Should I be eating more fiber?

High-grade cancer that’s still confined to the prostate is generally treated surgically. But a third of the men who have their cancerous prostates removed will experience a rise in blood levels of prostate-specific antigen (PSA). This is called PSA recurrence. And since detectable PSA could signal the cancer’s return, doctors will often treat it by irradiating the prostate bed, or the area where the gland used to be.

In February, Dr. William U. Shipley and his colleagues at Massachusetts General Hospital reported that radiation is a more effective treatment for PSA recurrence when given in combination with androgen-deprivation therapy (ADT). ADT interferes with the body’s ability to make or use testosterone, which is the hormone (or androgen) that makes prostate tumors grow more aggressively. It targets rogue cancer cells in the body that escape radiation.
Here’s what the study found

The newly published study randomly assigned 760 men with detectable PSA after surgery to one of two groups. One group got radiation plus ADT and the other group got radiation plus a daily placebo tablet. The study recruited patients between 1998 and 2003, and after an average follow-up of 12 years, 5.8% of men in the combined treatment group had died of prostate cancer, compared to 13.4% in the radiation-only group. Rates of metastatic prostate cancer were also lower among men treated with ADT: 14.5% compared to 23% among the placebo-treated controls.

“The take-home message is that ADT has a major and beneficial impact on the risk of death from prostate cancer when added to radiation for PSA recurrence,” said Ian Thompson, M.D., a professor of oncology at the UT School of Medicine, in San Antonio, Texas, and the author of an editorial accompanying the newly published findings.

Men in this study received a high dose of the ADT drug bicalutamide, which doctors use less frequently for PSA recurrence today, instead favoring other testosterone-suppressing medications that have since been shown to be more effective. Therefore this is an instance of a long-term study reporting results after treatment standards — in this case the selection of a specific ADT regime — have changed.
A new treatment standard

Still, some men have difficulty tolerating ADT, and not all of them should get it, particularly if they’re older and more likely to die of something other than prostate cancer. “I’d reserve ADT for younger men with a long life expectancy ahead of them who were diagnosed initially with high-grade or late-stage disease,” Thompson said.

“This important study confirms that combined therapy is superior to radiation alone and should be viewed as the standard treatment for PSA relapse,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “High dose bicalutamide has been associated with cardiovascular side effects, but ongoing and future research is clarifying how best to use ADT in this particular setting.” The prescription retinoid that my dermatologist suggested sounded like a great idea. It was a topical vitamin A-based cream, which has been shown to help reduce fine lines and wrinkles. Now that I’m a middle ager, I thought I’d give it a try. Then I got to the drugstore, and found that the little tube had a huge price: $371! I didn’t want to shell out that much for a mere face cream, so I didn’t fill the prescription.

But my case was only skin-deep. What about people who can’t — or don’t want to — pay for prescription medications to treat chronic or serious illness? “It’s a real problem. Medications only work if people take them, and you can’t take them if you can’t afford them,” says Dr. Joshua Gagne, a pharmacist and epidemiologist with Harvard-affiliated Brigham and Women’s Hospital.

According to a National Center for Health Statistics survey, about 8% of adults in the United States don’t take prescribed medications because they can’t afford them.

Even if cost is not affecting your medication regimen, the following ideas may save you some money.

    Try generics. Generic drugs have the same active ingredients as brand-name medications, but generics are substantially less expensive. For example, the cholesterol-lowering drug Lipitor retails for about $390 for a 30-day supply. The generic version, atorvastatin, is about $10 for a 30-day supply. Always ask your doctor if a generic is available. “If a generic isn’t available, ask if there’s a similar drug with a generic version,” suggests Dr. Gagne.
    Go to a big-box store. Many pharmacies in grocery stores and big-box chains offer hundreds of generic medications for just $4 (for a 30-day supply) or $10 (for a 90-day supply). Ask for the list when you’re at the pharmacy or look it up on the Internet, and bring a copy to your doctor. Don’t be discouraged if your medication isn’t on the list; check a different store. “Different chains have different lists,” says Dr. Gagne.
    Get a bigger dose. Some prescription medications can be divided with a pill splitter. Ask your doctor if that’s the case with your medication, and if it’s possible to get a double dose. For example, you might get 10-milligram (mg) pills that can be split into 5-mg pills. Some medications cannot be split, such as capsules or tablets that are enteric-coated, or those that release medicine over time. “As a general rule, extended-release or slow-release medications should not be split,” says Dr. Gagne. These include drugs like metformin ER (Glucophage XR) for diabetes and pantoprazole (Protonix) for heartburn.
    Get a larger supply. Instead of getting a prescription that lasts for 30 days, and making an insurance copay each time, ask for a 90-day supply so you can make just one copay every three months. This works for medications you take long-term.
    Apply for assistance. There are many kinds of prescription assistance programs, offered by state and local governments, Medicare, nonprofit groups, and even drug makers. The programs typically have income requirements. Nonprofit organizations include: Needy Meds and Partnership for Prescription Assistance. Other resources include state assistance programs and Medicare Extra Help. Another option is to call the manufacturer of your medication directly. You can look up your medication on this Medicare website.
    If you’re on Medicare, consider updating your plan. Medicare plans can change from year to year, including the medications they cover, and the copays and deductible amounts. You have an opportunity to switch Medicare plans during the annual enrollment period from October 15 to December 7. Review the options using Medicare’s personalized plan search on its website.
    Shop around. Medication retail prices vary. Some pharmacies buy directly from drug makers; others use a middleman, which can drive up prices. Call pharmacies in your area to compare prices, or use a computer or smartphone app to do the work for you, such as WeRx or GoodRx. The attorney general’s office in your state may also have a website that provides similar information.

This last strategy is the one that worked for me. My dermatologist directed me to a pharmacy that sold the retinoid cream for less (because of a deal with the drug maker). It wasn’t free by any means, but the price was enough to get me to fill the prescription. Do I look younger yet? Not quite. But thanks to the discount, my wallet is looking a little better. Imagine a chronic medical condition in which the treatment itself has serious side effects. Examples of this are plentiful in medicine. For example, in diabetes, giving too much insulin can cause hypoglycemia (low blood sugar), a dangerous and potentially life-threatening condition. That doesn’t happen very often, but imagine that it was a common complication of treating diabetes because doctors couldn’t really tell how powerful a given dose of insulin actually was. And suppose that doctors and patient safety experts advocated for places where patients with diabetes could be carefully monitored when taking their insulin. Would you be opposed to this idea? Would you blame the patient for developing diabetes, or for needing this carefully supervised medical treatment in order to live? I suspect that the answer is “of course not!”

Now, let’s shift gears and discuss opioid addiction, specifically people who use illicit drugs like heroin and black-market fentanyl. Heroin is the strong opioid substance derived from the poppy seed that has been used for thousands of years. Fentanyl is a synthetic opioid that can be hundreds of times more powerful than morphine or heroin. Increasingly, illicit heroin is adulterated with fentanyl and similar chemicals, which public health experts believe is the reason for the continued rise in opioid-related deaths despite aggressive measures to decrease opioid prescriptions, increase substance use disorder treatment facilities, and widely distribute naloxone, the antidote to opioid overdose.
Saving lives in the face of increased risk for dying of a heroin overdose

People who use heroin are now at significant risk for overdose death, mainly because the opioid content can vary considerably from dose to dose. Previously, a little too much could have caused a decrease in respiratory rate and a high dose could lead to overdose. Now, with the variability of potency from the synthetic opioids, the strength of each dose can be markedly different. Furthermore, the uptake of fentanyl in the brain is so rapid that a fatal overdose can occur much more quickly than with heroin alone.

If we, as a society, are truly serious about saving lives, we have no choice but to allow people who use injectable opioids to do so in safe, monitored locations without fear of negative repercussions (e.g., being arrested). If you had asked me about this several years ago, I never would have believed that I could write the preceding sentence. I would have said, “Why empower junkies to abuse illegal drugs? Why make it easier on them instead of harder? Why should society condone this activity?”

However, I was wrong — dead wrong.
Good reasons for a change of heart

It turns out that addiction (called substance use disorder or, more specifically here, opioid use disorder in medical jargon) is a disease that can affect any one of us, just like diabetes or high blood pressure. It does not discriminate and does not represent a moral failure on the part of the individual who develops it. It is a condition that no one chooses, but when it attacks, it changes the brain of those with the disease. We can actually visualize those changes with tests like functional MRIs. It leads people to make choices that destroy their lives and the lives of others, such as loss of job, isolation and loss of relationships, incarceration, and even death. We also now know that this is a treatable disease, but the window for successful treatment depends on the psychological state of the person. We must be ready to engage them in treatment at that moment when they are ready.

My opinions changed drastically after a visit to a local needle exchange facility. By current law, individuals can’t inject inside the building. They have to take their chances outside and then they can come inside to be monitored after injecting. I initially envisioned the facility to be sterile, dirty, and depressing. Instead, I was surprised to see that it looked like a living room. There were sofas and a television. There was a warm light, and it appeared to be a welcoming place. Across from the sofas were two desks where staff members sat. Their job is to watch for any signs of overdose (a person who is too sleepy or who is breathing too slowly) and then rapidly respond by providing a nasal dose of naloxone to reverse the overdose. More importantly, they are there to help people right when they are open to treatment for substance use disorder. The staff will help connect them to treatment resources, whether it is group therapy or medical treatment like buprenorphine (Suboxone) or methadone.

If that moment of opportunity in which the individual is receptive to treatment passes, the consequences can be deadly.

Furthermore, the facility is all about harm reduction. There are boxes of free supplies: needle kits so that people do not share needles, condoms for safe sex, kits to help treat small skin infections, even little clean cups to freebase injectable drugs. Naloxone kits are also provided free of charge. There is no judgment there. It is only about reducing a person’s risk of serious, life-threatening infections like HIV and hepatitis C, or the risk of death. And it makes sense. If we are going to agree that opioid use disorder is just another medical condition that needs to be treated, then the compassionate thing to do is to remove the stigma associated with it and reduce associated harms while a person is suffering with substance use disorder. Plain and simple: people with this disease are going to use drugs. Is it better for them to use in the shadows, risking transmission of serious infectious diseases, or monitor them when they are using and be there for them to get them treatment at the moment they are ready?

Currently it’s still illegal in the US to allow people to inject in these supervised environments, but the tide is turning. The city of Ithaca, NY is contemplating a safe injection space, as is Seattle. Multiple studies have confirmed that they work. In Vancouver, Canada, where such facilities were implemented in 2003, they concluded: “Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts.” Massachusetts is also contemplating a similar pilot supervised injection facility program. With the crises of the opioid epidemic now claiming more than 30,000 lives every year in the US, it’s time to change our biases and old ways of thinking — people’s lives depend on it.

Read More »

What is addiction?

Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.
A revised view of addiction

It might seem strange to group gambling problems in the same category as a problem with drugs or alcohol. But addiction experts are beginning to move away from the notion that there are multiple addictions, each tied to a specific substance or activity. Rather, the Syndrome Model of Addiction suggests that there is one addiction that is associated with multiple expressions. An object of addiction can be almost anything — a drug or drug-free activity. For addiction to develop, the drug or activity must shift a person’s subjective experience in a desirable direction — feeling good or feeling better.

Several scientific advances have shaped our contemporary understanding of this common and complex problem. For example, brain-imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from ingesting psychoactive substances, such as alcohol and other drugs, or engaging in behaviors, such as gambling, shopping, and sex. Genetic research has revealed that some people are predisposed to addiction, but not to a specific type of addiction.

These findings suggest that the object of addiction (that is, the specific substance or behavior) is less important than previously believed. Rather, the new thinking reflects the belief that addiction is functional: it serves while it destroys. Addiction is a relationship between a person and an object or activity. With addiction, the object or activity becomes increasingly more important while previously important activities become less important. Ultimately, addiction is about the complex struggle between acting on impulse and resisting that impulse. When this struggle is causing suffering related to health, family, work, and other activities of everyday life, addiction might be involved.
There are many routes for recovery, and the road may take time

Addiction is a chronic and often relapsing disorder. It is often preceded by other emotional problems. Nevertheless, people can and do recover from addiction, often on their own. If not on their own, people can recover with the help of their social network or a treatment provider. Usually, recovery from addiction requires many attempts. This can lead to feelings of frustration and helplessness. Smoking is often considered one of the most difficult expressions of addiction to change. Yet, the vast majority of smokers who stopped quit on their own! Others stopped smoking with the help of professional treatment. It is important to remember that the process of overcoming an addiction often requires many attempts. Each attempt provides an important learning opportunity that changes experience and, despite the difficulties, moves recovering people closer to their objectives. There are many pathways into addiction and many routes to recovery. Think about recovery from addiction as a five-year process that will have its ups and downs; after about five years, life can and will be very different. As life becomes more worth living, addiction loses its influence.
Going out for dinner can be a nice way to unwind with family or friends. But if you’re watching your salt intake, restaurants aren’t always so relaxing. Much of their fare is loaded with sodium, a main component of salt. In fact, some entrees at popular chains contain far more than 2,300 milligrams (mg) of sodium — the recommended limit for an entire day’s worth of food.

Limiting sodium is especially important for people with high blood pressure, because excess salt worsens this common condition, leaving you more prone to heart attack and stroke. If you eat out only once a month, you probably needn’t worry too much. But Americans tend to eat out far more frequently — about five times a week, on average.
For starters, do your prep work

But there are plenty of strategies for staying within your salt budget when eating out, starting before you even leave home, says Debbie Krivitsky, director of clinical nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital. When possible, check the restaurant’s website to look up the nutrition information (including sodium) for different menu items beforehand. You can also search for your favorite dishes at CalorieKing, which includes nutrient data for foods from hundreds of popular nationwide chains. Federal law now requires all restaurants with more than 20 locations to provide this information.

Not surprisingly, the highly processed fare at fast-food restaurants is quite salty (for example, a Big Mac has 950 mg of sodium). Beware of unexpected sources: a Dunkin’ Donuts reduced-fat blueberry muffin contains 540 mg of sodium. But sit-down restaurants aren’t all that much better. “The typical meal at a chain sit-down restaurant contains about 2,100 mg of sodium for every 1,000 calories,” says Krivitsky.

Certain cuisines tend to have higher sodium levels than others. Asian restaurants use a lot of sodium-rich soy and fish sauces, and Italian food (especially pizza) has high-sodium sauces, cheeses, and cured meats, such as pepperoni and prosciutto.
Fresher options and menu tweaks

A better option (if available) is a “farm-to-table” restaurant. These newly fashionable eateries focus on fresh and often locally grown or raised foods. While they may not provide nutritional information, these establishments — as well as other neighborhood and smaller “mom-and-pop” places — may be willing to work with you to prepare a lower-sodium meal. These days, with more people following gluten-free and vegan diets, they’re used to making adjustments. And it’s in their best interest to make their customers happy.

If you’re comfortable doing so, tell your server you have a medical condition or are taking medication and need to limit your salt. They may be more inclined to take you seriously, says Krivitsky. Then say, “Please tell the chef to grill, broil, or steam my food with no added seasonings or sauces.” If you’re ordering a piece of meat, chicken, or fish, find out the weight of the serving size. Have the server bring you a plate with only the amount you want to eat and bag the rest to take home.

If you’ve got your heart set on a special entree that’s over your sodium budget, ask the server to box up half of the dish to save for the next day before bringing it to your table. That way, you can enjoy the portion without being tempted to pick at the rest just because it’s in front of you.
Harvard Medical School (HMS) has a bicycle-friendly campus. Faculty, staff, and students who commute by bike can park their wheels in secured cages, wash off road grime in showers, buy new helmets at a discount, and receive a monthly reimbursement for bike maintenance costs. HMS encourages bicycle commuting not just to relieve parking congestion and foster cleaner air, but also because observational studies have suggested that cycling, like other forms of exercise, is good for us.

A recent study suggests that bicycle commuting, like recreational cycling, is not only associated with a lower risk of serious disease, but with a longer life as well. For that study, researchers from the University of Glasgow followed more than 263,450 commuters in England, Scotland, and Wales for an average of five years. The group was composed of 52% women and 48% men ages 40 through 69.

The researchers divided the participants into five groups based on how they got to and from work on a typical day — walking, cycling, riding in a car or on public transportation, mixed walking (a combination of walking and riding), and mixed cycling (cycling and riding). They found that compared with riding to work, bike commuting was associated with a lower risk of being diagnosed with cardiovascular disease or cancer, or dying of any cause during the five-year period. Walking was associated with a lower risk of developing cardiovascular disease.
The benefits of biking outweigh the risks

“The benefits of regular physical activity are well documented, but there have been concerns that traffic crashes may negate the benefits from commuting by bicycle,” says Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, and a bicycle commuter himself. “This study is important because it confirms, with a much larger sample size, previous findings from other countries. Moreover, it shows that the benefits strongly outweigh the risks.”

The study also provides some assurance to cyclists in the US, where biking conditions are similar to those in the United Kingdom and less friendly than in many European countries. For example, in the Netherlands the bicycle is the major mode of transportation for more than a third of the population, who have access to separated cycle tracks, networks of bicycle paths, and ample dedicated bike parking, and where traffic laws give them the right of way over cars, trucks, and buses. A 2015 analysis conducted by researchers at the University of Utrecht determined that cycling prevents about 6,500 deaths each year in the Netherlands and is responsible for adding six months to the life expectancy of the average Dutch person.

Read More »

Run for your (long) life

While the adjective salty can be used in today’s slang to describe one’s personality, it also pertains to our food. It’s saturated in it. And that’s not good.
Salt: The good, the bad, and the too much

Sodium is an essential part of our diet. It helps nerves and muscles function as well as hold onto water. Sodium in the blood is what keeps it viscous, but too much sodium means your body could retain too much liquid. This surge in volume increases blood pressure, which is the root of many serious ailments including heart and kidney disease. Experts estimate that we could save 280,000 lives in the United States if we lowered the average daily sodium intake by 40% for the next 10 years. And that’s just because lowering blood pressure protects the heart.

The average American consumes 3,409 milligrams of sodium each day, according to a new report from the Centers for Disease Control and Prevention. That’s way above the amount we should be getting per day: 1,500 mg. It means we’re ingesting 1.5 teaspoons of salt each day, when we really need only a third of that. And most of that sodium comes from prepared and processed foods — 75%, actually. Salt helps to preserve and add flavor to food, which is great when you want that strawberry Pop-Tart to taste the same whether you eat it the day after you buy it or a month after. But the CDC recently published a list of the 10 most sodium-dense foods in our diets. You know what’s at the top? Yeast bread, pizza, and sandwiches. The good stuff, the convenient stuff, the stuff like Pop-Tarts.
Dialing back the sodium

Cutting back on sodium in our prepared foods has been made easier by the increase in packaged food companies’ creating reduced-sodium versions of them, like low-sodium chicken broth. While that sounds simple, sodium lurks in some unexpected places. Kathy McManus, director of the Department of Nutrition at Brigham Health/Brigham and Women’s Hospital, says there are some ways to cut back on sneaky salt.

McManus says a good way to reduce the amount of sodium you eat is to focus on natural and whole foods. Preparing your own food, while sometimes inconvenient, can cut down on a lot of the sodium you consume. For instance, a frozen dinner of Marie Callender’s Vermont White Cheddar Mac and Cheese contains more sodium in one meal than you’re supposed to have in an entire day. But it’s not that hard to prepare a decadent mac and cheese yourself with Barilla pasta, your own white cheddar cheese, and a little cream. The sodium count comes out to around 715 mg. That is much more manageable when watching your sodium intake. It’s less convenient, but it works.

Buying low-sodium products and then adding salt to them is still better than buying the regular version. Cooking techniques can also help compensate for flavor lost when cutting back on salt. McManus suggests playing around with grilling or stir-frying with healthy oils to change the flavor. You can also add fresh or dried herbs to enhance taste. Over time, your taste buds will adjust. Your palate will change. You’ll be less accustomed to salt and less desensitized to it, so a little bit will travel farther in terms of flavor.

Restaurants remain at the top of the list for sodium-dense meals. Looking at the menu online ahead of time can help you prepare and research your options, but so can keying in on words that indicate healthier options. Look for baked, grilled, or steamed as a description for lean meats like fish or poultry. Keep an eye out for sides that are prepared simply, like vegetables. Avoid soups or pastas with sauces. Put salad dressing on the side, and definitely avoid the bread basket.
Top 10 high sodium foods

Nutrition is not a one-size-fits-all kind of science, but it does get us thinking about what we eat and how it affects us. You could never cut sodium completely out of your diet, nor would you want to, but you can be more aware of the sodium in the foods you eat. To see the complete list of high-sodium foods, check out the table below. In April, researchers announced empowering results from a pilot investigation of men with metastatic prostate malignant growth, or disease that has spread past the prostate organ. Since a long time ago viewed as hopeless, these propelled malignant growths are normally treated by giving men foundational drugs that objective new tumors framing in the body. The researchers who drove this new examination adopted an increasingly forceful strategy. Notwithstanding giving fundamental treatment, they precisely evacuated the prostate organ and influenced lymph hubs, and furthermore treated unmistakable malignancy during the bones with radiation. By tossing everything except for the kitchen sink at these malignancies, they accomplished a staggering outcome: a portion of the treated men are still disease free following four years, and one has lived without proof of malignancy for a long time. "On the off chance that these reductions endure sufficiently long, at that point we need to solicit whether some from these men have been relieved of their malady," said the examination's lead creator, Dr. Matthew O'Shaughnessy, a urologic oncologist at the Memorial Sloan Kettering Cancer Center, in New York.

How the investigation was led

The little pilot ponder enlisted 20 men, and O'Shaughnessy stressed that catch up with a bigger gathering is expected to affirm the outcomes. Five of the men had malignant growth that had spread to lymph hubs in the pelvis, and 15 of them had harmful injuries in their bones. Every one of the men were treated for somewhere in the range of six and eight months with hormonal treatment, which squares testosterone (the male sex hormone that influences prostate malignancy cells to become quicker). As noted beforehand, they likewise had their prostates and lymph hubs evacuated, and bone injuries were treated with radiation as required. What the analysts were going for is a finished nonattendance of prostate-explicit antigen (PSA) in blood for at least 20 months after the beginning of hormonal treatment. Prostate malignancy cells will shed PSA into blood, yet on the off chance that the organ has been expelled and all hints of disease expelled from the body, the dimensions should drop to zero and remain there, even after testosterone levels come back to typical.

Generally speaking, five men had imperceptible PSA at 20 months and tallying, despite the fact that that number is too little to even think about drawing any decisions about who may profit most from the methodology. As indicated by O'Shaughnessy, when utilized together hormonal treatment, medical procedure, and radiation all added to delayed reductions that would not have been conceivable if just a single treatment was utilized. An examination utilizing similar techniques is made arrangements for in the not so distant future.

What this implies for treating propelled prostate malignant growth

Up to this point, taking out the prostate and lymph hubs in men with cutting edge prostate malignant growth would have been unbelievable. Specialists stressed that medical procedure could discharge malignancy cells into the circulation system, however fresher examinations show it can securely protract survival. Specialists have additionally been joining hormonal treatment and radiation with empowering results, and now giving each of the three medications is "steady with a pattern of supporting propelled prostate disease than doing less," said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and manager in head of HarvardProstateKnowledge. All things considered, Garnick alerts that remedies for cutting edge prostate disease can take a long time to affirm. "Ideally follow-up research will bolster this transformative methodology," he said. “Researchers find that running can add three years to your life!” shout the headlines. And yes, a new study did find that cardiovascular exercise, including running, can decrease the risk of death, and potentially prolong life. But there’s more: the authors not only include analyses of piles of data, but also an exhaustive review of just about every other study of cardiovascular fitness and mortality out there. They cite (and discuss) almost 70 reference articles!
By popular demand…

Their newest study came about due to demand. The authors had previously published data from over 55,000 people followed for over 15 years, and found that running was associated with a 45% reduced risk of death from heart attacks and strokes, as well as a 30% reduced risk of death from anything. This benefit was seen even with as little as five to 10 minutes a day of running, even at paces as slow as six miles per hour, and after accounting for age, sex, weight, and other health risk variables (like high blood pressure, diabetes, smoking, and alcohol consumption).

These findings made sense, as other studies had found that in addition to reducing the risk of cardiovascular disease, running also lowered the chances of developing cancer and neurologic diseases (such as Alzheimer’s and Parkinson’s). But there were questions:

    People demanded to know, was there any such thing as too much running?
    The original data set consisted of mostly college-educated, middle-class adult males. What about other populations?
    What about other cardiovascular exercise, such as walking, cycling, or other sports? Any benefits from those?
    The authors themselves point out that in the original study, running was based on self-report. Would their findings hold up if they looked at more objective measures of fitness?

The latest on running and longevity

So, the authors went back to their own data pool, and others. They found, again, that running just about any amount increased people’s lives by about three years; put another way, running for an hour provided seven hours of life benefit.

This benefit topped off at about 4.5 hours of running per week, so the people who ran more than that didn’t live any longer. They didn’t live any shorter, either: there was no risk associated with running longer or farther. They looked at other large studies, and saw that similar results had been found for women and other ethnic groups, as well. And, while other physical activities like walking and cycling offer some benefit, it’s less than running.

How can we explain these findings? The authors hypothesize that running is a particularly effective way to increase our cardiorespiratory fitness level, which is typically measured in metabolic equivalents (METs), like in a treadmill stress test. The authors had treadmill stress test data, and they found that a lower MET measurement (a lower fitness level) was associated with 16% of all deaths — more than high blood pressure, smoking, obesity, high cholesterol, and diabetes.
The takeaways from all these data are…

The lower our fitness level, the higher our risk of death, from just about any cause. Just being inactive accounts for approximately 9% of deaths worldwide (the fourth leading cause of death, by the way, after smoking, diabetes, and high blood pressure). This has been shown time and again. In this current study, even five minutes of running a day was beneficial.

The higher our fitness level, the lower our risk of death. The authors suggest that doctors should “measure” fitness levels, either self-reported physical activity or objectively measured cardiopulmonary fitness during routine physical exams. Fitness levels should be considered just as much as vital signs and the other things we currently measure, like body mass index and blood pressure.

Read More »

Racket sports serve up health benefits

It’s the end of the school year, the time of graduation speeches, of looking back at accomplishments and making plans for new ones. It’s a time when many parents think about their hopes and dreams for their children, whether they are graduating or just learning to walk.

As parents, we tend to think about getting good grades, excelling at athletics, being popular, getting into good schools, and getting good jobs. All of this is great, of course. But there is something that children need if they are going to truly succeed in life, and that’s resilience.

Resilience is the ability to overcome hardship and be okay. It’s the ability to navigate life’s inevitable bumps and still be happy and healthy and stay on track. What worries me sometimes is that our current parenting culture of achievement and obsessing over safety — and the way that electronic devices have become so ubiquitous — may get in the way of learning resilience.

According to Harvard University’s Center on the Developing Child, there are four factors that help children develop resilience. They are:

    Supportive adult-child relationships. This is crucial. All it really takes is one supportive, nurturing relationship to make all the difference. This gives children a buffer, and helps them know that they aren’t alone and that they matter to someone. While all parents want to have a good relationship with their child, the demands of daily life can get in the way. Try to spend regular time with your child when they have your undivided attention. Ask about their day, get involved in activities they enjoy, spend time doing things together. Make sure your child knows that no matter what, you have their back — and you will love them.
    A sense of self-efficacy and perceived control. Basically, you want to help a child learn that they can manage, and that even if things go wrong, they can figure a way through. You can’t do this just by telling your child that he is smart and capable; he needs to learn it himself. Bit by bit, giving independence, letting children make decisions and take risks helps them learn to weather life’s storms. It’s not always easy to let children take risks —we never want them to be hurt, emotionally or physically — but with you at their back, and in a gradual way, most children can and do manage just fine. Learning this also involves shutting off the screens and being active. Learning to be physically capable is important. In being active, in running and climbing and other such activities, children learn not just their strengths and limitations but how to plan and troubleshoot.
    Strong adaptive skills and self-regulatory capacities. This is what we call “executive function.” It’s like the air traffic controller functions of life: the ability to prioritize, not get distracted, make a plan, negotiate, get along with others, and manage emotions. These are not easy tasks, and there is no way to learn them without practice. One of the best ways for children to practice is through unstructured playtime, either alone (so they can find ways to entertain themselves) or with others (so they can learn how to work with others). Consistent discipline, not giving in to tantrums, and helping children manage sadness or frustration rather than just fixing things for them, can also help. The Center on the Developing child also has suggestions on activities to support executive function at different ages.
    Being able to mobilize sources of faith, hope, and cultural traditions. It helps to be part of something bigger, to have community, to have traditions that help you through difficult times. This doesn’t mean that you need to join a faith if you don’t belong to one. But if you do, maybe you could go to services a bit more often. If you don’t, spending time with extended family, joining a community group, taking part in service opportunities together… these activities can help give your child a perspective on life, as well as strategies for handling challenges. Because ultimately, the ability to keep perspective and handle challenges is what gets us through and helps us succeed.

In April, scientists reported encouraging results from a pilot study of men with metastatic prostate cancer, or cancer that has spread beyond the prostate gland. Long considered incurable, these advanced cancers are usually treated by giving men systemic drugs that target new tumors forming in the body. The scientists who led this new study took a more aggressive approach. In addition to giving systemic therapy, they surgically removed the prostate gland and affected lymph nodes, and also treated visible cancer in the bones with radiation. By throwing everything but the kitchen sink at these cancers, they achieved a stunning result: some of the treated men are still cancer-free after four years, and one has lived without evidence of cancer for five years. “If these remissions persist long enough, then we have to ask whether some of these men have been cured of their disease,” said the study’s lead author, Dr. Matthew O’Shaughnessy, a urologic oncologist at the Memorial Sloan Kettering Cancer Center, in New York.
How the study was conducted

The small pilot study enrolled 20 men, and O’Shaughnessy emphasized that follow-up with a larger group is needed to confirm the results. Five of the men had cancer that had spread to lymph nodes in the pelvis, and 15 of them had cancerous lesions in their bones. All the men were treated for between six and eight months with hormonal therapy, which blocks testosterone (the male sex hormone that makes prostate cancer cells grow faster). As noted previously, they also had their prostates and lymph nodes removed, and bone lesions were treated with radiation as needed. What the researchers were aiming for is a complete absence of prostate-specific antigen (PSA) in blood for a minimum of 20 months after the start of hormonal therapy. Prostate cancer cells will shed PSA into blood, but if the gland has been removed and all traces of cancer removed from the body, the levels should drop to zero and stay there, even after testosterone levels return to normal.

Overall, five men had undetectable PSA at 20 months and counting, although that number is too small to draw any conclusions about who might benefit most from the approach. According to O’Shaughnessy, when used together hormonal therapy, surgery, and radiation all contributed to prolonged remissions that would not have been possible if only one treatment was used. A study employing the same methods is planned for later this year.
What this means for treating advanced prostate cancer

Until recently, taking out the prostate and lymph nodes in men with advanced prostate cancer would have been unthinkable. Doctors worried that surgery could release cancer cells into the bloodstream, but newer studies show it can safely lengthen survival. Researchers have also been combining hormonal therapy and radiation with encouraging results, and now giving all three treatments is “consistent with a trend of doing more for advanced prostate cancer than doing less,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. Still, Garnick cautions that cures for advanced prostate cancer can take decades to confirm. “Hopefully follow-up research will support this transformative approach,” he said.
When I was a kid, my summer sport of choice was baseball. Every day I played in marathon neighborhood games until it was too dark to see the ball. It was about fun and not fitness. But now that I’m older, and my Louisville Slugger has been officially retired, I need a summertime sport that recaptures the playfulness of my youth, but also works to keep my physical and mental skills sharp.

So, I picked up a racket.

It turns out that racket sports are not only fun, but they may help me live longer. A study published online by the British Journal of Sports Medicine examined the link between six different types of exercise and the risk of early death. Researched looked at racket sports, swimming, aerobics, cycling, running, and soccer. Study volunteers included 80,306 people, who ranged in age from 30 to 98. Over the course of the study’s nine years, those who regularly played racket sports were 47% less likely to die of any cause and 56% less likely to die of cardiovascular disease.

“In many ways, racket sports like tennis, squash, badminton, racquetball, Ping-Pong, and other variations are the ideal exercise for many older adults,” says Vijay A. Daryanani, a physical therapist and personal trainer with Harvard-affiliated Spaulding Outpatient Center. “Besides offering a good cardiovascular workout, they can help with both upper- and lower-body strength at one time. They can be played at any age, can be modified to fit most fitness levels, and do not involve a lot of equipment.”
Body and mind games

Racket sports offer something other fitness sports do not — lateral movement. “Most of our lives are spent moving forward, and that includes our exercise,” says Daryanani. “Racket sports force you to move both back and forth and side to side. This helps improve balance and weight shifting, which can lower your risk of falls.”

This kind of activity also exercises your mind. From a cognitive standpoint, it sharpens your planning and decision-making skills, as you must constantly anticipate and execute your next shot.

Racket sports also serve up a strong social component. You play against other people — either as a single or part of a doubles team — while other exercises like running, swimming, and cycling are more isolated activities. Frequent social contact is essential for a long and healthy life. In fact, a 2012 study in the Archives of Internal Medicine found that loneliness was associated with functional decline and an increased risk of death among adults older than age 60.
Pick up pickleball

While there are many types of racket sports to try, one of the fastest-growing among older adults is “pickleball.” It’s a hybrid sport that blends tennis, table tennis, and the backyard childhood game of Wiffle ball. The paddle is between a table tennis paddle and a tennis racket in size and made of lightweight composite material, such as aluminum or graphite, which cuts down on fatigue. The plastic pickleball resembles a larger Wiffle ball and travels about one-third the speed of a tennis ball, so it is easier to see and hit. Pickleball is played both indoors and outdoors. The court is 20 by 44 feet, or about the size of a double badminton court. The net is shorter than a tennis net, which makes it easier to hit over. Here are the basic rules:

Read More »