% carbs, 30% fat). People expended the most energy while on the very low carbohydrate diet and the least energy on the low fat diet. The high glycemic index diet split the difference, burning 150 calories more at rest than did those on the low fat diet. The low fat diet exacerbated risk factors for metabolic syndrome, such as insulin resistance, triglycerides, and lower HDL and higher CRP, a measure of chronic inflammation. Stress hormones were also elevated on the low fat diet. 


Studies such as these show that calories are not all created equal from a metabolic perspective. The low glycemic index is the one most recommended by Functional Medicien practitioners. 


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Low Testosterone and Weight Loss

Research presented at ENDO 2012: The Endocrine Society 94th Annual Meeting showed that pre diabetic, overweight men with hypogonadism (low testosterone) showed improvements in testosterone levels after lifestyle modifications consisting of calorie and fat reduction and exercise. This was a three armed study of about 900 men with about one third getting lifestyle and exercise modification, another receiving the drug metformin, and a third receiving a placebo. Only in the lifestyle group did testosterone rise. Ideally testosterone is not given in a vacuum, but in conjunction with positive lifestyle program, which alone may raise levels sufficiently. This is the Functional Medicine approach. 


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Weight as a Risk Factor for Cancer

A new report from the Cancer Research UK group, title Cancer Prevention: Stacking the Odds in Your Favour showed that after smoking, excess weight is the next biggest factor associated with cancer. Extra weight around the middle, or visceral fat, is far more active than subcutaneous fat. Some of the many substances released by this fat include chemicals that can make cells in the body divide far more often than usual, thus increasing the risk for cancer. Less than one third of the people surveyed for this report ate the recommended 5 fruits and vegetables daily. Only 23% managed to do the recommended 150 minutes of moderate exercise per week. While think people who exercise regularly also get cancer, improving one's risk profile decreases the odds. Genetics play a surprisingly small role. Various cancer-causing genes get turned on or off by the environment, including nutrition and exercise. 


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