Cachexia

Cachexia means "poor condition" in Greek. Cachexia has been defined as a syndrome characterised by progressive loss of lean tissue and body fat. Losses are often in excess to that explained by the associated anorexia. Cachexia occurs with various diseases, especially those that are chronic and debilitating. Diseases commonly associated with cachexia are cancer, AIDS, congestive heart failure, COPD and chronic inflammatory rheumatological diseases (e.g. rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, polymyositis, etc).

Weight loss in cancer cachexia is different to weight loss in simple starvation , due to accelerated loss of muscle compared with fat tissue, presence of proinflammatory cytokines and prolonged acute phase protein response that contributes to increased resting energy expenditure and weight loss. Patients with cancer cachexia experience anorexia, early satiety, weakness, sarcopenia, fatigue, anaemia and severe weight loss.

There are no definitive methods for diagnosis of cancer cachexia. Clinical signs of anorexia and weight loss =5% in 6 months would be expected but clinical judgement is required.

Treatment of cachexia should be directed towards:

Treatment of underlying disease Controlling the symptoms of cachexia

Controlling the symptoms of cachexia

Several treatment options have been outlined to treat cachexia. The principle is to improve the nutrition of the patients and to suppress the inflammatory response that is eating up the body's energy. These include:

Feeding the patient with high calorie food Drugs to stimulate the appetite Drugs to stimulate the body to build up more muscle mass

It has been proposed that eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, may reduce the production of proinflammatory cytokines and thus may improve energy and protein intake, performance status and quality of life in cancer patients with cachexia. This may be taken as fish oil capsules or commercial nutrition supplements. However, the results of studies into the effects of EPA have been inconsistent. Your dietitian can provide more information about the dietary management of cancer cachexia.

Article kindly reviewed by:

The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

Kotler D. Review: Cachexia. Ann Intern Med. 2000;133:622-634.Dietitians Association of Australia. 2005. Evidence Based Practice Guidelines for Nutritional Management of Cancer Cachexia.

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Flatulence (gas)

Flatulence refers to the passage of gastrointestinal gas (flatus) under pressure via the rectum and anus (back passage). In colloquial terms this is referred to as 'farting.' Excess gastrointestinal gas is most commonly caused by air-swallowing (aerophagia) which occurs in patients who ingest food too quickly or are overly anxious. Rarely flatulence may be secondary to a serious underlying gastrointestinal disorder so it is worth having this symptom investigated by a doctor. In addition, flatulence can be a potentially embarrassing disorder and be quite socially disabling for patients. Management concentrates on lifestyle measures as drug treatments have shown little benefit to date.

Flatulence is the release of a mixture of gases (flatus) from the rectum under pressure. Flatus consists of methane, nitrogen, hydrogen and carbon dioxide gases and is often accompanied by a sound and smell. The ratio of the constituent gases varies depending on your diet which subsequently alters the odour of the flatus. Normally flatus is passed 10-20 times per day, equating to 400-1300 mL of gas passed via the rectum. However, the normal amounts of flatus varies largely between people so it is more important to take note of changes in the amount and other associated symptoms such as belching (which is the passage of gastrointestinal gas via the mouth, commonly referred to as 'burping') and abdominal bloating.

You may therefore notice you have flatulence due to the following symptoms:

Passing wind often Smelly flatus Loud flatus Abdominal distension and discomfort Rumblings in the lower abdomen.

Production of intestinal gas is a normal part of the digestive process caused by reactions of enzymes and the breakdown of food by bacteria. Normally most of this gas produced will be reabsorbed and enter the bloodstream. However, if a large amount is produced it will remain in the intestines and travel along to be later expelled. The following conditions may lead to an increase in gas expulsion:

Your doctor will take a thorough history to determine the likely cause of your symptoms. This will include questions such as:

What is your diet like? Any recent changes to your diet (particularly an increase in fibre)? How fast do you normally eat, chew and swallow your food? How severe are your symptoms? Do they impact on your daily life? Does your gas seem to be related to eating milk products or other specific foods? Are you taking any current medications? Do you have other symptoms?

Following this your doctor will carefully exmine you focussing on the abdomen for any signs of abnromality. Occasionally further tests may be ordered such as endoscopy (can help find ulcers or reflux), blood tests, sigmoidoscopy or colonoscopy, barium enema and so on, to identify possible causes.

Management of excessive gas can be quite difficult and does not always work in all patients. You can help relieve this symptom by adopting the following lifestyle measures:

Eat more slowly. Chew your food thoroughly. Relax whilst you eat. Avoid carbonated drinks and chewing gum. Limit foods associated with large amounts of flatus such as legumes, beans, lentils, raisins, foods high in insoluble fibre, artificial sweeteners and vegetables of the cabbage family. Quit smoking. Reduce milk consumption if lactose intolerance has been identified as the problem. Add probiotics (such as yoghurt) to your diet to replenish the normal good bacteria in the bowel.Relaxation techniques have been shown to be helpful. Unfortunately the medical treatments currently available such as simethicone, antacids, activated charcoal and beano have failed to produce favourable results. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001. Price KR, Lewis J, Wyatt GM, Fenwick GR. Flatulence - causes, relation to diet and remedies. Molecular Nutrition and Food Research. 2006; 32(6): 609-26.Kumar, Clark. Clinical Medicine. 5th Edition. Saunders. 2002. Longmore, Wilkinson, Rajagopalan. Oxford Handbook of Clinical Medicine. 6th Edition. Oxford University Press. 2004. Medline Plus- Medical Encyclopedia. Gas- Flatulence. US National Library of Medicine, 2004. Available [online] at URL: http://www.nlm.nih.gov/medlineplus/ency/article/003124.htm Szarka L, Levitt M. Belching, bloating and flatulence. American College of Gastroenterology. 2006. Available [online] at URL: http://www.acg.gi.org/patients/gihealth/belching.asp

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Abdominal Bloating

 

Abdominal bloating is felt by patients as a feeling of fullness, tightness or distension in the abdomen. Bloating is different to abdominal swelling, where the abdomen is actually increased in size, although both of these features may be present. 

Abdominal bloating is quite common and in the majority of cases will not be caused by anything serious. Excessive gas due to dietary factors, irritable bowel syndrome (IBS) or difficulty absorbing certain foods are amongst the most common causes. If your abdominal bloating is prolonged, severe, or if you have other worrying symptoms (e.g. diarrhoea, constipation, weight loss or bleeding) it is extrememly important you see your doctor so they can exclude serious conditions (e.g. cancer).

Abdominal bloating refers to a sensation of fullness or a sense of abdominal enlargement. It is often due to disturbance in the normal function of the gastrointestinal tract, causing an increase in intestinal gas.

Gas in the intestine is a mixture of numerous different components which can be increased by swallowing too much air, excess production, or impaired absorption due to obstruction. Excess gas causes bloating as well as other gas symptoms such as flatulence or burping.

If the abdomen is visibly distended in association with bloating, it is more likely that there is an organic, rather than functional, cause of the symptom. Bloating is frequently associated with abdominal pain that may be relieved by passing gas or bowel motions.

Abdominal bloating may be a feature of a number of disorders, the majority of which are not serious and result from changes in gastrointestinal function. Possible common causes are:

Diet

Your body takes a long time to break down and expel fat from the body. Too much fat in your diet can cause episodes of bloating. Other foods can cause bloating due to the formation of extra gas. These foods include cabbage, cauliflower, baked beans and salads.

Malabsorption syndromes

A number of disorders exist where the body cannot break down and absorb certain components of food. In these cases, the remaining food products can produce extra gas due to certain chemical reactions, or due to the good bacteria in the bowel trying extra hard to break these foods down. Lactose intolerance, coeliac disease and other food intolerances are examples of disorders that cause bloating by these mechanisms.

Air swallowing

If you swallow large amounts of air, your bowel has trouble absorbing or removing it all from the body fast enough. This means more will stay within the bowel lumen and cause the sensation of a full bowel. Anxiety or nervousness, eating quickly, gulping food or beverages, drinking through straws and chewing gum can all cause you to swallow increased amounts of air.

Irritable bowel syndrome 

Irritable bowel syndrome is a common disorder where patients have alternating episodes of constipation and diarrhoea. Abdominal bloating is one of the key features of this diagnosis.

Partial bowel obstruction

A blockage at some point in the intestines will impair the mechanical transit of food and may lead to bloating.

Constipation

Constipation is characterised by a reduction in the frequency of bowel motions, and may cause bloating.

Menstruation

Bloating is common in women at the time of menstruation, or as part of a premenstrual stress disorder.

Other causes

Very rarely, your bloating may be due to a more serious condition, so it often pays to discuss your symptoms with a doctor. The following conditions are less common but don't want to be missed:

Ascites: Sometimes you may feel bloated due to the accumulation of fluid within the abdominal cavity, called ascites. This is often the result of liver disease. Tumours: Very occasionally, you may feel bloated because there is a tumour present within your abdomen, of the ovaries, liver, stomach or elsewhere. The present of a lump or swelling should alert you to the possibility of a tumour or cancer. Infection: Certain parasitic disorders can cause abnormal dilatations of the colon (megacolon) associated with symptoms of bloating.

If you experience abdominal bloating, it is important to see your doctor to make sure there is nothing serious present. In particular, if you have symptoms of diarrhoea, constipation, weight loss or bleeding from anywhere in the gastrointestinal tract (vomiting blood or bloody or dark stools), there is a greater possibility that something more serious is present rather than just a functional problem.

When you see your doctor, you should be prepared to answer detailed questions about:

Duration of the bloatingYour dietThe relationship of the bloating to certain foodsIf you're a female, any change in bloating during the menstrual cycleAny other associated symptomsAny past medical historyCurrent medications

Your doctor will then examine you, paying particular attention to palpating your abdomen for any masses or swelling. Your doctor will also tap your belly to identify any fluid present. Listening to bowel sounds can help your doctor determine if there is an obstruction. The doctor may perform a rectal examination if you have other bowel symptoms.

If your bloating is due to a functional problem, such as an inability to tolerate dairy products or wheat, examination is likely to be normal. Your doctor may suggest trials of certain diets to determine if it is a particular food triggering your symptoms.

Investigations are needed in some patients, particularly when the other serious symptoms are present. Your doctor may refer you for the following:

Radiography: Plain x-rays of your abdomen can tell if it is blocked in certain places. Ultrasound or CT scans: May be done if the doctor suspects ascites (fluids) or a mass. Colonoscopy: Involves inserting a long tube (with a light and a camera on the end of it) into the rectum (back passage). The doctor can then look at the inside of the bowels to make sure there are no tumours (e.g. colon cancer). Barium enema  

If a specific cause is suggested (e.g. lactose intolerance), special trial diets or further diagnostic testing (e.g. lactose tolerance test) may be required. Coeliac disease may be diagnosed by a series of blood tests looking for certain antibodies.

The treatment of bloating mainly depends on the underlying cause of the symptom. Your doctor would have performed a number of necessary tests to exclude serious problems. Treatment then focuses on a number of diet and lifestyle changes:

Avoid carbonated beverages. Avoid chewing gum as this predisposes to air swallowing. Avoid foods that are difficult to digest or that cause increased amounts of gas (e.g. brussel sprouts, cabbage, beans and lentils). Be careful of your sources of fibre. Patients with IBS often need increased amounts of fibre to relieve their symptoms, however, some types of fibre such as psyllium (in Metamucil) can exacerbate bloating. You should discuss your choice of fibre supplements with a pharmacist. Eat small, frequent meals at a reasonable pace (slowly). Drinking fennel tea may help your symptoms.

In some patients, over-the-counter medications such as simethicone, beano and activated charcoal can help gas symptoms. Your doctor may suggest a trial of some of these, but unfortunately they have only modest benefits and do not work in all patients.

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition. 

Abraczinskas D, Goldfinger SE. Intestinal gas and bloating [online]. Waltham, MA: UpToDate; 2006 [cited 25 July 2006]. Available from: URL link Glickman R. Abdominal swelling and ascites. In: Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (16th edition). New York: McGraw-Hill Publishing; 2006. [Book]Lehrer JK, Lichtenstein GR. Irritable bowel syndrome [online]. Omaha, NE: WebMD eMedicine; 2005 [cited 25 July 2006]. Available from: URL linkLongmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Book]Abdominal bloating [online]. Bethesda, MD: National Institutes of Health Medline Plus; 2004 [cited 25 July 2006]. Available from: URL link Szarka L, Levitt M. Belching, bloating and flatulence [online]. Bethesda, MD: American College of Gastroenterology; 2006 [cited 25 July 2006]. Available from: URL link

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Food: Basics of What We Need to Eat

Something that we all do every day is eat. But eating can get complicated – there is a lot of variety and choice, and a lot of contradictory advice on what's best for us. Dr Joe Kosterich explains the basics of what we need to eat.

Something that we all do every day is eat. It’s pretty basic stuff, and yet surprisingly it’s become quite difficult for a lot of people. In some respects there is a lot of choice, and there is a lot of contradictory and confusing information out there as to what is the best to eat. One week they tell you to eat these foods because they are really good for you, and the next week somebody tells you that these foods have been linked with cancer. Alright, so in this video let’s make it really, really simple.

The three main food groups

Firstly, there are the three main food groups: proteins, fats, and carbohydrates. You need all of them, and you need them in the right proportions. The simplest way to think about protein is that it moves around. That means things like meat, fish, and chicken. There are also vegetable sources of protein; obviously they don’t move around, things like lentils, chick peas, legumes, quinoa, and soy are vegetable sources of protein. But, the simplest way to think about protein is that it moves around, and proteins are the building blocks of the body. Carbohydrates give you energy; they basically grow in the ground. So, obviously, your fruits, vegetables, nuts, and seeds are carbohydrates. There are good and bad carbohydrates, and we’ll touch on that briefly. Your good carbohydrates are your unprocessed carbohydrates, things like fruits, vegetables, nuts, seeds, and whole grains. Your bad carbohydrates are the very refined sugars, a lot of processed food, white sugars, and some of the white flour-based products. Your fats are good and bad. The good fats are the omega-3s and the omega-6s, and these are essential, you do actually need them, the body can’t make them. Flaxseed oil and olive oil are reasonable sources, and of course oily fish, things like salmon, tuna, mackerel, and sardines are excellent sources of your omega-3s. Now, your bad fats are your saturated fats, and in particular the trans fats.  Always read the labels because the worst sorts of fats are, in fact, the trans fats, and these are brought about often through manufacturing-type processes. Always have a quick look at the label as to what sorts of fats are in the foods that you’re buying.

The right proportions

How much of each should we have? Again, it’s going to depend a little bit on individuals and circumstances. Protein, generally somewhere between 10% and 35%, so about a quarter of your calories per day; your fats, somewhere between 15% and 25% of your total calories; carbohydrates roughly make up the rest.

Buying the right foods

So, in thinking about your shopping, there are a couple of simple things to keep in mind. When you’re going out and buying food for the week, buy food that if you don’t eat it this week, might have to be thrown out next week. Now, that immediately knocks out a lot of things in boxes and packages that have a use by date of one or two years down the track. Buy foods that until fairly recently were either moving around, or growing in the ground somewhere. So again, that’s your fresh fruits, vegetables, nuts, and seeds. For those who are non-vegetarian, obviously animal sources such as your meat, fish, and poultry. Again, all of these foods are going to need to be thrown out fairly quickly, unless you eat them by next week, where as you can keep processed and packaged foods for a year, maybe two years. Again, don’t get too fancy as to whether you buy beef or pork, or chicken or turkey; that is all going to be personal taste and preference. So, focus on the big picture.

To summarize, you want the three main food groups in your diet: proteins, good carbohydrates, and good fats. You want foods that are fairly fresh, foods that until fairly recently were moving around, or growing somewhere. You want foods that, by and large, if you don’t eat them fairly quickly, are going to go off, and you’re going to have to throw them out, that you can’t put on the shelf till next year or the year after. Follow these broad, brushstroke guidelines (nutritional), and you’ll do pretty well with your diet.

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Blood Pressure Calculator

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For more information on blood, blood types, blood tests, and blood donation and transfusion, see Blood.

For more information on high blood pressure, including investigations and treatments, as well as some useful animations, videos and tools, see Hypertension (High Blood Pressure).  

Created: 24/2/2010


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Treating Chronic Non-Cancer Pain

Chronic pain can be a difficult medical problem for both doctors and patients. Often, there is no one diagnosis that can account for the pain, and the treatment is often complicated, long term, and sometimes unsatisfactory. This page will deal with chronic non-cancer pain, and is broken into sections detailing:

Chronic pain is defined as pain that is present for more than three months, or for four weeks longer than would be expected as part of a normal recovery. The management of chronic pain can be difficult for both patients and doctors because it is often difficult to find an exact cause that can be treated leading to frustration from both groups.

While you may think that all pain is the same, the anatomy and physiology of pain is actually very complex and there are two major groups of pain that feel quite different. The pain we are most familiar with is called 'nociceptive' or 'somatic' pain, and is due to activation of pain receptors due to real or perceived injury. This is usually quite localised, constant or worse with movement, and of an aching or throbbing quality.

The other type of pain is called 'neuropathic' pain and is due to damage to the nerves that sense pain, or even the part of the brain that deals with pain. It often follows an injury, but not always, and feels different to somatic pain. Neuropathic pain typically occurs in certain patterns and is often described as being a 'burning' pain, or even like electric shocks are being sent to the area. This can be accompanied by changes in the sensation of the area supplied by the nerve.

Before a doctor can treat someone for chronic pain, it is important that they ask a few questions so that they can work out the best course of treatment. Some of the things they may try to find out are:

That pain is the primary problemWhat 'type' of pain is it, how bad is it, and what are the symptoms of the pain?What is causing the pain?How is the pain impacting your life?Is there anything else that is making the pain worse?

After this assessment has been made, then the doctor might set some 'goals' for your treatment, that you should feel are significant but achievable. These will depend on just how bad your pain is. For example, in some cases being able to sleep through the night or walk to the shops may be the 'goals' as these will greatly improve the quality of life of the person with chronic pain. Your GP may also decide to send you to another health professional to help out with your treatment and there are numerous different people who can help with the care of someone with chronic pain. Rheumatologists (joint doctors), physiotherapists, occupational therapists and specialised pain doctors can sometimes be a great help in dealing with chronic pain.

Once a full assessment has been made, then the first step is to try and make some changes to your lifestyle that are easy to do, will also improve other aspects of your health, and can greatly reduce pain:

Weight Reduction: Reducing weight can greatly reduce the pressures exerted on joints, and thus lessen the pain that is associated with movement.Exercise: an exercise program should be included in the treatment plan of all people suffering from chronic pain. Obviously, the plan must be individualised taking into account what each individual is capable of.Cognitive-Behavioural Therapy: CBT can be a great asset in the treatment of chronic pain, improving their feeling of well-being, reducing pain scores and allowing for an improved quality of life.Mindfulness and other relaxation therapies can also be of some benefit, helping to focus patient's minds on things other than their pain and thus allowing an improved quality of life.Paracetamol: Paracetamol is a good first choice in the treatment of chronic pain, as it is very safe and also very effective for the relief of mild to moderate pain.Non-steroidal anti-Inflammatory agents: NSAIDs can be highly effective in the treatment of chronic pain, especially if there is an inflammatory character. While there is a risk of adverse effects when used for a long period of time, most notably bleeding from a stomach ulcer, this can be reduced with the use of other 'selective' NSAIDs (e.g. Celebrex) that cause less of this problem.Opiods: If the chronic pain persists, or is increasing, then in addition to the non-opioid agents, an opioid regimen with a medication such as codeine, oxycodone or tramadol should be started. If these agents are also ineffective at relieving the chronic pain and it is of a moderate to severe severity, then agents such as systemic morphine, hydromorphone, fentanyl (e.g. Durogesic) or methadone can be used.Tricyclic antidepressants: TCAs such as amitryptyline (Endep) have been shown to be useful in treating neuropathic chronic pain. While people are unsure as to how they actually work, it does more than just improve depression as the pain relief requires a much lower dose, and starts long before it helps with depression. They are also sometimes used to increase the effectiveness of opioid agents like those described above. Anticonvulsants and antiarrhythmics: these are usually used for conditions like epilepsy, but have also been shown to reduce neuropathic pain. Pregabalin (Lyrica), gabapentin and carbamazepine are all used for their membrane stabilizing properties and have been shown to be effective in neuropathic pain. Gabapentin is less likely to be effective when there is no objective finding of nerve injury. Lignocaine Patches: Lignocaine 5% patches have been shown to be effective in the treatment of neuropathic pain, presumably due to their membrane stabilising actions.

Beyond the medications mentioned above, there are also more invasive options available for those suffering from chronic pain:

Corticosteroid Injections: given into the site of the pain, especially joints, can be very useful, and give rapid and reasonably long-term relief for those suffering chronic pain.Nerve Blocks: this involves the injection of an anaesthetic agent directly into the site of the pain, into the nerve supplying the painful area, or centrally into the spinal cord. Catheters can be inserted into the epidural or subarachnoid spaces, providing excellent pain relief.Neurostimulation: This involves the placement of electrodes around areas of the nervous system that are responsible for the painful stimulus. These electrodes can be placed in the spinal cord, on a peripheral nerve, or even into the brain.Spinal Cord Stimulation: Like neurostimulation, this involves the strategic placement of electrodes into the spinal cord, which artificially stimulate the nerves to the painful area. This usually involves the placement of a spinal cord stimulation device which come in various forms.Brunton, S. Approach to assessment and diagnosis of chronic pain. The Journal of Family Practice, 2004; 53(10 supp): S3-S10.Colvin L, Forbes K, Fallon M. Difficult Pain. BMJ, 2006; 332:1081-1083Fields H, Martin J. Pain: Pathophysiology and Management. Harrison's Principles of Internal Medicine. McGraw-Hill, London, 2007.McCarberg, B. Contemporary management of chronic pain disorders. The Journal of Family Practice, 2004; 53(10 supp): pS11-S22.Murtagh, J. General Practice (Third Edition). McGraw-Hill, Sydney, 2005.

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Happy marriage adds pounds

Findings challenge the notion that quality relationships always benefit health, indicating that satisfied spouses gain weight over time because they may be less motivated to attract an alternative mate.

On average, young newlyweds who are satisfied with their marriage gain weight in the early years after they exchange vows, putting them at increased risk for various health problems related to being overweight.

That is the finding of a new study on marital satisfaction and weight gain, according to psychologist Andrea L. Meltzer, lead researcher and an assistant professor in the Department of Psychology at Southern Methodist University in Dallas.

“On average, spouses who were more satisfied with their marriage were less likely to consider leaving their marriage, and they gained more weight over time,” Meltzer said. “In contrast, couples who were less satisfied in their relationship tended to gain less weight over time.”

The study’s researchers said the findings challenge the long-held notion that quality relationships are always beneficial to one’s health. Instead, they said, the findings suggest that spouses who are satisfied in the marriage are less motivated to attract an alternative mate. As a result, satisfied spouses relax efforts to maintain their weight.

The article is published online in the scientific journal Health Psychology.

The study was based on data from 169 first-married newlywed couples whose marital satisfaction and weight were tracked over the course of four years.

Previous psychological research has established that marriage is associated with weight gain and that divorce is associated with weight loss. But the role of marital satisfaction in those changes in weight is less clear, Meltzer said.

Previous research also has demonstrated that marital satisfaction is associated with health maintenance behaviours, she said.

“For example, studies have found that satisfied couples are more likely to take medications on time and schedule annual physicals,” Meltzer said. “Yet the role of marital satisfaction and actual health is less clear.”

Meltzer set out to examine the association between marital satisfaction and changes in weight over time.

For four years, the newlyweds reported twice a year on their marital satisfaction and steps toward divorce. They also reported their height and weight, which was used to calculate their body mass indices.

Spouses who were less happy in their marriage were more likely to consider leaving their partner, Meltzer said, and on average gained less weight over time.

“So these findings suggest that people perhaps are thinking about their weight in terms of appearance rather than health,” she said.

The study suggests young couples should be educated and encouraged to think about their weight as a factor of maintaining their health.

“We know that weight gain can be associated with a variety of negative health consequences, for example diabetes and cardiovascular disease,” Meltzer said. “By focusing more on weight in terms of health implications as opposed to appearance implications, satisfied couples may be able to avoid potentially unhealthy weight gain over time in their marriages.”

(Source: SMU: Health Psychology)

Article Date: 17/4/2013

View the original article here

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Major weight loss tied to microbes

Scientists at Harvard may have new hope for people struggling with obesity.

A study conducted in collaboration with researchers at Harvard-affiliated Massachusetts General Hospital hints at a future where doctors could deliver the weight-loss benefits of gastric bypass surgery without the surgery. In a study described in a 27 March paper in Science Translational Medicine, researchers found that the surgery caused drastic changes to microbes in the guts of mice. When those microbes were transferred into the guts of sterile mice, the result was rapid weight loss.

"Simply by colonising mice with the altered microbial community, the mice were able to maintain a lower body fat, and lose weight — about 20 percent as much as they would if they underwent surgery," said Peter Turnbaugh, a Bauer Fellow at the Faculty of Arts and Sciences' Center for Systems Biology, and one of two senior authors of the paper.

As striking as the results were, they weren't as dramatic as they might have been.

"In some ways we were biasing the results against weight loss," Turnbaugh said, explaining that the mice used in the study hadn't been given a high-fat, high-sugar diet to increase their weight beforehand. "The question is whether we might have seen a stronger effect if they were on a different diet."

"Our study suggests that the specific effects of gastric bypass on the microbiota contribute to its ability to cause weight loss, and that finding ways to manipulate microbial populations to mimic those effects could become a valuable new tool to address obesity," said the other senior author, Lee Kaplan, director of the Obesity, Metabolism & Nutrition Institute at MGH.

"We need to learn a good deal more about the mechanisms by which a microbial population changed by gastric bypass exerts its effects, and then we need to learn if we can produce these effects — either the microbial changes or the associated metabolic changes — without surgery," added Kaplan, an associate professor of medicine at Harvard Medical School. "The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity, one that could help patients unable or unwilling to have surgery."

Turnbaugh warned that it could be years before the research contributes to treatment, and that any procedure tied to it would likely not be for someone looking to lose those stubborn last 10 pounds. Rather, the technique may one day help dangerously obese people who want to lose weight without the trauma of surgery.

"It may not be that we will have a magic pill that will work for everyone who's slightly overweight," he said. "But if we can, at a minimum, provide some alternative to gastric bypass surgery that produces similar effects, it would be a major advance."

While there had been hints that the microbes in the gut might change after bypass surgery, the speed and extent of the change came as a surprise.

In earlier experiments, researchers had shown that the guts of both lean and obese mice were populated by varying amounts of two types of bacteria — firmicutes and bacteroidetes. When mice undergo gastric bypass surgery, however, it "resets the whole picture," Turnbaugh said.

"The post-bypass community was dominated by proteobacteria and verrucomicrobia, and had relatively low levels of firmicutes," he said. What's more, Turnbaugh said, those changes occurred within a week of the surgery, and were lasting — the altered gut microbial community remained stable for months afterward.

There is plenty left to uncover about what exactly is driving the weight loss in mice, the researchers said.

"A major gap in our knowledge is the underlying mechanism linking microbes to weight loss," Turnbaugh said. "There were certain microbes that we found at higher abundance after surgery, so we think those are good targets for beginning to understand what's taking place."

In fact, he said, the answer may not be the specific types of microbes, but a by-product they excrete.

In addition to changes in the microbes found in the gut, researchers found changes in the concentration of certain short-chain fatty acids. Other studies have suggested that those molecules may be critical in signaling to the host to speed up metabolism.

"To some degree, what we're learning is a comfort for people who have an issue with their weight, because more and more we're learning that the story is more complicated than just how much you exercise and how much you eat," Kaplan said.

(Source: Harvard University : Science Translational Medicine)

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.
Article Date: 12/4/2013

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7 Breakfasts Under 500 Calories

At only 70 calories, an egg is a great way to get lean protein into breakfasts under 500 calories.

Image: Clipart.com Listen up breakfast skippers -- it's time to start eating that all-important morning meal. Get your day off to a great start with these ideas for breakfasts under 500 calories.

PB and Apple
Natural peanut butter, 1 Tbsp.
Whole-wheat English muffin
Apple, 1
1% milk, 1 c.
416 calories

Waffle and Yogurt
Whole-grain waffles, 2
Light syrup, 1 Tbsp.
Light vanilla yogurt, 6 oz.
Banana, 1, small
414 calories

Starbucks
Fruit, Yogurt & Granola Parfait
Nonfat cappuccino, tall
400 calories

Jamba Juice
Bright Eyed & Blueberry yogurt blend smoothie
380 calories

Oatmeal with Cherries
Oatmeal, 1 c.
Dried tart cherries, ¼ c.
Brown sugar, 1 tsp.
Cinammon, dash
1% milk, 1 c.
371 calories

McDonald’s
Fruit and yogurt parfait
Fruit and walnut salad, snack size
370 calories

Bagel Breakfast
Whole-wheat mini bagels, 2
Whipped cream cheese, 2 tsp.
Egg, 1, hard-boiled
Orange, 1
369 calories

Brown Betty for Breakfast
Apple, cored and sliced, microwaved for three minutes and topped with:
Raisins, 1 Tbsp.
Almonds, chopped, 1 Tbsp.
Walnuts, chopped, 1 Tbsp.
Light vanilla yogurt, 8 oz.
362 calories

Did you know? You can plan your own calorie-controlled breakfasts using the simple, free tools at About.com's Calorie Count.

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Emotions and Weight Loss - Get Past Your Barriers

Having trouble losing weight? The solution might not be in the kitchen or the gym, but in your head and in your heart. Emotions and weight loss go hand in hand.

If you simply can't shed the pounds, and you know that there are no medical causes or environmental barriers that are standing in the way, take some time to think about how your feelings might affect your eating habits. Getting past emotional barriers might be the key to your weight loss success.

Stress. There is a good reason that comfort food got its name. For most people, eating feels good. And in times of stress, some people use food as the best way to calm their emotions. While emotional eating doesn't result in weight gain for everyone, it can be a cause of obesity in some.

In a study about the eating and exercise habits of obese mothers, researchers found that stressful experiences triggered overeating and prevented the women from practicing healthier habits. Of course, isolated cases of overeating won't cause long-term weight gain, but researchers in other studies have found that for some people, overeating can become a chronic coping mechanism for managing life's stressors.

Avoiding stress is not always possible. But relaxation techniques can be a healthy alternative for managing emotions during stressful times. In a published study about using relaxation training with obese women, study participants received relaxation techniques under the guidance of a licensed mental health professional. A specific type of relaxation technique, guided imagery, helped them reach weight loss success.

Even if you are not working with a therapist, it's possible to learn guided imagery on your own. It takes some time to master, but guided imagery may be the most effective technique for weight loss if your emotions are causing you to eat during stressful times.

Depression. The link between depression and weight loss is a hazy one, and researchers are not sure of their exact relationship. For example, some studies have found that depression can be a cause of obesity, while others have not.

In a review of obesity literature, one group of researchers identified several ways in which depression may cause obesity. Some commonly prescribed antidepressants can cause weight gain. The researchers also noted that lack of sleep, a common symptom of depression, is also a risk factor for obesity. Inactivity, another common symptom, can spark increased weight.

If you find yourself battling obesity or if you simply can't lose weight, getting screened for depression may be a reasonable step to take. Consider speaking to your primary care physician about getting a referral to a mental health professional. He or she will be able to investigate further and determine whether you have depression and give you reasonable strategies for moving forward.

Personal or Childhood Trauma. Some researchers have found that people who were exposed to physical abuse, sexual abuse or peer bullying are at higher risk for obesity.

According to one published report, researchers speculated that weight gain can be used as an emotionally protective "solution" for survivors of abuse. The study was conducted by a group of California physicians affiliated with the Positive Choice Weight Loss Program in San Diego. The researchers noted that the sexual, physical and social protective benefits of being obese were hard for many non-obese individuals to accept or understand.

If you have experienced emotional trauma, it could be affecting your eating habits and your weight. It might be worth your time to find a behavioral health specialist who is skilled at treating the underlying emotional causes of overeating and weight gain. Your primary-care provider may be able to provide a referral. If not, there are other ways to find a therapist. The American Psychological Association provides resources to help consumers get the help they need, including a locator service to find practitioners in your area.

If you are struggling unsuccessfully to lose weight, there may be more than one factor that is contributing to your battle. Try to consider all of the underlying causes to find out which barriers stand in the way of reaching a healthy weight.

Sources:

António L Palmeira, David A Markland, Marlene N Silva, Teresa L Branco, Sandra C Martins, Cláudia S Minderico, Paulo N Vieira, José T Barata, Sidónio O Serpa, Luis B Sardinha and Pedro J Teixeira. "Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis." International Journal of Behavioral Nutrition and Physical Activity 2009, 6:9 .

Chang MW, Nitzke S, Guilford E, Adair CH, Hazard DL. " Motivators and Barriers to Healthful Eating and Physical Activity among Low-Income Overweight and Obese Mothers." Journal of the American Dietetic Association 2008 Jun;108(6):1023-8..

Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD. "Overweight, Obesity, and Depression, A Systematic Review and Meta-analysis of Longitudinal Studies" Archives of General Psychiatry 2010;67(3):220-229.

Gian Mauro Manzoni, Francesco Pagnini, Alessandra Gorini, Alessandra Preziosa, Gianluca Castelnuovo, Enrico Molinari, Giuseppe Riva. " Can Relaxation Training Reduce Emotional Eating in Women with Obesity? An Exploratory Study with 3 Months of Follow-Up." Journal of the American Dietetic Association August 2009.

Gregory E. Simon, Evette J. Ludman, Jennifer A. Linde, Belinda H. Operskalski, Laura Ichikawa, Paul Rohde, Emily A. Finch, Robert W. Jeffery. " Association between obesity and depression in middle-aged women." General Hospital PsychiatryJanuary 2008.

Kinzl JF. " Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance." Eating and Weight Disorders 2010 Dec;15(4):e275-80.

M. S. Faith, M. Butryn, T. A. Wadden, A. Fabricatore, A. M. Nguyen, S. B. Heymsfield. " Evidence for prospective associations among depression and obesity in population-based studies." Obesity ReviewsMay 2011.

Sanjay R. Patel and Frank B. Hu. "Short Sleep Duration and Weight Gain: A Systematic Review." Obesity January 2008.

Vincent J Felitti, MD, FACP, Kathy Jakstis, Victoria Pepper, MS, and Albert Ray, MD. " Obesity: Problem, Solution, or Both?" The Permanente Journal 2010 Spring; 14(1): 24-3.

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Mexican Dining "Quick Guide"

Mexican food can be a dieting "do" if you say si to fajitas!

Image: © Jupiterimages Corp. Mexican restaurants offer a variety of diet-friendly menu menu options. Our dining out "Quick Guides" list the best and worst dishes at many different types of restaurants. This guide will help you make healthy choices at Mexican restaurants. gazpachochicken or vegetable fajitasgrilled chicken-based dishes (e.g., arroz con pollo)grilled seafood-based dishes (e.g. camarones de hacha)salsa and picante saucessoft tacos with chicken or beeftamaleschicken flautasfish tacoschile con carne (hold the cheese)pico de gallochipsguacamolenachoschimichangasquesadilliascrunchy tacostaco saladchorizo sausagesour creamsopapillas

To search the nutritional information for many other restaurant foods, visit About.com's Calorie Count.

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Does This Medication Make Me Gain Weight?

(LifeWire) - In addition to poor diet and lack of exercise, one other culprit has been blamed for contributing to obesity: medication. Some of the most widely prescribed drugs in the United States -- for common conditions like diabetes, migraines, high blood pressure, depression and bipolar disorder -- have been found to cause weight gain.

Medications That Can Contribute to Weight Gain

Medication can add pounds to your figure in several ways:

Metabolism changes: Some drugs change the body's metabolism, and calories are burned more slowly.

Corticosteroids: Corticosteroids are known to stimulate appetite while reducing the body's ability to absorb glucose, which can promote fat deposits in the midsection.

Beta-blockers: Beta-blockers can cause shortness of breath and fatigue, making it difficult for patients taking them to exercise.

Calcium channel blockers: Calcium channel blockers taken for high blood pressure can cause users to retain water.

Antipsychotic medications: Drugs used to treat psychiatric conditions and mood disorders, like depression and bipolar disorder, are among those most closely associated with weight gain. It is so common with drugs like Paxil (paroxetine), Zoloft (sertraline), Clozaril (clozapine), Seroquel (quetiapine), Zyprexa (olanzapine) and Risperdal (risperidone) that researchers have called it "an epidemic within an epidemic."

As a result, the FDA has, since 2004, required manufacturers of certain antipsychotic medications to add a warning statement to doctors prescribing these drugs. The warning outlines the increased risk of diabetes and hyperglycemia that can result from use of the drugs.

Side Effects of Weight Gain

How much weight is gained varies from patient to patient and from drug to drug. Some patients may gain a few pounds over the course of a year; others experience weight gains in excess of 100 pounds in a matter of months. Because many of these drugs are taken for chronic conditions, their use over a period of several years can contribute to substantial weight gains patients often experience.

In addition to the emotional and social dimension of weight gain, patients can also experience serious health conditions -- diabetes, high blood pressure, osteoarthritis, metabolic syndrome, high cholesterol -- that are created or made worse by added weight.

Perhaps the most serious result of drug-induced weight gain is that many patients stop taking their medication or decide on their own to switch to a lower dosage. As a result, potentially serious underlying health conditions may go untreated. Lack of compliance with a drug regimen because of weight gain has been cited as a particular problem with patients taking antipsychotic and antidepressant drugs.

Some healthcare providers proactively tell their patients about the potential for weight gain when prescribing certain drugs and advise the patients to moderate their diet and increase their aerobic exercise to offset any weight increases.

Alternative Medications

All patients, regardless of condition, should talk to their healthcare provider before stopping medication or changing doses.

In many cases, your doctor may be able to recommend a drug that works just as well without the added pounds. Or, your doctor may decide to prescribe an additional drug to treat any weight gain you might experience.

Sources:

"2004 Safety Alert: Zyprexa (Olanzapine)." fda.gov. 22 Mar. 2004. Food and Drug Administration. 27 Feb. 2009 .

Deshmukh, Rashmi and Kathleen Franco. "Managing Weight Gain as a Side Effect of Antidepressant Therapy." Cleveland Clinic Journal of Medicine 70:7 (2003): 614-23. 27 Feb. 2009 .

Fenton, Wayne S. and Mark R. Chavez. "Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia." American Journal of Psychiatry 163 (2006): 1697-704. 27 Feb. 2009 .

"Prescription Drugs That Cause Weight Gain." Johns Hopkins Health Alert. Jun. 2008. Johns Hopkins Medicine. 27 Feb. 2009 .

Simpson, MM, et al. "Weight Gain and Antipsychotic Medication: Differences Between Antipsychotic-Free and Treatment Periods." Journal of Clinical Psychiatry 62:9 (2001): 694-700. 27 Feb. 2009 .

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Marc Lallanilla is a New York-based freelance writer and editor. He has written extensively on health, science, the environment, design, architecture, business, lifestyle and travel.

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Is Coconut Oil The Ultimate Fat Burner For Weight Loss?

When I was working in the fitness industry, the amount of people that would ask me about fat burning and fat blocking products was unbelievable (think high caffeine and guarana). They generally speed up your metabolism which will come with longer term side effects. The reason for this is that they elevate your heart rate which will end up raising cortisol levels. If you know anything about cortisol then you will understand that this prompts the body to hang on to body fat (hint: I feel this is why stressed people struggle to loose weight).

WHY COCONUT OIL FOR WEIGHT LOSS?

Without trying to get technical, coconut oil is a saturated fatty acid that is predominately a MCT oil (medium-chain triglycerides). This is very different to most of the vegetable oils on the market today.

The short and medium-chain fatty acids which can be found in coconut oil (and grass-fed butter which I use too), are sent directly to our liver and used directly for energy. So this means:

1. It does not get stored in fat cells as easily as long-chain fatty acids, and produce ketones which gives us a steady source of energy
2. Enhances thermogenesis which increases fat burning
3. Helps eliminate food cravings with increased feelings of satiety

According to Christine Cronau's book the Fat Revolution, there are studies of participants that were fed the same diet which was not designed for weight loss. But some of them were fed medium-chain fatty acids and they lost weight, whilst the weight in the rest of the group remained the same.

It also compared diets with three types of fat intake. Low fat, monounsaturated fat and coconut oil. There was a 60% reduction in fat storage for the groups consuming coconut oil.

SO WHATS THE MAGIC DOSAGE?

If you do not consume many natural fats including coconut oil, start in small amounts or the toilet may come calling. Add a teaspoon to a smoothie, or if a sugar craving comes calling eat a teaspoon straight from the jar as this will kill those cravings. Cook with it or just start adding it to things where you usually wouldn't. I have it in a high fat smoothie most mornings.

I consume up to 3-4 tablespoons of coconut oil a day. But I eat a low-carb and natural high fat diet, especially after getting my DNA results back.

So if you are on a weight loss plan, eliminate sugar, grain, soy and all processed fats & oils. Increase your coconut oil up to 2-4 tablespoons a day for your steady source of energy and over time you will feel the magic happen!

Do you use coconut oil? Are you worried about saturated fat? Are you a weight loss plan but are frightened of fat? Would love to hear your thoughts...

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Evolution Vs Revolution

Weight loss doesn't happen overnight, but the decision to change happens in an instant. It's really no different than any other decision to change. It's more than thinking about it, although that's where it often starts. It's more a decision to commit. Sometimes the decision to change starts off as nothing more than a passing thought in the back of your mind. Some thoughts disappear as quickly as they came and others grow into nagging desires.

Once the light bulb comes on and you decide, I mean really commit, to making a change about something in your life, that is a revolution. It can even feel like an epiphany. It's the a-ha moment. Maybe you're fed up with your current situation or just want something else entirely different for yourself. Whichever it is, having a revolution means wanting the change badly enough to commit to completing the steps it will take to make that change a reality.

The revolution is the kick-off to the evolution.

Again, change doesn't happen overnight. Now the hard work kicks in. To really change something, especially your weight, you need to commit to a lifestyle change. Temporary solutions offer temporary results. Why bother? We're talking about permanent, healthy change. And that is definitely an evolution. You know your body will not magically transform overnight. Don't expect your habits and thoughts to, either. And both of those components are necessary to create lasting change.

Let's look at your habits first. So many people set New Year's Resolutions to lose weight. It's become very cliche. Now that spring is here... how are you doing on that resolution? It's very difficult to wake up one morning and do everything differently than you did in the previous months and years. A healthy lifestyle includes eating the right foods in the right amounts and exercise, all on a regular basis. It takes a great deal of time and energy to make these changes. Some people are successful at it on a short-term basis. They can do enough of the right things for a week or two and maybe even see some results. However, much of the time these efforts slip and old habits return whether it be out of comfort, habit, social pressure or whatever.

By changing your habits slowly, you give yourself the opportunity to build a healthy lifestyle in a sustainable manner.

Small changes done one or a few at a time allow you to incorporate them into your daily routine and get used to them before taking on additional changes. It's not as disruptive or time consuming to learn a few things at a time versus having to work to learn all new recipes, habits, etc. at once.

Now let's look at your thoughts. Your thoughts play a large role in weight loss. What kind of mind set are you in regarding the changes you're making? Consider what you are giving yourself versus what you are taking away from yourself. Try to frame your thoughts in a positive perspective versus a negative perspective.

For example, what would you say to yourself and others if one of your changes was to not eat sweets like doughnuts for breakfast anymore? If someone brings a fresh, hot box of doughnuts into the office to help everyone beat the "Monday blues," and you know you need to politely decline, how do you word it? Do you say "No thanks, I've already eaten this morning." Or do you say "I wish I could but I'm on this stupid diet and I'm not allowed." One of these responses indicates that you gave yourself a nutritious breakfast at home or on the way to work that morning. The other indicates that you feel like you are depriving yourself of something you want.

Whatever you think about will drive your actions.

If you think about being healthy and eating the right foods, you will seek those things. If you allow yourself to be consumed by thoughts of foods that are detrimental to your health, you will crave them and eventually consume them.

If you are overweight and want to become slimmer and healthier, then you must make changes in your lifestyle. The same actions that got you where you are today will not get you where you want to go. Creating a healthier lifestyle is a journey. Change doesn't happen overnight but the decision to can. If you've made that decision and are committed to it, congratulations. You've had a revolution. Awesome! Now you're ready to start your evolution. Ask yourself "What small changes am I willing to commit to this week? Month? Year?" Make a promise to yourself and keep it.

Stacie Dickerson is the CEO of the Healthy Lifestyle Institute for Women. Access their free article archive, become a member absolutely free and get your health & fitness tools at  http://hliwconnect.com/.

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