Thursday, August 24, 2017

Is our love of protein hurting our health? Make sure you're eating the right amount

The protein powder aisle is beginning to look like the cereal aisle. Dozens of options, an abundance of ingredients and colorful packaging, with promises of better health. The market for more protein in the American diet has arrived — and it’s not going away. The attraction to protein as a weight-loss and muscle-building nutrient has exploded so exponentially that many of us may be getting more than medical experts think we need.

Recently, a story came out about a woman who died after consuming an extremely high-protein diet. She was a body builder and suffered from a rare genetic condition called urea cycle disorder. This condition is an inborn error of metabolism and can be diagnosed in both children and adults. Those who have it may have a diminished ability to break down protein in the correct manner. As a consequence, the byproducts of protein don't leave the body like they should. Instead, they build up in the blood, and can cause coma or death.

According to the National Urea Cycles Disorder Foundation, the condition may be mild, and undiagnosed for years if the individual carrying it produces enough enzymes to remove these protein byproducts from the blood. It’s when the body is pushed to the limit that problems may occur. An excessively high intake of protein can be one of these stressors.

Death from too much protein intake is not something you hear of every day, but there are certainly people who should focus on getting less (not more) protein in their diets. For example, individuals who have chronic kidney disease, certain diseases of the liver as well as phenylketonuria (PKU) and other inherited disorders all require a low-protein diet. On the opposite end of this are populations that need more protein: endurance or weight-training athletes, pregnant and breastfeeding women, individuals recovering from surgery or injury and elderly. Then, there's the rest of us. What’s the protein sweet spot for everyone inside the extreme ranges and can we keep including all the bars, powders and liquids safety and effectively?

Unlike other macro and micronutrients, there remains no official standard defining an upper limit for protein consumption, and most government standards recommend a bare bone minimum to be assessed by a universal calculation that takes your weight in kilograms multiplied by 0.8. For example, if you are a healthy, 150-pound woman, your low end of protein would start at 54.5 grams per day, and as for your high end, there’s really no agreement on what that is.

Bottom line: Should we take a chill on this very hot macronutrient? Will death by protein be the next fear derived from food? My advice to my patients is this: Embrace protein and the many benefits it can provide to health, but resist the urge to triple or quadruple your recommended amounts on a regular basis by downing protein drinks the way you would water. Going to this extreme may mean you're skimping out on other important macronutrients, like healthy fats and complex carbohydrates. While it may not lead to death in relatively healthy individuals, too much for too long may put too much stress on your kidneys, which can lead to other serious problems.

Some liquid forms of protein and protein powders and drinks can be loaded with additional supplements and herbs, added sugar or excess amounts of sugar alcohols (which can lead to diarrhea) or artificial sweeteners. Just like any other dietary choice, you’ll want to find the options that best fit your goals. If you’re a vegetarian or dairy intolerant, your best bet is a plant-based option made with pea, soy, hemp or rice. If you're not interested in a plant-based form, then whey, or bone broth products may work best for you. Do your research, and try a few single packet options before you settle on buying an entire vat of it.

A powder or drink can never mimic whole foods, so use them as a way to boost your protein for one meal, or after a workout, for example, but not exclusively. You can get plenty of protein in the day by adding in small amounts at each meal, like sprinkling hemp seed in your yogurt in the morning, enjoying canned wild salmon over a salad for lunch, munching on roasted chick peas as a snack and ending the day with a grilled tempeh sandwich. In the world of food, you can have too much of ANY good thing. Protein included.

Wednesday, August 23, 2017

Women open up about hair loss: 'It's not spoken about'

Lauren Engle was just 28 when she noticed her hair falling out. As her strands got thinner, her part line widened and her ponytail shrunk to the thickness of a pencil. When she saw more scalp showing, she knew she had a problem. Engle, who lives in Dallas, Texas, is far from alone. Millions of women in the U.S. suffer from hair loss, caused by genes, age or alopecia areata. In Engle’s case, the culprit was unexplained female pattern baldness.

“There’s tons of us out there, but it’s not spoken about,” Engle, 35, who writes about her experience in the Corner of Hope & Mane blog, told TODAY. “It’s really sad for women. Their hair is oftentimes their crowning glory. That’s what we do to make ourselves look different, feel beautiful … Everything in the media is always women with long, flowing hair and we don’t have that, so there’s a lot of shame.”

August is National Hair Loss Awareness Month — an effort to bring attention to a condition that can cause "dramatic and devastating" emotions in patients, dealing a blow to their self-esteem, body image and self-confidence, the American Academy of Dermatology notes. A thinning mane can be challenging for anyone since hair is associated with identity, sexuality, age and mortality, but it’s definitely harder for women, said Dr. Marc Glashofer, a hair loss expert with The Dermatology Group in West Orange, New Jersey. “For a man to have a bald head or even a shaved head, it’s so common. For women, there’s still a lot of social stigma to it and it’s tougher to accomplish that confidently,” Glashofer said.

When it comes to hair loss, a big culprit is alopecia areata, an auto-immune condition in which the body’s immune system attacks its own cells instead of bacteria and viruses. In the case of alopecia areata, it targets hair follicles, Glashofer said. Almost 7 million people in the U.S. have or will develop the condition, according to the National Alopecia Areata Foundation. Both genders can get it, though it’s a bit more common in women, Glashofer noted. The trigger is a mystery. Margaret Staib, 49, still remembers the questions swirling in her head when she was diagnosed. “Why me? What did I eat? Will it grow back? Will my husband still love me and find me attractive?” the Long Island, New York, businesswoman recalls thinking. "Our disease does not 'hurt' physically; it's an emotional and mental disease once you get it."

Treatment: Right now, there’s no treatment for alopecia areata that’s sustainable or consistently works for everyone, Glashofer said. That might change in the next couple of years as researchers develop new pills and creams based on a class of compounds called JAK inhibitors that might be the first official medications specifically for alopecia areata. “It’s very exciting that that’s on the horizon,” he said. “We feel like we’re on the precipice of some real success.” These drugs were originally used for rheumatoid arthritis and, by coincidence, it was discovered that some patients who took it for that condition and who also had alopecia aerata grew their hair back. Clinical trials are underway to see how safe and effective this option is, the National Alopecia Areata Foundation says. For now, therapies include cortisone injections directly into the bald patches; topical cortisone; Minoxidil — known to many people under the brand name Rogaine; and anthralin cream. A less-widely available option is topical immunotherapy: certain chemicals applied to the scalp can trigger an allergic rash, which alters the immune response, NAAF notes.

About half of women over the age of 50 start to have some thinning of the hair to the point where the scalp begins to show through, Glashofer said. This is also called androgenetic alopecia or female pattern baldness. “It’s not discussed frequently because it’s a sensitive subject, so everybody thinks they’re in their own personal vacuum, their own agony, that they’re the only ones dealing with it,” he noted. “The reality of it is that a large number of women are dealing with this issue after a certain age.” It’s all about hormones: As women start to reach perimenopause and menopause, the balance of estrogen and testosterone starts to change. Extra testosterone around the hair follicle can lead to decreased thickness of the hair and increased shedding, Glashofer noted. A British journalist recently described how upsetting she found it to lose a third of her hair with age.

Treatment: Minoxidil. This over-the counter topical treatment can help maintain some of the hair you have and decrease the amount of shedding, Glashofer said. There’s inconclusive data about whether Propecia, a drug used to treat male pattern hair loss, can help women, he added. Female patients can try it, but it’s not a first-line therapy. A more recent option is PRP, or platelet-rich plasma. Doctors draw a small amount of blood and separate the platelets from other blood cells. “It’s been shown that the platelets, when injected back into the areas of thinning hair, can help maintain the amount of hair you have, so it can slow down the hair loss,” Glashofer noted.

Thinning hair can run in families. When women in their 20s and 30s see their hair thinning, genes could be to blame. Chances are their mothers and grandmothers experienced a similar problem. Kayla Itsines, a 26-year-old Australian fitness star, recently revealed she has genetically thin hair and wears a clip-in pony tail to add length and volume. Engle wears a topper — “faux hair” extensions that clip to the top of her head — which helps her take back control of the situation, she said. Treatment: Minoxidil may also help with hereditary-pattern baldness. Many women choose to wear clip-in hair. If you are a woman experiencing hair loss for any reason, don’t suffer in silence and don’t become a hermit, Glashofer advised. Talking to a therapist can help. “Life can be challenging in general, but especially when you’re dealing with a chronic condition that’s evident to the whole public,” he said. “Try to gain perspective and then try to share that perspective with other women.”

Tuesday, August 22, 2017

Neighborhoods with more light have higher breast cancer risk, study says

A new study from Harvard has found greater risk of breast cancer in women who live in neighborhoods that have higher levels of outdoor light during the night.

The findings are based on the Nurses' Health Study (NHS), which has for decades been advancing our understanding of risks to women's health. For this study, epidemiologist Peter James and colleagues followed nurses in the NHS for breast cancer occurrence from 1989 to 2013. The home of each of 109,672 nurses was geocoded, and the average light level in the immediate neighborhood at night was estimated from satellite images taken by the Defense Meteorological Satellite Program. These estimates were updated over the 15-year follow-up period. By 2013, a total of 3,549 new cases of breast cancer had been diagnosed, about what's expected among this number of women.

The study found a direct relationship between a woman's neighborhood nighttime light level before diagnosis and her later risk of developing breast cancer: The higher the light level, the higher the risk. These findings held even when taking into account many other factors that may also affect risk such as age, number of children, weight, use of hormone medications and a long list of additional potential confounders. Of importance if confirmed in more studies, the relationship was strongest in young women diagnosed before menopause.

The study is significant because it adds a strong piece of evidence to the growing body of studies supporting the idea that excessive electric light exposure at night increases a woman's risk of breast cancer.

The idea that electric light at night (LAN) might explain a portion of the breast cancer pandemic dates back to 1987. It was pretty far-fetched at the time because light doesn't seem toxic in any way that could cause cancer. It can't break chemical bonds and damage DNA, and it's not a hormone like estrogen, which, in excess, can cause changes in the breast that can lead to cancer. Light is, by definition, the visible part of the electromagnetic spectrum, and so it does not include X-rays or even ultraviolet radiation, which can burn skin.

Light is an exposure that challenges the conventional definition of a toxic substance. If a little asbestos is bad for you, more is certainly worse. The same holds for ionizing radiation (like X-rays), dioxin and lead. The difference is that the effects of exposure to light on human health depend crucially on timing. Over millions of years, we have evolved with a daily cycle of about 12 hours of bright light (the sun) and about 12 hours of dark. So during the day, our body expects light, whereas during the night it expects dark. There is a deep biology to this, and electric light is throwing it out of kilter. One perplexing possible consequence of this light exposure is an increased risk of breast cancer in women. Researchers, including me, have been exploring this possible link in part because breast cancer has no single known major cause. This is unlike many of the other common cancers such as lung, liver, cervix and stomach, for which a major cause has been identified for each; these major causes are, respectively, smoking, hepatitis viruses, human papilloma virus and the bacterium Helicobacter pylori.

But how could the nighttime light level outside a woman's home in her neighborhood affect her risk of breast cancer? The rationale for studying the outside light level is the assumption that communities that shine brightly to a satellite at night are composed of people who in general are bathed in LAN: They have greater exposure in their home, outside on the street, and for evening entertainment in the city. So, the satellite data are thought to be a surrogate, or a proxy, for this actual LAN exposure to each woman, particularly in the evening before sleep.

My colleagues and I did a similar analysis using satellite data in the state of Connecticut. We also found a stronger effect in younger women, as did another study from 2014 conducted among teachers in California. The studies from Harvard and from California are superior to ours because they both had individual-level data on many more potential confounders than just age, which we did not. Yet all three studies do point in the same direction.

The Harvard study comes closely on the heels of a very public warning from the American Medical Association on potential health problems from "white" LED street lights. It is important to note that the nighttime light levels used in this new study were recorded before any widespread use of "white" LED street lighting.

If the results from Harvard are real, and too much light at night from any and all sources does increase a woman's risk of breast cancer, then retrofitting street lighting all across America should be done in a way that does not further contribute to the problem. It would be best to select luminaires that are as dim as possible, and weak in the short wavelengths (e.g., blue), yet still consistent with accomplishing their intended purpose. Electric light is one of the signature inventions of an inventive species. But its overuse has caused an obliteration of night in much of the modern world. The loss of night has consequences for all forms of life, including us. And the mounting evidence for a connection to breast cancer is alarming.

Friday, August 18, 2017

10 nutrients that will prevent hair loss during MENOPAUSE

All your life, you have taken pride in your hair. It’s a symbol of your beauty and fertility. But come menopause and few things start going awry in your body. By this time, your body undergoes a series of hormonal changes and one of the commonest problems you will face is that of hair loss. Menopausal women often complain about their waning mane, when they find clumps of hair in the hair brush and on the pillow. Typically, women achieve menopause by the age of 50.Almost 20-60% women face this condition, which also causes low-self esteem among women who are already coming to terms with their menopause. A good diet comprising of hair-growth nutrients will ensure that you don’t lose your precious hair after menopause. Here are the 10 top nutrients you will need include in your diet to prevent menopausal hair loss.


The most important set of macronutrients you will need is proteins, which should make up at least 10-15% of your diet. If your diet is insufficient in proteins, you face problems like hair fragility and brittleness. Ensure your diet is rich in cystine and L-lysin, without which, hair will become limp and brittle. Good sources of these important amino acids include paneer, yoghurt, fish, meat, turkey, chicken, legumes, sunflower seeds, pistachios, peanuts and beans. Grains like buckwheat (kuttu), barley groats and brown rice should be had. Having at least 2-3 eggs per week is recommended for good hair growth.


Irrespective of where you stand in the fat versus anti-fat debate, include a good amount of healthy fats in your diet. Fats supply your body with linoleic acids and long-chain polysaturated fatty acids which are important for hair structure. Deficiencies of these nutrients will make your hair look limp and dehydrates. So fill up on good fat sources like fish oil, flax seeds, walnuts, poultry, eggs, olive oil and rapeseed oil.


A lot of women go off on carbs and embrace a more protein rich diet for maintaining body weight. While loading up on simple carbs in processed foods can damage your hair from within, deficiency of complex carbohydrates can also trigger hair loss. It’s important that you eat a complex-carb-rich diet with a low glycemic index. Carbs should comprise 50-70 percent of your diet from sources like grain bread, brown-red rice, whole meal pasta and low glycemic fruits.

Vitamin C
Vitamin C deficiency can have an impact on the development of the hair shaft. It is important for the body since the micronutrient helps in absorbing iron from iron-rich foods like spinach. Hence it is important that your diet contains a vitamin C-rich diet such as parsley, peppers, sprouts, broccoli, spinach and fruits like strawberries, kiwi fruit and citrus fruits.

Folate is a type of B-vitamin that occurs naturally in certain foods; it helps in the production of red blood cells and haemoglobin, which transports oxygen to your hair cells. Folic acid, a type of folate, plays a crucial role in helping hair tissues grow by stimulating hair rebuilding mechanism of the follicle cells. Additionally, it also helps prevent greys! To should prevent hair loss, eat green peas, white beans, kohlrabi and beets. Non-vegetarians can also eat eggs, cod fish and poultry livers to supplement folic acid production.

Pantothenic acid (B5 vitamin)
This important vitamin prevents premature greying of hair and restores the original hair colour. Among its many virtues include, promoting cell division in hair follicles, hydrating hair, protecting from inflammation, regulating sebaceous glands and accelerating melanin creation. Women who have crossed 50 should eat a diet full of B5 rich foods like cauliflower, mushrooms, soya beans, eggs, whole grains, milk, beans and green leafy vegetables.

Women who want to grow their hair out often take biotin supplements. Vitamin H or B7, as it is otherwise known, takes part in metabolising fat. Having a biotin deficiency means hair loss, skin inflammation, brittle nails and greasy scalp. Eating a diet rich in meat, livers, egg yolks, nuts, vegetables and milk will take care of your biotin deficiency and take care of hair loss during your menopausal phase.

Niacin or Vitamin PP is responsible for keeping your hair in ship shape. Some of the richest sources of the crucial vitamin include meat, whole wheat grains, legumes, vegetables, seeds, milk, green leafy vegetables, fish, peanuts, shellfish and yeast.

Cobalamin or Vitamin B12 is a water-soluble vitamin which helps in the production of red blood cells, responsible for carrying oxygen to your tissues and maintaining the colour of your hair. Vegetarians and vegans who shun animal products are the ones who are often deficient in this crucial vitamin. Women should eat a diet rich in meats, fish, eggs and dairy products to ensure they get enough B12 to prevent any episodes of hair loss.

Vitamin A
Vitamin A deficiency can decrease the speed of cell regeneration and synthesis. It is responsible for moisturising and protecting hair from being brittle. The best source for Vitamin A would be through plant sources like spinach, carrots and sweet potato. Excess of the vitamin through animal sources could cause build-up in the liver, which could trigger hair fall.

Wednesday, August 16, 2017

How the 'Instagram diet' works

At 37 years old, Lisa Pessah-Bloom, a mother of three, was pre-diabetic, struggling with losing postpartum pounds and concerned about her health. "I had gestational diabetes for all three of my pregnancies. After my third, my A1C (blood sugar measurement) kept rising, and the doctor told me for the first time to be careful, because I was on track for diabetes." Pessah-Bloom knew that she had to shed her pregnancy pounds and get her blood sugar under control. She did a Google search on diets for diabetes and stumbled upon the Paleo diet, which includes protein-rich foods like meat, fish, eggs and nuts, as well as vegetables and fruit, but excludes grains, dairy, legumes, sugars and salt. "People said that their diabetes was reversed," she said.

She started eating more vegetables and unprocessed foods. But while following Paleo helped Pessah-Bloom eat a clean, lean diet, it wasn't enough to get her to her goal. She needed something else -- a support system of sorts -- and so she opened an account on Instagram under the handle @paleoworkingmama. "I started my Paleo page for motivation, really for myself," Pessah-Bloom said. But it wasn't long before she found people with health issues like herself who were also using the photo-driven app. "I started following others who reversed Crohn's and IBS too, which I also had," she said. "The more I followed people, the more I felt empowered. And then something unexpected happened. After some time, people who followed me told me that I -- me! -- empowered them. It was a chain of support," she said. "I got it from others, and I gave it to others. People asked me to come to their house to perform refrigerator cleansing! They are inspired by the pictures I post of the food I make and what I keep in my kitchen, like my spices."

The community support that Instagram provides may be its most valuable asset for those hoping to achieve their health goals. "The first picture I posted was a mason jar of water with lemons," Pessah-Bloom said. "I had just learned about my high blood sugar, and I wrote, 'Making lemonade out of lemons.' " The post marked the start of Pessah-Bloom's new diet and exercise journey, and in her post, she encouraged others to follow and support her.

"One person posted my post on her page -- she had over 15,000 followers, and she said, 'Let's give @thepalemoworkingmama our support' -- and then all of a sudden I had 100 followers. This was someone I didn't even know ... someone who has plenty of her own followers, but she really wanted me to succeed on my journey." There's also the benefit of being part of a more intimate community. "With Instagram, you can have a separate part of your profile dedicated to food journaling, and you don't have to be worried that your family member or neighbor who just wants to see pictures of your dogs or vacations will be turned off," said Christina Chung, a doctoral student at the University of Washington and lead author of a study that analyzed women who consistently use Instagram to record and share what they eat, in order to learn about the benefits and challenges of using the platform to achieve one's health goals. "Instagram is just pictures. There are no posts about politics. It's easy to navigate, with no chaos or clutter," Pessah-Bloom added. "If you follow someone, you're following them for a specific reason ... and often someone with a similar goal." Pessah-Bloom also appreciates the convenience that Instagram provides. "People are so busy, and sometimes you can't go in person to a Weight Watchers meeting. With Instagram, it's in your face. You're seeing it all the time. When I eat something bad ... and I see someone preparing something wonderful, I say, 'Why did I do that?!' It keeps you inspired!" Food pictures that create cravings for tasty, healthy food help, too. "When you see something so mouthwatering and appetizing, you're more likely to try it, and then you get hooked on eating well," Pessah-Bloom said.

For those who use Instagram to track what they eat, the ease of snapping a picture is particularly helpful during a jam-packed day. "The benefit of photos is that it's more fun to do than taking out a booklet or typing hundreds of words of description in an app," Chung said. "Plus, it's more socially appropriate for people who are trying to track their diets to snap a photo of their plate when they're out with friends: Everyone's doing it, and it doesn't look weird." As one of the study participants noted, "if I was out with friends or something, then a quick snapshot of the food would be easier than saying, 'Hold on, guys, I need to pull up MyFitnessPal and put everything down and the right serving size.' "

But just how accurate is Instagram as a tracker for weight loss? Can you really know the portion sizes, fat grams and calorie counts of what you ate -- or should eat -- when you swipe through photos? "When it comes to losing weight, food pics may or may not help," said Angela Lemond, a registered dietitian nutritionist and spokeswoman for the Academy of Nutrition and Dietetics. "The food could be great quality, but even an excessive amount of 'good' food will cause weight gain." If, for example, someone spots a picture of healthy chicken parmigiana as food inspiration for weight loss, it may be difficult to figure out the correct portion size, unless it is listed. "It's not very accurate if you are looking for tracking information such as detailed nutrients, portion size and calories, since it might be difficult to assess this information from photos," Chung said.

f you're looking for a 200-calorie meal, you might search using the hashtag #200calories and find some options. But in Chung's study, participants used the platform in conjunction with other apps if they were seeking more detailed nutrition data. Calories aside, for those who use Instagram, the visual cues that the app provides -- actual pictures of food -- may be just enough motivation to continue eating on plan, or in some cases to eat less. "Before (when using MyFitnessPal), I would have a small snack pack that was a bag of chips and be like, 'Oh, that doesn't really count because it's just a little tiny bag.' But I think with Instagram, it helped me because I was taking a picture of it: It's real, and it exists, and it does count towards what I was eating. And then putting a visual image of it up really helped me stay honest," one study participant said. Tensions between tracking honestly and posting something perceived as more desirable were also observed in the study. That could present a dilemma, leading some to spend time on making photos look better, explained Chung. But the thought of posting something "off-plan" may also help people stay on track, she added.

Monday, August 14, 2017

A Cancer Conundrum: Too Many Drug Trials, Too Few Patients

With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research. There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on.

The logjam is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients. In July, an expert panel of the Food and Drug Administration recommended approval of a groundbreaking new leukemia treatment, a type of immunotherapy. Companies are scrambling to develop other drugs based on using the immune system itself to attack cancers. Many of these experimental candidates in trials are quite similar. Yet each drug company wants to have its own proprietary version, seeing a potential windfall if it receives F.D.A. approval.

As a result, there are more than 1,000 immunotherapy trials underway, and the number keeps growing. “It’s hard to imagine we can support more than 1,000 studies,” said Dr. Daniel Chen, a vice president at Genentech, a biotechnology company. In a commentary in the journal Nature, he and Ira Mellman, also a vice president at the company, wrote that the proliferating trials “have outstripped our progress in understanding the basic underlying science.”

“I think there is a lot of exuberant rush to market,” said Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. “And we are squandering our most precious resource — patients.” Take melanoma: There are more than 85,000 cases a year in the United States, according to Dr. Norman Sharpless, director of the Lineberger Comprehensive Cancer Center at the University of North Carolina, who was recently named director of the National Cancer Institute.

Most melanomas are cured by surgery, leaving about 10,000 patients who have had relapses and could be candidates for an experimental treatment. But nearly all will be treated by doctors outside of academic medical centers, who are not part of the clinical trials network and so do not offer patients experimental treatments. Companies therefore must compete for the few patients with relapsed melanoma who are at centers offering clinical trials.

Many end up struggling to find enough subjects to determine whether a treatment actually works — and if so, for whom. And these drugs often are not so different from one another. Immunotherapy drugs that attack a protein known as PD-1 are approved for treatment of lung cancer, renal cell cancer, bladder cancer and Hodgkin’s disease, noted Dr. Richard Pazdur, director of the F.D.A.’s Oncology Center of Excellence. Yet many pharmaceutical companies want their own anti-PD-1. Companies are hoping to combine immunotherapy drugs with other cancer drugs for added effect, and many do not want to have to rely on a competitor’s anti-PD-1 drug along with their own secondary drugs. So in new trials, additional anti-PD-1 drugs are being tested all over again against the same cancers — a me-too business strategy taken to multibillion-dollar extremes. “How many PD-1 antibodies does Planet Earth need?” wondered Dr. Roy Baynes, a senior vice president at Merck, which received approval for its first such drug in 2014.

Immunotherapy trials have proliferated so quickly that major medical centers are declining to furnish patients to them. The Yale Cancer Center participates in fewer than 10 percent of the immunotherapy trials it is asked to join. The problem is that many of the trials are uninteresting from a scientific view, said Dr. Roy Herbst, the center’s chief of medical oncology. The companies sponsoring these trials are not addressing new research questions, he said; they are trying to get proprietary drugs approved. If the struggle to find patients for immunotherapy trials is challenging, finding patients for another new type of cancer treatment can be next to impossible.

Friday, August 11, 2017

From Cancer to Career Changes, Kathy Bates Talks Life's Challenges

Kathy Bates knows how to roll with the punches. In the last 14 years, she has beaten both ovarian cancer and breast cancer. And, after a long and lauded career in film, the 69-year-old actress has shifted her focus to TV, starring in four seasons of FX’s American Horror Story and playing actress Joan Blondell in FX’s Feud. Next, she’ll star as Ruth, the owner of a California cannabis dispensary, in Netflix’s comedy Disjointed, out August 25.

An ongoing challenge for Bates is lymphedema, a blockage in the lymphatic system often triggered by removing lymph nodes during breast cancer surgery. The chronic condition causes excessive swelling in the arms and legs and affects 10 million Americans, “yet nobody really knows what it is,” says Bates. She’s now a spokesperson for the Lymphatic Education & Research Network (LE&RN). We caught up with Bates to talk about lymphedema, her newfound niche in TV and ditching the prosthetics after a double mastectomy.

Cancer and its aftermath changed my outlook in a profound way. I’ve become less of a hermit and I travel more. I really enjoy every moment of my life now. It’s not that every moment is terrific—we all go through tough times— but I try to be more present and grateful for the good times that I have. I realized that I had to get back in shape. I started walking more. I’ve lost around 55 pounds. Just being physically free of that extra weight has been liberating and has helped keep the [lymphedema] swelling down. I avoid salt and alcohol, too, because of lymphedema.

I’ve recently decided to “go flat.” I read that more and more women are doing that, and finally I came to the conclusion, “I don’t have breasts anymore, why do I have to pretend like I do?” I have prosthetics and I can put them on for a character, but in my own life I wear Spanx tanks under my shirts and I feel much more comfortable with that than having to strap on a bra with these fake boobs in them. That has given me a lot of freedom and confidence and I just feel better. TV has rejuvenated my career.

I’ve gotten to really push my envelope. Oftentimes, I’m cast as the sort of dumpy dishrag mother or best friend part, so to be able to play someone like [the twisted New Orleans socialite in American Horror Story] Madame Delphine LaLaurie, it’s a panoply of opportunities for an actor. And now I’m getting to do a sitcom with Disjointed. People will see a side of me they haven’t seen before. My two Yorkies are at the very center of my well-being and happiness. My favorite part of every day is when I get to come home and cuddle with them. Their philosophy is: it’s always a good time to take a nap. Wise creatures. I recently bought an electric guitar. I used to play guitar years ago. It brought me a lot of pleasure when I was a teenager growing up and was having tough times. Now that I’m navigating the waters of being older and going through some tough times adjusting to that, I decided I’d like to get back to what gave me joy.

My inner strength comes from my friends. I have a very close group of friends and family and we all help each other through our dark times. That love and support has really flourished in the last few years of being sick. I have really focused on mindfulness. That helps me make better choices both physically, psychologically, and emotionally. If something bad happens, rather than flying off the handle, I try to breathe and focus and wait till the anger/fear subsides so that I can really think through something and realize a) it isn’t about me or b) this is what I can do to change it. The things that I can’t do anything about, I have to learn to let go of.

I think I’ve been living my bucket list for the last few years. I’ve done and experienced so many wonderful things. If I went tomorrow, I wouldn’t be disappointed. I might want to go out and buy a Bentley or a sports car or something like that but then I’d think, “I don’t need all of that stuff.” But cars are always in my fantasy bucket list.

Thursday, August 10, 2017

Why Inflammation in Your Mouth May Raise Your Risk of Cancer

Women with gum disease are 14% more likely to develop cancer than those with healthy teeth and gums, according to a study published in Cancer Epidemiology, Biomarkers & Prevention. The link appears to be strongest for esophageal cancer, but associations were also found between poor oral health and lung, gallbladder, breast, and skin cancer.

The study looked at data from nearly 66,000 postmenopausal women, ages 54 to 86, who were followed for about eight years. At the start of the study, they completed a health survey and reported whether they had ever been diagnosed with periodontal disease, an inflammation off the gums that can lead to tooth loss. Gum disease is caused by sticky, bacteria-laden plaque that forms on teeth. In the early stages, known as gingivitis, the gums can be swollen and bleed easily. Daily flossing and brushing can usually reverse gingivitis. If plaque is left on teeth, it can progress to periodontal disease, which is inflammation around the teeth that causes gums to pull away and form pockets, which can trap more food and bacteria.

With time, the bacteria, inflammation, and body's immune reaction can damage teeth and supporting bone structures, which can lead to tooth loss. During the study’s follow-up period, about 7,100 of those women developed cancer. Overall, those with a history of periodontal disease were more than three times as likely to develop esophageal cancer—and nearly twice as likely to develop gallbladder cancer—than women without. Their risk for lung cancer, skin melanomas, and breast cancer was also increased by 31%, 23%, and 13%, respectively.

Periodontal disease is more common in people who smoke and drink, which are also risk factors for several types of cancer. And in the new study, women with periodontal disease were more likely to report a history of smoking, exposure to secondhand smoke, and alcohol consumption. But even among non-smokers, gum disease was still associated with a 12% increased risk of developing cancer overall. For some types of cancer, the link to gum disease did disappear when the researchers factored out smoking habits. For other types—like melanoma and cancers of the gastrointestinal tract—the connection remained.

This isn’t the first study to suggest that gum disease is associated with certain cancers, but few studies—and none on older women—have calculated an overall increased risk. The researchers focused on this population because risks for gum disease and cancer both increase with age, and because a link had already been established in men. Researchers don’t know for sure why gum disease and cancer are linked, says senior author Jean Wactawski-Wende, dean of the School of Public Health and Health Professions at the State University of New York at Buffalo. But she and other researchers believe that bacterial pathogens in the oral cavity may play a role.

“These pathogens can travel to different parts of the body through your saliva, and they come in contact with your stomach and esophagus when you swallow, or end up in your lungs through aspiration,” says Wactawski-Wende. When gums become inflamed and infected, pathogens—or disease-causing toxins—can also permeate the tissue and enter the blood stream, and travel to other parts of the body as well. Previous studies have shown that these pathogens may play a direct role in the formation of cancer tumors and other inflammatory health issues throughout the body. Gum disease has also been tied to obesity, diabetes and cardiovascular disease, but it’s not clear whether gum disease contributes to these conditions or vice versa.

The study authors point out that they were only able to find an association, not a cause-and-effect relationship, between gum disease and cancer risk. And it’s possible that gum disease in the study was under-reported, they add, since they relied on survey responses rather than a doctor's or dentist's exam. But the large study size and the strength of their findings make a good argument for more research, they say. In fact, they’re currently studying the oral microbiome—the type and variety of mouth bacteria—of women with gum disease, and they plan to see if there are any patterns or links to the cancers the women may develop n the future.

The study also makes a good argument for taking care of those pearly whites, says Wactawski-Wende—and the gums that keep them in place.“Between this and other studies, we’ve seen a link between periodontal disease and heart disease, diabetes, and now cancer, so it seem to me that it would be prudent to recommend maintaining good oral health,” says Wactawski-Wende. “That involves brushing and flossing, but also seeing a dental professional who can monitor and clean your teeth, and who can prevent periodontal disease or treat any cases that do arise.”

Wednesday, August 9, 2017

Little evidence for supplements to treat thinning hair, dry skin and brittle nails

There’s no shortage of products on the market that are claimed to help stave off thinning hair, fine lines on the skin and dry, brittle nails. Among these are a slew of dietary supplements, some topping $100.

These commonly contain antioxidants such as vitamins A, C and E, or coenzyme Q10, as well as biotin, a B-complex vitamin. The minerals manganese and selenium are often found in supplements marketed for healthy hair, along with fatty acids such as fish and flaxseed oils.

Deficiencies of the nutrients above, although uncommon, can cause a litany of hair — and, sometimes, skin and nail — changes. Over time, for instance, insufficient intake of vitamins A and E can cause rough, scaly skin patches. A deficiency of biotin may cause eczema and hair loss. But can a pill restore your locks, nails and skin? This is what we know right now.

For healthy people, there’s no good evidence that supplements can make a difference. “I’m not aware of any robust data suggesting that any supplements can treat natural, aging-related hair loss or nail damage, or give you healthier skin,” says Pieter Cohen, an assistant professor of medicine at Harvard Medical School and an expert on dietary supplements.

Two 1990s studies did find that biotin supplements may help strengthen soft, easily breakable nails. But the studies were small and not rigorously conducted, and they haven’t been replicated, Cohen says. “It’s nothing that would ever lead me to recommend it to any of my patients,” he adds.

Most people get enough of the nutrients in these supplements, but in rare cases a medical problem may cause deficiency or affect your hair, nails or skin. The few who take antibiotics long term or who use anti-seizure drugs, for instance, are more likely to be biotin-deficient. An overactive or underactive thyroid may cause hair loss and dry strands. Iron-deficiency anemia can lead to brittle, oddly shaped nails.

If you’re experiencing chronic hair, nail and skin problems for no clear reason, talk with your doctor. “If nothing shows up after appropriate testing, because we don’t have a good blood test to detect biotin deficiency, it might be worthwhile to try a supplement for three months,” says Marvin M. Lipman, Consumer Reports’ chief medical adviser. “Since it can interfere with thyroid testing, make your doctor aware.”

But remember that dietary supplements are not well regulated and might contain substances not listed on the label or have much less or more of an ingredient than promised. For example, in 2008, one brand of multivitamin was found to have 200 times the labeled concentration of selenium — after it had caused hair loss and discolored, brittle nails in about 200 people across 10 states.

Manage the damage 

Eat enough protein. It’s important to maintain a healthy diet for overall health. But getting 30 percent of your daily calories from protein (preferably lean) can help keep your hair in shape.

Treat your body well. Be cautious with hair dye (semipermanent is less damaging than permanent), blow-dryers, flatirons and styles such as tight ponytails. If you bite your nails, keep them trimmed or consider using a clear, bitter-tasting polish to help you stop. Wear cotton-lined gloves when washing dishes, moisturize hands and nails daily, and use moisturizing soap. Moisturize skin frequently and take short, tepid showers. Run a humidifier in your bedroom or office to keep the air between 30 and 50 percent humidity. If you smoke, work at quitting.

Protect yourself from the sun. Exposure to its UV rays can cause premature wrinkling, sagging, spots and skin coarsening. Limit sun time and use a broad-spectrum sunscreen of at least SPF 30 daily.

Consider Rx help. Prescription topicals such as tazarotene and tretinoin creams have been shown to reduce fine-line wrinkles, skin roughness and sun and age spots. Over-the-counter formulations with retinol, retinaldehyde, retinyl esters and oxoretinoids are also available, though less evidence supports their effectiveness.

Thursday, August 3, 2017

How Exercise Fights Inflammation

From jogging to weightlifting, physical activity is good for you, in part because it helps your body fight inflammation.

Now, a new review explains exactly how exercise works to lower inflammation. Inflammation is the body's way of healing itself after an injury and protecting itself from infection; but chronic inflammation is linked with all kinds of diseases, from diabetes to heart disease. When you start exercising and moving your muscles, your muscle cells release a small protein called Interleukin 6, or IL-6, which appears to play an important role in fighting inflammation.

IL-6 has several anti-inflammatory effects, including: Lowering levels of a protein called TNF alpha, which itself triggers inflammation in the body. Inhibiting the signaling effects of a protein called interleukin 1 beta, which triggers inflammation that can damage the cells in the pancreas that produce insulin. The biggest factor in determining how much IL-6 your muscles release is the length of your workout — the longer your workout, the more IL-6 is released, according to the review of relevant research.

For example, after a 30-minute workout, IL-6 levels may increase fivefold, but after a marathon, the levels may increase by a factor of 100, according to the review. IL-6 levels peak around the time you finish a workout, and then rapidly decrease back to pre-exercise levels.

A study published in 2003, and part of the new review, explored the role of IL-6 in reducing inflammation. In that study, the researchers injected participants with a molecule from E. coli bacteria that is known to activate the body's inflammatory response. The researchers found that, indeed, when they injected this molecule, there was a two- to threefold increase in levels of the inflammation-triggering protein TNF alpha. But if participants engaged in 3 hours of stationary cycling before the injection, they experienced an increase in their IL-6 levels, and they did not see a similar rise in TNF alpha. This study and others show that a single bout of exercise induces a strong anti-inflammatory effect that appears partly due to IL-6, the review said.

Still, the review acknowledges that IL-6 is likely not the only factor involved in exercise's anti-inflammatory effects. For example, studies have found that regular exercise increases levels of another protein, called Interleukin-15 (IL-15), in muscle cells. IL-15 appears to help regulate the accumulation of abdominal fat, with higher levels of IL-15 providing protection against abdominal fat buildup in mice, the review said. Since abdominal fat itself is thought to promote inflammation, reducing abdominal fat levels may be another way exercise fights inflammation, the review said. The review concludes that exercise should be used as part of the treatment for chronic diseases involving inflammation.

"Physical activity represents a natural, strong anti-inflammatory and metabolism-improving strategy with minor side effects, and should be integrated in the management of patients with chronic diseases," such as type 2 diabetes and cardiovascular disease, the review said.

Wednesday, August 2, 2017

A Popular Hair Loss Drug Costs 40% More for Women Than Men

Dr. Jules Lipoff was browsing the pharmacy shelves of his local Target when he stumbled across an interesting finding: Ounce for ounce, the women’s version of Rogaine foam—an over-the-counter treatment for hair loss—cost significantly more than the men’s.

Men’s and women’s Rogaine are marketed differently but contain the same ingredients. “I thought, maybe this is just a fluke,” says Lipoff, assistant professor of dermatology at the University of Pennsylvania Perelman School of Medicine. “But I went to a couple different stores and saw it was pretty consistent.” Lipoff and his colleagues then compared prices for Rogaine and its generic version, minoxidil, at 21 pharmacies in four states. Their findings, published in JAMA Dermatology, show that the drug is routinely priced higher when marketed for women. Although they only looked at a specific selection of products, the authors say their paper “may reflect the larger issue of gender-based pricing” for many types of health care. The researchers included Target in their analysis, along with five of the country’s other largest chain pharmacies: CVS, Kroger, Rite Aid, Walgreens and Walmart. From July to November 2016, they recorded the prices, sizes and ingredients of 41 unique minoxidil products at stores in Pennsylvania, New York, Ohio and Indiana.

Rogaine’s foam formulas are the company’s newest, most popular products, and at 5% strength, they are FDA-approved for both men and women. But despite having identical formulations, the researchers found a 40% average increase in the price of the women’s foam version ($11.27 per ounce) compared to the men’s ($8.05 per ounce) when sold at these stores. Lower-cost generic versions of minoxidil foam are available. But these products are branded for men only, because Rogaine still owns a patent on the women’s foam formula. A spokesperson for Rogaine told Health that Rogaine foam for men and women are the same price per ounce when purchased directly from the company’s website, and when sold wholesale to pharmacies. “I can’t speak for pricing by individual retailers,” he said in an email. A spokesperson for Target said the company was not able to respond by press time. The researchers also looked at topical (liquid) minoxidil, which is available for men and women as Rogaine or a generic.

It’s an older version of the medicine and is sold for men at 5% strength and for women at 2%. In this case, even though the men’s formula has more active ingredient, the two versions cost about the same: $7.61 on average for women’s and $7.63 for men’s. “On one hand, we see that women are paying more than men for essentially an identical product,” says Lipoff. “And on the other, we see that they’re paying the same as men for something that’s not as effective.” Lipoff points out that women’s and men’s versions of these products are sometimes sold in different sizes and quantities, so women may not even realize they’re paying more. To add to the confusion, Rogaine foam is approved for women as a once-daily treatment and for men as a twice-daily treatment—so the same size container is labeled as a two-month supply for women and a one-month supply for men. But doctors may tell women to use the medicine twice a day for better effectiveness. They may also tell women to buy the men’s 5% topical formula instead of the women’s 2%.

Lipoff tells his female patients to buy men’s Rogaine because it’s cheaper. “I would also encourage them to seek out generic versions, whatever is least expensive, because the active ingredients are going to be the same,” he adds. Gender-based price differences are not new; one 2015 report found that women pay more for personal care products 56% of the time. But since few medications are marketed differently to men and women, it isn’t often that researchers can compare drug costs in this way. Lipoff says the purpose of his study wasn’t to accuse stores of intentional discrimination, but simply to document and make people aware of the real difference in cost.“I also hope we can bring forth a larger issue,” he says, “that we should consider how many of our costs in health care—not just medications but things like insurance and medical procedures—could be affected simply by gender.”