Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?

Health Report:


Prostate Cancer, Fatigue & Exercise

Does your Surgeon “Warm-up” Before Surgery?



"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Last Updated: 01/25/2009


The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.



PROSTATE CANCER, FATIGUE & EXERCISE

Several different types of treatment are available for patients with prostate cancer. For most men with early-stage prostate cancer, either surgery or radiation treatment may be selected (in some cases, both types of therapy may be indicated). Each treatment option has its own specific range of potential risks and benefits, and patients should be careful to obtain a full discussion from their doctor regarding the most appropriate treatment for their prostate cancer before making a decision.

For men who choose radiation therapy as the primary treatment for their prostate cancer, a new prospective clinical research study provides important information regarding the role of resistance and aerobic fitness training (also known in some circles as “exercise”) in reducing fatigue and other side effects of prostate cancer treatment.

This study, newly published in the Journal of Clinical Oncology, randomized 121 prostate cancer patients undergoing radiation therapy into 3 groups. The first group of 41 men was not assigned to any fitness training sessions, and this group of men agreed not to initiate an exercise program during the 24-week period of observation. The second group of 40 men was assigned to resistance training for a period of 24 weeks. Resistance training was conducted 3 times per week, and for those of you who are exercise aficionados, the resistance routine consisted of performing two sets of 8 to12 repetitions of 10 different exercises (leg extension, leg curl, seated chest fly, latissimus pull-downs, overhead press, triceps extension, biceps curls, calf raises, low back extension, and modified curl-ups). Resistance weights were then increased by 5 pounds when participants completed more than 12 repetitions. Finally, the 40 men in the third group were randomized to aerobic exercise training for a period of 24 weeks. The aerobic training was also conducted 3 times per week, and consisted of aerobic work-outs using a cycle ergometer, treadmill, or elliptical trainer. Exercise duration began at 15 minutes and was then increased by 5 minutes, every 3 weeks, until it reached 45 minutes. Exercise intensity was standardized using heart rate monitors.

At the end of the 24-week study period, all patient volunteers were assessed for fatigue using a validated cancer therapy fatigue scale. The results of this study indicated that both resistance training and aerobic exercise significantly reduced short-term levels of fatigue in prostate cancer patients when compared to similar patients who did not participate in fitness training. Interestingly, resistance training appeared to provide a longer duration of fatigue reduction when compared to aerobic fitness training in this cohort of middle-aged and elderly men with prostate cancer. Moreover, resistance training not only improved upper and lower body strength, as expected, but it also reduced triglyceride levels in the blood and improved aerobic fitness levels as well. The men who were assigned to the aerobic training group also experienced an improvement in aerobic fitness levels, as expected but, as already noted, they did not appear to experience some of the other health benefits that were observed among the resistance training group. Aerobic fitness training was not only less effective in providing long-term fatigue reduction, but was also, not surprisingly, less effective in improving muscle strength when compared to resistance training (anecdotally, one of the men assigned to the aerobic fitness training group actually experienced a serious adverse health event as a result of aerobic fitness training).

This is an interesting study, and for a couple of reasons. Cancer diagnosis and treatment is very often accompanied by varying degrees of anxiety, depression, and fatigue. We already know that the severity of these cancer-associated affective disorders can be significantly reduced with even moderate levels of exercise. However, the conventional thinking among most exercise physiologists has been that aerobic exercise is the most effective means of attaining good cardiovascular health, as well as all of the other ancillary health benefits that arise from a good cardiovascular work-out (including reductions in anxiety, depression and fatigue). In this small prospective study, a graduated program of resistance training appeared to provide not only increased upper and lower body strength, as expected, but also appeared to provide a longer lasting reduction in fatigue levels while also simultaneously improving aerobic fitness. (Unfortunately, this study did not include a fourth group of men who were randomized to undergo both aerobic and resistance training at the same time.)

As a follow-up to this excellent but small prospective clinical study, I would like to see a large cohort of patients and a longer duration of follow-up. I would also like to see that fourth group added, as well. However, for patients with joint or mobility limitations that preclude moderately vigorous aerobic exercise on a frequent basis, this small study of cancer patients suggests, as have other studies, that a progressive and frequent weight training program can provide both improved muscle strength and significant improvements in aerobic fitness. Other recent non-cancer studies looking at resistance training for older patients have also confirmed clinically significant improvements in body strength, agility, balance and overall vigor.

As soon as I finish this column, I think that I’ll visit the gym…!



DOES YOUR SURGEON “WARM-UP” BEFORE SURGERY?

Given that it is generally thought that performing sham surgical operations on human beings is a bad thing, I rarely include surgical research in this column as there are no randomized, controlled clinical surgery research trials being performed. As I am a surgeon, however, I am always on the look-out for an interesting surgery research study that can be included in this weekly health research column. In the current issue of the Journal of the American College of Surgeons, I came across an interesting little study looking at the value of “preoperative warm-up” exercises by surgeons who are about to go into the operating room to perform a surgical procedure.

Modern surgical procedures require a great deal of both cognitive and motor skills, and there has recently been a new emphasis on borrowing “best practices” guidelines from other professions that, similarly, require the integration of these two high-level skills. For example, today, using “best practices” borrowed from the airline industry, the operating team is required to go through a check-list of at least 7 different patient safety parameters before the surgeon may begin the actual operation. In this particular surgery research study, the authors have sought to learn whether or not a brief period of simulated surgical maneuvers, when performed just prior to the actual operation, can improve a surgeon’s performance during surgery.

Much as professional athletes warm-up before the big game, and practice key skills before facing their opponents on the court or field, the researchers conducting this study hypothesized that a brief period of “preoperative warm-up” exercises, before the big operation, might improve the surgeon’s dexterity and precision during the course of the actual operation. The “warm-up” exercises consisted of simulated laparoscopic surgery procedures whereby surgeons transferred small objects from one place to another while watching a television monitor. A particularly fascinating aspect of this study was the inclusion of surgeons who had been up all night on call, in an effort to determine whether or not “warm-up” exercises can reduce the decrease in cognitive and motor skills that is known to occur in fatigued surgeons.

In this prospective surgery research study, 15 to 20 minutes of simulated practice with simple laparoscopic surgical maneuvers, prior to performing surgery, resulted in significant improvements in performance during the conduct of surgical operations on live patients. Moreover, significant improvements were noted among both very junior and very senior surgeons following completion of these “warm-up” exercises. Interestingly, the performance of surgeons who had been up all night while on call was also significantly improved after performing these “warm-up” exercises. However, although their surgical skills were improved, the “warm-up” exercises still could not restore these surgeons’ skills to the levels that they had demonstrated before starting their on-call shifts.

Certainly, both surgeons and their patients should find the results of this innovative little study to be of interest, although its findings are not particularly surprising. Most surgeons already know that, as with most complex psychomotor skills, surgical performance improves with frequent repetition. Indeed, over the course of a long day in the operating room, most of us are probably unconsciously aware that our movements become more precise and more fluid with each successive operation that we perform.


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California


Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net



Dr. Wascher's Biography


Links to Other Health & Wellness Sites
http://doctorwascher.com/


Copyright 2009.
Robert A. Wascher, MD, FACS.
All rights reserved.


Dr. Wascher's Archives:

1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors

Health Report:


Cancer and Vitamins

Teenagers, MySpace and Risky Behaviors

______________________________


"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Last Updated: 01/18/2009

______________________________

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

______________________________


CANCER & VITAMINS

Regular readers of this column already know that the results of recent cancer prevention research studies have been very disappointing with regards to antioxidant vitamins. Earlier, and much lower powered, laboratory and epidemiological research had suggested a role for Vitamin C, Vitamin E and beta-carotene in preventing some types of cancer. However, recent large-scale prospective human clinical trials have not identified any protective role for these vitamins against either cancer or cardiovascular disease. Now, yet another prospective, randomized, placebo-controlled clinical trial adds its weight to other recently published cancer prevention trials and, once again, the study’s outcomes are not favorable.

In this study, just published in the Journal of the National Cancer Institute, 7,627 women were randomly assigned to take daily supplements of Vitamin C, Vitamin E, or beta-carotene, or an identical placebo (sugar pill). In addition to it prospective, randomized, placebo-controlled design, this study is also laudable for its large cohort of patient volunteers, and for its nearly 10-year duration of follow-up.

During the course of this decade-long study, 624 women developed cancer, and 176 died of cancer. At nearly 10 years of average follow-up, there was no statistically significant difference in cancer risk or cancer-associated deaths among women in any vitamin group when compared with the women in the placebo group. Vitamin C, Vitamin E and beta-carotene supplements, taken alone or in combination, did not have any significant effect on the risk of developing cancer, or of dying of cancer, when compared to placebo sugar pills. (There was, however, a non-significant trend towards a decreased incidence of colon cancer in the Vitamin E group, and a non-significant trend towards an increase in lung cancer risk in the beta-carotene group; both of which have been observed in previous studies).


As someone who previously held great hope that antioxidant vitamins and other dietary supplements might reduce the risk of both cancer and cardiovascular disease, I really wish that I could report some positive findings in this area of research. However, increasingly, when subject to the much greater power of “gold standard” prospective, randomized, placebo-controlled clinical research trials, our earlier hypotheses about antioxidant vitamins and cancer prevention simply haven’t held up to this higher level of research scrutiny. (Which makes other scientifically validated lifestyle approaches to cancer prevention all the more important, as I discuss in much greater detail in my forthcoming book, “A Cancer Guide for the Human Race.”)

As the inventory of bottles in my own little plastic tray of vitamins and other supplement continues to shrink in the face of overwhelming research pointing to their lack of benefit, my wife has been able to reclaim more space in her kitchen cabinets, and I have been saving some spare change that I previously spent on Vitamin E, Vitamin C and beta-carotene supplements.



TEENAGERS, MYSPACE & RISKY BEHAVIORS

Okay, so what parent doesn’t already know what their teenager is likely thinking about much of the time? We all know that adolescence is a turbulent, intense, hormone-fuelled period when kids begin to question almost everything that their parents have been telling them; and a time when many teens either fantasize or actually engage in risk-taking behaviors. However, what is different about today’s teens, when compared to my own Baby Boomer generation, is that, through the twin miracles of the Internet and social online networks like MySpace, today’s adolescents can easily tap into a universe of like minds (as well as many nefarious denizens that anonymously lurk everywhere on the Web).

A new clinical study, just published in the journal Archives of Pediatric & Adolescent Medicine, provides some disturbing insight into how teens may be using social networking sites, like MySpace, to reveal behaviors associated with sexual content, substance abuse and violence. In this intriguing study, the researchers analyzed the content of 500 publicly available MySpace profiles of 18 year-old teens in the United States.

Of the 500 MySpace profiles, 54 percent were associated with content specific for risky behaviors. Twenty-four percent of these 18 year-olds referenced risky sexual behaviors in their online profile, 41 percent made references to engaging in illegal substance abuse, and 14 percent alluded to having engaged in violent acts. Not surprisingly, female teens were much less likely to make reference to violent behaviors when compared with males. Teens reporting a non-heterosexual sexual orientation were nearly 5 times more likely to report sexual behaviors when compared to self-reported heterosexual adolescents. Among the 18 year-olds who reported strong religious feelings or who referenced attending church, discussion of sexual behaviors was 68 percent less common when compared to other teens. These religious teens were also 62 percent less likely to report illegal substance abuse, and were 88 percent less likely to report violent behaviors. Likewise, reporting involvement in a sport, or other hobbies, was associated with a significantly lower involvement in risky sexual, substance abuse, and violent behaviors.

While this study undoubtedly suffers from “selection bias,” in that it only analyzed a cross-section of adolescent MySpace profiles that were accessible to the general public, it still provides a fascinating window into the online behavior of American adolescents. (Indeed, one must assume that the prevalence of the self-reporting of risky behaviors by teens who have chosen to keep their profiles confidential is likely to be significantly higher than was identified in this particular study.) Given the unregulated environment of the Internet, I urge all parents to closely monitor the activities of their children online. Stay involved with your teens, and keep the lines of communication open, always.

____________________________

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

____________________________

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Director of Surgical Oncology for the Kaiser Permanente healthcare system in Orange County, California

____________________________

Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net

____________________________

Dr. Wascher's Biography

____________________________

Links to Other Health & Wellness Sites

____________________________

http://doctorwascher.com

______________________

Copyright 2009.

Robert A. Wascher, MD, FACS.

All rights reserved.

_____________________________


Dr. Wascher's Archives:

1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Health Report:

Exercise Reverses Some Effects of
Fatty Meals

Vitamin C and Blood Pressure


"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Last Updated: 01/11/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


EXERCISE REVERSES SOME EFFECTS OF FATTY MEALS

The cells lining the interior of our bodies’ blood vessels do more than just provide a smooth surface over which blood cells can glide without forming dangerous blood clots. These vascular endothelial cells also regulate the tone and diameter of our blood vessels, including the critical vessels that supply blood to the heart, brain, kidneys, and other vital organs. Complex biochemical feedback loops control the synthesis of nitric oxide, and other chemicals, from within the vascular endothelial cells, enabling blood vessels to dilate up when the organs that they serve require additional blood flow. When this “demand-related” dilation of blood vessels is impaired, vital organs, including the heart, can become starved of life-sustaining oxygen due to reduced blood flow (also known as ischemia). In addition to potential ischemia, other adverse physiological effects are also associated with inadequate blood vessel dilation, or vasodilation. These adverse factors include an increase in vascular resistance that can strain the heart, an increased risk of potentially dangerous clots within blood vessels, and increased inflammatory activity that can accelerate atherosclerosis (narrowing of the arteries) and organ damage.

There are multiple known risk factors for decreased vascular endothelial cell function, including elevated cholesterol levels, high blood pressure, obesity, diabetes, smoking, atherosclerosis, and increasing age. Interestingly, merely eating a fatty meal can rapidly induce vascular endothelial cell dysfunction, leading to a decrease in nitric oxide synthesis by these cells. When this happens, arteries become stiff, and can no longer dilate up to provide increased blood flow when required. When coronary arteries are already narrowed and diseased by atherosclerosis, a sudden loss of nitric oxide from endothelial cells can result in a critical lack of blood supply to the heart’s muscle, causing myocardial ischemia, as well as the formation of blood clots within severely narrowed coronary arteries. This, in turn, can result in a complete obstruction of the coronary arteries, causing a heart attack (myocardial infarction). Similar events can occur in the brain, causing a stroke.

It is known that vigorous exercise can improve vascular endothelial cell function, although the precise mechanisms at work are not entirely understood at this time. However, just as regular and vigorous exercise helps to keep our bodies looking and feeling young, overall, so does exercise also appear to keep our blood vessels young, supple, and able to dilate up to provide increased blood flow when required. Now, a newly published study in the Journal of the American College of Cardiology looks at the ability of exercise to prevent vascular endothelial dysfunction following a fatty meal.

In this study, 8 healthy adult males were fed high-fat meals. All patient volunteers underwent vascular testing before and after consuming the high fat meals in order to assess the level of endothelial cell dysfunction in the artery that supplies the arm. The experiment was varied such that each high-fat meal was preceded by either a 16 to 18 hour period of rest, a similar period of moderate-intensity exercise, or by a similar period of high-intensity exercise. The ability of the brachial artery to dilate up under conditions requiring increased blood flow was then measured under each of these three experimental conditions.

Following consumption of a high-fat meal, the brachial arteries of the men who had rested before eating narrowed, on average, by about 10 percent from their pre-meal baseline diameter, confirming the onset of significant endothelial cell and arterial dysfunction. The men who engaged in moderate-intensity exercise prior to their super-sized meals also experienced a 10 percent reduction in the diameter of their brachial arteries after consuming their high-fat meals, just like the men who rested before they ate. However, even these moderate levels of exercise did restore some (but not all) of their arteries’ ability to dilate in response to increased blood flow requirements, whereas there was no return of this flow-mediated vasodilation in the arteries of the men who had rested prior to eating. Among the men who engaged in vigorous, high-intensity exercise prior to chowing down, however, arterial dilation in response to increased blood flow was preserved even after a high-fat meal. This protective effect of high-intensity exercise on vascular endothelial function following a high-fat meal occurred despite laboratory evidence of increased fat and cholesterol levels in the blood of these same men after eating.

While I am certainly not suggesting that it is safe to gorge on high-fat foods as long as you exercise like a maniac before you eat, this clinical study nonetheless suggests that at least one adverse cardiovascular effect acutely associated with eating a fatty meal can be substantially prevented with exercise, but only when that exercise is performed before eating, and at a very high intensity level. On the other hand, this research study cannot provide any reasonable assurance that all of the other adverse and life-threatening health effects of high-fat diets (including cancer) can be prevented by exercising before meals, even if you exercise like crazy!


VITAMIN C AND BLOOD PRESSURE

The past few years have not been very kind to antioxidant vitamins like Vitamin C, Vitamin E, and Vitamin A and its derivatives. Large-scale, high-powered prospective clinical trials have recently dashed prior hopes that these vitamins can significantly reduce the risk of cancer or cardiovascular disease. Despite intriguing results from earlier and much lower powered research studies, we simply have not been able to show that any of these potential health benefits are associated with antioxidant vitamin supplements in humans. However, a new clinical research study in the Nutrition Journal suggests that there may still be some potential long-term cardiovascular health benefit from high Vitamin C levels in the blood.

High blood pressure is generally defined as a systolic blood pressure (the “top number”) greater than or equal to 140 mm Hg, or/and a diastolic blood pressure (the “bottom number”) greater than or equal to 90 mm Hg. As we age, our blood pressure tends to gradually rise, and by the time we reach our 60s, the majority of us will have elevated blood pressure. Hypertension is known as “the silent killer” for good reason, as it can cause gradual, asymptomatic, and irreversible damage to the body’s vital organs, including the heart, brain, and kidneys, if left untreated.

More than 240 African-American and Caucasian women participating in a large prospective study (the National Heart, Lung and Blood Institute Growth and Health Study) were evaluated in this smaller study. All of these women were between 18 and 21 years of age when they enrolled in this large public health study. During their 10th year of participation in this ongoing clinical study, blood levels of Vitamin C were measured in all of these women. Blood pressure readings during the 9th and 10th years of participation were then analyzed as a function of Vitamin C levels in the blood of these 242 patient volunteers. These patient volunteers were then divided into 4 groups, based upon the level of Vitamin C in their blood.

The women in the group with the highest blood levels of Vitamin C had, on average, significantly lower systolic and diastolic blood pressure readings when compared to the women in the group with the lowest Vitamin C levels, even after adjusting for differences between the two groups of women in terms of other hypertension risk factors like race, obesity, dietary intake of fat and salt, and education levels. The average systolic blood pressure among the women with the highest levels of Vitamin C in their blood was almost 5 mm Hg lower than the systolic blood pressure among the women with low Vitamin C levels. Likewise, the average diastolic blood pressure reading among the women with highest Vitamin C levels was 6 mm Hg lower than what was observed among the women with very low Vitamin C levels in their blood.

When blood pressure readings in the 10th year of this study were compared with the blood pressure results from the previous year, higher Vitamin C levels also appeared to be associated with a smaller annual increase in blood pressure when compared with very low Vitamin C levels.

Thus, in this prospective clinical research study, high levels of Vitamin C in the blood appeared to be linked with, on average, lower blood pressure readings and with significantly less increase in blood pressure readings over a period of one year.

While the results of this cohort study are very intriguing there are, as always, a few caveats that must be mentioned. First of all, this study did not link dietary Vitamin C intake with Vitamin C levels in the blood, so it is not possible to know, from this study, if a diet rich in vitamin C (which is rapidly excreted from the body following ingestion) resulted in the higher blood levels of this vitamin that were observed, or if there are other factors, including genetic factors, that determine a person’s average Vitamin C levels in the blood. Similarly, if genetic factors are primarily responsible for the level of Vitamin C in the blood, these same genetic factors could also be affecting blood pressure independent of any direct action by Vitamin C. Also, while this study of young women strongly suggests that high levels of Vitamin C in the blood may decrease the natural rise in blood pressure that occurs with aging, it cannot yet tell us if these favorable changes in blood pressure, presumably due to Vitamin C, will be sustained as these women grow older. This study also cannot tell us whether or not, in the long run, the apparently favorable effects of Vitamin C on blood pressure will actually lead to any clinically significant improvements in health, either.

Given the recent drumbeat of dismal news regarding the antioxidant vitamins and other related dietary supplements, this small study does offer some hope that Vitamin C might still be associated with potential health benefits beyond its primary role in the synthesis of collagen (a critical structural protein found throughout the body). However, it will take many more years before we know whether or not Vitamin C supplementation can truly reduce the inexorable rise in blood pressure that occurs with aging, and if so, whether or not this effect has any clinically meaningful impact on health.


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, widely published author, and the Director of Surgical Oncology for the Kaiser Permanente healthcare system in Orange County, California


Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net


Dr. Wascher's Biography


http://doctorwascher.com


Copyright 2009.
Robert A. Wascher, MD, FACS.
All rights reserved.



Dr. Wascher's Archives:

1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

Health Report


Secondhand Smoke & Heart Attack Risk


Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood



"A critical weekly review of important new research findings for health-conscious readers..."


By, Robert A. Wascher, MD, FACS

Last Updated: 01/04/2009



The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.



SECONDHAND SMOKE & HEART ATTACK RISK

In one of the most important public health research studies published in 2008, the Centers for Disease Control published an update of the Pueblo Heart Study on December 30th. This epidemiological study was performed, prospectively, over a 3-year period between 2002 and 2004 in Pueblo, Colorado. During the second half of this study, Pueblo enacted stringent legislation to eliminate smoking in public places. The incidence of admissions to hospitals for heart attack in the Pueblo area were monitored throughout the course of this study, both before and after the smoking ban was initiated.

Although there is abundant evidence linking chronic smoking with heart and lung disease, and with multiple types of cancer (including lung cancer, the #1 cause of cancer death in the United States, and throughout much of the world), most of these diseases arise after several years of smoking. However, recent research has shown us that many deleterious health effects associated with smoking occur almost instantaneously. These rapid-onset effects of smoking include an increase in blood clot formation (increased coagulability) and a loss in the normal ability of blood vessels to dilate when increased blood flow is required within vital organs, including the heart. Smoking also drives up carbon monoxide levels in the blood, which prevents oxygen-carrying red blood cells from picking up and delivering life-sustaining oxygen. (These adverse health effects are known to occur within 30 minutes of lighting up.) Moreover, these same acute-onset smoking-associated adverse health effects have been documented not only in smokers, but in nonsmoking bystanders who are exposed to secondhand smoke, as well.
There are a couple of factors that make this public health study so powerful, including its prospective design, and the fact that the entire population of the Pueblo area was assessed for changes in the incidence of heart attack following the implementation of a new ban on smoking in public places. Also, the heart attack admission rates for two adjacent communities without public smoking bans, including the much larger Colorado Springs area, added an important set of controls that have not been included in similar previous studies.

In the initial report of the results of this study, in November of 2005, the Pueblo Health Study researchers identified a 27 percent reduction in the number of admissions to Pueblo-area hospitals for heart attack during the second half of the original 3-year study, after the smoking ban had been enacted. (In the 18 months before the smoking ban went into effect, there were 399 heart attack patients admitted. During the second 18 months, there were only 291 heart attack admissions to the same hospitals.) The Centers for Disease Control update extends the initial 3-year results from the Pueblo Heart study through June 2006, thus adding an additional 18 months of follow-up data.

The updated data from this study reveals a striking cumulative reduction in the number of hospital admissions for heart attacks. When compared to the number of heart attack admissions that occurred prior to the enactment of the public smoking ban, there was an incredible 41 percent reduction in such admissions noted during the additional 18 months of follow-up data. Thus, within 3 years of implementing a public smoking ban, the number of heart attacks in Pueblo dropped, amazingly enough, by nearly one-half. At the same time, similar data collected from two surrounding communities without a public smoking ban showed no significant changes in heart attack admissions during the same timeframe.

I should note that, while this study did not separate smokers from nonsmokers, previous studies have shown that susceptible nonsmokers appear to be at an especially high risk of experiencing heart attacks due to exposure to secondhand smoke. (Other less comprehensive studies have also shown, as the Pueblo Heart Study did, that smoking bans quickly result in rapid declines in heart attack admissions.)

As with previous and similar studies, the beneficial effects of public smoking bans appear to be related to at least two factors. First, nonsmokers are spared exposure to the acutely toxic cardiovascular and lung effects of secondhand smoke. Secondly, strict public smoking bans have been shown not only to decrease smoking behaviors among smokers, but to also improve quitting rates among smokers.

While the Pueblo Heart Study is subject to the same limitations as other so-called observational studies, and other undetected factors may have also, therefore, contributed to the dramatic decline in heart attacks after the smoking ban was implemented, this study joins 8 previous and similar studies that also identified a significant reduction in heart attacks after public smoking bans were enacted. Taken together, these 9 studies strongly suggest that the dangers of secondhand smoke may be far greater than public health experts have previously believed. (According to the Centers for Disease Control, exposure to secondhand smoker causes at least 46,000 deaths due to heart disease every year, as well as 3,000 or more lung cancer deaths among nonsmokers each year.)

Based upon more than five decades of scientific data linking tobacco smoke with cancer, chronic lung disease, and cardiovascular disease, it still amazes me that there are so many communities that still permit smoking in public places, or that have enacted hopelessly anemic limitations on the ability of smokers to subject the 80 percent of the U.S. population that does not smoke to highly toxic secondhand tobacco smoke. An estimated 500,000 people die every year in the United States, alone, from completely preventable tobacco-associated diseases. This updated data from the Pueblo Heart Study should galvanize public health advocates and agencies, and government leaders, to better protect the public from unwanted exposure to tobacco smoke.



POOR PHYSICAL FITNESS DURING CHILDHOOD & HEART DISEASE RISK DURING ADULTHOOD

interesting very long-term prospective clinical study from Norway has been following more than 1,000 volunteers who first entered the study, in 1979, as children (the Oslo Youth Study). In this study, which has just been published in the journal Pediatrics, all of the study’s volunteers were assessed for cardiovascular disease factors upon entering into the study at an average age of 13 years. Subsequently, the volunteers were reassessed at an average age of 15, 25, 33 and 44 years. The findings of this study are rather intriguing given the worsening epidemic of decreased physical activity and obesity among children in many countries throughout the world, including the United States.

Early on in this study, lower levels of physical fitness among the child volunteers were associated with an increased likelihood of obesity and increased blood pressure, which are known cardiovascular disease risk factors. However, as the children matured into adults, the impact of their previous childhood physical fitness levels upon known cardiovascular disease factors diminished with advancing age. By age 40, there was no longer any correlation between the level of physical fitness and physical activity that was present at 13 years of age and the presence or absence of cardiovascular disease factors in adulthood.

I do not want to send the wrong message here by quoting the results of this epidemiological study, but I do believe that there is a positive message here as long as one does not over-interpret the results of this research study (as with all observational studies, there are many potential sources of bias that can skew either the results of such studies, or the interpretation of their results). There is no question but that physically inactive children are at increased risk of becoming obese, or that obese children have a higher risk of the same diseases that plague obese adults. (These obesity-associated illnesses include arthritis, high blood pressure, lung disease, cardiovascular disease, diabetes, and cancer.) But what this study seems to suggest is that adverse cardiovascular risk factors associated with poor levels of physical fitness during childhood can be reversed by middle age. While this study leaves many unanswered questions, it does offer some reassurance that physically inactive and unfit children can still grow into otherwise healthy adults, presumably because they adopt healthier lifestyles that, over time, nullify the effects of childhood physical inactivity, including childhood obesity and hypertension.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.


Dr. Wascher is an oncologic surgeon, professor of surgery, widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html


Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net



Dr. Wascher's Biography


http://doctorwascher.com



Copyright 2009. Robert A. Wascher, MD. All rights reserved.




Dr. Wascher's Archives:

12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome

12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008: Smoking & Quality of Life

10-19-2008: Agent Orange & Prostate Cancer

10-12-2008: Pomegranate Juice & Prostate Cancer

10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity

3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?

2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality

12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer