Health Facts Proven, Once and For All!

This is the headline would like to see, whenever we hear about the latest scientific research in the media.  However, even with the best scientific journals, pinning down "the truth" in medicine can be a tricky business.  I think that science is important in guiding our health care decisions this, but we must be wary about overreliance on so-called evidence-based medicine.

At the most basic level, any time there is a health claim, you have to ask whether it comes from a credible source or not.  Testimonials or "studies" conducted by a product manufacturer that actually involve only a few subjects are not valid sources to draw any hard conclusions.

Okay, so can we rely on the well conducted studies in the major medical journals?  Well, they are better, but they still need to be taken with a grain of salt.  There are many sources of errors for the data and conclusions in major scientific studies:

• Bias: researchers themselves are biased to interpret their data in a way that supports their hypothesis; journals commonly exhibit publication bias, being more likely to publish studies that agree with previous research findings
• Difficulty with randomization: the "gold standard" of medical research is the randomized controlled trial (selecting research subjects at random to receive either the active therapy or placebo).  However, achieving true randomization, and controlling adequately for confounding factors is more difficult than is commonly believed.  These issues can lead to drawing wrong conclusions.
• The decline effect: sometimes, a new research headline will grab us with its dramatic statistics.  As further research is conducted in the same area, however, it often turns out that the new therapy is not as effective as it seemed at first.  There are many theories as to why this occurs -- the simplest being that this is just "regression to the mean" as more data are gathered -- but the significance is that if treatment decisions are made based on early evidence, it might lead us down the wrong path.  One of the most dramatic examples of this is what are called "second-generation" antipsychotic medications.  These medications (such as Zyprexa) were initially found to be incredibly more effective than older drugs at controlling schizophrenic symptoms.  As further research has been conducted, it now appears that the newer drugs are no more effective than the old ones (and may even be less effective).

So what does this mean about our reliance on scientific research?  The biggest take-home message is that we have to look at the big picture, rather than chasing down every rabbit hole of the latest headline.  A healthy diet and exercise are irrefutably good for our health.  Indeed, it may be argued that the most significant improvement of human health in the last 200 years was brought about by modern sanitation (clean drinking water and good sewer systems).  Everything since then may just be splitting hairs.

Labos C.  It Ain't Necessarily So: Why Much of the Medical Literature Is Wrong. Medscape, 9 Sep 2014.

Are You Sitting Down? Think Again...

Imagine two co-workers:  one slim, the type who can seem to eat anything without gaining a pound -- and therefore does not feel the need to exercise; the other one overweight, but who works out regularly.  In spite of your latter colleague's efforts, he has found it very difficult to lose weight.  Which one is at greater risk for health problems down the road?

The answer is not so clear-cut, since both obesity and physical inactivity have been linked to chronic diseases:  cardiovascular disease, diabetes, osteoarthritis, etc.  If you were forced to choose, though, it appears more and more that keeping physically active is the more important variable for decreasing health risks.

• Australian researchers (1) recently found that being sedentary accounts for about half the risk for cardiovascular disease in middle-age women -- more than obesity, high blood pressure, or even smoking.
• Recent studies in BMJ (the British Medical Journal) found that for older adults, light daily physical activity decreased the disability associated with knee arthritis (2), and poor physical fitness nearly quadrupled the risk for all-cause mortality (death by any cause) (3).
• While many studies have focused on light-to-moderate exercise, a new study in the Journal of the American College of Cardiology looked at something a bit higher impact -- namely running -- and found that running, even as little as 5-10 minutes per day, decreased cardiovascular and all-cause mortality risk by 30-50%. (4)
• Author Nilofer Merchant has compiled the research, and calls sitting the "new smoking" -- the big public health scourge that needs to be addressed in the 21st century.

What can you do today to incorporate more physical activity?

• Park a little further from your destination
• Walk the dog a little further each morning
• Jog in place during each commercial break on TV

Our bodies are designed for exercise throughout life -- so keep it moving!

1. Br J Sports Med. Published online May 8, 2014.
2. Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: prospective cohort study.  BMJ 2014;348:g2472
3. Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study.  BMJ 2014;348:g2219
4. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk.  J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058

Many People Would Rather Receive Electric Shocks than Engage in this Healthy Habit

"Holistic medicine" does not just mean substituting herbs for prescription drugs; it means looking at the whole person -- body and mind.  Stress has a powerful impact on our mental/emotional health, as well as our physical health (via the neurologic and endocrine systems).  To that end, I often teach people techniques such as quiet breathing exercises to improve stress management.

Quiet breathing, meditation -- these fall along the continuum of being alone with our thoughts, which is something most modern Americans are not accustomed to.  This has always been the case, but it seems to have gotten worse lately, with the 24/7 accessibility of technology.  Being alone with our thoughts has been proven to help decrease the stress response, which can improve our health in a variety of ways.  These techniques fall under the category of what I call "simple, but not easy:"  simple in concept, but not easy to perform.  A lot of people find that their mind rebels when faced with a lack of constant input.

Though I know from personal experience how challenging it can be to sit quietly with one's thoughts, researchers at the University of Virginia recently investigated this phenomenon through an interesting experiment.  They recruited adults to sit quietly alone in a room for about 15 minutes.  The volunteers were asked not to fall asleep.  The only activity they were allowed, other than just thinking, was to press a button that would administer a mild electric shock.

Now one would think that people would avoid this painful stimulus.  I mean, how hard can it be to just sit for 15 minutes?  The researchers were surprised, therefore, when 25% of female subjects and fully two-thirds of male subjected shocked themselves at least once.  Yes, most people preferred deliberately self-inflicted pain to sitting quietly for 15 minutes.

The researchers concluded that the conscious human mind is designed to engage with the world, which may be why this exercise is so difficult for many people.  That's why I recommend a variety of techniques to help people enjoy the benefits of quieting the mind:

• Focus on the feeling of the breath moving in and out of the lungs.
• Use visualizations, such as light moving in and out of your body.
• Use a mantra (repetitive word, with or without meaning) to engage the cognitive mind while allowing the rest of the mind to settle down.
• Use the techniques of Mindfulness Meditation:  actually focusing on the sensory input around you (rather than tuning it out), but without judgment or evaluation.
• Engage in "moving meditation," such as walking a labyrinth.

You might need to experiment to find which methods work best for you, but it is definitely worthwhile to make this a part of your daily routine.

1.  Just think: The challenges of the disengaged mind.  Science 4 July 2014: Vol. 345 no. 6192 pp. 75-77.
2.  What’s So Bad About Being Alone With Your Thoughts?  Science Friday, July 11, 2014.