Sunday, January 27, 2008

Train Brain to Think Thin

Dr. Judith Beck is the Director of the Beck Institute for Cognitive Therapy and
Research, Clinical Associate Professor of Psychology in Psychiatry at the University of Pennsylvania, and author of Cognitive Therapy: Basics and Beyond. Her most recent book is The Beck Diet Solution: Train Your Brain to Think Like a Thin Person.

ref: SharpBrains Nov 2007

The main message of cognitive therapy overall, and its application in the diet world, is straight-forward:
problems losing weight are not one’s fault.
Problems simply reflect lack of skills--skills that can be acquired and mastered through practice. Dieters who read the book or workbook learn a new cognitive or behavioral skill every day for six weeks. They practice some skills just once; they automatically
incorporate others for their lifetime.

What are the cognitive and emotional skills and habits that dieters need to train, and where your book helps?
Great question. That is exactly my goal: to show how everyone can learn some critical skills. The key ones are:
1) How to motivate oneself. The first task that dieters do is to write a list of the 15 of 20 reasons why they want to lose weight and read that list every single day.
2) Plan in advance and self-monitor behavior. A typical reason for diet failure is a strong preference for spontaneity. I ask people to prepare a plan and then I teach them the skills to stick to it.
3) Overcome sabotaging thoughts. Dieters have hundreds and hundreds of thoughts that lead them to engage in unhelpful eating behavior. I have dieters read cards that remind them of key points, e.g., that it isn’t worth the few moments of pleasure they’ll get from eating something they hadn’t planned and that they’ll feel badly afterwards; that they can’t eat whatever they want, whenever they want, in whatever quantity they want, and still be thinner; that the scale is not supposed to go down every single day; that they deserve credit for each helpful eating behavior they engage in, to name just a few.
4) Tolerate hunger and craving. Overweight people often confuse the two. You experience hunger when your stomach feels empty. Craving is an urge to eat, usually experienced in the mouth or throat, even if your stomach is full.

When do people experience cravings?
Triggers can be environmental (seeing or smelling food), biological (hormonal changes), social (being with others who are eating), mental (thinking about or imagining tempting food), or emotional (wanting to soothe yourself when you’re upset). The trigger itself is less important than what you do about it. Dieters need to learn exactly what to say to themselves and what to do when they have cravings so they can wait until their next planned meal or snack.

How can people learn that they don’t have to eat in response to hunger or craving?

I ask dieters, once they get medical clearance, to skip lunch one day, not eating between breakfast and dinner. Just doing this exercise once proves to dieters that hunger is never an emergency, that it’s tolerable, that it doesn’t keep getting worse, but instead, comes and goes, and that they don’t need to “fix” their usually mild discomfort by eating. It helps them lose their fear of hunger. They also learn alternative actions to help them change their focus of attention. Feel hungry? Well, try calling a friend, taking a walk, playing a computer game, doing some email, reading a diet book, surfing the net, brushing your teeth, doing a puzzle. My ultimate goal is to train the dieter to resist temptations by firmly saying “No choice,” to themselves, then naturally turning their attention back to what they had been doing or engaging in whatever activity comes next.

You said earlier that some cravings follow an emotional reaction to stressful situations. Can you elaborate on that, and explain how cognitive techniques help?

In the short term, the most effective way is to identify the problem and try to solve it. If there’s nothing you can do at the moment, call a friend, do deep breathing or relaxation exercises, take a walk to clear your mind, or distract yourself in another way. Read a card that reminds you that you’ll certainly not be able to lose weight or keep it off if you constantly turn to food to comfort yourself when you’re upset. People without weight problems generally don’t turn to food when they’re upset. Dieters can learn to do other things, too.
And in the long term, I encourage people to examine and change their underlying beliefs and internal rules. Many people, for example, want to do everything (and expect others to do everything) in a perfect way 100% of the time, and that is simply impossible. This kind of thinking leads to stress.

Build up Brain Reserve - Delay Alzheimers

Building Your Cognitive Reserve

SharpBrains 2007 Nov
Alvaro Fernandez (AF): Dr. Yaakov Stern (YS)


AF: OK, so our goal is to build that Reserve of neurons, synapses, and skills. How can we do that? What defines “mentally stimulating activities” or good “brain exercise”?
YS: In summary, we could say that “stimulation” consists of engaging in activities. In our research almost all activities are seen to contribute to reserve. Some have challenging levels of cognitive complexity, and some have interpersonal or physical demands. In animal studies, exposure to an enriched environment or increased physical activity result in increased neurogenesis (the creation of new neurons).
You can get that stimulation through education and/ or your occupation. There is clear research showing how those two elements reduce the risk. Now, what is very exciting is that, no matter one’s age, education and occupation, our level of participation in leisure activities has a significant and cumulative effect. A key message here is that different activities have independent, synergistic, contributions, which means the more things you do and the earlier you start, the better. But you are never stuck: better late than never.

AF: Can you give us some examples of those leisure activities that seem to have the most positive effects?

YS: For our 2001 study we evaluated the effect of 13 activities, combining intellectual, physical, and social elements. Some of the activities with the most effect were reading, visiting friends or relatives, going to movies or restaurants, and walking for pleasure or going on an excursion. As you can see, a variety. We saw that the group with high level of leisure activities presented 38% less risk (controlling for other factors) of developing Alzheimer’s symptoms. And that, for each additional type of activity, the risk got reduced by 8%. There is an additional element that we are starting to see more clearly. Physical exercise, by itself, also has a very beneficial impact on cognition. Only a few months ago researchers were able to show for the first time how physical activity promotes neurogenesis in the human brain. So, we need both mental and physical exercise. The not-so-good news is that, as of today, there no clear recipe for success. More research is needed before we prepare a systematic set of interventions that can help maximize our protection.

AF: We typically emphasize the importance of a good nutrition, physical exercise, stress management and mental exercise that presents novelty, variety and challenge. What do you think of the relatively recent appearance of so many computer-based cognitive training programs, some more science-based than others?

YS: Those elements you mention make sense. The problem is that, at least from the point of view of Alzheimer’s, we cannot be much more specific. We don’t know if learning a new language is more beneficial than learning a new musical instrument or using a computer-based program. A few of the cognitive training computer programs we have seen, like the one you discussed with Prof. Daniel Go6pher to train the mental abilities of pilots, seem to have clear effects on cognition, generalizing beyond the training itself. But, for the most part, it is too early to tell the long-term effects. We need better designed clinical trials with clear controls. Right now, the most we can say is that those who lead mentally stimulating lives, through education, occupation and leisure activities seem to have the least risk of developing Alzheimer’s Disease.

Saturday, January 26, 2008

Exercise is Good for Brain

Exercise and the Brain

http://web.sfn.org/index.cfm?pagename=brainBriefings_exerciseAndTheBrain

For years many exercise enthusiasts have suspected that exercise positively affects the brain as well as the body. But while it seemed logical that an active lifestyle would help the brain, the scientific evidence was lacking. Now several biological studies indicate that working out does benefit the brain. The new insights help confirm the notion that exercise has overall health benefits and also may lead to specialized physical activity programs for patients.

Kickboxing. Salsa aerobics. A spinning class. Or maybe you'll simply run some laps around the park. Then again, watching the barbecue cook-off on the food channel from your recliner or hot tub seems the most appealing. Why even bother with the whole work-out thing?
The reasons to get moving are greater than you think. It's common knowledge that physical activity generally makes you feel good and helps keep your body lean and in prime working order. Now researchers also are finding biological evidence that exercise benefits specific brain mechanisms.

The findings, culled from a spattering of animal studies, are leading to:

  • A better understanding of the overall health rewards of exercise.
  • Heightened support for exercise regimens that could aid recovery from a wide range of illnesses.

Much of the new research suggests that exercise positively affects the hippocampus, a sea-horse shaped brain structure that is vital for memory and learning.
In one recent study, researchers found that adult mice doubled their number of new brain cells in the hippocampus when they had access to running wheels. The fact that the mammalian adult brain can increase its number of brain cells is surprising in itself. It was once thought that the brain stopped producing new brain cells early in its development. And presumably brain power dimmed as cells died over the years. But in the past decade, researchers have found definitive evidence that the brain continues to generate new brain cells throughout life, even in humans. Studies indicated that challenging environments, which included a number of components, such as pumped-up learning opportunities, social interactions and physical activities, were key to boosting the growth.
In the new study, the scientists found that voluntary physical activity alone was enough to trigger a boost in brain cell proliferation. So far, the proliferation is seen only in relation to the running wheel. Swimming produced no change in mice and rats, but this may be because these rodents had pool access for only a brief stint per day. The runners had round-the-clock wheel access. It's also possible that rodents don't enjoy swimming and it causes a stress to their systems that counters any benefit. Researchers believe that rodents particularly enjoy the running wheel because they will voluntarily trot away on one if it's in their cage. Mice will log some 20,000 to 40,000 revolutions or four to six miles per day.
In the next phase of the research, scientists are trying to map the biological steps that induce the brain cell proliferation in the runners. One participant in the growth phenomenon may be brain-derived neurotrophic factor, which supports the function and survival of brain cells. The factor increased in the hippocampi of rats that voluntarily exercised on running wheels, according to an earlier report.
In addition, scientists are studying whether exercise alters the molecular mechanisms that are important for learning and memory. It seems likely since the cell research shows that changes occur in the brain's learning and memory center. In addition, past behavioral research on mice indicated that treadmill running improved certain learning and memory tasks. Even members of a family of mice that were poor learners improved their performances on the tasks. The exercise also prevented an age-related decline in mouse performance.
Researchers also are finding biological evidence that exercise can help the brain on other fronts. For example, animal studies are determining that exercise prevents the negative effects of chronic stress on the brain at the molecular level and boosts the brain's biological battle against infection.
Together the group of studies suggests that an active lifestyle, whether filled with exotic gym classes or simple jogs, plays an important role in maintaining the function of the brain. Furthermore, the research indicates that specialized exercise regimens may help repair damaged or aged brains. Scientists are currently investigating this possibility.


Dancing Delays Dementia

Mental stimulation staves off dementia

Main Category: Seniors / Aging
Article Date: 23 Jun 2003 - 0:00 PST
http://www.medicalnewstoday.com/articles/3813.php

If you like to play chess, bridge or a musical instrument, do not let old age stop you. A new study, conducted over two decades, concludes that regular exercise - the kind that challenges the mind - appears to ward off dementia.

The research adds to a growing body of evidence that exercising the mind reduces the chances of Alzheimer's and other forms of dementia related to old age.

The latest study, conducted by researchers at the Albert Einstein College of Medicine in New York, found that mentally active seniors reduced their risk of dementia by as much as 75 percent, compared to those who do not stimulate their minds.

Experts agree that physical exercise is necessary for a healthy lifestyle, regardless of age. But the researchers also looked at whether physical activity contributes to mental agility.

Albert Einstein neurologist Joe Verghese, who led the study, said most of the types of physical exercise they looked at did not appear to significantly reduce the risk of dementia in older adults, with one exception.

'It turns out that one of the 11 activities, the physical activities we studied, that was associated with a significant risk reduction when looked at one-by-one, and that was dancing. It may be that dancing is not purely physical, in the sense that it does involve a lot of mental effort,' he said.

The benefit of mental exercise among seniors was seen in all of the elderly participants, regardless of their intelligence.

During the course of the 21-year study, researchers followed more than 450 people over the age of 75, beginning in 1980. None of the participants suffered from dementia at the start. Investigators tracked how many of the participants developed Alzheimers disease and other forms of dementia, and looked at what activities they had engaged in.

The seniors who remained mentally active showed the least decline in mental acuity.

James Coyle is a professor of psychiatry and neuroscience at Harvard University Medical School in Boston, who wrote an independent review of the study. Dr. Coyle said there is growing evidence that mental exercise may do more than forestall dementia, it may actually repair the brain, as well.

'And that as we use the brain to do particular things, it rewires itself. Perhaps the most interesting thing is the evidence that has accrued over the last couple years that there are stem cells in the brain, and that, in the adult brain, new neurons can be generated,' Dr. Coyle said.

The results of the Albert Einstein study were published in the New England Journal of Medicine.

Stress Killing You softly

It’s clear that our society has changed faster than our genes. Instead of being faced with physical, immediately life-threatening crises that demand instant action, these days we deal with events and illnesses that gnaw away at us slowly without any stress release.

Dr. Robert Sapolsky, in an interview about his book Why Zebras Don’t Get Ulcers, points out that humans uniquely “can get stressed simply with thought, turning on the same stress response as does the zebra.” But, the zebra releases the stress hormones through life-preserving action, while we usually just keep muddling along, getting more anxious by the moment.

Prolonged exposure to the adrenal steroid hormones, like cortisol, released during stress can damage the brain and block the formation of new neurons in the hippocampus, which is the key player in encoding new memories in your brain. Recent studies have shown these neurons can be regenerated with learning and environmental stimulation, but while short-term stress may improve attention and memory, chronic stress leads indirectly to cell death and hampers our ability to make changes and be creative enough to even think of possible changes to reduce the stress.

What are the best defenses against chronic stress?

1. Exercise strengthens the body and can reduce the experience of stress, depression, and anxiety. Exercise promotes arousal and relaxation and improves quality of sleep.

2. Relaxation through meditation, biofeedback, yoga, or other techniques to lower blood pressure, slow respiration, slow metabolism, and release muscle tension.

3. Empowerment because attitudes of personal confidence and control of your environment, even if illusory, resolve the stress response.

4. Social network of friends, family, and even pets help foster trust, support, and relaxation.

So hey, go ahead, call your mom. It may save your life!

Further resources:
Brain Fitness Articles, Now with Some Humor
Robert Sapolsky on Stress
Stress Management Tips from the Serengeti
Prenatal stress suppresses cell proliferation in the early developing brain

Saturday, January 12, 2008

Eat Whole Grain to Reduce Diabetic Risk

Arrow Whole Grain Consumption Lowers Diabetes Risk

Physician's First Watch for August 29, 2007

Eating more whole grains could reduce diabetes risk, reports a study in PLoS Medicine.

As part of the Nurses' Health Study, researchers periodically recorded consumption of whole grains in some 160,000 women. After 12 to 18 years' follow-up, the multivariate-adjusted risk for type 2 diabetes was about 35% lower in women in the highest quintile of whole grain intake compared with those in the lowest quintile. Although further adjustment for BMI "substantially weakened the association," significant differences remained.

Researchers also conducted a meta-analysis of six prospective studies of men and women and concluded that a two-servings-per-day increment in whole grain consumption was linked to a 21% lower risk for diabetes.

The authors note that on average, adults eat one serving of whole grains per day, "suggesting that increased consumption has the potential to contribute substantially to reducing risk of type 2 diabetes."

PLoS Medicine article (Free

Control BP & Blood Sugar to Delay Eye Damage

Blood Pressure and Glycemic Control Key to Preventing Diabetic Retinopathy

Physician's First Watch for August 22, 2007

Strict blood pressure and glycemic control are effective in reducing vision loss from diabetic retinopathy and remain "the cornerstone in the primary prevention" of the disorder, according to a review published in JAMA.

Researchers examined 41 studies with a minimum follow-up of 12 months and 3 meta-analyses.

The 10-year Diabetes Control and Complications Trial found that, over 6.5 years of follow-up, intensive glycemic control in patients with type 1 diabetes reduced the incidence of diabetic retinopathy by 76% and progression by 54%, compared with conventional treatment. Tight blood pressure control had a similar effect, with one U.K. study reporting a 34% reduction in progression after 9 years' follow-up.

JAMA article (Free abstract; full text requires subscription

Non Fasting Triglycerides Predict Risk for Heart Disease

Nonfasting Trigylceride Levels Seem Better at Defining Risk for Heart Disease


Physician's First Watch for July 18, 2007


Two studies measuring triglycerides in the nonfasting state show a strong association between elevated levels and risk for cardiovascular disease or death. Both appear in today's JAMA.

One study, using a population sample from Copenhagen, followed nearly 14,000 men and women for an average of 26 years. Researchers found that the risk for MI, ischemic heart disease, or death increased with increasing levels of nonfasting triglycerides, especially among women.

Another study, performed within the Women's Health Initiative, followed some 26,500 women for a median of 11 years and compared the effects of fasting versus nonfasting triglycerides on risk for cardiovascular events. When measured in the nonfasting state (especially 2 to 4 hours postprandially), triglyceride levels showed a strong, independent association with future risk, which persisted in fully adjusted analyses. Fasting levels, according to the authors, "showed little independent association with cardiovascular events."

According to an editorialist, the results "suggest that using 2- to 4-hour postprandial triglyceride measurements may be more predictive [of risk] than LDL-C."

JAMA article on risk in Copenhagen population (Free abstract; full text requires subscription)

JAMA article on risk in Women's Health Initiative participants (Free abstract; full text requires subscription)

JAMA editorial (Subscription required)

Older Diabetic Drugs as effective

Older Diabetes Drugs at Least as Effective as Newer Ones

Physician's First Watch for July 17, 2007

Older oral drugs for type 2 diabetes are at least as effective as newer agents, according to a systematic review released early online in Annals of Internal Medicine.

The review included data from more than 200 studies of older diabetes agents (metformin and second-generation sulfonylureas) and newer drugs (e.g., thiazolidinediones). Among the findings:

  • Most agents lowered hemoglobin A1c to a similar extent.
  • Metformin was the only drug that decreased LDL cholesterol and one of the only ones that didn't increase body weight.
  • Thiazolidinediones raised HDL cholesterol but also increased LDL cholesterol.
  • Second-generation sulfonylureas were associated with greater risk for hypoglycemia; metformin with gastrointestinal symptoms; and thiazolidinediones with edema.

The authors conclude that metformin "seemed to have the best profile of benefit to risk." They note that metformin and sulfonylureas offer three advantages over newer agents: "lower cost, longer use in practice, and more intensive scrutiny in long-term trials."

Annals of Internal Medicine article (Free)

International Travel Medical Advice

Arrow CDC Releases Updated "Yellow Book" on International Travel

Physician's First Watch for July 16, 2007

The CDC has released its biennial revision of "the yellow book," a health guide for international travel.

The book describes travel-related infections and diseases endemic to each region. Changes in the latest edition include updates on recommended immunizations, developments in malaria treatment and prevention, advice for avoiding deep vein thrombosis while flying, and a section on avian influenza.

The yellow-covered book, officially titled "CDC Health Information for International Travel 2008," is available free online (and can also be purchased in bookstores).

CDC's "Yellow Book" (Free)


Tuesday, January 8, 2008

Prevent Cancer Tips

Recommendations for Cancer Prevention

1. Be as lean as possible within the normal range of body weight.
2. Be physically active as part of everyday life.
3. Limit consumption of energy-dense foods; avoid sugary drinks.
4. Eat mostly foods of plant origin.
5. Limit intake of red meat; avoid processed meat.
6. Limit alcoholic drinks.
7. Limit consumption of salt; avoid moldy cereals (grains) or pulses (legumes).
8. Aim to meet nutritional needs through diet alone.

Special Population Recommendations

9. Mothers should breast-feed; children should be breast-fed.
10. Cancer survivors should follow the recommendations for cancer prevention.

World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR; 2007.

HPV vaccination Gardasil

AP: Gardasil Most Painful Childhood Vaccination

Physician's First Watch for January 7, 2008

Gardasil, the HPV vaccine, is becoming known as the most painful childhood vaccination, according to the Associated Press.

The AP reports that patients complain of a burning sensation and an inability to drive with or sleep on the affected arm for up to a day. Merck's premarketing studies also showed more reports of pain than with placebo shots.

The AP cited CDC data showing there were 50 reports of vaccine-associated fainting in girls from 2002–2004 and 230 from 2005 until last July; however, it is unclear how many of these incidents were pain-related.

Associated Press story (Free)


Sunday, January 6, 2008

Asthma Guidelines Update 2007

see my blog

http://pediatricianinhouse.blogspot.com/2008/01/asthma-latest-management-guidelines.html

Tuesday, January 1, 2008

Obesity Drugs Moderate Weight Loss

Obesity Drugs Linked to 'Modest' Weight Loss

Physician's First Watch for November 16, 2007

The principal antiobesity drugs have a "modest" effect on weight loss, and their effect on cardiovascular health "remains unknown," according to a BMJ meta-analysis.

Researchers examined 30 double-blind placebo-controlled studies involving orlistat, sibutramine, or rimonabant (a cannabinoid type-1 receptor antagonist not available in the U.S.). The studies all had high attrition rates, averaging over 30%.

The drugs' effects:

  • Orlistat reduced weight more than placebo by 2.9 kg, but produced gastrointestinal side effects, such as oily spotting and fecal urgency;
  • Sibutramine provided a 4.2-kg reduction, but raised blood pressure and pulse rate; and
  • Rimonabant produced a 4.7-kg weight loss, but had a "worrying" incidence of psychiatric disorders.

Commenting on the lack of mortality data offered in the studies, the authors remind us that "drugs that improve surrogate end points, such as weight loss, may not ultimately improve more clinically relevant outcomes."

BMJ article (Free)