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Category: healthy living

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Even though the researchers said this was a "preliminary study"(looking only at non-Hispanic whites), what was good was that results are based on a very large sample size. Coffee drinkers can definitely feel that they are doing something beneficial for their health. From Medical Xpress:

Coffee may be associated with a lower risk of malignant melanoma

Both epidemiological and pre-clinical studies have suggested that coffee consumption has a protective effect against non-melanoma skin cancers. However the protective effect for cutaneous melanoma (malignant and in situ) is less clear, according to a study published January 20 in the Journal of the National Cancer Institute.

To determine if there is an association between coffee consumption and risk of cutaneous melanoma, Erikka Loftfield, M.P.H., of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, and colleagues used data from the NIH-AARP Diet and Health Study. Information on coffee consumption was obtained from 447,357 non-Hispanic white subjects with a self-administered food-frequency questionnaire in 1995/1996, with a median follow-up of 10 years. 

Overall, the highest coffee intake was inversely associated with a risk of malignant melanoma, with a 20% lower risk for those who consumed 4 cups per day or more. There was also a trend toward more protection with higher intake, with the protective effect increasing from 1 or fewer cups to 4 or more. However, the effect was statistically significant for caffeinated but not decaffeinated coffee and only for protection against malignant melanoma but not melanoma in-situ, which may have a different etiology.

The researchers point out that the results are preliminary and may not be applicable to other populations, and therefore additional investigations of coffee intake are needed. 

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I feel like I'm posting the same thing over and over as study after study finds the same or similar results. Bottom line: sitting much is bad for health, so get up and move (walks are good). The more you move or exercise, the better for health.

From Science Daily: Sitting for long periods increases risk of disease and early death, regardless of exercise

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study.

"More than one half of an average person's day is spent being sedentary -- sitting, watching television, or working at a computer," said Dr. David Alter, Senior Scientist, Toronto Rehab, University Health Network (UHN), and Institute for Clinical Evaluative Sciences. "Our study finds that despite the health-enhancing benefits of physical activity, this alone may not be enough to reduce the risk for disease." The meta-analysis study reviewed studies focused on sedentary behaviour.

The authors found the negative effects of sitting time on health, however, are more pronounced among those who do little or no exercise than among those who participate in higher amounts of exercise."The findings suggest that the health risk of sitting too much is less pronounced when physical activity is increased," said Biswas. 

In the interim, Dr. Alter underlines strategies people can use to reduce sitting time. The target is to decrease sedentary time by two to three hours in a 12-hour day...For example, at work, stand up or move for one to three minutes every half hour; and when watching television, stand or exercise during commercials."

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Research study after research study finds all sorts of health benefits from exercise. But what about the air quality in those stuffy crowded gyms, especially those in already polluted areas? From November 2014 NY Times:

The Bad Air in Our Gyms

But a new study of air quality in gyms raises some interesting questions about whether the places in which we work out are as healthy as they should be. Science and common sense tell us that exercising in polluted air is undesirable. People who frequently run alongside heavily trafficked freeways and breathe great lungfuls of exhaust have been shown to have an increased risk of heart disease, even if they are otherwise in admirably good shape.

...researchers at the University of Lisbon in Portugal and the Delft University of Technology in the Netherlands decided that they would place air-quality monitoring equipment in gyms throughout Lisbon. Portuguese fitness sites are similar to those in the United States, said Carla Ramos, a graduate student at the University of Lisbon who led the new study. Most feature a weight room and multiple, smaller studio spaces for aerobics classes, yoga sessions and similar programs.

For the new study, Ms. Ramos obtained permission from 11 Lisbon gyms to position air-quality monitors in each site’s weight room and several studios. The machines were set to measure pollutants during the late afternoon or evening hours, when the gyms were at their most crowded. For about two hours at each gym, the monitors measured the levels of commonly found indoor pollutants. These include carbon monoxide, carbon dioxide, ozone, airborne particulates such as dust, and various chemicals released by carpeting, cleaning products, furniture or paint, including formaldehyde.

To gain even more detailed readings, the scientists subsequently placed additional monitors in three of the gyms, which measured air quality throughout the building and throughout the entire day.Then they checked the pollutant levels from all of the gyms.

Their findings were disquieting. In general, the gyms showed high levels of airborne dust, formaldehyde and carbon dioxide. The concentrations of these substances generally exceeded most accepted standards for indoor air quality. (No government agency in the United States formally monitors air quality in gyms.) The levels were especially high during evening aerobics classes, when many people were packed into small studios, stirring up dust and fumes and puffing heavily, producing carbon dioxide with every breath.

The high concentrations of dust and chemicals like formaldehyde in the air at the gyms represent perhaps the greatest potential concern, Ms. Ramos said. In sufficient concentrations, these substances can contribute to asthma and other respiratory problems, she said. Almost all of the gyms in the study had levels of these substances that significantly exceed European standards for healthy indoor air standards.

Carbon dioxide, though not toxic to people, could also be cause for concern. In high concentrations, Ms. Ramos said, it has been found to contribute to bodily fatigue and cognitive fogginess, neither of which is desirable during a high-intensity aerobics class. Elevated levels of carbon dioxide can also indicate a poorly ventilated building, she said, especially if they remain inflated for hours, as they did in her study.

“We consider that the gymnasiums meet the criteria for a poor indoor quality,” Ms. Ramos said. Poor indoor air quality is a particular issue in gyms, of course, because people there tend to be breathing heavily. “When we exercise, we take in more air with each breath and most of that air goes through the mouth, bypassing the natural filtration system” in the nostrils, Ms. Ramos said. “The pollutants go deeper into the lungs compared to resting situations.”

The findings should not, however, discourage anyone from visiting a gym, Ms. Ramos said. None of the sites in the study had measurable levels of carbon monoxide, she pointed out, one of the most dangerous of known air pollutants.

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Inactivity is more deadly than obesity. From Medscape:

Inactivity More Deadly Than Obesity, Large New Study Finds

Fresh evidence that just a little bit of exercise, such as 20 minutes walking a day, is extremely beneficial — regardless of whether people are overweight/obese or not — has emerged from a large European study.

In fact, the most pronounced reduction in premature death risk was observed among individuals who were normal weight/abdominally lean and "moderately inactive," compared with those of the same build who were completely inactive, which was defined as having a sedentary job with no reported recreational physical activity.

Looking at this another way, the study — in more than 330,000 men and women — showed that twice as many premature deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, the researchers say.

"This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive," said Dr Ekelund in a statement. "Although we found that just 20 minutes would make a difference, we should really be looking to do more than this — physical activity has many proven health benefits and should be an important part of our daily life," he added.

So they set out to examine the relationship between physical activity and all-cause mortality and to look at whether BMI and waist circumference modified these associations in a large sample of 334,161 men and women followed for more than 12 years... Just under a quarter (22.7%) of participants were categorized as inactive, reporting no recreational activity in combination with a sedentary occupation.

Over the 12 years of follow-up, 21,438 participants died.The greatest reduction in risk for premature death occurred in the comparison between inactive and moderately inactive groups. All-cause mortality was reduced by 16% to 30% in the moderately inactive group compared with those categorized as inactive, across all strata of BMI and waist circumference.

The authors estimate that doing exercise equivalent to just a 20-minute brisk walk each day — burning between 90 and 110 kcal — would take an individual from the inactive to moderately inactive group and thereby reduce the risk for premature death by this same amount (ie, between 16% and 30%).

The impact was greatest among normal-weight individuals, but even those with higher BMI saw a benefit of physical activity.

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This wonderful opinion piece is by Dr. John Mandrola, a cardiologist who also posts on his own blog at http://www.drjohnm.org/ . The bottom line: lifestyle is more important than drugs in preventing heart disease. The following is from Medscape:

Heart Disease and Lifestyle: Why Are Doctors in Denial?

I think and write a lot about the role of lifestyle choices as a treatment strategy. As an endurance athlete, I know that exercise, diet, sleep, and finding balance in life are the key components of success. It is the same in cardiology.

In a randomized controlled trial of primary prevention, no cardiologist would want to be compared against a good physical trainer or nutritionist. We would get trounced. Our calcium scores, biomarkers, pills, and procedures would not stand a chance. The study would be terminated early due to obvious superiority of lifestyle coaching over doctoring—which would blunt the true treatment effect and make us look less bad. (Wink to my epidemiology friends.)

I write a post about new oral anticoagulant drugs or statins or AF ablation, and people pay attention. You see it in the traffic. It's the same story at medical meetings: sessions on drugs and procedures draw the crowds. Late-breaking studies rarely involve the role of exercise or eating well. Exercise, diet, and going to bed on time have no corporate backing. The task of drawing attention to the basics is getting harder, not easier.

And this is our problem. I believe the collective denial of lifestyle disease is the reason cardiology is in an innovation rut. This denial is not active or overt. It is indolent and apathetic. Bulging waistlines, thick necks, sagging muscles, and waddling gaits have begun to look like normal. During the electronic medical record (EMR) click-fest after seeing a patient, I rarely click on "normal" physical exam. The general appearance is abnormal—either overweight or obese.

This is how I see modern cardiology. Our tricks can no longer overcome eating too much and moving too little. We approach health but never get there. If you waddle, snore at night, and cannot see your toes while standing, how much will a statin or ACE inhibitor or even LCZ696 help?

In fact, a reasonable person could make an argument that our pills and procedures might be making patients sicker.

When I started electrophysiology, I mostly treated people with fluky problems. My ablation procedures were on people with supraventricular tachycardia (SVT) due to aberrant pathways. My devices were mostly pacemakers in the elderly—a disease due to aging. These sorts of problems are (mostly) independent of how many sugar-sweetened beverages one drinks.

Now it is different. My practice is dominated by atrial arrhythmia—a disease now recognized as being due (in large part) to excesses of life, such as obesity, high blood pressure, sleep disorders, and overindulgence in alcohol. In other words: unnecessary. I make hundreds of dollars putting a hundred burns in a left atrium for a disease that a poorly paid physical trainer might prevent or treat. This has become cardiology writ large.

But the thing I cannot get over is that I am doctor, not a proceduralist. I am tasked with helping people be well. I fail in that task if I ignore the most effective and safest treatment option. I fail if I take the easy path. The prescription pad is easy. The EP lab is easy. The truth is hard... New anticoagulant drugs are easy. Ablation technology is easy. Statins are even easier. The truth—nutrition, exercise, balance in life—is hard.

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Nowadays many medical societies do NOT recommend annual physicals for healthy adults.

From Medscape: Is the Annual Physical Past Its Prime...Again?

Few medical societies still recommend healthy adults undergo annual physicals, and some groups actively recommend against them, yet many physicians continue to offer the visits to their patients. This week, oncologist and health policy expert Ezekiel Emanuel, MD, PhD, has taken the debate to the opinion pages of the New York Times, where he explains again why the formerly prescribed practice should be proscribed. Once again, however, not everyone agrees the healthy patient exam should be a thing of the past.

According to Dr Emanuel, who is vice provost, global initiatives, and chair, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, recent estimates say about 45 million Americans will have a routine general physical this year, which he likens to the human equivalent of the 15,000-mile check-up on their cars. "If you estimate the cost of the exam alone conservatively at $100, it's beginning to be a nontrivial amount of money," Dr Emanuel told Medscape Medical News.

And that is before you add in the costs of laboratory panels, follow-up tests, patient anxiety, and the overdiagnosis or overtreatment of conditions that, if left undetected, would never have become clinically significant. "We see this with prostate cancer and thyroid cancer," Dr Emanuel said.

As he writes, "If you screen thousands of people, maybe you'll find tens whose exams suggest they might have a disease. And then upon further tests, you'll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis."

From a health-promotion perspective, then, the annual physical exam is of little value, does not reduce morbidity and mortality from acute or serious chronic conditions, and may even lead to unwarranted complacency in "people who just want to make sure," he said to Medscape Medical News.

To support that statement, Dr Emanuel points to evidence from a 2012 Cochrane Collaboration review of 14 randomized controlled trials involving 182,000 people followed for a median of 9 years. The unequivocal conclusion of the analysis was that routine general check-ups, not prompted by actual symptoms, are unlikely to yield much benefit. No matter what screenings and tests were administered, annual physicals did not reduce mortality overall or specifically from the big killers, cancer and heart disease.

More recently, data from the Danish Inter99 study, a large, randomized trial, supported the conclusion that general check-ups are ineffective. The community-based trial of almost 60,000 adults aged 30 to 60 years, with screening for ischemic heart disease risk and repeated lifestyle interventions over the course of 5 years, found no effect on ischemic heart disease, stroke, or mortality at the population level after 10 years.

Dr Emanuel noted that the US Preventive Services Task Force does not recommend routine annual check-ups, and the Canadian Task Force on the Periodic Health Examination has recommended against the practice since 1979. "Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial," he writes in his article.

So far, physicians' response to his op-ed piece "has been 90% supportive. They've looked at the data and are not convinced by the data [of the annual check-up's value]," he told Medscape Medical News... Many physicians, however, stand by an annual visit to the consulting room, including Peter C. Galier, MD, professor of medicine, University of California, Los Angeles, School of Medicine. "You can manipulate the data from these meta-analyses any way you want, but when you see patients regularly, you get important information that you may never get until there's an acute problem," he said.

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Nice write-up of how what happens from the type of birth (vaginal vs cesarean) affects the baby's microbiome (community of microbes). Remember, it is very complicated and much is still unknown. (UPDATE: see January 16, 2015 post discussing research by Dr. Dominguez-Bello who is conducting a study in which babies born via C-section are immediately swabbed with their mother's vaginal secretions; these babies will then be followed for years). From Gastroenterology and Endoscopy News:

Delivery Mode Alters Newborn’s First Bacterial Exposure

 A baby’s first exposure to bacteria varies by the method of delivery, researchers have found. These differences could have health implications later in life, according to an emerging body of evidence that suggests gut bacteria may be important to the development of a healthy immune system (Arrieta MC et al.Front Immunol 2014;5:427). For example, evidence shows that alterations in gut bacteria early in life may increase the incidence of allergies later on (Bendiks M, Kopp MV. Curr Allergy Asthma Rep 2013;13:487-494).

In the new study, presented at the 2014 annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, a group at the University of Colorado School of Medicine, in Aurora, compared oropharyngeal aspirates taken from 12 infants born by cesarean delivery and 11 born vaginally, and their bacterial content by sequencing the bacterial genes in the samples (abstract 7). Samples taken from the mothers’ vaginal and rectal areas, and samples of the infants’ stool, were also analyzed for bacterial genes.

Bacteria in aspirates from newborns delivered vaginally were more similar to the bacteria found in samples from their mothers than the aspirates from infants born by cesarean delivery, the investigators found. Infants born vaginally had higher numbers of firmicutes (62.6% vs. 30.1%; P=0.0013), particularly lactobacilli typically found in the vagina.

Aspirates from infants born by cesarean delivery, in contrast, had higher levels of Actinobacteria (20.1% vs. 3.8%; P=0.045), which are found on the skin. Stool samples from vaginally delivered newborns also had greater numbers of Bacteroidetes than stool samples from infants born by cesarean delivery. This difference persisted through six weeks of life, the researchers said.

David Brumbaugh, MD, assistant professor of pediatrics at the University of Colorado School of Medicine, in Aurora, said the finding of fewer Bacteroidetes in cesarean newborns is potentially alarming. Studies of mice raised in sterile conditions have shown that exposure to a specific type of Bacteroidetes, Bacteroides fragilis, suppresses the animals’ inflammatory response (Mazmanian SK et al. Nature 2008;453:620-625), he said. 

“The fact that this bacteria never gets established early in life [in babies born by cesarean delivery] is concerning,” he said. Some studies have suggested that infants born by cesarean delivery may be at greater risk for developing conditions such as asthma, type 1 diabetes and celiac disease (Cho CE, Norman M. Am J Obstet Gynecol 2013;208:249-254). But not all studies have supported such risks; other studies suggest that genetic factors or the reason for the cesarean delivery itself may contribute to disease later in the child’s life (Almqvist C et al.Clin Exp Allergy 2012;42:1369-1376).

Jean-Eric Ghia, PhD, assistant professor of immunology and internal medicine at the University of Manitoba, in Winnipeg, Canada, said the findings add to a body of evidence suggesting that gut bacterial colonization is affected by mode of delivery, and these altered gut bacteria might contribute to immune system–related disease later in life (Neu J, Rushing J.Clin Perinatol 2011;38:321-331). “The first colonization of the gut happens when the baby comes out,” he said. But he noted that long-term studies are needed to assess the effect of these gut differences on health in the long term. He noted that a multitude of exposures before and after birth can also influence gut biota (Munyaka PM et al. Front Pediatr. doi:10.3389/fped.2014.00109 [published online October 9, 2014]). “It’s really, really complicated,” he said.

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I bet eating fresh blueberries daily instead of blueberry powder would not only be more delicious, but also have even more health benefits. From Science Daily:

Blueberries may help reduce blood pressure and arterial stiffness

Just one cup of blueberries per day could be the key to reducing blood pressure and arterial stiffness, both of which are associated with cardiovascular disease. .... Johnson said she is interested in looking at how functional foods -- foods that have a positive impact on health beyond basic nutrition -- can prevent and reverse negative health outcomes, particularly for postmenopausal women.

Over an eight-week period, 48 postmenopausal women with pre- and stage-1 hypertension were randomly assigned to receive either 22 grams of freeze-dried blueberry powder -- the equivalent to one cup of fresh blueberries -- or 22 grams of a placebo powder. Participants, meanwhile, continued their normal diet and exercise routines.

At the end of the eight weeks, participants receiving the blueberry powder on average had a 7 mmHg (5.1 percent) decrease in systolic blood pressure, which is the top number in the blood pressure reading that measures the pressure in the arteries when the heart beats. They also saw a 5 mmHg (6.3 percent) reduction in diastolic blood pressure, or the bottom number measuring the pressure in the arteries between heartbeats.

Additionally, participants in the blueberry-treated group had an average reduction of 97 cm/second (6.5 percent) in arterial stiffness.They also found that nitric oxide, a blood biomarker known to be involved in the widening of blood vessels, increased by 68.5 percent. That is important, Johnson said, because arterial stiffness and the narrowing of blood vessels are both a part of hypertension. This rise in nitric oxide helps explain the reductions in blood pressure.

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So perhaps mother knew best - that you'd catch a cold easily if you didn't bundle up when going outside in the winter. Study was done on mice cells, so now need to study this in humans. From Science Daily:

Cold virus replicates better at cooler temperatures

The common cold virus can reproduce itself more efficiently in the cooler temperatures found inside the nose than at core body temperature, according to a new Yale-led study. This finding may confirm the popular yet contested notion that people are more likely to catch a cold in cool-weather conditions.

Researchers have long known that the most frequent cause of the common cold, the rhinovirus, replicates more readily in the slightly cooler environment of the nasal cavity than in the warmer lungs. 

To investigate the relationship between temperature and immune response, Iwasaki and an interdisciplinary team of Yale researchers spearheaded by Ellen Foxman, a postdoctoral fellow in Iwasaki's lab, examined the cells taken from the airways of mice. They compared the immune response to rhinovirus when cells were incubated at 37 degrees Celsius, or core body temperature, and at the cooler 33 degrees Celsius. "We found that the innate immune response to the rhinovirus is impaired at the lower body temperature compared to the core body temperature," Iwasaki said.

The study also strongly suggested that the varying temperatures influenced the immune response rather than the virus itself. Researchers observed viral replication in airway cells from mice with genetic deficiencies in the immune system sensors that detect virus and in the antiviral response. They found that with these immune deficiencies, the virus was able to replicate at the higher temperature. 

Although the research was conducted on mouse cells, it offers clues that may benefit people, including the roughly 20% of us who harbor rhinovirus in our noses at any given time. "In general, the lower the temperature, it seems the lower the innate immune response to viruses," noted Iwasaki. 

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And the scary part is that they only tested for 32 chemicals, but there are thousands of others they didn't test for that could be lurking in the water, including pesticides used on the lawns and grounds around outdoor swimming pools. From Science Daily:

Pharmaceuticals, personal care products could taint swimming pools

A new study suggests pharmaceuticals and chemicals from personal care products end up in swimming pools, possibly interacting with chlorine to produce disinfection byproducts with unknown properties and health effects.

Chlorination is used primarily to prevent pathogenic microorganisms from growing. Previous research has shown that many constituents of urine including urea, uric acid, and amino acids, interact with chlorine to produce potentially hazardous disinfection byproducts in swimming pools. However, chemicals from pharmaceuticals and personal care products, or PPCPs, also could be interacting with chlorine, producing potentially harmful byproducts. There are literally thousands of chemicals from pharmaceuticals and personal care products that could be getting into swimming pool water.

A research group led by Ching-Hua Huang, a professor in the School of Civil and Environmental Engineering at the Georgia Institute of Technology, has developed an analytical technique that identifies and quantifies 32 pharmaceuticals and personal care products in water... Water samples were taken from indoor swimming pools in Indiana and Georgia.

Of the 32 chemicals investigated, the researchers detected three: N,N-diethyl-m-toluamide, known as DEET, the active ingredient in insect repellants; caffeine; and tri(2-chloroethyl)-phosphate (TCEP), a flame retardant.

"The other 29 could have been present at concentrations below the detection level," Blatchley said. "And because there are literally thousands of pharmaceuticals, this is just a small subset of compounds that could be present in swimming pools. The main issue is that the release of chemicals into a place like a swimming pool is completely uncontrolled and unknown. I don't want to be an alarmist. We haven't discovered anything that would be cause for alarm right now, but the bottom line is we just don't know."

Some chemicals are volatile, which means they can escape into the air to be inhaled. Others can be ingested or absorbed through the skin."Swimmers are exposed to chemicals through three different routes: You can inhale, you can ingest and it can go through your skin. So the exposure you receive in a swimming pool setting is potentially much more extensive than the exposure you would receive by just one route alone," Blatchley said.

His previous research has shown that certain airborne contaminants are created when chlorine reacts with sweat and urine in indoor swimming pools. Pharmaceuticals may get into swimming pool water from personal care products applied to the skin such as insect repellant, makeup and sunscreen. Many pharmaceuticals that are ingested are not fully metabolized by the body and are excreted in sweat and urine.

"Urine, I think, is really the primary mode of introduction," Blatchley said. "When it comes to pharmaceuticals, these are chemicals designed to be biologically active at pretty low concentrations. Birth control pills, for example, contain hormones. If those chemicals and others are present, especially in a mixture in a water sample that humans are going to be exposed to, then what are the consequences of that? That is a largely unanswered question."...The previous research suggested that about 93 percent of uric acid introduced to pools comes from human urine.