Health Tip: Intermittent Fasting - Are There Health Benefits?

Intermittent fasting (IF) is a type of diet strategy that limits calorie consumption to certain hours within a day, or days within a week. Proponents claim that going without food on a regular basis can reduce disease burden/risk and increase longevity. Some of the more popular types of intermittent fasting are:

1. Time-restricted feeding: requires limiting calorie intake to a certain time period, somewhere between eight and 12 hours per day.
    
2. Intermittent calorie restriction: calls for reducing daily caloric intake to 800-1,000 calories, for two consecutive days per week.
    
3. Periodic fasting: requires limiting caloric intake for between three and five days, such that cells are depleted of glycogen stores.

One of the theories behind the health benefits of IF involves an exercise analogy.  Just as high intensity exercise can produce added fitness gains, stressing the body's cells with occasional starvation causes them to be more immuno-fit, ready to fight off disease and inflammation (such as cancer). Another theory is that IF can reset circadian rhythms in the liver, kidney, and stomach, causing more regular hormone production that improves satiety and results in decreased overall calorie consumption. A third theory is that by starving cells of food for a couple of days at a time, the body switches to burning fat rather than sugar, and any weak or damaged cells die off during the fast, hence stimulating a kind of Darwinian health benefit at the cellular level.

These are interesting hypotheses, but currently there is insufficient human research/evidence of such mechanisms to confirm or deny them.

What We Do Know…

1. Fat loss has health benefits, especially for those who are obese or have obesity-related disease, such as type 2 diabetes, heart disease, or high cholesterol.
2. Fat loss attained via IF techniques can produce these health benefits, but does not seem to be superior to fat loss achieved through general (non-timed) calorie reduction.
3. IF, if it causes rebound binging (where foregone calories are consumed later on), does not produce weight loss or associated health benefits.
4. There are at least 40 published, human research studies measuring the effects of IF, most of which have shown health benefits from weight loss produced by IF, but none has demonstrated that IF is superior (for weight loss efficiency) over continuous calorie restriction.  Questions remain about the lifestyle sustainability of IF, as long term studies are currently lacking.

What I Think…
If the prospect of being constantly hungry is what's keeping you from losing weight, and you have no medical conditions that would preclude you from trying IF (i.e. diabetes or an eating disorder), then why not give it a try? At least there are some days/times when you will not feel hungry. Keep in mind that you will be very tempted to binge eat on your days/hours off the fast, and that if you do not decrease your overall average calorie intake, you won't reap the benefits of your efforts.

Although I cannot prove it, I hypothesize that IF may be particularly helpful for those prone to "grazing." Reducing eating hours may naturally result in overall calorie reduction for those who consume a significant amount of calories due to stress or without mindfulness (e.g. the bowl of candy or nuts at the office).
However, if going without food throws you into a tailspin, where you end up thinking about it all the time and then binging the minute you're fast ends, this diet strategy is not for you.

The Bottom Line:
The best weight loss strategy is the one that you can sustain for a lifetime. Barriers to fat loss are complex and differ from person to person. If you have medical conditions that might be worsened by fasting, ask your doctor before you embark on a trial of IF. There's no magic to IF, and so far human studies have not proven it superior for general weight loss than our usual methods. Remember that a healthy diet* is important to maintain, regardless of when you plan to eat. Using IF as an excuse to starve yourself so you can eat all the "bad" foods you've been craving (such as deep fried foods, desserts, and low-nutritional-value snacks) is a recipe for disaster.

*My favorite healthy diet is the Mediterranean Diet. See more at the link below.

References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
http://scopeblog.stanford.edu/2016/07/07/intermittent-fasting-fad-or-science-based-diet/
https://www.medpagetoday.com/primarycare/dietnutrition/70663
https://www.ncbi.nlm.nih.gov/pubmed/26384657
https://endpoints.elysiumhealth.com/the-science-of-fasting-2f5b56a2a65d
Mediterranean diet: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/multimedia/mediterranean-diet/sls-20077104

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Health Tip: Low Testosterone – Who Needs Treatment?

Most of us have heard of the male hormone, testosterone, and may have even blamed it for everything from extreme sports to the road rage videos on 'YouTube'. You may also have seen ads on TV, promoting testosterone therapy for aging men. This strange cultural phenomenon - simultaneously rolling our eyes at a hormone and yet also wanting to supplement it - may be unique to our time.

Both men and women produce testosterone, though women far less of it. And as we age, the amount we make decreases by about 1% per year, starting at age 40. Our natural tendency is to want to supplement things that we lose over time, but the truth is that lower testosterone is not clinically relevant for most men. The aging process is very complicated, and one hormone is not the cause of decline. Supplementing that one hormone, therefore, does not single-handedly reverse the aging process. Symptoms of aging may be related to physical inactivity, over-eating, medical illness, thyroid dysfunction, depression, life stressors, and accumulated injuries completely unrelated to testosterone levels.

Testosterone does support bone density, muscle strength and mass, facial and body hair, red blood cell production, sex drive, and sperm production. But most men have enough to do the job - even at lower levels than their youth's maximum. Low testosterone is diagnosed with a blood test - if your level of the hormone is less than 300 ng/dL, you may have low testosterone. However, keep in mind that testing is tricky because testosterone levels vary over the course of a day - causing the potential for false positive results. The test should be done first thing in the morning and sampled on two different days to make sure the result is accurate.

Conditions associated with reduced testosterone include obesity, diabetes, use of certain medications, hyperthyroidism, and alcoholism. Testosterone exists mostly in an inactive form (bound to proteins in the bloodstream), with only 1-3% of its total free and active. Medical conditions such as obesity and diabetes can cause more of the normal level of total testosterone to be bound to protein, reducing the small, active pool of it. Weight loss and careful management of diabetes, for example, can reverse the seemingly "low" testosterone issue for many men.

Prescription testosterone supplementation has a significant downside, as it can increase your risk for heart disease, blood clots, prostate cancer, sleep apnea, acne, and quite paradoxically, testicular shrinkage and breast enlargement.

If you are looking for natural methods for reducing the aging process and stimulating testosterone production then you're in luck - the answer is regular exercise, particularly weight lifting and high intensity interval training.

Now, there is a fairly rare condition called "hypogonadism" (a dysfunction of the testicles or the pituitary gland that controls them) that results in truly low testosterone levels (below 200 ng/dl). For these men, testosterone supplementation with injections, pellets, or gels, is important. There are various tests and imaging studies available to evaluate hypogonadism, so ask your doctor about your options before you consider supplementation - over the counter or otherwise.

The bottom line is that treating normal aging with testosterone therapy is not currently advisable. Regular exercise (and lowering body fat) with an emphasis on weight-lifting and high intensity interval training 3-4 times a week is the best thing you can do to maintain your manly verve.

References
https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/testosterone-therapy/art-20045728?pg=1
https://www.medscape.com/viewarticle/525147_3

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Health Tip: Fish Oil Capsules – Can They Help Your Heart?

I've been hopeful about the potential health benefits of fish oil since the late 90's when researchers proposed that omega-3 fatty acids reduced inflammation. Our cells are covered in a lipid bilayer that contains a compliment of omega 3 and omega 6 fatty acids, and a higher percentage of omega-3 fatty acids has the potential to decrease inflammatory reactions at the microscopic level. Unfortunately, the clinical significance of having a greater ratio of omega 3 fatty acids to omega 6's on your cell membranes, remains unclear.

In the largest meta-analysis to date (from JAMA Cardiology, January 31, 2018), over 77 thousand patients (in 10 different trials) at high risk for heart attacks and cardiac death were monitored. Those who took fish oil supplements had no decrease in their rates of cardiac disease (or its complications) than those who did not take the capsules.

I think this analysis shuts the door on the belief that fish oil supplements can stave off heart disease. Far more effective are interventions such as: weight loss, healthy diet, regular exercise, quitting smoking and excessive alcohol use, and taking medicines as directed for high cholesterol or diabetes.

Now, remember that fish is an excellent source of healthy protein, and is a staple in the Mediterranean Diet, which has been shown to be one of the heart healthiest diets to follow. Eating fish on a regular basis (especially grilled or prepared without batter) is highly recommended.

However, if you're enduring the "fishy burps" that come along with daily fish oil supplements as a means to keep your heart healthy, I'd say don't bother.

Save the money you're spending on fish oil (as much as $40/month), go for a nice walk to the grocery store and get yourself some fresh fish instead. Your heart (and your loved ones who have noticed your supplement breath) will thank you.

References

The Meta-Analysis:
https://jamanetwork.com/journals/jamacardiology/fullarticle/2670752?utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email

How to reduce your risk of heart attack:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attack-Prevention_UCM_303934_Article.jsp#.WntdG6inGHk

The Mediterranean Diet:
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

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Health Tip: Skin Cancer, Part 2: Treatment and Prevention

Skin cancer is the most common form of cancer in the United States, occurring in over two million people each year.  Three of the most common types of skin cancer are squamous cell carcinoma, basal cell carcinoma, and melanoma. Last week, characteristic features of each of these were described in order to help alert you to the possibility that you may have developed a skin cancer.  This week we’ll look at how these common forms of skin cancer are treated and learn how to reduce your risk of developing skin cancer.
 
Treatment of non-melanoma skin cancers.  Squamous Cell Skin Cancer (SCC) and Basal Cell Skin Cancers (BCC) are the two primary types of non-melanoma skin cancer.  Unlike melanomas, these two types of skin cancer typically remain confined to a primary site and rarely spread. When detected at an early stage and removed promptly, both of these are almost always curable. Treatment methods for these two types of skin cancer are similar and are described below:

Mohs micrographic surgery---This form of treatment results in a near 100% cure rate for SCC and BCC.  It can be performed on an outpatient basis and usually requires only local anesthesia.  Mohs surgery involves removal of visible tumor along with a thin rim of apparently normal tissue using a scapel or surgical curette.  The tissue is examined under a microscope immediately afterward to determine if the tumor was completely removed. If not, the procedure is repeated until the microscopic specimens are tumor-free.  The surgical wound can then be sutured (stitched) or left to heal naturally.

Excisional Surgery---This is similar to Mohs surgery in that the tumor is removed surgically, but the microscopic examination is not performed. As a result, residual tumor may remain which reduces the cure rate as compared to Mohs surgery. 

Electrodessication and Curettage (ED&C) ---Following administration of a local anesthetic, the cancerous lesion is “scraped off” using a sharp instrument called a curette.  Then the tumor bed is “burned” using an electrical current which helps to destroy any remaining cancer cells. This technique works best with skin cancers that are more superficial and have not penetrated the deeper layers of the skin.

Cryosurgery---Commonly known as “freezing”, cryosurgery involves the application of liquid nitrogen using an applicator or spray device.  In this procedure, no cutting, suturing or anesthesia is required.  The cancerous growth is frozen which destroys the tumor cells.  After a few weeks the dead tissue falls off and the skin heals on its own.  Like ED&C, this procedure is best performed on fairly superficial lesions.

Topical medications---Imiquimod and 5-Fluorouracil (5-FU) have FDA-approval for use in treating superficial basal cell skin cancers but not for treating squamous cell skin cancers.  These medications are also approved for treating actinic keratoses (AK’s) of which 10% progress to become squamous cell cancers.
 
Photodynamic Therapy (PDT) may be used for treating AKs or superficial basal cell skin cancers. This form of treatment involves the use of a photosensitizing drug (one that becomes active when exposed to light) along with a light source.  In the U.S., the most common photosensitizing drug for this purpose is aminolevulinic acid (ALA) which is marketed under the trade name Levulan®.   When absorbed by the skin lesion, the cells become highly sensitive to light.  With exposure to FDA-approved light sources a reaction occurs that destroys the abnormal cells.

Treatment of Melanoma Skin Cancers. Melanoma is the most serious type of skin cancer.  Treatment in almost all cases begins with surgical excision, typically including a margin of apparently normal skin to insure that the lesion is removed entirely. Beyond surgical excision, treatment depends on the “stage” or extent of involvement of the cancer.  In the more advanced stages, the tumor can invade deeply, spread to lymph nodes, or even metastasize to other areas of the body.  For the least serious type of melanoma skin cancers (Stage 1), wide surgical excision may be all the treatment that is necessary. The outcome of treatment in these cases may be enhanced by using the Mohs technique.  For higher stages, treatment may include chemotherapy, radiation therapy, immunotherapy, and targeted therapy.  An example of targeted therapy involves the use of a drug, e.g. vemurafenib (Zelboraf) that attacks certain proteins in the tumor, leading to its destruction. While most Stage 1 melanoma patients can be cured, the 5-year survival rate for a Stage 4 melanoma patient is about 15% to 20%.

Reducing the risk of developing skin cancer. The development of most types of skin cancer is directly related to damage from exposure to ultraviolet (UV) radiation from the sun.  Here are some suggestions for minimizing exposure to these harmful rays:

• Avoid being in the sun during the peak hours for UV exposure between 10 AM and 4PM. Don’t forget that snow and water can concentrate the sun’s rays and increase the risk of burning.

• If sun exposure is unavoidable, use a broad spectrum sunscreen that is effective against UVA and UVB radiation with a SPF of 30 or higher.

• For extra protection wear long sleeves and long pants and a wide-brimmed hat.

• Avoid tanning beds or lights. Despite claims of tanning bed companies and booths, the radiation (predominantly UVA) in the lights that they use increases your risk of developing AKs and skin cancer.  

In order to detect AKs or skin cancer in their earliest stages, check your skin regularly and let your doctor know if you notice any suspicious lesions. Look particularly for changes in existing moles or for the development of new skin growths.

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