Archive for February, 2010

Nothing is as confusing and ever changing in the world of sports and fitness as the question of supplements. Which should you take, and why? Which are essential, which provide only a minimum benefit, and which are a complete waste of time, money, and potentially your health? Should you be taking fifteen pills a day, or should you be trying to get everything simply from your food? What is the science behind the claims, and where should you spend your money? With so many questions, and with the range of available products ever changing, its easy to feel defeated before you even try to get a grips with it all.

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By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

Is your teen overweight and having a hard time dropping pounds? As a parent, it can be equally as frustrating for you as it is for them. So what’s the answer

Gastric bypass surgery is one option.

A new report in the Journal of the American Medical Association (JAMA) showed that a clinical trial of bariatric surgery on obese teens was much more effective at shedding weight than a diet and exercise regimen. Twenty-four surgery subjects between the ages of 14 and 18 who completed the study lost an average of 76.3 pounds, or about 28% of their body weight. By contrast, the 18 subjects who completed the diet and exercise program lost just 6.6 pounds on average, or 3% of body weight.

Adolescent obesity is a problem in the U.S. The percentage of adolescents (ages 12-19) who are obese was approximately 7% in 1980, and it increased to about 15% in 2000. Today, more than 17.4%, or more than 5 million, are obese. Those extra pounds put our youth at risk for severe, even life-threatening health problems.

Over the past two decades there has been a 10-fold increase in the prevalence of type 2 diabetes in adolescents. Diseases once considered rare or unknown in teens are now commonplace, such as metabolic syndrome (a pre-diabetic condition), obstructive sleep apnea, hypertension, elevated lipids, and fatty inflammatory infiltration of the liver (steatohepatitis), along with a host of psychosocial disabilities.

Sadly, multiple reviews of lifestyle programs for teens targeting diet, exercise and behavioral modification, such as those recently promoted by the first lady Michelle Obama, show mostly poor results. One review of 17 randomized controlled trials of lifestyle programs showed modest weight reduction for up to 12 months followed by packing back on the pounds.

Bariatric surgery is commonly used to help obese adults lose weight. Several studies have shown the benefits of gastric banding, a minimally invasive procedure, over lifestyle changes alone. But gastric banding has rarely been used in adolescents: Fewer than 1,000 such surgeries are performed in the U.S. each year, less than 1% of the number done on adults.

Previous reviews of teenage bariatric surgery have been inconclusive because the trials were observational and not randomized and controlled. And that’s why the current study is so important. It’s the first prospective, randomized controlled trial of gastric banding compared to lifestyle interventions in severely obese adolescents.

A total of 24 adolescent surgery patients with an original Body Mass Index (BMI) of greater than 35 (extremely obese) completed the two-year Australian study. All received the Allergan LAP-BAND adjustable gastric banding system. (Seven surgery patients required follow-up procedures including replacement of the band or the access port under the skin used to adjust the band’s fit around the stomach.) There were no serious complications, such as stomach perforation or herniation, as have been reported in some adult patients.

The lifestyle program was focused on reduced food intake through an individualized diet plan; increased activity with a target of 10,000 or more steps per day as measured on a pedometer; a structured 30-minute exercise program of at least 30 minutes per day; and behavioral modification. Parents and families were involved where appropriate and consultations occurred every 6 weeks with a dietician or exercise consultant and a study nurse coordinator.

These results are both encouraging and profoundly discouraging. Further studies will be necessary to confirm these results on such a limited number of patients. But the fact that any therapy exists to help morbidly obese adolescents lose considerable weight is encouraging.

However, it’s very discouraging that a well-designed lifestyle modification program with regular coaching and follow-up was so ineffective. It doesn’t bode well for current national initiatives.

See All House Calls by Dr. Geehr.

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer
In 1998, the MMR vaccine was linked to a “syndrome” of autism and bowel disease, reported the medical journal Lancet. The triple vaccine was released in Britain in 1988 and had been in use in the U.S. since 1971. The vaccine was credited with reducing the incidence of measles, mumps and rubella-related illness and death.

These findings led to concerns about the safety of vaccines, particularly regarding the preservative thimerosal that contains mercury. Several newspapers and celebrities jumped on the story and stoked fears about vaccine safety.

Twelve years later, the Lancet has totally retracted the MMR-autism research. The journal’s editor says parts of the report were “utterly false” and that he feels “deceived.”

If you think it’s unusual for a medical journal to print such a complete and unqualified retraction, you’re right. And the background story is interesting, if not disheartening.

In the 1998 paper, Andrew Wakefield, M.D., a British physician, and colleagues described 12 children with gastrointestinal problems, eight of which were thought related to MMR vaccination. Nine of the 12 exhibited autistic behaviors. The children were allegedly selected through a random process from those who showed up at a hospital with certain symptoms.

A series of events behind the scenes would cast doubt on the findings. According to published reports, Wakefield, the lead author of the 1998 paper, didn’t disclose that he had been hired two years before as a consultant, allegedly to support a planned legal attack on MMR manufacturers. He also didn’t disclose that he and attorney Richard Barr requested funding that same year from the UK Legal Aid Board in order to show a link between MMR and a new “syndrome” of autism and bowel disease.

In 1996, the first autistic child to enter the study was admitted to Royal Free Hospital. But the children enrolled weren’t impartially selected. Of the 12 who entered the study, most were referred by Barr or related anti-MMR campaigns, and 11 turned out to be litigants against the vaccine manufacturer.

Just one year later in 1997, Wakefield filed for a patent on his own supposedly “safer” single measles vaccine and for other products intended to treat autism and related bowel disease. In 2001, the Daily Mail and other British national daily newspapers launched campaigns backing Wakefield, who published a review of his evidence and repeated calls for single vaccines.

In 2004, it was revealed that Wakefield had been paid to conduct his study on children who were Barr’s clients. The Lancet held firm and declined to fully retract the study, commenting that it had been correct to “raise new ideas.”

The effect on vaccination rates was dramatic. Child vaccination rates dropped below 70% in some communities, down from more than 90% in the mid-1990s. Waves of measles outbreaks ensued, growing from 56 cases in 1998, to 1370 in 2008. In 2006, the first British child died of measles in more than a decade. In the U.S., as many as 2.1% of children weren’t immunized with the MMR vaccine in 2000, up from 0.77% in 1995, according to a 2008 study published in Pediatrics.

In light of the 2004 revelations, British journalist Brian Deer uncovered the manipulation behind the study findings. He found, for example, that the hospital’s clinicians and pathology service had found little to implicate MMR in the study findings. The pathology service had repeatedly reported bowel biopsies to be normal and all 12 cases had major discrepancies between actual clinical records and the 1998 study results. Deer reported that Wakefield had changed and misreported diagnoses, histories and descriptions of children that made it appear the syndrome had been discovered and not fabricated.

According to a report in The Sunday Times in 2009, the effect was to give the appearance of a causal link between MMR and autism and bowel disease where none existed. Some of the children showed signs of autism before vaccination and some didn’t have autism at all.

The Lancet story is a lesson of how even reputable publications can become conduits for unscrupulous conduct, particularly when research is aligned with popular consumer or political causes. In this instance, children are still suffering the consequences of the Wakefield’s manufactured autism scare.

See All House Calls by Dr. Geehr.

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

There are many good reasons to exercise – weight management, improved mood, cardio-vascular health, lowered risk of diabetes and osteoporosis, improved energy levels, better sleep, improved sex life, reduced cancer risk, and elevated good cholesterol. Now we have another reason – brain fitness.

In a recent study published in the Annals of Internal Medicine, researchers in British Columbia found that older women who did 1-2 hours of strength-training exercises each week had improved cognitive function a year later.

Researchers randomly assigned 155 women ages 65-75 either to strength training with dumbbells or weight machines once or twice a week or to a balance and toning exercise group. The strength training group had improved their performance on tests of selective attention and conflict resolution, so-called executive functions, by 10%-12%. The balance and toning group actually experienced a slight deterioration in the same measures by 0.5%.

The researchers note that older women are less likely than others to do strength training, even though it improves bone strength and counteract muscle loss. Elaborate equipment isn’t necessary to conduct a well-designed, strength-training exercise program for senior women 1-2 times per week.

This study is one of many recent articles that demonstrate the value of exercise on the brain. Another study published in 2008 in Nature Review Neuroscience found that intense bouts of aerobic exercise improve immediate cognitive performance. And the more intense, the better the results.

In this study, 21 young adults completed 30 minutes of either resistance training or intense aerobic exercise on a treadmill. Study subjects were tested before and immediately after training sessions for reaction time and accuracy. Both measures were improved in the aerobic exercise group compared to the resistance training and resting controls. Further improvements in cognitive testing were observed with more intensity of exercise.

The researchers reasoned that intense exercise on a treadmill carries certain growth factors from the periphery of the body to the brain that may trigger a molecular cascade on new neurons and brain connections. This transport of growth factors probably requires a dramatic change in blood flow to the brain only observed with vigorous exercise.

It was felt that the weight-lifting routine was not vigorous enough to maximally stimulate flow of growth factors which may stay in the muscles. However, we know from the Annals study that weight bearing does improve cognitive function in older women over time, but it’s likely not as efficient as intense aerobic activity over the short term.

See All House Calls by Dr. Geehr.