A new study published in the Archives of Internal Medicine gives further evidence to the linkage between exercise and good health. The study, entitled “Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older”looked at 13,500 women, who were part of the Nurses’ Health Study who had survived to age 70 years or older, without any of 10 major chronic diseases, open heart surgery or cognitive or physical impairment.

The Nurses’ Health Study, just to give a little background, is considered the “grandmother” of women’s health studies and represents the single largest “cohort” study of women, in which the same patients were followed and monitored over many years. It has resulted in more than 265 published scientific papers. The study was established in 1976, with the initial idea of studying the relationship between oral contraceptives, cigarette smoking and the risk of major illnesses. Thanks to the dedication and commitment of the participants, the scope and range of the study has broadened over time to evaluate other lifestyle factors, as well.

Using data from this group, the Harvard-based researchers found that higher physical activity levels at midlife were significantly associated with better odds of successful survival. Regular walking also was found to have a beneficial effect, but not quite as much as more vigorous exercise. Women in the upper 40% of activity were between 1.34 and 1.99 (for the top 20%) timesmore likely to successfully make it to age 70 without major health issues, compared to women in the lowest 20% of activity.

Now, if we could just find a way to make exercise fun!

One recent breakthrough in the understanding of aging, aging-related diseases and cancer has to do with the detailed mechanics of how our human cells divide. It’s really a pretty nifty discussion – and I promise not to get too technical. But it has major implications for research and development of new medical therapies, as well as anti-aging implications, so it’s worth hearing about.

We remember, from high school biology, that our cells DNA is duplicated as cell division takes place, right? Well, it turns out that there is an important detail missing from that explanation, and that our little human DNA photocopier doesn’t make perfect copies.

At the end of a strand of DNA, there is a “cap” called a telomere. Dr. Elizabeth Blackburn, who was later awarded the 2009 Nobel prize in medicine for her work in this area, famously compared telomeres to the little plastic tips on the ends of shoelaces that keep them from fraying. (For those of you in the crowd who like cell biology, a telomere is a long repeating section of DNA, with the base pair pattern TTAAGGG repeating many times.)

As our cells undergo division, our personal little DNA photocopier, called “DNA polymerase”, can’t properly copy this section properly, and so the newly minted telomere gets progressively shorter with each round of cell division. That’s the problem.

This limits cells to a fixed number of divisions, and sets a limit on the cell’s lifespan. Except for cancer cells – which have figured out how to beat this problem with a telomere repair enzyme, called telomerase, giving them the potential for an unlimited number of replications, or a sort of immortality.

Studies have found shortened telomeres in many cancers, including pancreatic, bone, prostate, bladder, lung, kidney, and head and neck. Short telomeres have also been linked to an aging effect on the cells (“senescence”) and are found in multiple non-cancer disease states, like Alzheimer’s dementia, ALS and coronary heart disease.

So, significant research is going into ways to keep telomeres from shortening, or perhaps how to reverse the telomeric shortening process. Not only would this help to fight multiple cancers and Alzheimer’s, but there could be significant anti-aging effects as well. Ideally, we could find a way to keep telomeres nice and long in healthy cells, but not in cancerous cells.

In this week’s issue of JAMA, researchers looked at the effect of a fish oil, omega-3 fatty acid, and its effect on telomere shortening over a 5 year period. It turns out that omega-3 fatty acid is good for your telomeres. People with the lowest levels of omega-3 fatty acids in their blood stream showed the most aging changes in their telomeres, and vice versa. You might want to consider getting some omega-3 supplements!

A double-blind, randomized trial on whether omega-3 fatty acid actually reduces cellular aging is now planned.

Here in Orlando, UCF has a national reputation in this area: much research is done here on the effect of telomere shortening and neuro-degenerative diseases. Go team!

A new study released Monday in Circulation: Journal of the American Heart Association confirms what Mom always told you – too much TV watching is bad for you.

The study looked at health data among 8,800 men and women over age 25 in the Australian Diabetes, Obesity and Lifestyle Study. Researchers separated the participants into three groups: those who regularly watched less than two hours a day, those who watched two to four hours a day and those who regularly watched more than four hours of television each day.

People with a history of cardiovascular disease were excluded from the study.

People who watched more than four hours a day showed an 80 percent greater risk of death from cardiovascular disease and a 46 percent higher risk of all causes of death, compared with those who watched less than two hours a day. Researchers controlled for smoking, high blood pressure, high cholesterol, an unhealthy diet and leisure-time exercise.

Researchers found a strong connection between TV hours and risk of death from cardiovascular disease; that link was found not just among the overweight and obese but among people who had a healthy weight and exercised.

It’s probably pretty similar for playing video games and surfing the web. Being a couch potato is a dangerous occupation!

 

Here’s a interesting commentary by Florida Medical Association President, Dr. James Dolan, regarding the constitutionality of the proposed Healthcare reform proposal that requires the mandatory purchase of health insurance. I have quoted the relevant sections, below.****

Interestingly, the one proposal that has united critics on the left and the right is the so-called “individual mandate,” which requires everyone to carry health insurance. The rationale for this is that adding healthier individuals to the pool of the insured lives increases the risk spread, making insurance cheaper for all. But because underwriters won’t be able to age-adjust premiums appropriately, and no exclusions for pre-existing conditions will be allowed, premiums will cost more for the healthy individuals.

Jim Dean, brother of Howard Dean, MD, and chairman of Democracy for America, said, “We’d like to see the individual mandate stripped. It was fair given the presence of a government entity (the “public option”) that could provide competition and control the cost. It ‘s not fair if people are required to buy insurance from the same insurance industry that caused this problem in the first place.”

Michael Cannon, a policy analyst at the Cato Institute said, “The federal government does not have the power (constitutional authority) to force you to purchase a private product.”

Our Florida State Attorney General, Bill McCollum and a dozen or so other state attorneys general agree. “It’s a tax on living,” McCollum said. It’s different than being required to buy auto insurance, because drivers are free to choose whether or to own a car, he argues.

Watch for immediate legal challenges to the bill that is eventually signed into law. While Congress can pass any law it wants, the U.S. Supreme Court can nullify it based on constitutional challenges.

****

Comments welcome.

I had an interesting conversation with a patient this week, who strenuously asserted that the link between cholesterol levels and heart disease remains “unproven”. As it happens, this month’s issue of the Journal of the American Medical Association (JAMA) has a major new study reviewing the link between cholesterol, heart disease and stroke, so I was able to show him the data.

The study group came up with some new findings, and re-confirmed some older findings:

1. HDL levels (high density lipoprotein) – aka “the good cholesterol” – is clearly protective for heart disease. Higher levels are strongly correlated with a reduced rate of coronary heart disease. We knew this already.

2. Everything else (other than HDL) in the cholesterol family is “bad”, with the risk of cardiac disease increasing significantly for non-HDL levels above 135 mg/ml. “Non-HDL cholesterol” is certainly simpler to remember than LDL’s, VLDL’s, chylomicrons and all the rest.

3. Triglyceride levels had no relation to heart disease risk in this study. Before you start celebrating, remember that excess triglyceride levels have been linked to pancreatitis.

4. Interestingly, there was no significant linkage between non-HDL (bad) cholesterol and stroke rates. That finding was unexpected.

5. Also new, Cholesterol levels did not vary significantly from the fasting and non-fasting states. Therefore, next time you go to have your cholesterol blood test, you will no longer need to skip breakfast.

Essentially, this study simplifies assessment of the lipid risk profile for cardio-vascular disease. Measure your total cholesterol and your HDL cholesterol, and don’t worry too much about the other cholesterol groups. And don’t worry about getting fasting lab work, unless the fasting state is needed for some other lab test, like glucose levels.

Ever see a product and go, “I wish I had thought of that”? Today, I tested a new surgical product called the Keller funnel, named after its inventor, also a plastic surgeon – and I had that very same sentiment.

Essentially, the Keller funnel looks like a high-tech cake decorator’s funnel, the triangular bag with which cake icing would be squeezed onto a cake – except that this one is made of fancy materials, is sterile, and has an inner surface which is coated with a slippery space-age coating. Dr. Keller devised it to help plastic surgeons place silicone gel breast implants more easily during surgery, through smaller incisions, and with potentially less contamination or chance of implant damage.

While these other possible benefits haven’t yet been scientifically proven, the gadget certainly does work for its primary purpose – the implant slides into the surgical pocket, easy as can be.

If the company can produce these at a reasonable price, I think they’ll have a winner.

New details have now emerged regarding the tragedy which occurred in south Florida, following liposuction surgery at an unlicensed medispa, which we discussed in an earlier chapter of the blog.

According to an October 30, 2009 article in the Sun-Sentinel, the patient was not having the liposuction surgery performed with just local anesthesia (numbing with lidocaine), but she also was given the anesthesia drug Propofol for intravenous sedation. Propofol is a safe drug in the trained hands of an anesthesiologist, but, as Michael Jackson found out, it can be lethal in the hands of an amateur.

This discovery makes a huge legal and regulatory difference. It’s giving anesthesia without a trained anesthesiologist or nurse-anesthetist being present.

Receiving any sort of intravenous sedation automatically defines the procedure, according to existing Florida regulations, as a “level II office surgery” at a minimum. The level II category mandates significantly more stringent requirements than a procedure performed with local anesthesia only, such as:
– a well-defined list of safety equipment present in the office
– certain monitoring standards for the patient’s vital signs and oxygenation
– completion of inspection of the surgery center by either the State of Florida or one of the national accreditation agencies
– hospital privileges for the surgeon
– a standing hospital transfer agreement in case of emergency.

None of these regulations were being followed by the Weston Medi-spa. The physician who performed this surgery was not board-certified in a surgical specialty, and reportedly did not have hospital privileges to perform liposuction in any hospital.

The Board of Medicine is now looking at a new rule, which would require all Medi Spas where surgical procedures are performed to follow the same regulations as surgery centers. I think this is an excellent idea, that would enhance patient safety.

However, these rules have to have some “teeth”. It’s one thing to write a good law, but another thing altogether to insure that the law is followed. Currently, it is the enforcement of existing regulations that is lacking. There are some good people working for the Board of Medicine – but they are stretched thin, in terms of manpower and funding.

I’ve been saying this for years, and now the World Health Organization has issued a definitive statement: tanning booths cause skin cancer.

In the story from the CBC news website, the International Agency for Cancer Research or IARC, the World Health Organization’s cancer wing in Lyon, France, updated the cancer risk level from tanning beds, based on research published online Wednesday in the medical journal Lancet Oncology

Tanning beds and ultraviolet radiation cause cancer and have been moved up to the highest risk category by these international cancer experts. The new classification means tanning beds and UV exposure definitely causes cancer in humans, just as tobacco smoke, the hepatitis B virus, radon gas, plutonium and mustard gas do.

Experts upgraded the level after an analysis of about 20 studies concluded that the risk of skin melanoma is increased by 75 per cent when people started using tanning beds before age 30.

Previous studies found younger people who regularly use tanning beds are eight times more likely to get melanoma than people who have never used them.

WHO has warned people younger than 18 to avoid tanning beds. The Canadian Cancer Society has called for minors to be barred from using tanning beds, and the American Cancer Society advises people to try self-tanning creams instead of tanning beds.

According to a recent report, obesity rates in the U.S. have further increased over the last year, with adult obesity rates rising in 23 states.

For the fifth year in a row, Mississippi had the highest rate of adult obesity at 32.5%. Three other states – West Virginia, Alabama and Tennessee – also had adult obesity rates in excess of 30%.
In just one state – Colorado – was the adult obesity rate below 20%.

In 1991, not one state had an adult obesity rate above 20%.

Mississippi also had the highest rate of obese and overweight children (ages 10 to 17) at 44.4%. Minnesota and Utah had the lowest rate at 23.1%.
Childhood obesity rates in the US have more than tripled since 1980.

This is an epidemic, people!

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