Moderation...In...All...Things

"She's expending more calories than she's taking in, so, yeah, there's going to be weight loss."
"I have absolutely nothing against a plant-based diet. A properly balanced, plant-based diet is probably the ideal diet. But it doesn't have any special properties for weight loss."
Joe Schwarcz, professor, Office for Science and Society, McGill University

"[Vegetarians have to eat foods high in protein] to make sure you don't get into these deficits that can lead to fatigue."
"And, so, it's exactly the opposite: A restrictive anything is going to make you feel worse, not better."
"People need to understand that Beyonce's job is to look a certain way. She has a myriad of trainers and personal chefs at her fingertips and, just like the Kardashians who promote weight-loss teas, these people are selling a product."
Dr. Valerie Taylor, head, psychiatry, University of Calgary

"[Beyonce's diet] also embraces a bunch of food myths -- 'no carbs, no dairy, no meat' -- giving the impression that there's a magical formula to lose weight and maximize health."
"This kind of celebrity noise can distract people from the science-informed, and more sustainable basics; lots of fruits and veggies, whole grains and healthy proteins."
Timothy Caulfield, Canada Research Chair, health law and policy

The singer didn't consume any bread, sugar, dairy, meat, fish or alcohol for 44 days prior to her 2018 Coachella performance.
Larry Busacca/Getty Images for Coachella

She and trainer, Marco Borges who developed her rigorous diet — “no bread, no carbs, no sugar, no dairy, no meat, no fish, no alcohol,” and exercise plan, which includes multiple hours of daily workouts, now -- surprise!!! -- are selling memberships to the 22 Days Nutrition meal planner for $18 monthly, which works out to $130 annually. According to the singer/entertainer's website, members receive “access to tools and foods that empower everyone to become their healthiest self through proper nutrition.”

And food experts are weighing in on whether the meal planner they're hawking does in fact represent 'proper nutrition', finding it wanting from just about any perspective. The diet plan the pop diva is advertising that her "exercise physiologist" Marco Borges created and posted as a YouTube video has drawn the fervid attention of wannabe Beyonces who adore her style and flair. The video promoting the diet plan has Borges declaring that a plant-only diet where he had Beyonce shunning carbs, sugar, dairy, meat, fish and alcohol will "definitely" improve energy, sleep and complexions.

"Your mood is going to change completely", he promises the Beyonce dancers appearing in the video. And then the viewer is treated to watching the entertainer as she performs deep squats, battle rope training and completely intense workouts while continuing to manage her time-consuming, gruelling rehearsal practices. So the critics had a deep look at the publicity introducing yet another scheme to relieve fans of money and set them on the road to looking like, feeling like, being like, their adored celebrity.

Merely eating a plant-based diet equates with nothing particularly useful, since within that plant-based regimen are the critical details of what is chosen and what accompanies the 'plants'. Dr. Taylor questions the claim a plant-based diet results in an improvement of mood, pointing out that when people seek her advice with their symptoms of depression, one of the first issues she deals with is a medical workup, including ensuring they aren't deficient in vitamin B12, associated with not consuming sufficient protein, usually from animal sources.

People tend to lose weight with restrictive eating plans, points out Dr. Taylor, simply as a result of having removed multiple food groups and that would include foods such as high-fat or high-sugar snacks which generally cause people to gain weight. But does this leave them in a healthy condition, depriving their body of nutritional sources that are beneficial and necessary for a healthy body? Not quite. People will lose weight but restrictive eating is doomed to fail.

There is the example of Gisele Bundchen, supermodel, and her husband following an 80 percent alkaline, 20 percent acidic diet that stipulates non-consumption of white sugar, white flour or tomatoes, eggplant, mushrooms and few fruits eaten. No caffeine, MSG, iodized salt or dairy. But husband NFL quarterback Tom Brady insists the diet restores "balance and harmony through my metabolic system."  

Gisele Bündchen shared health tips in her new book.

Neilson Barnard/Getty Images

"I think people need to remember that they aren’t celebrities. Not that being a celebrity makes it OK to follow this sort of diet, but Beyoncé has resources that most of us don’t have — like a chef, trainers, assistants."
"They make it a lot easier for her to follow this kind of [restrictive] eating plan."
“Our body has hunger cues for a reason. They exist because your body wants to tell you something. In our diet culture, we’re accustomed and conditioned to ignore these cues."
"If you have to pee, you wouldn’t say to yourself: ‘I’m not going to pee right now, I’m going to wait another hour.’ Our hunger cues are just as important as any other cue your body gives."
"[A good way to tell if a diet is too restrictive is if you’re hungry] an hour or two [after you last ate]. This is how you know you’re not feeding yourself adequately.”
"We concentrate so much on what we eat but we push to the back-burner the emotional part of it and how food makes us feel. Having a good relationship with food [means] not feeling guilt or shame about eating."
"When people eliminate meat from their diet, they [tend to] rely on things like nuts to provide them their protein… but it takes a lot of those little foods to get what we need, [The average person needs 20 to 25 grams of protein with each meal]."
"Stay away from the more restrictive diets and cutting out things you don’t need to cut out just because a celebrity tells you they’re toxic. It doesn’t have to be complicated."  

Registered dietitian, nutritionist Abby Langer 

C-Section Party-Time, Brazil

The Washington Post

"It's cultural. Brazilians want to plan for everything. They don't want to hit traffic on the way to the
 hospital."
"They want to get their nails done, get a wax, to play it like an event."
Marcia da Costa, director, Sao Luiz Hospital, Sao Paulo

"We saw that we had to re-evaluate these percentages and make sure that birth decisions were being geared toward the health of the mother and  the child, and not for convenience."
"Here we had the opposite statistics [to the WHO estimate that ten percent of births require a C-section."
Rodrigo Agular, director, National Supplementary Health Agency, Brazil

"C-sections today are much safer than they were thirty years ago."
"Things are changing. Women are in the job market. Couples are trying to schedule a moment when the family can get together."
"[Caesarean sections fit some lifestyles]."
Olimpio de Moraes Filho, president, Brazilian Federation of Obstetrics and Gynecology

"The mom has just given birth, she is learning to breastfeed, she doesn't want to entertain at home."
"So while she's getting ready for the birth, we are getting ready to host."
Paula Ascar Baracat, co-founder, Estudio Matre

"It [a natural birth] doesn't fit with our lifestyle. I'm a doctor, and my husband is, too. We have a very planned life and had to take vacation for the baby to be born."
"I love it [her hospital room, decorated in blue and white balloons, refrigerator stocked with rum-barrel-aged beer, her luxury suite lined with succulent plants, parting gifts for the 80 guests she expects]. To be surrounded by the people you love [as you give birth by C-section], people who saw you grow up, is extraordinary."
Bruna Viera, 32, Albert Einstein Maternity Hospital, Sao Paulo

Albert Einstein must be chuckling at yet another manifestation of human absurdity. True, he was absorbed with abstract, abstruse suppositions relating to physics, the cosmos, but his dry, amused comments on humanity and and peoples' proclivity toward extremes and the absurd were beyond entertaining, infused with wisdom and tolerance. Childbirth, the most natural experience a woman can have, the process nature designed females to undergo in the interests of natural increase of any population, is fairly straightforward.

In this busy-busy, distracted modern world of ours, patience is at a premium. People want things they anticipate to occur when they want them to; natural processes be damned. When a woman is in labour in hospital, her gynecologist is likely a very busy man, and he will, if it hasn't already happened on its own, break a woman's waters to speed labour and delivery. Women have taken to a more extreme level of management, opting for Caesarean Section over natural delivery in a bid to 'save time'.

Women appear increasingly in North America to look upon a C-section delivery as convenient and desirable. Gone are the days when such invasive surgery was looked upon with dread, a misfortune, a procedure undertaken to save a baby's life because a natural delivery was unfeasible, the baby's position in the uterus awkward and dangerous, delivery potentially hazardous. Instead of delivering vaginally, as nature has intended, a surgeon slits open a woman's abdomen and uterus to extract the fetus.

C-sections are 'legitimate' in the sense of being medically required in but ten percent of pregnancies. They are more expensive procedures to undertake than natural childbirth. At one time, the chance of death through C-section for both mother and child loomed dangerously; that danger has been dramatically reduced with modern techniques and well-equipped hospitals. Even so, hemorrhage and infection is more likely to occur in an elective Caesarean than as a result of a natural birth process.

C-sections are linked to higher rates of respiratory distress, diabetes and the potential for high-blood-pressure for babies delivered by C-section. When the choice is made for a premature C-section related to some event that corresponds in time with the event, and the procedure is carried through prematurely in the fetal development stage, the chance of respiratory problems for the baby and prolonged hospital stays for mothers and babies is more likely.

The government of Brazil does not view the new cultural normalcy around C-sections in a positive light, the Health Ministry attempts to reduce the Caesarean "epidemic" by persuasion if possible, through legislation if not, with the government banning medically unnecessary C-sections in 2015, before 39 weeks' gestation. In the past, Brazil's public health system saw the health community lacking resources to monitor women through hours of labour.

In those situations C-section meant medical staff could monitor mothers for a shorter time period. At private hospitals, mothers began to favour C-sections. At private hospitals it has become routine for a pregnant woman in labour to have her hair and makeup looked after in her hospital room. About $500 as a daily fee allows a family to rent the presidential suite, with living room and bathroom to accommodate guests, along with a balcony and mini-bar.

A frosted window looking into the operating room at the Albert Einstein Maternity Hospital turns transparent during surgery, so guests may view the drama inherent in the moment of birth. Clients of businesses specializing in C-section parties taking place in private hospitals pay up to $10,000 for floral arrangements, guest books, monogrammed sheets, personalized water bottles, and silver-plated guest favours.

Mothers in Brazil have been opting to schedule their child’s birth rather than wait for it to occur naturally so much that the Health Ministry was forced to step in to try an quell the “epidemic." (iStock)

Director of the maternity ward at Einstein Hospital in 2015 conferenced with doctors, doulas, midwives, feminist activists and government officials in a discussion of possible methods that could result in an increase in the number of natural births at private hospitals in Brazil. The Appropriate Birth Project was launched in a partnership with 35 hospitals pledged to prioritize natural births over C-section deliveries.

They began by offering the same luxuries and party favours to natural births deliveries as is done with C-sections. Five new natural-birth centres with private showers and tubs were opened at the Einstein hospital. At Sao Luiz, those opting for natural births may select colours of lighting arrangements with their in-room whirlpool bathtubs. Ceiling Fairy lights can be blue or red, reflecting patient mood, with all rooms equipped with MP3 players patients can load with personal playlists.

In four years, the rate of natural births at Einstein increased close to 50 percent from 18 percent. Now, over 200 hospitals have adopted the same program.

"The changes have to be concurrent for everyone: women, their families, their workplace, doctors, nurses."
"When the husband comes in and says, 'I'm working, I need to know the date of the birth' -- it's about learning to plan for the unplannable."
Linus Pauling Fascina, director, maternity ward, Einstein Hospital

iStock

Say "Quack"

"He couldn't even say, 'Why am I  taking this medication'?"
"At the same time, we didn't have the words to give him answers or explain to him what was making him sick."
"He's able to say [now[, 'My bones hurt more than usual', for example, which we didn't know before. I'll say, 'How are you feeling outside'? and he'll pick the emoji that is silly. And then I'll say, 'How are you feeling inside'? and when he's feeling horrible he'll pick up the emoji that shows he's feeling really bad."
"It's hard to imagine what a two-year-old is deriving from this whole journey [of chemotherapy]. So it's good for him to be able to emote what he's feeling also."
Rachid Abdallah, Children's National Health System, Washington

"If there's a ten-year-old, I can focus on the technology and the cool things the duck can do. But if I'm giving it to a four-year-old, it's more like, 'This is your friend. This is your buddy who is here with you."
"It's always therapeutic. It can be therapeutic to educate a child or it can just be therapeutic for them to play with a duck and not even talk about the medical aspect of things."
"There are so many ways we can use it [child-centric therapeutic duck robot]."
Joe Bauer, certified child life specialist, Children's National Health System

Over fifteen thousand children and teenagers are diagnosed annually with cancer in the United States, according to figures from the American Childhood Cancer Organization. Aflac, the larges private insurer in the U.S., used a quacking duck as a mascot in its commercials several decades ago. Now, in a partnership between Aflac and robotics toy company Sproutel, a robot named My Special Aflac Duck has been produced for child-friendly therapeutic purposes.

This endearing little robotic creature has special features that help children deal with their physical pain and emotional puzzlement over how they feel, being treated for cancer. The insurance company has donated four thousand of the robotic duck models to about two hundred hospitals across the United States. Designed as a companion for children whose lives have been compromised by serious illness it guides children to be able to express their emotions when language itself fails them.

"It is an indescribable feeling to see the smile on children's faces when they receive My Special Aflac Duck.
"It is wonderful to know that they enjoy the functions of the duck that we designed specifically for them. We're honored to work with Aflac and see this grow from a concept to a program that is impacting the lives of children across the country."
Sproutel CEO and Co-Founder Aaron Horowitz

Aflac Chairman and CEO Dan Amos with a 13 year old patient at the Aflac Cancer and Blood Disorders Center in Atlanta, GA admiring the My Special Aflac Duck at a "duck delivery" event in September

There are plastic emoji discs that the robot comes with, each of them characterizing an emotion. Placing any of the discs against the duck's chest programs the robot to act out the specific emotion that the disc represents. The duck emits sounds representing happy chirps all the way to uneasy moans. The My Special Aflac Duck makes use of a series of touch sensors enabling the device to respond to whoever interacts with it.

The robot is able to turn its neck, nuzzle, open its beak -- and it emits sounds and vibrations. The duck can emit a series of pulses designed to mimic a heartbeat that can assist in calming a child and guide their breathing, useful when doctors want a patient to breathe in a rhythmic pattern. When medications are administered to patients, a toy syringe can be attached to the robot allowing a child to mimic what is happening to themselves by giving the duck medication as well.

Coping strategies are developed to help guide a child toward a feeling of control in uncertain environments, or to distract them through times of extreme stress, according to the experts. It helps them to deal with the painful pricks caused by syringes. And this sense of calm and control distracting the child from the immediate discomfort felt -- and insecurity, is provided with the use of the duck.

Rachid Abdallah, whose two-year-old son Savi Abdallah-Sinha underwent initial chemotherapy treatment to expunge leukemia from this body, considers the robot duck to be a "great translator". The child was unable to communicate at that age the acute pain he was experiencing each time a new drug was introduced or a treatment completed, during the first months chemotherapy began. And then, a year ago the family received a new tool meant to help in communicating; the quacking robotic duck that seemed like a soft stuffed animal.

Now, Savi is four years old and is able to express how he feels, giving his parents details once unavailable when he was younger. In his final phase, and the least intensive of his three-year chemotherapy plan, the child -- often stoic in the face of pain -- hesitates to communicate distress. Which makes the duck as a communication tool, particularly useful.

A robotic duck helps Savi Abdallah-Sinha, 4, and battling leukemia, share his ups and downs. The Washington Post

Walking on Eggshells

"There has been debate about barefoot running being good or bad, or shoes being good or bad, and this is the wrong debate. It should be about what the costs and benefits of shoes are and how we can better understand how shoes affect our feet, our health, the way we walk."
"We live in this weird world where calluses are bad, like you have a problem with your shoe, and you go to a podiatrist, and they remove them. But until recently it was abnormal not to have calluses." "We’ve lost touch with our bodies in some respects and this is a good example of that. When we tell our results to barefoot people, they say, 'Tell me something I don’t already know'."
"I'm not saying people shouldn't wear shoes." 
"If your feet can’t sense what’s going on on the ground, maybe you’re more susceptible and more vulnerable [to falls], and shoes may be a part of that. If we can give people’s brains, their reflexes, more information, that might help them."
"I find it unimaginable to be barefoot in middle of Europe in the Ice Age, but then again, all the other animals in Europe during the Ice Age were barefoot—so maybe our cousins, the Neanderthals, were able to handle it just fine."
Daniel E. Lieberman, Edwin M. Lerner II Professor of Biological Science, chair, Department of Human Evolutionary Biology, Harvard University

"We tested the sense of touch, the dynamic sense of what you feel on the ground. We found these stiff calluses don’t prevent any communication between the force of the feeling of what you are stepping on and what makes its way to the nerve cell to be transmitted to your brain."
Nicholas B. Holowka, postdoctoral fellow, Graduate School of Arts and Sciences, lecturer in Human Evolutionary Biology

Credit: Getty Images

 A new study recently published in the journal Nature, posits that when people wear shoes it alters their natural way of walking, a manner of walking that nature designed us for, shoeless. The study builds on earlier research whose findings popularized barefoot running. The study conclusion was that when walking, people move differently when barefoot than they do when their feet are encased in shoes. Moreover the sensitivity of the sole of the foot to the ground differs as well. An unclad foot is directly exposed to the texture of any surface being walked upon, whereas the sole of the shoe interrupts that sensitivity to a degree without entirely erasing it.

What the researchers feel, however, is that the differences in sensitivity, in feeling between the sole of the foot and the surfaces being trod upon may have the potential to affect balance (which presumably is compensated for in the way the body responds to the differences) as well as joint loading. One of Dr. Lieberman's takeaways, is that this could lead to arthritis for some people. The intimation is that it may be advantageous to walking and running with bare feet. One of the surprise findings was the advantage of a bare foot coming directly in contact with the ground, is the gradual build-up of calluses.

Yes, those are the calluses that are seen as an impediment to good foot health, that we take as a signal that something is wrong. When calluses develop, on the other hand, as a result of constant direct contact with the ground by a bare foot, they tend to serve as a protective screen, making the foot while not impervious to harm from stones, roots, sharp objects, better able to absorb the shock that interacting directly with those objects results in, on contact.

Dr. Lieberman has wondered at the function of calluses even while most people consider them unsightly, needing to be removed. After mulling the issue over, that the calluses could conceivably be viewed as an advantageously unacknowledged utilitarian purpose, he decided to launch a study to revolve around that hypothesis. He and a team of collaborators took to comparing how a select subject group in Kenya walked, with and without shoes, then comparing the results with a similar group in Boston.

At the Lieberman lab in Boston when male and female volunteers walked on treadmills barefoot their feet hit the g round in a manner very similar to the unshod walkers in Kenya, but when the volunteers wore average cushioned sneakers, there was a subtle alteration in their walking pattern. Their feet struck the ground slightly more lightly initially, yet the stride impacts lingered longer than when the subjects were barefoot. Impacts of this nature tend to move up, dissipating through legbones, ankles and knee joints.

Custom-built device used to measure tactile sensitivity of foot at different frequencies. Credit: Daniel Lieberman

The shorter, sharper jolts felt when people walk barefoot on the other hand, are likelier to rise through soft muscles and tendons in the body, according to Dr. Lieberman. Suggesting that the way people walk is determined by what is worn on their feet. Shoes have a protective function, and absorb the slight pounding that feet undergo while walking, but at the same time they alter strides and over time have the potential to increase pressure and wear on leg joints.

The particular calluses that arise when walking shoeless on the other hand, shield the foot from discomfort of coming in contact with objects on the ground while barefoot, even while not reducing contact with and the ability to feel the ground's complex texture. Which suggests that people experiencing concerns over balance, and less concerned over how their feet would appear with calluses might benefit from walking about barefoot at times.

Comparing the foot of a shoe wearer vs. the barefoot walker. In Kenya, researchers measured the biomechanics of the barefoot walker.

Photos by Thomas Milani and Daniel Lieberman

The Impotent Ignorance of U.S. Legislators

"The Canadian medicine supply is not sufficient to support both Canadian and U.S. consumers. The supply simply does not, and will not, exist within Canada to meet such demands."
"Hospital and community pharmacies in Canada are resourced to serve the Canadian public. they are not equipped to support the needs of a country ten times its size without creating important access or quality issues."
Warning communication to Canada's Minister of Health

Quinn Nystrom holds insulin she purchased in Canada after travelling over the border for more affordable medication. (Lorenda Reddekopp/CBC)

It is grossly inconceivable that people with diabetes, requiring the hormone insulin to manage their chronic disease, ensure quality of life and life itself, are faced in the United States -- where pharmaceutical companies who manufacture human-type insulin for broad consumption nationwide value the free enterprise system over adequate profits with the assurance that their product prolongs lives -- with steeply unaffordable costs for vials of insulin. There are times, and none more urgent than this one, when government intervention should be required to correct such a dire situation.

It belies belief that a free enterprise system can be so bereft of human values beyond profit that it can without conscience raise the cost of an elemental, vital drug from $30 to $300, placing it beyond the reach of people desperate to continue a difficult-enough therapeutic mode sustaining and prolonging life. That drug manufacturers can and do raise prices to such impossible levels is breath-takingly incongruous given that drugs manufacturing has a purpose and that purpose is now interrupted by greed.

Federal and state legislators in the United States, in recognition of the plight of people with diabetes without health insurance either through employment or independent means, whose incomes are modest and strained beyond acceptability by sky-rocketing costs of medication, have turned not to enacting needed legislation to curtail manufacturing greed, or to supplement the costs of such vital drugs through public subscription, but to allowing Americans to purchase their drugs abroad where they are available at a tenth of the cost.

Laws permitting residents of various states to import drugs from Canada represents no kind of a workable solution to the crisis inflicted upon American diabetics. It is beyond ludicrous that someone like Senator Bernie Sanders plans to highlight the issue by accompanying Americans with diabetes to Canada on an insulin-buying trip. That people with diabetes in the United States must organize trips to Canada to enable them to buy a drug that sustains their lives is beyond incredible.

The very country known for its manufacturing of drugs and their wide distribution -- and the greed of those involved in manufacturing -- sees a situation now where diabetics ration their medication, fearful of not having enough to maintain a balance of wellness. In so doing they risk hastening the onset of complications that ensue from diabetes such as neuropathy, blindness, kidney failure, heart conditions. The issue represents a country-wide medical emergency.

As for Canada; recent years have seen Canadian pharmaceutical manufacturers reporting thousands of shortages of their own, often linked to manufacturing issues but to increased demand as well. Over 27 different bills have been introduced in the U.S. Congress and state legislation over the past year -- according to data from the National Academy for State Health Policy -- which allow Americans to buy their drugs from Canadian sources.

This evades the source of the problem and it exports the problem to a neighbour's vulnerable population, threatening them with a potential precarious position in drug availability. What kind of solution does that signify?  Canada ensures the regulation of drug prices through the federal Patented Medicine Prices Review Board, with its mandate to ensure that the cost of medications is "not excessive".

"We have got to do better in our country."
"People are where we need to be on it, regular folks. It’s our political leaders lack the courage to do the right thing."
John Kennedy, who travelled to Canada from Ohio

Lija Greenseid prepares to draw insulin at her home in St. Paul, Minn. Greenseid, whose daughter has Type 1 diabetes, is organizing a group trip to Canada to buy insulin at one-tenth the U.S. cost.  Photo: Jenn Ackeerman, The Washington Post

Higher Prevalence of Atrial Fibrillation in former NFL Players

"We have to be aware that athletes who participate in these kinds of sports, particularly retired NFL players, do have an increased risk of atrial fibrillation compared to the general population."
"Athletes need to make sure they continue to go for annual physicals where this can be checked out." 
"Most former NFL [National Football League] athletes with AFib were unaware of any symptoms and yet should have been taking blood thinners to prevent stroke. [The findings highlight] the importance of being vigilant and intermittently checking for AFib in this group."
"Although the study was observational, which means it identifies a relationship but does not prove cause and effect, the prolonged strength training involved in American football may increase heart chamber size and wall thickness, which can alter heart rhythms and electrical signals in the heart."
“It’s known that endurance athletes - the elite ones who are middle aged and have done it for many years - are at increased risk. This is the first time this has been looked at in strength-type sports."
"For the majority of people, the benefits of both aerobic exercise, such as walking, and strength training, such as working with weights, is strongly linked to a healthier heart, and this study should not discourage people from being physically active."
"Mild to moderate exercise reduces the risk of atrial fibrillation for most people."
Dr.Dermot Phelan, director, Sports Cardiology Center, Cleveland Clinic, Ohio

"[The new study is a] good initial observation, but we will have to have more objective evidence of [other health conditions] and risk factors plus long-term monitoring of atrial fibrillation for there to be a clear correlation."
"[One issue with the study is that] there are many other factors that can increase the incidence of atrial fibrillation, like age, smoking, alcohol use, steroid use, poor sleeping hygiene, and sleep apnea."
Dr.Johanna Contreras, director, heart failure, Mount Sinai St.Luke's, New York city

HealthDay

The atrial is the top chambers of the heart. They are caused to almost quiver instead of pumping blood when the electrical impulses that spark heartbeats fire erratically. This is atrial fibrillation, which can result in the pooling of blood and clotting. Should a clot in an atrium travel to a blood vessel leading to the brain, a stroke can occur. According to an estimate by the American Heart Association, over 2.7 million people in the United States experience atrial fibrillation (AFib); it is the most common irregular heart rhythm that can occur.

Long-term endurance sports activities like marathon running has been linked by studies to an increased risk of atrial fibrillation. It had occurred to Dr. Phelan and his research colleagues that a similar link might be discovered in sports requiring muscular strength, and they set about testing their hypothesis by comparing 460 retired pro-football players to 925 men who took part in the Dallas Heart Study, to represent the control group.

Both of the groups, the control group and the retired players,
 were middle-aged and roughly half from each group were African-Americans. Information was collected on participants' history of high blood pressure, high cholesterol, diabetes, coronary artery disease, stroke and heart failure. In both groups this data originated with self-reports, and were not individually measured by the researchers. The finding was that the retired NFL players showed fewer cardiovascular risk factor including type 2 diabetes and high blood pressure. As well, most had lower resting heart rates.

The study was published in the Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association. The study conclusion was clear; former National Football League players were almost six times likelier to have atrial fibrillation than men of similar age who were not professional football players. 

• 5 % of former NFL players had AFib compared to 0.5 % of men in the control group.
• Other predictors for developing AFib were older age, white race and higher weight, all of which have been recognized previously as risk factors for AFib.
• The players group had overall lower risk factors for cardiovascular disease mortality, type 2 diabetes and high blood pressure, and had lower resting heart rates compared to the control group, yet the incidence of atrial fibrillation was still higher.
• Former NFL athletes were 8 times more likely to have pacemakers compared to the control group. Pacemakers are devices that are implanted in a person’s chest, usually to treat slow heart rates and other problems of electrical conduction in the heart.

Type 2 Diabetes Risk Reduction

"We found that eating plant-based diets was associated with, on average, 23% reduction in diabetes risk."
"We further showed that individuals who consumed a healthy version of the plant-based diet by emphasizing the intake of fresh fruits, vegetables, whole grains, nuts and legumes, and minimizing intake of sugar-sweetened beverages and refined carbohydrates, had a further 30% reduction in their risk of developing type 2 diabetes."
"I would describe these risk reductions as being quite significant." 
"Plant-based diets can promote metabolic health and reduce diabetes risk through many pathways, including preventing excess weight gain, improving insulin sensitivity, reducing inflammation and other mechanisms."
"It does matter what veggies people eat and how the veggies are processed. Therefore, consuming healthy plant foods that are not or minimally processed, such as fresh fruits and vegetables, legumes, nuts, and whole grains, should be emphasized."
Dr. Qi Sun, associate professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston 

Healthy plant-based diets can help prevent type 2 diabetes, new analysis suggests.

ISTOCK/LISOVSKAYA

"Plant-based dietary patterns, especially when they are enriched with healthful plant-based foods, may be beneficial for the primary prevention of type 2 diabetes."
"Multiple interventional and observational studies have indicated that increased consumption of plant-based foods can lead to short-term weight loss or prevention of long-term weight gain."
"In turn, it is likely that a considerable proportion of the protective association between plant-based diets and risk of type 2 diabetes can be attributable to weight control."
"Moreover, refined grains, starches, and sugars can also be characterized as plant-based, although they are independently associated with a higher risk of type 2 diabetes." 
Study report, published in JAMA Internal Medicine

"People truly have to understand that what they put in their mouth affects their health. You’re gonna have to commit to yourselves and acknowledge that your current diet is hurting you."
"What if we had a world without processed food in it?" 
"We wouldn’t have the weight problems we have now if it weren’t for processed food. It would be very difficult to become obese while eating a whole-food, plant-based diet."
"By eating the wrong foods, we increase our insulin levels. Increased insulin levels actually block the production of leptin [a hormone that works to regulate appetite by signalling to the brain that enough has been consumed].”
Mara Schwartz, CDE, RN, coordinator, Diabetes Prevention Program, Self Regional Healthcare, Greenwood, South Carolina

Ms. Schwartz, while well-credentialled as a dietitian, knows the issues of controlling diabetes from the inside-out, since she is herself a Type 1 diabetic; completely insulin-dependent. Her body does not produce insulin and to compensate she must take multiple daily doses of insulin injections to maintain life-saving balance controlling her diabetes, enabling her body to process glucose for energy. Most Type 1 diabetics are diagnosed at a young age; diabetes-onset having a large genetic component. Diet management is critical to the health of people with Type 1 diabetes.

Unless diabetes is under control, avoiding both high- and low-blood-sugars through constant monitoring of blood sugar levels, the potential for acquiring further chronic diseases is high, from neuropathy to blindness; kidney failure to amputations, and not least, heart conditions. In contrast it is not some disturbing event that causes the body's immune system to attack its insulin-producing beta cells that causes Type 2 diabetes. This type of mostly non-insulin-dependent diabetes is viewed largely as a middle-age-overweight-sedentary problem leading to the condition.

Type 2 diabetes is generally controlled by a regimen of lifestyle changes including diet, exercise and medications in pill form meant to enable the efficient use of the insulin the body produces through body cells' uptake. In some instances, insulin must be resorted to as therapy when the drugs fail to work. All of the potential incidence of heart and kidney disease, nerve damage, blindness that can assail Type 1 diabetics, are issues that Type 2 diabetics are also susceptible to, requiring careful blood sugar monitoring as part of therapy.

While Type 1 diabetes cannot be avoided until more is known about its onset-provoking mechanisms, Type 2 diabetes is avoidable with a change of lifestyle. And that, critically, includes diet and weight loss. Researchers have produced a new study that categorically validates plant-based diets as a deterrent to weight gain and Type 2 diabetes onset. It was found that those people who adhered to a vegan, a vegetarian or other kind of plant-based diet were 23 percent less susceptible to developing Type 2 diabetes.

Those people who consume a wide variety of meals based on plants are able to reduce risk of diabetes without being strict vegetarians avoiding meat, poultry and fish. On the other hand, white rice, white bread, pastas and other types of highly processed grains vastly reduce the inherent benefits of including grains alongside fresh fruits and vegetables. Those who took part in the study following this kind of nutritional dietary advice were 30 percent less likely to develop Type 2 diabetes than others who ignored the advice.

Undertaking the study, the researchers studied data from nine published studies which totalled 307,099 participants, among them 23,544 people who developed Type 2 diabetes. The studies' timelines ranged from two to 28 years and all of the studies made use of food frequency questionnaires in assessing participants' diets.  The conclusion was that those who most carefully followed a vegan, vegetarian or plant-based diet were more successful in protecting themselves from diabetes onset as opposed to those consuming a lesser amount of plant-based meals.

Fresh vegetables are a good choice. Some processed plant-based foods aren’t always the best option. Getty Images

 

Self-Empowered to Benefit by Reduced Health Outcomes

"The widely held view of the health benefits of alcohol needs revisiting, particularly as improved methods and analyses continue to show how much alcohol use contributes to global death and disability."
Newly published study in the Canadian Medical Association Journal

"[ER visits are the] tip of the iceberg."
The bodily harms are often not the biggest issue. It's the impact on the family."
"Our study shows that people aren't meeting those guidelines [maximum daily serving guidelines]. They're not even close." 

"I think all of society, to be quite frank, needs to see this this data."
"It's a responsibility of all of society to look at these numbers. Look how sobering they are and make sure that the trends don't continue."
Dr.Peter Tanuseputro, researchers, physician, assistant professor, University of Ottawa

Patients who visited emergency departments for alcohol intoxication were disproportionately more likely to result in hospital admissions, according to the study published in the Canadian Medical Association Journal. (Shutterstock/SpeedKingz)

"There's a generational effect. Younger women who were drinking in the early 2000s are still drinking more."
Dr. Daniel Myran, family physician, public health and preventive medicine resident, University of Ottawa

"The Ontario government has gone in the opposite direction with such glee and without any embarrassment."
"There was falling alcohol consumption around the time of the financial crisis. But about the time of the recovery, people started to drink again."
"In the past five years, there has been a rapid uptick in deaths and hospital presentations."
Timothy Stockwell, director, Canadian Institute for Substance Use Research, University of Victoria

Tobacco kills more people [than alcohol]. But having an alcohol addiction is more likely to result in disruption to people's lives. If you include harms to others, alcohol is the most harmful substance out there."
"We're not saying that alcohol shouldn't be available, but that it should be available in a public health model."
Dr. Sheryl Spithoff, family, addiction medicine physician, Women's College Hospital, Toronto

According to a CMAJ study, alcohol-related visits by women went up 86.5 per cent during the study period, compared to 53.2 per cent for men. (Justin Tang/Canadian Press)

A new study recently published by researchers at the Institute for clinical Evaluative Sciences, The Ottawa Hospital, the Bruyere Research Institute and the University of Ottawa, derived its conclusions by sifting through 2003 - 2016 hospital administrative data province-wide. During that period more than 765,000 emergency room visits took place in the province, all attributable to alcohol consumption. Intoxication accounted for 44.6 percent of visits, with 21.4 percent representing harmful use; 11.4 percent for withdrawal, and alcohol dependence accounted for 10.9 percent.

For women around legal drinking age, alcohol-related emergency room visits were seen to peak, while for men the peak was in their early 50s. Although men remain at greater risk of alcohol-related harm, women are steadily catching up. Women ages 25 to 29 saw an increase of 240 percent in alcohol related ER visit for the years 2003 to 2016. Dr. Daniel Myran, lead researcher for the study, noted that young people drink in more harmful patterns, and are failing to age out of their pattern of consumption.

The study is viewed as yet another tranche of growing evidence linking alcohol with serious social costs. Alcohol is known to cause liver disease, addiction and withdrawal problems, heart damage and cancer. According to Cancer Care Ontario, 3,000 cancer diagnoses annually might be avoided were people to follow safe alcohol consumption guidelines. Alcohol consumption accounts for between two and seven percent of breast cancer cases.

As for the health-care system, the estimate is that alcohol care costs totalled $4.32 billion across the country in 2014, while alcohol-related deaths increased by 26 percent for women and by five percent for men between the years 2001 to 2017. One survey that Cancer Care Ontario reported resulted in the information that one-third of Canadians only are aware they are able to reduce their risk of cancer by reducing their alcohol consumption.

Guidelines for low-risk consumption in Canada are under two drinks daily; ten for a week, or three drinks on special occasions for women -- while for men three drinks a day, 15 for a week, and four on special occasions; figures supplied by the National Alcohol Strategy Advisory Committee at the Canadian Centre on Substance Use and Addiction. A standard 740 mL bottle of wine contains over five servings; a serving of beer is 341 mL.

Dr. Myran points out that marketing alcohol to women has become both targeted and sophisticated. Convincing women that alcohol consumption represents an issue of empowerment for women. "It can be very seductive", he points out pointedly. "It's pretty low down on the agenda politically. You have people in one area collecting revenue and other people who are aware, but who don't have the power", noted Timothy Stockwell. "We are all blissfully unaware that this does so much harm. It's a silent problem. We don't question it much. It's like the industry owns parts of our minds."

Headache Central

"It's the type [tension headache] that people can usually treat by having some water and resting a bit."
"It's very difficult for sufferers [of migraine headaches] to go to work or even to socialize."
"[Try yoga or meditation to reduce stress, get more sleep, cut down on alcohol, eat a healthy diet, and avoid excess caffeine consumption that can lead to withdrawal headaches.]"
Giorgio Lambru, consultant neurologist, Headache Centre, Guy's and St.Thomas' Hospital, London

Photo: WebMD

Tension headaches, characterized by a tight feeling in the neck and pressure behind the eyes, can be triggered by being tired, by skipping meals, by stress, dehydration. They are readily remedied by using a common over-the-counter painkiller like acetaminophen or ibuprofen. Medical science still puzzles over headaches, of which there are 300 types that have been identified. It's the rare person who doesn't suffer from some kind of headache, some of the time. It has been estimated that four of five in any population suffer with tension headaches, while one in seven experience migraines, which can seriously impact the quality of life.

Migraine headaches are serious disruptions in anyone's normal life with about one in seven people susceptible to migraines; women three times likelier to experience them than men. The effect of a migraine can be so severe that someone can spend days in bed, unable to cope with the pain. Vomiting, nausea and sensitivity to light or noise are among some of its symptoms. Four stages of progression occur from onset to fully-dimensioned pain, beginning with a pre-headache called the prodromal stage.

In that stage the sufferer is assailed by fatigue, low-feeling, and depressed appetite. Then comes the "aura" of flashing lights, blind spots even progressing to memory loss, fainting, or partial paralysis followed by a severe throbbing headache on one side of the head, along with nausea or vomiting. The "migraine hangover" concludes the process as the fourth stage arrives and with it exhaustion, irritability and difficulty in concentrating. Hormonal changes linked to menstruation can trigger migraine, as well as hunger, stress, insufficient sleep, weather changes, even certain foods.

WebMD

 

 

 

 

Hormone replacement therapy is often prescribed for women suffering with migraine before menstruation onset -- perimenopause or menopause can also trigger migraines. According to the Migraine Trust, simply taking a nap or submitting to the emotional upset by letting it all hang out in a cleansing crying fit, and certainly first of all taking painkillers proactively helps the process of recovery. Drugs called triptans may be prescribed for chronic migraine. Botox injections to disrupt brain signals that lead to attacks present as another treatment option. And there is a monthly injection as a new treatment with the drug Aimovig.

Unusually rare, and miserably severe is the cluster headache, with one or two in every thousand people afflicted, more commonly seen in men than women, with a pain that is uncommonly intense. Debilitating pain arrives swiftly with cluster headaches, felt on one half of the head, around one eye or one temple with sufferers seen to have a red or weeping eye on the pain side, a droopy eyelid and a blocked or runny nose. Such a headache can last fifteen minutes and as long as three hours.

With a cluster headache, the individual feels restless and in attempts to distract from the pain, paces back and forth. Efforts to relieve the intense pain has some sufferers banging their head against a wall, literally. The syndrome is called 'cluster' simply in reflection of the fact that the headaches arrive in clusters, occurring on a daily basis for a several-week period of unrelenting pain, at the same time each day. Spring and autumn appear somehow to trigger cluster headaches, attributable to changing weather systems.

Cluster headaches can run in families, beginning at age 30 and 40, with smoking increasing the risk of onset. Typically, an attack can initiate shortly after falling asleep, leading to advice to avoid napping since it can disrupt sleep-wake patterns, increasing the likelihood of cluster attacks. A drug called sumatriptan, taken by injection or in a nasal spray, or breathing oxygen through a face mask represents the most effective form of treatment for a type of headache that over-the-counter painkillers fail to affect.

And then there are trigger headaches that some people report are brought on by coughing, exertion, sex or consuming a particular food. The headache typically arises swiftly, lasting a short period, and trigger avoidance is the first line of therapy with the caution that this type of headache can occasionally indicate an underlying condition such as a tumour or aneurysm, making it mandatory that a doctor be involved for consultation.

Migraines are categorized as a primary headache, and are often accompanied by visual disturbances.  Photo: MedicalNewsToday

Not least, painkilling medication used to excess paradoxically can cause medication-rebound headaches. Such a headache can be problematic to identify from the original headache. It is felt as a dull constant pain, more miserable in the morning hours. Using codeine or triptan-based drugs for over ten days a month, or paracetamol or ibuprofen for 15 days in a month, risks this type of headache occurring. Treatment? Stop using the painkillers....

New Standards for Celiac Detection

"People have preconceived ideas of what celiac disease looks like. They expect to see patients who because of nutrient malabsorption and diarrhea will end up being skinny with lots of deficiencies."
"But now we have lots of patients who haven't lost weight -- and many who are quite overweight -- but still have micronutrient deficiencies. While they are not losing calories, they are not absorbing some vital nutrients."
"It's a very common symptom [fatigue]. People come in and say they don't have the energy they used to [have], whether it's during exercise or doing daily living activities. This illustrates they might be deficient in iron because of hidden celiac disease."
"They don't have diarrhea or belly pain but they have no iron because of damaged intestines. And while a patient taking large quantities of iron might absorb enough to correct anemia, it's not going to fix the inflammation in the intestines and it's not going to prevent other complications that can occur later in life." 
"If that [blood test] comes back positive, then the patient needs to be referred to a gastrointestinal specialist since you want to make sure it's really celiac before coming to a lifelong diagnosis that will require lifelong treatment."
Dr.Joseph Murray, professor of medicine, Mayo Clinic, Rochester, Minnesota

"The message is that if you see nutritional deficiencies, you should start thinking about celiac disease."
"That way, you may save these patients from damage to the intestines."
Dr.David Whitcomb, professor, gastroenterology, hepatology and nutrition, University of Pittsburgh

Photo: Mayo Clinic

An immune reaction to gluten, a protein common to wheat, barley and rye, produces celiac disease. To avoid the symptoms of celiac disease and the condition's long-range complications people diagnosed with celiac disease follow a dietary protocol of gluten avoidance. The immune response to consuming gluten eventually will compromise the lining of the intestine, preventing it from absorbing certain nutrients. And this leads to diarrhea, fatigue, anemia and weight loss, along with other related complications.

Doctors have long become accustomed to identifying typical symptoms such as unexplained weight loss or extreme thinness in their patients to lead them toward the diagnosis of celiac disease. Now, new research findings lead to the conclusion that the hallmark signal of the presence of celiac disease may instead be seen in low levels of vitamins and other micronutrients, points out a report in Mayo Clinic Proceedings.

Doctors, in other words, need to expand their search for celiac disease symptoms, looking as well for the presence of certain micronutients at low levels, particularly iron, vitamin D and zinc. It is through blood tests that low levels of these critical nutrients are discovered and in the absence of such tests being regularly performed, it becomes incumbent on diagnosing physicians to become alert to the single most common symptom of iron deficiency -- fatigue.

If that telltale sign is there, then a blood test should be ordered as the initial screening mechanism. Should the blood test be returned positive, referral is then made to the medical specialist whose area of expertise is required to validate the initial diagnosis. Because of the long-range complications inherent in undetected and untreated celiac disease, aggressive follow-up is required. Dr. Murray is of the opinion that up to half of the adults with celiac disease are undetected because they fail to present with weight loss and other symptoms felt to typify the disease.

Alternately, should someone self-diagnose and place themselves on a gluten-free diet, the results of the blood test can be compromised. The research undertaken by Dr. Murray and his colleagues involved close scrutiny of 309 adults who were newly diagnosed -- between 2000 and 2014 -- with celiac disease, matched by age with subjects from the National Health and Nutrition Examination Survey, a national database. (NYHANES).

The researchers discovered large variances in nutrient levels on comparing the recently-diagnosed celiac patients with the NHANES participants; zinc deficient in 59.4 percent of the celiac group as compared to 33.2 percent of the control group; copper low in 6.4 percent of celiac patients, versus 2.1 percent of controls; folate low in 3.6 percent of celiac patients, compared to 0.3 percent of controls, and vitamin B12 low in 5.3 percent of celiac group, versus 1.8 percent of the control group.

Iron was low in 30.8 percent among celiac patients but no comparable iron measurements were available to compare with the controls. Weight loss was seen in 25.2 percent of patients diagnosed with celiac, contrary to traditional assumptions respecting celiac and thinness. The new study is meant to serve as a caution to primary care physicians who should take note of nutrient deficiencies in their patients. Dr. Murray cautions "just because someone is overweight doesn't mean they don't have celiac disease."

If you have celiac disease, you cannot eat grains that contain gluten, such as:

• Barley
• Rye
• Triticale
• Wheat (including couscous, bulgur, spelt and kamut)

"It was somewhat surprising to see the frequency of micronutrient deficiencies in this group of newly diagnosed patients, given that they were presenting fewer symptoms of malabsorption."
"Our study suggests that the presentation of celiac disease has changed from the classic weight loss, anemia and diarrhea, with increasing numbers of patients diagnosed with nonclassical symptoms," "Micronutrient deficiencies remain common in adults, however, and should be assessed."
Adam Bledsoe, M.D., gastroenterology fellow, Mayo Clinic, Rochester campus