Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.
EXERCISE & WEIGHT LOSS
It’s no secret that our society is the heaviest in the recorded history of mankind. There have been a number of theories put forth attempting to explain exactly why obesity has become rampant across the globe, and in both wealthy and poor cultures. Most scientists believe that there are several essential elements underlying our ever-expanding waistlines. First, like most mammals, humans are genetically primed to preferentially seek high energy foods, namely foods packed with sugar and fat. For much of human history, these high calorie foods have been difficult to come by for most people, and people have historically subsisted on far less calorie-dense and more nutritious foods. Now, in our fast food culture, there is easy access to an overabundance of highly processed and inexpensive sugar- and fat-rich foods. A second element underlying the obesity pandemic is the progressive decline in physical activity levels in our remote control world.
There is a great deal of research that reveals something that most of us already know, and that is the fact that dieting alone rarely leads to meaningful and sustained weight loss. Other research confirms something that many of us also already know: if you spend most of your day sitting on a chair or laying on a couch, it is darned hard to lose excess weight, even if you are able to overcome that compelling little voice in your head that, primed by those pesky appetite-stimulating genes, keeps pleading for burgers, french fries, and ice cream!
A new study in the Archives of Internal Medicine provides further clinical evidence that it is not only what we eat that drives our bathroom scales to ever higher displays of poundage, but it is also what we do, in terms of physical activity, that determines which hole in our belts we can comfortably use. This study, from the University of Pittsburgh, assigned 201 overweight and obese women volunteers to 1 of 4 behavioral weight loss intervention groups. Each group varied from the other based upon assigned physical activity targets (1,000 vs. 2,000 calories per week) and the intensity of the assigned physical activity targets (moderate vs. vigorous activity). All of the women enrolled in this study were also placed on a diet consisting of 1,200 to 1,500 calories per day. To improve their chances of success, the researchers also provided the study’s volunteers with standard weight-loss group counseling, and with treadmills as well. This study was conducted over a period of 24 months.
Six months into the study, there was no significant difference in average weight loss between each of the 4 groups of women, and the average weight loss at this point in the study was 10% of initial body weight. By 24 months, however, the average amount of lost weight had declined to only 5% of initial body weight.Â
The researchers then compared the 25% of women who had successfully maintained a weight loss of at least 10% of their initial body weight, after 24 months, with the women who did not achieve (or did not sustain) at least a 10% weight loss. After analyzing the average weekly activity levels for all of the women in this study the researchers determined that at least 1,835 calories worth of physical activity per week was necessary to achieve and sustain a 10% weight loss over a period of 2 years (equivalent to about 275 minutes of moderate-to-vigorous activity each week).
What I find to be especially important about this study is that it actually puts some numbers on the table (no pun intended) with respect not only to caloric intake, but caloric expenditure as well. This study confirms the findings of numerous other studies that have shown that moderate dieting, alone, is not sufficient to lose weight and to keep it off over time. As with other studies, this study also confirms that you don’t have to sprint 30 miles a week in order to lose weight (and to improve cardiovascular fitness). Instead, regular and sustained moderate physical activity, such as brisk walking, when combined with a sensible diet, will achieve the same results as were demonstrated in this study. Indeed, as most of us know, stringent diets and exhausting exercise routines often result in significant weight loss over short periods of time. However, the vast majority of us are simply not able to sustain lifestyle modifications as severe as this for very long. Soon enough, most of us return to our sedentary lifestyles and our unhealthy diets, and the weight starts piling back on again.
Watch what you eat, to be sure, but combine a sensible diet with a sensible exercise plan. If your health permits, takes the stairs instead of the elevator at work. Park your car at the far end of the parking lot and walk to the store (as a bonus, your car is probably much less likely to get dinged by the car door of an adjacent vehicle!), instead of going to the cafeteria or a nearby fast food joint, pack a healthy lunch and take it to work, and use part of your lunch period to take a brisk stroll. With these kinds of more moderate lifestyle changes, you are far more likely to keep that excess weight off because you are more likely to be compliant with these less rigorous changes over the long haul. At the same time, you will be reducing your risk of cardiovascular disease, diabetes, and some forms of cancer.
GREEN TEA, FOLIC ACID & BREAST CANCER RISK
Regular readers of this column already know that I have a strong interest in cancer and cardiovascular disease prevention, particularly through lifestyle and dietary modifications. Recently, there has been a great deal of high quality research looking at the effects of green tea and other dietary supplements on human diseases, including cancer. A great deal of rather simple laboratory research, often using cancer cells growing in a Petri dish or in a mouse, suggests that polyphenols, the biologically active components of green tea, may have some anti-tumor properties. However, the results of most human epidemiological studies have been less compelling.
A newly published study of green tea, in the journal Carcinogenesis, evaluated the impact of green tea consumption among ethnic Chinese women living in Singapore. As previous research has suggested that deficiencies of folic acid (Vitamin B9) might be linked to an increased risk of breast cancer (as well as colorectal cancer and cardiovascular disease), this study also evaluated the effects of green tea consumption in Singaporean women with both normal and decreased folic acid intake. Finally, the effects of green tea on breast cancer risk were also assessed in Singaporean women with genetic variants of the methylenetetrahydrofolate reductase (MTHFR) gene that results in increased activity of the enzyme that is responsible for metabolizing folic acid. This study was conducted by the University of Minnesota, the University of Southern California, and the National University of Singapore.
The results of this study, which included 380 women who developed breast cancer and 662 women who did not, appear to confirm that green tea polyphenols may exert a breast cancer prevention effect through their effects on the folic acid metabolism pathway. In this study, women with inadequate folic acid intake and frequent green tea consumption appeared to experience a 55% reduction in breast cancer risk when compared to women with inadequate folic acid intake and only occasional green tea intake. Similarly, women who were found to have a genetic variant of MTHFR that resulted in rapid metabolism of folate were found to have lower risk of breast cancer when they frequently consumed green tea. Among all women with this genetic variant, frequent green tea consumption reduced the risk of breast cancer by 34%. Among women with both poor folic acid intake in their diet and the high activity MTHFR enzyme, daily or weekly green tea consumption reduced the apparent risk or breast cancer by 56% (frequent green tea consumption by women with both high folic acid intake and the normal activity MTHFR gene variant only reduced their apparent risk of breast cancer by 8%).
The findings of this suggest (but do not prove) that green tea polyphenols may be able to reduce the risk of breast cancer, but only in women who either have MTHFR variants that increase folic acid metabolism, or (and) in women with inadequate dietary folic acid intake. A prospective, randomized clinical trial, which would take many years to conduct, would be the best way to confirm the findings of this epidemiological study. However, the results of this Singaporean study are still intriguing, nonetheless.
FOREIGN LANGUAGE INTERPRETERS & ICU PATIENTS
In our multicultural, multiethnic society, physicians must often rely on interpreters to communicate with patients and families who do not speak English well. Most of the time, these volunteer or paid interpreters have little if any medical training. Additionally, foreign-born translators are often, themselves, not fully fluent in English, and they often miss both subtle and complicated nuances that the physician may be trying to communicate to the patient, or to the patient’s family.
A new study in the journal Chest, and conducted at the University of Washington, has rather creatively quantified the extent of clinically important errors made during family conferences requiring a translator for patients in the intensive care unit (ICU).
Ten family conferences, arranged to discuss end-of-life issues and requiring an interpreter, were audiotaped with the families’ permission. Research interpreters with a clinical background then reviewed these audiotapes and translated the non-English discussion into English.
When the physicians who conducted the family conferences analyzed the transcribed translations, they determined that mistranslations by the interpreter present during the conference had occurred 55% of the time. Moreover, three-quarters of these mistranslations were deemed to have been clinically significant translations. Even worse, 93% of these mistranslations were considered to be associated with potentially negative effects on communication between the physicians and the families.Â
The mistranslations were further analyzed and classified. Following this analysis, the mistranslations were attributed to additions, omissions or substitutions of information other than what was intended by the physicians, and editorializations, on the part of the translators.
I can certainly attest to similar anecdotal experiences myself in dealing with non-English speaking patients, families and interpreters. In such cases, particularly when I haven’t worked with an individual translator before, I usually ask the translator to have the patient or family members repeat what I have just told them, using the same translator. If there appears to be any significant deviation from what I have said, then I work with the translator to convey the same information in a slightly different way. As this study reveals, conducting important conferences with the non-English speaking families of gravely ill patients can be potentially hazardous for all concerned.
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Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:
http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html
Copyright 2008. Â Robert A. Wascher, MD, FACS. Â
All rights reserved.
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Cancer surgeon, professor of surgery & author. Webmaster: http://doctorwascher.com | More from Robert A. Wascher, MD, FACS
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