Jumping jacks or medications

Have you seen the hilarious comments of sir Ken Robinson on attention deficit hyperactivity disorder (ADHD) in America? If not, watch RSA Animate - Changing Education Paradigms at approximately minute 3:40.

Can you imagine the following description of the human evolution: “Our predecessors evolved by sitting for hours and listening to the speeches of their tribal leaders. In fact, our predecessors rarely engaged in any physical activity. The children and adolescents occasionally (once or twice weekly) practiced hunting for 45 minutes, but for the rest of the time they sat and listened to the adults preaching them about many unrelated to life things.” 

Wait a minute! This is not how Homo sapiens developed! However, the fact that our children sit through hours of lessons in school means that our current educational system has gone against the very evolutionary mechanisms that allowed us to become humans. My child (and I assure you, your child) sits, listens or watches something for more than 12 hours every day. Our brain did not evolve to be occupied for 12 hours with listening, reading and learning, and our body did not evolve to be unused and restrained for 12 hours every day. ADHD is the result of our crime against our bodies and brains. 

What are the results of this crime? Here are some shocking facts from the Centers of Disease Control: Recent surveys asked parents whether their child received an ADHD diagnosis from a health care provider. The results show that:

• Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011.

• The percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011.

• Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of approximately 5% per year from 2003 to 2011.

• Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.

• The average age of ADHD diagnosis was 7 years of age, but children reported by their parents as having more severe ADHD were diagnosed earlier.

• Prevalence of ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.

One of the many consequences of this ADHD obsession is that in adulthood, the number of stimulant misusers addicted to ADHD medications has been increasing. The drug supply has risen sharply: about 2.6 million American adults received ADHD medication in 2012, a rise of 53% in four years. Use of ADHD medications among adults 26- to 34-year old has almost doubled.  
Actionable
Dear doctors, instead of ADHD medications, would you please prescribe jumping jacks to our children? Dear federal government, instead of being blind to the drugging of our children, would you require the school system to offer time and space for the prescribed jumping jacks? By the way, sir Ken Robinson suggested that we offer dances instead of jumping. I agree, a daily dose of dancing might be better.

People Do Not Want To Know Their Cancer Risk?

Here is a study that suggests that many people don’t want to know their personal cancer risk; reasons for this are given as well.

Based on our representative sample, 39% of the population indicated that they agreed or strongly agreed that they would "rather not know [their] chance of getting cancer." This preference was stronger among older participants, female participants, and participants with lower levels of education. Preferring to avoid cancer risk information was stronger among participants who agreed with the beliefs that everything causes cancer, that there's not much one can do to prevent cancer, and that there are too many recommendations to follow. Finally, the preference to avoid cancer risk information was associated with lower levels of screening for colon cancer.

Note several things here. First, in certain populations at higher risk for cancer (older, less educated), there is an increased prevalence of the “I rather would not know” mentality.  We also see the cost of the media distorting and exaggerating various studies that come out – some of them occasionally contradictory – about cancer risk and health.

The constant drumbeat of scare articles about various things that may cause cancer is not helpful. There are some well-documented and important factors: smoking, obesity, diet, radon, certain viruses – and these should be publicized MORE. On the other hand, the constant stream of poorly documented speculation, often refuted by new studies, does more harm than good. It is like the “boy who cried wolf” story, straining credibility, and also giving the impression that since every daily activity causes cancer, then, “what can you do?” Of course, if new cancer-causing agents are discovered and are well-documented, then this needs to be publicized. But ill-documented sensationalism for the sake of “page hits” is irresponsible.

Related to this is the confusion of recommendations, which mirror in their complexity and contradictions the endless stories of new and often esoteric causes of cancer

Then there is the attitude of “there’s not much I can do to prevent cancer” which is in part due to recent articles claiming that “most cancers are due to genetic bad luck.”

What happens is that people skip over the part about screening, they skip over the part about those cancers that are affected by environmental factors (and they will not be aware of flaws in the interpretation of the study), and they will shrug their shoulders, smoke that cigarette while eating a deep-fried Twinkie and trust in their “good luck.” This is of course inconsistent with the “everything in the environment causes cancer” idea, but then this is the problem – extremes of opinion in one direction or another.

This has real-life consequences, such as lower levels of colon cancer screening, and, likely, continued bad health habits. And I believe this not only applies to cancer, but other problems as well: obesity, diabetes, etc. Human nature is to avoid thinking about potential bad news and to avoid hearing things that may be unpleasant or which go against currently held beliefs or which might result in undesired changes in habits (change in diet, exercise, etc.). Therefore, the scientific, medical, and media communities need to be cognizant of this, and to present to the public solidly documented and easy-to-understand pieces of information, particularly those that concentrate on major risk factors, and which avoid sensationalism for its own sake and large amounts of background “noise” static obscuring the most important messages about health and cancer risk.

Addictive Foods?

A study has investigated which types of food are most addictive. The results are not surprising:

For the first time, a team of researchers looked at exactly which types of foods could be the most addictive. They asked a group of 120 undergraduates at the University of Michigan, and another group of nearly 400 adults, about 35 different types of food -- from pizza to broccoli -- and whether they think they could have problems controlling how much they ate of each one. Eighteen of the items were processed foods, meaning they contained added sugars and fats.
 
Topping the list were pizza, chocolate, chips, cookies, ice cream, French fries, cake and soda, all considered processed foods. They were followed by cheese and bacon -- both unprocessed foods, but high in fat and salt.
 
The researchers found that the most problematic foods tended to be those with a high glycemic load, meaning they contained a lot of sugar and caused a spike in blood sugar. The authors wrote that these qualities could make foods more difficult to stop eating in a similar way as drugs that are highly concentrated and rapidly absorbed into the body are more addictive.
 
The researchers also found that, among the adults in their study, those with a high BMI and those who were at risk of having any kind of food addiction were most likely to have difficulty controlling themselves around a particular food item.
Note that this article considers bacon to be an “unprocessed food” defining such as having “added sugars and fats” while bacon is typically considered to be a processed food.
The take home message is that foods that are less healthy choices are those which are most addictive, and those two characteristics are linked. Sugar, fat, and salt promote cravings, and at the same time, these components have the worst nutritional profile. Further, those most at risk for food-related health problems, such as individuals with a high BMI, are more likely to have problems with food addiction.

It is important to try to break the vicious cycle of eating these foods, craving more, and eating more. In theory, if you have never eaten these foods, and avoid being exposed to them, you won’t develop the addiction. This is unrealistic since almost all of us, myself included, have consumed these foods many times at one point or another in our lives. So, you need to make a conscious decision to resist: avoid eating out, do not buy these items, and eat healthier at home. The good news is that with time, your tastes will adapt. After ditching foods like Pop Tarts for fresh fruit, I have found that the fruit tastes sweeter to me than it did before, when I was routinely exposed to high-sugar, highly processed food.
It is important not to be obsessed with food, not to use food as some sort of “comfort” or “drug” in response to stressors and problems. Certainly, you should enjoy what you eat, and once you adjust to a healthier diet, you will find out that you enjoy the healthy foods more, and the types of foods you ate in the past taste “too rich.” So, yes, healthy food can and should be palatable. However, do not make food a focus of your life, so that avoiding unhealthy and addictive foods would not feel like a sacrifice. Once you have a healthy food regimen in place, you could have “cheat meals” infrequently – the occasional slice of pizza, a piece of chocolate, or a Pop Tart, or even that dreaded slice of bacon.
Actionable
You need to make the commitment that your relationship with food will change. The primary function of food is to be fuel for your body and to improve your health. Food consumption cannot be a major focus in your life, food cannot be a drug to distract you from life’s problems.

What type of cancers will kill us by year 2030

What allowed the human species to evolve is the capability to adapt to the environment. How? Mutations in our DNA allowed our predecessors to fit better the changing conditions, and paved the way to a successful “species” story.  The same adaptability that established Homo sapiens as the “ruler of all species” also made cancer our most dangerous enemy. Thus, an extreme evolution based upon mutations and epigenetic changes is the core of cancer. 

The deadly adaptability of cancer cells is evident when a patient is treated, and after a promising initial therapeutic response, the cancer re-grows and kills the patient. This happens frequently, and it is due to the great variety of cells within a single neoplasm, and the ability of the cancer cells to adapt to drug exposure or any other change in their environment via mutations and epigenetic changes.This suicidal “evolution” takes place even in the inception stage of cancer, when the neoplastic development is driven by few mutations in one or more abnormal cells. At the nascent stage of cancer, our lifestyle might be the most decisive factor for whether or not the neoplasm will continue to grow and become an invasive cancer.  There is convincing evidence that the deleterious development into cancer is fueled by the “Western-type” of lifestyle. In addition to contributing to changes in the genome (e.g., epigenetic changes, etc.), the Western lifestyle creates a metabolic profile and microenvironment that are highly “accommodating” for abnormal cells with cancer-initiating mutations. Physical inactivity, obesity, highly-processed food diet, and stress, all of which describe the Western style of life, can collaborate with mutated cells in our bodies. The impact of these factors on cancer incidence also explains the changing landscape of cancers that will kill us in the near future.  A recent study reveals the top four cancer killers of Americans in year 2030. 

According to the projections of the researchers, lung cancer will remain the top cancer killer. However, the deaths from pancreatic or liver cancers will exceed these from breast, prostate, or colorectal cancers. The worse news is that lung, pancreatic, and liver cancer are “recalcitrant” since they have 5-year relative survival rates below 50%: pancreas (6%), lung (16.6%), and liver (18%).There is no doubt that the increase in liver and pancreatic cancer incidence today is related to the obesity epidemic in the U.S. For example, non-alcoholic fatty liver disease (called also non-alcoholic steatohepatitis) is associated with obesity and is the major reason for the increase of liver cancer incidence in the developed countries, including the U.S.  The majority of liver cancers are still associated with hepatitis, and the prevention of hepatitis B and C infections has  significantly reduced the incidence of liver cancer. However, now obesity is reversing the trend, and by year 2030, we will witness record numbers of liver cancer.

More On the WHO Report

After the recent WHO report linking the consumption of processed and red meat with increased risk of colorectal cancer, a backlash ensued, in part promoted by the meat industry as well as meat-eaters. Now the WHO is taking a more conciliatory tone:

The WHO however stressed Thursday that IARC's review merely confirmed the UN health agency's 2002 diet and nutrition recommendations, urging people "to moderate consumption of preserved meat to reduce the risk of cancer."

"The latest IARC review does not ask people to stop eating processed meats, but indicates that reducing consumption of these products can reduce the risk of colorectal cancer," WHO said in a statement.

It pointed out that it has a standing group of experts who regularly evaluate the links between diet and disease.

"Early next year they will meet to begin looking at the public-health implications of the latest science and the place of processed meat and red meat within the context of an overall healthy diet," WHO said.

Additional studies and analyses on this subject will be welcome, and it is of course true that consumption of these meats will be less problematic if part of a diet high in vegetables and fiber.

The problem is that many people, particularly those who eat a diet enriched in processed and red meat, do not eat sufficient vegetables (or fruits and whole grains) and have an insufficient fiber intake. In addition, the lack of a clear message can be taken as an excuse to ignore the basic message. Meat-lovers, supported by rhetoric from the meat lobby, and indecisive language from experts, will assume that “eating processed/red meat is OK,” ignoring the parts on moderation and on vegetables/fiber, or misunderstanding what it means.

If someone eats robust helpings of processed and/or red meat every day, but not at every single meal, is that “moderation?”  Is eating their processed meats with deep-fried hash browns an example of “vegetable consumption?”  Is eating one Fiber One bar along with their bacon and steak sandwich an adequate fiber intake?

If you have a truly healthy diet, eating the occasional meal with processed or red meat is highly unlikely to cause any harm.  If you have a diet high in vegetables, fruits, whole grains, with a good intake of dietary fiber, then, yes, certainly, there is no need to completely eliminate processed or red meat from the diet.

Perhaps we need to stress more on what people should be eating, rather than what they should not. If people consume mostly plant-based and fiber-rich foods, and if they eat in moderation, then they likely “will not have the room” to tuck away large amounts of meat. Adjusting their diet to include healthy foodstuffs may adjust their attitude toward food better than dire WHO warnings. The best way to get people to cut back on more unhealthy foods is to point out healthier substitutes, and positively encourage consumption of those substitutes. One has to be careful not to trigger a stubborn sense of defiance in people; they may not like to be lectured to, and may eat bacon breakfast, lunch, and dinner as sense of independence and autonomy.

Perhaps studies need to be done on the public’s perception about food, to find out precisely why the more unhealthy choices are more popular (aside from the known appeal of fat, sugar, and salt).

Unleashing the immune system on cancer

There has been a much awaited step forward in cancer therapy: by removing roadblocks on the path of patients’ immune response, the management of some types of cancer (e.g., melanoma, etc.) has improved.  These roadblocks or checkpoints, as scientists call them, are necessary so that our immune system “knows” when to stop its response to a trigger. The trigger could be a protein that the immune system considers “foreign” to the organism.  Some cancers express such “foreign” proteins, since mutations may transform our normal proteins into “foreign” proteins that are not recognized by the immune system.  If this happens, the immune system can attack the cancer cells expressing “foreign” proteins, and eventually kill these cells.  The caveat is that some tumor cells evade the immune response because they “utilize” the natural checkpoints of the immune system to stop its response. Such cancers are spared by the immune system, and continue to grow unperturbed.  

Currently, immunotherapy targets two checkpoints that are utilized by cancers to evade  immune response.  In successful cases, the untethered immune system of the cancer patient is able to attack the cancer cells. However, not all patients respond to this intervention.  A recent study reveals one possible explanation for this differential response.  The authors of the study hypothesized that sometimes the suppression of the checkpoints does not work since some cancers do not express proteins that are recognized as “foreign” by the immune system. Thus, only proteins that the immune system has not encountered in the past elicit an immune response.   

The analyses revealed that the probability for a successful checkpoint therapy was higher when the cancer had more mutations. This is logical, since the more mutations a cancer cell has, the higher the chance that one or more of these mutations result in “foreign” proteins that elicit an immune response. The surprise, however, was that there were not too many common “foreign” proteins among the cancer (melanoma) patients who have benefited from the therapy. Thus, the “foreign” proteins seem to be the result of “passenger” mutations. These mutations do not contribute to the selective growth advantage of cancer cells, but accumulate along with the “driver” mutations, which do contribute to the cancer growth.  Whereas the “driver” mutations are somewhat common among some types of cancer, “passenger” mutations are diverse.

Actionable

Our understanding of why immunotherapy sometimes does not work may lead to its proper application. In the future, the decision as to whether the checkpoint therapy is appropriate for a cancer patient would be based upon the patient's mutation profile.