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Published on Leave a comment on Breast Cancer Study Finds A Lot of Overdiagnosis

Another large study looking at screening mammograms for breast cancer has raised the issue of overdiagnosis and overtreatment once again. The purpose of mammography screening is to find cancer when it is small and so prevent cancer from growing and becoming advanced cancer. However, the researchers did not find this - there was a major increase in finding small cancers (the kind that may grow so slowly as to never cause any problems or that may even regress), but the rate of advanced cancers stayed the same.

The problem of overdiagnosis (finding small tumors that may never cause problems) and overtreatment (treating unnecessarily), which is leading to medical experts "rethinking cancer screening" is a major shift in how cancer screening is being viewed for a number of cancers. This is because studies show that overall death rates are basically the same in screened vs non-screened persons for mammography, colon, prostate, and lung cancer screening (see post). The view of how cancer grows and spreads may have to be reexamined and changed. One possibility suggested by Dr. H. Gilbert Welch is that aggressive cancer is already "a systemic disease by the time it's detectable" (Oct. 28, 2015 post).

The following excerpts are from the thoughtful review of the study in Health News Review: Overdiagnosis of ductal carcinoma in situ: ‘the pathology equivalent of racial profiling’

Danish researchers are providing new evidence that many breast cancers found via screening mammograms don’t need to be treated. Women with these non-threatening tumors are said to be “overdiagnosed” with breast cancer. Overdiagnosis occurs when breast screening such as mammography detects small, slow-growing cancers that may never cause the patient any trouble. Yet, women diagnosed with such tumors are exposed to very real harms–possible surgery, chemotherapy, radiation, and living life as a “cancer patient.”

How much overdiagnosis are we talking about? If you don’t include cases of ductal carcinoma in situ (DCIS) in the tallies, anywhere from 14.7% to 38.6% of breast cancers found via screening represent overdiagnosis, the study authors found. The rate ranges from 24.4% to as high as 48.3% when DCIS is included.

DCIS is a collection of abnormal cells inside a milk duct that may–but usually doesn’t–break out to become invasive and potentially lethal cancer. About 60,000 women are told they have DCIS each year in the United States. Some experts estimate that up to 80% of women with DCIS found via screening may not need any treatment at all–and instead should just keep an eye on things. Obviously, women need to be fully and accurately informed about the benefits and risks — including the risk of overdiagnosis — before embarking on any decision to get screened for breast cancer or choosing a course of action following a diagnosis.

Otis Brawley, MD, Chief Medical Officer for the American Cancer Society, says it’s been difficult for modern medicine to wrap its brain around the concept of overdiagnosis. The natural inclination is to assume that cancerous-looking cells “will grow, spread, and eventually kill,” he writes in an editorial accompanying the Danish study. “However, some of these lesions may be genomically predetermined to grow no further and may even regress. In many respects, considering all small breast lesions to be deadly and aggressive types of cancer is the pathologic equivalent of racial profiling.

Excerpts from the original study from the Annals of Internal Medicine: Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis

Background: Effective breast cancer screening should detect early-stage cancer and prevent advanced disease. Objective: To assess the association between screening and the size of detected tumors and to estimate overdiagnosis (detection of tumors that would not become clinically relevant).... Setting: Denmark from 1980 to 2010. Participants: Women aged 35 to 84 years. Intervention: Screening programs offering biennial mammography for women aged 50 to 69 years beginning in different regions at different times.

Conclusion: Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS (ductal carcinoma in situ) diagnosed in women offered screening represent overdiagnosis (incidence increase of 48.3%).

Breast screening is associated with a substantial increase in the incidence of nonadvanced tumors and DCIS (ductal carcinoma in situ) in Denmark but not with a reduction in the incidence of advanced tumors, and the overdiagnosis rate is substantial. These findings support that screening has not accomplished the promise of a reduction in invasive therapy or disease-specific mortality.

Published on Leave a comment on A Medical Device Can Sniff Out Multiple Diseases?

 Image result for breathing mouth What if you could detect cancer by a gadget that can sniff for cancer or some other disease? The theory that disease is detectable from exhaled breath dates back to about 400 BC when the Greek physician Hippocrates used to smell his patients' breath to find out what ailed them. More recently a number of individual diseases, such as diabetes, have been detected with "breath analysis".

But Israeli scientist Hossam Haick and others wanted to invent a medical diagnostic tool (an "electronic nose") that could detect multiple diseases, including cancer, by "sniffing" a patient’s exhaled breath. They recently published a study suggesting that such a device that they developed can work for 17 diseases (including 8 types of cancer, Crohn's disease, ulcerative colitis, irritable bowel syndrome, Parkinson's disease, multiple sclerosis, pre-eclampsia in pregnant women, and chronic kidney failure). The results showed that each of these diseases has its own unique "breathprint", and which overall could be detected with 86% accuracy using the device.

The study used breath samples collected from 1,404 people from 2011 to 2014 in 5 countries (Israel, the United States, Latvia, China, and France). The test subjects were either known to be healthy or to be suffering from one of the 17 diseases. Please note that this diagnostic tool is currently being further researched and developed. It is not available yet.

From Science Daily: Nanoarray sniffs out and distinguishes multiple diseases

Before modern medical lab techniques became available, doctors diagnosed some diseases by smelling a patient's breath. Scientists have been working for years to develop analytical instruments that can mimic this sniff-and-diagnose ability. Now, researchers report in the journal ACS Nano that they have identified a unique "breathprint" for each disease. Using this information, they have designed a device that screens breath samples to classify and diagnose several types of diseases.

Exhaled breath contains nitrogen, carbon dioxide and oxygen, as well as a small amount of more than 100 other volatile chemical components. The relative amounts of these substances vary depending on the state of a person's health. As far back as around 400 B.C., Hippocrates told his students to "smell your patients' breath" to search for clues of diseases such as diabetes (which creates a sweet smell). In more recent times, several teams of scientists have developed experimental breath analyzers, but most of these instruments focus on a single type of disease, such as cancer. In their own work, Hossam Haick and a team of collaborators in 14 clinical departments worldwide wanted to create a breathalyzer that could distinguish among multiple diseases.

The researchers developed an array of nanoscale sensors to detect the individual components in thousands of breath samples from patients who were either healthy or had one of 17 different diseases, such as kidney cancer or Parkinson's disease. By analyzing the results with artificial intelligence techniques, the team could use the array to classify and diagnose the conditions. The team used mass spectrometry to identify the breath components associated with the diseases. They found that each disease produces a unique volatile chemical breathprint, based on differing amounts of 13 components. They also showed that the presence of one disease would not prevent the detection of others -- a prerequisite for developing a practical device to screen and diagnose various diseases in a noninvasive, inexpensive and portable manner.

Published on Leave a comment on A Daily Handful of Nuts Keeps the Doctor Away?

A large review of nut studies found that people eating a daily handful of nuts (about 20 g) have a lower risk of heart disease, cancer, stroke, premature death, and death from respiratory disease, type 2 diabetes, and infectious disease. Truly impressive. Benefits seem to be for all nuts, and also peanuts - which are called nuts, but are actually legumes (other posts about nut consumption benefits). An earlier post discussed how some of these effects could be to nuts lowering systemic inflammation throughout the body. Bottom line: try to eat a handful of nuts every day or most days a week for your health. And make it a variety of nuts - walnuts, almonds, hazelnuts, cashews, pistachios, pecans, Brazil nuts, and peanuts. From Science Daily:

A handful of nuts a day cuts the risk of a wide range of diseases

A large analysis of current research shows that people who eat at least 20g of nuts a day have a lower risk of heart disease, cancer and other diseases. The analysis of all current studies on nut consumption and disease risk has revealed that 20g a day -- equivalent to a handful -- can cut people's risk of coronary heart disease by nearly 30 percent, their risk of cancer by 15 percent, and their risk of premature death by 22 percent. An average of at least 20g of nut consumption was also associated with a reduced risk of dying from respiratory disease by about a half, and diabetes by nearly 40 percent, although the researchers note that there is less data about these diseases in relation to nut consumption.

The study, led by researchers from Imperial College London and the Norwegian University of Science and Technology, is published in the journal BMC Medicine. The research team analysed 29 published studies from around the world that involved up to 819,000 participants, including more than 12,000 cases of coronary heart disease, 9,000 cases of stroke, 18,000 cases of cardiovascular disease and cancer, and more than 85,000 deaths. While there was some variation between the populations that were studied....the researchers found that nut consumption was associated with a reduction in disease risk across most of them.

The study included all kinds of tree nuts, such as hazel nuts and walnuts, and also peanuts -- which are actually legumes. The results were in general similar whether total nut intake, tree nuts or peanuts were analysed. What makes nuts so potentially beneficial, said Aune, is their nutritional value: "Nuts and peanuts are high in fibre, magnesium, and polyunsaturated fats -- nutrients that are beneficial for cutting cardiovascular disease risk and which can reduce cholesterol levels. "Some nuts, particularly walnuts and pecan nuts are also high in antioxidants, which can fight oxidative stress and possibly reduce cancer risk. Even though nuts are quite high in fat, they are also high in fibre and protein, and there is some evidence that suggests nuts might actually reduce your risk of obesity over time."

The study also found that if people consumed on average more than 20g of nuts per day, there was little evidence of further improvement in health outcomes. [ORIGINAL STUDY]

Published on Leave a comment on Tobacco Use Is Most Preventable Cause of Cancer

The CDC (Centers for Disease Control and Prevention) released a report this week stating that tobacco use is the most preventable cause of cancer, and that 40% of US cancer cases are linked to its use. It is estimated that currently there are more than 36 million smokers in the US. For in depth information, go to the CDC Cancer and Tobacco Use page. They also point out that tobacco smoke has at least 70 chemicals that cause cancer (carcinogens), and that exposure to secondhand smoke also causes cancer and thousands of deaths each year. From Medical Xpress;

Tobacco linked to 40 percent of US cancers

Tobacco use remains the most preventable cause of cancer, and 40 percent of diagnosed US cancer cases may have a link to its use, health authorities said Thursday. Lung cancer, acute myeloid leukemia, and tumors of the mouth and throat, voice box, esophagus, stomach, kidney, pancreas, liver, bladder, cervix, colon and rectum are all caused by tobacco use, according the report by the US Centers for Disease Control and Prevention.

The CDC Vital Signs report found that every year from 2009 to 2013, about 660,000 people in the United States were diagnosed with a cancer related to tobacco use. About 343,000 people died each year from these cancers. "Three in ten cancer deaths were due to cigarette smoking," said the report. Lung cancer is the top cause of tobacco related smoking, followed by colon cancer and pancreatic cancer.

Published on Leave a comment on Emulsifiers in Processed Food Linked to Cancer?

An earlier post discussed how emulsifiers (which are added to most processed foods to aid texture and extend shelf life) can alter the the community of microbes that live in our gut (gut microbiota) in such a way as to cause intestinal inflammation. Now the same researchers found that regular consumption of emulsifiers alter intestinal bacteria in a manner that promotes low-grade intestinal inflammation and possibly colorectal cancer.

The emulsifiers used in the study were the commonly used carboxymethylcellulose and polysorbate-80, but some others are soy lecithin, carrageenan, and polyglycerol ester. Processed foods often contain several emulsifiers, and while food regulations limit the amount of each emulsifier present in a particular food product to 1% to 2%, they don’t restrict the number of emulsifiers allowed. The study was done in mice, but the researchers tried to model the level of exposure of humans who eat a lot of processed food. From Science Daily:

Common food additive promotes colon cancer in mice

Emulsifiers, which are added to most processed foods to aid texture and extend shelf life, can alter intestinal bacteria in a manner that promotes intestinal inflammation and colorectal cancer, according to a new study. The findings, published in the journal Cancer Research, show regular consumption of dietary emulsifiers in mice exacerbated tumor development....There is increasing awareness that the intestinal microbiota, the vast, diverse population of microorganisms that inhabits the human intestines, play a role in driving colorectal cancer.

The microbiota is also a key factor in driving Crohn's disease and ulcerative colitis, the two most common forms of inflammatory bowel disease (IBD). IBD is known to promote colon tumorigenesis and gave rise to the term "colitis-associated cancer." Low-grade inflammation, a condition more prevalent than IBD, was shown to be associated with altered gut microbiota composition and metabolic disease and is observed in many cases of colorectal cancer. These recent findings suggest dietary emulsifiers might be partially responsible for this association.

Previous reports by the Georgia State research team suggested that low-grade inflammation in the intestine is promoted by consumption of dietary emulsifiers, which are detergent-like molecules incorporated into most processed foods that alter the composition of gut microbiota. The addition of emulsifiers to food seems to fit the time frame and had been shown to promote bacterial translocation across epithelial cells. Viennois and Chassaing hypothesized that emulsifiers might affect the gut microbiota in a way that promotes colorectal cancer. They designed experiments in mice to test this possibility.

In this study, the team fed mice with two very commonly used emulsifiers, polysorbate 80 and carboxymethylcellulose, at doses seeking to model the broad consumption of the numerous emulsifiers that are incorporated into the majority of processed foods. Researchers observed that consuming emulsifiers drastically changed the species composition of the gut microbiota in a manner that made it more pro-inflammatory, creating a niche favoring cancer induction and development. Alterations in bacterial species resulted in bacteria expressing more flagellin and lipopolysaccharide, which activate pro-inflammatory gene expression by the immune system.

Published on Leave a comment on Low Vitamin D Levels and Bladder Cancer

Another study finding a link with low levels of vitamin D and a health problem - this time an increased risk of bladder cancer. Vitamin D is frequently called the "sunshine vitamin" because sunlight is the best source of vitamin D (our body makes vitamin D3 from sunlight exposure on our bare skin). If you take vitamin D supplements, look for vitamin D3 (rather than D2). From Medical Xpress:

Low vitamin D levels linked to increased risk of bladder cancer

Vitamin D deficiency is associated with an increased risk of developing bladder cancer, according to a systematic review of seven studies presented today at the Society for Endocrinology annual conference in Brighton. Though further clinical studies are needed to confirm the findings, the study adds to a growing body of evidence on the importance of maintaining adequate vitamin D levels.

Vitamin D, which is produced by the body through exposure to sunshine, helps the body control calcium and phosphate levels. Vitamin D can also be obtained from food sources such as fatty fish and egg yolks. Previous studies have linked vitamin D deficiency with a host of health problems including cardiovascular disease, cognitive impairment, autoimmune conditions, and cancer.

In this work, researchers from the University of Warwick and University Hospital Coventry and Warwickshire, Coventry and the investigated the link between vitamin D and bladder cancer risk. They reviewed seven studies on the topic which ranged from having 112 to 1125 participants each. Five out of the seven studies linked low vitamin D levels to an increased risk of bladder cancer.

In a separate experiment, the researchers then looked at the cells that line the bladder, known as transitional epithelial cells, and found that these cells are able to activate and respond to vitamin D, which in turn can stimulate an immune response. According to lead author of the study Dr Rosemary Bland, this is important because the immune system may have a role in cancer prevention by identifying abnormal cells before they develop into cancer. "....our work suggests that low levels of vitamin D in the blood may prevent the cells within the bladder from stimulating an adequate response to abnormal cells," said Dr Bland. 

Published on Leave a comment on FDA Finds Weed Killer Residues in Oatmeal

New research shows that the most applied pesticide in the world - glyphosate - is being detected in more and more foods (such as honey, wheat). Glyphosate is a herbicide (weed killer) found in the product Roundup. Its use is increasing annually due to its use on crops genetically engineered to tolerate applications of the herbicide ("Roundup Ready" corn, soybeans, canola).

The latest news is that glyphosate residues are found in oat products, including baby cereals. The FDA (Food and Drug Administration) only started testing this year for glyphosate residues in foods (see post), but they may already be slowing down testing - because they are already talking about shutting down one of the testing labs (tested honey). There are various health concerns about glyphosate and its residues in foods, including that it is a probable carcinogen and a biocide that may disrupt the bacteria of the human gut. What are the long-term health implications of constantly (daily) eating foods with pesticide residues such as glyphosate? No one knows, but it is concerning. Yes, individual foods have low levels, but we're ingesting the pesticide residue in many foods every day - thus chronic exposure. And yes, studies show that it is found in our urine (one European study found it in 100% of people tested)

Note that Monsanto (producer of the glyphosate product Roundup) also encourages farmers to apply Roundup right before harvest as a "preharvest dessicant" to non-genetically modified crops, which also increases the odds that residues will be found in food. (Look at the preharvest application guide from Monsanto for oats and some other crops). What can one do? Buy organic foods - because glyphosate is not allowed to be used in organic farming. From the investigative journalist Carey Gillam's article for Huffington Post:

FDA Tests Confirm Oatmeal, Baby Foods Contain Residues of Monsanto Weed Killer

The U.S. Food and Drug Administration, which is quietly starting to test certain foods for residues of a weed killing chemical linked to cancer, has found the residues in a variety of oat products, including plain and flavored oat cereals for babies.

Data compiled by an FDA chemist and presented to other chemists at a meeting in Florida showed residues of the pesticide known as glyphosate in several types of infant oat cereal, including banana strawberry- and banana-flavored varieties. Glyphosate was also detected in “cinnamon spice” instant oatmeal; “maple brown sugar” instant oatmeal and “peach and cream” instant oatmeal products, as well as others. In the sample results shared, the levels ranged from nothing detected in several different organic oat products to 1.67 parts per million, according to the presentation.

Glyphosate, which is the key ingredient in Monsanto Co.’s Roundup herbicide, is the most widely used weed killer in the world, and concerns about glyphosate residues in food spiked after the World Health Organization in 2015 said a team of international cancer experts determined glyphosate is a probable human carcinogen. Other scientists have raised concerns about how heavy use of glyphosate is impacting human health and the environment.

The EPA maintains that the chemical is “not likely” to cause cancer, and has established tolerance levels for glyphosate residues in oats and many other foods. The levels found by the FDA in oats fall within those allowed tolerances, which for oats is set by the EPA at 30 ppm. The United States typically allows far more glyphosate residue in food than other countries allow. In the European Union, the tolerance for glyphosate in oats is 20 ppm.

Monsanto, which derives close to a third of its $15 billion in annual revenues from glyphosate-based products, has helped guide the EPA in setting tolerance levels for glyphosate in food, and in 2013 requested and received higher tolerances for many foods. The company has developed genetically engineered crops designed to be sprayed directly with glyphosate. Corn, soybeans, canola and sugar beets are all genetically engineered to withstand being sprayed with glyphosate.

Oats are not genetically engineered. But Monsanto has encouraged farmers to spray oats and other non-genetically modified crops with its glyphosate-based Roundup herbicides shortly before harvest. The practice can help dry down and even out the maturity of the crop. “A preharvest weed control application is an excellent management strategy to not only control perennial weeds, but to facilitate harvest management and get a head start on next year’s crop ” according to a Monsanto “pre-harvest staging guide.”  Glyphosate is also used on wheat shortly before harvest in this way, as well as on other crops. A division of the U.S. Department of Agriculture....has been testing wheat for glyphosate residues for years for export purposes and have detected the residues in more than 40 percent of hundreds of wheat samples examined in fiscal 2009, 2010, 2011 and 2012.

Even though the FDA annually examines foods for residues of many other types of pesticides, it has skipped testing for glyphosate residues for decades. It was only in February of this year that the agency said it would start some glyphosate residue analysis. That came after many independent researchers started conducting their own testing and found glyphosate in an array of food products, including flour, cereal, and oatmeal. Monsanto and U.S. regulators have said glyphosate levels in food are too low to translate to any health problems in humans. But critics say such assurances are meaningless unless the government actually routinely measures those levels as it does with other pesticides. And some do not believe any level of glyphosate is safe in food. 

In addition to oats, the FDA also earlier this year tested samples of U.S. honey for glyphosate residues and found all of the samples contained glyphosate residues, including some with residue levels double the limit allowed in the European Union, according to documents obtained through a Freedom of Information Act request. The EPA has not set a tolerance level for glyphosate in honey, so any amount is problematic legally....the FDA did not notify the honey companies involved that their products were found to be contaminated with glyphosate residues, nor did it notify the public. The FDA has also tested corn, soy, eggs and milk in recent months, and has not found any levels that exceed legal tolerance, though analysis is ongoing.

Published on Leave a comment on Eating Foods With Turmeric May Be Good For You

The spice turmeric is very popular these days, especially because studies link it to various health benefits. But is this true? Is it better to eat turmeric in foods or take it in pill form as a supplement? Today's post is about a study that was done by the BBC teaming up with researchers at Newcastle University (in the UK) where they looked at whether modest doses of turmeric had health benefits when ingested daily for 6 weeks. Specifically, they looked at what turmeric does to various blood markers thought to be associated with inflammation and changes that could eventually lead to the onset of cancer. It is currently thought that many or turmeric's supposed health benefits come from the compound curcumin found in it.

The researchers took blood samples of 100 volunteers, who were then split up into 3 groups (turmeric powder, a turmeric pill, or a placebo pill daily). Only the group that ingested turmeric in powder form (1 teaspoon mixed in food) showed changes after 6 weeks, and they were exciting beneficial changes in the methylation of DNA. This is because "methylation of the DNA can ‘go wrong’ and this can cause cells to become cancerous".

It's still early days in this research, and more has to be done, but it is exciting. In the meantime, don't take turmeric in pill form, but eat it in foods. It seems that more of the turmeric gets absorbed when eaten with foods, especially foods with fat, and also with a little black pepper. Excerpts from the article written by Michael Mosley, one of the presenters of the broadcast show "Trust Me, I'm A Doctor", from the BBC News:

Could turmeric really boost your health?

Turmeric is a spice which in its raw form looks a bit like ginger root, but when it's ground down you get a distinctive yellowy orange powder that's very popular in South Asian cuisine.....So we tracked down leading researchers from across the country and with their help recruited nearly 100 volunteers from the North East to do a novel experiment. Few of our volunteers ate foods containing turmeric on a regular basis.

Then we divided them into three groups. We asked one group to consume a teaspoon of turmeric every day for six weeks, ideally mixed in with their food. Another group were asked to swallow a supplement containing the same amount of turmeric, and a third group were given a placebo, or dummy pill. The volunteers who were asked to consume a teaspoon of turmeric a day were ingenious about what they added it to, mixing it with warm milk or adding it to yoghurt. Not everyone was enthusiastic about the taste, with comments ranging from "awful" to "very strong and lingering".

But what effect was eating turmeric having on them? We decided to try and find out using a novel test developed at University College, London, by Prof Martin Widschwendter and his team....There are at least 200 different compounds in turmeric, but there's one that scientists are particularly interested in. It gives this spice its colour. It's called curcumin. Thousands of scientific papers have been published looking at turmeric and curcumin in the laboratory - some with promising results. But they've mainly been done in mice, using unrealistically high doses. There have been few experiments done in the real world, on humans.

Prof Widschwendter is not particularly interested in turmeric but he is interested in how cancers start. His team have been comparing tissue samples taken from women with breast cancer and from women without it and they've found a change that happens to the DNA of cells well before they become cancerous. The change is in the "packaging" of the genes. It's called DNA methylation. It's a bit like a dimmer switch that can turn the activity of the gene up or down. The exciting thing is that if it is detected in time this change can, potentially, be reversed, before the cell turns cancerous.

So we asked Prof Widschwendter whether testing the DNA methylation patterns of our volunteers' blood cells at the start and end of the experiment would reveal any change in their risk of cancer and other diseases, like allergies. It was something that had not been done before. Fortunately he was very enthusiastic. "We were delighted," he said, "to be involved in this study, because it is a proof of principle study that opens entirely new windows of opportunity to really look into how we can predict preventive measures, particularly for cancer."

So what, if anything, happened? When I asked him that, he pulled out his laptop and slowly began to speak."We didn't find any changes in the group taking the placebo," he told me. That was not surprising. "The supplement group also didn't also show any difference," he went on. That was surprising and somewhat disappointing.

"But the group who mixed turmeric powder into their food," he continued, "there we saw quite substantial changes. It was really exciting, to be honest. We found one particular gene which showed the biggest difference. And what's interesting is that we know this particular gene is involved in three specific diseases: depression, asthma and eczema, and cancer. This is a really striking finding."

It certainly is. But why did we see changes only in those eating turmeric, not in those taking the same amount as a supplement? Dr Kirsten Brandt, who is a senior lecturer at Newcastle University and who helped run the experiment, thinks it may have something to do with the way the turmeric was consumed. "It could be," she told me, "that adding fat or heating it up makes the active ingredients more soluble, which would make it easier for us to absorb the turmeric.....She also told me, because our volunteers all tried consuming their turmeric in different ways, that we can be confident it was the turmeric that was making the difference and not some other ingredient used to make, say, chicken tikka masala. There is a lot more research that needs to be done, including repeating the experiment to see if these findings can be confirmed.

More information about the study and results from BBC News: Does turmeric really help protect us from cancer?

Published on Leave a comment on Time For Doctors To Prescribe Exercise

We all know that exercise is beneficial for health. Research suggests that exercising out in nature is best for several varied reasons -  including that it lowers markers of inflammation, and that it's good for our gut microbiome (community of gut microbes). The following excerpts are written by Dr. John La Puma encouraging other doctors to prescribe exercise for their patients and why.

An important message of his is that exercise is more important than a drug prescription for a number of conditions, including diabetes prevention, reducing the risk of recurrence of several cancers (he mentions breast cancer, but it also holds for prostate cancer). While exercising and walking out in nature may be best, any exercise anywhere is better than no exercise. (Other posts on exercise as prescription medicine are here and here; and check the category exercise for all exercise research posts).

From Medscape: Rx: Exercise Daily -- Outdoors. Doctor's Orders

With dazzling Olympic feats on display all summer, too many of my patients are still literally immobilized. Medically, sitting too long shuts off the enzyme lipoprotein lipase. In people who are sedentary, the enzyme doesn't break down fat to create energy, like it should. But medical prescription for exercise has lagged even the slowest runner. Why? Some reasons are time, training, and money. Time especially is a scarce commodity: The average clinician visit lasts just 20 minutes. Fitness is a shamefully small part of medical training. And as doctors, we don't get paid for discussing exercise, let alone monitoring a prescription and assessing the response. 

Finally, there are practical reasons. Clinicians find it difficult to persuade patients that exercise is more effective than medication for any number of conditions, including stroke recovery, diabetes prevention, and treatment of low back pain. Regular exercise reduces the risk for recurrent breast cancer by approximately 50%. Given all these reasons, it's easy to see why fitness prescriptions are seldom more than an afterthought. Yet even without formally prescribing the frequency, intensity, time, and type of exercise, clinicians can speak with patients and families about fitness in inspiring, life-changing ways.

Because clinicians have a secret weapon to use that most people don't even know about—location. Exercising in nature (in sight of and preferably near water or greenery, whether a deserted beach or an urban park) is better. Walking city streets and the office itself can be harder on your health than you think. In both environments, your attention is demanded and directed—sometimes by digital interruptions, sometimes by vehicles, toxins, or duties. In nature, your attention is drawn, not pushed, to a variety of often unexpected but not unpleasant sounds, colors, aromas, textures, and forms.

A recent Stanford study of nature therapy showed significantly reduced rumination after a 90-minute walk in nature, compared with a 90-minute walk through an urban environment. On MRI, "nature walkers" showed lower activity in an area of the brain linked to risk for mental illness, the subgenual prefrontal cortex, compared with "urban walkers." In other words, nature offers a sense of something bigger than ourselves on which to focus. MRIs show the way the brain changes when that sense occurs to us.

Exercising in nature may improve a person's immune system by enriching the diversity in the microbiota. Microbiota buffer the immune system against chronic stress-related disease. They appear to act as a hormone-producing organ, not simply a collection of beneficial bacteria. Microbiota are sensitive and responsive to physical environmental changes as well as dietary ones. So, exercise in nature may favorably boost microbiota.

And finally, exercise in nature is clinically preferred and calming. A Norwegian study showed that exercise in nature and in view of nature improves both mood and diastolic blood pressure vs exercise without nature. A Chinese study showed higher energy levels, and lower levels of interleukin-6 and tumor necrosis factor (both markers of inflammation), in a forest walking group compared with an urban exercising group. A British study showed significantly improved mood and self-esteem with "green" exercise, with the largest benefits from 5-minute engagements. Five minutes!

Of course, there are areas in our country and world in which it is dangerous to walk, never mind exercise. It may not be as easy to generate sweat and intensity with outdoor exercise as it is with indoor exercise. It may be stormy, or baking hot, or otherwise harsh outside, and the cool recesses of one's own bedroom or the gym may be just perfect for you today. And with the 2013 total cost of inactivity estimated at $24.7 billion for the United States, and with the public sector bearing almost one half of that expense, any exercise anywhere is better than none.  Yet physicians have a therapeutic tool few others in our culture wield—a prescription pad—and we have every patient's attention, at least for a few minutes. Patients try harder when doctors advise them about fitness. 

Published on Leave a comment on What’s In Your Household Dust?

Ten chemicals suspected or known to harm human health are present in more than 90% of U.S. household dust samples, according to a new study. The research adds to a growing body of evidence showing the dangers posed by exposure to chemicals we are exposed to on a daily basis. The chemicals come from a variety of household goods, including toys, cosmetics, personal care products, furniture, electronics, nonstick cookware, food packaging, floor coverings, some clothing (e.g., stain resistant), building materials, and cleaning products. How do the chemicals get into the dust? The chemicals can leach, migrate, abrade, or off-gas from the products, which winds up in the dust and  results in human exposure. (That's right:  vacuum a lot and wash your hands a lot, and try to avoid or cut  back use of products with these chemicals,)

What was found in the dust? The main chemicals were: phthalates — a group of chemicals that includes DEP, DEHP, DNBP and DIBP (these were present in the highest concentrations),  highly fluorinated chemicals (HFCs), flame retardants (both old and newer replacement ones), synthetic fragrances, and phenols. These chemicals are known to have various adverse health effects, including endocrine disruption, cancer, neurological, immune, and developmental effects. (See posts on endocrine disruptors and flame retardants) Studies typically study one chemical at a time, but household dust contains MIXTURES of these chemicals with effects unknown. How does it get into us? Inhalation, ingestion, and through skin contact. And while the levels we are exposed to may be low, research is showing that even low level exposure can have adverse health effects. From Medical Xpress:

Potentially harmful chemicals widespread in household dust

Household dust exposes people to a wide range of toxic chemicals from everyday products, according to a study led by researchers at Milken Institute School of Public Health at the George Washington University. The multi-institutional team conducted a first-of-a-kind meta-analysis, compiling data from dust samples collected throughout the United States to identify the top ten toxic chemicals commonly found in dust. They found that DEHP, a chemical belonging to a hazardous class called phthalates, was number one on that list. In addition, the researchers found that phthalates overall were found at the highest levels in dust followed by phenols and flame retardant chemicals....."The findings suggest that people, and especially children, are exposed on a daily basis to multiple chemicals in dust that are linked to serious health problems." ...continue reading "What’s In Your Household Dust?"