4 Keys to Strength Building and Muscle Mass

Muscle is harder to build and maintain as we age. In fact, most of us start losing muscle around age 30, with a 3- to 8-percent reduction in lean muscle mass every decade thereafter.

This is due to lower testosterone levels in men and lower estrogen levels in women — both hormones that help build muscle — as well as changes in nerve and blood cells and the body not converting amino acids to muscle tissue as efficiently, among other factors. But muscle loss doesn't have to be inevitable: For adult men and women, regular resistance training exercises are key to building and keeping muscle. 

Strength Training and Health

Strength training is an important piece of the fitness equation. Men and women should participate in muscle strengthening activities that work the major muscle groups (legs, hips, back, chest, abdomen, shoulders and arms) at least two times each week. Examples of strength training include lifting weights, using resistance bands and doing push-ups, pull-ups and sit-ups. Even everyday activities such as carrying groceries, playing with your kids and gardening can strengthen muscles.

One of the best ways to support strength building is good nutrition. Protein, carbohydrates and fat play a major role, as does getting enough calories throughout the day. Read on to find out how each macronutrient can help you bulk up — and how much to eat every day.

Protein and Muscle Building

When building muscle, the more protein the better, right? Not necessarily. While you're working to build muscle with exercise, protein should make up 10 to 35 percent of total calories for adults. Research shows there is no benefit to eating more protein than this amount and it can be harmful.

Keeping muscle mass, on the other hand, requires a lot less protein than building new muscle. For example, the recommended dietary allowance for protein for the average adult is 0.37 grams per pound of body weight, and that equals about 56 grams of total protein for a 150-pound adult. A typical day that includes 3 servings of low-fat or fat-free dairy plus 3 servings of protein foods (such as lean meat, poultry, fish or beans) will provide quality sources of protein to help reach that goal. Grains, especially whole grains, also provide some protein but may not be enough to meet dietary needs.

Protein levels of common foods:

• 1 large egg = 6 grams
• 1 cup low-fat milk = 8 grams
• 1 cup plain low-fat yogurt = 12 grams
• ½ cup low-fat cottage cheese = 14 grams
• 2 tablespoons peanut butter = 8 grams
• 1 cup cooked quinoa = 8 grams
• 3 ounces of lean ground beef = 22 grams
• 3 ounces skinless, baked chicken = 26 grams
• 3 ounces grilled salmon = 21 grams
• 3 ounces firm tofu = 8 grams

Carbohydrates and Muscle Building

Carbohydrates are an important group of foods for fueling your muscles. That's because carbs are partially converted to glycogen, which is stored in muscle to power your workouts. Men and women who are strength training at least twice a week need at least half of their calories from carbohydrates per day. That doesn't mean you should be loading up on pizza and bagels. Try adding in good quality carbohydrates that are low in fat, such as whole-grain breads and cereals for the best strength-training boost. Low-fat milk and yogurt and fruits and vegetables also are good options and provide some carbohydrates in our diet. When planning your meals and snacks, it is recommended to stay away from higher fiber foods immediately prior to or during exercise.

Fat and Muscle Building

Contrary to the fat-free trend, you actually need fat in your daily diet. Your body relies on fat to supply energy to muscles during activity, and how much fat a person needs can vary. As a general guideline, fat should make up 20 to 35 percent of your total calories.

For overall health and muscle strength, focus on sources of heart-healthy fats, including extra-virgin olive oil, canola oil, walnuts, pistachios, almonds, avocados and fatty fish such as salmon, halibut, mackerel, sardines and trout.

Fat contains twice the number of calories as carbohydrates and protein, so it is important to monitor serving sizes. For example, 1 tablespoon of olive oil has 120 calories and 1 ounce of walnuts (about 14 nuts) has 185 calories. If possible, measure and count before eating.

Reviewed November 2016

Caffeine and Exercise

Caffeine is the No. 1 most socially acceptable and frequently used drug. Yes, caffeine is a drug. More specifically, it's an ergogenic aid, meaning caffeine helps the body perform better during physical activity. The 2014 Perceived Exertion Laboratory Manual reports the ergogenic effect of caffeine occurs because it changes a person's perception of how much effort an individual puts forth while exercising. In other words, caffeine gives exercisers a boost in energy so they push themselves harder.

What is Caffeine?

Caffeine occurs naturally in some seeds and plants, the most common being coffee beans and cacao beans. Historically, people have consumed caffeine mostly through coffee and tea, but manufacturers have started producing it chemically and adding it to numerous drinks and foods for its physical and psychological boost. Most people are familiar with energy drinks, which reduce fatigue and improve performance. And, many individuals now consume caffeine pre-workout, predominantly through energy drinks or gels, to reap the benefits of a more exerting workout.

How Does it Work?

Caffeine improves both endurance and resistance training. The Limits of Human Endurance, published in 2013, explains that caffeine increases dopamine in the brain, especially in the areas related to focus, vigilance and perception of fatigue. The Journal of Sports Sciences published a study in 2012 reporting inactive men bicycled harder when they had consumed caffeine than when they did not have any caffeine; but in both cases the men felt like they had exerted the same effort. And a 2005 study in the Scandinavian Journal of Medicine & Science in Sports found the same: Researchers concluded the effect of the caffeine in the participants' brain made them feel like they did less work when consuming caffeine, but, in reality, they actually exercised harder.

How Much Caffeine is Healthy?

A healthy adult can safely consume 300 to 400 milligrams of caffeine or about 3 to 4 cups of brewed coffee a day. A shot of espresso has about 75 milligrams of caffeine and energy drinks range from 47 to 163 milligrams of caffeine per 8 ounces.

Used properly and within the recommended amounts, caffeine can have positive outcomes. Enjoying a caffeinated beverage before hitting the gym does have its benefits, but it is important to make wise choices. For example, consider ordering a 12-ounce low-fat latte before a workout. At 120 calories with 10 grams of protein, 75 milligrams of caffeine and naturally occurring sugars, a latte can be a healthy pre-workout boost.

Reviewed by Sharon Denny, MS, RDN

Reviewed April 2015Sarene Alsharif, MPH, is a self-employed nutrition educator and writer in Rockford, Ill.

3 Easy Tips for Fueling Your Workout without Overdoing It

Heading to the gym after work for a quick workout? Out for a morning walk with the dogs? Working out is good for physical and mental health. Although many individuals workout for weight loss or maintenance, exercising burns fewer calories than you might think. For example, you burn about 100 calories for every mile you walk or run. Yet, the average energy bar provides about 250 calories and a 16-ounce fruit smoothie has 350 to 400 calories, so it is easy to overdo it when you think you're just preparing for your workout.

Here are some tips for fueling your workout without sabotaging the calorie-burning effort of exercise.

The Morning Workout

A low-intensity morning workout — such as a walk, bike ride, yoga or round of golf — requires very little fuel. Concentrate on hydration and a small carbohydrate-rich snack, such as 16 ounces of water and a mini-bagel or a 100-calorie granola bar. That will give you enough energy to compensate for an overnight fast without loading up on calories. After your workout, eat a smart breakfast of quality carbohydrates and protein. This can be a hard-cooked egg, a slice of whole-grain toast and 100-percent fruit juice, or oatmeal with berries and fat-free milk.

In the Evening

If you exercise after work, plan to eat lunch 3 to 4 hours before your workout. Good choices include a grilled chicken salad, a grilled cheese sandwich with a cup of tomato soup, or a turkey sub with baked chips. A healthy lunch will provide enough calories to sustain a late afternoon workout, but give yourself a little energy boost 15 to 30 minutes before your workout by eating a banana, orange slices or a handful of grapes, along with a cup of water. When it comes to hydration, water is a good choice for exercise lasting less than an hour, but consider a sports drink if you are exercising for more than an hour at a higher intensity. If you are working out for more than an hour in a hot, humid climate, be sure to stay hydrated with 3 to 8 ounces of a sports drink every 15 to 20 minutes.

Refueling

After a workout, rehydrate with water. If you are heading home and eating dinner within a couple of hours, there is no need for a post-workout snack. If your meal will be delayed, then recover with 6 to 8 ounces of fat-free chocolate milk, 6 ounces of low-fat Greek yogurt, or a stick of string cheese with a few whole-grain crackers.

Try not to fall into the cycle of skipping breakfast, eating a light lunch and, then, exercising after work with little fuel on board. With this scenario, you are more likely to overeat after your workout because you are so hungry from not eating enough during the day. Another mental trap is rewarding a good workout with high-calorie or fatty foods. Rewarding your workout with food and high-calorie fluids will undo your efforts in the gym; instead, treat yourself to a new pair of sneakers for a job well done.

Reviewed October 2016

What Do Olympians Eat? The Role Sports Dietitians Play in Athletes' Training

What does it take to fuel the strength, speed, endurance and grace of Olympic athletes? It takes years of training and hard work, and sports dietitians are part of many Olympic hopefuls' team — helping to propel athletes to achieve the Olympic motto: Citius, Altius, Fortius (Faster, Higher, Stronger).

For athletes, nutrition is one leg of the three-legged stool that supports their performance. Genetic endowment coupled with sport-specific training and coaching cannot stand on their own without proper food and fluid intake.

Registered dietitian nutritionists are finding creative ways to feed athletes to help them get the most out of their training. Shawn Hueglin, PhD, RD, CSSD, senior United States Olympic Committee sports dietitian, provides nutrition coaching for team sports. Many of her athletes focus on achieving and maintaining lean body mass to have the endurance, agility and skill they need. "I find that blanket nutrition recommendations are not always helpful, as different athletes on the same team have different nutritional needs," Hueglin says. "The field hockey goalie is different from a midfielder who might run several miles during a match, so altering dietary intake based on physiological demands of the position is important."

Athletes and their nutrition needs can differ significantly from that of the general public. Who could forget Michael Phelps' 8,000- to 10,000-calorie-per-day diet while training for the 2008 Olympics? The International Olympic Committee's 2010 Consensus Statement on Sports Nutrition recommends athletes eat enough carbohydrate-rich foods to maximize muscle glycogen stores before training and competition and replenish the stores after hard exercise. The timing of protein intake can promote muscle protein synthesis.

Page Love, MS, RD, CSSD, LD, who has worked as a nutrition consultant to United States Tennis Association, has helped prepare future Olympians to take the court. Love helps athletes make healthful food choices and develop sound on-court hydration plans. Heat illness is one of the most common sports medical issues and it is completely preventable. "Matches can be quite long — three to four hours with five sets — so they need more than fluids. I encourage them to eat high-carbohydrate energy bars, gels and bananas, in addition to high-carbohydrate sport drinks with packets of electrolytes to help them replace on-court losses," she says.

Athletes seek every edge they can get, and proper nutrition with the help of a registered dietitian nutritionist can help them find it.

Larger doses of vitamin C may lead to a greater reduction in common cold duration

The relationship between vitamin C dosage and its effects on the duration of the common cold symptoms may extend to 6-8 grams per day.

Dozens of animal studies using different animal species have found that vitamin C significantly prevents and alleviates infections caused by diverse bacteria, viruses, and protozoa. Given the universal nature of the effect of vitamin C against various infections in different animal species, it also seems evident that vitamin C influences the susceptibility to, and the severity of infections in humans. However, the practical importance of vitamin C in human infections is not known.

The common cold is the most extensively studied infection regarding the effects of vitamin C. The majority of controlled trials have used a modest dosage of only 1 g per day of vitamin C. The pooled effect of all published studies has shown a statistically highly significant difference between the vitamin C and placebo groups, which indicates a genuine biological effect. However, the optimal doses and the maximal effects of vitamin C on the common cold are unknown. The trials that used doses higher than 1 g per day usually found greater effects than trials with exactly 1 g per day, which suggests a dose dependent effect. Nevertheless, definitive conclusions cannot be made from such a comparison because of numerous confounding differences between the trials. The most valid examination of dose-response is therefore within a single trial that has randomly selected trial groups with different vitamin C doses, so that exposure to viruses is similar and the outcome definition is identical in the study groups.

Dr. Harri Hemilä from the University of Helsinki, Finland, analyzed the findings of two randomized trials each of which investigated the effects of two vitamin C doses on the duration of the common cold. The first trial administered 3 g/day vitamin C to two study groups, 6 g/day to a third group, and the fourth group was administered a placebo. Compared with the placebo group the 6 g/day dose shortened colds by 17%, twice as much as the 3 g/day doses did. The second trial administered 4 g/day and 8 g/day vitamin C, and placebo to different groups, but only on the first day of the cold. Compared with the placebo group, the 8 g/day dose shortened colds by 19%, twice as much as the 4 g/day dose did. Both studies revealed a significant dose-response relationship between the vitamin C dosage and the duration of the common cold. The dose-response relationship in these two trials was also quite linear up to the levels of 6-8 g/day, thus it is possible that even higher doses may lead to still greater reductions in the duration of common cold. Dr. Hemilä notes that there have been proposals that vitamin C doses should be over 15 g/day for the best treatment of colds, but the highest doses that have so far been investigated in randomized trials have been much lower.

Dr. Hemilä concludes that "given the consistent effect of vitamin C on the duration of colds, and its safety and low cost, it would be worthwhile for individual common cold patients to test whether therapeutic 8 g/day vitamin C is beneficial for them. Self-dosing of vitamin C must be started as soon as possible after the onset of common cold symptoms to be most effective." Dr Hemilä also states that further therapeutic trials should be carried out to investigate the dose-response relation in the region of over 8 g/day of vitamin C.

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Materials provided by University of Helsinki. Note: Content may be edited for style and length.

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Journal Reference:

1. Harri Hemila. Vitamin C and Infections. Nutrients, 2017; 9 (4): 339 DOI: 10.3390/nu9040339

Insomnia associated with increased risk of heart attack and stroke

Insomnia is associated with increased risk of heart attack and stroke, according to research published today in the European Journal of Preventive Cardiology.

"Sleep is important for biological recovery and takes around a third of our lifetime, but in modern society more and more people complain of insomnia," said first author Qiao He, a Master's degree student at China Medical University, Shenyang, China. "For example, it is reported that approximately one-third of the general population in Germany has suffered from insomnia symptoms."

"Researchers have found associations between insomnia and poor health outcomes," continued Miss He. "But the links between insomnia and heart disease or stroke have been inconsistent."

The current meta-analysis assessed the association between insomnia symptoms and incidence or death from cardiovascular disease (acute myocardial infarction, coronary heart disease, heart failure), stroke, or a combination of events. Insomnia symptoms included difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep.

The authors analysed 15 prospective cohort studies with a total of 160 867 participants. During a median follow-up of three to 29.6 years, there were 11,702 adverse events.

There were significant associations between difficulty initiating sleep, difficulty maintaining sleep, and non-restorative sleep and the risk of heart disease and stroke, with increased relative risks of 1.27, 1.11, and 1.18, respectively, compared to those not experiencing these insomnia symptoms. There was no association between early-morning awakening and adverse events.

Miss He said: "We found that difficulty initiating sleep, difficulty maintaining sleep, or non-restorative sleep were associated with 27%, 11%, and 18% higher risks of cardiovascular and stroke events, respectively."

"The underlying mechanisms for these links are not completely understood," continued Miss He. "Previous studies have shown that insomnia may change metabolism and endocrine function, increase sympathetic activation, raise blood pressure, and elevate levels of proinflammatory and inflammatory cytokines -- all of which are risk factors for cardiovascular disease and stroke."

Women with insomnia symptoms had a slightly higher risk of cardiovascular and stroke events than men, especially for non-restorative sleep, but the difference between sexes did not reach statistical significance.

Miss He said: "We cannot conclude that insomnia is more dangerous for women, given the limitations of meta-analyses and the lack of a statistically significant difference between sexes. However, we do know that women are more prone to insomnia because of differences in genetics, sex hormones, stress, and reaction to stress. It may therefore be prudent to pay more attention to women's sleep health."

Miss He concluded: "Sleep disorders are common in the general population and sleep health should be included in clinical risk assessment. Health education is needed to increase public awareness of insomnia symptoms and the potential risks, so that people with sleep problems are encouraged to seek help."

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Story Source:

Materials provided by European Society of Cardiology. Note: Content may be edited for style and length.

New treatment for antibiotic resistant bacteria and infectious disease

A study, published in the American Journal of Respiratory and Critical Care Medicine, describes a new treatment pathway for antibiotic resistant bacteria and infectious diseases with benefits for patients and health care providers.

Researchers from the University of Birmingham and Newcastle University found that the unusual approach of removing antibodies from the blood stream reduced the effects of chronic infections, the requirement for days spent in hospital and the use of antibiotics.

In this study, the team identified two patients with bronchiectasis who suffered with chronic Pseudomonas aeruginosa infections that were resistant to many antibiotics; a 64-year-old male, diagnosed with bronchiectasis aged fifteen, and a 69-year-old female who had bronchiectasis from childhood.

Bronchiectasis is a disease that leads to permanent enlargement of the airways in the lung and affects over 300,000 patients in the UK. Symptoms are debilitating for patients, and typically include a chronic cough, shortness of breath, coughing up blood, and chest pain. Bronchiectasis often affects patients beyond the age at which lung transplantation is possible.

Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis. Pseudomonas aeruginosa is a common bacterium that can cause disease and is known as a multidrug resistant pathogen, recognised for its advanced antibiotic resistance mechanisms and association with serious illnesses.

The patients volunteered to be part of an explorative treatment that built on previous findings from the research group in 2014.

Professor Ian Henderson, Director of the Institute of Microbiology and Infection at the University of Birmingham, explained, "These patients had an excess of a particular antibody in the bloodstream. In contrast to the protective effect normally associated with antibody, in these patients the antibody stopped the immune system killing the Pseudomonas aeruginosa bacterium and this worsened the patients' lung disease. Perhaps counter-intuitively, we decided to remove this antibody from the bloodstream and the outcomes were wholly positive."

Dr Tony De Soyza, Bronchiectasis service lead, Newcastle Upon Tyne Hospitals Trust and Senior Lecturer at Newcastle University, explained, "We needed a brand new way of tackling this problem. Working with kidney and immunology experts, we used a process known as plasmapheresis that is somewhat like kidney dialysis. The plasmapheresis involved the removal, treatment, and return of blood plasma from circulation, and was done 5 times in a week in order to remove antibody from the patients. We then replaced antibodies with those from blood donations. This treatment restored the ability for the patients' blood to kill their infecting Pseudomonas."

Both patients reported a rapid improvement in health and wellbeing, greater independence and improved mobility compared to any point in the previous two years.

Professor Henderson added: "This shows that we can improve patient wellbeing significantly, by reducing the need for treatment and the numbers of days spent in hospital, which will also help to reduce the reliance on antibiotics. The next step is to do longer term studies to investigate whether an earlier intervention, with slightly less aggressive therapies, could help prevent disease progression in patients."

This is the first description of antibody-dependent enhancement of bacterial disease. It may be widely applicable to other bacterial infections and offers hope for the treatment of some antibiotic resistant infections.

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Story Source:

Materials provided by University of Birmingham. Note: Content may be edited for style and length.

Metabolic Syndrome Prevention: Causes, Symptoms, Risk Factors and Treatment

Metabolic syndrome is a genetic disease, however, it is not fully understood why the metabolic syndrome X occurs but if it is known that people who have it have an increased risk of myocardial infarction or coronary artery disease.

Metabolic Syndrome prevention
Metabolic Syndrome Risk Factors:

There are risk factors that play an important role in the likelihood of a person suffering from cardiovascular disease.

Some of these cardiovascular risk factors are presented together in certain people. This conjunction of risk factors is called the metabolic syndrome.

Metabolic syndrome increases the risk of heart disease, stroke, diabetes mellitus type 2, kidney disease and circulation problems in the legs.

Central obesity, an excess of fat in the abdominal area.

High blood pressure of 130/85 mm.Hg. (Millimeters of mercury) or higher. A normal blood pressure measurement is 120 mm.Hg. Or less for systolic (maximum) and 80 mm.Hg. Or less for diastolic (minimum) pressure.

Elevated fasting blood glucose level equal to or greater than 150 mg./dl.

Elevated levels of Triglycerides:

More than 150 mg./dl. (Milligrams per deciliter). Triglycerides are a type of fat in the blood.

Low HDL cholesterol levels (“good” cholesterol), defined as less than 40 mg./dl. In men and less than 50 mg./dl. In the women.
Metabolic Syndrome Treatment:

Treatment of metabolic syndrome is to treat the other underlying diseases. Therefore, if the patient has diabetes, hyperinsulinemia, elevated cholesterol or high blood pressure, he or she should receive appropriate treatment.

Exercising and losing weight are also useful measures to improve insulin sensitivity and lower blood pressure and cholesterol levels.

In some cases, medications may be given to treat the metabolic syndrome, but the doctor will recommend changes in lifestyle, such as following a healthy diet, quitting smoking, and reducing alcohol.

The anti-aging diet: 9 foods that fight wrinkles

If you’re scrutinizing over your dull, dry winter skin and fine lines and wrinkles, you’re not alone. According to a recent national survey by Allergan, Inc., approximately 60 percent of women 21- to 65-years-old said they would rather have a younger-looking face than a younger-looking body.

Yet experts say it’s time to forget the expensive creams and procedures. The key to aging gracefully is simple: Eat healthy.

Here, find out which foods to avoid and which to add to your plate for beautiful, younger- looking skin..

1. Cut out inflammatory foods.
“Foods that create inflammation are pro-aging,” said Dr. Frank Lipman, an integrative and functional medicine physician and author of “The New Health Rules.” Nix processed, packaged and fast foods, as well as gluten, dairy and sugar.

“Eating too much sugar will make you more prone to wrinkles and make you age quicker,” he said.

2. Omega fatty acids.
Keeping your skin well-hydrated from the inside out is one of the best ways to prevent dry skin and wrinkles. Omega fatty acids -3, -6, and -9 found in healthy fats and oils are vital because they become part of the skin cell walls.

“If the skin cell walls are plump and healthy, the skin will look more hydrated and dewy as well,” said Paula Simpson, a nutricosmetics formulation expert and beauty nutritionist.

Salmon, walnuts, flaxseeds, chia seeds, coconut oil, olive oil and avocado are all great choices.  

3. Amino acids.
Another cause of wrinkles is the weakening of collagen and elastin in the skin that happens as we age. Amino acids found in protein sources can help rebuild and repair damage. Meat, fish, eggs, tofu, some grains, nuts, and seeds are all excellent sources.

4. Leafy green vegetables.
Broccoli, kale, spinach and mustard greens will keep your skin hydrated and healthy. Green juices are also an easy way to help absorb the nutrients more quickly.

“It’s like a liquid multi-vitamin full of antioxidants,” Lipman said. Be sure to limit the added sugar and fruits with a high glycemic load.  

5. Phytoceramides.
“As we age, the epidermis (the skin’s outer layer) thins and weakens, making it susceptible to dehydration and wrinkling,” Simpson said.
What’s more, production of ceramides— molecules that keep the skin firm —starts to slow down. Phytoceramides, plant-based ceramides found in wheat germ, brown rice, spinach and beets, can help to protect the skin’s outer layer.

6. Antioxidants.
Too much time out in the sun is a leading cause of aging.  The sun creates free radicals that can permanently kill off healthy skin cells. Yet the sun is not the only culprit— an unhealthy diet can do the same. Load up on a variety of brightly colored, antioxidant-rich foods that contain carotenoids like tomatoes, carrots, kale and pumpkin that can protect the skin and reverse some of the damage.

7. Potassium-rich foods.
If you have dark circles under your eyes, it’s probably genetic but they can also be caused by water retention or sodium-rich foods. Many fruits and vegetables, as well as potatoes, nuts, beans, legumes, meat, poultry and fish are potassium-rich and can offset the sodium. Plus, cutting down on your salt intake is a wise choice for your skin and your overall health.

8. Rooibos tea.
High in polyphenols that help protect the skin from premature aging, rooibos tea hydrates the skin and is an alternative to coffee, which can dehydrate your skin.

9. Fermented foods.
Probiotics regulate digestion and put the good bacteria back in the gut, which can also help skin look healthy, Lipman said. Sauerkraut, kimchi, kefir, and fermented vegetables are all probiotic-rich.

Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She's also a mom of two. Learn more about Julie at revelantwriting.com.

Researchers identify key hormone critical for preventing spread of bacterial pneumonia

Researchers have found that a hormone responsible for controlling iron metabolism helps fight off a severe form of bacterial pneumonia, and that discovery may offer a simple way to help vulnerable patients.

The researchers at the University of Virginia School of Medicine have identified a key hormone critical for preventing pneumonia bacteria from spreading throughout the body. The hormone, hepcidin, is produced in the liver and limits the spread of the bacteria by hiding the iron in the blood that the bacteria need to survive and grow.

Stimulating hepcidin production in patients who do not produce it well, such as people with iron overload or liver disease, may help their bodies effectively starve the bacteria to death. That finding could be lifesaving for these vulnerable patients, especially as pneumonia bacteria grow increasingly antibiotic antibiotic-resistant.

"The rate at which these organisms become resistant to antibiotics is far faster than the rate at which we come up with new antibiotics. It's a race, and they're winning it," said researcher Borna Mehrad, MBBS, of UVA's Division of Pulmonary and Critical Care Medicine. "Increasingly, the choice of antibiotics to treat these infections is more and more limited, and there are occasions where there just isn't an antibiotic to treat with, which is a very scary and dangerous situation."

Helpful Hormone

Mehrad and his team, including colleagues at the University of California, Los Angeles, found that mice that had been genetically modified to lack hepcidin were particularly susceptible to bacterial pneumonia. Nearly all of the mice had the pneumonia bacteria spread from the lungs into their bloodstream, ultimately killing them. "It's the exact same thing that happens in people," Mehrad said. "The mice that lacked the hormone weren't able to hide iron away from the bacteria, and we think that's why the bacteria did so well in the blood."

Researcher Kathryn Michels, a graduate student in Mehrad's lab and the first author of a manuscript outlining the findings, noted that many people lack the hormone because of genetic illnesses or liver disease. "It's quite common," she said. "We think this line of research is very relevant to the many people who can't make this hormone very well and are, clinically, very susceptible to these infections."

She noted that there is already a drug in development that mimics the function of hepcidin and could be used to decrease the iron levels in the blood of pneumonia patients who lack hepcidin. That drug has been developed primarily to treat chronic iron overload, such as is seen in people with hereditary hemochromatosis, but the new research may give it another, lifesaving application.

"We think that short-term treatment with this drug should be an effective way of treating these [pneumonia] infections," Mehrad said. "At least in mice, it seems to work extremely well."

Source:

https://news.virginia.edu/content/discovery-may-help-patients-beat-deadly-pneumonia

Flexible approach to exercise works better for new moms than specific regimen

Often running on empty, new moms may need a bit more flexibility and support to ease back into exercise after giving birth, according to a Kansas State University researcher.

Emily Mailey, assistant professor in kinesiology, said when a mom has survived the first several weeks of having a new baby and is ready to start adding exercise — and all of its benefits — back into her life, a more flexible approach works better than a specific regimen. That's according to Mailey's study, recently published in the Journal of Health Psychology.

"Specific exercise programs can seem like an insurmountable barrier to new moms," Mailey said. "The results of this study suggest that the idea of encouraging new moms to fit in any kind of activity any way they can might be the best approach for easing back into exercise after giving birth."

As part of the intervention study, Mailey hosted workshops for mothers who had given birth between six weeks to 12 months before the start of the study to discuss strategies for increasing physical activity. All participants wore accelerometers for a week to measure activity before the workshops, immediately after the workshops and six months later. Mailey also specifically measured mothers' perceptions of barriers to exercise.

"Even people who were really active before having kids tend to decrease their physical activity after having kids because they prioritize the baby's needs first," Mailey said. "In the workshops, we talked specifically about guilt and the idea that doing something for yourself is not selfish — it actually might help you be more patient or have more energy for your kids."

Mailey divided the workshop participants into two groups. One group got general advice to increase activity and help with barriers while doing any exercise they chose, including exercise with the baby. The other group got the same advice but it was centered around a regimented running program that is designed to help a sedentary person gradually increase running with 30 minutes of exercise three times a week.

"I went into the study to see if the running program would help new moms find success with getting back into exercise," Mailey said. "It seemed to me that it would be especially appropriate for new moms because it laid out the steps they need to be successful. That's the opposite of what I found."

Moms that were in the flexible group — the group that chose their favorite exercise — increased physical activity slightly more than the regimented running group over six months, but all moms became more proficient at planning exercise into their lives as new moms and perceived time and guilt to be more surmountable barriers.

"It's difficult for a mom to get out of this mindset that her main role is to care for her family," Mailey said. "In the workshops, we talked about how that didn't necessarily need to be at odds with exercising. Being active might actually help moms be better equipped to care for their family by enjoying some of the mental health benefits of exercise."

Time and type of physical activity may have been why the flexible approach had a slight increase in prolonged physical activity.

"Some people hate running and this program didn't change that," Mailey said. "So, the type of exercise might have been one barrier, but another was time. I was surprised by how many people said finding a 30-minute block of time that they can dedicate to exercise was too difficult."

Building confidence in planning around potential barriers is one way moms can successfully balance the demands of motherhood and exercise. For example, Mailey said a kid's sleepless night might make her too tired for her morning workout so she has a backup plan — like a noontime walk or evening dance party. The backup plan gives moms confidence to follow through with exercise.

The exercise shouldn't be something the person hates to do, Mailey said. In the flexible group, she discussed the importance of finding an activity that the moms enjoyed doing and talked about how that activity can be broken into three 10-minute bouts of activity if needed instead of one 30-minute session a day.

"Maybe all you can do is fit in five minutes here or do 10 minutes there," Mailey said. "By changing your mindset so that everything counts, you can build it into your day and it's more feasible than these 30-minute chunks."
She also advised moms in the flexible group to set realistic measurable goals. For example, the 10,000 steps guideline may be too much for new moms.

"I don't think there is a magic number for steps," Mailey said. "Though 10,000 steps per day is what is thrown out a lot, I encourage people to start with a baseline week just to see how many steps they get normally and then try to increase gradually."

Overall, the workshops gave mothers support and strategies to overcome barriers, but Mailey also tried help mothers see exercise differently.

"Modeling healthy behaviors for our children and talking positively about exercise will help them have a healthy view of exercise, what it is and what it is for," Mailey said.

Source:

http://www.k-state.edu/media/newsreleases/2017-03/newmoms32317.html

Prostate screening often occurs without discussion of benefits, risks

A new study finds that while a blood test that helps to screen for prostate cancer remains common, only 30 percent of men in a large national survey reported having a balanced discussion of the advantages and disadvantages of the screening with their doctor. Moreover, having such a discussion of both pros and cons has become less likely since the U.S. Preventive Services Task Force issued a recommendation against performing prostate-specific antigen (PSA) testing in 2012.

"That only about a third of patients reported having a discussion of advantages and disadvantages is an alarming statistic," said study lead author Dr. George Turini III, clinical instructor in medical science at the Warren Alpert Medical School of Brown University and a urologist with the Southcoast Physician Group.

Co-author Dr. Joseph Renzulli, associate professor of surgery and a urologist at the Minimally Invasive Urology Institute at Miriam Hospital, added, "The concept of 'shared decision making' for prostate cancer screening is not occurring in the community."

For example, in 2014 out of a sample of 111,241 men who responded to the national Behavioral Risk Factor Surveillance System survey, 29.5 percent reported discussing both advantages and disadvantages, 33.9 percent discussed neither, 35.7 percent reported discussing only advantages of PSA, and 0.8 percent reported discussing only disadvantages. In data from 2012, before the task force made its recommendation against the test, out of 105,812 men who responded to the survey, 30.1 percent discussed both, 30.5 percent discussed neither, 38.5 percent discussed only advantages, and 0.8 percent discussed only disadvantages.

Meanwhile, 63.0 percent of the men in 2012 had PSA tests, as did 62.4 percent of the men in 2014, according to the study published online in the journal Urology. In each year thousands of men had the test without having a discussion of how it could either benefit them, for instance via early detection of cancer, or lead to unnecessary adversity, such as a side effects from biopsy or unneeded treatment. They either got no information or only one side of the story.

In addition, the researchers found, men who have low incomes, did not finish high school, lack insurance, or are Hispanic were significantly less likely than men overall to report hearing about the pros and cons of screening via the PSA test, the study found.

"The most vulnerable men are getting less counseling," said co-author Annie Gjelsvik, assistant professor of epidemiology in the Brown University School of Public Health.

A controversial topic

The PSA test reveals blood levels of a protein naturally secreted by the prostate. Levels could become elevated for a number of reasons including the normal enlargement of the prostate as men age, Turini said. But cancer could also elevate them.

When the task force in 2012 discouraged PSA testing, Turini said, it was because there are risks to what follows from screening. If cancer is suspected, it can only be confirmed with a biopsy and that could cause problems such as infection, bleeding or discomfort.

Beyond those concerns, if prostate cancer is confirmed, the risks inherent in treatment options such as surgery, radiation or hormonal alteration, can be "truly life altering," he said.

"In some cases, a low volume of less aggressive prostate cancer may not necessitate treatment, but even in those cases where a 'treatment' is not performed in favor of active surveillance, the emotional distress of a cancer diagnosis shouldn't be underestimated," Turini said.

But whenever a cancer does present a threat to health, there are also clear advantages to catching it early. Therefore many urologists still believe that doctors and their patients should weigh these pros and cons of screening. For that reason, the authors wrote, the American Urologic Association and the American Cancer Society advocate thorough discussion and decision-making between doctors and patients.

The study authors sought to understand the state of those discussions and how the task force recommendation may have changed them. Gjelsvik noted that it's important to measure and track the full spectrum of effects of public health actions, such as the new national recommendations.

The findings could be explained by factors independent of the U.S. Preventive Services Task Force recommendation, the authors acknowledged, but they concluded the paper with this concern: "We believe our findings may be indicative of a shift in practice patterns away from detailed pre-screening discussions among health care providers who have implemented the [USPSTF] recommendation into their care giving. Long-term evaluation of this trend is necessary, particularly to ensure that men who are given an order for a PSA test receive the absolutely necessary counseling required to allow them to appreciate the important consequences associated with the decision to pursue screening."

Amid all the findings of concern, including the overall trend and disparities of income, education, insurance and ethnicity, the researchers did find one bright spot: Black men, who are known to be at higher risk for prostate cancer incidence and death, were more likely to report having discussed advantages and disadvantages than men on average.

Turini said the study suggests that urologists may be able to do more to help their primary care physician colleagues have balanced and informative conversations with their patients. Primary care physicians are increasingly pressed for time with each patient and it can seem easy to order an additional test if blood is going to be drawn for other purposes anyway, Turini said. But the moment when a PSA test comes back with an elevated reading is not the ideal moment to only begin the conversation of what that could mean.

"It's our job in the urology community to make it as easy as possible for the primary care physicians and other general practitioners to comfortably disseminate as complete and balanced information as possible," he said.

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Materials provided by Brown University. Note: Content may be edited for style and length.

Protein identified as potential druggable target for pancreatic cancer

A protein known as arginine methyltransferase 1 (PRMT1) may be a potential therapeutic target for pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer, and one of the most deadliest with a less than 10 percent, five-year survival rate. PRMT1 is involved in a number of genetic processes including gene transcription, DNA repair and signaling.

"Our study has identified and validated for the first time an arginine methyltransferase as a novel genetic vulnerability in PDAC," said Giulio Draetta, M.D., Ph.D., professor of Genomic Medicine and director of Institute for Applied Cancer Science (IACS) at The University of Texas MD Anderson Cancer Center. "These findings strongly suggest a role for PRMT1 in PDAC development and illuminate a path toward the development of therapies for patients in desperate need of innovative solutions."

Results from the study will be reported April 3 at the annual meeting of the American Association for Cancer Research in Washington, D.C.

Various treatment regimens have failed to improve PDAC patient survival, driving the critical need for finding druggable targets essential for tumor maintenance. Draetta's team developed an in vivo platform called Patient-based In vivo Lethality to Optimize Treatment (PILOT), a technology enabling systemic identification of tumor vulnerabilities in patient-derived tumors. Through PILOT, they discovered novel epigenetic drivers in PDAC, including PRMT1 in tumors that harbor KRAS mutations on the background of p53. KRAS and p53 are genes often associated with cancer.

"Through this assessment of epigenetic regulators, we identified PRMT1 as a top scoring 'hit' in these patient-derived tumors," said Virginia Giuliani, Ph.D., senior research scientist, IACS. "This novel dependency was subsequently validated in multiple patient-derived pancreas models."

The team confirmed that genetic "knockdown" of PRMT1 significantly impaired PDAC cell growth in vitro through use of genetic editing tools, including CRISPR and small hairpin RNA (shRNA). This correlated with a global reduction in arginine methylation, which controls multiple cellular processes, including DNA replication and DNA repair.

"We also confirmed a role in PDAC tumor maintenance as inhibition of PRMT1 in patient-derived mouse models significantly inhibited tumor growth and extended survival," said Giuliani. "These data suggest that small molecule inhibition of PRMT1 could be an impactful therapeutic strategy in pancreas cancer."

The teams at MD Anderson's and Center for Co-Clinical Trials are using the PILOT platform to investigate novel vulnerabilities across tumor subtypes with the aim of identifying targets for therapeutic development. PRMT1 is one of several epigenetic dependencies that have been identified using this approach.

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Materials provided by University of Texas M. D. Anderson Cancer Center. Note: Content may be edited for style and length.

Less invasive hysterectomy for early-stage endometrial cancer finds clinical support

Researchers found similar rates of disease-free survival and no difference in overall survival among women who received a laparoscopic or abdominal total hysterectomy for stage I endometrial cancer, according to a study published by JAMA.

Endometrial cancer is the most common gynecological cancer in developed countries. Standard treatment involves removal of the uterus, tubes, ovaries and lymph nodes. Laparoscopic hysterectomy is associated with less morbidity and results in better recovery than open operations, but it is not known if the operation results in survival outcomes equivalent to abdominal hysterectomy.

Andreas Obermair, M.D., of the University of Queensland, Herston, Australia, and colleagues randomly assigned 760 women with stage I endometrial cancer to either total abdominal hysterectomy (TAH; n = 353) or total laparoscopic hysterectomy (TLH; n = 407).

Disease-free survival at 4.5 years was 81.6 percent with total laparoscopic hysterectomy vs 81.3 percent with total abdominal hysterectomy (between-group difference, 0.3 percent), meeting the prespecified criteria for equivalence (a margin of seven percent or less). There was no statistically significant between-group difference in recurrence of endometrial cancer (7.9 percent in the TAH group vs 8.1 percent in the TLH group) or in overall survival (6.8 percent in the TAH group vs 7.4 percent in the TLH group).

"These findings support the use of laparoscopic hysterectomy for women with stage I endometrial cancer," the authors write.

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Elevated blood pressure not a high mortality risk for elderly with weak grip

A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.

New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders' frailty status as measured by walking speed.

The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.

"If people are very frail, they typically don't respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure," said lead author Chenkai Wu, a graduate student in OSU's College of Public Health and Human Sciences. "The research is basically saying older adults are not one single group, they're very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don't just look at age, you look at other things like functional status."

Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.

Most people's diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure -- hypertension -- can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.

But as Wu's research suggests, an elderly patient's level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.

Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.

Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.

The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.

"We did three analyses," Wu said. "One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength -- weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.

"Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial."

OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.

"As we age, our blood vessels lose elasticity and become stiff," said Odden, an assistant professor in the College of Public Health and Human Sciences. "Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.

"And everyone ages differently -- there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process."

In addition to the connection with weak grip strength, Wu said there was a "very clear" inverse association between high blood pressure and mortality among those who weren't physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.

Put another way, among those who couldn't walk a little over 8 feet, high blood pressure was associated with less mortality risk.

"It's a small group but not negligible -- 6 percent -- of people who were not able to complete the test," he said. "Compared to grip strength, it's a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc."

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Materials provided by Oregon State University. Note: Content may be edited for style and length.

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Journal Reference:

1. Chenkai Wu, Ellen Smit, Carmen A. Peralta, Harini Sarathy, Michelle C. Odden. Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14816