How do the previous blogs fit into everyday situations? I am on a 4 hour plane ride to San Jose to talk about breast cancer pvention with Evista. I am reading Instant Recess by Toni Yancey and learning alot.
One of h stated objects in the book is to make physical activity enjoyable: to make physical activity part of our social, work, office, home life. Exercise is enjoyable for some, but not for all. Anything is better than being sedentary. We've seen the data in previous blogs, on the news, in her book, etc. Well, how 'bout on a long plane ride: a practical application?
The pilot made me say that I keep my seat belt loosely fastened when in my seat, but 4 hours? We are just beginning our fourth. I get up at least every hour and walk the aisle, stretch, do heel-to-toes 'till they tell me to sit. I flex in the seat, lift my legs, straighten then bend, do leg lifts, hold what I'm reading in different positions. Boy I'm fun to sit next to! I practice what I preach, not just go the gym, but move! You've heard of the nonsmoking flight? How about the non sedentary lifestyle?
One of the ways to prevent chronic disease and cancer is physical activity. So let's all get
moving!
Tuesday, April 26, 2011
Monday, April 25, 2011
What do "successful losers" (weight that is) have in common?
The National Weight Control Registry gives us more data. The registry was begun in 1994 by Dr. Rena Wing and Dr. James O. Hill and is the largest prospective investigation of "successful (weight) losers"! As of the most recent publication, American College ofSports Medicine's Health and Fitness Journal 2011 found at www.acsm-healthfitness.org, the registry now consists of 6000 individuals. Each has maintained a weight loss of 30 lbs for an average of 5 years.
These "successful losers" have several highly commendable behaviors in common: including high levels of physical activity, consistent low fat and low calorie diet, and self-monitoring of weight and calorie intake.
Some facts about the program are found at www.nwcr.ws/ and are revealing:
80% are women
the average age is 45 years
members have lost an average of 66 lbs
they have kept the weight off 5.5 years.
How was the weight loss achieved?
45% lost by changing what they ate on their own
55% used the help of some program.
98% modified food intake in some way, mostly lower calorie and lower fat.
94% increased physical activity!
In the variety of ways that NWCR members kept the weight off there are 4 stand outs:
78% eat breakfast (they didn't lose weight by skipping breakfast)
75% weigh at least once a week and some daily
62% watch less than 10 hours of TV a week
90% exercise an average of 1 hour per day!
Dr. Hill comments that "these people, almost to a person, tell us it's all worth it, they feel better and life is better than when they were obese or overweight".
These are the ones that may have tried many times and failed, but didn't give up. The message is clear. It is worth it! I hear the same in my office. If you need help from encouragement, to an accurate scale to a weight loss program, call me. I want to see more women who don't get breast cancer.
Monday, April 18, 2011
More benefits of regular exercise!
Benefits of Regular Exercise
- Fewer Breast Cancers
- Fewer Breast Cancer Recurrences
- Decreased all-cause mortality
- Decreased cancer mortality including breast cancer
- Decreased cancer mortality including prostate cancer
- Fewer heart attacks
- Fewer cardiac events
- Fewer heart disease deaths
- Better blood pressure control
- Lower VLDL
- Higher HDL
- Fewer blood clots
- Fewer strokes
- Fewer colds and flu-like illnesses
- Better glycemic control and insulin sensitivity
- Fewer patients with Type II Diabetes
- Helps maintain healthy weight
- Helps quit smoking
- Fewer symptomatic gallstones
- Improves functional ability
- Prevents or delay of cognitive decline
- Reduce stress, anxiety and depression
- Saves money; Lower annual direct medical costs
- Live better longer
Find out more at http://www.owenwinsettmd.com/
Thursday, April 14, 2011
Other benefits of weight loss: from top to bottom!
We have shown the numbers for breast cancer: risk goes up with weight going up and risk goes down with weight going down. In the Nurses Health Study the benefit of weight loss was twice as powerful with 2% fewer cancers with a single pound lost and kept off. There are many other benefits of weight loss, but we will review two, today.
The top is the brain. In an article to be published in the Journal of the American Society for Metabolic and Bariatric Surgery, Gunstad (a neuropsychologist) et al studied 150 people, comparing 109 bariatric surgery patients to 41 obese controls. Weight loss is dramatic after the surgery and only 12 weeks after the surgery they noted improved memory and concentration, measured by performance on cognitive testing. Imagine the application to voluntary weight loss!
Now near the bottom: the knees. The knees are among the most frequent joints involved by osteoarthritis. Felson, DT et al, published in Ann Intern Med 1992;116:535 the findings in a subgroup of patients with knee pain. Reports from the ongoing Framingham Study (www.framinghamstudy.org) have shown among other findings that cigarette smoking increases the risk of heart disease (in 1960) and physical activity was found to reduce the risk of heart disease and that obesity increases the risk of heart disease (in 1967). In 1992, they reported that weight loss reduces the risk of knee pain in 800 women. In this long term study, weight loss of 12 pounds or about 2 units on the BMI table, decreased symptomatic knee osteoarthritis by 50%. Imagine reducing pain without a pill!
So, there are two more reasons for pursuing that ideal body weight: from top to bottom; and in the middle fewer breast cancers.
The top is the brain. In an article to be published in the Journal of the American Society for Metabolic and Bariatric Surgery, Gunstad (a neuropsychologist) et al studied 150 people, comparing 109 bariatric surgery patients to 41 obese controls. Weight loss is dramatic after the surgery and only 12 weeks after the surgery they noted improved memory and concentration, measured by performance on cognitive testing. Imagine the application to voluntary weight loss!
Now near the bottom: the knees. The knees are among the most frequent joints involved by osteoarthritis. Felson, DT et al, published in Ann Intern Med 1992;116:535 the findings in a subgroup of patients with knee pain. Reports from the ongoing Framingham Study (www.framinghamstudy.org) have shown among other findings that cigarette smoking increases the risk of heart disease (in 1960) and physical activity was found to reduce the risk of heart disease and that obesity increases the risk of heart disease (in 1967). In 1992, they reported that weight loss reduces the risk of knee pain in 800 women. In this long term study, weight loss of 12 pounds or about 2 units on the BMI table, decreased symptomatic knee osteoarthritis by 50%. Imagine reducing pain without a pill!
So, there are two more reasons for pursuing that ideal body weight: from top to bottom; and in the middle fewer breast cancers.
Wednesday, April 13, 2011
Should I get a breast MRI?
I am ask that question often, so lets look into the issue. The American College of Radiology lists screening criteria at www.acr.org, but begins the list with "current indications for breast MRI include, but are not limited to:" There is some controversy and a new program of breast MRI accreditation is enrolling now to help sort it out. I think a breast specialist is needed. In the meantime lets look at a group, for whom, routine MRI is not in much dispute.
A carrier of a deleterious mutation for breast cancer, BRCA 1 or BRCA 2, has at least an 85% chance of developing breast cancer in her life, much higher than the population risk of 12%. Fortunately, only about 7% of women are carriers, usually with young primary relatives (mother, daughter, sister) with breast and/or ovarian cancer. One option for these women is risk reduction TOTAL mastectomy, but the procedure is not chosen by all women who carry one of the gene mutations. Several reports have been published about MRI in these women with a very high known lifetime risk who have declining surgery. Let's look at two recent reports, interestingly enough with the same lead author.
Published this week in J Clin Oncol online by Dr. Ellen Warner from Toronto, is a prospective study of 1275 women carriers of the BRCA1 or BRCA2 mutation, comparing routine breast cancer surveillance (Clinical Breast Examination and mammography) without MRI to routine surveillance (CBE and mammography) with added yearly MRI. The hope is that routine breast MRI would reduce mortality from breast cancer, like routine mammography has done. When the two groups were compared over time, the number of cancers that developed was the same in each group. In each group 9.2% of the women were diagnosed with breast cancer in only a mean of 3.2 years of follow-up. But the tumors in the MRI group were significantly smaller (9mm vs 18mm), more were noninvasive and fewer were later stages.
Breast MRI is more sensitive in finding cancer in these women with a very high lifetime risk of developing cancer, but long term follow-up will be needed to see whether breast cancer mortality is reduced.
The second study in The Breast Journal 2011;17:9-17, by the same author offers more insight into why not offer MRI breast screening to all (lower risk) women. Even at very experienced breast MRI centers, the false positive rate is too high. A false positive breast MRI is one that looks like cancer, but isn't, but we don't know until further studies or even breast biopsy have ruled-out cancer. MRI may be very sensitive at finding cancer, but finds too many benign tumors. Breast MRI is also much more expensive than other breast screening, even without considering the other procedures, necessary to prove that the positive finding is not breast cancer.
So the answer is, for now, talk to your breast doctor about it. Breast MRI might be right for you, but in general screening use may cause too much mental and fiscal pain.
A carrier of a deleterious mutation for breast cancer, BRCA 1 or BRCA 2, has at least an 85% chance of developing breast cancer in her life, much higher than the population risk of 12%. Fortunately, only about 7% of women are carriers, usually with young primary relatives (mother, daughter, sister) with breast and/or ovarian cancer. One option for these women is risk reduction TOTAL mastectomy, but the procedure is not chosen by all women who carry one of the gene mutations. Several reports have been published about MRI in these women with a very high known lifetime risk who have declining surgery. Let's look at two recent reports, interestingly enough with the same lead author.
Published this week in J Clin Oncol online by Dr. Ellen Warner from Toronto, is a prospective study of 1275 women carriers of the BRCA1 or BRCA2 mutation, comparing routine breast cancer surveillance (Clinical Breast Examination and mammography) without MRI to routine surveillance (CBE and mammography) with added yearly MRI. The hope is that routine breast MRI would reduce mortality from breast cancer, like routine mammography has done. When the two groups were compared over time, the number of cancers that developed was the same in each group. In each group 9.2% of the women were diagnosed with breast cancer in only a mean of 3.2 years of follow-up. But the tumors in the MRI group were significantly smaller (9mm vs 18mm), more were noninvasive and fewer were later stages.
Breast MRI is more sensitive in finding cancer in these women with a very high lifetime risk of developing cancer, but long term follow-up will be needed to see whether breast cancer mortality is reduced.
The second study in The Breast Journal 2011;17:9-17, by the same author offers more insight into why not offer MRI breast screening to all (lower risk) women. Even at very experienced breast MRI centers, the false positive rate is too high. A false positive breast MRI is one that looks like cancer, but isn't, but we don't know until further studies or even breast biopsy have ruled-out cancer. MRI may be very sensitive at finding cancer, but finds too many benign tumors. Breast MRI is also much more expensive than other breast screening, even without considering the other procedures, necessary to prove that the positive finding is not breast cancer.
So the answer is, for now, talk to your breast doctor about it. Breast MRI might be right for you, but in general screening use may cause too much mental and fiscal pain.
Wednesday, April 6, 2011
An apple a day keeps breast cancer away
I know that's not what your grandmother told you, but the evidence is mounting. There have been numerous reports (over 100 epidemiological studies) linking regular fruit and vegetable consumption to fewer cancers. In 1992, a review published in Nutr Cancer 18:1-29 found that in 128 of 156 dietary studies, fruits and vegetables had a significant protective effect against many cancers.
Apples are unique because they are enjoyed by many cultures, they are a source of many antioxidants and several studies have looked specifically at apple consumption and its effects in humans and laboratory animals. These positive effects include protection from cancer, reduced cardiovascular disease and general good lung health (less asthma), just to mention a few.
We are interested in breast cancer reduction. Dr. Liu at Cornell has published repeatedly on the subject (www.news.cornell.edu/ for a listing), but we will look at one study as an example and discuss the possible mechanisms at work. Data published in J Agric Food Chem 2005: 53:2341-3 shows that whole apple extracts prevent breast cancer in a rat model in a dose-dependent manner. A dose comparable to one apple a day prevented 43% of breast cancers and 3 and 6 apples, inhibited 50% and 75% respectively. Almost half of the breast cancers prevented with just one apple a day!
This and other studies highlight the role of phytochemicals in apples, particularly phenolics, a large group of aromatic hydrocarbon compounds. Remember the benzene ring? It is these compounds that have anticancer properties. These properties can be classified as antiproliferative (inhibiting cell growth), antiinflammatory (we are just now understanding how inflammation is related to cancer development) and antioxidant. We will discuss all of these in later editions.
For now, which apple should I eat? To get the greatest benefit: eat the skin, eat red apples (Fuji, Red Delicious and Gala have the highest concentrations) and only fresh and unprocessed (apple juice in the store has only 10% of the good compounds).
Apples are a good source of dietary fiber and vitamin C. They are very low in saturated fat, cholesterol and sodium. The calories, about 100 in the average-sized apple, are mostly from the sugars: 50% from fructose and 25% each from sucrose and glucose. The Environmental Working Group put apples on the list of those contaminated by pesticides in 2003 and suggests organic apples.
Best of all, an apple is better than any processed snack like candy or cookies.
Apples are unique because they are enjoyed by many cultures, they are a source of many antioxidants and several studies have looked specifically at apple consumption and its effects in humans and laboratory animals. These positive effects include protection from cancer, reduced cardiovascular disease and general good lung health (less asthma), just to mention a few.
We are interested in breast cancer reduction. Dr. Liu at Cornell has published repeatedly on the subject (www.news.cornell.edu/ for a listing), but we will look at one study as an example and discuss the possible mechanisms at work. Data published in J Agric Food Chem 2005: 53:2341-3 shows that whole apple extracts prevent breast cancer in a rat model in a dose-dependent manner. A dose comparable to one apple a day prevented 43% of breast cancers and 3 and 6 apples, inhibited 50% and 75% respectively. Almost half of the breast cancers prevented with just one apple a day!
This and other studies highlight the role of phytochemicals in apples, particularly phenolics, a large group of aromatic hydrocarbon compounds. Remember the benzene ring? It is these compounds that have anticancer properties. These properties can be classified as antiproliferative (inhibiting cell growth), antiinflammatory (we are just now understanding how inflammation is related to cancer development) and antioxidant. We will discuss all of these in later editions.
For now, which apple should I eat? To get the greatest benefit: eat the skin, eat red apples (Fuji, Red Delicious and Gala have the highest concentrations) and only fresh and unprocessed (apple juice in the store has only 10% of the good compounds).
Apples are a good source of dietary fiber and vitamin C. They are very low in saturated fat, cholesterol and sodium. The calories, about 100 in the average-sized apple, are mostly from the sugars: 50% from fructose and 25% each from sucrose and glucose. The Environmental Working Group put apples on the list of those contaminated by pesticides in 2003 and suggests organic apples.
Best of all, an apple is better than any processed snack like candy or cookies.
Monday, April 4, 2011
BREAST CANCER AND WEIGHT
I appreciate all the comments about the blogs last week and I invite you to invite your friends to participate.
We begin this week with a topic some don't like to consider, but we should because of its impact. The numbers are so profound that we will make this blog short.
We have all been reading about the "obesity epidemic" and the negative effects of being overweight, but let's take a look and the science in two of the many article relating weight increase to breast cancer risk increase.
The first study, published in 2000 in Am J Epidemiol 152:514, is a pooled analysis of almost 350,000 US women using data from 7 prospective cohort studies. Women who weighed at least 176 pounds (80kg) had a 25% higher risk of breast cancer than those women weighing less than 132 pounds (60kg). The analysis was controlled for other factors. Expressed as Body Mass Index (calculate yours at www.nhlbisupport.com/bmi/), women with a BMI >33kg/m2 had almost 30% excess cancer risk when compared to BMI <21kg/m2.
The next study is another report from the Nurses Health Study published in 2006 in JAMA 296:193. Weight changes since menopause were followed in 50,000 US women for up to 24 years. Among those not taking hormone replacement the results were very dramatic. Those women who gained and kept on 22 pounds had an 18% higher risk of breast cancer than those who maintained their weight. But even more exciting, those women who lost and kept off 22 pounds or more had a 57% lower risk of breast cancer than those maintaining their weight. So, after menopause, each pound put on and kept on equals one percent more breast cancer risk, BUT for each pound taken off and kept off there is a two percent decrease in the breast cancer risk. Twice the benefit for losing weight!
In future blogs we will look at potential reasons. We are learning that some kinds of fat cells, particularly those gained after menopause are tiny "endocrine" factories secreting all kinds of substances, most of them harmful.
We begin this week with a topic some don't like to consider, but we should because of its impact. The numbers are so profound that we will make this blog short.
We have all been reading about the "obesity epidemic" and the negative effects of being overweight, but let's take a look and the science in two of the many article relating weight increase to breast cancer risk increase.
The first study, published in 2000 in Am J Epidemiol 152:514, is a pooled analysis of almost 350,000 US women using data from 7 prospective cohort studies. Women who weighed at least 176 pounds (80kg) had a 25% higher risk of breast cancer than those women weighing less than 132 pounds (60kg). The analysis was controlled for other factors. Expressed as Body Mass Index (calculate yours at www.nhlbisupport.com/bmi/), women with a BMI >33kg/m2 had almost 30% excess cancer risk when compared to BMI <21kg/m2.
The next study is another report from the Nurses Health Study published in 2006 in JAMA 296:193. Weight changes since menopause were followed in 50,000 US women for up to 24 years. Among those not taking hormone replacement the results were very dramatic. Those women who gained and kept on 22 pounds had an 18% higher risk of breast cancer than those who maintained their weight. But even more exciting, those women who lost and kept off 22 pounds or more had a 57% lower risk of breast cancer than those maintaining their weight. So, after menopause, each pound put on and kept on equals one percent more breast cancer risk, BUT for each pound taken off and kept off there is a two percent decrease in the breast cancer risk. Twice the benefit for losing weight!
In future blogs we will look at potential reasons. We are learning that some kinds of fat cells, particularly those gained after menopause are tiny "endocrine" factories secreting all kinds of substances, most of them harmful.
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