Monday, September 20, 2010

Tobacco legislation works: Cleaner indoor air reduces childhood asthma hospitalizations

Powerful data reported from Scotland in the New England Journal of Medicine last week (see report)  show substantial reductions in childhood hospitalizations for asthma following implementation of a ban on smoking in public laces. Using sate of the art approaches to data analysis the authors report on hospitalizations for children and adolescents. After the implementation of the legislation in Scotland in March 2006, smoking in public places was banned and measures of exposure showed expected decreases.

Childhood asthma is exacerbated by exposure to second hand smoke, or environmental tobacco smoke. The reduction in hospitalization again points to the value of a full-scale public health efforts including policy changes to reduce the burden of cigarettes. Hospitalizations were reduced by 18 percent per year after the legislation!  This reduction was seen in both preschool and school aged children.

This impact on hospitalization not only reduced the burden of asthma on children and their families but also clearly must have saved the Scottish health care system substantial expenditures for acute admissions of asthmatic children.  Other benefits for children not included in this report are fewer middle ear infections. These data will add to the power of public policy as a key component of our tobacco control and public health actions.

Wednesday, September 15, 2010

Supplements – magic bullet or poison pill?

It seems everywhere you turn, someone is touting a new herbal supplement or extract as the solution to what ails you – prevent cancer, lose weight, reduce cholesterol, boost immunity. You name it, someone is probably selling an herbal concoction to fix it. And often, these claims seem to be backed by scientific research. So what’s the problem?

Unfortunately, there are many:
  1. Quality. As detailed in today’s Wall Street Journal, when supplements are submitted to quality testing, about 25% have problems like contamination or mislabeled dosage. In some cases, that contamination can be quite dangerous such as with lead.
  2. Safety. Herbal supplements aren’t subject to the same kind of testing that pharmaceutical drugs have to go through. This often means unsubstantiated claims and little information about risks associated with long term or high dosage use.
  3. Research quality. Many of the claims made about supplements are backed by research. Unfortunately, the fine print often reveals the research was funded by the supplement maker. The potency of plants can often vary as well – so the variety tested in the research study may not be the one included in the supplement you buy.  In many instances, the studies are also very small or not well designed, which makes for less reliable results, something often missing from the scientific pedigree supplement makers list in their ads or on their websites.  That many people who write about the benefits of these supplements don't have a great understanding of the research process, and what may seem in an article to be rock solid health benefits of a supplement, may be little more than anecdotal evidence.
  4. Reductionism.  Reductionism is when a single component of a whole food found to have health benefits is put into a supplement and assumed to have the same (or greater) health benefits of the whole foods.  The food is "reduced" to a single component, usually with mixed results.  The classic example is beta-carotene.  Studies had found that individuals who consumed higher amounts of fruits and vegetables had lower rates of lung cancer. Researchers hypothesized that this was due to the antioxidants (like beta-carotene) found in fruits and vegetables and began randomized controlled trials to see if these individual components had any health benefits in smokers.  The results were surprising.  Lung cancer rates were HIGHER in the groups taking beta-carotene. These results don’t mean you should go off and eat Twinkies instead of carrots, but they do suggest that extracting one component from a food doesn’t always lead to the desired result.
  5. Extrapolation. Extrapolation is taking a narrow set of results and applying it to broader populations.  It's a common practice, particularly in health news stories, and while it makes for great headlines, it often results in over-reaching.  Supplement makers do the same.  A small study in mice or cells in a petri dish can have seemingly astounding results - but the problems is that these studies are in....mice and cells.  Animal and cell studies are just a starting point in the research process, and more often than not the results don't pan out in good studies in humans.  It is also important to note that the doses of supplements and extracts applied to animals and cells in the laboratory often exceed those that humans would (or could) consume. The big concern here is that these extracts and compounds, tested in labs, will result in the same unanticipated consequences that beta-carotene did on lung cancer when tested in humans. Of course, there is also the possibility that they will have benefit, but until they are evaluated, we just don’t know.
It might seem that we're anti-supplement here at CNiC.  But that's certainly not true.  For a very long time, we've recommended a daily multivitamin as a great nutrition insurance policy for most people. A daily multivitamin with folate can provide added protection against certain cancers and other chronic diseases. Folate is a B vitamin that has been shown to lower the risk of colon cancer, as well as breast cancer in women who regularly drink alcohol. The calcium and vitamin D in most multivitamins may also help provide added protection against colon cancer.

What we worry about are the health claims many supplement makers and other proponents make that over-reach (often by a great deal) what the science has to say about both the effectiveness and the safety of their products.

In this day of ever-growing health care costs and tight budgets, it's only natural that we want to take control over our health, and turning to supplements can seem like an easy route to take.  But, it's important to know about some of the potential pitfalls with supplements so you can make good, informed decisions about your health.  Most of the time, the best choice is to keep those supplements on the store shelves and go for a good walk instead. Focus on fruits, vegetables, and whole grains, trying to get a wide variety of each. A single 100% RDA daily multivitamin is also a good nutrition insurance policy for most people.

Monday, September 13, 2010

Become an Ex - stop smoking

Second hand smoke exposure in the US was thoroughly documented last week in the CDC report noted in many media stories.

The report evaluated national data from 1999 through 2008, and estimates that 88 million non smokers greater than age 3 were exposed to second hand smoke. The authors note that the decline in exposure within the US has slowed pointing to the tapering off in our national public health efforts to control cigarette smoking.

Despite the increasing attention paid to obesity and the economic burden on society due to obesity, tobacco remains a leading cause of premature mortality, cancer onset. lost productivity, and health care expenditures. Continued efforts at smoking cessation and state-wide comprehensive laws to limit exposure in work places and public places can help avoid serious health effects.

The health effects of second hand smoke are are well documented.
Risks of secondhand smoke
Smokers not only risk their own health, they can also impact the health of those around them. Secondhand smoke (also known as environmental tobacco smoke) has been shown to increase the risk of disease in nonsmokers.  For example, secondhand smoke increases the risk of:
  • Lung cancer 
  • Heart disease
and in children, secondhand smoke exposure increases the risk of:
  • Sudden infant death syndrome
  • Reduced lung function
  • Asthma
  • Respiratory infections
  • Ear infections in children
 The good news is that many of tobacco’s harmful effects can be reduced by smoking cessation, and benefits of quitting can be seen almost immediately.  Quitting smoking is the single best thing that smokers can do to improve their health, and over 46 million Americans have successfully quit.

There are many rewards that come from quitting

Within the first day of quitting:
·      Blood pressure decreases
·      Carbon monoxide levels drop
·      Risk of heart attack decreases

Within the first year after cessation:
·      Energy increases
·      Circulation improves
·      Pulmonary function increases
·      Coughing and wheezing diminish
·      Respiratory infections decrease

Within the first 2 years:
·      The risk of dying from cardiovascular disease becomes half that of a current smoker.  
·      The risk of stroke falls.

With sustained abstinence of 5-15 years:
·      The risk of premature death drops significantly.
·      Risk of oral cancer is cut in half, with continued decline over time.
·      Esophageal cancer risk drops.
·      Laryngeal cancer risk decreases.
·      Bladder cancer risk drops by 50%.
·      The risk of cervical cancer in women falls significantly.
·      The risk of pancreatic cancer is reduced.
·      Lung cancer risk falls to 1/3-1/2 the risk of continued smokers, and continues to decrease with time.
·      Chronic obstructive pulmonary disease mortality is reduced.
·      The risk of cardiovascular disease is similar to that of someone who has never smoked.
·      The risk of stroke is reduced to the level of a never smoker.
·      The risk of peripheral vascular disease falls.

Not smoking also:
·      Saves money
·      Sets a good example for children and other adults
·      Helps prevent the exposure of others to second-hand smoke

It is important for health care providers and patients to recognize that there are significant health benefits for smoking cessation for men and women at any age, even in older individuals and those who have been diagnosed with smoking-related illness.  For example, cessation in people with known coronary heart disease results in a decreased risk of recurrent heart attack and cardiovascular death.  For patients with peripheral vascular disease, quitting smoking leads to a drop in risk of amputation following surgery, and increased exercise tolerance.  Health care providers should counsel all smokers and tobacco users to quit as soon as possible.

 Smoking during pregnancy

Because of the many health risks to the mother and baby, it is especially important that women not smoke during pregnancy.  While rates have been decreasing, over 10% of women continue to smoke during pregnancy.  Of those who do quit, about two thirds restart within the first year after delivery. 

Quitting smoking before pregnancy provides the greatest health benefits.  However, cessation at any point can benefit the mother and child.  Women who quit before or during pregnancy decrease the risk of preterm delivery, premature rupture of membranes, and low birth weight, compared to continued smokers.  In addition, women who quit smoking before delivery also reduce the risk of exposing their children to second-hand smoke and the many health problems associated with it.

Stopping smoking

for help stopping smoking many resources are available. Among the most helpful web-based resources is the site become an ex , where you can relearn life without cigarettes.

Thursday, September 9, 2010

Second hand smoke in bar workers

More news from Alvin J. Siteman Cancer Center showing significant nicotine exposure from cigarette smoke in restaurant and bar workers. It is time for regulations to protect workers. We can cut the health impact of smoking now.  See story 

Wednesday, September 8, 2010

Decline in smoking stalls in US

Despite the high priority for tobacco control new CDC data show the decline in smoking has stalled (see story). As we have note previously, smoking is the leading cause of cancer. It causes more than 30% of all cancers in the United States and an increasing cause on developing countries as smoking rates rise throughout Asia and South America.  

While media draws attention to possible new environmental causes of cancer (see NYT story), we can all be distracted from the enormous burden of smoking on society.  In addition to the burden among those who smoke (half die due to their smoking), CDC notes that in the US 88 million non smokers are exposed to second hand tobacco smoke, have measureable toxins, and thus are at risk of numerous health effects of tobacco smoke. Smoking is a major cause of heart disease, stroke, and many other chronic health considerations. These cost society huge amounts in health insurance, taxes to support health care, and lost productivity.

Many highly effective strategies to counter the health effects of smoking are thoroughly documented in the literature and regularly summarized in reports form the Surgeon General. Moving from knowledge to action often stalls, however, in State House and local government settings where industry is highly effectively lobbying against regulations that may lower the rates of smoking. Proven effective strategies include increasing access to smoking cessation services, policy (clean indoor air, limiting advertising, and increasing taxation on cigarette sales), and workplace wellness programs. These all play a role in our response to counter the addictive habit of smoking and the ensuing huge health consequences.

Thursday, September 2, 2010

Pizza, Cookies, and the Importance of Being a Mindful Eater

There is a fascinating little study out this week in the journal Appetite, which was also highlighted in a piece in The Economist.  What the study found was that dieters, when they felt they were given a larger piece of pizza than other people were for lunch (pieces were actually the same),  were more likely to eat more cookies afterward than the others were.  While it's hard to pin a motivation on exactly why this was, one explanation is that the dieters felt the perceived larger piece of pizza pushed them off their dieting program, which then opened the "might as well" flood gates when it came to eating cookies afterward.

There are a number of possible conclusions to draw from this study when it comes to battling the current obesity epidemic -- all of which would be little more than conjecture.  But, it does highlight the very complex problem we're dealing with it comes to weight gain and weight loss and the important role that external influences can have on our internal cues to eat.

With the food industry spending millions to get us to eat more and more food (most of which is unhealthy), it's important to do what we can to listen to our bodies and understand when we're truly hungry and when we've eaten enough to feel satisfied but not bursting.  It seems like a simple thing but this small study and the growing numbers of people who are overweight and obese tell us its not.

Try these simple steps to get in touch with your internal cues and keep your weight in check:

  • Exercise, exercise, exercise.  Being active is one of the best ways of controlling weight.
  • Go Mediterranean.  A diet rich in fruits, vegetables, whole grains, and healthy oils (like olive oil) can make you feel full,  help regulate your appetite, and actually taste really good
  • Choose smaller portions and eat more slowly.  Slow down and give your body a chance to feel full before you move on to seconds.
  • Be a mindful eater.  Food is big business, and their main goal is to get you to eat.  Try to listen to what  your body is telling you, not what the food business wants you to hear.  

Wednesday, September 1, 2010

Do competitions help you get healthy?

This week marks one of my favorite times of the year - the US Open. The New York Times had a couple of articles this week that got me thinking about how competition can fuel (or harm) health. The first was a great photojournalism article in the Sunday Magazine about how much harder the women are hitting than in years past. I love seeing a discussion about how increasing strength is pushing women to do more. Strength training has lots of benefits and we're seeing more and more discussion of them (the Times also covered the role of strength training in aging-related muscle loss). The need to keep or get a competitive edge is pushing women to start strength training at younger ages -- I remember this being a really novel part of our pre-season soccer training when I played in high school (aka, the old days). However, we didn't get any instruction on proper form or how to progress safety and not injure our growing bodies. It is nice to see so many programs now for youth addressing these issues.

The other article is about a "friendly" wager (of $10,000!) between Andy Roddick and Justin Gimelstob as to whether Gimelstob can complete the New York City Marathon this November. Gimelstob's motivation isn't health - it is competition with Roddick - who isn't even running! Lots of sites that offer tips for getting healthy and starting (or maintaining) exercise programs suggest friendly competitions or reward systems to keep you motivated. Gimelstob and Roddick have pushed it a bit beyond this, with friends and family worrying that Gimelstob has progressed to a significant risk of injuring himself. It got me thinking about whether friendly wagers and competitions can help or do they push us past where we should go in our pursuit of health?

What do you think? Do you use rewards or competition to motivate yourself to get active?