You’re Not Who You Think You Are

Posted on February 6, 2013 by David A Fein, MD

By: David Fein, MD
Medical Director

You’re not who you think you are.  In fact, at least 90% of you isn’t you.

Yes, by weight, you are mostly human.  But if we count the number of cells in your body, more than 90% of them are bacteria, not human.

Until recently, we have tended to divide those bacteria into two general categories- those that are “pathogenic” and cause infectious diseases, and those that are generally “harmless” residents of certain parts of the body.  Newer research shows that these “harmless” bacteria actually can exert a tremendous amount of influence over our health, possibly even determining whether one person remains healthy while another person living on the same diet gains weight or even becomes obese .

A study recently published in the Journal of Proteome Research highlighted one mechanism by which the bacteria in our colons may affect how much weight we gain. Researchers compared mice that were germ-free with those who had a normal bacterial population in their colons.  They measured the activity of brown fat, a type of fat that burns calories more quickly than other types of fat.  In humans, brown fat is found in the neck area and in small deposits elsewhere in the body.  The brown fat in the germ-free mice was more active and burned more calories than in the regular mice, suggesting that the bacteria in the regular mice would tend to make them burn less calories and gain weight more easily.

The scientists also noted that the regular male mice were heavier and had more body fat than the female regular mice.  In the bacteria-free mice, this difference disappeared.

Scientists generally have to rely on animal models to try to determine how bacteria interact with their hosts because it’s virtually impossible to reliably alter and control the bacterial population in humans going about their normal daily activities.  Because of the difference between animal species and the bacteria they harbor compared with humans, it is possible that these results do not necessarily reflect how we are affected by our bacteria. But another recent study suggested an additional link to the role bacteria play in our weight.

An experiment was recently reported in the International Society for Microbial Ecology.  Researchers in China isolated a bacteria, Enterobacter cloacae, from the gut of a 385 pound man.  This bacteria accounted for 35% of the microbes in his gut and when he was put on a diet designed to reduce the bacteria he lost 113 lbs.  When this bacteria was given to mice that are genetically resistant to obesity, they gained weight.

Other studies have suggested that gut bacteria may produce substances that affect the hormones that modulate appetite in humans.  Since it is to the advantage of the bacteria to ensure that you continue to provide them with a constant food supply, it would not be surprising if some of them have evolved a mechanism that tricks you body into eating just a bit more to keep the bacteria fat and happy.  Just an extra 50 calories per day would translate into about an extra 5 lbs per year added to your frame.

So, while we typically think that weight gain is simply a matter of eating more calories than you burn, it could turn out to be that some of those bacterial cells that make up 90% of our bodies have effects on how many calories we choose to eat or how fast we burn those calories.  We are not yet at the point where we can treat obesity by altering gut bacteria, but that may turn out to be a useful strategy in the future.

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Top 4 Reasons Why Diets Fail

Posted on January 30, 2013 by cvolgraf

This Friday marks the beginning of February, which is a good time to critique and tweak your weight loss plans for 2013. The simplest of things may be holding you back from reaching your goals, so it is important to analyze your journey towards a healthier you frequently to maximize your success. After all, only 20 percent of those trying to lose weight succeed and actually maintain their results.  So why do the majority of dieters fail?

A recent article sheds light on the top 4 reasons why dieters do not lose weight.  Take advantage of the fact that the list is short! There is no doubt we can all make improvements with underestimating caloric consumption, overestimating caloric expenditure with exercise, timing our meals appropriately and getting better “quality” sleep. They make up the staples of success when it comes to following a healthy lifestyle and believe it or not…if you followed these 4 rules, the chances of reaching your weight loss goal increase tremendously!

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Regular low intensity exercise can get you “Olympic Longevity!”

Posted on December 31, 2012 by cvolgraf

A recent article in the New York Times  talks about the longevity benefits experienced by Olympians compared to non-Olympians in two studies that appear in the Christmas issue of the British Medical Journal.  One of the two studies showed that Olympians lived an average of 2.8 years longer than their non-Olympian counterparts and 13 percent were alive 30 years after their Olympic performance.  Even more impressive to me, was what can be concluded from the second sited study from the BMJ,  “athletes from disciplines with moderate cardiovascular intensity or high cardiovascular intensity were similar,” in terms of their lifespans, to “athletes from disciplines with low cardiovascular intensity.” Cyclists, rowers, runners, cricketers and golfers who competed at the Olympics all enjoyed similar lifespans. The study’s results seem to show the cardiovascular and health benefits of endurance and mixed sports are greater than the health benefits of power sports, at least in terms of longevity. While many will say that is debatable, take it for what it is worth…even a low intensity regular exercise can go a long way to help you increase your lifespan!

This is of particular interest to me when it comes to this time of year when people are setting lofty New Year’s resolutions with their fitness, nutrition and wellness goals.  Many think they have to set the bar really high, perform high intensity workouts to achieve their wellness/longevity goals and often quit before Valentine’s day, when this study shows us that high-intensity competitive activity was in fact no better than much less strenuous pursuits at increasing lifespans.  It really is simple for the unconditioned population…get moving with walking, golfing or recreational cycling “…and that will probably help us live just about as long as those (Olympic) sporting superstars.”

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To PSA or Not To PSA- The Great Prostate Screening Debate

Posted on October 16, 2012 by David A Fein, MD

By: David A Fein, MD
Medical Director

It’s the second leading cause of cancer death and the most common cancer in non-smoking men. Prostate cancer claims more than 28,000 men each year.  It used to be an even more common cause of death until the 1994 introduction of a blood test, Prostate Specific Antigen (PSA), which was followed by a 40% decline inprostate cancer mortality.  Then, in May, 2012, the US Preventive Services Task Force ignited a controversey when it released a recommendation advising against routine screening for prostate cancer, including PSA tests.   As the debate about the Task Force’s recommendation rages in the medical community patients are left confused about the pros and cons of prostate cancer screening. So, what should you do?.

Let’s start with the downside of screening.

It has been known for many years that if a man lives long enough he is almost certain to get prostate cancer.  Autopsy studies have shown that by age 85 almost 100% of men have cancer in the prostate. But only a very small percentage of those tumors spread beyond the prostate and become clinically apparent.  Unfortunately, medicine does not yet have a reliable way of telling in advance which tumors are likely to spread and cause illness or death and which ones are so indolent that they are likely to remain limited to the prostate.

The prostate makes PSA and prostate cancers make the level of this marker in the blood climb even higher. But the PSA test is prone to false positives.  There are reasons other than prostate cancer for the PSA to rise such as common mild infections or the enlargement of the prostate that often comes with aging.   When the PSA is elevated doctors often recommend a series of biopsies of the prostate, in itself a pretty unpleasant procedure, to look for the presence of cancer cells.  Since the prevalence of prostate cancer increases with age, biopsies are very likely to spot at least a few cancer cells in older men.  But many, possibly most, of those cancers would not have progressed to a dangerous stage had they never been found.

Two recent studies found that there was little or no improvement in survival in men who had screening tests for prostate cancer. The first trial took place in the US and found there was no benefit at all to the men who were screened.  A second trial in Europe found a small improvement in survival among the men who were screened but also found that many more were treated without benefit.  Overall, in the European study only 1 out of every 49 men who underwent treatment (surgery, radiation or hormonal therapy) for prostate cancer appeared to have any improvement in longevity.

Treating prostate cancer often results in incontinence, impotence, rectal bleeding and surgical complications that can seriously impact quality of life.  Put all this together and you appear to have a test that frequently turns out not to indicate the presence of cancer when mildly elevated, often leads to unneeded,uncomfortable biopsies and can result in treatment that may be worse than the disease.

But it turns out not to be that simple.

It helps to first understand that the problem is not with the PSA test itself.  It does a pretty good job of identifying who needs further evaluation.  Even though up to 80% of the men with elevated PSA levels turn out to be fine, that is not at all unusual in medicine.  Many common tests, including mammography, have comparable false-positive rates.  Just as important is the Negative Predictive Value. This means that if your PSA is very low, it is very unlikely that you have clinically significant prostate cancer at that point.  That is useful information.

It also turns out that the data on which the Task Force based their decisions may have been premature and potentially flawed.  Nearly 40% of the patients enrolled in the US study had a PSA level done prior to the start of the study.  This could result in “selection bias” where many of the men with early prostate cancer would have already been treated and thereby excluded from the study.  Additionally, about 50% of the PSA tests done did not follow the recommended protocol.

Just as important, it takes many years for the survival benefit to show up in these types of studies.  The average follow up of the data published last year in the European study was only 9 years.  As the study participants continued to be followed It has since become apparent, according to data presented by the researchers at a recent urology meeting, that a significant survival benefit has started to appear in the men who had PSA screening.  The relative risk of dying of prostate cancer is now 29% lower in the group of men who had PSA testing compared with those who were not screened.

So, maybe the PSA test is not so useless after all.

Meanwhile, doctors have been exploring new options for those who are found to have an elevated PSA or a biopsy that shows cancer.  Mildly elevated PSA levels can be monitored to see if there is a significant increase over time.  Levels that are stable may not require aggressive therapy.  If we can be more selective about who gets treated it is likely the benefits of treatment will become more apparent.

It is also important to consider the age and underlying health of someone who is a candidate for screening. It often takes 15 years or more for a prostate tumor to develop, spread and cause death.  For an 80 year old man with poor overall health it very likely does not make sense to do a PSA test.  It is almost certain that if his PSA is elevated and enough biopsies are done a cancer will be found.  But that cancer is unlikely to be a cause of his demise before his other medical problems.

At the other end of the spectrum, a healthy 45 year old man with a rapidly rising PSA who turns out to have prostate cancer is very likely to find that tumor shortening his life without treatment. It is very difficult to argue that we should not be screening that man for such a common and treatable causes of cancer death.

The FDA has recently approved a new screening strategy for prostate cancer called the Prostate Health Index.  This test combines 3 tests: the PSA, the Free PSA (which specifically measures PSA that is not bound to proteins in the blood) and a new marker called the -2 Pro PSA. It appears to be more accurate at detecting prostate cancer and may reduce the need for biopsies in men with elevated PSA levels but without cancer.   This test is currently available in Europe but is not yet in use here.

New genetic tests are in development that may help us to better differentiate the cancers that are more aggressive from the ones that can be left alone. Researchers recently claimed to have found genetic markers that may identify the more dangerous forms of the disease.  This is likely to be the true key to improving treatment for prostate cancer.  If we can reliably identify the cancers that will spread and cause death we can limit the treatment to those who will benefit most.

For now, Princeton Longevity’s recommendations are that men under the age of 70 should continue to have an annual digital rectal exam and PSA level coupled with a discussion of the current data on screening.  In men over 70, the decision should be guided by an assessment of overall health.  When life expectancy is less than 10-15 years, the benefits of detection and treatment using currently available technology may be limited.

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The Next Ten Years

Posted on October 16, 2012 by David A Fein, MD

By: David A Fein, MD
Medical Director

This month Princeton Longevity Center is proud to celebrate our 10 Year Anniversary.

From the start, many of you were quick to recognize the vital role of the new technologies offered at PLC in taking preventive medicine into a new realm.  Others called us charlatans and tried to defend the status quo.  Today, we are very pleased to see coronary calcium scans, cardiac CT angiography, virtual colonoscopy and many other tools that were at the cutting edge now becoming widely recognized.

We have seen the value to our patients using state of the art technology to enhance early disease detection.  We are about to enter a fascinating and revolutionary time in medicine’s ability to predict future disease and provide individualized treatment.  Here are a couple of my predictions for where the science of preventive medicine is heading in the next ten years.

With today’s ultrasound, CT and MRI scanners, we are able to visualize internal organs with unprecedented detail.  The leading killers, cardiovascular disease and cancer, are being diagnosed earlier than ever, when treatment is more likely to be effective.  The technologies to come are going to move us past what our eyes can see into the realm of microscopic disease.

New imaging modalities utilizing lasers and light will allow us to visualize details too small to be seen with current scanners.  Researchers recently presented their findings at the Optical Society Annual Meeting using Optical Coherence Tomography in a hand-held scanner to non-invasively create 3-D images on a microscopic scale.  The device can see bacteria behind the eardrum or measure the thickness of the retina to detect the earliest eye complications from diabetes.  Undoubtedly, the uses for this technology will rapidly multiply in coming years.

Raman Spectroscopy measures the scattering of laser light from tissues.  Hand-held scanners using this technology are already in use in Europe and allow doctors to quickly, painlessly and accurately differentiate skin cancers, including melanomas, from less dangerous skin lesions and moles.  The same technique has been shown to be highly accurate in early detection of cervical and oral cancers.

Nanotechnology is taking the medical laboratory from the size of an office building down to the size of a single chip.  Researchers at Kansas State University recently announced a blood test using a chip with iron nanoparticles coated with amino acids that interact with specific enzymes in the patient’s blood.  The test can accurately identify the beginning stages of lung and breast cancer.  The researchers expect to soon have a test available for pancreatic cancer.

Initially, these tests will be useful for those who are in high risk groups. In the coming years this kind of testing will become cost-effective and accurate enough to allow us to detect cancers at a microscopic stage, before they have spread.
Along with other new imaging techniques and advances in genetic testing, we expect the next 10 years to usher in an unprecedented ability to detect disease at the earliest stage and initiate treatment long before symptoms occur.

While our ability to predict disease continues to improve, the past 10 years have seen another revolution whose impact is just beginning to emerge.  We have gone from cellphones that often could not even complete a phone (making “Can you hear me now?” was an effective advertising campaign) to a digitally interconnected world where the internet and all the social media it brings are constantly at everyone’s fingertips.

Smartphones have become much more than communication devices.  “Apps” are being developed that will allow doctors to stay in touch with their patients and monitor the state of their health on a daily basis.  This will mean better control of conditions such as high blood pressure and diabetes.  “Virtual office visits” will utilize video conferencing and downloadable diagnostic tools to make medical professionals available their patients right in the comfort and convenience of their home or office.   Mobile “apps” will also provide Princeton Longevity Center with tools for helping our patients to achieve their goals for living a healthy lifestyle and preventing disease.

We live in interesting times where the pace of change continuously accelerates.  There are amazing advances just over the horizon that are sure to change how we live and how we age.  Our goal at Princeton Longevity Center is to keep our patients at the forefront of these exciting new technologies.   Stay tuned

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Childhood Obesity

Posted on October 16, 2012 by kmillerplc

Childhood Obesity Can Start in the Womb

By: Kristen L. Miller, MS

We are facing in epidemic of childhood obesity here in the US.  Obesity in children has increased from 5% in the 1960’s to 17% currently (Ogden et al., 2006).  There are many factors that may contribute to childhood obesity, such as diet, sedentary lifestyle and role models, all postnatal issues.  However, growing research points to the prenatal environment as the one most closely associated with childhood obesity.

The Institute of Medicine has recommended weight gain guidelines for pregnant women based on pre-pregnancy BMI.  It appears that women who gain more than the recommended weight may predispose their kids to childhood obesity (Rasmussen K. and Yaktine, A, 2009).  This holds true regardless of pre-pregnancy weight classification.  Women who have normal pre-pregnancy BMI values are just as likely to have overweight children as women who are overweight or obese before conception.

The main culprit is thought to be blood sugar, which is often elevated in women who gain too much weight during pregnancy, whether or not they develop gestational diabetes.  Glucose passes through the placenta, but insulin does not, therefore, when fetal blood sugar is elevated the fetal pancreas must secrete more insulin to normalize blood sugar levels.  Insulin is a growth factor, thus, elevated fetal insulin causes the fetus to grow larger.  The elevated insulin may also lead to increased appetite and weight gain in childhood.

The most important steps a pregnant woman can take to avoid this dilemma are to optimize nutrition and exercise regularly during pregnancy.  The goal is to exercise at an intensity of at least 60% of heart rate reserve (Max HR- Resting HR) for at least 30:00 on most days of the week.  This may be contrary to what pregnant women were told just a few years ago.  Current research and the American College of Obstetricians and Gynecologists (ACOG) support these guidelines as well (Zavorsky and Longo, 2011a).

Great effort is being taken to change the nutrition and activity behaviors of children.  Parents, especially mothers, can help by optimizing maternal health through good nutrition and exercise.  Mothers have the power to shape the future of their child’s health before they are even born!

Ogden, C.L. et al. (2006). Prevalence of overweight and obesity in the United States, 1999−2004. Journal of the American Medical Association, 295, 13, 1549−1555.

Rasmussen K. and Yaktine, A. (2009). Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, D.C.: Institute of Medicine

Zavorsky, G.S. and Longo, L.D. (2011a). Exercise guidelines in pregnancy: New perspectives. Sports Medicine, 41, 5, 345−360

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Iron: Too much of a good thing?

Posted on August 16, 2012 by Gail Wikler RD CDN

This excellent article in the New York Times earlier this week discusses the role of Iron in the body, how to identify symptoms of deficiency (anemia), and who might have TOO much iron.

Click the link below to read this helpful article

http://well.blogs.nytimes.com/2012/08/13/a-host-of-ills-when-irons-out-of-balance/?src=me&ref=health

 

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Blueberry Bliss

Posted on August 15, 2012 by Gail Wikler RD CDN

Blueberries, rich in antioxidants to promote heart health and cancer prevention, are in the peak of their season. Try this great low-fat blueberry muffin recipe to boost your antioxidant intake. Eat as a snack between meals or with a lean protein such as egg whites for breakfast.

Ingredients:

1 1/2 cups wheat bran

1 cup skim milk

1/2 cup unsweetened applesauce

1 egg or 1/2 cup egg beaters

2/3 cup brown sugar

1/2 teaspoon vanilla extract

1 cup whole wheat flour

1 teaspoon baking soda

1 teaspoon baking powder

1 cup blueberries

Directions: Preheat oven to 375 degrees. Grease muffin cups or use paper muffin liners. Mix together wheat break and milk. Let stand for 10 minutes.

In a large mixing bowl, mix together applesauce, egg, brown sugar, and vanilla. Beat in bran mixture. Sift together whole wheat flour, baking soda, baking powder. Stir into bran mixture, and fold in blueberries. Scoop mixture into muffin cups. Bake 15-20 minutes or until tops are golden.

 

 

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PLC Recipe: Sea Bass with Avocado Sauce

Posted on August 1, 2012 by karenplcdietitian

Add flavor to a mild fish like sea bass with this quick protein-rich recipe.  The avocado complements the other flavorful ingredients in this recipe and it also supplies healthy monounsaturated fat to help your body absorb nutrients and keep inflammation controlled.

1 small avocado, chopped

¼ cup skim milk

1 Tbsp. lime juice

1 clove garlic, minced

1 dash hot sauce

2 Tbsp. lemon juice

1 Tbsp. light soy sauce

1 tsp. lemon rind, grated

1 tsp. Dijon mustard

16 oz. sea bass fillets

1/3 cup bread crumbs

Canola oil based cooking spray

  1. Combine the 1st 5 ingredients in a blender; cover & process until smooth. Set mixture aside
  2. Combine lemon juice and the next 3 ingredients in a shallow dish
  3. Dip sea bass fillets in lemon mixture and then dredge in bread crumbs
  4. Place on a baking sheet coated with cooking spray
  5. Bake at 450 for 7 minutes.  Turn fillets over and bake an additional 7 minutes or until fish flakes easily with a fork
  6. Transfer fillets to a serving dish and top with avocado sauce

Nutritional Information per serving (serves 4):

Calories 240, Total Fat 10 g (2 g saturated fat), Cholesterol 45 g, Carbohydrate 14 g, Protein 24g, Sodium 440 mg, Fiber 4 g

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Playground or Health Club?

Posted on July 26, 2012 by keburns

More and more I hear from patients that they do not really enjoy going to a health club to exercise, and that they would rather spend their time outdoors playing with their kids or exercising in the fresh air.  I often reply back that I understand where they are coming from and how much of a workout I get when my 4 year old wants to play tag and other various games outside.  I even find myself using some of the apparatus at our local playground to get in a few repetitions while my son runs around and plays.

It has even crossed my mind to start a program geared towards physical education for children and adults.  With the alarming increases in both the adult and childhood obesity rates among Americans, we should be looking for ways to make exercise or play time a part of our daily schedule.  Think back to the good old days where recess or play time was a normal part of our daily life.  That was the best part of our day.  With a program geared towards family fitness, a parent would be able to get their workout in and have some fun, all while setting a great example  for their kids and getting them to be more active as well.  To make it even better, no daycare worries.

In fact, I recently began to research potential venues for a program like this when a colleague of mine told me of an actual playground geared towards adults and physical fitness.   While this concept is very common in countries like China, these adult playgrounds are just beginning to become more accessible here in the U.S.  In fact, NYC has one such playground already with more expected on the way.  The concept is to provide a fun environment that promotes regular physical activity.

To see if any of these playgrounds are being planned for your community, check with your local parks and recreation office.  Otherwise you can grab your kids and head to their local playground for some fun and fitness together.  Tag… your it!

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