Why losing weight is so hard and gaining weight is so easy

You just went away for the weekend and you came back to find that you gained 5 pounds over the course of 3 days. In your disbelief, you quickly curse the Weight Gods for being so cruel. Sound familiar? This was me last weekend. A little jaunt to Montreal, eating at decadent cafes, packed it on quick. This inspired me to discuss the seemingly unbalanced equation of weight gain vs. weight loss, the facts that surround the issue and how losing the 5 pounds feels so much harder than gaining them:

FACT 1 - It is Simple Math: To maintain your ideal weight, you need to eat as many calories as you burn in one day. The balanced equation looks like this:

Calories Eaten = Basal Metabolic Rate + Physical Activity

If what you eat equals more than what your body uses, you will gain weight. In the situation of a vacation, it is likely that you eat more unhealthy food than normal and possibly get less exercise, resulting in an imbalanced equation, with a higher number of calories on the eaten side than on the burned side. That imbalance over the course of a few days can easily represent a few pounds. (To assess an approximate of how many calories you need, click here.)

FACT 2 - A Pound is a Pound is a Pound: One pound of body mass represents 3,500 calories. Regardless, if you are trying to lose a pound or gain a pound, the pound will always represent 3,500 calories. So, if you eat 3,500 calories more than your body requires, you will gain 1 pound. Similarly, if you eat 3,500 calories less than your body requires, you will lose 1 pound.

FACT 3 - Exercise is Weight Discriminating: Whether you are 120 pounds or 175 pounds, you will gain one pound from eating 3,500 calories more than you need. Unfortunately, this doesn't hold true for burning calories. How much you weigh actually dictates how many calories you burn per hour. The more you weigh, the more you burn, and as a result, the easier it is to lose the pound...sound crazy? It is true. Check out the Calories Burned Chart .

FACT 4 - Aging Contributes to Weight Gain: As if aging doesn't contribute enough to unfavorable things, it also contributes to weight gain. As we get older, our metabolism slows down, requiring us to need less food and calories. If you don't modify your caloric intake as you get older to reflect this change in metabolism, you will start to see weight gain.

The Bad News: Unfortunately, eating an extra couple of unhealthy snacks or drinking a few extra glasses of wine can happen in a blink of an eye. However, the time and energy required to burn off those calories takes a lot more effort. We have provided a chart on what 1,000 calories looks like on both sides in the chart below (remember, it is 3,500 calories that make up a pound).

The Good News: Whether it is rapid or slow weight gain that you have experienced, losing the extra weight can be tackled through two avenues (and should be): calorie reduction and exercise . Choosing to lose weight through both calorie reduction and exercise will accelerate the process. If for seven days you burn 200 extra calories through exercise and reduce your food intake by 300 calories each day, you will lose that extra pound. Further, it is a lot easier than trying to either reduce your caloric intake by 3,500 calories (which is physically impossible) or burning an extra 3,500 calories during exercise (which takes a ridiculous amount of time and energy).

What you Can Do: Assess whether your weight gain was a rapid gain due to atypical behavior (E.g., vacationing) or a longer-term gain. If it was a rapid gain, there is a good chance you will lose the weight by returning to your normal habits. You might have to be a little strict for a day or two, but you shouldn't feel like a major overhaul is in order. If, however, you have gained the weight over a period of time, assess your habits and think about what has changed in your life. Have you stopped exercising? Have you let your eating habits go? Have you hit a milestone birthday? Once you can assess the reality of your situation, remember the equation: to maintain balance, burn the calories you eat.

Relevant Topics:

• Calculate your Caloric Needs
• What is your Basal Metabolic Rate?
• Calories Burned During Exercise
• Everything you Need to Know about Fitness

http://shine.yahoo.com/channel/health/why-losing-weight-is-so-hard-and-gaining-weight-is-so-easy-240502

Triathlete? Ball Girl? Amputee? All of the Above.

August 29, 2008

U.S. Open ’08

By JOSHUA ROBINSON

After every few dashes across Court 14, Kelly Bruno reached down to her right leg and flicked at something. It was a gesture so slight and so fleeting, she could have been swatting away a bug. It was also the only thing she did that was not in the protocol for a United States Open ball girl — nowhere does it mention popping the pressure valve on a prosthetic leg.

Bruno was born with several defects in her right leg and has been an amputee since she was 6 months old. By 18, she had turned herself into a track star among disabled athletes, with her own sponsorship deals. And as a world-class triathlete and Ironman competitor, she has raced in some of the most grueling events on the planet.

Now, at 24, Bruno has scaled back her training for three weeks to shuttle back and forth across courts at the Billie Jean King National Tennis Center to scoop up balls at the net. In a job done correctly only by those who are barely noticed, Bruno has stood out by blending in.

“It’s definitely harder than I expected,” she said, flashing an easy smile. “For me the running is not as tiresome, but I didn’t think standing was going to be so exhausting.”

This coming from a woman who began her journey to the Open after a brutal 0.9-mile swim in jellyfish-laden waters, a 24.9-mile bike ride and a 6.2-mile run at the sun-baked New York City Triathlon in June. John Korff, the triathlon’s organizer and a member of the United States Tennis Association board of directors, suggested that she try out to be a ball girl to give disabled athletes more exposure.

From the start, she received no special treatment. In June, she turned up to the first round of tryouts as one of two amputees — the other one became a court attendant — amid roughly 400 hopefuls. Before the second round, her athlete’s mentality kicked in. She decided she would take the same route to the Open as the players: she would train. Instead of slice serves and topspin backhands, she would master the two-handed grab and the one-hop throw.

Bruno slogged through a second tryout and the tournament’s qualifying rounds to become one of the 75 people assigned to ball duty for the Open’s main draw. At first, she had to answer a lot of questions from her younger colleagues, which she did with her usual good humor.

“Most of them have never met anyone who’s run an Ironman, let alone lost a leg,” she said.

In 18 years as the Open’s director of the ball program, Tina Taps said she had never seen an amputee apply to be a ball worker. “I can’t say she’s no different than anyone else,” Taps said. “She’s actually probably superior in terms of athletic ability.”

But long before Bruno’s athletic ability catapulted her into the elite ranks, she used sports like soccer, basketball and baseball to prove that she could be just average.

“Especially during a lot of those years when you’re trying to fit in, you want to be like everyone else,” she said. “I obviously wasn’t.”

By high school, she had turned to track. She briefly held world records in her Paralympic category in the 200 and 800 meters. But injuries born from overuse and compensating for her Cheetah prosthetic — the same kind used by the South African runner Oscar Pistorius — sent her to cross-training as a freshman at Duke. It was there, spending time in the swimming pool, on the stationary bike and in training with Duke’s cross-country team that she explored triathlons.

Within three years, she had reached the International Triathlon Union World Championships. She has competed there again twice since graduating in 2006 and finished third among women this year in Vancouver, running in the able-bodied field. It is the only place, she said, where her results really matter.

“It’s a pretty small group to be competing just in the physically challenged categories,” she said. “So to really get any better, you have to pick a new goal.”

Bruno lives in Durham, N.C., and is applying to medical school. She has two more major races this season, and she said her training was being severely affected by the Open. All the free time she has had in New York, those precious hours not consumed by tennis or by her applications, have been sweated away in the hotel gym and on long, lonely runs.

It is the same kind of commitment she sees every day from the players hammering shots into the nets she patrols.

“What I enjoy the most is just being on the court with someone else who’s competitive,” she said. “I can appreciate their drive and their athleticism. You almost feel like you’re a part of it.”

Rested star Bolt heads to Zurich

Bolt's coach expects him to break 9.5 seconds over 100m

Triple Olympic champion Usain Bolt will race for the first time since taking the Beijing Games by storm at the Zurich Grand Prix on Friday.

Jamaican Bolt, 22, claimed gold in the 100m, 200m, and 4x100m relay, recording world record times in each race.

"I've had some sleep since I've been here so I'm not tired," he said. "I'm trying to get my blood pumping again."

Yelena Isinbayeva, Dayron Robles and Kenenisa Bekele are among 12 Olympic champions who will compete in Zurich.

But centre stage will be Jamaican Bolt, whose coach Glen Mills believes could have run closer to 9.5 seconds on his way to the Olympic 100m title, when he clocked a world record 9.69 secs despite celebrating before crossing the line.

"If he had continued running, the slowest he would have run would have been 9.52," said Mills.

I'm just trying to get to the end of the season and to go home and enjoy myself Usain Bolt

"In two more years he should be peaking at this distance and by then I am certain he will be down to there."

But Bolt struck a more cautious note ahead of his first opportunity to break his own 100m world record.

"I'm just trying to get to the end of the season, injury-free, and go home and enjoy myself."

Bolt's sprint compatriot Asafa Powell, who runs in Gateshead on Sunday, will missing from the 100m final - but the Golden League Grand Prix is packed with other Olympic stars.

In winning both the 5000m and 10000m Olympic titles in Beijing, both in Olympic record times, Bekele became the first athlete to achieve the feat since fellow Ethiopian Miruts Yifter 28 years ago in Moscow.

Bekele says that chasing his four-year-old 5000m world record does not figure in his plans for Zurich because of tiredness.

He and other Ethiopian medallists celebrated with more than a million fans in the country's capital of Addis Ababa on Wednesday.

"It's very different," said Bekele. "I don't think about world records. After Beijing I'm too tired for a fast race. Maybe I will just go for winning."

But teenager Pamela Jelimo, the 800m Beijing gold medallist, is planning to try and break Jarmila Kratochvilova's 25-year-old world record of one minute 53.28 seconds.

606: DEBATE The Olympics was the Usain Bolt show Mikesiva

"I'm going to try for the world record here, I'm not feeling tired after the Olympics," she said.

Cuba's Olympic 110m hurdles champion, Dayron Robles, also insisting he is in top shape, could make an attack on the world record of 12.87 secs he achieved in mid-June.

The meeting will also offer the sell-out crowd something the Olympic Games could not quite manage when Jamaica take on the United States in the 4x100m.

The US failed to qualify for the final in Beijing after they dropped the baton in qualifying.

http://news.bbc.co.uk/sport2/hi/athletics/7584685.stm

Vitamin D Deficiency May Lurk in Babies

August 26, 2008

By RONI CARYN RABIN

Until she was 11 months old, Aleanie Remy-Marquez could have starred in an advertisement for breast milk. She took to nursing easily, was breast-fed exclusively for six or seven months, and ate little else even after that. She was alert and precocious and developed at astonishing speed, her mother said, sitting at four months and walking by eight months.

But once Aleanie started putting weight on her feet, her mother noticed that her legs were curving in a bow shape below the knees. Doctors diagnosed vitamin D-deficiency rickets, a softening of the bones that develops when children do not get enough vitamin D — a crucial ingredient for absorbing calcium and building bone, and the one critical hormone that breast milk often cannot provide enough of.

“I thought I was doing the best thing for her,” said Stephanie Remy-Marquez, of Hyde Park, Mass., after blood tests showed her daughter had no detectable vitamin D. X-ray images of the baby’s wrists and knees showed the edges of the bones and growth plates as blurry and fraying instead of crisp and sharp.

“Breast milk is supposed to be an entire meal, dessert and drinks included,” Ms. Remy-Marquez said. “I thought it was the ultimate cocktail.”

Aleanie’s case was unusual enough to be written up in the journal Clinical Pediatrics in May, but several similar reports have been published in recent years. Some experts fear that vitamin D deficiency, which can be asymptomatic, may be more common than pediatricians realize and that rickets — perceived to be a 19th-century scourge that was wiped out with the fortification of milk — may be going undetected.

Physicians have known for more than a century that exclusive breast-feeding may be associated with vitamin D deficiency and rickets, and that the condition is easily prevented and treated with inexpensive vitamin drops or cod liver oil. But doctors are reluctant to say anything that might discourage breast-feeding.

Now some researchers are also linking vitamin D deficiency with other chronic diseases like diabetes, autoimmune disorders and even cancer, and there have been calls to include blood tests of vitamin D levels in routine checkups.

“I completely support breast-feeding, and I think breast milk is the perfect food, and the healthiest way to nourish an infant,” said Dr. Catherine M. Gordon, director of the bone health program at Children’s Hospital Boston and an author of several studies on vitamin D deficiency, including Aleanie’s case.

“However,” Dr. Gordon continued, “we’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up. They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk.”

Some doctors and public health officials say conditions may be ripe for rickets to re-emerge: more infants are being breast-fed for extended periods, children are drinking more juice or soda and less milk, and they are spending less time exposed to sunlight, which enables the skin to synthesize vitamin D.

Children with dark skin, like Aleanie, who is African-American, appear to be at even greater risk for rickets because they do not synthesize vitamin D through the skin as easily as those with light skin.

The solution, Dr. Gordon said, is not to quit breast-feeding but to supplement breast-fed infants with vitamin drops, as recommended by the American Academy of Pediatrics. The academy issued guidelines in 2003 recommending that infants be given 200 international units of vitamin D daily, and it may be increasing the recommended level soon.

But pediatricians do not consistently prescribe vitamin drops. A 2004 survey of North Carolina pediatricians found that fewer than half routinely recommended them, and one in six never recommended them.

Vitamin D deficiency may not be immediately apparent, even as it affects growth, muscle and bone mineralization, said Dr. Craig Langman, professor of kidney disease and pediatrics at Feinberg School of Medicine in Chicago.

“It sort of sneaks up on you,” he said. “So the worst scenario is the gas tank is empty and the car won’t go — you have rickets. But at very low levels of gas the car doesn’t perform very well and you start having intermittent loss of power and that sort of thing; as a result you may not be forming enough bone during childhood.”

A recent review of 14 studies, done by researchers at the National Institute of Child Health and Human Development and published in The Archives of Pediatrics & Adolescent Medicine in June, found that extreme vitamin D deficiency was rare in the United States, but that up to 78 percent of breast-fed babies who were not supplemented in wintertime were deficient.

Meanwhile, the number of papers describing cases of nutritional rickets in babies and young children in the United States has been accumulating over the past decade or so, from places as disparate as Alaska, Minnesota, Nevada and Texas.

The patients are more likely to be African-American and dark-skinned, and more likely to have been exclusively breast-fed for an extended period of time, without vitamin supplementation. Rates are often higher when there is less sunlight.

In a study conducted by Dr. Gordon of vitamin D levels in 365 mostly African-American and Latino infants and toddlers, 40 percent had low levels and 12 percent were deficient. Although there is a debate about what levels are considered deficient, one toddler in the study was found to have rickets, 13 children showed evidence of bone loss and 3 had bone changes consistent with rickets.

The study, published in The Archives of Pediatrics & Adolescent Medicine in June, found that breast-feeding without supplementation was a significant risk factor.

“Human milk is very low in vitamin D, absolutely — there is no question about that,” said Dr. Frank Greer, professor of pediatrics at University of Wisconsin School of Medicine and Public Health and chairman of the committee on nutrition of the American Academy of Pediatrics. “Historically speaking, we probably got it from the sun, but now we’re afraid of the sun and we don’t go out as much.”

Teenagers are also at risk for vitamin D deficiency. Although their large bones protect them against rickets, they are at risk for osteopenia and even osteoporosis, and may have weaker bones that are more likely to fracture, said Dr. Robert Schwartz, professor of pediatrics at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., who said he had observed cases of osteopenia and osteoporosis in teenagers.

“The tragedy of this is that when they’re young, they’re building up bone for the rest of their life,” Dr. Schwartz said. As people age and their bones weaken, he said: “Those who had adequate vitamin D and calcium will slide down from the top of the mountain. These kids will slide down from the middle.”

The Well column will return next week.

http://www.nytimes.com/2008/08/26/health/research/26rick.html?em

Living Longer, in Good Health to the End

August 26, 2008

Personal Health

By JANE E. BRODY

You don’t have to be an actuary or funeral director to have noticed the striking increase in the length of many Americans’ lives. The obituaries in this or any other newspaper show a growing number of people who depart this world in their late 80s or 90s, or even at 100 or older.

The fastest-growing segment of the population consists of people over 85, and by 2050 some 800,000 Americans will have celebrated their 100th birthday.

Doomsayers consider this a terrifying trend, bound to bankrupt Social Security and Medicare and overwhelm the ability of doctors and medical facilities to care for the burgeoning population of the oldest old.

But there is increasing evidence that the societal burden of increased longevity need not be so drastic. Long-term studies have shown that how people live accounts for more than half the difference in how hale and hearty they will remain until very near the end.

Many very old people have assumed “bragging rights” about their age and what they can still accomplish despite it, as Michael Kinsley wrote in The New Yorker in April.

At a pool in downtown Los Angeles, Mr. Kinsley encountered a stranger who interrupted his laps long enough to say, “I’m 90 years old.” The man, Richard Ibañez, a retired judge, died in November at age 97, but swam every morning until the last week of his life, his grandson, Christopher A. Karachale, wrote in a letter to the magazine.

A friend’s father, Irving Weinig, who lived in an assisted living facility in New York, requested new clothes for his 104th birthday so he could look spiffy when he had lunch with “the girls,” an activity he enjoyed until his death at 108.

And last spring the Island Nursing and Rehab Center in Holtsville, N.Y., boasted about a new resident, Nora Elizabeth Wright, who was turning 106.

All of these examples speak to a concept proposed in The New England Journal of Medicine in 1980 by Dr. James F. Fries of Stanford University: that adult vigor can be extended well into the ninth decade of life, with illness and disability compressed into a period that shortly precedes death.

Who Lives the Longest?

Many studies have examined the factors that predict the length of people’s lives, with nearly universal agreement that about 35 percent is determined by genes over which we have little or no control.

Dr. Nir Barzilai and colleagues at Albert Einstein College of Medicine found, for example, that individuals “with exceptional longevity” and a low incidence of age-related diseases have significantly larger HDL and LDL particles in their blood, a genetic characteristic that reduces their risk of developing cardiovascular diseases.

Scientists are searching for ways to extend healthy life spans by manipulating “bad” genes, but the potential exists now for modifying many of the environmental factors that account for the other 65 percent of longevity. And I suspect that most of us who hope to join the ranks of the oldest old would like to do so in a manner similar to that of Richard Ibañez and Irving Weinig — in rather good shape physically and mentally almost to the very end.

“Longevity is a Pyrrhic victory if those additional years are characterized by inexorable morbidity from chronic illness, frailty-associated disability and increasingly lowered quality of life,” Dr. William J. Hall of the Highland Hospital Center for Healthy Aging in Rochester wrote in The Archives of Internal Medicine in February.

New Habits Are Effective

Dr. Richard S. Rivlin, an internist and director of the nutrition and cancer prevention career development program at Weill Cornell Medical College, said in an interview that it was never too late to adopt habits that predict a healthy old age.

“While measures started early in life are most likely to have the greatest health benefit,” he said, “older people should never feel that turning over a new leaf at their age is anything but highly effective.”

He said there was clear evidence that measures taken in one’s 70s could help prevent “several important categories of disease, such as hypertension, heart disease, osteoporosis and even cancer.”

In The American Journal of Clinical Nutrition last year, Dr. Rivlin noted that changes in body composition, like loss of bone and muscle and accumulation of body fat, typically accompany aging and can affect health in a variety of ways: poor posture that impairs breathing; falls and fractures; loss of mobility; a reduced metabolic rate; and weight gain that can lead to diabetes, heart and blood vessel disease and some forms of cancer.

But these changes in body composition, he added, “are not an invariable accompaniment of aging.” Much can be done to limit and even reverse them, he said, including restricting calories and following a diet of high-quality protein and limited saturated fat and replacing simple sugars with whole grains rich in fiber.

The Importance of Exercise

A second critical measure for the “young-elderly,” as he calls 70-year-olds, is to “make regular exercise a part of their daily lifestyle,” including aerobic activities that raise the heart rate; weight-bearing activities that strengthen muscles and bones; and stretching exercises that reduce stiffness and improve flexibility and balance.

Another age-related concern is cognitive decline, which is more likely in people with metabolic syndrome, a cluster of modifiable risk factors that includes abdominal obesity, high blood pressure, insulin resistance and abnormal cholesterol levels. Dr. Hall cautioned against therapeutic nihilism in treating older people with such risk factors.

“Chronological age is a very imperfect determinant on which to base medical decision-making,” he wrote.

Dr. Hall’s comments were based on a 25-year study by Dr. Laurel B. Yates of Brigham and Women’s Hospital and her Boston colleagues of 2,357 men who were healthy at an average age of 72 when the study began. Of the 970 men who survived to at least age 90, the primary modifiable predictors of longevity were not smoking; preventing diabetes, obesity and high blood pressure; and exercising regularly.

“Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle, had a lower incidence of chronic diseases and were three to five years older at disease onset,” the Boston team reported in February in The Archives of Internal Medicine. “They had better late-life physical function and mental well-being. More than 68 percent rated their late-life health as excellent or very good, and less than 8 percent reported fair or poor health.”

Other long-term studies have also pinpointed exercise as the single most potent predictor of healthy longevity, in women as well as in men. It is not that very old people like Judge Ibañez can exercise because they are healthy, these findings indicate. Rather, they achieve a healthy old age because they exercise.

http://www.nytimes.com/2008/08/26/health/26brod.html?em

NEED TO LOSE WEIGHT

For a healthy diet, replace unhealthy and fattening foods with healthier alternatives, such as fresh fruits and vegetables. Fish is a great alternative to red meat. Fish is a healthy, lean protein and contains a type of fat called "omega-3," which may help protect the heart. It takes time for the body to recognize that you have eaten and for the feeling of hunger to go away. Eating too quickly may cause you to eat more food over the same period of time as eating slowing and allowing your body to feel "full". To lose weight, you must burn more calories than you eat. Exercise is the best way to do this. When you exercise regularly, you build stronger muscles, even if you do not work out with weights. Muscles use more calories than fat throughout the day, even while you are resting. This contributes to what is commonly called a "faster metabolism. Reference from A.D.A.M. Back to TopInformation Regular exercise and a healthy diet are crucial when it comes to controlling your weight. A weight management plan depends on whether you are overweight or underweight. An easy way to determine your own desirable body weight is to use the following formula: Women: 100 pounds for the first 5 feet of height plus 5 pounds for each additional inch. Men: 106 pounds of body weight for the first 5 feet of height plus 6 pounds for each additional inch. For a small body frame, 10% should be subtracted. For a large frame, 10% should be added. Body fat and body mass measurements are used to determine whether a person is under- or overweight. A registered dietitian or exercise physiologist can help you calculate your body fat. The recommended amount of body fat differs for men and women. For women: The recommended amount of body fat is 20 - 21%. The average American woman has approximately 22 - 25% body fat. A woman with more than 30% body fat is considered obese. For men: The recommended amount of body fat is 13 - 17%. The average American man has approximately 17 - 19% body fat. A man with 25% body fat or higher is considered obese. Body mass index (BMI) is an indirect measurement of your body composition. It takes into consideration both your weight and height. BMI helps determine your risk for certain diseases, including diabetes and hypertension. It is important to note that the terms "overweight" and "obesity" do NOT mean the same thing. Weight management for people who have been overweight involves continued physical activity and monitoring the amount of food eaten. UNDERWEIGHT Anorexia nervosa and bulimia are eating disorders associated with a negative body image. Anorexia nervosa is a disorder in which people extremely limit their food intake. This results in dangerously quick weight loss, to the point of starvation. This disorder is most commonly found in adolescent females, but may also occur in males, children, and adults. Bulimia is binge eating followed by self-induced vomiting. It's often associated with anorexia nervosa. Many people with bulimia don't lose a lot of weight, and may not get medical attention until they seek help. Excessive intentional weight loss can cause a person to be dangerously underweight. To maintain their weight, people with eating disorders must eat enough food to prevent them from losing the weight they have gained. CALORIES FOR WEIGHT MAINTENANCE To maintain your weight, you can use the following formula: 10 calories per pound of desirable body weight if you are sedentary or very obese 13 calories per pound of desirable body weight if your activity level is low, or if you are over age 55 15 calories per pound of desirable body weight if you regularly do moderate activity 18 calories per pound of desirable body weight if you regularly do strenuous activity Activity levels: Low activity: No planned, regular physical activity; occasional weekend or weekly activity (such as golf or recreational tennis) is the only type of physical activity Moderate activity: Participating in physical activities such as swimming, jogging, or fast walking for 30 - 60 minutes at a time Strenuous activity: Participating in vigorous physical activity for 60 minutes or more at least 4 - 5 days per week A BALANCED DIET Do not eat meat more than once a day. Eat fish and poultry more often than red or processed meats because they are less fattening. Avoid frying food. Fried food absorbs the fats from the cooking oils, increasing your dietary fat intake. Instead, bake or broil food. If you do fry, use polyunsaturated oils, such as corn oil. Cut down on your salt intake. Limit table salt, or flavor intensifiers that contain salt, such as monosodium glutamate (MSG). Include adequate fiber in your diet. Fiber is found in green leafy vegetables, fruit, beans, bran flakes, nuts, root vegetables, and whole-grain foods. Do not eat more than 4 eggs per week. Although they are a good source of protein, and they're low in saturated fat, eggs are very high in cholesterol. Choose fresh fruit for dessert, rather than cookies, cake, or pudding. Eat a well-balanced diet. Too much of anything -- calories or a particular type of food -- has its drawbacks. Follow the recommendations of the food guide pyramid. RECOMMENDATIONS FOR WEIGHT MANAGEMENT To successfully manage your weight, follow these basic guidelines: Eat a healthy, well-balanced diet. Balance physical activity with diet to maintain your desired weight. Aerobic exercise will help increase muscle tissue and burn calories. Gradually adjust your eating habits to encourage a permanent lifestyle change. You may need counseling and behavior modification to change your diet. Avoid alcohol, or drink in moderation. RESOURCES A registered dietitian is an excellent resource for individualized weight management. The registered dietitian can provide information on classes and programs available in your community. The Federal Trade Commission offers consumer brochures that evaluate commercial weight management programs. Note: 1 calorie equals 1000 calories or 1 kilocalorie. See also: Diet and calories More Information on This Topic Background Causes Risk Factors Lifestyle Changes and Psychosocial Treatments Complications Dietary Management Surgery Medications References News & Features Reporter's File Expert Q & A Questions for Your Doctor Clinical Trials Review Date: 5/17/2007 Reviewed By: Benjamin W. Van Voorhees, M.D., M.P.H., Assistant Professor of Medicine, Pediatrics, and Psychiatry, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

Losing excess weight by eating a healthy diet is one of the best ways of helping to prevent disease. Obesity increases the risk of illness and death due to diabetes, stroke, coronary artery disease, and kidney and gallbladder disorders. The more overweight, the higher the risk becomes. http://health.nytimes.com/health/guides/specialtopic/weight-management/overview.html

For Heart Health, Sprints Match Endurance Training

June 5, 2008, 10:25 am

For Heart Health, Sprints Match Endurance Training

Intense bursts of exercise may be as good for the heart as longer, moderate-intensity training. (Lynn L. Walters for The New York Times)

Short bursts of exercise can benefit heart health just as much as tedious endurance training, a new study suggests.

The research, published in the American Journal of Physiology — Regulatory, Integrative and Comparative Physiology, is good news for time-strapped exercisers. It supports the notion that people who engage in brief, high-intensity forms of exercise reap the same cardiovascular health benefits as those who exercise at moderate intensity for a longer period of time.

Researchers at McMaster University in Canada recruited 20 healthy men and women whose average age was 23. All of the study subjects rode stationary bikes. Some exercised five days a week, doing 40 to 60 minutes of moderate-intensity cycling. Others did four to six sets of 30-second sprints on the cycle, allowing 4.5 minutes of recovery time between sets; their total exercise time was about 15 to 25 minutes just three days a week.

After six weeks, the researchers found that the intense sprint interval training improved the structure and function of arteries as much as traditional, longer endurance exercise.

“More and more, professional organizations are recommending interval training during rehabilitation from diseases like chronic obstructive pulmonary disease, peripheral artery disease and cardiovascular disease,'’ said Maureen MacDonald, academic advisor and an associate professor in the department of kinesiology. “Our research certainly provides evidence that this type of exercise training is as effective as traditional moderate-intensity training. We wouldn’t be surprised to see more rehabilitation programs adopt this method of training since it is often better tolerated in diseased populations”.

The data don’t mean everyone should give up endurance training. Some people prefer moderate exercise, and for some, high-intensity intervals like sprinting are too demanding and may increase the risk of injury.

But Dr. MacDonald notes that those who have a hard time scheduling exercise into their lives can still get the benefits of exercise if they are willing to work hard for brief periods of time.

http://well.blogs.nytimes.com/2008/06/05/for-heart-health-sprints-match-endurance-training/

Think of Your Poor Feet

May 13, 2008

Feet

By LAURIE TARKAN

Correction Appended

THE average person walks the equivalent of three times around the earth in a lifetime. That is an enormous amount of wear and tear on the 26 bones, 33 joints and more than 100 tendons, ligaments and muscles that make up the foot.

In a recent survey for the American Podiatric Medical Association, 53 percent of respondents reported foot pain so severe that it hampered their daily function. On average, people develop pain in their 60s, but it can start as early as the 20s and 30s. Yet, except for women who get regular pedicures, most people don’t take much care of their feet.

“A lot of people think foot pain is part of the aging process and accept it and function and walk with pain,” said Dr. Andrew Shapiro, a podiatrist in Valley Stream, N.Y. Though some foot problems are inevitable, you can slow the progress of many problems.

The most common foot conditions that occur as you get older are arthritic joints, thinning of fat pads cushioning the soles, plantar fasciitis (inflammation of the fibrous tissue along the sole), bunions (enlargement of the joint at the base of the big toe), poor circulation and fungal nails. If you have the following risk factors, take more preventive steps as you age.

Are you overweight? The force on your feet is about 120 percent of your weight. “Obesity puts a great amount of stress on all the supporting structures of the foot,” said Dr. Bart Gastwirth, a podiatrist at the University of Chicago. It can lead to plantar fasciitis and heel pain and can worsen hammertoes and bunions. It’s also a risk factor for diabetes, leading to the next question.

Are you diabetic? Being farthest from the heart, the feet can be the first part of the body to manifest complications like poor circulation and loss of feeling, both of which can lead to poor wound healing and amputation. Diabetics should have their feet examined annually by a doctor and avoid shoes that cause abrasions and pressure.

Do you have poor circulation? If you’re suffering from peripheral artery disease — a narrowing of arteries in the legs — your feet are more susceptible to problems, said Dr. Ross E. Taubman, president of the American Podiatric Medical Association. Smoking also contributes to poor circulation.

Do your parents complain about their feet? Family history is probably your biggest clue to potential problems.

Do you have flat feet or high arches? Either puts feet at risk. A flat foot is squishy, causing muscles and tendons to stretch and weaken, leading to tendinitis and arthritis. A high arch is rigid and has little shock absorption, putting more pressure on the ball and heel of the foot, as well as on the knees, hips and back. Shoes or orthotics that support the arch and heel can help flat feet. Those with high arches should look for roomy shoes and softer padding to absorb the shock. Isometric exercises also strengthen muscles supporting the foot.

Are you double-jointed? If you can bend back your thumb to touch your lower arm, the ligaments in your feet are probably stretchy, too, Dr. Gastwirth said. That makes the muscles supporting the foot work harder and can lead to injuries. Wear supportive shoes.

Do your shoes fit? In the podiatric association’s survey, more than 34 percent of men said they could not remember the last time their feet were measured, and 20 percent of women said they wore shoes that hurt weekly; 8 percent wore painful shoes daily. Feet flatten and lengthen with age, so if you are clinging to the shoe size you wore at age 21, get your feet measured (especially mothers — pregnancy expands feet).

Do you wear high heels? “The high heel concentrates the force on the heel and the forefoot,” Dr. Gastwirth said. Heels contribute to hammertoes, neuromas (pinched nerves near the ball of the foot), bunions and “pump bump” (a painful bump on the back of the heel), as well as toenail problems. Most of the time, wear heels that are less than two and a half inches high.

Do your feet ever see the light of day? Fungus thrives in a warm, moist environment. Choose moisture-wicking socks (not cotton), use antifungal powders, and air out your toes at home.

Have you seen a podiatrist? Minor adjustments — using drugstore foot pads or prescription orthotics — can relieve the pressure on sensitive areas, rebalance the foot and slow the progress of a condition.

Do you walk? Putting more mileage on your feet is the best way to exercise the muscles and keep them healthy.

This article has been revised to reflect the following correction:

Correction: May 16, 2008
An article in the special Well section on Tuesday about foot health described incorrectly peripheral artery disease, which reduces blood circulation to the feet. The disease involves narrowing of arteries in the legs, not veins.

http://www.nytimes.com/2008/05/13/health/13feet.html

More Than an Exercise in Vanity

May 13, 2008

Muscles

By GINA KOLATA

DR. PAUL D. THOMPSON, a 60-year-old marathon runner and chief of cardiology at Hartford Hospital, stood in front of a medical audience recently and began his talk with a story about himself.

“I’ve been lifting weights since I was 12 years old and look at me,” he said. Dr. Thompson is small and wiry with not a bulging muscle on him. He speculated that he must have a genetic inability to build muscles, no matter how hard he works at it.

But are his muscles healthy?

It is not the kind of question most people ask themselves. But muscle researchers say it is important because muscle health is emerging as an important part of overall health. And, they say, when it comes to muscles, bulk does not matter. How big they can become depends on your sex as well as genetics. What matters for health is whether, like Dr. Thompson, you use them.

Healthy muscles, researchers say, are those that have been worked, stressed and pushed to their limit so that they have enough power and strength to get you through life, especially as you grow older. And keeping muscles fit takes effort, which means regular training with weight lifting and cardiovascular exercise even if the results are not a sculptured look, these experts add.

If you don’t work your muscles, they will atrophy, especially as you grow older. Older people often fall because they are too weak to brace themselves, and they have trouble with steps and opening jars because their muscles have lost so much strength. Much of that loss can be avoided, muscle researchers say. Even elderly people can gain muscle strength if they work at it, studies have shown.

There are two aspects to healthy muscles: endurance and strength, said Robert H. Fitts, an exercise physiologist at Marquette University and chairman of the biology department there. To maintain endurance, you should engage in activities that pump blood to the muscles, like walking. For strength, you need to lift weights, concentrating on what Professor Fitts calls the antigravity muscles, those of the back and legs. And, he adds, you should also maintain arm strength.

But while many people walk, fewer lift weights, and those who do often use incorrect techniques, said William J. Kraemer, a professor of kinesiology at the University of Connecticut.

Some try to do it on their own but tend to buy weights that are too light and may not know the well-researched methods that get results.

Others go to gyms, where they may be intimidated when they venture into weight rooms filled with people grunting and straining and machines that can seem daunting. Those who do try to lift at the gym can end up using weights that are not heavy enough to fully stimulate their muscles.

That is especially true of women, Dr. Kraemer said, even those who work with personal trainers. While women often say they are afraid they will bulk up, this fear is unfounded, Dr. Kraemer and others say. Acquiring muscle mass requires testosterone levels that women don’t have. Instead, the toning that many women say they want comes from lifting heavy weights.

The most effective way to stimulate muscles is with a system known as progressive resistance. This approach can take about three hours a week and includes days, once a week or so, when you lift weights so heavy that you can do only three to five repetitions before your muscles are too tired to lift again.

Other days are devoted to moderate resistance, with weights you can lift 8 to 10 times. And then you should have some light days, with weights you can lift 12 to 15 times before your muscles tire.

It may sound like a lot of effort, but even people like Dr. Thompson, who does not acquire bulk, benefit.

“I still lift,” he said, “because it makes doing other stuff — yardwork, carrying groceries, carrying grandkids — easier. “I think some folks outlive their muscles, meaning that they are fine mentally and cardiacwise but have so little muscle strength that they can’t catch themselves with their other leg when they start to fall,” Dr. Thompson added. “And if they fall they cannot get up.”

He does not want to be one of those people.

http://www.nytimes.com/2008/05/13/health/13muscles.html

Eating Your Way to a Sturdy Heart

May 13, 2008

Heart

By TARA PARKER-POPE

MOST people think heart-healthy living involves sacrifice. Give up your favorite foods. Break a sweat. Lose weight. But some of the best things you can do for your heart do not involve deprivation or medication. Simple and even pleasurable changes in the foods you eat can rival medication in terms of the benefit to your heart.

“Almost everyone has something they can do in their diet or activity that will impact their risk of heart disease,” said Dr. Graham Colditz, adjunct professor of epidemiology at Washington University in St. Louis. “It’s not about taking anything to the extremes of major deprivation, extreme marathon running or becoming a vegetarian.”

Even so, many people are not getting the message. While doctors still advise patients to diet, exercise and stop smoking, the medical community has adopted an almost singular focus on cholesterol-lowering drugs as the fastest and best way to battle heart disease. Americans spend $18 billion a year on cholesterol-reducing drugs, making them the nation’s biggest-selling class of drugs.

Clearly, drug treatments have played a role in the health of American hearts. Since 1950, age-adjusted death rates from cardiovascular disease have dropped 60 percent, a statistic praised by government health officials.

Average blood pressure and cholesterol levels are dropping, partly because of drug treatments. But drugs don’t get all the credit. A sharp drop in smoking has had a huge impact on heart health. And major changes in diet have also played a role. Surveys of the food supply suggest that consumption of saturated fat and cholesterol has decreased since the early 1900s. Medical care has also improved.

But an important lesson from the last 50 years is that when it comes to improving heart health, it is important to look beyond the medicine cabinet.

Just a few small changes — eating more fish, vegetables, nuts and fiber — can have a major impact on your risk for heart problems. For some people, drinking moderate amounts of wine may offer additional benefits. Even a 55-year-old man who is about 20 pounds overweight and does not exercise regularly will have a heart-disease risk far below average if he regularly consumes fish, nuts, fiber and vegetables and drinks moderate amounts of wine.

It’s hard to believe that such simple food changes can make a meaningful difference, but data from hundreds of studies show they can.

For instance, a review of nearly 100 studies evaluating various cholesterol-lowering agents and diets showed just how potent fish can be as a heart protector. In studies of people who consume diets rich in omega-3 fatty acids like those found in fish, heart risk was 23 percent lower compared with a control group. The 2005 review appeared in The Archives of Internal Medicine.

The same report also reviewed studies of statin use and showed a 13 percent lower heart risk. Because it was not a head-to-head comparison, it cannot be concluded that eating fish is better than using statins. But the results clearly show the powerful effect of fish in the diet.

Many studies of fish consumption and heart health are based on observation of Eskimos and people in Mediterranean regions. And random clinical trials have shown that consuming omega-3 fatty acids can reduce heart attacks and cardiovascular death. These fatty acids can also slow the progress of atherosclerosis in coronary patients, according to the American Heart Association.

Several studies now show that regular consumption of omega-3s from a variety of sources, including fish, nuts and soybean oil, can lower cardiovascular risk as much as 60 percent, according to a 2006 review in The American Journal of Cardiology.

It doesn’t take much fish. Doctors recommend eating it, particularly fatty kinds like mackerel, lake trout, herring, sardines, albacore tuna and salmon, just twice a week.

People worry about exposure to mercury and toxins from fish, but experts say that for middle-age and older men and postmenopausal women, the benefits of fish far outweigh the risks of exposure to environmental pollutants.

The data on increasing consumption of fiber-rich foods, vegetables and nuts is also compelling. A 2001 report in Nutrition Reviews concluded that eating just a handful of nuts (about three to four tablespoons) five times a week can reduce risk of coronary artery disease between 25 and 40 percent.

And while everyone knows it is good to eat your vegetables, many people do not realize how easy it really is to consume five to nine servings of fruits and vegetables a day. Just having a salad of leafy greens (two cups) with tomatoes and half a cup of broccoli, for instance, totals four servings. If you had juice with breakfast, you’re already up to five by lunchtime.

Whether to add alcohol to your daily diet is more controversial. Increasingly, studies support the idea that drinking a small amount each day — no more than one to two servings — is better for you than not drinking. Large observational studies show that drinking moderate amounts of alcohol can lower the risk of dying in a given year by about 25 percent, compared with those who rarely drink. But it’s not true for everyone. Excessive use of alcohol can lead to addiction, traffic accidents and potentially fatal medical problems.

Even small amounts of alcohol can increase risk for certain health worries, like breast and colon cancer. Although those risks are generally offset by the extra heart benefits, some people may decide it is not worth it. Much of the research on alcohol’s benefit comes from studies that observe people over time rather than from controlled clinical trials, which are more reliable. So while there is a strong association with moderate alcohol consumption and better health, the results are not conclusive.

Making better food choices won’t always produce obvious results, like weight loss. But substituting fish for red meat, high-fiber foods for processed pastries and eating more vegetables may push more fattening foods off your plate, and at the least, prevent weight gain. Add a half-hour walk after dinner and you have gone a long way toward lowering heart risk.

http://www.nytimes.com/2008/05/13/health/13heart.html

May 13, 2008

Eyes

Care of the Eyes Demands Diligence

By NICHOLAS BAKALAR

READING in poor light, sitting too close to the TV, wearing the wrong prescription glasses and crossing your eyes — things your mother warned you would ruin your vision — are actually generally harmless. But a truly dangerous false belief is that there is nothing you can do to prevent the loss of vision.

According to Dr. Paul R. Lichter, a professor of ophthalmology and director of the Kellogg Eye Center at the University of Michigan in Ann Arbor, seeing an ophthalmologist regularly is essential, and not just to get a new pair of glasses. “In the way of preserving your sight,” he said, “it’s making sure you don’t have any hidden eye diseases.”

Dr. Lichter recommends an ophthalmologist’s examination before a child enters school, and if everything looks good at that point, then an exam every five years is enough. But it should be a thorough exam in which the doctor dilates the pupils and examines the optic nerve.

Although there are many eye diseases, there are three that together affect more than 10 percent of the United States population: an estimated 2.2 million people have glaucoma, more than 26 million have cataracts or related lens problems, and 2 million have macular degeneration.

Glaucoma is a group of diseases that cause damage to the optic nerve. The most common is primary open-angle glaucoma, in which the eye’s drainage canals are partly clogged. Most people have no symptoms, and the disease causes a gradual loss of vision. But if it is caught early enough, it can be treated successfully with medication or surgery.

A test for pressure inside the eye, or intraocular pressure, is one way to screen for the disease, but people with normal pressure can still have glaucoma. An examination of the optic nerve is the only sure way to tell.

Narrow-angle glaucoma, sometimes called angle-closure glaucoma, is much less common. This happens when the drainage canals become completely blocked, and symptoms can be vivid — blurred vision, headaches, eye pain and nausea. The usual treatment is surgery.

By the time people reach their 40s they begin to develop presbyopia, a natural part of aging in which the lens of the eye stiffens so that it cannot change shape enough to give the proper focus; the usual remedy is to buy reading glasses.

Sometimes, people run to the eye doctor when this problem crops up, and that can be a good thing, because by this age eye diseases become more common, and, Dr. Lichter said, exams every three years should be routine.

Age-related cataracts can start as early as the 40s, but it is most often after age 60 that such clouding of the lens begins to affect vision. The treatment is to remove the clouded lens and replace it with a permanent plastic lens. At one time, cataracts were removed only when they became intolerable, but with the development of effective permanent artificial lenses, Dr. Lichter said, people with otherwise healthy eyes should have cataracts removed as soon as they become bothersome.

After age 50, an exam every two years is recommended to search for, among other things, signs of age-related macular degeneration, a leading cause of blindness in older people. This disease is caused by hardening of arteries in the macula, the light-sensitive tissue in the center of the retina. It causes no pain, but as the cells in the macula die, vision in the central part of the eye can deteriorate quickly, but usually it happens so slowly that people notice little change.

While medications and laser surgery are effective for the wet form of the disease, in which delicate new vessels grow and then easily break and bleed, the more common dry form is very difficult to treat. Still, Dr. Lichter said, “It’s important for patients to know if they have the signs of the disease, even in its more common dry form, so that they can be advised about signs to look for that might warrant treatment. Considerable research into macular degeneration holds promise for future success in treating the disease.”

As for maintaining healthy eyes, diet and exercise are important, said Dr. James C. Tsai, chairman of the department of ophthalmology at Yale. Carrots, yes, really are effective — they have high levels of beta carotene, which can be converted into vitamin A, needed for good night vision.

Vitamins C and E and omega-3 fatty acids may reduce the risk of cataracts and prevent worsening of macular degeneration, and aerobic exercise can lower pressure in the eye. Smoking and excessive sun exposure increase the risk both for cataracts and macular degeneration. As for good diet, Dr. Tsai said, “It’s what your mother told you: fruits and vegetables.”

For routine preventive measures, Dr. Lichter suggests sunglasses and hats for protection against ultraviolet rays and safety goggles for yardwork and other activities that might endanger the eyes with flying objects. As for over-the-counter eyedrops for people who have no eye-related medical condition, he said: “They are typically a waste of money. Most people buying these things don’t get anything from them.”

http://www.eyecareamerica.org/eyecare/conditions/

http://www.nytimes.com/2008/05/13/health/13eyes.html

For a Sharp Brain, Stimulation

May 13, 2008

Brain

By RONI CARYN RABIN

AMERICANS may worry about heart disease, stroke and diabetes, but they downright dread Alzheimer’s disease, a recent survey found.

For good reason. One in eight adults over 65 is affected by the disease. Those who are spared know they may end up with the burden of caring for a parent or a spouse who is affected. Even though the number of older adults with dementias is rising rapidly, only a few drugs that have been approved to treat symptoms are on the market, and they slow down the disease but do not cure it.

Researchers, however, are more optimistic than ever about the potential of the aging brain, because recent evidence has challenged long-held beliefs by demonstrating that the brain can grow new nerve cells.

“For a long time, we held the assumption that we’re born with all the nerve cells we’re ever going to have, and that the brain is not capable of generating new ones — that once these cells die we’re unable to replace them,” said Molly V. Wagster, chief of the Neuropsychology of Aging branch of the National Institute on Aging. “Those assumptions have been challenged and put by the wayside.”

The birth of new nerve cells, she said, “has been shown to occur in the adult — not only in adult rats and monkeys, but also in older adult humans.” Most of the areas that show neurogenesis and that have been investigated so far are important for learning and memory, particularly the hippocampus, she added.

So how does one stimulate neurogenesis?

Scientists do not have all the answers, but studies of older people who have maintained their mental acuity provide some clues. They tend to be socially connected, with strong ties to relatives, friends and community. They are often both physically healthy and physically active. And they tend to be engaged in stimulating or intellectually challenging activities.

The big question is whether they remain mentally alert because they engage in these activities, or whether they are able to engage in these activities because they are cognitively intact.

“We don’t know whether this is an example of reverse causation or not — it’s probably a two-way street,” said Bruce S. McEwen, who heads the neuroendocrinology lab at Rockefeller University in New York.

But some interventional studies that have introduced older adults to exercise regimens have reported remarkable results. Researchers at the University of Illinois at Urbana-Champaign recruited a group of sedentary adults between the ages of 60 and 75, assigning half of them to an aerobic exercise program that met three times a week to walk, while a control group did anaerobic stretching and toning.

The scientists measured the group’s cognitive function before and after the six-month program and found improvements among those who had done the walking.

“Six months of exercise will buy you a 15 to 20 percent improvement in memory, decision-making ability and attention,” said Arthur F. Kramer, a professor of psychology at the University of Illinois. “It will also buy you increases in the volume of various brain regions in the prefrontal and temporal cortex, and more efficient neuronetworks that support the kind of cognition we examined.”

Other studies have found improvements in cognitive function after a combined regimen of physical exercise and cognitive training.

But skeptics say there is no guarantee that intellectual stimulation will prevent Alzheimer’s disease or other forms of dementia. “Maybe it does, but I don’t think we have a shred of evidence,” said Dr. Robert N. Butler, a psychiatrist and gerontologist who is president of the International Longevity Center-USA. “What it does is maintain good health,” he said, adding, “I don’t think we can go much further than that.”

But there is consensus among scientists on a few recommendations for action that, most agree, cannot hurt.

Regular physical activity may improve brain function, both by increasing blood flow to the brain and stimulating the production of hormones and nerve growth factors involved in neurogenesis. Animal studies have found that physically active animals have better memories and more cells in their hippocampus. Exercise also plays a role in countering diseases like Type 2 diabetes, which increases the risk of dementia. Cholesterol and hypertension, which affect vascular health, also need to be kept in check.

Seeking out stimulation through interesting work, volunteer opportunities or continuing education is beneficial. Travel, read, take up a new language or learn to play a musical instrument. Staying socially connected is also associated with brain health, as is managing stress effectively. Chronic stress can lead to the rewiring of areas of the brain that are involved in emotion, memory and decision-making, Dr. McEwen said, “and the brain becomes more biased toward more anxiety, more depression, less flexibility in terms of decision-making and becomes less able to store information.”

Most scientists recommend eating a Mediterranean-style diet, including fish and nuts containing omega-3 fatty acids, antioxidant-rich fruits and vegetables, olive oil and possibly some red wine. (Blueberries are also recommended.) Some also suggest avoiding playing games like football, because of the risk of head injuries, staying away from pesticides and insecticides that contain neurotoxins and not drinking excessively.

“Another thing that’s important as people get older is to maintain flexible attitudes and be willing to try new things,” said K. Warner Schaie, who in 1956 started the Seattle Longitudinal Study, which follows the psychological development of participants through adulthood. “You have to expect things will shift over time and won’t be the same as when you were young. Those who manage to roll with the punches, and enjoy change rather than fighting it, tend to do well.”

http://www.nytimes.com/2008/05/13/health/13brain.html

Reducing Your Risk for Breast Cancer

May 13, 2008

Breasts

By RONI CARYN RABIN

GO for regular checkups, do breast self-exams and get your mammograms on time, and chances are you’ll detect breast cancer early on, when it is most treatable. But what about prevention? Short of radical surgery, are there steps you can take to reduce the risk?

Turns out there are.

True, immutable factors like genetics, a family’s medical baggage and just being born female determine much of the risk of breast cancer. And, as with all cancers, that risk increases with age: a 30-year-old woman’s chances of developing breast cancer over a 10-year period are less than half of 1 percent, or 1 in 234, while a 60-year-old has a 3.5 percent risk, or 1 in 28. (The often-heard “one in eight” figure refers to the lifetime risk that women face.)

But there is now solid evidence that lifestyle can play a role as well. Choices that have an effect include how much alcohol a woman drinks (none is best), the amount of physical activity she gets (the more the better) and whether she takes hormones (the less the better). Doctors also urge women to keep their weight down, as obesity increases the risk of developing breast cancer during the postmenopausal years.

“Breast cancer is a disease of how much estrogen you have in your body,” said Heather Spencer Feigelson, strategic director of genetic epidemiology for the American Cancer Society, and these seemingly disparate factors — alcohol, physical activity and hormone pills — affect levels of estrogen and other hormones.

“There are things you can’t change, like when you got your first period, or your family history,” said Dr. Carolyn D. Runowicz, director of the Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center in Farmington, Conn., referring to two well-known risk factors, early menstruation and having a close relative with breast cancer. “But you can change a lot about you. Empower yourself with knowledge and information.”

Know your family’s medical history — but even if there is no history of breast cancer, don’t be complacent. Consult a genetic counselor if you are concerned about your family history, and inquire about being tested for the genetic mutations that increase breast cancer risk (more common among Ashkenazi Jews). Do not forget that breast cancer genes come from both sides of the family, not just your mother’s.

Among relatives, “the special red flags” are premenopausal breast cancer, bilateral breast cancer (cancer that appears in both breasts) and ovarian cancer, said Dr. Larry Norton, deputy physician in chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center. But even if no one in the family had breast cancer, that is no guarantee that you are safe, said Dr. Runowicz; in fact, only 10 percent of breast cancer patients have a family history.

Cut down on alcohol, or avoid it altogether. When it comes to breast cancer, studies have been pretty consistent: there is no safe amount of alcohol. Even one glass of wine a day can increase your risk slightly, and the risk climbs with each additional drink. “This is something you can control,” said Jasmine Q. Lew, a student at the Pritzker School of Medicine at the University of Chicago who recently completed a National Institutes of Health study that is one of the largest on the subject. “Women can choose not to drink.”

Exercise, exercise, exercise. Obesity after menopause increases the risk of breast cancer, so try to keep your weight down. But exercise is beneficial regardless of weight, and even a small amount of physical activity may be helpful. “Women who are overweight and exercising are at lower risk than those who are overweight and not exercising; women who are lean and exercising are at lower risk than women who are lean but not exercising,” Dr. Feigelson said. Risk drops with increased hours and strenuousness of exercise, and studies have found that women who do an average of three hours of strenuous exercise a week reduce their risk of breast cancer by 20 percent.

Breast-feed if you can. Early menstruation, late menopause, postponing pregnancy and never having gone through a full-term pregnancy increase the risk of breast cancer, but those factors cannot be changed easily. If you do have a baby, however, you may want to breast-feed, and the longer the better; studies have found that breast-feeding reduces the risk of breast cancer.

Try not to take combined hormone therapy. The recommendation for all hormone therapy is to take the lowest dose for the shortest period necessary. A Women’s Health Initiative study found a slightly higher risk for breast cancer among women who took estrogen with progestin after menopause, and a drop in breast cancer diagnoses since then has been attributed to the fact that many women quit using hormones. (In the same study, women on estrogen-only therapy, which is used by those who have had hysterectomies, did not have a higher breast-cancer risk.) A woman who has recently used birth control pills is also at greater risk; Dr. Norton urges women to find alternative contraceptive methods and avoid so-called natural or herbal hormones as well.

Have regular mammograms, but if you have very dense breast tissue or are at high risk of breast cancer for other reasons, insist on an M.R.I. as well. Having high breast-tissue density can drastically raise your risk of developing breast cancer, as does finding atypical hyperplasia, or abnormal cell growth, which is confirmed by a biopsy. After a mammogram, discuss the results with your physician. “Everyone just wants to hear that it’s negative,” Dr. Runowicz said. But important information can be gleaned even from a negative screening, she said. “Learn about your breast density. If a biopsy shows hyperplasia, your doctor can put you on a chemoprevention program.”

Become familiar with your personal risk factors. Your breast cancer risk could be higher than normal if you are above average height, upper middle class (probably related to the tendency to postpone childbearing and having fewer children), never had a full-term pregnancy or you had children after age 30, or if you ever had endometrial, ovarian or colon cancer or ever had high-dose radiation to the chest, your risk for breast cancer could be higher than average.

http://www.nytimes.com/2008/05/13/health/13breast.html