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Study highlights potential for healthy life after heart attack

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According to the findings of a new study, adherence to lifestyle advice and medications could add seven healthy years of life after a heart attack.

“Most heart attack patients remain at high risk of a second attack one year later,” said study author Dr. Tinka Van Trier of Amsterdam University Medical Centre, the Netherlands. “Our study suggests that improving both lifestyles and medication use could lower this risk, with a gain in many years of life without a cardiovascular event,” The study was presented at ESC Congress 2021.

The interheart study previously demonstrated that 80-90 per cent of the risk of a heart attack can be modified by managing factors such as smoking, unhealthy diet, abdominal obesity, inadequate physical activity, hypertension, diabetes and raised blood lipid levels.2 Such management consists of two main strategies: lifestyle change and medication.

However, the response studies showed that adequate levels of these risk factors are seldom reached after a heart attack, even in programs aiming to help patients improve their lifestyles and optimise their medication.

Therefore, “residual risk”, i.e. the risk for another heart attack that is left after conventional treatment, is high to very high in a large number of patients. Dr. Van Trier said: “This study was conducted to quantify this residual risk and estimate the extent to which it could be lowered with optimal management.”

The study pooled data from 3,230 patients that had a heart attack or received a stent or bypass surgery. The average age was 61 years and 24 per cent were women. At an average of one year after the cardiac event, nearly one in three (30 per cent) continued smoking, 79 per cent were overweight, and 45 per cent reported insufficient physical activity.

Just 2 per cent reached treatment targets for blood pressure, LDL (“bad”) cholesterol, and glucose levels – with 40 per cent having high blood pressure and 65 per cent having high LDL cholesterol. However, use of preventive medications was common: 87 per cent used antithrombotic medications, 85 per cent took lipid-lowering drugs and 86 per cent were on blood pressure-lowering drugs.

Using the SMART-REACH model, the researchers calculated the lifetime risk of a heart attack, stroke, or death from cardiovascular disease and estimated changes in healthy years, i.e., cardiac event-free, when lifestyle or medication was changed or optimised.

The model incorporates the following treatment targets: 1) not smoking; 2) antithrombotic therapy with two antiplatelet drugs; 3) lipid-lowering medication (high-intensity statin, ezetimibe and PCSK9 inhibitor); 4) systolic blood pressure below 120 mmHg; 5) if diabetic, use of GLP1-agonist and SGLT2 inhibitor and controlled blood sugar (HbA1c less than 48 mmol/mol).

Dr. Van Trier explained: “The model does not incorporate all lifestyle advice since quantitative data are lacking to calculate gains in healthy life years. But that does not mean that recommendations to eat healthily, maintain a normal weight, and do regular physical activity are less important to reduce your risk.”

The estimated average residual lifetime risk was 54 per cent – meaning that half would have a heart attack, stroke, or die from cardiovascular disease at some point during their life. If the treatment of patients in the study was optimised to meet all targets in the model, the average risk would drop to 21 per cent (one in five patients).

Dr. Van Trier said, “The findings show that despite current efforts to reduce the likelihood of new events after a heart attack, there is considerable room for improvement. Our analysis suggests that the risk of another cardiovascular event could, on average, be halved if therapies were applied or intensified. For individual patients, this would translate into gaining an average of 7.5 event-free years.”

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Medically Speaking

INFANTS EXPOSED TO DOMESTIC VIOLENCE HAVE POOR COGNITIVE DEVELOPMENT: STUDY

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A new study has revealed that infants coming from homes with domestic violence often go on to have poor academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating, and sleeping, as well as stress and illness.

The findings of the study were published in the ‘Maternal and Child Health Journal’. While assessing a pregnant woman with premature labour in 1983, Linda Bullock noticed bruises on the woman. When she asked what happened, the woman told Bullock a refrigerator had fallen on her while cleaning the kitchen.

“Something didn’t seem right, but I didn’t know what to say at the time. I just went on to the next question of the assessment,” said Bullock, now a professor emerita at the University of Missouri Sinclair School of Nursing.

“We stopped her labour and sent her home, but I will bet my last dollar I sent her back to an abusive relationship, and it sparked my interest in helping other nurses assist battered women. What we didn’t know at the time was the impact violence had on the baby,” Bullock added.

Bullock helped implement the Domestic Violence Enhanced Perinatal Home Visits (DOVE) program in rural Missouri, which empowered safety planning and reduced domestic violence for hundreds of abused pregnant women.

After learning from home health visits that many of the abused women had up to nine different romantic partners during and following pregnancy, Bullock conducted a study to examine the impact of multiple father figures on the cognitive development of newborn infants.

After administering neurodevelopmental tests during home visits three, six and 12 months after birth, she was surprised to find the infants of women who had only one male partner who abused them had worse cognitive outcomes compared to infants of women with multiple male partners, only some of whom were abusive.

“The findings highlight the variety of ways the multiple father figures may have been helping the mom support her baby, whether it was providing food, housing, childcare or financial benefits,” Bullock said.

“For the women with only one partner who abused them, the infant’s father, the father may not have provided any physical or financial support or played an active role in the child’s life. It can be difficult for busy, single moms struggling to make ends meet to provide the toys and stimulation their infants need to reach crucial developmental milestones,” Bullock added.

Bullock added that infants coming from homes with domestic violence often go on to have worse academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating and sleeping, as well as stress and illness.

“When nurses are visiting homes to check in on pregnant women and their developing babies, we want them to be trained in recognising the warning signs of potential intimate partner violence,” Bullock said.

“I still think back to 1983 when I sent that lady back home into a terrible situation, and I am passionate about making sure I can help nurses today not make the same mistake I made,” Bullock continued.

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Transplant recipients face elevated risk of developing cancer, says a new study

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The findings of a new study suggest that people who have received organ transplants face an elevated risk of developing cancer, primarily due to immunosuppression from medications to prevent organ rejection, as well as underlying medical conditions.

An important unresolved question relates to the contribution of cancer to years of life lost among transplant recipients, which is a measure of the impact of cancer on premature death. This question was explored recently in a study published by Wiley early online in CANCER, a peer-reviewed journal of the American Cancer Society. For the study, Anne-Michelle Noone, Ph.D., of the National Cancer Institute, and her colleagues examined organ transplant and cancer registry data in the United States from 1987 to 2014, with information related to all ages and all organs. The team quantified the life-years lost to cancer or the extent to which the average lifespan is shortened by cancer, among transplant recipients.

Among 221,962 transplant recipients, 13,074 (5.9 percent) developed cancer within 10 years of transplantation. During this 10-year post-transplant period, recipients who developed cancer lost an average of 2.7 years of life due to their cancer diagnosis. In total, cancer was responsible for 11 percent of all life-years lost due to any cause.

Lung cancer and non-Hodgkin lymphoma had the highest impact, and each resulted in a lifespan shortened by approximately five years. Lung recipients had the highest life-years lost due to cancer, followed by heart recipients. Also, life years lost due to cancer increased with age.

The authors stress the importance of cancer prevention and screening in transplant recipients, with special attention for those at the highest risk.

“For example, there may be opportunities to screen for non-Hodgkin lymphoma especially in groups at high risk for this cancer, such as children. Also, healthcare providers should consider screening older transplant recipients with a smoking history for lung cancer, as recommended for people who smoke in the general population,” said Dr Noone.

Among 221,962 transplant recipients, 13,074 (5.9 percent) developed cancer within 10 years of transplantation. Recipients who developed cancer lost an average of 2.7 years of life due to their cancer diagnosis. In total, cancer was responsible for 11 per cent of all life-years lost due to any cause.

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LOOKING AT EASY LIFESTYLE CHOICES FOR IMPROVING BRAIN HEALTH

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Living a brain-healthy lifestyle is particularly important once you reach middle age, as this is the time when changes in the brain start to occur. It may start decades before the symptoms appear. This means that it is important to look after the brain throughout your life. It is never too late or too early to bring lifestyle changes as brain function can be improved at any age.

EXERCISE YOUR BRAIN

Any activity that involves thinking, learning and active networking regularly challenge your brain. These stimulating activities can improve your brain health. The best activities are those that you enjoy. Hobbies like painting, woodwork, sewing, knitting and writing provide stimulus to the brain. Doing jigsaw puzzles, crossword, sudoku, chess, card games learning to dance, playing an instrument, learning a new language challenge the brain.

Regular and enjoyable interaction with friends like traveling, volunteering with a local charity, walking with friends and family, joining a book club, catching up with friends, and talking to your neighbours is active networking which is beneficial to the brain. Passive networking such as Whatsapp or Facebook does not give such benefits.

PHYSICAL EXERCISE IS NEURO-PROTECTIVE

Regular physical exercise can reduce the risk of Dementia. It can also slow down further deterioration in those who are showing early symptoms of Dementia. It is very helpful if you are regularly involved in activities like exercising for 30 minutes at least, walking, jogging, cycling, hiking, swimming, or joining a dance group but not gyming. To avoid the risk of fall balance and coordination exercises can help you stay agile. Exercises like Yoga, Pilates, Tai chi go a long way to improve balance and coordination and avoid fall or head injury. You can also introduce exercise in your daily routine by taking some simple steps. Walk while you are on your mobile phone and take stairs instead of the lift. If you have to work for long hours while sitting on a desk, take frequent breaks and walk around or stand up for a couple of minutes. Some of the offices’ are providing standing work stations in the place of work and conference rooms. Opt for that option if available, or request for that healthy change in your workplace.

The human brain is an organ that improves through mental stimulation. It continues to adapt, grow and rewire itself through the growth of new neurons. Using your non-dominant hand to write, using is to control a computer mouse, television remote, brushing your teeth, opening doors, etc will strengthen neural connections. Exercise also improves body posture. Walking with a hunch slows down your gait is associated with an increased risk of Dementia.

There is clear evidence that physical exercise helps in the sprouting of neurons to prevent neuro-generative diseases like Alzheimer’s.

HEALTHY DIET

The foods we eat can have a big impact on the structure and health of our brains. Eating a brain-boosting diet can support both short- and long-term brain functions. Indian home-cooked diet of Roti, dal, legumes, vegetables, and salads (washed well) is good for brain health. Red meats, beef, pork, and chicken should be limited in your daily intake. Fish could be included in your diet but make sure it is not bred in toxic waters with high content of mercury.

All Vegetables and fruits of different colours like capsicum, green, yellow and red, cabbage, green leafy vegetables, zucchini, cauliflower, kale, carrots, broccoli (it has glutathione a very powerful antioxidant, which prevents memory decline) and fruits like apple, guava, mangoes, pears, grapes, bananas and others should be included in our diet regularly.

ANTIOXIDANT-RICH BERRIES THAT CAN BOOST BRAIN HEALTH

Include strawberries, blackberries, blueberries, blackcurrants and mulberries in your diet.

Eating more nuts and seeds may be good for the brain, as these foods contain omega-3 fatty acids and antioxidants, and healthful unsaturated fats. Walnuts and Brazil nuts, cashews, almonds and peanuts can give you protection against chronic diseases. Sunflower seeds, flaxseed and chia seeds also reduces the risk of Alzheimer’s disease. Eggs are a source of vitamin B-6, vitamin B-12 and folic acid. Recent research suggests that these vitamins may prevent brain shrinkage and delay cognitive decline.

YOGHURT

Yoghurt contains beneficial bacteria known as probiotics. These bacteria stimulate the Vagus nerve, and that, in turn, stimulates the production of various neurotransmitters, which get depleted under stress.

TURMERIC

Turmeric is a super spice. It contains Curcumin a natural anti-inflammatory compound and a potent antioxidant. It keeps the memory sharp, boosts the brain and helps it to heal.

HEALTHY OILS

Include healthy oils in your diets such as mustard oil , peanut oil, sunflower oil, soyabean oil, olive oil and a small amount of Ghee. Palm oil is unhealthy and is used mostly in bakery products like cakes, biscuits, sweets, etc. Also, these processed food have high sugar and salt content which is unhealthy as it promotes obesity, diabetes, and high cholesterol which is toxic to the brain and body. Avoid snacking on junk food, sugary drinks, sweets and inculcate this habit in children as it will provide many benefits to them in their mid-life and beyond in protecting their brain health.

SLEEP DEPRIVATION

Sleep is absolutely essential for good mental health. Sleep is not a passive but an active function of the brain. In the daytime, we all make Beta-amyloid proteins in the brain. During sleep, the brain cells known as glymphatic enlarge and pulsate to remove toxins from the brain. Due to lack of sleep, the brain does not have enough time to drain beta amyloids and other neurotoxic waste. These substances continue to accumulate day after day in form of plaques and tangles in the brain, which is the main cause of Alzheimer’s disease.

Harmful effects of inadequate sleep can start at the age of 50 if not earlier. It is essential to have 6-8 hours of sleep. Avoid sleeping pills as it does not give you the deep sleep required for memory consolidation in the permanent memory centres of the brain.

QUIT SMOKING

Smoking or inhaling tobacco smoke or passive smoking has been linked to oxidative stress. Due to this the risk of Alzheimer’s/ Dementia becomes significantly higher. The brain uses 20% of the body oxygen supply from the blood. Smoking damages the structures of blood vessels making it harder for the blood to flow freely around the body and brain. Due to this, the brain is deprived of oxygen-rich blood supply and the brain cells do not get adequate nutrients to survive, thrive and resist damage.

ALCOHOL IN MODERATION

Long-term exposure to excessive alcohol can shrink the brain. It can change a person’s typical behaviour without mental clarity, interfere with his or her long-term memory, and may cause hallucinations. All these factors can substantially increase the risk of developing Alzheimer’s/ Dementia.

LAUGHTER IS THE BEST MEDICINE

Laughter triggers the release of endorphins, the body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and de stresses the brain.

So how do we bring more laughter in our lives? Practice smiling at someone like your coworkers or someone you meet regularly in the lift or bus. You will notice that smile-like laughter is contagious.

When you hear laughter move towards it. Spend time with playful friends. Join a laughter club. Learn to laugh at yourself to make an embarrassing moment funny. Put up a funny poster in your home or office. Choose a computer screen saver which makes you laugh. You may think of countless other ways of humour to improve brain health. Laughter is also as effective as antipsychotic medications for reducing anxiety in elderly people with Dementia.

The writer is Member Secretary, Alzheimer’s Related Disorders Society of India, Delhi Chapter.

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Lifestyle choices for brain health

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Living a brain healthy lifestyle is particularly important once you reach middle age, as this is the time when changes in the brain start to occur. They may start decades before symptoms appear. This means that it is important to look after the brain throughout your life. It is never too late or too early to bring lifestyle changes as brain function can be improved at any age.

Exercise your brain: Any activity that involves thinking, learning and active networking regularly challenges your brain. These stimulating activities can improve your brain health. The best activities are those that you enjoy. Hobbies like painting, woodwork , sewing, knitting and writing provide stimulus to the brain.  Doing jigsaw puzzles, crossword , suduko, chess , card games learning to dance , playing an instrument, learning a new language challenge the brain.

Regular and enjoyable interaction with friends like travelling , volunteering with a local charity, walking with friends and family, joining a book club, catching up with friends and talking to your neighbours is active networking which is beneficial to the brain. Passive networking such as Whattsapp or Facebook do not give such benefits.

Physical exercise is neuro-protective: Regular physical exercise can reduce the risk of Dementia. It can also slow down further deterioration in those who are showing early symptoms of Dementia. Exercise for 30 mins, walk, jog, cycle,hike,swim or join a dance group….. not gyming !! To avoid risk of fall balance and coordination exercises can help you stay agile. Exercises like Yoga , Pilates, Tai chi go a long way to improve balance and coordination and avoid fall or head injury.

You can also introduce exercise in your daily routine by taking some simple steps. Walk while you are on your mobile phone, take stairs instead of lift. If you have to work for long hours while sitting on a desk, take frequent breaks and walk around or stand up for a couple of minutes.  Some of the offices are providing standing work stations in the place of work and conference rooms. Opt for that option if available , or request for that healthy change in your work place.

The human brain is an organ which improves through mental stimulation. It continues to adapt, grow and rewire itself through the growth of new neurons. Using your non-dominant hand to write, use is to control computer mouse, television remote, brushing your teeth, opening doors etc will strengthen neural connections. Exercise also improves body posture . Walking with a hunch slows down your gait is associated with increase risk of Dementia. There is clear evidence that physical exercise helps in sprouting of neurons to prevent neuro-generative disease like Alzheimer’s.

Healthy Diet: The foods we eat can have a big impact on the structure and health of our brains. Eating a brain-boosting diet can support both short- and long-term brain functions. Indian home cooked diet of Roti ,dal ,legumes vegetables , salads ( washed well) is good for brain health. Red meats, beef , pork and chicken should be limited in your daily intake.  Fish could be included in your diet but make sure it is not bred in toxic waters with high content of mercury. All Vegetables and fruits of different colours like capsicum, green, yellow and red, cabbage , green leafy vegetables , zucchini , cauliflower, kale, carrots , brocolli ( it has glutathione a very powerful antioxidant, which prevents memory decline) and fruits like apples guava, mangoes, pears, grapes bananas etc should be included in our diet regularly.

Antioxidant-rich berries that can boost brain health: Include strawberries, blackberries, blueberries, blackcurrants and mulberries in your diet. Eating more nuts and seeds may be good for the brain, as these foods contain omega-3 fatty acids and antioxidants and healthful unsaturated fats .  Walnuts and Brazil nuts, cashews, almonds and peanuts can give you protection against chronic diseases.
Sunflower seeds,flaxseed and chia seeds also reduces the risk of Alzheimer’s disease. Eggs are a source of  vitamin B-6, vitamin B-12 and folic acid. Recent research suggests that these vitamins may prevent brain shrinkage and delay cognitive decline.

Yoghurt :  Yoghurt contain beneficial bacteria known as probiotics. These bacteria stimulates the Vagus nerve, and that, in turn stimulates the production of various neurotransmitters , which get depleted under stress.

Turmeric: Turmeric is a super spice. It contains Curcumin a natural anti- inflammatory compound and a potent antioxidant. It keeps the memory sharp, boosts the brain and helps it to heal.

Healthy oils: Include healthy oils in your diets such as mustard oil , peanut oil,sunflower oil , soyabean oil, olive oil and a small amount of Ghee. Palm oil is unhealthy and is used mostly in bakery products like cakes, biscuits , sweets etc. Also these processed food have high sugar and salt content which is unhealthy as it promotes obesity , diabetes and high cholesterol which is toxic to brain and body .
Avoid snacking on junk food, sugary drinks, sweets and inculcate this habit in children as it will provide many benefits to them in their mid life and beyond in protecting their brain health.

Sleep Deprivation:
Sleep is absolutely essential for good mental health. Sleep is not a passive but active function of the brain.
In the daytime we all make Beta amyloid proteins in the brain. During sleep the brain cells known as glymphatics enlarge and pulsate to remove toxins from the brain. Due to lack of sleep the brain does not have enough time to drain beta amyloids and other neuro toxic waste . These substances continue to accumulate day after day in form of plaques and tangles in the brain, which is the main cause of Alzheimer’s disease . Harmful effects of inadequate sleep can start at the age of 50 if not earlier. It is essential to have 6-8 hours of sleep. Avoid sleeping pills as it does not give you the deep sleep required for memory consolidation in the permanent memory centres of brain.

Quit Smoking: Smoking or inhaling of tobacco smoke or passive smoking has been linked to oxidative stress. Due to this the risk of Alzheimer’s/ Dementia becomes significantly higher. Brain uses 20% of body oxygen supply from the blood. Smoking damages the structures of blood vessels making it harder for the blood to flow freely around body and brain. Due to this the brain is deprived of oxygen rich blood supply and the brain cells do not get adequate nutrients to survive, thrive and resist damage.

Alcohol in moderation: Long term exposure to excessive alcohol can shrink the brain. It can change a person’s typical behaviour without mental clarity , interfere with his or her long term memory and may cause hallucinations. All these factors can substantially increase the risk of developing Alzheimer’s/ Dementia.

Laughter is the best medicine: Laughter triggers the release of endorphins, the body’s natural feel good chemicals. Endorphins promote overall sense of well-being and de-stress the brain. So how do we bring more laughter in our lives? Practice smiling at someone like your coworkers or someone you meet regularly in the lift or bus. You will notice that smile like laughter is contagious. When you hear laughter move towards it. Spend time with playful friends. Join a laughter club.  Learn to laugh at yourself to make an embarrassing moment funny. Put up a funny poster in your home or office. Choose a computer screen saver which makes you laugh. You may think of countless other ways of humour to improve the brain health. Laughter is also as effective as antipsychotic medications for reducing anxiety in the elderly people with Dementia.

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Medically Speaking

STUDY ASSERTS BLOOD ENZYME ACTIVITY LEVEL MAY INDICATE WHICH BREAST CANCERS ARE GROWING SLOW

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Patients with metastatic hormone receptor-positive breast cancer who have low activity levels of the enzyme sTK1 in their blood serum at the start of anti-estrogen treatment live longer and go longer without their disease progressing than patients with high levels, according to a recent study by SWOG (the Southwest Oncology Group) Cancer Research Network.

The findings of the study were published in the journal ‘Clinical Cancer Research’. The results suggest that patients with low sTK1 activity levels have a slow-growing disease that can be controlled initially with single-drug endocrine therapy for a prolonged period.

It remains to be determined whether these patients gain further benefit from adding a CDK4/6 inhibitor to their endocrine therapy. The findings come from an analysis of serum samples from 432 women with breast cancer who took part in the S0226 clinical trial, which was conducted by the SWOG Cancer Research Network, a cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH).

“SWOG researchers have demonstrated that a blood serum test can identify which of these patients have a slow-growing disease that might be controlled with a simple aromatase inhibitor pill alone,” said Dr Lajos Pusztai, MD, DPhil, professor of medicine (medical oncology) at Yale Cancer Center, who is a co-author on the paper.

Study S0226 found that most women with metastatic hormone-receptor-positive breast cancer who have not had previous treatment for their metastatic breast cancer live longer when they get a combination of the endocrine therapy drugs anastrozole and fulvestrant than when they get just anastrozole.

However, not all patients see extra benefit from the combination; some do just as well on a single drug. Having a way to identify which patients would not derive added benefit from the combination could save these patients the additional side effects and extra costs associated with taking two drugs instead of one.

The work was led by Costanza Paoletti, MD, who was then with the University of Michigan Rogel Cancer Center. She and her colleagues measured the level of serum thymidine kinase 1, or sTK1, considered a marker of cellular proliferation, in 1,726 samples taken from S0226 patients before the start of their treatment and at four-time points during treatment.

The samples were evaluated using a commercially available test known as the DiviTum assay, produced by Biovica International of Uppsala, Sweden, which measures levels of the enzymatic activity of sTK1. The researchers found what was considered high levels of the enzyme in samples from 171, or 40 per cent, of the patients.

Patients with high sTK1 levels, either before treatment or at any time during treatment, tended to have a significantly shorter period of time before their disease advanced (progression-free survival time, or PFS). Those with high levels at the start of treatment, or baseline, had a median PFS of only 11.2 months compared to 17.3 months for patients with low levels at baseline.

The high-sTK1 patients also died sooner, on average, than patients with low levels of the biomarker, with median overall survival times of just 30 months versus 58 months.

Importantly, patients with low sTK1 levels did just as well on the single drug anastrozole as on the combination. This means a measurement of pretreatment sTK1 level could potentially be used to determine whether a patient should start treatment with two-drug endocrine therapy (high sTK1) or single-drug endocrine therapy (low sTK1).

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STUDY FINDS PRIMARY CAUSE OF CURRENT OBESITY EPIDEMIC

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A new study has claimed that much of the blame for the current obesity epidemic lies on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.

These foods cause hormonal responses that fundamentally change our metabolism, driving fat storage, weight gain, and obesity. The findings of the study were published in ‘The American Journal of Clinical Nutrition’.

Statistics from the Centers for Disease Control and Prevention (CDC) show that obesity affects more than 40 per cent of American adults, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain types of cancer.

The USDA’s Dietary Guidelines for Americans 2020 – 2025 further says that losing weight “requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity.”

This approach to weight management is based on the century-old energy balance model which states that weight gain is caused by consuming more energy than we expend. In today’s world, surrounded by highly palatable, heavily marketed, cheap processed foods, it’s easy for people to eat more calories than they need, an imbalance that is further exacerbated by today’s sedentary lifestyles.

Overeating, coupled with insufficient physical activity, is driving the obesity epidemic. On the other hand, despite decades of public health messaging exhorting people to eat less and exercise more, rates of obesity and obesity-related diseases have steadily risen.

The study points to fundamental flaws in the energy balance model, arguing that an alternate model, the carbohydrate-insulin model, better explains obesity and weight gain. Moreover, the carbohydrate-insulin model points the way to more effective, long-lasting weight management strategies.

According to lead author Dr David Ludwig, Endocrinologist at Boston Children’s Hospital and Professor at Harvard Medical School, the energy balance model doesn’t help us understand the biological causes of weight gain: “During a growth spurt, for instance, adolescents may increase food intake by 1,000 calories a day. But does their overeating cause the growth spurt or does the growth spurt cause the adolescent to get hungry and overeat?”

In contrast to the energy balance model, the carbohydrate-insulin model makes a bold claim: overeating isn’t the main cause of obesity.

Instead, the carbohydrate-insulin model lays much of the blame for the current obesity epidemic on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.

When we eat highly processed carbohydrates, the body increases insulin secretion and suppresses glucagon secretion. This, in turn, signals fat cells to store more calories, leaving fewer calories available to fuel muscles and other metabolically active tissues.

The brain perceives that the body isn’t getting enough energy, which, in turn, leads to feelings of hunger. In addition, metabolism may slow down in the body’s attempt to conserve fuel. Thus, we tend to remain hungry, even as we continue to gain excess fat.

To understand the obesity epidemic, we need to consider not only how much we’re eating, but also how the foods we eat affect our hormones and metabolism. With its assertion that all calories are alike to the body, the energy balance model misses this critical piece of the puzzle.

While the carbohydrate-insulin model is not new–its origins date to the early 1900s–The American Journal of Clinical Nutrition perspective is the most comprehensive formulation of this model to date, authored by a team of 17 internationally recognised scientists, clinical researchers, and public health experts.

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