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Do You Have Text Neck?

The alarming news that millions of people who habitually send text messages from their smart phones could eventually develop a postural problem leading to early wear-and-tear on the spine, degeneration and even surgery went viral before Thanksgiving. The source was the early release of a paper by New York spine specialist Kenneth Hansrajn that will appear in an upcoming issue of the journal Surgery Technology International. In an interview with the Washington Post Dr. Hansraj said "text neck" is "epidemic or, at least...very common." Or maybe not. In a related article published in The Atlantic on November 25, contributor James Hamblin, M.D., notes that the position of the head when you're texting is essentially the same as it is when you're reading a book or holding a baby. Dr. Hamblin also quoted Washington University in Saint Louis neurosurgeon Ian Dorward, who took issue with the assertion that there's an epidemic of "text neck" since Dr. Hansraj provided no evidence of this in his paper and no objective evidence of "wreckage of any spines." Dr. Dorward also noted that what's really increasing wear and tear on the spine is the obesity epidemic. As you gain weight, your center of gravity moves forward, which can drastically increase the force on the lumbar spine. And, for the record, he made the point that "people are walking around now while texting, falling into water fountains and lakes and walking into traffic—that's a real danger."


The Downside of Gluten-Free Eating

A recent Consumer Reports survey of 1,000 Americans found that 63 percent believed that following a gluten-free diet would be good for them, resulting in better digestion, healthy weight loss, increased energy, lower cholesterol and a stronger immune system. But the magazine's research of the scientific evidence suggested otherwise. It reported that unless you're among the seven percent of Americans who have true celiac disease (an inherited, autoimmune disorder that damages the small intestine when those with this condition consume gluten), going gluten-free could have more risk than benefit. The investigation found that many products touted as gluten-free aren't enriched or fortified with micro-nutrients such as folic acid and iron, which are common additions to wheat flour. What's more, these gluten-free products may be higher in fat and sugar than regular versions, contain rice or rice flour, which in turn may expose you to more inorganic arsenic than considered safe. In addition, there's no scientific evidence that a gluten-free diet will help you lose weight - the opposite is more likely to occur (patients with celiac disease frequently gain weight on the gluten-free diet). The CR team also points out that gluten-free products are often more expensive than their regular counterparts, and analysis indicates that some of them contain more than the FDA's limit of less than 20 parts per million of gluten.

My take? While some experts have agreed that "non-celiac gluten sensitivity" can be seen clinically, and that those affected may benefit from a gluten-free diet, there is no reliable test for gluten sensitivity. The only way to be reasonably confident that gluten is the problem is to rule out other medical possibilities and undergo a trial period without gluten in the diet. The most common symptoms linked to gluten sensitivity are digestive problems (similar to those of irritable bowel syndrome), headache, fatigue, numbness, and depression as well as more than 100 different non-specific symptoms including "foggy mind," ADHD-like behavior, anemia, joint pain, osteoporosis, leg numbness and balance problems. Other than for true celiac patients, I know of no evidence demonstrating that following a gluten-free diet leads to all the health benefits being claimed for it, but if you feel positive changes in your health without gluten, be sure to consider the other important aspects of diet, including fiber and nutrition.


Gout and Alzheimer's Disease

Here's some good news about gout: new research suggests it might protect against Alzheimer's disease. Investigators looked at medical database records in the U.K. to examine the health consequences associated with gout. They identified 59,224 individuals with gout, about 71 percent of them male, and matched their medical cases with 238,805 men and women of similar health who didn't have gout. After 5.1 years of follow up, the researchers found 309 new cases of Alzheimer's disease in the gout patients and 1,942 in the control group. After adjusting for body mass index, smoking, alcohol use and other factors, the researchers concluded that gout seems to lower the risk of Alzheimer's disease by 24 percent. Earlier research had suggested that increased uric acid levels may be protective against dementia, and elevated blood levels of uric acid, a breakdown product of protein metabolism, are a hallmark of gout. Study leader Hyon Choi, M.D., Dr.P.H., director of epidemiology at Massachusetts General Hospital, was quoted in news reports as saying that while the association of uric acid and cognitive health are still speculative, uric acid has proven antioxidant properties, and has been shown in animal studies to protect against oxidative stress induced death of brain cells. The study results were presented at the annual meeting of the American College of Rheumatology.


A Bad Marriage Can Hurt Your Heart

Having an unhappy marriage can raise your risk of heart disease, particularly if you're female. Hui Liu, a sociologist at from Michigan State University, looked at five years of data from 1,200 couples - ages 57 to 85 - in order to discern how happy or unhappy marriage affected heart health. She found that bad marriages have a bigger impact on heart health than good ones - they have a negative effect while good marriages don't necessarily have beneficial effects. Participating couples were asked to respond to survey questions about the quality of their marriages and their heart health - whether or not they had had heart attacks, strokes, high blood pressure, and whether lab tests had shown high blood levels of C-reactive protein, a marker for inflammation in the body. Lui suggested that over time, stress from a bad marriage may worsen heart health because of age-related increased frailty and declining immune function and concluded that bad marriages have greater impacts on women's heart health than on men's, possibly because "women tend to internalize negative feelings and thus are more likely to feel depressed and develop cardiovascular problems."


Can Fiber Promote Weight Loss?

A new study from the University of Illinois suggests that adding fiber to the diet can influence the growth of two kinds of bacteria in your gut (known collectively as the microbiome) toward a ratio typically seen in lean people.  Unfortunately, the researchers observed, most Americans consume only 12 to 14 grams of fiber a day, which is half the recommended amount of 25 to 38 grams. The investigative team had previously studied whether adding fiber to the diet would cause gut bacteria to shift toward "lean." They gave snack bars to 20 men whose reported daily fiber intake was about 14 grams a day. About one third of the men received snack bars with no fiber; another third were given bars containing 21 grams of polydextrose, a common fiber food additive, and the remainder of the participants received bars with 21 grams of corn fiber. The researchers reported significant positive shifts in the ratio of gut bacterial populations toward more bacteriodetes (associated with being lean) and fewer firmicutes (associated with overweight and obesity) with the addition of fiber. However, they also found that the beneficial changes didn't last when the participants went back to their normal diets. Earlier research had shown that a high fiber diet is protective against obesity. The take-home message from lead researcher Kelly Swanson is that if you want a healthier gut and hope to lose weight, you have to make lasting changes to your diet.

My take? It's well established that a diet high in fiber influences health for the better: it prevents constipation, and reduces the risks of colon cancer, heart disease and diabetes. We've also known for some time that fiber helps to maintain ideal weight. This new study adds to the growing body of evidence demonstrating the importance of fiber in the diet, and especially as it pertains to weight. I recommend getting 40 grams a day from bran cereals, beans, vegetables, fruit and whole grains. Freshly ground flaxseed and psyllium seed are also excellent sources of fiber.


Coffee Compound Offsets Obesity Effects

The compound under investigation is chlorogenic acid (CGA, for short) and in studies with mice researchers at the University of Georgia found that it can reduce insulin resistance and the accumulation of fat in the liver, two harmful side effects of obesity. Untreated, these side effects can lead to type 2 diabetes and compromised liver function. The researchers noted that earlier studies indicate that regular consumption of coffee may help lower the risks of type 2 diabetes and cardiovascular disease in some individuals. For their study, the investigators fed mice a high-fat diet for 15 weeks and injected them twice a week with a solution of CGA. They report that the mice didn't gain the weight normally expected as a result of their high fat diet and that the animals maintained normal blood sugar levels and healthy liver composition. In addition to coffee, CGA is found in apples, pears, tomatoes and blueberries." But don't reach for that second cup just yet - the dose of chlorogenic acid given the mice was much higher than amounts humans would get from drinking coffee and eating the fruits and vegetables that provide the compound, and the researchers don't suggest boosting your coffee intake to get more CGA. Instead, they're hoping to create a CGA based treatment that would provide benefits for humans similar to those observed in mice.


Statins for Fibroids?

New research suggests that statin drugs commonly prescribed to lower high cholesterol levels may do double duty in women with benign fibroid tumors of the uterus. Fibroids, the most common tumors in the female reproductive system, account for half the annual hysterectomies in the U.S. Earlier research has shown that statins have anti-tumor effects on breast, ovarian, prostate, and lung cancers, but until recently, their effect on fibroids was unknown, researchers from the University of Texas Medical Branch at Galveston said. They collaborated on the investigation with teams from Baylor College of Medicine, the Georgia Regents University and the University of Texas Health Science Center at Houston. Their study in laboratory tissue cultures showed that the statin simvastatin blocks the growth of fibroid tumor cells and also promotes calcium-dependent cell death mechanisms in the tumor cells themselves. More research is needed before we know whether or not treatment with statins can elicit positive effects in fibroid tumors in women, but studies in animals are currently underway.


Exercise vs. Diet for Weight Loss

Sad, but unfortunately true - exercise alone is not enough to ensure weight loss. In a recent small study, most of the 81 overweight and sedentary women who volunteered for a 12-week supervised exercise program ended up putting on weight, in the form of fat. Some gained as much as 10 pounds despite walking on treadmills three times a week for 30 minutes at a pace representing 70 percent of their maximum endurance. The upside here is that when the program ended, all of the women were aerobically more fit than they had been at the start. In addition, several of the participants had more positive results: some of the women were losing weight four weeks into the program and continued to do so after the exercise program ended. The probable explanation for the varied results of the participants is caloric intake. When they joined the study, the women were asked not to make any changes in their diets, but study leader Glenn Gaesser suggested that the 70 percent of the women who gained weight were likely to have eaten more and moved less than they usually did when they weren't on the treadmills. Dr. Gaesser noted that if you really want to lose weight when undertaking an exercise program, keep checking your bathroom scale and if you're not losing weight, cut back on your food intake.

My take? My own experience is that exercise alone is much less effective at promoting and maintaining weight loss than exercise combined with a positive change in eating habits. According to the American College of Sports Medicine (ACSM), to maintain weight you have to perform between 150 - 250 minutes of moderate intensity physical activity per week - that translates to between 2 1/2 and about four hours per week. But if your goal is to lose significant weight, the ACSM says you'll have to put in more than 250 minutes (four hours plus) per week. And to prevent regaining any weight you do lose, you'll need to continue to exercise more than four hours a week.

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