Wednesday, July 29, 2009

Reduce Cancer risk? EXERCISE!!

Exercise Reduces Risk for Premature Death From Cancer
Zosia Chustecka
From Medscape Medical News

July 27, 2009 — A study from Finland has shown that men who exercised for at least 30 minutes a day at moderate to high intensity halved their risk of dying prematurely from cancer, mainly gastrointestinal and lung cancer.
The results were published online July 28, 2009 in the British Journal of Sports Medicine.

Physical inactivity over a person's lifespan might be a "key factor in the initiation of cancer development," the authors note.

This study adds ammunition to the public-health message promoting at least 30 minutes a day of exercise, lead author Sudhir Kurl MD, from the School of Public Health at the University of Kuopio in Finland, told Medscape Oncology.

"All doctors should be giving their patients this message," he said, although he acknowledged that many do not have the time, and many are not aware of all of the research showing benefits.

"We found a 50% reduction in the risk of dying prematurely from cancer," Dr. Kurl pointed out. Exercise also improves well being and confidence, and leads to better sleep and weight control, he added.

The study was carried out in men, but Dr. Kurl said he expects to see similar results in women.

Intensity of Physical Activity Was Important

The study involved 2560 men, aged 42 to 60 years, living in the town of Kuopio and the surrounding rural communities. They self-reported their leisure-time physical activities on questionnaires over a period of 1 year, and were then followed for an average of 16.7 years, during which time there were 181 cancer-related deaths.

In their analysis, the researchers adjusted for age, cigarette smoking, alcohol consumption, body mass index, and total intake of calories, fat, and fiber.

The reduction in the risk for premature death from cancer was seen in men who exercised for more than 30 minutes every day, and with an intensity that was moderate to high, Dr. Kurl noted. The activities they performed included jogging, swimming, cycling to work, and gardening or yard work, he said

Exercise intensity was measured in metabolic equivalents of oxygen consumption (METs). The average intensity of jogging was 10.1 MET, of skiing was 9.6 MET, of ball games was 6.7 MET, of swimming was 5.4 MET, of rowing was 5.4 MET, of cycling was 5.1 MET, of gardening/farming/yard work was 4.3 MET, and of walking was 4.2 MET.

"Anything above an average of 4 MET can be considered [to be] moderate-intensity exercise," Dr. Kurl told Medscape Oncology.

Other activities reported by the men included crafts, repair or building, which had an average intensity of 2.7 MET, hunting, picking berries or gathering mushrooms (3.6 MET), and fishing (2.4 MET).

"The intensity of leisure-time physical activity should be at least moderate so that the beneficial effect of physical activity for reducing overall cancer mortality can be achieved," the authors write.

The results show that at least moderate-intensity physical activity is more beneficial than low-intensity physical activity in the prevention of cancer, the authors note. This finding is consistent with American consensus statements suggesting that at least moderate-intensity physical activity is needed to prevent chronic diseases caused mainly by cardiovascular disease, they add.

Several Mechanisms Involved

They speculate that the mechanisms by which physical activity could protect against cancer include beneficial effects on energy balance and body mass, intestinal transit time, hormonal concentrations (e.g., reduced testosterone), prostaglandin levels, and antioxidant enzymes activities.

For example, exercise increases the F-series of prostaglandinsbut decreases the E2 series, and these physiologic events have been shown to increase gut motility and to decrease colonic cell division, the researchers point out.

Many of the cancer-related deaths that were reported during the follow-up period affected the gastrointestinal tract (57 of 181 cases). The remaining cancers affected the lung (n = 48), prostate or urinary tract (n = 25), brain (n = 9), or lymphoma (n = 6).

"Our results indicate that those with an active lifestyle have a decreased risk of gastrointestinal cancers," the researchers note. This finding may be due to changes in energy balance, which includes body mass, which is particularly important for colon cancer, they note. In addition, the increased gut motility with exercise training decreases gastrointestinal transit time, thereby reducing the contact time between fecal carcinogens and the colonic mucosa, as well as allowing less opportunity for the initiation of carcinogenesis and colonic cell division and proliferation. There may also be an affect on insulin and fat metabolism, they add.

Br J Sports Med. Published online before print July 28, 2009.

Monday, July 27, 2009

Teen Drug Use Often Begins With the Family Medicine Cabinet

From Medscape Medical News
Janis Kelly

Authors and Disclosures

July 20, 2009 — Adolescents who buy prescription drugs for illicit use are more likely to have ongoing substance-abuse problems, but most teen drug misuse involves drugs obtained for free from family or friends. This is important because prescription-drug misuse by teens is rising even though the use of other illicit drugs, alcohol, and tobacco has decreased.

Prescription drugs are surpassed only by alcohol, tobacco, and marijuana in misuse by adolescents. A study by Ty Schepis, PhD, and Suchitra Krishnan-Sarin, PhD, published in the August 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, shows that much of this drug use likely begins at home.

The researchers also report that how an adolescent obtains prescription drugs predicts whether other substances, such as alcohol, are being abused at the same time and signals a risk for more severe substance and prescription-drug misuse problems.

Drs. Schepis and Krishnan-Sarin, both from the department of psychiatry at Yale University School of Medicine, in New Haven, Connecticut, used data from the 2005 and 2006 National Survey on Drug Use and Health (NSDUH) to show that, across all classes of medications (opioids, stimulants, tranquilizers, and sedatives), nearly 50% were obtained from friends or family members free of charge.

With the exception of opioids, the most common source was purchasing the drug from friends or relatives (13.1% – 29.7%) or from a drug dealer (4.6% – 12.0%). For opioids, the second most common source was from a physician.

"The group with greatest odds of concurrent other substance use may be those who purchased their medication for misuse from friends, family, or drug dealers. In comparison with adolescents who misused medication obtained from a physician, adolescents who buy medication are more likely to have endorsed binge alcohol use (opioids and tranquilizers), daily cigarette use (opioids and stimulants), past month marijuana use (all 3 classes examined), and past-year cocaine use (opioids and stimulants)," the authors conclude.

"Disturbingly Easy" to Obtain Drugs

Richard A. Friedman, MD, who also studies teenage drug abuse, told Medscape Psychiatry that"these data underscore how (disturbingly) easy it is for young people to obtain potentially abusable prescription drugs. It is clear from these data that the main source is not street dealers, but friends, family members, and physicians." Dr. Friedman is professor of clinical psychiatry and director of the Psychopharmacology Clinic at Cornell University's Weill Medical College, in New York City.

Drs. Schepis and Krishnan-Sarin say that their data indicate that physicians should be routinely screening all adolescent patients for prescription misuse.

"Screening for prescription misuse depends on your clinical impressions of your patient and of his/her current substance use. With patients who have a presenting complaint of depressive symptoms or anxiety, simply asking about substance use across the spectrum of alcohol, tobacco, marijuana, prescriptions, etc, in a nonjudgmental and matter-of-fact way is likely best," Dr. Schepis told Medscape Psychiatry.

"The main questions are about whether the patient has ever used a substance, timeframe of last use, and frequency of use over a specified time period. That information can then help a practitioner decide how to proceed with a potential intervention, if one is needed."

Urine testing may be indicated when a patient is in treatment for substance use or there is clear evidence that the patient has intentionally misled care providers about substance use. The risk inherent in urine testing, however, is that it can be very counterproductive for establishing and keeping trust, especially if it is a surprise to the patient," Dr. Schepis said.

False Impression?

Dr. Friedman suspects that because prescription drugs are approved by the US Food and Drug Administration and are widely advertised directly to consumers in the print and electronic media, young people might have the mistaken impression that these drugs are safe.

"After all, if their parents use them and their doctors prescribe them, how bad can they be? Another factor is peer acceptance. If you look at other data from this survey, acceptance of prescription drugs has been steadily rising, while attitudes among youth about cocaine and stimulants has become more negative," he said.

Dr. Schepis warned that availability is also a factor. "Many people have medications that they previously needed that remain in their medicine cabinet, perhaps an opioid analgesic for a surgery. These medications are easy targets for adolescents wishing to experiment, continue to use, or sell medications to peers. Thus, proper medication disposal is really important, and all patients should be counseled on that."

Major Implications

Dr. Friedman said that the implications of these findings for clinicians are "huge and pressing."

"Physicians have to be very careful about prescribing drugs of potential abuse to young people. Although it's true that the rates of undetected psychiatric illness are quite high in this population, the mainstays of [pharmacologic] treatment, are, with the exception of stimulants for attention-deficit/hyperactivity disorder, drugs like antidepressants, antipsychotics, and mood stabilizers — none of which are addictive. In contrast, there is rarely a medically legitimate rationale to use tranquilizers, hypnotics, narcotics, and the like in this usually medically healthy population," he said.

J Am Acad Child Adolesc Psychiatry. 2009;48:828-836.

HBA1C for diabetic followup

ADA 2009: Expert Committee Recommends Use of Hemoglobin A1C for Diagnosis of Diabetes
Martha Kerr
From Medscape Medical News

June 7, 2009 (New Orleans, Louisiana) — The American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) have joined forces to recommend the use of the hemoglobin A1C assay for the diagnosis of diabetes.

"This is the first major departure in 30 years in diabetes diagnosis," committee chairman David M. Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston, declared in presenting the committee's findings.

"A1C values vary less than FPG [fasting plasma glucose] values and the assay for A1C has technical advantages compared with the glucose assay," Dr. Nathan said.
A1C gives a picture of the average blood glucose level over the preceding 2 to 3 months, he added.

"A1C has numerous advantages over plasma glucose measurement, It's a more stable chemical moiety.... It's more convenient. The patient doesn't need to fast, and measuring A1C is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test.... And it is correlated tightly with the risk of developing retinopathy."

The committee has determined that an A1C value of 6.5% or greater should be used for the diagnosis of diabetes.
This cut-point, Dr. Nathan said, "is where risk of retinopathy really starts to go up."

He cautioned that there is no hard line between diabetes and normoglycemia, however, " A1C level of 6.5% is sufficiently sensitive and specific to identify people who have diabetes."

"We support the conclusion of the committee, that this is an appropriate way to diagnose diabetes," stated Paul Robertson, MD, president of medicine and science at the ADA and professor of medicine at the University of Washington in Seattle.

"We purposely avoided using estimated average glucose, or EAG, as this is just a way to convert the A1C into glucose levels.... And one thing we want to try to get away from is the term prediabetes," Dr. Nathan said. "It suggests that people with it will go on to get diabetes, but that is not the case."

"We don't know if we will be diagnosing more patients with diabetes or less, with AIC," Dr. Nathan commented. Cut-off values or practice guidelines have not been established. More study needs to be done first, but "physicians should not mix and match A1C and blood glucose levels. They should stick with one in reviewing a patient's history," Dr. Nathan asserted.

"There is no gold standard assay," said session moderator Richard Kahn, PhD, chief medical and scientific officer of the ADA, which is headquartered in Alexandria, Virginia. "All of these tests measure different things. They all have value. But A1C is the best test to assess risk of retinopathy."

"Some parts of the world are not going to be able to use this," Dr. Robertson added. "It may be too expensive to use in the developing world. Some of these countries have severe chronic anemia, hemolytic anemia, and so on, where we will have to fall back on traditional tests. We are being very cognizant of the international implications." A1C assays are inaccurate in cases of severely low hemoglobin levels.

"We don't think physicians will have a hard time adopting the test...a lot of them are doing it already. We think it will only take a couple of years to be adopted widely into clinical practice," Dr. Kahn told Medscape Diabetes & Endocrinology. "Physicians won't be shocked by this report, but patients — and insurance companies — might be. There are wider social issues that haven't been looked at yet."

American Diabetes Association (ADA) 69th Scientific Sessions. Presented June 5, 2009.

Diabetes Care. Published online June 5, 2009.

Friday, July 17, 2009

Visceral Reaction: Abdominal Fat Trumps BMI

From Heartwire
by Steve Stiles

July 14, 2009 (Quebec, Quebec City) — Two years ago, a group reported an inverse relationship between cardiorespiratory fitness and intra-abdominal adiposity that was independent of body-mass index (BMI) in patients with asymptomatic diabetes enrolled in the Quebec Family Study.

Now that research team, studying nondiabetics from the same observational study, has observed that poor fitness in overweight and obese people, compared with those with good cardiorespiratory fitness, is associated with low-grade inflammation. That's not necessarily a new finding, but another was more novel: "Our results show for the first time that the relation between obesity and inflammation is attributable to a very large extent to visceral adipose-tissue accumulation rather than to excess body weight per se," write Benoit J Arsenault (Université Laval, Quebec, QC) and colleagues in the July 15, 2009 issue of the American Journal of Cardiology.

A cohort of 272 asymptomatic men and women were scored for inflammation based on plasma biomarker levels. Visceral adipose tissue, measured by computed tomography (CT), was positively associated with levels of C-reactive protein (CRP) and interleukin-6 (p<0.0001) but inversely associated with adiponectin levels (p<0.0003) after adjustment for fitness levels (as measured by bicycle ergometry).

Inflammation scores went up (p<0.05) with greater insulin resistance, and they were reduced (p<0.05) in subjects with low vs high levels of visceral adiposity (low defined as <130 cm2 for men and <100 cm2 for women). Within both subgroups with low and high levels of visceral adiposity, subjects with high and low fitness had similar inflammation scores.

Visceral adiposity levels varied widely at any given BMI value.

"The state of insulin resistance associated with visceral adiposity appeared to represent a potential link between low [cardiorespiratory fitness] levels and low-grade inflammation. Hence, we propose that unfit subjects are characterized by an inflammatory state because of their increased visceral [adipose-tissue] accumulation and associated insulin-resistance state."

Tuesday, July 14, 2009

Reject the Victim Mentality

By: Ken Keis

"We live in a society of victimization, where people are much more comfortable being victimized than actually standing up for themselves."
Marilyn Manson, Musician 1969 -

"The price of greatness is taking responsibility."
Sir Winston Churchill, British Politician 1874 - 1965

Reject the Victim Mentality. Take Personal Responsibility!

Victim: One who is acted on and usually adversely affected by a force or agent; one who is injured, destroyed, or sacrificed under any of various conditions; one who is subjected to oppression, hardship, or mistreatment; one who is tricked or duped.

Responsibility: The quality or state of being responsible; moral, legal, or mental accountability; reliable; trustworthy; something for which one is responsible.

Are you taking responsibility for your life and circumstances or are you playing the role of a victim?

Do you know individuals who are constantly playing the victim card -- blaming others and the world for their unfortunate circumstances?

Several activist groups would have you believe their entire group is oppressed and that they are ALL victims! Yes, some have a legitimate story that supports their situation -- but does that justify the victim mentality?

Absolutely not -- and here’s why!

When the victim card is played, the victim is trying to shift the onus for the condition of the person or group onto outside influences. That suggests the victim has played no role in creating the situation and that he or she has no power to change it.

That attitude plays perfectly into the victim mentality: After all, it’s not the victim’s fault, so he or she can’t do anything about it.

In his book The Road Less Traveled, author Scott Peck identified that one of the most difficult character disorders to treat is where it is everyone else’s fault. The reason successful treatment is so challenging is that the individuals do not take personal responsibility for the contribution they are making to their own situation.

The motto of the victim-mentality mindset? It’s not my fault!

Although most of us are guilty of feeling that way at some level or another, we don’t make it a way of life. Here are examples of victim mentality.

Watch who these individuals are blaming for their external conditions.

- My son felt he could not get good grades in math because of the teaching style of the teacher. We reframed the situation to show that no matter what, he is responsible for his marks. His math grade is now the highest in 2 years.

- Previous board members at our school said we could never grow the school, given the condition of the community and that most individuals could not afford private education. Obviously, the school was a victim of circumstances.

Now, that the victim-mentality individuals have left the board, we are on our way to 60% growth in just the past 12 months. I guess all the individuals who could not invest in private education moved out of the area in the past year.

- A local poverty-action group said that unless the government and the community put several initiatives in place, individuals could never get out of the cycle of poverty. So far, they have fulfilled their expectations and their poverty group continues to grow.

Note: This does not suggest new programs are not needed but this group is implying no one can get out of poverty without new programs.

- A very successful colleague in Chicago tells me that many of his friends still struggle and blame their race for their poor conditions. That did not stop him.

- It has been proven in research that your posture and the way you carry yourself reveal whether or not you are an easy target (victim). If you act like a victim, it’s more probable that you will become one -- even just walking down the street.

- When confronted by a teenage mother-to-be who wanted support because she could no longer work, Minnesota Governor Jesse Ventura suggested she should have thought about that before she got herself into that condition. He asked why the state should pay for other people’s choices/mistakes.

- Over the past 5 years, my company has contracted three different marketing copywriters, all of whom did not work out for us. We started to play into the victim mindset, feeling sorry for ourselves and blaming everyone for this failure except ourselves. In the end, it was us that had to be held accountable. After all, we signed the contracts.

I’m sure you can think of examples where similar victim mindsets were evident.

Nothing positive or productive comes out of that attitude.

You are also a product of your environment and the company you keep.

Who are you are hanging out with? They are influencing your behaviors and mindset.

Be aware of your primary peer group(s). If you are spending most of your time interacting with individuals who like to blame others for their circumstances, guess which path you will be heading down.

Even if they are family members or long-term friends, don’t play victim to the victim. Take personal responsibility and upgrade your circle of friends and peers.

Action Steps to Reject the Victim Mentality

1. When someone around you is constantly playing the victim card, how does that make you feel?
2. Think and make a list of the negative consequences of the victim mindset.
3. Is there any part of your life where you are currently playing the victim card? If Yes, list them now.
4. What has playing a victim cost you or others around you?
5. List what has to change for you to take personal responsibility for your current condition. What attitudes do you have to give up?
6. Are there people in your life who frequently play the victim card? How is that affecting you? What can you do to limit, reduce, or eliminate these individuals from your life?
7. List the benefits that individuals enjoy when they take personal responsibility for their circumstances.
8. To improve their circumstances, victims believe they must wait for others to act -- which might never happen. Alternatively, taking personal responsibility can happen this very instant, providing you the opportunity to improve and more forward.

Until next time, keep Living On Purpose,

Ken Keis, MBA, CPC, is an internationally known author, speaker, and consultant. He is President and CEO of CRG Consulting Resource Group International, Inc., Many professionals herald CRG as the Number One global resource center for Personal and Professional Development.

For information on CRG Resources, please visit

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Tuesday, July 7, 2009

Vegetarian Diet

American Dietetic Association Endorses Vegetarian Diets
by Laurie Barclay

July 6, 2009 — Vegetarian diets, if well-planned, are healthful and nutritious for all age groups and can help prevent and treat chronic diseases, according to an updated position paper released by the American Dietetic Association. The revised recommendations are published in the July issue of the Journal of the American Dietetic Association. The position was adopted by the House of Delegates Leadership Team in 1987 and was reaffirmed in 1992, 1996, 2000, and 2006; the updated position paper is to remain in effect until December 31, 2013.

"Common reasons for choosing a vegetarian diet include health considerations, concern for the environment, and animal welfare factors," write Winston J. Craig, PhD, MPH, RD, from Andrews University in Berrien Springs, Michigan, and Ann Reed Mangels, PhD, RD, LDN, FADA, from the Vegetarian Resource Group in Baltimore, Maryland. "Vegetarians also cite economic reasons, ethical considerations, world hunger issues, and religious beliefs as their reasons for following their chosen eating pattern.... Individual assessment is required to accurately evaluate the nutritional quality of the diet of a vegetarian or a self-described vegetarian."

Defining and Planning a Vegetarian Diet

The American Dietetic Association defines a vegetarian diet, or lacto-ovo vegetarian diet, as one that does not include meat, fowl, seafood, or products containing those foods. The lacto-vegetarian diet also excludes eggs and primarily consists of grains, vegetables, fruits, legumes, seeds, nuts, and dairy products. The vegan, or total vegetarian, eating pattern excludes eggs, dairy, and other animal products. Within these broad definitions, there is still variation in the degree to which animal products are excluded.

A well-planned vegetarian diet can meet current recommendations for all vital nutrients, including protein, omega-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. However, use of supplements or fortified foods may be helpful to boost intake of important nutrients in certain cases.

The American Dietetic Association contends that carefully planned vegetarian diets, including vegan diets, are healthful and nutritionally sufficient for individuals of all ages, including pregnant or lactating women, infants, children, adolescents, and athletes. During pregnancy, adherence to a nutritionally adequate vegetarian diet can lead to positive health outcomes for both the mother and infant.

Furthermore, well-constructed vegetarian diets may offer health benefits in terms of preventing and treating certain chronic diseases, including heart disease, cancer, obesity, and diabetes. Vegetarian diets are linked to lower risk for death from ischemic heart disease, according to findings of an evidence-based review. In addition, low-density lipoprotein cholesterol levels, blood pressure, and body mass index appear to be lower in vegetarians than in nonvegetarians, as do rates of hypertension, type 2 diabetes, and cancer.

The position paper also reviews available evidence concerning the effects of vegetarian diets on cardiovascular disease, obesity, osteoporosis, renal disease, dementia, diverticulitis, and rheumatoid arthritis.

Specific vegetarian considerations regarding specific nutritional programs are also reviewed, including the Special Supplemental Nutrition Program for Women, Infants, and Children; child nutrition programs; feeding programs for elderly adults; corrections facilities programs; military and armed forces programs; and other institutions and quantity food service organizations.

During the next decade, the number of vegetarians in the United States is expected to increase. Vegetarian diets are typically characterized by certain healthful features that may lower the risk for chronic disease — notably, reduced consumption of saturated fat and cholesterol and increased consumption of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals with potent antioxidant, antiproliferative, and cancer-protective activity.

However, individual diets should be evaluated to ensure that they are nutritionally adequate, given the variability of dietary habits among vegetarians. Other important roles for food and nutrition professionals are to educate vegetarians regarding sources of key nutrients, food purchase and preparation, and individual dietary modifications to meet their specific requirements.

Recommendations for a Healthy Diet

Specific recommendations to help ensure that vegetarians have healthful diets with sufficient nutrients are as follow:

•The diet should contain a wide variety of healthful foods, including whole grains, vegetables, fruits, legumes, nuts, and seeds, as well as dairy and eggs if desired.
•Consumption of foods that are high in sugar, sodium, and fat, particularly saturated fat and trans-fatty acids, should be minimized.
•The diet should contain a wide range of healthful fruits and vegetables.
•For vegetarians who consume dairy products and eggs, moderation is recommended, as well as use of lower-fat dairy products.
•A regular source of vitamin B-12 is recommended, as well as of vitamin D if sunlight exposure is limited.
•Nutritionists should be able to recommend local, reliable sources for purchase of vegetarian foods, or mail order sources in some communities where suitable local sources are unavailable.
•To facilitate meeting nutrient needs on a vegetarian diet, clinicians should collaborate with family members, especially the parents of children following vegetarian diets.
•Practitioners unfamiliar with the principles of vegetarian nutrition should help their vegetarian patients find a nutritionist or other qualified provider to advise them regarding their diet.
"It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases," the position paper authors write. "Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.... Food and nutrition professionals can assist vegetarian clients by providing current, accurate information about vegetarian nutrition, foods, and resources."

J Am Diet Assoc. 2009;109:1266–1282.