Laughter May Increase Appetite

A hearty laugh and a moderate workout may have more in common than anyone thought.

Both affect the appetite hormones in much the same way:

- When leptin goes down, it increases appetite
- When ghrelin goes up, it increases appetite

That is what typically happens after moderate exercise.

Leptin (from Greek, leptos, meaning thin) is a protein hormone that plays a key role in regulating energy intake and expenditure, including appetite and metabolism. Leptin acts on receptors in the hypothalamus of the brain where it inhibits appetite.

Ghrelin is a hormone that stimulates hunger. The name is based on its role as a growth hormone-releasing peptide, with reference to the root "ghre", meaning to grow. It is produced by the cells lining the fundus of the stomach and epsilon cells of the pancreas. It is considered the counterpart of the hormone leptin, produced by adipose tissue.

Twitter comments:

@LJaneTn Fat and Funny?

@doctorwhitecoat This explains why I'm always so hungry.

@scanman That explains why I eat too much when I party with friends.

References:
Laughter Affects Appetite Much Like a Workout Does. WebMD.

Image source: Wikipedia, public domain.

Anticancer effect of "5 a day" fruit and vegetable servings is negligible

It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk.

People who eat more fruit and vegetables than average may have a slightly reduced risk of getting cancer, a big study concludes, but the benefit is much smaller than previous studies suggested.

The European Prospective Investigation Into Cancer and Nutrition (EPIC) was a 9 year prospective study of nearly 500 000 Europeans. It concluded that the protective effect of eating fruit and vegetables is “very small” (J Natl Cancer Institute 2010).

Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97); 100 g/d increased intake of total vegetables, HR = 0.98); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99).

The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol.

References:

Study finds that anticancer effect of “5 a day” is less than expected. BMJ, 2010.
Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 2010 Apr 21;102(8):529-37. Epub 2010 Apr 6.

President Obama has been smoking for 30 years and managed to quit - and so can you

The White House says President Obama has kicked the habit and stopped smoking. "It's been probably about nine months since he last smoked a cigarette," says Robert Gibbs, the President's press secretary, in an interview with CNN. Mr. Obama, like a lot of smokers, has quit before and started back up again. This time may be different. Gibbs says this is the longest he's known the President to go without a cigarette. He quit by chewing Nicorette gum and exercising a lot of will power.

References:

Stop smoking: Follow the President's example. CNN.
The Presidents Club | Photos: Oval Office Secrets from Truman to Obama | TIME, 2012.

Cleverest women are the heaviest drinkers, according to Telegraph newspaper

Not sure if this is the best choice for a headline... This is the original source: Education, alcohol use and abuse among young adults in Britain. Soc Sci Med. 2010 Jul.

The findings come from a study carried out at the London School of Economics in which researchers tracked the lives of thousands of 34-year-old women and men, all born in the UK during the same week in 1970.

The report states: "The more educated women are, the more likely they are to drink alcohol on most days and to report having problems due to their drinking patterns.

"The better-educated appear to be the ones who engage the most in problematic patterns of alcohol consumption."

They may have more active social lives or work in male-dominated workplaces with a drinking culture. As girls, they may have grown up in middle-class families and seen their parents drink regularly.

According to the researchers, higher educational attainment is associated with increased odds of daily alcohol consumption and problem drinking. The relationship is stronger for females than males. Individuals who achieved high educational test scores in childhood are at a significantly higher risk of abusing alcohol across all dimensions.

References:
Cleverest women are the heaviest drinkers. Telegraph.

Education, alcohol use and abuse among young adults in Britain. Huerta MC, Borgonovi F. Soc Sci Med. 2010 Jul;71(1):143-51. Epub 2010 Mar 31.

Image source: Wikipedia.

Positive attitude and cheerfulness not related to college success

This study investigated the relation between positive affect and college success for undergraduate students matriculating at 21 colleges and universities in the United States.

Positive affect — cheerfulness — was positively related to students’ self-rated academic abilities, self-predicted likelihoods of various college outcomes, self-stated major and academic-degree intentions, and self-reported subjective college outcomes, but negatively related to most objective college-success variables (e.g., cumulative college grade-point average) recorded by the institution of matriculation, and not related to objective college outcomes reported by the student.

Positive affect was thus associated with “positive illusions” about college-success variables.

References:
Positive Affect and College Success. Journal of Happiness Studies - SpringerLink Journal, 2010.

Image source: OpenClipArt.org (public domain).

30 minutes is not enough - middle-aged need full hour of exercise to avoid gaining weight as they age

Middle-aged women need to get at least an hour a day of moderate exercise if they hope to ward off the creep of extra pounds that comes with aging.

According to JAMA, among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

Already, two-thirds of U.S. adults and nearly one in three children are overweight or obese.

Sheila Anderson, 50, works out at the fitness center three to four times a week, doing 45 minutes of cardiovascular training and a couple of hours a week of weight training.

"Does it strike me as too much?" she said of the finding. "Maybe. It sure is hard to fit in an hour each day. I could not come to the gym seven days a week," she said.

One hour per day of exercise is difficult to achieve. However, even 30 minutes is better than no exercise at all.



Dr. Michael Roizen, Cleveland Clinic Chief Wellness Officer, answers the question "How much exercise is enough?"

Three parts of exercise have been shown to be beneficial to health:

1. Moving the equivalent to 10,000 steps a day.
2. Resistance exercise for 30 minutes a week.
3. 20 minutes of cardiovascular exercise.

References:

Hour of exercise may be too much for busy U.S. women | Reuters.

JAMA 2010;303[12]:1173-1179

Sitting on a patient’s bed, by visitors or doctors, is prohibited by infection control

Iona Heath, general practitioner from London comments on this issue in BMJ:

"I learnt recently from senior nursing colleagues that sitting on a patient’s bed, by either visitors or clinicians, is now also prohibited, apparently in the interests of infection control. A quick internet search of "sitting on the bed" and "infection control" produces a huge list of leaflets from a variety of hospitals, each reinforcing the prohibition.

Doctors should never be discouraged from sitting, because patients consistently estimate that they have been given more time when the doctor sits down rather than stands. Standing makes the conversation seem hurried even when it is not; and, in the hospital setting, sitting on the chair does not seem to work nearly as well, because the levels are somehow all wrong."

Sitting on a chair next to the patient's bed is the best approach.

References:
Do not sit on the bed -- Heath 340: c1478 -- BMJ.

Image source: OpenClipArt.org, public domain.

Correcting Vitamin D Deficiency May Decrease Risk of Heart Disease

Vitamin D is a steroid hormone and a component of a complex endocrine pathway sometimes called 'vitamin D endocrine system' (Medscape, 2012).  In a recent study, 9,400 patients had an average vitamin D level of 19.3 nanograms per milliliter - levels of 30 are generally considered "normal". At their next follow-up visit, 50% of patients had raised their vitamin D levels to above 30 nanograms per milliliter.

Compared with patients whose vitamin D levels were still low, patients who raised their vitamin D levels were 33% less likely to have a heart attack, 20% less likely to develop heart failure, and 30% less likely to die between the two visits (source: WebMD).

"While normal has generally been considered to be 30, some people have suggested 40 or 50 is better. People who increased their vitamin D blood level to 43 nanograms per milliliter had the lowest rates of heart disease and stroke. But increasing it beyond that, say to 60 or 70, offered no greater benefit."

One of the BMJ blogs calls vitamin D "the elixir of life", but it all starts to sound a bit too good to be absolutely true.

What is the best test to diagnose vitamin D deficiency?

Serum 25(OH)D.

The circulating half-life of 25(OH)D is 2 weeks. This is the best test to determine vitamin D status. A 25(OH)D level of less than 32 ng/mL is considered vitamin D insufficient because intestinal calcium absorption is optimized at levels above 32 ng/mL.

A 25(OH)D level of less than 15 or 20 ng/mL have been used to define vitamin D deficiency.

Parathyroid hormone levels start to rise at 25(OH)D levels below 31 ng/mL, which is another marker of vitamin D insufficiency. Although not always required for the diagnosis of vitamin D insufficiency, a serum PTH may be used to help establish the diagnosis of vitamin D insufficiency.

The word vitamin was originally derived from Funk's term "vital amine."

A vitamin D3 dosage of 800 IU/d increased serum 25-(OH)D levels to greater than 50 nmol/L in 97.5% of women http://bit.ly/GzBCcA 

References:
Vitamin D Supplements Lower Heart Disease Risk. WebMD.

Low vitamin D levels in children associated with higher plasma glucose and lower HDL

Vitamin D deficiency occurs frequently in COPD and correlates with severity

Image source: Wikipedia, public domain.

COPD patients with anxiety have a higher risk of exacerbations

Psychological functioning is an important determinant of health outcomes in chronic lung disease.

COPD was associated with a greater risk of anxiety in multivariable analysis (OR 1.85). Among patients with COPD, anxiety was related to poorer health outcomes including worse submaximal exercise performance (less distance walked during the 6-min walk test) and a greater risk of self-reported functional limitations.

Subjects with COPD with anxiety had a higher risk of COPD exacerbations.

COPD is associated with a higher risk of anxiety. Once anxiety develops among patients with COPD, it is related to poorer health outcomes.

References:

Influence of anxiety on health outcomes in COPD. Eisner et al. Thorax 2010;65:229-234 doi:10.1136/thx.2009.126201

Chronic Obstructive Pulmonary Disease (COPD). AllergyCases.org.

Action plan is a key component of self-management programs in patients with COPD. Thorax, 20111.

Image source: Enlarged view of lung tissue showing the difference between healthy lung and COPD, Wikipedia, public domain.

Comments:

Dr RW: I don't have the full text of this paper, and I wonder if they controlled for continued smoking. Nicotine is a powerful anxiolytic for some COPD patients.

16% of motorists may be under the influence of drugs during weekends - one in six cars

Motorists under the influence of drugs are a growing threat on U.S. roads. If you think about driving on a Friday or Saturday evening about 16% of the vehicles - one in six of the cars - the driver will be under the influence of an illicit or licit drug.

"Drugged driving" hampers judgment, reaction time, driving skills and memory.

Video: "Fall down alcohol test".

References:

U.S. says drugged driving growing threat. Reuters.

Am I driving a car? Drunk motorist stuns police http://goo.gl/D9NOa
Drunk Driving, Distracted Driving, Moralism, and Public Health - NEJM
30% of U.S. adults have been arrested by age 23: study. Reuters, 2011.

Following DASH Diet Improves Brain Activity in Overweight Adults

A new study suggest that the DASH diet in combination with regular exercise improves mental activity by 30% in overweight adults compared with those who didn’t diet or exercise. The DASH diet was developed for the Dietary Approaches to Stop Hypertension (DASH) study and emphasizes low-fat dairy products and low-cholesterol foods as well as carbohydrates and fruits and vegetables.

Researchers say high blood pressure affects about 50% of adults aged 60 and older and increases the risk of Alzheimer’s disease and other forms of mental decline like dementia.

These are 5 healthy lifestyle factors associated with a lower risk of developing high blood pressure:

1. Healthy weight: body mass index (BMI) of less than 25.

2. Daily exercise: average of 30 minutes of vigorous exercise per day.

3. Heart-healthy diet (DASH).

4. Moderate alcohol use.

5. Use non-narcotic pain relievers less than once per week.

References:

DASH Diet Fuels the Brain - WebMD.

6 healthy lifestyle factors associated with a lower risk of developing high blood pressure

A table to show the impact of lifestyle interventions on blood pressure http://bit.ly/johjzs - Great for patient education.

Related: What is the best diet in the world? DASH Diet, according to the latest review. TIME, 2011.
The long history of dieting fads: "soap should be eaten for its diuretic properties", wrote a prominent surgeon in 1810. Lancet, 2012. 

Be lucky - it's an easy skill to learn, says researcher

From Telegraph:

The study findings have revealed that although unlucky people have almost no insight into the real causes of their good and bad luck, their thoughts and behaviour are responsible for much of their fortune.

Personality tests revealed that unlucky people are generally much more tense than lucky people, and research has shown that anxiety disrupts people's ability to notice the unexpected.

Unlucky people miss chance opportunities because they are too focused on looking for something else. They go to parties intent on finding their perfect partner and so miss opportunities to make good friends.

Lucky people generate good fortune via 4 principles:

1. They are skilled at creating and noticing chance opportunities.
2. Make lucky decisions by listening to their intuition.
3. Create self-fulfilling prophesies via positive expectations.
4. Adopt a resilient attitude that transforms bad luck into good.

Unlucky people often fail to follow their intuition when making a choice, whereas lucky people tend to respect hunches.

Unlucky people tend to be creatures of routine. Lucky people tend to see the positive side of their ill fortune.



References:

Be lucky - it's an easy skill to learn - Telegraph.co.uk.

Image source: OpenClipArt.org, public domain.

Low risk of transmission of influenza on the plane: 3.5% if sitting within 2 rows of infected passengers

This BMJ study assessed the risk of transmission of pandemic A/H1N1 2009 influenza (pandemic A/H1N1) from an infected high school group to other passengers on an airline flight and the effectiveness of screening and follow-up of exposed passengers.

The design was a retrospective cohort investigation using a questionnaire administered to passengers and laboratory investigation of those with symptoms.

The setting was in Auckland, New Zealand, with national and international follow-up of passengers. The participants were passengers seated in the rear section of a Boeing 747-400 long haul flight that arrived on 25 April 2009, including a group of 24 students and teachers and 97 (out of 102) other passengers in the same section of the plane who agreed to be interviewed.

9 members of the school group were laboratory confirmed cases of pandemic A/H1N1 infection and had symptoms during the flight. Two other passengers developed confirmed pandemic A/H1N1 infection. Their seating was within two rows of infected passengers, implying a risk of infection of about 3.5% for the 57 passengers in those rows.

A low but measurable risk of transmission of pandemic A/H1N1 exists during modern commercial air travel. This risk is concentrated close to infected passengers with symptoms.

Video: "How to Sneeze" Demonstrated by the U.S. Health and Human Services Secretary Kathleen Sebelius. She shows NBC’s Chuck Todd the “Elmo way” to sneeze.

Don't forget to get your influenza immunization (flu shot or spray) this season. The CDC video embedded below clearly explains why this is extremely important.


CDC video: Why Flu Vaccination Matters: Personal Stories from Families Affected by Flu.

References:

Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ 2010; 340:c2424 doi: 10.1136/bmj.c2424 (Published 21 May 2010).

Diagram of influenza virus nomenclature. Image source: Wikipedia, GNU Free Documentation License.

Five faces of life with HIV - Chicato Tribune video

The World AIDS Day is December 1. Video source: Chicago Tribune.