Leisure Time Physical Activity

PLoS one published an interesting study looking at leisure time physical activity. The editor's summary explains it best: 

These findings suggest that participation in leisure time physical activity, even below the recommended level, is associated with a reduced risk of mortality compared to participation in no leisure time physical activity. This result may help convince currently inactive people that a modest physical activity program may have health benefits, even if it does not result in weight loss. The findings also suggest that physical activity at recommended levels or higher may increase longevity further, and that a lack of leisure time physical activity may markedly reduce life expectancy when combined with obesity. Although the accuracy and generalizability of these findings may be limited by certain aspects of the study's design (for example, some study participants may have overestimated their leisure time physical activity), these findings reinforce the public health message that both a physically active lifestyle and a normal body weight are important for increasing longevity.

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More Good News on Berries

A study published in the January 14, 2013 edition of Circulation based on data from the Nurses' Health Study 2 found that a diet rich in blueberries and strawberries, as well as a diet rich in anthocyanins both reduce the risk for myocardial infarction. Strawberries and blueberries are high in anthocyanins, as are eggplant and other purple vegetables and fruits. While the data comes from food frequency questionnaires, and is controlled for all sorts of factors, it is still difficult to quantify the effects. Most of the women consuming berries also took better care of themselves overall. A good diet consists of a variety of fruits and vegetables. One rule of thumb is to try and consume all the colors of the rainbow daily. Eating berries at breakfast already gives you blue and red!

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Potassium and Bone Health

A Swiss study published in the October 5, 2012 edition of The Journal of Clinical Endocrinology & Metabolism concluded that including potassium citrate supplementation in the diet can increase bone density in non-osteoporotic individuals. The reasoning behind this supplementation is the reduce the body's acidic environment that is created by a diet high in meat and grains. While the article doesn't say this, a diet high in fruits and vegetables is also high in potassium, which could be an alternative to supplementation. It is certainly something to keep in mind in addition to calcium (at lower doses than previously recommended), vitamin D3, and vitamin K2. 

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Vitamin D and Old People

Two studies published in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences found a correlation between low levels of vitamin D and dementias and/or Alzheimer's in older women. Vitamin D can be gotten from sunshine, oily fish, and supplements. The women may have had low vitamin D from not getting outside due to lack of mobility. Lack of mobility has also been shown to increase the risk for dementia. It becomes a chicken and egg question. While it wouldn't hurt to supplement an older person's diet with vitamin D, and highly likely would be beneficial, I'm not entirely convinced it alone would improve dementia. It would have to be part of a comprehensive program including both mental and physical exercise, along with a good diet. 

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Antibiotics and Acute Sinusitis

A study published in Evidence Based Medicine in 2012 that reviewed 4 meta-analyses found that antibiotics provide only the barest minimum of benefit over a placebo in acute sinusitis. However, unlike the placebo, antibiotics had more adverse events, such as diarrhea, which was reported in 30-74% of patients. Like my previous report on coughing and antibiotics, it might be time to rethink automatically giving antibiotics to patients with sinus infections. 

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Vitamin B6 for Bone Health

A Chinese study published in Osteoporosis International on December 13, 2012 found that women with the highest intake of vitamin B6 had the lowest incidence of hip fracture. The highest intake was 0.78-1.76 mg/1,000 kcal/day, or not that much. This amount would be found in 2-3 bananas/day, or 3-4 servings of meat/day, or 10 servings of milk or dark green leafy vegetables, or in a supplement. What the article did not say, but is important to remember, is that for B6 or pyridoxine to function well, the body must have adequate magnesium. Most Americans are deficient in magnesium. 

I posted another Chinese study on my professional page on Facebook (www.facebook.com/drjessicaseaton) that thin older men with higher carotenoid (fruits and vegetables, especially orange and yellow) had a lower risk of hip fracture. 

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Eggs and Risk of Coronary Heart Disease and Stroke

The British Medical Journal published a meta-analysis about egg consumption and cardiovascular disease risk. This is an issue because people with cardiovascular disease used to be told to avoid eggs because of the high cholesterol in eggs. This study found that one egg a day did not increase the risk for coronary heart disease or for stroke in non-diabetics. However, there was in increased risk in diabetics, for which the mechanism was not known. 

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Major Depression and Methylfolate

A study published in the December 2012 issue of the American Journal of Psychiatry reported good outcomes when L-methylfolate was added to selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder (MDD). This was a randomized placebo controlled study of 75 adults with MDD who were resistant to SSRIs alone. In this study they were continued on SSRIs and given either a placebo or 15 mg/day of L-methylfolate. The L-methylfolate group did better than the placebo group. L-methylfolate is a biologically available form of folic acid, a necessary B vitamin involved in countless reactions in the body. It is particularly important in reactions involving methyl groups, such as in biotransformation or detoxification cycles. While this study needs to be replicated, it would also be interesting to see how this population would do with an excellent diet and L-methylfolate supplementation...maybe throw in some fish oil and vitamin D as well. 

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Exercise and Mental Health

Most often the recommended amount of exercise is 150 minutes a week, or 30 minutes 5 times a week. Research published in the September 7, 2012 issue of Preventive Medicine looked at how much exercise is ideal for good mental health. The study included self-reported data on physical activity and mental health symptoms from 7674 adults from the 2007 US Health Information National Trends Survey (HINTS). The researchers concluded that the optimal amount of physical activity for improved mental health may be from 2.5 (150 minutes) to 7.5 hours of activity per week. Less than that or more than that did not result in a better mental health profile. The researchers speculated that more exercise than that might be coming at the expense of other activities, such as spending time with family or social activities. I think there is a fair amount of wiggle room here. It surely depends on whether the individual has a time-consuming job or not, is single or not, and a host of other factors. This is a good starting point, however. 

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Fish Oil, Glucosamine Sulfate, Chondroitin Sulfate and Inflammation

A study published online in the November 8 issue of the American Journal of Epidemiology found that glucosamine sulfate, chondroitin sulfate, and fish oil all reduce hs-CRP, a marker of inflammation associated with cardiovascular disease, cancer, and rheumatoid diseases. The researchers examined data from the 9947 participants in the National Health and Nutrition Examination Survey (NHANES). While the effects were seen in both men and women, the effects were stronger in women. In women, glucosamine sulfate reduced hs-CRP by 27%, and chondroitin sulfate reduced it by 33%. Fish oil reduced it by about 16%. In earlier research these supplements have been associated with a reduced risk of chronic diseases associated with inflammation. 

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Fiber and Breast Cancer

The results from the European Prospective Investigation into Cancer and Nutrition showed that a higher intake of fiber, particularly from vegetables, was associated with a small reduction in risk of breast cancer, especially the estrogen negative and progesterone negative types. There are not a lot of things that prevent these types of breast cancers, so every little bit helps. 

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The Limits of MRI in Sciatica

MRI or magnetic resonance imaging is a wonderful tool. With no radiation we can peer into the body and visualize not only bone, but also soft tissue, such as muscles and nerves. A Dutch study published in the March 14 issue of the New England Journal of Medicine cautions doctors, and patients, not to read too much into a positive MRI. Whether surgery or conservative care was performed for disc herniations, there was little to no correlation between MRI findings and outcomes. In my own clinical practice, I've often seen patients with sciatica get an MRI only to find that it does not explain their pain. I've also had patients with pretty gnarly looking MR images who were not experiencing any back pain or sciatica at that moment. Back pain and sciatica are often the result of many factors, the underlying anatomy as seen on MRI being just one factor. An MRI does not or should not replace taking a good history and doing a good examination. 

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Omega-3 Beneficial for Brain and Metabolism

A Swedish study published in the December issue of Nutrition Journal looked at the effects of supplementing with three grams of omega-3 polyunsaturated fatty acid (PUFA) fish oil or a placebo for 5 weeks. 40 participants between the ages of 51 and 72 were enrolled in the study with half given fish oil and the other half placebo. The fish oil contained 3,000 mg of omega-3 fats, of which 1500 mg were EPA and 1050 mg were DHA. After 5 weeks the supplementation was stopped for 5 weeks. Then the groups were switched. Cognitive function, such as working memory, improved in the fish oil group but not the placebo group. The omega-3 group also had lower systolic blood pressure and lower plasma inflammatory markers. Other studies have shown that the natural glycerol form of omega-3 oils, such as found in Nordic Naturals and Designs of Health products, are superior because the body recognizes them, as compared to the prescription form, such as Luvaza. 

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Effects of Different Types of Activity

An interesting research article published on PLoS ONE found that minimal intensity physical activity, such as standing and walking, for longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise, such as cycling, in sedentary subjects when energy expenditure is comparable. What does this mean? If a sedentary person spends their day standing and walking, they will burn more calories, usually about 500 more, than when just sitting. Now, instead of walking and standing, that person does one hour of moderate to vigorous physical exercise burning about 500 calories, and then sits the remaining of the day. So either way the person is burning about 500 more calories over just sitting. The study found that walking and standing during the day resulted in better insulin sensitivity (a good thing) and a better lipid profile (such as cholesterol values) than if all of the calories are burned in a one hour session. These results lead to a reduced risk for diabetes and metabolic syndrome.

The best of both worlds would be one hour of moderate to vigorous physical exercise to improved cardiovascular fitness followed by spending the bulk of the day standing or walking, such as with a standing desk. 

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Physical Activity and Cognitive Health

A study published in the November 2012 issue of Stroke: Journal of the American Heart Association found that physical activity can protect against vascular dementia and cognitive impairment in non-disabled individuals ages 65-84 with some loss of brain white matter. For the purposes of this study, physical activity was considered moderate activity for 30 minutes 3 times a week. The people in this study were evaluated over a three year period of time. There is no downside to exercising as we age. 

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Gazpacho May Help to Lower Blood Pressure

A Spanish study published in Nutrition, Metabolism & Cardiovascular Diseases looked at the effect of gazpacho consumption on cardiovascular risk factors in nearly 4,000 people. They found that regularly consuming gazpacho soup lowered the risk for high blood pressure, or hypertension. This held true for both systolic and diastolic blood pressure.  Previous studies found a correlation between higher consumption of the individual ingredients: tomato, cucumber, garlic, and olive oil, and a reduced risk for hypertension.  Gazpacho lowered blood pressure in spite of its higher salt content.

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Diet and Heart Events

A study published last fall in Circulation looked at the diet of people with heart disease and/or diabetes who were already taking medications for their conditions. 31,546 men and women with an average age of 66.5 were given food frequency questionnaires and  followed for 56 months. Those whose diets were on the healthy end of the spectrum had a lower risk of recurrent cardiovascular events, such as cardiovascular death, congestive heart failure, or stroke. This study was significant because it showed that even if you're on medication, you can still benefit from a healthy diet. 

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Coughs Takes Longer To Clear Up Than You Think

We all expect our coughs to clear up in about a week after we've had a cold. Researchers reporting in the Annals of Family Medicine in January reviewed cough studies and said they found that coughs take about 3 weeks to clear up. At about 2 weeks post-cold many people visit their family practice doctor to get antibiotics. This only fuels antibiotic resistance and will not clear up a viral cough. Of course it is quite something else if after three weeks you still have fever and a cough that is not improving. You could have pneumonia. The researchers found that about 50% of patients diagnosed with an acute cough in 2006 were prescribed antibiotics, although most respiratory infections are viral. Bronchitis is generally a viral infection. 

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Processed Meat and Cancer Deaths

The March 7 online edition of BMC Medicine published one of the largest studies to look at processed meat consumption and mortality. The news was not good for those who enjoy bacon, sausage, and ham. There was a positive association between processed meat consumption and an increased risk of death from both cardiovascular causes and cancer. Over a 12 year period of time the risk of death was twice as high for those with high consumption compared to those with low consumption. The risk for cancer death was 43% higher and the risk for cardiovascular death was 70% higher in people eating more than 160 g/day of processed meats than in those eating 10.0-19.9 g/day. These data come from the European Prospective Investigation into Cancer and Nutrition (EPIC) study invovling 10 countries and almost half a million men and women. 

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Flaxseed and Blood Pressure

A study presented at the American Heart Association 2012 Scientific Session showed that over a 6 month period of time, people with hypertension and peripheral artery disease were able to lower their blood pressure significantly with 30 grams of flaxseed daily. The researchers were unable to determine which component of flaxseed was responsible for the  drop, since there are several candidates: alpha-linolenic acid, enterolignans, and fiber. Systolic pressure declined by 10-15mmHg and diastolic by 7 mmHg. 

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Diet and Heart Attacks

A study published in the December 2012 issue of Circulation found that eating a healthy diet results in fewer deaths from cardiovascular disease and strokes. This study used food frequency questionnaires to evaluate the diets of 31,546 patients, who had a mean age 66.5. The patients were taking drugs to treat their heart disease or diabetes already. Those who ate healthier and followed a more Mediterranean-type diet, high in fruits, nuts, olive oil, and vegetables, low in meat and saturated fats, had significant risk reductions for cardiovascular death, congestive heart failure, and stroke. 

Another study of similar design was just published in the New England Journal of Medicine and written about in the New York Times

:http://www.nytimes.com/2013/02/26/health/mediterranean-diet-can-cut-heart-disease-study-finds.html?smid=fb-share&_r=0

More and more we're seeing studies that are looking at the whole nutritional picture and not just singling out a single nutrient for study. This makes more sense for a lot of different reasons. 

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MRI and Sciatica

Magnetic Resonance Imaging (MRI) is a terrific way to see inside the body. It gives us a snapshot in time. The downside is that what we're seeing may not be the cause of the patient's problems. Early studies showed that about 40% of the population with no back pain or sciatica had herniated discs on MRI. Now a new study published in the March 14 issue of the New England Journal of Medicine found that MRI findings in patients with sciatica were not correlated with clinical outcomes whether or not they had surgery. After a successful round of conservative or surgical care, successful being the patient no longer has pain, did not necessarily mean that a herniated disc was no longer visible. The authors concluded that doctors and patients should not rely too much on MRI for their decision making. 

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Alzheimer's plaques and Vitamin D and DHA

A small pilot study conducted at UCLA and published in Journal of Alzheimer's Disease found that both vitamin D3 and the omega-3 fatty acid DHA may play an important role in eliminating amyloid plaques in the brain, a hallmark of Alzheimer's disease. Blood was drawn from patients with Alzheimer's disease and then allowed to incubate overnight in a solution containing either an active form of vitamin D3 or an active form of DHA. Both solutions increased the ability of macrophages, immune cells, to gobble up amyloid beta, and both solutions decreased cell death induced by amyloid beta. Each solution used a different pathway to achieve the same result. 

Vitamin D3, the "sunshine vitamin," and DHA, found primarily in fish oils, are important for health in general, so including it in one's daily supplementation is probably a good idea whether or not long-term human studies show a benefit in preventing Alzheimer's disease. Stick to the recommended doses. 

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Hypermobility or "Double Jointed"

In my clinical practice I often see people who are extremely flexible. As children they would have been known as "double-jointed." In my experience they tend to have a lot more muscle, tendon, ligament, and joint issues. Now findings published in Arthritis and Rheumatism, a journal of the American College of Rheumatology, indicate that children with hypermobile joints are twice as likely to develop pain at these joints. The children were evaluated at ages 14 and 18. It would be interesting to follow them well into adulthood and then old age and see if they end up with more osteoarthritis. 

My advice to people with hypermobile joints is to emphasize strength and core training to give the body more stability. 

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