The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
EXERCISE
& WEIGHT
LOSS
It’s no secret
that our society is the heaviest in the recorded history of mankind. There have been a number
of theories put
forth attempting to explain exactly why obesity has become rampant
across the
globe, and in both wealthy and poor cultures.
Most scientists believe that there are several essential
elements
underlying our ever-expanding waistlines.
First, like most mammals, humans are genetically primed to
preferentially seek high energy foods, namely foods packed with sugar
and
fat. For much of
human history, these
high calorie foods have been difficult to come by for most people, and
people have
historically subsisted on far less calorie-dense and more nutritious
foods. Now, in our
fast food culture,
there is easy access to an overabundance of highly processed and
inexpensive
sugar- and fat-rich foods. A
second
element underlying the obesity pandemic is the progressive decline in
physical
activity levels in our remote control world.
There
is a great
deal of research that reveals something that most of us already know,
and that
is the fact that dieting alone rarely leads to meaningful and sustained
weight
loss. Other
research confirms something that
many of us also already know: if you spend most of your day sitting on
a chair
or laying on a couch, it is darned hard to lose excess weight, even if
you are
able to overcome that compelling little voice in your head that, primed
by
those pesky appetite-stimulating genes, keeps pleading for burgers,
french
fries, and ice cream!
A
new study in
the Archives of Internal Medicine
provides further clinical evidence that it is not only what we eat that
drives
our bathroom scales to ever higher displays of poundage, but it is also
what we do, in terms of physical
activity,
that determines which hole in our belts we can comfortably use. This study, from the University
of Pittsburgh,
assigned 201 overweight and obese women volunteers to 1 of 4 behavioral
weight
loss intervention groups. Each
group
varied from the other based upon assigned physical activity targets
(1,000 vs.
2,000 calories per week) and the intensity of the assigned physical
activity
targets (moderate vs. vigorous activity).
All of the women enrolled in this study were also placed
on a diet
consisting of 1,200 to 1,500 calories per day.
To improve their chances of success, the researchers also
provided the
study’s volunteers with standard weight-loss group counseling, and with
treadmills as well. This
study was
conducted over a period of 24 months.
Six
months into
the study, there was no significant difference in average weight loss
between
each of the 4 groups of women, and the average weight loss at this
point in the
study was 10% of initial body weight.
By
24 months, however, the average amount of lost weight had declined to
only 5%
of initial body weight.
The
researchers
then compared the 25% of women who had successfully maintained a weight
loss of
at least 10% of their initial body weight, after 24 months, with the
women who
did not achieve (or did not sustain) at least a 10% weight loss. After analyzing the
average weekly activity
levels for all of the women in this study the researchers determined
that at
least 1,835 calories worth of physical activity per week was necessary
to
achieve and sustain a 10% weight loss over a period of 2 years
(equivalent to
about 275 minutes of moderate-to-vigorous activity each week).
What
I find to be
especially important about this study is that it actually puts some
numbers on
the table (no pun intended) with respect not only to caloric intake,
but
caloric expenditure as well. This
study confirms
the findings of numerous other studies that have shown that moderate
dieting,
alone, is not sufficient to lose weight and to keep it off over time. As with other studies,
this study also
confirms that you don’t have to sprint 30 miles a week in order to lose
weight
(and to improve cardiovascular fitness).
Instead, regular and sustained moderate physical activity,
such as brisk
walking, when combined with a sensible diet, will achieve the same
results as
were demonstrated in this study. Indeed,
as most of us know, stringent diets and exhausting exercise routines
often
result in significant weight loss over short periods of time. However, the vast majority
of us are simply
not able to sustain lifestyle modifications as severe as this for very
long. Soon enough,
most of us return to
our sedentary lifestyles and our unhealthy diets, and the weight starts
piling
back on again.
Watch
what you eat,
to be sure, but combine a sensible diet with a sensible exercise plan. If your health permits,
takes the stairs
instead of the elevator at work. Park
your car at the far end of the parking lot and walk to the store (as a
bonus,
your car is probably much less likely to get dinged by the car door of
an
adjacent vehicle!), instead of going to the cafeteria or a nearby fast
food
joint, pack a healthy lunch and take it to work, and use part of your
lunch
period to take a brisk stroll. With
these kinds of more moderate lifestyle changes, you are far more likely
to keep
that excess weight off because you are more likely to be compliant with
these
less rigorous changes over the long haul.
At the same time, you will be reducing your risk of
cardiovascular disease,
diabetes, and some forms of cancer.
GREEN
TEA, FOLIC ACID & BREAST CANCER RISK
Regular readers of
this column already know
that I have a strong interest in cancer and cardiovascular disease
prevention,
particularly through lifestyle and dietary modifications. Recently, there has been a
great deal of high
quality research looking at the effects of green tea and other dietary
supplements on human diseases, including cancer.
A great deal of rather simple laboratory
research, often using cancer cells growing in a Petri dish or in a
mouse,
suggests that polyphenols, the biologically active components of green
tea, may
have some anti-tumor properties.
However, the results of most human epidemiological studies
have been
less compelling.
A newly published
study of green tea, in the
journal Carcinogenesis, evaluated
the
impact of green tea consumption among ethnic Chinese women living in Singapore. As previous research has
suggested that
deficiencies of folic acid (Vitamin B9) might be linked to an increased
risk of
breast cancer (as well as colorectal cancer and cardiovascular
disease), this
study also evaluated the effects of green tea consumption in
Singaporean women with
both normal and decreased folic acid intake.
Finally, the effects of green tea on breast cancer risk
were also
assessed in Singaporean women with genetic variants of the
methylenetetrahydrofolate reductase (MTHFR) gene that
results
in increased activity of the enzyme that is responsible for
metabolizing folic
acid. This study
was conducted by the University
of Minnesota,
the University
of Southern California,
and
the National University of Singapore.
The results of
this study, which included 380 women who developed breast cancer and
662 women
who did not, appear to confirm that green tea polyphenols may exert a
breast
cancer prevention effect through their effects on the folic acid
metabolism
pathway. In this
study, women with
inadequate folic acid intake and frequent green tea consumption
appeared to
experience a 55% reduction in breast cancer risk when compared to women
with inadequate
folic acid intake and only occasional green tea intake.
Similarly, women who were found to have a
genetic variant of MTHFR that resulted in rapid metabolism of folate
were found
to have lower risk of breast cancer when they frequently consumed green
tea. Among all
women with this genetic
variant, frequent green tea consumption reduced the risk of breast
cancer by
34%. Among women
with both poor
folic acid intake in their diet and the high
activity MTHFR enzyme,
daily or weekly green tea consumption reduced the apparent risk or
breast
cancer by 56% (frequent green tea consumption by women with both
high
folic acid intake and the normal activity MTHFR
gene variant only
reduced their apparent risk of breast cancer by 8%).
The findings of
this suggest (but do not prove) that green tea polyphenols may be able
to
reduce the risk of breast cancer, but only in women who either have
MTHFR
variants that increase folic acid metabolism, or (and) in women with
inadequate
dietary folic acid intake. A
prospective, randomized clinical trial, which would take many years to
conduct,
would be the best way to confirm the findings of this epidemiological
study. However, the
results of this Singaporean
study are still intriguing, nonetheless.
FOREIGN
LANGUAGE INTERPRETERS & ICU PATIENTS
In our
multicultural, multiethnic society, physicians must often rely on
interpreters
to communicate with patients and families who do not speak English well. Most of the time, these
volunteer or paid
interpreters have little if any medical training.
Additionally, foreign-born translators are
often, themselves, not fully fluent in English, and they often miss
both subtle
and complicated nuances that the physician may be trying to communicate
to the
patient, or to the patient’s family.
A
new study in
the journal Chest, and conducted at
the University
of Washington,
has rather
creatively quantified the extent of clinically important errors made
during
family conferences requiring a translator for patients in the intensive
care
unit (ICU).
Ten
family
conferences, arranged to discuss end-of-life issues and requiring an
interpreter, were audiotaped with the families’ permission. Research interpreters with
a clinical
background then reviewed these audiotapes and translated the
non-English
discussion into English.
When
the
physicians who conducted the family conferences analyzed the
transcribed
translations, they determined that mistranslations by the interpreter
present
during the conference had occurred 55% of the time.
Moreover, three-quarters of these
mistranslations were deemed to have been clinically significant
translations. Even
worse, 93% of these
mistranslations were considered to be associated with potentially
negative
effects on communication between the physicians and the families.
The
mistranslations were further analyzed and classified.
Following this analysis, the mistranslations
were attributed to additions, omissions or substitutions of information
other
than what was intended by the physicians, and editorializations, on the
part of
the translators.
I
can certainly
attest to similar anecdotal experiences myself in dealing with
non-English
speaking patients, families and interpreters.
In such cases, particularly when I haven’t worked with an
individual
translator before, I usually ask the translator to have the patient or
family
members repeat what I have just told them, using the same translator. If there appears to be any
significant
deviation from what I have said, then I work with the translator to
convey the
same information in a slightly different way.
As this study reveals, conducting important conferences
with the
non-English speaking families of gravely ill patients can be
potentially hazardous
for all concerned.
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
