Year: 2008

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Effect Of Exercise On Weight Loss

Well, is there anyone out there who does not want to lose weight?

May be a few. But the vast majority of the people are overweight. And many of them are trying to lose weight. They jump from diet to diet and get frustrated. They try different kinds of exercises and eventually give up because they cannot sustain the discipline of life long healthy eating and exercising.

For many years there has been a debate about the best diet for weight loss. Any diet will work for you if you stick to the demands of the diet. Variety is the spice of life hence people get tired of eating the same sort of food everyday. They need to go out with family members and friends to try different dishes. Many people find wining and dinning satisfying and socially invigorating. Most diets eventually become boring and monotonous.

Doing regular exercise is essential part of any weight loss program. Once people achieve their weight loss then they lose the enthusiasm and slack off. That is when they start putting on weight.

So, the question is how much exercise do you have to do to maintain the weight loss?

“Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women,” is an article which was recently published in the Archives of Internal Medicine. For two years the authors of the article studied 201 overweight and obese women with body mass index of 27 to 40, with age range of 21 to 45 years.

The participants were told to reduce calorie intake to 1200 to 1500 calories per day. They were also randomized to one of four physical activity intervention groups based on energy expenditure (either 1,000 calories or 2,000 calories burned per week) and exercise intensity (high vs. moderate).

The results were interesting.

They found weight loss did not differ among the randomized groups. At six months the weight loss was about 10 per cent of initial body weight. At 24 months the weight loss was five per cent of initial body weight.

They also found that by the end of the 24-month intervention, the women who managed to lose at least 10 per cent of their starting body weight and managed to keep it off were exercising twice as long as and burning more than twice as many calories through exercise as women who had no change in body weight. More they exercised, more they lost weight. Women who lost the most weight exercised 68 minutes a day, five days a week.

One of the conclusions was: exercise was more strongly associated with weight loss than any other factor, including diet. Over an hour of sustained exercise most of the days is required to burn enough calories to maintain weight loss. This should be combined with reduced calorie intake. Conventional advice of half-an-hour of moderate exercise does not help lose weight nor maintain weight loss.

The biggest challenge is to stick to a healthy weight reducing diet and overcome obstacles to regular exercise. One way to avoid slacking off is to join some existing programs or get few friends together and form a group of your own – call it “a happy hour group”.

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Tobacco Dependence Can Be Treated

“The World Health Organization estimates that, around the globe, 1.3 billion smokers purchase 10 million cigarettes every minute, and that every 8 seconds somebody dies from a tobacco-related disease,” Canadian Medical Association Journal (June 15, 2008).

Smoking is the single most preventable cause of death and disability. This has been said over and over again for many years. But smokers continue to smoke and each year we find new generation of smokers take up the habit. They get addicted and dependent on the tobacco to an extent that they find it difficult to give up the habit. In consequence they pay a price in terms of health and suffering. Not to mention the amount of money they spend to buy cigarettes and then to buy medications to treat complications of chronic smoking.

June 15 issue of the Canadian Medical Association Journal (CMAJ) has articles that review the “effective treatment for the ultimate vector of this epidemic: tobacco dependence.”

There are several effective medications available for the treatment of tobacco dependence but the problem is a failure of “dissemination of interventions from clinical trials to the broad population of tobacco users.”

Authors of one article in the CMAJ identified 69 well-designed randomized controlled trials which looked at the effectiveness of medications to help tobacco abstinence at six months and 12 months. The authors observed that varenicline (Champix), bupropion (Zyban) and 4 types of nicotine replacement therapy (nasal spray, patch, gum and tablet) roughly doubled the odds of smoking abstinence compared with placebo.

What about the nicotine inhaler?

Nicotine inhaler appeared to double the odds of abstinence as well, but the results were not statistically significant. Nicotine is also available as lozenges and nicotine sublingual tablets which dissolve under the tongue. Even in the US, 2008 guidelines on this subject agree with the above findings. The authors of the commentary in the CMAJ asks, “So why are we not doing a better job controlling the tobacco epidemic?”

The authors say that the answer is simple. It resides in our inability to disseminate effective interventions from the clinical research setting to the population. The authors give several reasons for this failure. At the physician and clinical level there is a primary emphasis on medically urgent issues, lack of time and support, inadequate training and low self-confidence among providers, and low rates of reimbursement for tobacco-treatment services.

At the population level, the authors say there is a lack of political will to restrict tobacco companies and to promote and disseminate the most effective tobacco control policies (e.g., smoke-free indoor air policies and higher tobacco taxes). Sometimes the politicians give low priority to anti-smoking programs and divert funds to other ventures.

One survey has shown that smokers in general will be receptive to receiving free nicotine replacement therapy and would use it to quit smoking. The question remains, how are we going to make the treatment accessible and affordable so we can prevent death and disability from tobacco-related illnesses? The all powerful multinational tobacco industry will not do it for us. The responsibility is in the hands of the government and the clinicians to target and encourage smokers to seek help. And the smokers should know there is help, if only they would ask.

Remember, every eight seconds somebody dies from a tobacco-related disease.

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What Can You Do About Varicose Veins?

Summer is here and it is time to show off your legs. But some of us are not so lucky because we have varicose veins. Nobody likes varicose veins. They are unsightly. But, do we have to hide our legs because of these veins. I hope not.

Varicose veins are enlarged veins that look dark purple or blue. They appear twisted and bulging. They are commonly found on the backs of the calves or on the inside of the leg.

Spider veins are similar to varicose veins, but they are smaller. They are closer to the surface of the skin than varicose veins. They can look like tree branches or spider webs. Spider veins can be found on the legs and face.

Deoxygenated blood from our lower limbs is transported to the heart through the veins located in the superficial and deep parts of the leg and thigh. These veins have valves which allow blood to flow one way towards the heart. Contractions of the calf muscles (also known as second pump) facilitate this process. When the valves become weak and defective there is a backflow of blood in the veins. This backflow stretch the veins and they become varicose veins.

Varicose veins and spider veins are common problems. About 40 to 50 per cent of Canadian men and women have this problem. There are many reasons why a person gets varicose veins or spider veins. The common reasons are: increasing age, genetic factors, pregnancy, hormonal changes, obesity, prolong standing and history of deep vein thrombosis (blood clot in the deep veins of the calf). Usually, there is more than one reason why a person develops varicose veins or spider veins.

Conservative measures like regular exercise (walking two miles a day), wearing support stockings and keeping legs elevated when resting and maintaining your weight does help prevent varicose veins and keep symptoms under control for those who have the problem. These veins are not life threatening. They are a nuisance and unsightly. They may give you aching legs, swelling or discoloration of the skin. They may become painful and inflamed (phlebitis).

Not all doctors treat varicose veins. Some doctors have a special interest and expertise in this area of medicine. The treatment requires patience, perseverance and some technical skills. You have a choice of conservative therapy (mentioned earlier), sclerotherapy, laser surgery or surgical ligation and stripping.

Sclerotherapy is a common treatment for both spider veins and varicose veins. The treatment involves injection of a solution into the vein that causes the vein to seal shut. You may need more than one treatment. There is about 50 to 90 per cent success rate and it is done in the doctor’s office.

Laser surgery has become very popular method of treatment. It transmits very strong bursts of light onto the vein. The vein slowly fades and disappears. The procedure involves no needles or surgical incisions. But the laser beam does produce heat sensation on the skin and can be painful. Cooling helps relieve the pain. More than one treatment is required depending on the severity of the problem.

Treatment of larger veins like the saphenous vein requires more invasive therapy. Endovenous techniques (radiofrequency and laser) require insertion of a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Surgical ligation and stripping of varicose veins is an old fashioned technique to fix the veins in the operating room mostly under general anaesthetic.

Choice of treatment depends on the severity of the problem. Each procedure has advantages and likely complications. Discuss your problem with your family doctor and get a referral to a physician who is skilled in the management of this problem. Don’t forget to work on your second pump.

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What’s New About Osteoporosis?

Osteoporosis is a condition in which there is a gradual softening of the bones which makes them fragile. It is caused by the loss of calcium. Our current understanding has been that osteoporosis occurs most often in women after the age of menopause. Men can suffer from osteoporosis as well when they experience low levels of testosterone.

Bone fracture is a common complication of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. A person may lose height if the vertebra collapses due to osteoporosis. One may develop a hump if several vertebrae collapse.

Other causes of osteoporosis for men and women are: long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, low body weight and medical conditions that affect absorption, such as celiac disease. Diagnosis of osteoporosis is made by measuring bone mineral density.

A recent article in the CMAJ says that our understanding of and approach to osteoporosis is in the middle of a revolution. Research now shows the bone loss begins before menopause and involves other hormones in addition to estrogen, and that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis.

The ongoing Canadian Multicentre Osteoporosis Study also shows that both men and women experienced an additional phase of accelerated bone loss from age 70 onward. Hormone replacement therapy with estrogen in women does protect against bone loss over time.

The finding that bone loss began before menopause indicates that estrogen loss alone cannot account for the changes. Therefore, interest has focused on other hormones whose levels change in early menopause such as follicle-stimulating hormone and the activins and inhibins. The role of steroid produced in the body and the size of the body composition is being determined.

The current national guidelines recommend that the test for osteoporosis (measuring bone mineral density) should be done every 2-3 years. In one of the CMAJ articles, Berger and colleagues suggest that densitometry for most women can be repeated every five years rather than every 2–3 years because the average changes in bone density over 2–3 years is small and comparable to the measurement error in the scanning technique.

There is also a question whether women who are already receiving treatment for osteoporosis should have follow-up assessments of bone density at all, since changes in density as a result of therapy account for only a small component of the effectiveness of these medications, says the CMAJ article.

There are four key points in the CMAJ articles: bone loss in women begins before menopause and is accelerated in old age, medications which reduce the loss of calcium from the bone helps preserve bone density, the interval between bone density assessments can safely be increased to 5 years for many untreated women and finally, decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk as indicated by the bone density test.

Osteoporosis is treated with calcium and vitamin D supplements, a variety of hormone treatments (hormone replacement therapy like estrogen) and Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis. But prevention is better than cure. So, increase calcium and vitamin D in your diet, increase the amount of weight-bearing exercise you do, reduce your alcohol intake and quit smoking.

So, have you had your glass of milk today?

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