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Archive for March, 2010

BY SARAH KLEIN

Scientists have finally confirmed what the rest of us have suspected for years: Bacon, cheesecake, and other delicious yet fattening foods may be addictive.

A new study in rats suggests that high-fat, high-calorie foods affect the brain in much the same way as cocaine and heroin. When rats consume these foods in great enough quantities, it leads to compulsive eating habits that resemble drug addiction, the study found.

Doing drugs such as cocaine and eating too much junk food both gradually overload the so-called pleasure centers in the brain, according to Paul J. Kenny, Ph.D., an associate professor of molecular therapeutics at the Scripps Research Institute, in Jupiter, Florida. Eventually the pleasure centers “crash,” and achieving the same pleasure–or even just feeling normal–requires increasing amounts of the drug or food, says Kenny, the lead author of the study.

“People know intuitively that there’s more to [overeating] than just willpower,” he says. “There’s a system in the brain that’s been turned on or over-activated, and that’s driving [overeating] at some subconscious level.”

In the study, published in the journal Nature Neuroscience, Kenny and his co-author studied three groups of lab rats for 40 days. One of the groups was fed regular rat food. A second was fed bacon, sausage, cheesecake, frosting, and other fattening, high-calorie foods–but only for one hour each day. The third group was allowed to pig out on the unhealthy foods for up to 23 hours a day.

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Not surprisingly, the rats that gorged themselves on the human food quickly became obese. But their brains also changed. By monitoring implanted brain electrodes, the researchers found that the rats in the third group gradually developed a tolerance to the pleasure the food gave them and had to eat more to experience a high.

They began to eat compulsively, to the point where they continued to do so in the face of pain. When the researchers applied an electric shock to the rats’ feet in the presence of the food, the rats in the first two groups were frightened away from eating. But the obese rats were not. “Their attention was solely focused on consuming food,” says Kenny.

In previous studies, rats have exhibited similar brain changes when given unlimited access to cocaine or heroin. And rats have similarly ignored punishment to continue consuming cocaine, the researchers note.

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The fact that junk food could provoke this response isn’t entirely surprising, says Dr.Gene-Jack Wang, M.D., the chair of the medical department at the U.S. Department of Energy’s Brookhaven National Laboratory, in Upton, New York.

“We make our food very similar to cocaine now,” he says.

Coca leaves have been used since ancient times, he points out, but people learned to purify or alter cocaine to deliver it more efficiently to their brains (by injecting or smoking it, for instance). This made the drug more addictive.

According to Wang, food has evolved in a similar way. “We purify our food,” he says. “Our ancestors ate whole grains, but we’re eating white bread. American Indians ate corn; we eat corn syrup.”

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The ingredients in purified modern food cause people to “eat unconsciously and unnecessarily,” and will also prompt an animal to “eat like a drug abuser [uses drugs],” says Wang.

The neurotransmitter dopamine appears to be responsible for the behavior of the overeating rats, according to the study. Dopamine is involved in the brain’s pleasure (or reward) centers, and it also plays a role in reinforcing behavior. “It tells the brain something has happened and you should learn from what just happened,” says Kenny.

Overeating caused the levels of a certain dopamine receptor in the brains of the obese rats to drop, the study found. In humans, low levels of the same receptors have been associated with drug addiction and obesity, and may be genetic, Kenny says.

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However, that doesn’t mean that everyone born with lower dopamine receptor levels is destined to become an addict or to overeat. As Wang points out, environmental factors, and not just genes, are involved in both behaviors.

Wang also cautions that applying the results of animal studies to humans can be tricky. For instance, he says, in studies of weight-loss drugs, rats have lost as much as 30 percent of their weight, but humans on the same drug have lost less than 5 percent of their weight. “You can’t mimic completely human behavior, but [animal studies] can give you a clue about what can happen in humans,” Wang says.

Although he acknowledges that his research may not directly translate to humans, Kenny says the findings shed light on the brain mechanisms that drive overeating and could even lead to new treatments for obesity.

“If we could develop therapeutics for drug addiction, those same drugs may be good for obesity as well,” he says.

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LONDON — The Easter Bunny might lower your chances of having a heart problem. According to a new study, small doses of chocolate every day could decrease your risk of having a heart attack or stroke by nearly 40 percent.

German researchers followed nearly 20,000 people over eight years, sending them several questionnaires about their diet and exercise habits.

They found people who had an average of six grams of chocolate per day – or about one square of a chocolate bar – had a 39 percent lower risk of either a heart attack or stroke. The study is scheduled to be published Wednesday in the European Heart Journal.

Previous studies have suggested dark chocolate in small amounts could be good for you, but this is the first study to track its effects over such a long period of time. Experts think the flavonols contained in chocolate are responsible. Flavonols, also found in vegetables and red wine, help the muscles in blood vessels widen, which leads to a drop in blood pressure.

“It’s a bit too early to come up with recommendations that people should eat more chocolate, but if people replace sugar or high-fat snacks with a little piece of dark chocolate, that might help,” said Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition in Nuthetal, Germany, the study’s lead author.

The people tracked by Buijsse and colleagues had no history of heart problems, had similar habits for risk factors like smoking and exercise, and did not vary widely in their Body Mass Index.

Since the study only observed people and did not give them chocolate directly to test what its effects were, experts said more research was needed to determine the candy’s exact impact on the body. The study was paid for by the German government and the European Union.

Doctors also warned that eating large amounts of chocolate could lead to weight gain, a major risk factor for heart problems and strokes.

“This is not a prescription to eat more chocolate,” said Dr. Robert Eckel, a professor of medicine at the University of Colorado and a past president of the American Heart Association. He was not linked to the study. “If we all had (a small amount) of chocolate every day for the rest of our lives, we would all gain a few pounds.”

Eckel said it was amazing to find such a small amount of chocolate could have such a protective effect, but that more studies needed to be done to confirm its conclusions.

Alice Lichtenstein, a nutritionist at Tufts University School of Medicine, said it was difficult to link the reduction in heart disease and stroke risk to the chocolate alone, since there may have been other differences between the study participants.

“The relationship between chocolate and good health outcomes is still uncertain,” she said. “If somebody really enjoys eating chocolate, then they should have a small amount of that and just really enjoy it,” she said.

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BY SANDEEP JAUHAR

“I’m tired of paying for everyone else’s stupidity,” is a comment I read on the Internet last week after the health care bill was passed. It summed up the views of many Americans worried about shelling out higher premiums and taxes to cover the uninsured. Why should we pick up the tab when so much disease in our country stems from unhealthy behavior like smoking and overeating?

In fact, the majority of Americans say it is fair to ask people with unhealthy lifestyles to pay more for health insurance. We believe in the concept of personal responsibility. You hear it in doctors’ lounges and in coffee shops, among the white collar and blue collar alike. Even President Obama has said, “We’ve got to have the American people doing something about their own care.”

But personal responsibility is a complex notion, especially when it comes to health. Individual choices always take place within a broader, messy context. When people advocate the need for personal accountability, they presuppose more control over health and sickness than really exists.

Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics. Patient noncompliance with medical recommendations undoubtedly contributes to poor health, but it is as much a function of poor communication, medication costs and side effects, cultural barriers and inadequate resources as it is of willful disregard of a doctor’s advice.

A few years ago surgeons in Melbourne, Australia, were refusing to provide heart and lung surgeries to smokers, even those who needed the operations to stay alive. “Why should taxpayers pay for it?” said one surgeon quoted in media reports at the time. “It is consuming resources for someone who is contributing to their own demise.”

Though some were outraged by this stance — the Australian Medical Association called it “unconscionable” to ration services based on personal habits — many doctors agreed with it. Like the majority of Americans, they saw nothing wrong with patients paying for the consequences of their actions.

The problem is that punitive measures to force healthy behavior do not usually work. In 2006, West Virginia started rewarding Medicaid patients who signed a pledge to enroll in a wellness plan and to follow their doctors’ orders with special benefits, including unlimited prescription-drug coverage, programs to help them quit smoking and nutrition counseling. Those who did not sign up were enrolled in a more restrictive plan that, among other things, limited drug coverage to only four prescriptions a month.

The program, by many accounts, is failing. As of August 2009, only 15 percent of 160,000 eligible patients had signed up. Patients with limited transportation options were having a hard time committing to regular office visits. And experts say there is no evidence that restricting benefits for noncompliant patients has promoted healthy behaviors.

As a cardiology fellow, I once took care of a young man with severe congestive heart failure. We were supposed to start him on a blood thinner early in his hospitalization, but it got overlooked. Fed up with the delays in getting his blood sufficiently thinned, he left the hospital against medical advice. He said he had to go home to care for his toddler.

He came to the clinic a week later looking very embarrassed. He had left without prescriptions, so he had been taking no medications since he left, leaving him short of breath. To compound the problem, he had been eating cold cuts, cheap and readily available, which made his condition even worse. But the attending physician refused to give him prescriptions. She said that he had to go to a walk-in clinic. She said he had to learn personal responsibility.

Healthy living should be encouraged, but punishing patients who make poor health choices clearly oversimplifies a very complex issue. We should be focusing on public health campaigns: encouraging exercise, smoking cessation and so on. Of course, this will require a change in how we live, how we plan our communities.

“It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

I must admit I often feel like my colleagues who grouse about spending all day treating patients who do not seem to care about their health and then demand a quick fix. I do not relish paying more taxes to treat patients who engage in unhealthy habits. But then I remind myself that we all engage in socially irresponsible behavior that others pay for. I try to eat right and get enough exercise. But then I also sometimes send text messages when I drive.

The whole point of insurance is to reduce risk. When people inveigh against the lack of personal responsibility in health care, they are really demanding a different model, one based on actual risk, not just on spreading costs evenly through society. Sick people, they are really saying, should pay more. Which model we eventually adopt in this country will say a lot about the kind of society we want to live in.

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BY DENISE GRADY

Being a woman is no longer a pre-existing condition. That’s the new mantra, repeated triumphantly by House Speaker Nancy Pelosi, Senator Barbara A. Mikulski and other advocates for women’s health. But what does it mean?

In the broadest sense, the new health care law forbids sex discrimination in health insurance. Previously, there was no such ban, and insurance companies took full advantage of the void.

“The health care industry and health care insurance in general has been riddled with the most discriminatory and unfair practices to women,” said Marcia D. Greenberger, the founder and co-president of the National Women’s Law Center. “This law is a giant leap forward to dismantling the unfairness that has been a part of the system.”

Until now, it has been perfectly legal in most states for companies selling individual health policies — for people who do not have group coverage through employers — to engage in “gender rating,” that is, charging women more than men for the same coverage, even for policies that do not include maternity care. The rationale was that women used the health care system more than men. But some companies charged women who did not smoke more than men who did, even though smokers have more risks. The differences in premiums, from 4 percent to 48 percent, according to a 2008 analysis by the law center, can add up to hundreds of dollars a year. The individual market is the one that many people turn to when they lose their jobs and their group coverage.

Insurers have also applied gender-rating to group coverage, but laws against sex discrimination in the workplace prevent employers from passing along the higher costs to their employees based on sex. Gender rating has taken a particular toll on smaller or midsize businesses with many women, like home-health care, child care and nonprofits. As a result, some businesses have been unable to offer health coverage or have been able to afford it only by using plans with very high deductibles.

In addition, individual policies often excluded maternity coverage, or charged much more for it. Now, gender rating is essentially outlawed, and policies must include maternity coverage, considered “an essential health benefit.”

“It has to be a part of the premium just like heart attacks, prostate cancer or any other condition,” Ms. Greenberger said.

Despite her enthusiasm for many aspects of the new law, Ms. Greenberger said she was profoundly disappointed in provisions that she thought would limit women’s access to abortion services.

Advocates for women’s health said one of the new law’s benefits would be to ban the denial of health coverage to women who have had a prior Caesarean section or been victims of domestic violence. Some companies providing individual policies have refused coverage in those circumstances, regarding Caesareans or beatings as pre-existing conditions that were likely to be predictors of higher expenses in the future.

In a statement issued Thursday, Senator Mikulski said: “One of my hearings revealed that a woman was denied coverage because she had a baby with a medically mandated C-section. When she tried to get insurance coverage with another company, she was told she had to be sterilized in order to get health insurance. That will never, ever happen again because of what we did here with health care reform.”

Peggy Robertson, 41, who lives in Centennial, Colo., is the woman to whom Senator Mikulski referred. Ms. Robertson was interviewed by The New York Times in June 2008 and testified at the hearing last October. Her husband, a chiropractor, is self-employed, so they rely on the individual market to cover them and their two sons. In 2007, they had insurance, but considered switching companies when a broker suggested they might find a better deal. They applied to a company called Golden Rule, which is based in Indianapolis and owned by UnitedHealthcare. The company rejected Ms. Robertson because of her Caesarean, explaining in a letter that she would have been eligible if she had been sterilized. When Ms. Robertson went public with her story, the word “sterilized” seemed to provoke particular outrage, she said.

Golden Rule later began offering coverage to women who had had Caesareans, but by charging extra if they wanted maternity coverage, or issuing policies that excluded maternity care.

In a telephone interview on Friday, Ms. Robertson said: “Barbara Mikulski told me, she promised me, ‘This will never happen again.’ She did it. It’s wonderful.”

Ms. Robertson’s only disappointment was that some of the new rules would not take effect until 2014.

But Ms. Greenberger said that while it is true that the specific requirements will be delayed until 2014, some changes should actually happen much sooner, because the law’s overarching ban on sex discrimination takes effect immediately. The legalese outlawing sex discrimination is not easy to find or to parse, but it refers to existing laws, like the Civil Rights Act and Title IX, to say that the same protections apply to people seeking health care and insurance.

The passage, Sec. 1557 on page 368 of the 2,074-page bill, says: “Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under this title (or amendments).”

What it means, Ms. Greenberger said, is that no organization receiving any federal money at all — as insurers generally do — can discriminate on the basis of sex. Gender rating, she said, “is a problem whose days are numbered.”

Ms. Greenberger acknowledged that insurance companies were masters at protecting their bottom line, but said she did not see an obvious way around the new rules. “I never want to underestimate what a creative mind might be able to come up with,” she said, “but I believe this is pretty straightforward.”

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Rating: 5 stars, a must see

Quick note here – if you haven’t seen it already, watch ABC’s “Jamie Oliver’s Food Revolution.”  It showcases American eating habits, specifically among children, and the disgusting state of school lunch.  What the country needs is truly a revolution to end our dependency on cheap, processed food, and a return to home-cooked meals and REAL food.

Bravo to Jamie Oliver for a daunting task and job well done.

View the pilot episode here:  http://www.hulu.com/watch/136381/jamie-olivers-food-revolution-episode-101

Warning:  It will shock you.

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BY SHALMALI PAL

Breast cancer patients can be assured that enjoying soy food products won’t hurt them and may even impart some benefit for reducing the risk of recurrence. But when discussing the pros and cons of soy, clinicians should be aware that there are differences in the quantity and quality of soy in popular food products.

Soy is known to contain both estrogenlike and anti-estrogenic properties, and previous research has yielded conflicting results. A 2003 study suggested that the soy protein genistein may cause ER-positive tumors to grow faster while a 2006 meta-analysis of research on soy intake and breast cancer noted only a modest reduction in risk (Cancer Res 61:5045-5050; J Natl Cancer Inst 98:459-471).

More recent studies have bolstered the benefits of soy (see Fact box), including the latest research from Xiao Ou Shu, MD, PhD, and colleagues. They studied the association of soy food consumption after a breast cancer diagnosis using data on 5,033 patients from the Shanghai Breast Cancer Survival Study. Dr. Shu is a professor of medicine in the division of epidemiology at Nashville’s Vanderbilt University Medical Center and Vanderbilt- Ingram Cancer Center. Co-authors are from the Shanghai Institute of Preventive Medicine. Dr. Shu reported having received a research development fund from the United Soybean Board in 2005, according to JAMA.

The women were sent a structured questionnaire. The authors collected clinical information and assessed habitual dietary intake at various times over a 36- month period. A food frequency questionnaire measured the consumption of soy foods (tofu, soy milk, fresh soy beans) and other foods such as meat, fish, and cruciferous vegetables. As of June 2009, the 36-month interview was completed for 4,354 of 4,934 eligible patients. The major endpoints for the study were death from any cause, cancer recurrence or metastasis, or death from breast cancer (JAMA 302:2437-2443, 2009).

In the multivariate analysis, Dr. Shu’s group adjusted for known clinical predictors and lifestyle factors related to soy intake and survival, including age at diagnosis, tumor stage, method of treatment (chemotherapy, radiotherapy, etc), hormone-receptor status, and tamoxifen use.

After a median follow up of 3.9 years, the authors documented 444 total deaths and 534 recurrences or breast cancerrelated deaths in the study group. They found that soy protein or soy isoflavone intake after cancer diagnosis was inversely associated with mortality and recurrence.

When comparing the hazard ratios for the highest and lowest quartiles of soy protein intake, the authors calculated HRs of 0.71 for total mortality and 0.68 for recurrence. The corresponding HRs for mortality when soy isoflavone intake was considered were 0.79 for mortality and 0.77 for recurrence. The multivariate-adjusted, four-year mortality rate for women in the lowest quartile was 10.3% while the recurrence rate was 11.2%. For women in the highest quartile, the multivariate-adjusted, four-year mortality rate was 7.4% and the recurrence rate was 8%.

Hormone-receptor status did not change the association between soy consumption, mortality, and recurrence, the authors reported. Also, the regular use of soy products did not confer additional benefits in women who were also on tamoxifen. However, women on tamoxifen with low to moderate soy intake did see an improvement in survival, the authors said, suggesting that “high soy food intake and tamoxifen use may have a comparable effect on breast cancer outcomes.”

However, Dr. Shu told Oncology News International that “it would be premature to recommend that women replace tamoxifen with soy food. In our observational study, we found the soy food consumption has [a] similar effect on breast cancer outcome [to] tamoxifen. [But] a definite answer will have to come from controlled clinical trials.”

As for how much intake is needed to reap the benefits of soy, in the Shanghai study 50% of women consumed soy foods that are the equivalent of 9.45 g of soy protein per day. Based on a dose-response pattern, Dr. Shu’s group determined that the association of soy food intake with mortality and recurrence topped out at 11 g of soy protein/day. No additional benefits were seen with more than 11 g of soy protein/day, they wrote.

The authors acknowledged that the study had several limitations. First, women with a higher soy intake engaged in a healthier lifestyle overall, including more exercise and a high vegetable intake. Also, the follow-up period was relatively short and the study did not have enough statistical power for a subanalysis by estrogen-receptor or tamoxifen status. Dr. Shu said that her group will continue with this research, looking specifically at subgroup analysis by ER status and tamoxifen use.

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BY MARTHA ROSE SHULMAN

Broccoli is an affordable vegetable, packed with nutrients and available in most supermarkets. To save on pasta, buy big bags of it at package stores. The Parmesan, the priciest part of the recipe, is optional.

1 pound broccoli, broken into florets, the stems peeled and cut in small dice

Salt

2 tablespoons extra virgin olive oil

2 garlic cloves, minced

1/4 teaspoon red pepper flakes (optional)

1 1/2 cups cooked chickpeas, or 1 (15-ounce) can, drained and rinsed

3/4 pound fusilli, bow-ties or orecchiette

1/4 cup freshly grated Parmesan (optional)

1. Bring a large pot of water to a boil. Fill a bowl with ice water. Meanwhile, prepare the broccoli, and separate the stems and the florets. When the water comes to a boil, salt generously and add the broccoli stems. Boil for five minutes and then remove from the water with a slotted spoon. Add the florets, and boil for three minutes. Transfer to the ice water, drain and chop medium-fine, so that some of the florets are falling apart. Return the pot to the heat.

2. Heat 1 tablespoon of the olive oil in a wide, heavy skillet over medium heat. Add the garlic and red pepper flakes (if using), and cook, stirring, until fragrant, about 30 seconds. Stir in the broccoli florets and the stems, season with salt and cook, stirring, until nicely seasoned and coated with the oil, just a minute or two. Add the chickpeas, and stir everything together.

3. Bring the pot of water back to a boil, and add the pasta. Cook al dente, following timing instructions on the package but checking to see if the pasta is done about a minute before the stated time. Add 1/2 cup of the pasta cooking water to the pan with the broccoli. Drain the pasta, and toss at once with the broccoli mixture and another tablespoon of olive oil. If desired, sprinkle on the Parmesan. Serve at once.

Note: If you can’t find chickpeas, substitute another type of bean, like white beans, kidney beans or red beans. If you can’t find fresh broccoli, substitute frozen.

Yield: Four generous servings.

Advance preparation: You can make the topping a few hours before cooking the pasta and hold it on top of the stove.

Good luck, healthy girl!

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