Category: Health

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Biology Diabetes Health

Diet or Diabetes

To be or not to be

Sweetness has always been associated with good things. And sugar has been an obsession for many. But sugar has a good many effects that are not good. And some are affected in worse ways than others. We need a certain amount of glucose in our systems to live. That amount has been described as about a teaspoon in all of our blood at any given time. The rest has to be consumed, excreted or stored. Most of us who love sweet things rarely consider what the impact of consuming large quantities could be.

Epidemic

There is a national epidemic of overweight & obesity, metabolic syndrome and diabetes that was become worse over the past 30 years. While there have been many articles written and documentaries made the situation has become worse and worse. Nutritionally dense processed food tastes good and recently we have begun to realize that salt, sugar, and carbohydrates are behaviorally addictive. My belt size and weight had gone up over the past several years and my workouts did not seem to be having any impact. After several months of my youngest daughter insisting I have a physical (and stop putting so much sugar in my coffee) and signing a contract with her I listened. 

Lose It 

On July 17 I had a physical examination and was told to lose 30-35 pounds and essentially get to a weight that I had not been at since I was running 50 miles a week. I was told to give up  pasta and bread and to skip potatoes. Thinking about all the delicious fresh, home-made bread my wife makes, along with lasagna, pesto, all sorts of pasta, and my love of pizza I said “No way. My wife is Italian. I don’t think that is going to happen.” I considered the near impossibility of losing just 5 pounds. Maybe with a tremendous effort it would be possible to drop 15. 

Motivation: Blood Sugar Sky High

But one day later, I was told I had a random blood sugar of 180 and an A1c of 8.5 (which indicated an average blood sugar of around 220) .  My doctor suggested a low carb diet, but was doubtful I’d follow through after my response the day before. He also suggested perhaps I visit an endocrinologist and take Metformin. I said “no thank you” to the idea of Metformin and said I thought we could handle this ourselves. 

I had an immediate change of heart and felt this was a great time to be motivated for a dramatic change in diet. What did I think I needed most?

  • Need to not be diabetic.
  • Need not to be on unnecessary medication.
  • Need to work on problems caused by being overweight:
    • High A1c and Blood Sugar
    • Overweight
    • Clothes fit
    • High Blood Pressure
    • Need to face up to the impact of diet health.
  • Need to realize that one can not live by workouts and the gym alone. 
  • Need more energy. Lately energy had been slacking from my unknown high blood sugar

Thinking about the domestic and global epidemic of overweight and obesity, I had to face the fact that I was joining this group and needed to change.

Changes: Trim the carbs. Keep the fat

I knew there were two possible ways to handle a dietary change. One was a vegan or vegetarian diet and the other was a low carb diet which is nutritionally ketogenic also called “Keto”. I was well aware that Tim Noakes had embraced this diet and received opprobrium in return. You can google his story which he describes quite well in both book and on YouTube. But as a long time follower of his I knew he had advocated a LC/HF (low carb – high fat) diet for years. He called it the “Banting Diet” after  William Banting who wrote  “Letter on Corpulence, Addressed to the Public” advocating this low carb diet for weight loss back in the 1800’s. Claude Bernard, a French physiologist, known for the concept of “homeostasis” had previously described a diet for diabetes which eliminated bread, butter, milk, sugar, beer and potatoes.

To me this approach made sense, although I know of people who have lost significant weight with a vegetarian approach. Eliminating most carbohydrates which would lead to higher glucose and a very variable blood glucose seemed logical. A quick literature search easily brought up dozens and dozens of academic articles. Further looking led to podcasts, online lectures, and books on the science, beginning Keto and Keto Cookbooks to read. And to my surprise, this diet had become popular and to some was known as a fad diet. I have not spent time following diet fads and trends so I had no idea.

Warnings:

I had at least two people tell me the “Keto” diet would kill me. Both were vegan and hopefully were not eating pesticide sprayed fruit. 

The word seemed to be that this diet is a hard road to follow and difficult to sustain.

I was given the task of 1200 kcal per day and decreased carbs. The lowest recommended calories is higher than this, so don’t try this on your own. 

One friend passed on a good number of presentations on the plant based diet, most of which were quite good. But I was well convinced that my path laid with the “Banting”, low carb approach. I also learned of the very hostile politics that is inherent to much of human interaction, and it was also present here in diverging nutritional opinions which should be based solely on science.

Tossing Out The Bread With the Chocolate Milk and Caramel Macchiatos 

Lots had to go. The first thing that came to mind was a lifetime of daily chocolate milk and for as long as I can remember sugar, milk and a touch of cocoa in my coffee.And a good number of cups of coffee each day. In fact, my coffee consumption was enough to power enough calories for  another meal each day. While much of my diet was considered healthy and included chicken, salmon, other healthy fish and vegetables, I did consume sugar chocolate milk, and would have an occasional “chip” binge. Warm, fresh, home made bread with butter was a periodic delight. But now, I can have the butter but not the bread. And over the past few years, ice cream became a joy.

So out went sugar, pasta, high fructose corn syrup, most fruits (except for certain berries), ice cream, fruit juices, chips, chocolate cake, breaded anything, most glutens, wheat flour, a good number of vegetable oils that were not olive oil. 

In came whole eggs, unprocessed bacon, more salmon, fish, chicken, occasional london broil, turkey burgers, blackberries, raspberries, blueberries, 5% Greek Yogurt, a very small daily piece of dark chocolate (85%), 1/2 piece of gluten-free crisp bread with a tablespoon of humus, almond butter, almonds, macadamia nuts and pecans. Much of my vegetables are green leafy kale, spinach but also broccoli, cauliflower, avocados and zuchini. 

Seriously?

This was done immediately, whole heartedly, and very seriously. Absolutely ZERO cheating. I obsessively read all food labels. I started going food shopping. I helped (at least a bit, like a back-seat driver, but tried to help) with food preparation. And I began weighing just about all of my portions.  

And most important I have kept track of my meals in a smartphone app. There are several apps available. I am using myFitnessPal to track food groups and calories. And I used a website to determine a good set of “macros” for protein, fat, and carbohydrate which was easily incorporated into myFitnessPal. 

I had great help from my wife in choosing low carb but tasty food. Some of the early options included chicken rolled in curry, pesto chicken, salmon, and tilapia with a variety of toppings. The vegetables I ate were all at her suggestion. 

Short Term Results

Before my weight went had gone down 3 pounds, my blood sugar dropped to the normal range. At the start my random blood sugar was 180. A week later my fasting blood sugar was 95. And it has not been higher than this since then. My weight has steadily decreased. I was able to stop taking 2 of 3 blood pressure medicines. And I needed to use smaller belts to keep my pants up. My energy level improved. And there was not much in the way of hunger pangs. The diet has been filling without spiking sugar or adversely impacting insulin. 

Longer Term Results

About three weeks in I went out for sushi with my doctor. He noticed the early but significant weight loss and was impressed with my daily blood sugars. I told him of my new found fear of carbs and how the rice in the sushi now scared me. It turned out that the restaurant would roll the sushi wrapped in cucumber without rice. But the surprise was my doctor was following the same diet and we then both happily ate sashimi. 

In less than 3 months my weight went down about 28 pounds and my waist size decreased about 5 inches. My blood sugars both fasting and after eating have all been at normal levels, well below 100, usually in the 70’s and 80’s. And a home test kit for A1c showed my A1c to be down to 4.8. I will have an in office test before the end of October and I expect the then 90 day test to be no higher than that and likely a bit lower. 

Support

At a nephew’s wedding about 6 months ago, I spoke with one of my wife’s cousins. He was definitely enthusiastic about his diet which helped him lose over 100 pounds over a year or two. He didn’t just say that his low carb diet was good. He said it was great and discussed the physiology of it in more detail than most people would even think about. A few months later we met again just after I began the same nutritionally ketogenic HC/LF diet. This time I had a lot of questions to ask. He told me about the importance of electrolyte supplements, fluid replacement and foods that were helpful and those that were not.  And he encouraged me to get a Ketone meter. I did, and use it every now and then. But the results are what has let me know things are working.

About 6 weeks or so into this process I contacted a friend, Mark Cucuzzella MD (https://www.drmarksdesk.com) who is a Family Physician in West Virginia, and on the faculty of the West Virginia University School of Medicine. Dr. Mark is one of the most community oriented people you could hope to meet. He owns a running shoe store, is involved in the racing community organizing and sponsoring races, and he even has a dozen bikes that are lent out to people in the community at no charge. Mark is an active lecturer nationally and around the world on diet, exercise, shoes and biomechanics and health. He has served for years as an Air Force Reserve Lieutenant Colonel. All this and he has maintained a running schedule that has had him completing 30 consecutive yearly marathons under 3 hours. His best time was 2:24. Dr. Mark’s involvement with his community, patients and students is inspirational. 

I remembered from our first meeting a few years ago that Dr. Mark was an expert in nutrition in addition to being involved in the mechanics of running and training. So after finding a good number of interviews, a book and podcasts, I thought I’d drop him a note about what I had been doing. He was very supportive. We also discussed the possibility of using a CGM (continuous glucose monitor) to see what foods might be causing glucose spikes. Dr. Mark immediately sent me a presentation he had done online for physicians and a dozen or so articles on the importance of maintaining a level glucose and the impact of a low carb diet. We had the chance to spend a lot of time together at the annual American Academy of Podiatric Sports Medicine seminar in Cambridge, Massachusetts. His lectures were the best since many of them involved going outside and moving on those beautiful September days.  I’ve learned much from Mark and continue to do so. 

All through these past few months I’ve read journal articles, blogs, listened to dozens of podcasts and online lectures. I’ve read books on getting started on ‘Keto’, books on how the science works and how to handle athletes attempting a low carb diet (it varies), and  books on low carb cooking. There are many resources available. I’d recommend researching the low carb diet thoroughly if you have reason to believe it would be helpful. Your public library is likely to have a good number of books on the shelves, surrounded by a lot of other diet books. But when I visited my library I wasn’t distracted. I knew what I was looking for.  

The Impact of Nutritional Ketosis Over 11 Weeks

Total Weight Loss: 28 pounds 

A1c from 8.5 down to 4.8

Fasting Blood Sugars: In 70’s and 80’s

Blood Pressure: Significantly lower on less medicine

Waist from about 39-40” to 34”

Energy level: significantly improved

So now, my blood sugar is normal. My clothes fit. My blood pressure is improved. And I don’t need to take any medicine to keep my sugar in the normal range. This worked faster and better than I would have believed. 

In an upcoming post, I’ll list some of the authors, researchers and references I found helpful. 

Categories
Biology Diabetes Health Microbiome

Diabetes Type 2 (T2D), Metformin and The Microbiome

Microbiome analysis is coming soon to a doctor near you. Microgenomics is going to be part of nearly everyone’s future. This week Nature magazine published an article which indicates that at least part of the action of the anti-diabetic medication Metformin may be occurring via the microbiome. At the leastMicrobiome Metformin there is a dramatic difference between the gut microbiota between those with type 2 diabetes (T2D) treated with Metformin (T2D-Metformin+)and those not treated  (T2D-Metformin-).

The article has an excellent discussion both of the direct effects of Metformin and the indirect effects and potential interactions of various gut bacteria

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Reference:

Forslund, K., et al. (2015). “Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota.” Nature advance online publication. Accessed Dec. 2, 2015

Categories
Aging Changes Health Neurosciences

Dementia and Alzheimer’s Disease: Exercise is Good – Studies, Not Always

There is significant evidence that exercise is helpful in lowering one’s risk of dementia by regular moderate to vigorous exercise. And every month a plethora of articles appears reporting on positive impact or no impact at all on a variety of factors from diet and supplements to exercise.

A number of studies have indicated that starting and maintaining an exercise program has been helpful. But, we also need to define what may not be helpful. Exercise below a certain aerobic level, may just not count as preventative exercise for dementia and cognitive decline.

And I realize my bias in favor of exercise, so I must admit that some reviews have found the evidence is weak that exercise is helpful in avoiding cognitive decline.

Reported studies need to be subject to evaluation. One can not blindly accept the authors’ interpretation of the results. The results and protocol need to be rationally evaluated in an absence of hype.

I’m not sure that a recent study by Sink et. al. which did not find a positive correlation between activity and cognition was scrutinized thoroughly in the media. Looking closely at this study we find that they used a good number of patients and controls. But we see that the inclusion criteria of being able to cover 400 meters in 15 minutes is not what many would consider to be an aerobic exercise activity. The study was restricted to those over 70. And the data was not gathered using a Fitbit, Pedometer, GPS motion detector or observation. The data was self-reported.

So what do we know as a result of this study:

  • Being able to move at a speed of 1 mile/hour for 30 minutes  (400 meters in 15 minutes) several times a week is not enough exercise to measurably diminish cognitive decline (it may have other benefits though).
  • Data acquisition by self-reporting may not be optimal. An objective measurement should be used in conjunction with a device to do and record these measurements.
  • The life style changes here may have been too little and too late to have an impact.
  • Commencing exercise prior to age 70 may be better than beginning later. If beginning later, results may only be seen if the individual is capable of exercising a moderate level.
  • Media coverage is often limited in interpretation and assessment of the meaning  of a study’s results.

In a predefined subgroup of those aged 80 and over and with worse starting fitness they did find an improvement in “executive function”.

“Despite the lack of overall benefit, our prespecified subgroup analyses of participants aged 80 years or older and those with lower baseline physical performance demonstrated that the physical activity group had better performance on executive function tasks than those in the health education group at 24 months. This finding is important because executive function is the most sensitive cognitive domain to exercise interventions,40 and preserving it is required for independence in instrumental activities of daily living. Future physical activity interventions, particularly in vulnerable older adult groups (eg, ≥80 years of age and those with especially diminished physical functioning levels), may be warranted.”

The authors did consider as the first possible explanation that the exercise level was insufficient to produce changes in the cognitive measures, but this escaped the media blitz. In reading the article, conclusions and discussion, the study was well designed, properly randomized and controlled, used an adequate sample size. The possibilities leading to the observed results were thoroughly discussed. But again, the subtleties were not discussed in the media and the headlines you saw were that exercise was not useful in preventing cognitive decline. As with most studies the media would lead you to believe that the current study overturns all previous thinking and is the only thing to follow.

Bayesian reasoning allows for new information to be added into the mix of the prior thought and research on any topic. That should be done and the meaning of that should be clear to anyone writing about science literature. One study doesn’t usually replace all thinking, it is added to it in that successive approximation of the truth that we reach for through science.

So the same recommendation to exercise, in my mind, holds. It still has the most evidence pointing in its favor. And for those older individuals who are not able to exercise as vigorously, exercise is still likely to have positive impact on mood and other neurological and physical functions not measured in this study.And I’d suggest more education on EBM and study evaluation for those charged with distributing results of medical studies. And please read the study.

References:

Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults Sink, KM et. al. JAMA. 2015;314(8):781-790. doi:10.1001/jama.2015.9617.

Exercise counteracts declining hippocampal function in aging and Alzheimer’s disease. Intlekofer, K, Cotman, C.  NEUROBIOLOGY OF DISEASE · JUNE 2012

Physical activity and cognitive function in individuals over 60 years of age: a systematic review. Clin Interv Aging. 2014 Apr 12;9:661-82. doi: 10.2147/CIA.S55520. eCollection 2014.  Carvalho A, Rea IM, Parimon T, Cusack BJ

Erickson, KI, Barr, LL, Weinstein, AM, Banducci, SE, Akl, SL, Santo, NM, Leckie, RL, Oakley, M, Saxton, J, Aizenstein, HJ, Becker, JT, Lopez, OL. (in press). Measuring physical activity with accelerometry in a community sample with dementia. Journal of the American Geriatic Society.

Weinstein, AM, Voss, MW, Prakash, RS, Chaddock L, Szabo, A, White, SM, Wojcicki, TR, Mailey, E, McAuley, E, Kramer, AF, Erickson, KI. (2012). The association between aerobic fitness and executive function is mediated by prefrontal cortex volume. Brain, Behavior, and Immunity, 26:811-9.

 

Erickson KI, Miller DL, Roecklein KA. (2012). The aging hippocampus: interactions between exercise, depression, and BDNF. Neuroscientist, 18: 82-97.

Okonkwo, O, Schultz,S et. al. Physical activity attenuates age-related biomarker alterations in preclinical AD. Neurology November 4, 2014 vol. 83 no. 19 1753-1760

 Brown, B, Bourgeat, P et. al. Influence of BDNF Val66Met on the relationship between physical activity and brain volume. Neurology. October 7, 2014 vol. 83 no. 15 1345-1352

Addendum:

Abstract of a British J of Sports Medicine editorial (Exercise is medicine, for the body and the brain, 2014):

“Cognitive decline is one of the most pressing healthcare issues of the 21st century. Worldwide, one new case of major cognitive decline (ie, dementia) is detected every 4 s. Given that no effective pharmacological treatment to alter the progress of cognitive decline exists, there is much interest in lifestyle approaches for preventing or treating dementia. Ideally, such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels.

One attractive solution that aligns with the above criteria is exercise. However, despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics, healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline. For example, the National Institutes of Health (NIH) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function. However, they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline. Adding fuel to the fire are publications such as a 2013 systematic review of randomised controlled trials (RCTs) (prior to 31 October 2011) reporting ‘weak’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment. Furthermore, there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise promotes neuroplasticity.”

Let’s Get Physical – Olivia Newton John

Categories
Aging Culture Fitness Health

Exercise is good for the mind and the soul

Another study has demonstrated that those who exercise regularly have a decreased incidence of depression.

The new study titled “Depressive Symptoms and Physical Activity During 3 Decades in Adult Life” appeared in JAMA Psychiatry in the issue published Oct 15, 2014.

At each age group, those who exercised had a lower incidence of depression than those who did not. Those who took up exercise were doing better 5 years later than those who continued to not exercise.

This is one more reason to exercise regularly. Exercise is good for ails you or for what might ail you in a few years!

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Moving is Exercise (Competing Tunes below)

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Categories
Health Running Tips

Summer Running Tips

It’s that time again. Hot and sticky. Take a quick look at some summertime do’s and don’ts.

1. Wear socks made of synthetic fibers that wick moisture away from your skin to help prevent blisters and athlete’s foot. For long distance running and long duration exercise, cotton is rotten.

2. Fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Get fit each time you buy new shoes.

3. Don’t wear sandals when playing sports! Shoes (or barefoot where appropriate and safe) is a better bet. Barefoot beach volleyball, beach or groomed, safe, outdoor surface Frisbee, and running is just fine for many people. In general though, be careful when running or walking barefoot outside. Cuts and bee stings are not fun for your feet.

4. Build up to your longer distance training slowly. Consider running your long distance runs earlier than usual to avoid midday heat and pollution.

6. Break in new sport shoes before racing or using them for a long run or workout.

7. Use sunscreen to prevent solar injury to your skin. UVA and UVB protection are important. Don’t forget your feet at the beach. Try to avoid mid-day exposure between the hours of 10am-2pm. Protect your eyes with UV safe glasses.

8. Don’t forget to replace your fluids on long runs, but avoid overhydration on events over 4 hours.

9. Do wear sport specific running shoes. Running shoes do not have the lateral support needed for tennis. Help yourself avoid ankle sprains and other injuries and do fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Do replace your running shoes often. Replace them at least every 350 – 450 miles run.

10. Be careful running in low light conditions both because of road traffic, uneven pavement and also be aware of increased balance problems.

See Dr. Pribut On Running in The Heat for more information.

Categories
Aging Health

Resveratrol: 700 Bottles of Wine On The Wall

Red wine has long been hailed as good for your health. Years ago it was found to contain resveratrol, adding to the good reputation of red wine. Nearly 10 years ago resveratrol was first believed to have beneficial actions by virtue of its activating sirtuin 1 (SIRT1) which is an NAD+ dependent deacetylase thought to protect against several metabolic disorders including  type 2 diabetes, Alzheimer’s disease, hearing loss (actually SIRT3), and cardiovascular disease. The actions of sirloins are believed to mimic the effect of caloric restriction on lifespan and disease in mammals. The actual caloric restriction needed to have beneficial effects though is too great for humans to attempt although gluttony is clearly both the opposite and detrimental to good health.

Recent research shows that things are more complicated than that, as research seems to do in many fields. Apparently it there is an intermediary reaction in which phospodiesterases which hydrolyze cAMP are inhibited. Skeletal muscle and white fat tissue responds to resveratrol by increasing the levels of cAMP. We need more research before we are able to use resveratrol as medicine.

Nature Reviews Molecular Cell Biology (Feb 29, 2012) quotes Andrew Murray, interviewed by the Telegraph of Cambridge University, UK about how much red wine it would take to ingest enough resveratrol to have physiological action. He is quoted as saying “you would need to drink about 700 bottles [of red wine] to get a meaningful dose.”

In short, it may be that researchers who like red wine, hail the miracles of red wine, those who like coffee, hail coffee. And the same may go for chocolate. Perhaps the effects of each augment the other which would be better than canceling each other out.

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Categories
Health Medicine Sports Medicine

Is Exercise Bad For You? Shocking News Reports!

Some say a meta-analysis is like a large pile of small, weak, and insignificant studies lumped together into one ugly mess. Sort of like a stew made up of left-overs that might be getting a bit moldy. Others say that by aggregating studies which alone would be too small to amount to anything of significance, the data can gain significance by having a larger number of subjects from different studies put together to be counted.

Couch Potato
Couch Potato

Study Title: Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?

Study Citation: Bouchard, C, Blair, S et. al. (2012) Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?

Study Premise: There is a variability in peoples response to exercise. Some may experience adverse response to exercise. The authors state no study has addressed adverse changes in cardiovascular and diabetes risk factors can occur. The risk factors chosen to be studied include: “Sixty subjects were measured three times over a period of three weeks, and variation in resting systolic blood pressure (SBP) and in fasting plasma HDL-cholesterol (HDL-C), triglycerides (TG), and insulin (FI) was quantified.”

Study Conclusion & Media Announcements: Adverse response to exercise may occur. Some individuals do not respons positively in the measured according to the authors this analysis of 6 previous studies (a meta-analysis) revealed the shocking truth that some overweight people did not have a positive response to exercise and the variables mentioned above worsened. 7% had two variables worsen over the course of an exercise program.

Analysis: Why should one expect 100% positive response to any intervention? The fact that 90% had a positive or non-adverse impact on risk factors is an overwhelming number of individuals for whom exercise is likely quite good. Emphasizing the negative in which case “the minority is the new majority” seems to be the in thing to do in current culture and society. In everything from politics to social policy a majority may be declared at 40% (the U.S. Senate) or at 12-17% as was seen in misused statistics during health care reform debates. The fact that 8% to 12% is neither a majority, nor a vast number, and the “adverse events” were not death, disease or morbidity and mortality should alert those reading this article and the large headlines in the paper that hyperbole is at play.

There is an overwhelming amount of information that says exercise is good for you in many, many ways. In many cases exercise is the missing link to the best health you can have. Exercise is something that almost everyone should be undertaking (to avoid the undertaker). In fact a famous saying goes “where there is no exercise, the people perish”. Well, maybe it was “where there is no vision the people perish”.The reality is that where there is no exercise the people develop sarcopenia (muscle wasting), osteoporosis, obesity, depression, diabetes, high blood pressure, and dementia. So whether or not your high blood pressure goes down and your HDL-C goes up, there are many positive benefits to be achieved by exercising regularly.

Exercise and diet are both vital to overall health. All of the individuals in the studies this meta-analysis selected to include were overweight. Improper diet plays a large role in being overweight or obese.

Successful implementation of a healthy life plan should actually include more than a mere exercise program. It needs life habit modifications that would include good sleep habits, healthy diet, and avoiding the excessive consumption of things that are bad for you (too much alcohol, drugs, etc.). But exercise may be the largest change that is easy to make. Diet is also critical and often needs a tune up. Let’s sum this up in one sentence!

You can exercise and have a great shot at doing as well as you can or you can sit on a couch and take your chances!

Notes:

  • The study group only included overweight people with a BMI from 25-30
  • Normal variablility in tests – is greater than zero

References:

Bouchard, C, Blair, S et. al. (2012) Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?

Bouchard C, Rankinen T (2001) Individual differences in response to regular physical activity. Med Sci Sports Exerc 33: S446–S451

deMello, V et. al. Insulin Secretion and Its Determinants in the Progression of Impaired Glucose Tolerance to Type 2 Diabetes in Impaired Glucose-Tolerant Individuals
The Finnish Diabetes Prevention Study. Diabetes Care February 2012 vol. 35 no. 2 211-217. Published online before print December 30, 2011, doi: 10.2337/dc11-1272

Study Notes

an adverse response was recorded if an increase reached 10 mm Hg or more for SBP, 0.42 mmol/L or more for TG, or 24 pmol/L or more for FI or if a decrease reached 0.12 mmol/L or more for HDL-C. Completers from six exercise studies were used in the present analysis: Whites (N = 473) and Blacks (N = 250) from the HERITAGE Family Study; Whites and Blacks from DREW (N = 326), from INFLAME (N = 70), and from STRRIDE (N = 303); and Whites from a University of Maryland cohort (N = 160) and from a University of Jyvaskyla study (N = 105), for a total of 1,687 men and women. Using the above definitions, 126 subjects (8.4%) had an adverse change in FI. Numbers of adverse responders reached 12.2% for SBP, 10.4% for TG, and 13.3% for HDL-C. About 7% of participants experienced adverse responses in two or more risk factors.

Categories
Health Medicine

Parenthetically Speaking: Colons, Math and the New York Times (repost 2008)

Science, Numbers, Journalism and Critical Thinking

I believe it was on a Merlin Mann podcast, where someone jokingly mentioned the concept of an iColon website which in typical Web 2.0 fashion people could share the images and films of their colonoscopy procedures. This week the New York Times managed to demonstrate where their heads were at regarding simple mathematics and statistics. An article by one of their most popular reporters reviewed a new study that showed that colonoscopies were not all they were cracked up to be as far as picking up colon cancer and in their ability to prevent future cancers from developing from detection and removal of polyps.

The American Cancer Society still strongly recommends the colonoscopy as a useful  screening procedure. and the physicians I know who both perform this procedure and recommend it all strongly feel that it is one procedure that can actually save lives. We will however take a quick and simple look at the use of math and see a lack of simple math skills and the failure of editorial checking at the New York Times.

The NY Times reported on a study that demonstrated that colonoscopy missed virtually all polyps on the right side of the colon. The  article stated that 40% of all cancers and polyps originated on this side. Of those on the left side of the colon up to 30% of those were missed. The article then went on to quote and conclude that rather than preventing up to 90% of colon cancer from devleloping it might only be useful in preventing 60% to 70%. Now, this seems to be a fairly simple math problem. And a quick glance by anyone even one with only minimal math skills just looks and sounds wrong on the surface of it all.

If 40% of the lesions occur on the left side but are undetectable, than you have remaining 60% of the lesions to deal with that you can find. If 1/3 of these ones are not found, by splitting them into 3 equal parts of 20% 20% and 20%, and you remove 1/3 you are then left with 40% of the lesions that you would be able to find.
Hence, it is clear that it is not 60%-70% number of lesions that you’ll expect to find, but a number significantly less than 50% and which clearly looks to be 40%. The physician interviewed in the New York Times encourages people to have the colonoscopy as a screening procedure, but to not necessarily expect to be safe for the next 10 years. It is strongly recommnended that you follow the colon cleaning procedures prescribed prior to undergoing the procedure.

There will be more studies in the future and likely ones that will be quite positive on colonoscopy. Techniques will likely be modified that also result in improved detection of right sided lesions. Until then, we now and always will need clear heads to do the math and keep evidence based medicine, based on evidence and not on an easily obtained quote.

Up soon we may dissect an article published within the last few months that looked at the longevity of runners and non-runners. If you know the study, here’s a hint: check out the disparate population groups studied and see if it looked like a well designed and controlled study.

New Math From the New York Times:

“In the new study, the test missed just about every cancer in the right side of the colon, where cancers are harder to detect but about 40 percent arise. And it also missed roughly a third of cancers in the left side of the colon.

Instead of preventing 90 percent of cancers, as some doctors have told patients, colonoscopies might actually prevent more like 60 percent to 70 percent.”