Adequate Vitamin D Levels May Aid Weight Loss in Obese Patients

Adequate plasma levels of vitamin D, both the precursor and active
forms, may play a role in promotion of weight loss in obese patients,
perhaps through effects on adipose metabolism, according to research
reported Thursday at The Endocrine Society's annual meeting in
Washington, D.C.

While vitamin D deficiency is associated with obesity, "there are
limited data on the temporal relationship between vitamin D and weight
loss -- an important step in establishing a cause-effect link between
vitamin D deficiency and obesity," Dr. Shalamar Sibley from the
University of Minnesota in Minneapolis told the conference.

She and colleagues investigated the temporal relationship between
baseline vitamin D levels and subsequent weight loss success in 38
overweight and obese men and women.

They measured plasma vitamin D (25-hydroxyvitamin D and
1,25-dihydroxyvitamin D) concentrations before and after an 11-week
weight loss intervention consisting of a 750 calorie per day deficit
from estimated total daily calorie needs. They used dual-energy X-ray
absorptiometry and computed tomography to measure body composition and
fat distribution.

On average, vitamin D levels in study subjects were in the insufficient
range.

According to the investigators, in separate models adjusted for gender,
baseline (pre-diet) 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D
levels predicted subsequent weight loss success (p = 0.020 and p =
0.015, respectively) on a reduced calorie diet.

For each 1-ng/mL increase in level of 25-hydroxyvitamin D, obese
patients lost almost half a pound (0.196 kg) more on their
calorie-restricted diet. For each 1-ng/mL increase in
1,25-dihydroxyvitamin D, subjects lost nearly one-quarter pound (0.107
kg) more.

"Abdominal fat loss, in particular, tended to be related to baseline
vitamin D concentrations, with the effect being stronger with the active
form of vitamin D," Dr. Sibley reported. "Vitamin D status did not
predict lean body mass changes, so there was relative preservation of
lean tissue."

The researchers say studies are needed to confirm these findings and
define underlying mechanisms.

"If it is established," Dr. Sibley said, "that vitamin D does indeed
synergistically contribute to standard weight loss approaches, such as a
reduced calorie diet, then identification and treatment of inadequate
vitamin D status could ultimately have a large public health impact on
the obesity epidemic. Our findings suggest that vitamin D may play an
important role in promoting optimal weight management," she concluded.

From Reuters Health, by Megan Rauscher

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Preventing Flu: What Works

From Airborne to vitamin D, the truth behind preventative measures and treatments.

In 2004, People magazine interviewed Dr. Peter Katona, an associate clinical professor of infectious diseases at the David Geffen School of Medicine at UCLA, about a money-making dietary supplement called Airborne.

The small tablets, then being marketed as a handy cold prevention and treatment remedy, are chock-full of vitamins, herbs and minerals and fizz once placed in water.

Katona gave a frank opinion, calling the over-the-counter supplement a "waste of money." The actor Kevin Costner, on the other hand, gave a brief but glowing review and confessed to stashing them on his private plane.

"Who do you think readers listened to?" says Katona, with a laugh.

In Depth: Cold/Flu Products To Try, And Toss

Katona's assessment was reinforced last December when Airborne agreed to pay up to $30 million to settle a class-action lawsuit. The Federal Trade Commission, which announced the settlement, said Airborne lacked "competent and reliable scientific evidence to support the claims."

Airborne is still on the shelves--with a slightly different marketing claim that it supports the immune system--but that doesn't make the product any more effective.

Though Americans spent $4.6 billion on cough, cold and sore throat remedies in 2008, in fact there are only a handful of scientifically proven preventions and treatments for viruses that cause the cold and flu, and none of them involve excess doses of vitamins. Instead, public health officials and physicians have a more common-sense approach, including avoiding sick people, getting vaccinated for the seasonal and H1N1 flues, managing symptoms with reliable medications like an anti-inflammatory or decongestant, and seeking treatment for the flu within the first 48 hours of flu symptom onset.

Prevention and Treatment Myths

Still, this doesn't stop sufferers from relying on a host of ineffective treatments. Like Dr. Katona, emergency physician Dr. Frank McGeorge often deals with patients who rely on remedies that lack scientific proof until their symptoms worsen and they have to see a health care professional.

McGeorge, a Detroit-Mich.-based spokesman for the American College of Emergency Physicians, says a lot of patients often take vitamins like echinacea, zinc and vitamin C once they get sick. While research on the use of the herb echinacea to treat colds and flues is still ongoing, many studies--including two funded by the government--have found no benefit.

Similarly, there's not enough scientific evidence to demonstrate that zinc and vitamin C are powerful weapons against the cold and flu. On the contrary, both can be harmful in excessive doses. Earlier this year, the Food and Drug Administration warned consumers that the homeopathic cold-treatment nasal spray Zicam, which contains the mineral zinc, had been linked to a loss of smell in more than 100 people since 1999. McGeorge also advises against regularly taking more than 500 milligrams of vitamin C per day. Doing so over a long period of time may be harmful; excess vitamin C can cause severe diarrhea.

"There are very intelligent, well-grounded people who swear by this stuff," says McGeorge, referring to vitamin supplements and homeopathic remedies. "My problem is that people taking these [products] sometimes ignore things that will really help them and instead choose voodoo medicine."

Getting Smart About the Cold and Flu

Instead, McGeorge would prefer patients to practice cold and flu prevention by washing their hands, avoiding sick people, staying healthy and, for the flu, getting vaccinated. This year that means obtaining both the seasonal flu vaccine and the H1N1 vaccine. The second vaccine is particularly important for high-risk patients like pregnant women and young children.

Controlling uncomfortable symptoms of either the cold or flu can be done with over-the-counter medications like ibuprofen, an anti-inflammatory that reduces fever and pain; a decongestant, which relieves swollen tissue in the nose; or an antihistamine, which minimizes sneezing, runny nose and coughing. And staying hydrated, which helps keep mucus moist and easy to clear from the nose, will do more to help the body heal than any alternative or homeopathic remedy.

Dr. Norman Edelman, chief medical officer at the American Lung Association, says an effective cold and flu prevention strategy should also include a healthy diet, exercise and plenty of sleep. Following these guidelines will help support the immune system, though Edelman stresses that minor slip-ups, like missing an hour or two of exercise during the week, won't severely compromise one's natural defenses.

And if you've been unfortunate enough to catch a cold or flu, Edelman has a final recommendation: be considerate of others.

"Cancel that trip to grandma's or don't go to work," he says. "If you're sick and spread it to someone else, that's an impolite thing to do."

Cold/Flu Products To Try, And Toss

Echinacea

Some who use this herb to shorten the duration of a cold or treat its symptoms say that it's effective, and at least one study of 95 people made a similar observation. Yet many studies, including two funded by the government, have found no benefit. The National Center for Complimentary and Alternative Health, a division of the National Institutes of Health, is continuing to study the use of Echinacea in treating upper respiratory infections and in supporting the immune system.

Vitamin C

There is no conclusive evidence to support vitamin C as a cold prevention or treatment remedy, according to the National Institute of Allergy and Infectious Diseases. Several controlled studies have been conducted, but the data on whether or not vitamin C reduces the severity or duration of symptoms is unclear. In fact, taking more than 500 milligrams of vitamin C daily over a long period of time may be harmful; excess vitamin C can cause severe diarrhea.

Consider Vitamin D

If there is a supplement you might consider taking this winter, says Dr. Edelman, it is vitamin D. Recent research has demonstrated an association between vitamin D deficiency and cardiovascular disease and increased risk of the common cold. It's easy to get sufficient levels of vitamin D--which the body processes when it's exposed to the sun's UV-B rays--during the summer months but more difficult throughout winter. Research on the use of vitamin D to protect against the cold is still ongoing; discuss the appropriate dose with your physician.

Tamiflu and Relenza

Practicing prevention doesn't guarantee immunity; for those who do come down with the flu, McGeorge recommends seeing a health care professional within the first 48 hours. That's a critical window of time during which a doctor can prescribe the antiviral medications Tamiflu or Relenza, both of which have been shown to shorten the course of the flu.

From Yahoo Health by Rebecca Ruiz

Reviewed/Posted by: M Keith Schrader, MD

6 Daily Habits That May Make You Sick

They say that home is where the heart is. But what you may not know is
that it's also where 65% of colds and more than half of food-borne
illnesses are contracted. The things we do around the house every day
have a big impact on both our long- and short-term health. Here are six
common household activities that may be making you sick.

1. Using a Sponge

The dirtiest room in everybody's home is the kitchen, says Phillip
Tierno, PhD, director of clinical microbiology and diagnostic immunology
at the New York University Langone Medical Center and author of The
Secret Life of Germs. "That's because we deal with dead animal carcasses
on our countertops and in the sink." Raw meat can carry E. coli and
salmonella, among other viruses and bacteria.

Most people clean their countertops and table after a meal with the one
tool found in almost all kitchens: the sponge. In addition to sopping up
liquids and other messes, the kitchen sponge commonly carries E. coli
and fecal bacteria, as well as many other microbes. "It's the single
dirtiest thing in your kitchen, along with a dishrag," says Tierno.

Ironically, the more you attempt to clean your countertops with a
sponge, the more germs you're spreading around. "People leave [the
sponge] growing and it becomes teaming with [millions of] bacteria, and
that can make you sick and become a reservoir of other organisms that
you cross-contaminate your countertops with, your refrigerator, and
other appliances in the kitchen," Tierno explains.

Solution: Tierno suggests dipping sponges into a solution of bleach and
water before wiping down surfaces. "That is the best and cheapest
germicide money can buy -- less than a penny to make the solution -- so
that you can clean your countertops, cutting boards, dishrags, or
sponges after each meal preparation."

In addition, once you've used your sponge, be sure to let it air-dry.
Dryness kills off organisms. Another way to keep bacteria from building
up in your sponge is to microwave it for one to two minutes each week.
"Put a little water in a dish and put the sponge in that," Tierno
advises. "That will boil and distribute the heat evenly [throughout the
sponge] and kill the bacteria."

2. Vacuuming

Conventional vacuum cleaners are intended to pick up and retain big
pieces of dirt, like the dust bunnies we see floating about on our
floors. But it's the tiny dust particles that pass right through the
porous vacuum bags and up into the air. So, while our floors may look
cleaner after running a vacuum over them, plenty of dust, which can
exacerbate allergies and asthma, remains.

Pet allergens and indoor dust, which contains the highest concentrations
of hazardous materials like heavy metals, lead, pesticides, and other
chemicals, are found in higher concentrations in the smallest particles
of the dust, explains David MacIntosh, MD. He is principal scientist at
Environmental Health & Engineering (EH&E), an environmental consulting
and engineering services firm based in Needham, Mass.

"The everyday habit of cleaning with a conventional vacuum cleaner
results in a burst of particles in the air and then they settle back
down over the course of hours," says MacIntosh.

Solution: Look for a vacuum cleaner with a high efficiency particulate
air (HEPA) filter. Unlike those in conventional vacuums, HEPA filters
are able to retain the small particles and prevent them from passing
through and contaminating the air you breathe in your home.

3. Sleeping With Pillows and a Mattress

The average person sheds about 1.5 million skin cells per hour and
perspires one quart every day even while doing nothing, says Tierno. The
skin cells accumulate in our pillows and mattresses and dust mites grow
and settle.

If that's not gross enough for you, Tierno explains that a mattress
doubles in weight every 10 years because of the accumulation of human
hair, bodily secretions, animal hair and dander, fungal mold and spores,
bacteria, chemicals, dust, lint, fibers, dust mites, insect parts, and a
variety of particulates, including dust mite feces. After five years,
10% of the weight of a pillow is dust mites. This is what you're
inhaling while you sleep.

"What you're sleeping on can exacerbate your allergies or your asthma,"
says Tierno.

Solution: Cover your mattress, box springs, and pillows with impervious
outer covers.

"Allergy-proof coverings seal the mattress and pillow, preventing
anything from getting in or out, which protects you," Tierno says. He
also suggests that you wash your sheets weekly in hot water. Make sure
the temperature range of the water is between 130 to 150 degrees
Fahrenheit.

4. Grilling Meat

So much for the summertime staple: Barbecuing meat creates the
cancer-causing compounds polycyclic aromatic hydrocarbons (PAHs) and
heterocyclic amines (HCAs). When fat drips from the meat onto the hot
grill, catches fire, and produces smoke, PAHs form. That's what's
contained in that delicious-looking charred mark we all look for on our
burger. HCAs form when meat is cooked at a high temperature, which can
occur during an indoor cooking process as well.

Solution: "Limiting your outdoor cooking, using tin foil, or microwaving
the meat first is a sensible precaution," says Michael Thun, MD. He is
emeritus vice president for epidemiology and surveillance research with
the American Cancer Society.

Wrapping meat in foil with holes poked in it allows fat to drip off, but
limits the amount of fat that hits the flames and comes back onto the
meat, Thun tells WebMD. Some of the excess fat can also be eliminated by
first microwaving meat and choosing cuts of meat that are leaner.

5. Opening Your Windows

When the weather turns nice, many of us throw open our windows to breath
in the fresh spring air. But that may be an unhealthy move, considering
the combination of seasonal allergies and poor air quality of many
cities throughout the U.S. According to a recent report by the American
Lung Association, 60% of Americans are breathing unhealthy air. And the
pollution inside our homes may be worse than outdoors. The Environmental
Protection Agency lists poor indoor air quality as the fourth largest
environmental threat to our country. Bacteria, molds, mildew, tobacco
smoke, viruses, animal dander, house dust mites, and pollen are among
the most common household pollutants.

Solution: Shut the windows and run the air conditioner. All
air-conditioning systems have a filter that protects the mechanical
equipment and keeps them clean of debris.

"Pollen and mold spores that have made their way indoors will be run
through the air-conditioning system and taken out of the air as they go
through the duct work," MacIntosh says.

But much like with the vacuum cleaner, these filters can only capture
the largest particles. "The conventional filters just pick up big
things, such as hair or cob webs," says MacIntosh. "Filters intended to
remove the inhalable particles, which are very small, exist on the
market and some are very effective."

They may also be worth the investment. A recent study published in The
New England Journal of Medicine showed that cleaner air might add as
much as five months to a person's life.

Tierno says that air purification systems are important, particularly in
a bedroom where bacteria are teaming.

6. Sitting in Front of the TV

Sitting in front of the television has become a national pastime and one
of our least healthy behaviors, particularly because we often do it
while snacking on food that is high in calories.

"When you're sitting there in a trance, you can really pack on some
calories," says Thun. "Today, more than one-third of the U.S. population
qualifies as obese and one-third qualifies as overweight. Thirteen
million Americans are morbidly obese."

Excess body weight puts us at greater risk for heart disease, cancer,
arthritis, and a host of other diseases, Thun says. "That poses a
greater health risk than the toxic cleansers under our sinks."

Solution: Turn off the TV, put away the bag of chips, and go for a walk.

From WebMD by Lisa Zamosky

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Robot Prostate Surgery: More ED, Incontinence

Minimally invasive prostate surgery -- often performed using a high-tech robot -- carries a higher risk of incontinence and erectile dysfunction than does open surgery.

However, the newer technique cuts patients' hospital stays, requires far fewer blood transfusions, and carries less than half the risk of leaving behind scar tissue necessitating a second surgery.

The findings come from an analysis of outcomes for men with prostate cancer who chose treatment with radical prostatectomy -- surgery to remove the prostate. There are two basic kinds of prostatectomy: the tried-and-true open surgery improved over 20 years or minimally invasive surgery, a much newer technique.

Today, as many as 70% of minimally invasive prostatectomies are performed using a surgeon-controlled robot, Brigham and Women's Hospital urologist Jim C. Hu, MD, MPH, said at a news conference. This appears to be driven by direct-to-consumer marketing by hospitals that have purchased the robots, which cost up to $2 million.

But does minimally invasive prostatectomy really work as well as open surgery? To find out, Hu and colleagues analyzed prostate surgery outcomes for nearly 9,000 men whose records are in the Medicare-linked SEER database.

Importantly, open and minimally invasive surgery (both manual and robotic) were equally excellent at ridding men of prostate cancer.

But there were big differences between the two surgical choices in other outcomes. Minimally invasive surgery had several important advantages over open surgery:

One day shorter hospital stay (two days vs. three days)

Far less need for blood transfusion

Much less likely to leave scar tissue (anastomotic stricture), which often requires surgical correction

Fewer surgical complications

But minimally invasive surgery also had several important drawbacks compared with open surgery:

18 months after surgery, a higher rate of incontinence

18 months after surgery, a higher rate of erectile dysfunction

Nearly twice as many urinary and genital complications

"Outcomes of minimally invasive prostatectomy are not uniformly superior to the open approach," Hu said.

He said the technique has been oversold to patients. But he noted that doctors have had decades to learn the best techniques for open prostate surgery.

"Dissemination of surgical technique takes years to unfold," Hu said. "Our study needs to be repeated in the future when teaching of proper minimally invasive technique has had time to diffuse." The Hu study appears in the Oct. 14 issue of The Journal of the American Medical Association.

By Daniel J. DeNoon / WebMD Health News

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Give Yourself a Boost

Beyond Flu Shots, Many Adults Forgo Vaccines That Could Prevent Potentially Lethal Illnesses

As the push gets under way to immunize Americans against swine flu and the seasonal flu, infectious-disease experts warn that many adults haven't received vaccinations for at least half a dozen other preventable diseases-some of which could put people who get influenza at even greater risk for complications and death.

Bacterial pneumonia is the most dangerous complication of the flu and a leading cause of death in previous flu pandemics. Yet only one in four adults under 65 who are considered by the Centers for Disease Control and Prevention to be at risk for the infection have been vaccinated against invasive pneumococcal disease, which causes bacterial pneumonia.

Adult-vaccination rates for other diseases also are dangerously low. Only half the people whom the CDC says should be vaccinated for whooping cough, which can also complicate the flu, have received the immunization. Those percentages are even lower for hepatitis B (32%), human papillomavirus (11%), which can lead to cervical cancer, and shingles (7%). Some adults need vaccinations because they never received them as children, or the immunity can fade over time. As people age, they also become more susceptible to infection. And some newer vaccines weren't available when many adults where children, while some have been improved on.

In all, more than 50,000 U.S. adults die from vaccine-preventable diseases annually-more than from breast cancer, AIDS, or traffic accidents. And hundreds of thousands of adults are sickened or suffer long-term problems from pneumococcal disease, meningitis, shingles and hepatitis, adding more than $10 billion annually to U.S. health-care costs.

"Vaccines have not been front and center in our national efforts for disease prevention as they should be," says Gregory A. Poland, director of the Mayo Clinic's vaccine-research group. "It's a collusion of ignorance-patients don't know to ask about vaccines, and physicians often don't have good mechanisms to screen patients and determine which vaccines they need."

A 2007 study by the CDC found that 78% of doctors either only occasionally ask or don't inquire at all about their patients' vaccination status. Doctors also reported that reimbursement for immunization is inadequate. While the federal vaccines-for-children program provides vaccines at no cost to underserved children, there is no national system to promote and monitor adult vaccination or pay for vaccines for those who can't afford them. Vaccines, which can range in price from $20 to nearly $300, often aren't covered or are only partly covered by insurance plans, including Medicare.

The National Vaccine Advisory Committee, which assesses federal immunization programs, is preparing several recommendations to improve vaccination rates and secure adequate federal funding for adult immunization. Vaccine-financing programs are also part of some health-reform proposals being considered by Congress. One proposal: a requirement that all insurance plans cover recommended vaccines for adults.

Unlike the flu shot, which is given annually and formulated to prevent specific strains of flu, adult vaccines are typically given once, with booster shots over time for some. And while children are typically followed by a pediatrician until they turn 18, "adults may see a lot of different doctors over their lifespan," which makes it harder to coordinate preventive care and keep track of which vaccinations have been received, says Carol Friedman, associate director for adult immunizations at the CDC's center for immunization and respiratory disease. Generally, if patients are unsure if they have been vaccinated, there is no harm in getting immunized again, or in receiving several shots at one doctor's visit.

A vaccine schedule for adults, updated annually, is available at CDC.gov/vaccines. The site also includes easy-to-understand vaccine fact sheets and an interactive quiz to help consumers determine which vaccines they need.

The CDC is urging state public health departments to encourage the use of the vaccine against pneumococcal disease, known as PSV, at the same time as vaccines for seasonal flu and the swine flu for those at risk. In addition to all adults over 65, those at risk include smokers and others aged 19 to 64 with asthma, heart disease, diabetes, or conditions that lower resistance to infection. Bacterial pneumonia has already been found in autopsies of 22 victims of swine flu who died in recent months, the CDC says.

A CDC national immunization survey conducted last year showed especially low rates for the vaccination for shingles, a reactivation of the childhood chickenpox virus. A vaccine was introduced three years ago, but only about 7% of adults over 60 who are recommended to get the vaccine have done so. Though not life threatening, shingles can cause a painful and disfiguring rash, and can involve nerves around the eye that can lead to blindness. Moreover, some patients experience severe nerve pain that can last for years, with little relief available from pain medications.

One barrier: The vaccine, which costs as much as $270, is covered by Medicare's part D drug benefit, not the Part B medical benefit. That means patients covered by the federal insurance program have to get a prescription from their doctor, take it to a pharmacy and then bring the vaccine back to their doctor for administration, unless they can find a drugstore-based clinic that will provide the vaccine on site.

Joan Ditcher, a New York City teacher, suffered excruciating pain after being diagnosed with shingles last fall at age 63, but says none of her doctors ever suggested the vaccine to her. "I believe in preventive care, as long as I'm aware of it," says Ms. Ditcher. "If I had known the vaccine was recommended for everyone my age, I would have gotten it." She has since received the vaccine, as shingles can recur, and convinced all of her friends to get it as well.

Only about half of adults have received the Tdap vaccine, which was licensed in 2005 as the first vaccine for adolescents and adults to combine a tetanus and diphtheria shot with pertussis, or whooping cough, which can cause violent coughing and pneumonia and presents a big risk when combined with influenza.

The CDC recommends that adults under 65 who have never received the Tdap vaccine substitute it for their next booster dose of tetanus, which should be received every 10 years. The most severe cases of disease and death linked to whooping cough have been in infants under six months of age, and the source of that infection is most often an older child or adult, so parents of newborns or women who plan to become pregnant are advised to get the vaccine.

Rates for vaccines against sexually transmitted diseases are also low. Only 11% of women between the ages of 19 and 26 have received the three-dose vaccine for human papillomavirus, or HPV, which prevents genital warts that can lead to cervical cancer. (The CDC's vaccine advisory committee is expected to vote at a meeting in Atlanta next week over whether to recommend that the vaccine be given to boys and young men as well.) The CDC also recommends that anyone who is not in a long-term, mutually monogamous sexual relationship and men who have sex with men to get a hepatitis B vaccination to prevent the infection that can cause liver cancer.

Making young adults more aware of vaccines is also crucial, experts say. A survey released this year by the National Foundation for Infectious Diseases, a nonprofit group funded by unrestricted grants from some vaccine makers, for example, shows only 49% of 18 to 26 year olds know that tetanus causes lockjaw, and that you should be vaccinated against it every 10 years.

Some patient advocacy groups are taking steps to raise awareness of vaccines for specific diseases, including Meningitis Angels (stompingoutmeningitis.com). The group was formed by Frankie Milley of Houston after her son Ryan died at 18 from bacterial meningitis, an infection that can lead to limb amputation, brain damage and death. Because it has been found to strike college students living in dormitories and frequenting crowded bars where smoking takes place, the CDC recommends that students get the meningococcal conjugate vaccine.

Leslie Meigs, a student at the University of St. Thomas in Houston, survived meningitis as a child but was left with chronic kidney disease that eventually required a transplant with a kidney donated by her father. She works with Ms. Milley's group.

"One of the things that young adults may not understand is this isn't a disease that you have and then go on normally with the rest of your life," says Ms. Meigs. "This is a disease that will leave you with after effects until the day you die."

From The Wall Street Journal by Laura Landro

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Happiness

"Happiness is when what you think, what you say, and what you do are in harmony."

-- Mahatma Gandhi

Busted Fitness Myths

Think you know the facts about getting fit? You may be surprised to learn how many are really fiction.

It's easy to fall into the trap: A workout buddy passes along an exercise tip, and then you pass it on to several folks you know. One day, you're at the gym, and sure enough, you hear the same tip repeated, so you figure it must be true. But experts say that in the world of fitness, myths and half-truths abound – and some of them may be keeping you from getting the workout you need.

"Some myths are just harmless half-truths, but many others can actually be harmful," says professional triathlete and personal coach Eric Harr, author of The Portable Personal Trainer. "They can cause frustration in working out and sometimes even lead to injury," he notes.

One reason myths get started, says Harr, is that we all react to exercise a little differently. So what's true for one person may not be true for another.

"In this sense you sometimes have to find your own 'exercise truths' – the things that are true for you," says Harr.

That said, experts say there are also some fitness myths that just need busting, and the sooner the better!

To help put you on the path to a healthier, safer, and more enjoyable workout, WebMD got the lowdown from several top experts on what's true and what's not when it comes to exercise tips.

Fitness Myth No. 1: Running on a treadmill puts less stress on your knees than running on asphalt or pavement.

"Running is a great workout, but it can impact the knees -- and since it's the force of your body weight on your joints that causes the stress, it's the same whether you're on a treadmill or on asphalt," says Todd Schlifstein, DO, a clinical instructor at New York University Medical Center's Rusk Institute.

The best way to reduce knee impact, says Schlifstein, is to vary your workout.

"If you mix running with other cardio activities, like an elliptical machine, or you ride a stationary bike, you will reduce impact on your knees so you'll be able to run for many more years," says Schlifstein.

Fitness Myth No. 2: Doing crunches or working on an "ab machine" will get rid of belly fat.

Don't believe everything you hear on those late-night infomercials! Harr says that while an ab-crunching device might "help strengthen the muscles around your midsection and improve your posture," being able to "see" your abdominal muscles has to do with your overall percentage of body fat. If you don't lose the belly fat, he says, you won't see the ab muscles.

But can doing ab crunches help you to lose that belly fat? Experts say no.

"You can’t pick and choose areas where you’d like to burn fat," says Phil Tyne, director of the fitness center at the Baylor Tom Landry Health & Wellness Center in Dallas. So crunches aren't going to target weight loss in that area.

"In order to burn fat, you should create a workout that includes both cardiovascular and strength-training elements. This will decrease your overall body fat content," including the area around your midsection, he says.

Fitness Myth No. 3: An aerobic workout will boost your metabolism for hours after you stop working out.

This statement is actually true -- but the calorie burn is probably not nearly as much as you think!

Harr says that while your metabolism will continue to burn at a slightly higher rate after you finish an aerobic workout, the amount is not statistically significant. In fact, it allows you to burn only about 20 extra calories for the day. While there's a little bit more of a metabolic boost after strength training, he says, it's still marginal.

"It doesn't really count towards your caloric burn," he says.

Fitness Myth No. 4: Swimming is a great weight loss activity.

While swimming is great for increasing lung capacity, toning muscles, and even helping to burn off excess tension, Harr says the surprising truth is that unless you are swimming for hours a day, it may not help you lose much weight.

"Because the buoyancy of the water is supporting your body, you're not working as hard as it would if, say, you were moving on your own steam -- like you do when you run," says Harr.

Further, he says, it's not uncommon to feel ravenous when you come out of the water.

"It may actually cause you to eat more than you normally would, so it can make it harder to stay with an eating plan," he says.

Fitness Myth No. 5: Yoga can help with all sorts of back pain.

The truth is that yoga can help with back pain, but it's not equally good for all types.

"If your back pain is muscle-related, then yes, the yoga stretches and some of the positions can help. It can also help build a stronger core, which for many people is the answer to lower back pain," says Schlifstein.

But if your back problems are related other problems (such as a ruptured disc) yoga is not likely to help, he says. What's more, it could actually irritate the injury and cause you more pain.

If you do have back pain, get your doctor's OK before starting any type of exercise program.

Fitness Myth No. 6: If you're not working up a sweat, you're not working hard enough.

"Sweating is not necessarily an indicator of exertion," says Tyne. "Sweating is your body’s way of cooling itself."

It's possible to burn a significant number of calories without breaking a sweat: Try taking a walk or doing some light weight training.

Fitness Myth No. 7: As long as you feel OK when you're working out, you're probably not overdoing it.

One of the biggest mistakes people tend to make when starting or returning to an exercise program is doing too much too soon. The reason we do that, says Schlifstein, is because we feel OK while we are working out.

"You don't really feel the overdoing it part until a day or two later," he says.

No matter how good you feel when you return to an activity after an absence, Schlifstein says you should never try to duplicate how much or how hard you worked in the past. Even if you don't feel it at the moment, you'll feel it in time, he says -- and it could take you back out of the game again.

Fitness Myth No. 8: Machines are a safer way to exercise because you're doing it right every time.

Although it may seem as if an exercise machine automatically puts your body in the right position and helps you do all the movements correctly, that's only true if the machine is properly adjusted for your weight and height, experts say.

"Unless you have a coach or a trainer or someone figure out what is the right setting for you, you can make just as many mistakes in form and function, and have just as high a risk of injury, on a machine as if you work out with free weights or do any other type of nonmachine workout," says Schlifstein.

Fitness Myth No. 9: When it comes to working out, you've got to feel some pain if you're going to gain any benefits.

Of all the fitness rumors ever to have surfaced, experts agree that the "no pain-no gain" holds the most potential for harm.

While you should expect to have some degree of soreness a day or two after working out, Schlifstein says, that's very different from feeling pain while you are working out.

"A fitness activity should not hurt while you are doing it, and if it does, then either you are doing it wrong, or you already have an injury," he says.

As for "working through the pain," experts don't advise it. They say that if it hurts, stop, rest, and see if the pain goes away. If it doesn't go away, or if it begins again or increases after you start to work out, Schlifstein says, see a doctor.

From WebMD, By Colette Bouchez

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

PSA screens need more discussion

Physicians need to involve men more in the decision to undergo prostate-specific antigen (PSA) tests, concluded two studies and two editorials in Archives of Internal Medicine.

Clinicians strongly influence men's decisions to undergo PSA screening, but the conversations about screening fail to qualify as shared decision making because patients received more information about the pros than the cons, had limited knowledge of their importance, and were not routinely asked for their preferences.

In one study, researchers conducted a telephone survey of 375 men who had either undergone or discussed with clinicians PSA testing in the previous two years. Researchers assessed the character of the discussion, the patient's knowledge of prostate cancer and the importance of decision factors.

Almost 70% of patients discussed screening beforehand. Clinicians most often raised the idea of screening (64.6%), and 73.4% recommended PSA testing. Clinicians emphasized the pros of testing in 71.4% of discussions but addressed the cons in 32% of talks.

Researchers then asked the patients three questions to test their knowledge:

"Of every 100 men, about how many do you think will die of prostate cancer?"

"Of 100 men, about how many will be diagnosed as having prostate cancer at some time in their lives?"

"For every 100 times a PSA test result suggests the need for further testing, about how many times does it turn out to be cancer?"

Although 58% of patients reported they felt well-informed about PSA testing, 47.8% failed to correctly answer any of the three questions, and only 7.2% of respondents could correctly answer more than one.

Only 54.8% of subjects reported being asked for their screening preferences. The clinicians' recommendations were the only discussion characteristic associated with testing (odds ratio, 2.67; 95% CI, 1.08-6.58). "Indeed, few subjects sought second opinions," researchers wrote.

An editorial concluded the research was an important step in prompting discussion about the tradeoffs between overdiagnosis and treatment complications versus the benefits of reduced risk of prostate cancer-related mortality.

A second editorial chided, "Today's practice environment presents few incentives or support tools for those clinicians and patients who prefer a discussion rather than simply marking a checkbox for PSA on a laboratory requisition form." It also noted some physicians may not ask to screen beforehand, but instead piggyback PSA tests onto other bloodwork.

A second study aimed to support individual decision making by creating a model of the likely benefits and harms.

Researchers in Australia created a model for men aged 40, 50, 60, and 70 years at low, moderate and high risk for prostate cancer. A Markov model compared patients with and without annual PSA screening using a 20% relative risk in prostate cancer mortality as a best-case scenario. The model estimated numbers of biopsies, prostate cancers and deaths from prostate cancer per 1,000 men over 10 years and cumulated to age 85 years.

Benefits and harms vary substantially with age and familial risk, the model found. As an example, among 1,000 60-year-old men with low risk screened annually, 115 would undergo biopsy triggered by an abnormal PSA screen. Among screened men, 53 would be diagnosed with prostate cancer over 10 years, compared with 23 men diagnosed as having prostate cancer among 1,000 unscreened men.

Among screened men, 3.5 would die of prostate cancer over 10 years compared with 4.4 deaths in unscreened men. For every 1,000 men screened from 40 to 69 years of age, there would be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men. Higher-risk men have more prostate cancer deaths but also incurred more prostate cancers diagnosed and related harms.

References:

Richard M. Hoffman, MD, MPH; Mick P. Couper, PhD; Brian J. Zikmund-Fisher, PhD; Carrie A. Levin, PhD; Mary McNaughton-Collins, MD, MPH; Deborah L. Helitzer, ScD; John VanHoewyk, PhD; Michael J. Barry, MD. Prostate Cancer Screening Decisions. Arch Intern Med. 2009;169(17):1611-1618.

Steven H. Woolf, MD, MPH; Alex Krist, MD, MPH. Shared Decision Making for Prostate Cancer Screening. Arch Intern Med. 2009;169(17):1557-1559.

Kirsten Howard, BSc(Hons), MAppSc, MPH, MHealthEcon, PhD; Alex Barratt, MBBS, MPH, PhD; Graham J. Mann, MBBS, PhD;Manish I. Patel, MBBS, MMed, FRACS, PhD. A Model of Prostate-Specific Antigen Screening Outcomes for Low- to High-Risk Men. Arch Intern Med. 2009;169(17):1603-1610.

Michael Pignone, MD, MPH. Weighing the Benefits and Downsides of Prostate-Specific Antigen Screening. Arch Intern Med. 2009;169(17):1554-1556.

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Obesity Epidemic Increases, Mississippi Weighs In As Heaviest State

Adult obesity rates increased in 23 states and did not decrease in a
single state in the past year, according to F as in Fat: How Obesity
Policies Are Failing in America 2009, a report released today by the
Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation
(RWJF). In addition, the percentage of obese or overweight children is
at or above 30 percent in 30 states.

"Our health care costs have grown along with our waist lines," said Jeff
Levi, Ph.D., executive director of TFAH. "The obesity epidemic is a big
contributor to the skyrocketing health care costs in the United States.
How are we going to compete with the rest of the world if our economy
and workforce are weighed down by bad health?"

Mississippi had the highest rate of adult obesity at 32.5 percent,
making it the fifth year in a row that the state topped the list. Four
states now have rates above 30 percent, including Mississippi, West
Virginia (31.2 percent), Alabama (31.1 percent) and Tennessee (30.2
percent). Eight of the 10 states with the highest percentage of obese
adults are in the South. Colorado continued to have the lowest
percentage of obese adults at 18.9 percent.

Adult obesity rates now exceed 25 percent in 31 states and exceed 20
percent in 49 states and Washington, D.C. Two-thirds of American adults
are either obese or overweight. In 1991, no state had an obesity rate
above 20 percent. In 1980, the national average for adult obesity was 15
percent. Sixteen states experienced an increase for the second year in a
row, and 11 states experienced an increase for the third straight year.

Mississippi also had the highest rate of obese and overweight children
(ages 10 to 17) at 44.4 percent. Minnesota and Utah had the lowest rate
at 23.1 percent. Eight of the 10 states with the highest rates of obese
and overweight children are in the South. Childhood obesity rates have
more than tripled since 1980.

"Reversing the childhood obesity epidemic is a critical ingredient for
delivering a healthier population and making health reform work," said
Risa Lavizzo-Mourey, M.D., M.B.A., RWJF president and CEO. "If we can
prevent the current generation of young people from developing the
serious and costly chronic conditions related to obesity, we can not
only improve health and quality of life, but we can also save billions
of dollars and make our health care systems more efficient and
sustainable."

The F as in Fat report contains rankings of state obesity rates and a
review of federal and state government policies aimed at reducing or
preventing obesity. Some additional key findings from F as in Fat 2009
include:

-- The current economic crisis could exacerbate the obesity epidemic.
Food prices, particularly for more nutritious foods, are expected to
rise, making it more difficult for families to eat healthy foods. At the
same time, safety-net programs and services are becoming increasingly
overextended as the numbers of unemployed, uninsured and underinsured
continue to grow. In addition, due to the strain of the recession, rates
of depression, anxiety and stress, which are linked to obesity for many
individuals, also are increasing.

-- Nineteen states now have nutritional standards for school lunches,
breakfasts and snacks that are stricter than current USDA requirements.
Five years ago, only four states had legislation requiring stricter
standards.

-- Twenty-seven states have nutritional standards for competitive foods
sold a la carte, in vending machines, in school stores or in school bake
sales. Five years ago, only six states had nutritional standards for
competitive foods.

-- Twenty states have passed requirements for body mass index (BMI)
screenings of children and adolescents or have passed legislation
requiring other forms of weight-related assessments in schools. Five
years ago, only four states had passed screening requirements.

-- A recent analysis commissioned by TFAH found that the Baby Boomer
generation has a higher rate of obesity compared with previous
generations. As the Baby Boomer generation ages, obesity-related costs
to Medicare and Medicaid are likely to grow significantly because of the
large number of people in this population and its high rate of obesity.
And, as Baby Boomers become Medicare-eligible, the percentage of obese
adults age 65 and older could increase significantly. Estimates of the
increase in percentage of obese adults range from 5.2 percent in New
York to 16.3 percent in Alabama.

Key report recommendations for addressing obesity within health reform
include:

-- Ensuring every adult and child has access to coverage for preventive
medical services, including nutrition and obesity counseling and
screening for obesity-related diseases, such as type 2 diabetes;

-- Increasing the number of programs available in communities, schools,
and childcare settings that help make nutritious foods more affordable
and accessible and provide safe and healthy places for people to engage
in physical activity; and

-- Reducing Medicare expenditures by promoting proven programs that
improve nutrition and increase physical activity among adults ages 55 to
64.

The report also calls for a National Strategy to Combat Obesity that
would define roles and responsibilities for federal, state and local
governments and promote collaboration among businesses, communities,
schools and families. It would seek to advance policies that

-- Provide healthy foods and beverages to students at schools;

-- Increase the availability of affordable healthy foods in all
communities;

-- Increase the frequency, intensity, and duration of physical activity
at school;

-- Improve access to safe and healthy places to live, work, learn, and
play;

-- Limit screen time; and

-- Encourage employers to provide workplace wellness programs.

Source: Trust for America's Health

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP