Saturday, 7 January 2012

Well Blog: Why Lost Pounds Come Back

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AppId is over the quota
Jen Davis for The New York Times

In this week’s New York Times Magazine, I explore new research that helps explain why most dieters who lose weight end up gaining it all back.

If anything, the emerging science of weight loss teaches us that perhaps we should rethink our biases about people who are overweight. It is true that people who are overweight, including myself, get that way because they eat too many calories relative to what their bodies need. But a number of biological and genetic factors can play a role in determining exactly how much food is too much for any given individual. Clearly, weight loss is an intense struggle, one in which we are not fighting simply hunger or cravings for sweets, but our own bodies.

To learn more, read the full article, “The Fat Trap,” and then join me in a discussion below. I’ll be taking reader questions, but also want to hear your own stories of weight loss and gain, and whether the science reported here reflects your own experiences.


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Personal Health: A Valuable Medical Tell-All Can Be Found in Urine

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AppId is over the quota

I was tempted to ask her who is likely to know or care, except perhaps a stranger in a public restroom. Surely there are worse offenses.

As one of the four routes by which substances normally exit the body (the others being feces, breath and sweat), urine has a uniquely valuable role in medicine: It holds clues not just to what people eat and drink, but also to how well their bodies are functioning. The search for these telltale signs is why doctors routinely request urine samples from patients, whether they seem healthy or are obviously sick.

The color, clarity and other physical characteristics of urine, as well as substances dissolved in it, can provide clues to a wide range of problems, including infections, inherited metabolic disorders, kidney disease, bladder cancer, diabetes, substance abuse, exposure to toxins, inadequate or excessive fluid intake and, as many competing athletes know all too well, the use of performance-enhancing drugs.

Recently, in an eight-year European study, the sodium content of 24-hour urine samples from 3,681 adults was used to estimate the effect of daily sodium intake on the development of high blood pressure and illness and death from heart disease. The authors’ conclusion that too little dietary sodium was riskier than too much has been widely challenged, and until further notice most Americans would be wise to reduce significantly how much salt and other dietary sources of sodium they regularly consume.

Color and Odor

Urine can acquire off-odors from consumption of a few foods like asparagus (a genetic factor in some people is most likely responsible) and beverages like coffee, or as a consequence of health problems like a urinary tract infection or diabetes (a sweet smell from excess sugar). But the characteristic of urine most likely to be noted by a lay person is color.

If you are well hydrated, normal urine is clear and pale yellow, a color imparted by the pigment urochrome. Dehydration — which can be the consequence of drinking too little, sweating too much or suffering from repeated bouts of vomiting or diarrhea — results in dark urine with a smell of ammonia; it should be treated as a warning to drink more water or other plain fluids.

But consistently dark-colored urine can be a sign of hepatitis, a liver disease that requires prompt medical attention.

Less seriously, many foods and certain medications can impart an unusual and, to the unsuspecting, sometimes alarming color. For example, beets, which contain a betalain pigment that turns hands and cooking water red, can turn urine a color that may resemble blood. Likewise, blackberries and rhubarb can result in red or pink urine.

Tea-colored urine can follow the consumption of fava beans and sometimes rhubarb. The beta carotene in carrots, carrot juice and high doses of vitamin C can cause orange-colored urine, and B vitamins and asparagus may turn urine a greenish color.

Among medications that can affect urine color are the laxative senna, which can bring a red or reddish brown tinge; chlorpromazine (Thorazine) and thioridazine (Mellaril), which may add redness; indomethacin (Indocin), cimetidine (Tagamet) and promethazine (Phenergan), which can color urine blue or green; warfarin (Coumadin), phenazopyridine (Pyridium) and rifampin, which can add orange; and chloroquine (Aralen), metronidazole (Flagyl), nitrofurantoin (Furadantin) and primaquine, which can make urine brown. Of course, sometimes blood does appear in urine — for example, as a result of a urinary tract infection, a kidney or bladder stone, an enlarged prostate, or a jarring accident that injures the bladder or urethra. Or blood-tinged urine may follow strenuous exercise like a long run or triathlon.

If there is no obvious explanation for blood in the urine or if it persists, a visit to the doctor is mandatory to check for kidney disease or cancer. If no other explanation for red-tinged urine is uncovered, a test for toxic levels of lead and mercury should be done.

If urine is excreted very rapidly, it may appear foamy. But consistently foamy urine can be a sign that protein is being lost, a symptom of kidney disease, and that a medical exam is needed.

Cloudy urine is typically a result of a bladder or urinary tract infection, which is typically accompanied by a frequent urge to urinate and a burning sensation or pain when urinating.

Other Important Factors

The volume of urine produced can be an important indicator of hydration. Normally, a healthy person produces about 100 milliliters (about 3.4 ounces) of urine an hour, or about one cup in 2 ? hours. If the hourly output exceeds 300 milliliters, it could be a sign of excessive fluid intake; if the volume drops below 30 milliliters, it is probably a sign of dehydration.

Consuming lots of salty foods or carbohydrates can temporarily reduce urine output, because salt, sugar and starch hold more water in the body than, say, protein. And consuming foods or beverages that are diuretics — including caffeine-containing drinks (like coffee, tea and many soft drinks), alcoholic drinks (especially beer), and foods with a high water content, like watermelon or asparagus — can temporarily result in higher-than-average urine output.

The urine of two-legged and four-legged athletes is now commonly tested for signs that performance-enhancing drugs were responsible for an unfair competitive advantage. Sometimes athletes who take medication for legitimate medical problems get caught in the net.

When you provide a urine sample as part of a routine medical checkup, it is likely to be tested for the presence of sugar (an indicator of diabetes) and protein (a sign of kidney disease), and perhaps for bile acids (an indicator of liver disease) or white blood cells (the result of an infection).

If symptoms of a urinary tract infection are present, the culprit organism — often the bacterium E. coli, a common resident of the lower digestive tract — can be isolated from urine and, if necessary, tested for antibiotic sensitivity.

Young girls who take bubble baths and sexually active women (especially those who are new or returning participants to the game of love) are especially prone to urinary tract infections. Doctors have a not-so-amusing name for this common plague of women in the throes of a new sexual relationship: They call it honeymoon cystitis.

In a healthy person, however, urine is sterile and contains neither infectious microorganisms nor white blood cells trying to fight them. Thus, in producing a urine sample for analysis, it is critically important that it be what doctors call a “clean-catch” specimen.

This entails first depositing some urine in the toilet before collecting the amount needed for testing. And be sure to cover the sample immediately to reduce the risk of contamination.


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Well Blog: New Year's Recipes for Health

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AppId is over the quota
December 19, 2011

Antonio Lambert, a self-taught ex-convict turned mental health educator, has relapsed into crime and drug use before. But now, he says, “I know when it’s time to reach out for help.”

December 8, 2011

Extreme cleaners get to work during the holidays, making sure floors and toilets shine as brightly as holiday lights.


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Eat: No Meat, No Dairy, No Problem

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AppId is over the quota
Yunhee Kim; food stylist: Maggie Ruggiero. Prop stylist: Megan Hedgpeth.

Among your other resolutions — do more good? make more money? — you’ve probably made the annual pledge to eat better, although this concept may be more often reduced simply to “lose some weight.” The weight-loss obsession is both a national need and a neurotic urge (those last five pounds really don’t matter, either cosmetically or medically). But most of us do need to eat “better.”

If defining this betterness has become increasingly more difficult (half the diet books that spilled over my desk in December focused on going gluten-free), the core of the answer is known to everyone: eat more plants. And if the diet that most starkly represents this — veganism — is no longer considered bizarre or unreasonably spartan, neither is it exactly mainstream. (For the record, vegans don’t simply avoid meat; they eschew all animal products, including dairy, eggs and even honey.)

Many vegan dishes, however, are already beloved: we eat fruit salad, peanut butter and jelly, beans and rice, eggplant in garlic sauce. The problem faced by many of us — brought up as we were with plates whose center was filled with a piece of an animal — is in imagining less-traditional vegan dishes that are creative, filling, interesting and not especially challenging to either put together or enjoy.

My point here is to make semi-veganism work for you. Once a week, let bean burgers stand in for hamburgers, leave the meat out of your pasta sauce, make a risotto the likes of which you’ve probably never had — and you may just find yourself eating “better.”

These recipes serve about four, and in all, the addition of salt and pepper is taken for granted. This is not a gimmick or even a diet. It’s a path, and the smart resolution might be to get on it.


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Friday, 6 January 2012

Vital Signs: Beer and Martinis: Just as Effective as Wine for Longevity?

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AppId is over the quota

Many studies have found an association between the moderate consumption of alcohol and increased longevity, and some have found evidence that wine has a more beneficial effect than other alcoholic drinks.

Now an analysis in the January issue of The Journal of Studies on Alcohol and Drugs suggests that martinis and beer may be just as effective at extending life. Wine may have appeared to be better only because the people who choose it are generally healthier.

Researchers studied 802 men and women ages 55 to 65: 281 low-wine drinkers who consumed less than one-third of their alcohol as wine, 176 high-wine drinkers who consumed two-thirds or more as wine, and 345 abstainers. The drinkers had one to two drinks per day, and researchers followed them for 20 years.

Wine drinkers lived longer than abstainers, and high-wine drinkers longer than low-wine drinkers. But compared with high-wine drinkers, low-wine drinkers were more likely to be older men, to be less active physically, to smoke and to be of lower socioeconomic status. After controlling for these factors, the difference between the two groups of moderate drinkers disappeared.

The lead author, Charles Holahan, a psychologist at the University of Texas, said there may be benefits for older moderate drinkers no matter what kind of alcohol they consume. Still, he added, “The study does not encourage initiating wine consumption as a pathway to better health.”


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Really?: The Claim: Listening to Music Can Relieve Pain

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AppId is over the quota
Christoph Niemann

THE FACTS

Can the right sonata soothe the pain of a medical operation?

A growing number of doctors have been using music in clinical settings, believing that it might have analgesic effects on patients — or at least take their minds off an otherwise painful procedure.

Scientists only now are seeking to determine whether the notion is more romance than reality.

In the most recent study, published in December in The Journal of Pain, 153 people were subjected to increasingly painful shocks on their hands as they listened to music. All the while, they were encouraged to engage in the songs and to identify certain notes and tones. By measuring pupil dilation and brain activity, scientists at the University of Utah found that as the subjects became focused on the melodies, they experienced more and more relief from the pain. The biggest effect was seen on the participants who were initially most anxious.

A Swedish study published in 2009 reported similarly encouraging findings: Children who were given “music therapy” after minor surgery required smaller amounts of morphine than those who were not.

But a meta-analysis of data on more than 3,600 patients in 51 studies, published in the Cochrane Database, found that the magnitude of the effect was not very large, so the potential usefulness in clinical practice — for now, at least — was “unclear.”

THE BOTTOM LINE

Listening to music during or after a medical procedure may relieve pain, but more research is needed to determine whether the effect is significant.


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Hospital Treatment for Anorexia Is Questioned

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AppId is over the quota

The strategy, called “start low, advance slow,” often results in further weight or fluid loss during the first day or two of hospitalization. Now some researchers and health providers, both in the United States and abroad, are challenging the start-low approach, suggesting that many patients could be fed more aggressively as long as they are closely monitored for medical complications.

Scientific evidence in support of the start-low method has been scarce. In a study published online in The Journal of Adolescent Health in August, researchers at the University of California, San Francisco, sought to evaluate it more closely, examining weight gain in hospitalized teenagers on a recommended refeeding protocol, in what they believe is the first study of its kind.

The study, which involved 35 young people, found that 83 percent on the start-low regimen, who were fed 1,200 calories a day with increases of 200 calories every other day, lost weight. Over all, patients did not regain the newly lost weight until the sixth day in the hospital, on average.

“It’s very upsetting to parents,” said Andrea K. Garber, an associate professor of pediatrics at University of California, San Francisco and the lead author of the study. “The irony is that the goal of hospitalization is to get the kids renourished, and we’re spending the first eight days without any weight gain.”

While it is not unusual for a patient with anorexia to lose weight after hospitalization, most practitioners attribute it to fluid loss, mostly water.

“There is a body of evidence that our older, more cautious feeding strategies are older and more cautious than they need to be,” said Dr. David S. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan Medical School, who leads the American Academy of Pediatrics Committee on Adolescence.

Still, he and other doctors are urging caution before making any radical changes in treatment, saying more research needs to be done. Twenty percent of the patients in the U.C.S.F. study had low blood phosphorus levels, indicating an electrolyte imbalance and a high risk of developing a potentially lethal condition called refeeding syndrome, Dr. Rosen noted.

“We’ve proven that with the regular approach, we don’t make as much progress as we’d like,” he said. “But do we know that feeding people more aggressively is a safe thing to do? The answer is, not really.”

Though medical practices are far from uniform and treatment is individualized depending on the patient’s circumstances, a typical regimen starts young patients with meals and snacks totaling around 1,200 calories a day.

Newer regimens being evaluated — and already introduced in some inpatient programs — start patients with 1,900 calories a day. Within a week and a half, a patient may be consuming 3,000 or more calories a day. The danger is that these patients may experience refeeding syndrome, which can lead to numerous complications including cardiac arrhythmia and death, when trying to return to normal diets too quickly. These patients also may have developed digestive disorders like constipation, diarrhea and reflux disease. They may vomit involuntarily because the stomach and digestive capacity is diminished.

And there are the psychological concerns. Starvation affects cognitive ability, experts say, and often counseling cannot be effective until weight is restored. Until then, patients with eating disorders are prone to continuing aversions to food.

“Think about the psychological trauma of being in a hospital and having to eat all this food,” said Marjorie Nolan, a registered dietitian in Manhattan who specializes in eating disorders and a spokeswoman for the Academy of Nutrition and Dietetics. “These adolescents are so young they can’t process the information, and here they’ve gained five pounds in a week and their biggest fear is happening: They’re getting fat. Which we know isn’t true, but that’s how they see it.”

Ms. Nolan said one of her patients, who is now 18, was fed aggressively at age 15, and it set her recovery back in the long term.

“They got the weight back on her, which medically stabilized her to a degree, which was necessary, but it was so aggressive that now, several years later, she’s still traumatized by it,” Ms. Nolan said.

One 27-year-old woman from the New York City area who was hospitalized twice, at age 18 and again at 20, said aggressive refeeding can be psychologically overwhelming and even physically painful.

“Your stomach shrinks when you don’t eat, so it feels like Thanksgiving, every day, when you are in the hospital getting large quantities of food,” said the woman, who asked that her name be withheld to maintain her privacy. “It’s physically difficult to walk around afterward, and it’s hard to keep it all down.” After having consumed so little for so long, she said, “you eat a carrot, and you feel it.”

She said she regained a lot of weight during her first hospitalization but was so upset by the rapid gain that she promptly lost the weight as soon as she was discharged. Two years later, she was hospitalized again but remained in the hospital for a longer stay of six weeks.

Current guidelines from the American Academy of Pediatrics recommend slow refeeding of malnourished children and teenagers to prevent refeeding syndrome; the Society for Adolescent Health and Medicine also recommends “gradual increase of calorie intake.”

Yet in an editorial accompanying the new study from U.C.S.F., Dr. Debra Katzman, head of the division of adolescent medicine at the Hospital for Sick Children in Toronto, said that overzealous application of the conservative refeeding guidelines had resulted in death in some cases.

In the United States, pressure to keep hospital stays short has made rapid weight gain even more urgent, because the goal is to restore as much weight as possible before discharge, she said in an interview.

Experts agree that much more research is needed to develop clear, evidence-based guidelines for treatment.

“We don’t know the best way to treat these kids, even when they wind up in the hospital,” Dr. Rosen said. “It’s a balancing act. What you want to do is find the sweet spot between feeding people as aggressively as you can but not causing refeeding syndrome, which is a lethal, scary, dangerous disease.”


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