Fitness Club

Just one week after the spread of Influenza A (H1N1) -- commonly referred to as "swine flu" -- caused declarations of public health emergencies from the local to the international level, questions are arising as to whether public health authorities overreacted to the outbreak and inadvertently triggered unnecessary and harmful behaviors.

This developing debate is important, acknowledged David P. Fidler, the James Louis Calamaras Professor of Law at the Indiana University Maurer School of Law, and author of Biosecurity in the Global Age: Biological Weapons, Public Health, and the Rule of Law.

However, people should be wary of simplistic hype about the "panic" public health responses to the outbreak have ostensibly caused, he cautioned.

"We have seen irrational responses to public health warnings about Influenza A (H1N1), whether we have the 'worried well' burdening emergency rooms or countries banning the importation of pork products from countries affected by the new virus," said Fidler.

"Some overreaction is anticipated and sometimes unavoidable when societies deal with serious infectious disease threats, because responses to such threats often occur in a context of great uncertainty, as has been the case with this new influenza virus," he observed.

"Unlike a hurricane or tornado, where the damage is geographically limited, readily observable, and regularly experienced, certain infectious diseases, particularly influenza, can appear unexpectedly and spread rapidly and silently across a community, a nation, and the planet before scientists and policy makers fully understand the threat," Fidler explained.

"Microbial threats often induce individual and collective fear, which makes promoting responses based on the best available science and public health principles difficult," he continued.

"However, compared to the climate experienced after the anthrax attacks in 2001 and the SARS outbreak in 2003, I am sensing much less panic and more prudence," noted Fidler, "which reflects, in part, the preparations made by governments at all levels for a potential pandemic of influenza. I will be relieved if, at the end of this outbreak, we are left debating whether public health responses were appropriate, rather than counting and mourning thousands killed by an influenza virus we did not fear enough."

Click here to read Fidler's analysis of the Influenza A (H1N1) outbreak and international law.

It is well established that cancer cells feed on blood sugar, but that is not the only nutrient they require. Another major energy source for cancer is glutamine, and a new study conducted by researchers at the Johns Hopkins University School of Medicine and published online in the journal Nature shows how a cancer-promoting gene called "Myc" controls its use.

The findings could offer a new approach toward combating cancer.

The research team was investigating how the Myc gene promotes cancer growth when it made a surprising discovery: The gene actually increases the utilization of glutamine by cancer cells, according to Chi V. Dang, MD, PhD, a professor of oncology at Johns Hopkins.

Protein experts joined the team effort, searching for proteins that responded to Myc. The researchers examined human cancer cells with the Myc gene turned on or off and found eight proteins in the cell's mitochondria that displayed a distinct response to the gene.

One of the proteins that responded to the Myc gene, glutaminase (GLS), supports the production of cellular energy. Cancer growth slowed down markedly when researchers removed GLS.

Building on earlier research, the team found that the Myc gene did not affect GLS directly, but rather affected an intermediary -- "something that in turn controls GLS," according to Ping Gao, PhD, a research associate in hematology at Johns Hopkins.

That "something" turned out to be some microRNAs, small bits of RNA that can bind to and inhibit RNAs, which contain instructions for making proteins. Two microRNAs called "miR23a" and "miR23b" link Myc to GLS expression.

The scientists intend to continue their exploration in a study with mice to see if removing GLS can impede cancer growth.

"If we know how cancer cells differ from normal cells in how they make energy and use nutrients, we can identify new pathways to target for designing drugs with fewer side effects," said Gao. Join the discussion! Send your comments to Daily News Central.

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Jonny Bowden had me at polymeal. Yet there's so much more to offer in this -- for want of a more-adequate term -- "cookbook," that I hardly know where to start. So I'll just relate my journey of discovery with The Healthiest Meals on Earth and encourage you to embark on your own.

First, there's the look and feel of this volume. I admit I'm not drawn to the cover art -- it's probably one of my least-favorite things about this book. But I like the hefty size of it and the durable stock of the 368 pages, and as I began flipping through them, I was enchanted by the photography. There are lush photographs of each polymeal, and nearly every recipe is accompanied by a mouth-watering picture of the dish, presented with antique kitchenware and utensils. The two-page photographic spreads throughout are stunning -- coffee-table quality, in fact: cattle grazing in a lush pasture, salmon leaping in an icy river, sacks of colorful spices, a brilliant cranberry bog, a farm field with soil so rich you can almost feel it, a sunlit orchard, a pomegranate dripping with goodness. The theme of the photography is clear: simplicity and purity, reverence for unspoiled land, and gratitude for the bounty it offers. READ AN EXCERPT

After drinking in the visuals, I began reading, and I must say The Healthiest Meals on Earth is something of a page-turner. It's as though Bowden is sitting on a stool in the corner of your kitchen, chatting amiably about the wonderful qualities of the meal as you assemble its ingredients. He tells you why fat isn't all bad, why sugar pretty much is (and what you can happily use in its place), why grains are overrated, why fiber is fabulous, the importance of omegas, and so on and on -- all in the context of quite wonderful meals that turn those concepts into delicious reality.

I was already familiar with the idea of the polymeal, but this is the first cookbook I've come across that offers a collection of them. The idea is to combine ingredients that boost cardiovascular health -- things like fish, garlic, almonds, fruits, vegetables, dark chocolate and red wine. Bowden takes it further, though, including foods with anti-cancer properties, foods that boost the immune system, foods that fight inflammation, foods that combat obesity -- and much, much more. Thanks to his collaborator, Jeannette Bessinger, CHHC, these foods are combined in innovative recipes that even a cook with modest abilities can enjoy putting together.

It was only after I read every word of this cookbook that I actually began experimenting with the recipes, and I haven't stopped. After preparing more than a dozen of these dishes, I can tell that The Healthiest Meals on Earth is destined to spend a lot more time on the counter than many of the other books on my kitchen shelf.

Among my favorites are real-food brownies -- sugarless and flourless, they're made with dates, cocoa, garbanzo beans, eggs, agave nectar and a few other ingredients. I made holiday gifts of these and haven't found anyone they failed to delight. My family also especially enjoyed the tamari-orange salmon, delicious dal, red beans and brown rice, chili with cashews and kale, and chicken curry. This book is a good mix of meatless and meat-based recipes, which works well for our mixed family. (I've experimented with some of the meat recipes to accommodate our vegetarians, and found them quite readily adaptable.)

I like the flax pancakes in principle, but the execution has been disappointing. They taste just fine, but they're very dry. Still, I'm going to keep making them and experiment with toppings until I get these cakes right.

This cookbook includes lots of tips, notes and some useful reference material (I particularly like the chart on healthy oils), along with pantry lists for each section that make shopping easier. Fans can find a lot more at Bowden's website, www.jonnybowden.com.

I have a few small quibbles with The Healthiest Meals on Earth. Surprisingly, it doesn't include standard nutritional information for each recipe. This is something I really expect in a health-oriented cookbook.

One contradiction concerning olive oil bothers me. The helpful chart on oils includes the direction, "Do not use extra virgin [olive oil] for cooking; heat will create free radicals." Yet recipe after recipe calls for heating extra virgin olive oil. I assume it's a matter of degree -- keeping the oil from reaching its smoking point -- but the chart doesn't say that.

Here's a word of cautionary advice for users of this cookbook: Ignore the prep times provided with each recipe. Unless you're an iron chef with a kitchen stadium at your disposal, you'll be a lot better off estimating on your own than planning according to these sometimes wildly optimistic guidelines. If, in a mere 10 minutes, you can assemble a dozen ingredients; finely chop an onion; peel and finely grate 3 T ginger; finely chop 4 to 5 cloves garlic; sort, rinse and drain a cup of lentils; wash, stem and chop 3/4 c. cilantro; and seed and dice 3 plum tomatoes, then more power to you.

Still, I'm so taken with The Healthiest Meals on Earth that I have since picked up two other Bowden books -- The 150 Healthiest Foods on Earth and The Most Effective Natural Cures on Earth -- which I recommend with equal enthusiasm.

I'm looking forward to more highly satisfactory cooking and dining as I continue to use this book. I'm going to try the roasted rutabaga chips next. Yum. Join the discussion! Send your comments to Daily News Central.

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A "good night's sleep" may be more important than we think. In addition to allowing us to feel rested, energetic and clear-thinking, studies have shown that there are connections between sleep and heart health. There also has been research demonstrating that sleep may affect body weight.

The latest to shed light on the sleep-weight connection is a study presented Sunday at the American Thoracic Society's 105th International Conference in San Diego, which indicates that body mass index, or BMI, is linked to length and quality of sleep in a surprisingly consistent fashion.

Researchers at Walter Reed Army Medical Center analyzed the sleep, activity and energy expenditures of 14 nurses who had volunteered for a heart-health program, part of the Integrative Cardiac Health Project.

The program included nutritional counseling, exercise training, stress management and sleep improvement.

The subjects were categorized either as "short sleepers" or "long sleepers." The short sleepers tended to have a higher BMI, averaging 28.3, compared with the long sleepers, whose average BMI was 24.5, according to lead investigator Arn Eliasson, MD.

The short sleepers also had greater difficulty falling asleep and staying asleep, he reported.

In spite of sleeping less, the overweight individuals in the study were more active than the normal weight participants by about 25 percent, and they burned almost 1,000 more calories per day, the study found.

Dr. Eliasson suggested that stress could disrupt the length and quality of sleep, as well as increase eating and other behaviors contributing to weight gain

Also, getting less sleep appears to cause a reduction in leptin, a hormone that triggers the feeling of fullness, perhaps causing short sleepers to eat more.

Leptin's Role

That raises the possibility of using leptin supplements to curb overeating.

"It is conceivable that leptin may become an agent that can be administered to help with weight management, but we are not there yet," Dr. Eliasson told Daily News Central. "Science is still sorting out the role that leptin plays in weight management and its variation with sleep."

He compared leptin to melatonin, in terms of the current level of scientific understanding of their roles.

"Melatonin pulses at predictable times that coincide with sleepy times of the day," noted Dr. Eliasson. "However, melatonin administration is not a reliable soporific agent. So what gives? Rozerem (ramelteon, a melatonin receptor agonist) has made it to market to help with sleep but it is less reliable for regulating sleep and inducing sleep than other agents like the new benzodiazepine receptor agonists. We know even less about leptin at this time."

Given the low likelihood that any magic pill will soon hit the market to make up for the effects of short sleep on body weight, one solution might be to get the proper amount of sleep. However, it can be tricky to figure out how much sleep you actually need for optimal functioning.

Calculating Sleep Needs

"Sleep needs vary greatly by individual, and there is no single good test to measure what an individual's sleep need is," Dr. Eliasson said.

On average, adults need regular episodes of about 8 hours 15 minutes per 24-hour period -- but that's a statistical average. The range is much broader: 4 hours to 10 hours, depending on the individual. Children require about 9 hours, and teens may need a little more. By adulthood, adults generally need about 8 hours per night, according to Dr. Eliasson.

Contrary to common belief, aging in itself doesn't reduce the amount of sleep required, he noted. Other things may conspire to interfere with a regular schedule of night-time sleeping though, such as medical conditions, orthopedic issues, medications, mental health and living circumstances -- whether one has to get up at the same time each morning to go to work or is retired, for example.

The result is that older people often break up their sleep into shorter episodes at night combined with daytime napping.

If you want to pinpoint the ideal amount of sleep for you, Dr. Eliasson suggests a six-month experiment: Attempt to get very regular amounts of a certain length of sleep for a few weeks, and keep a diary recording how you feel during that period. For example, get 7 hours of sleep per night for three to four weeks, noting what time you go to bed and get up, when you nap, and how you feel. Keep those regular sleep hours on week days, weekends and holidays. Then, expand your sleep time to 7 hours 20 minutes per night for three to four weeks recording similar variables. Then, expand to 7 hours 40 minutes per night for three to four weeks, and so on. Over six months, you will be able to zero in on the amount of sleep needed to feel rested and be functioning in peak form.

"This sort of experiment takes a lot of dedication and time, and not many people are willing or able to make this happen," Dr. Eliasson observed.

Primitive Biology

James Gangwisch, a post-doctoral fellow in psychiatric epidemiology at Columbia University, led an earlier study that found a relationship between sleep and obesity. He hypothesized that sleeping less might trigger our bodies to store more fat because we're still functioning biologically like primitive humans.

Early humans may have slept less during the long days of summer when food was plentiful, Gangwisch suggested, and their bodies may have then stored extra fat in anticipation of the winter, when food would be scarce. Perhaps the bodies of short sleepers now function as though it's perpetually summer, and they're always storing as much fat as possible.

"The theory involving storing fat in the summer during periods of short sleep appeals to common sense and is a tidy way to explain why short sleep may favor weight gain," Dr. Eliasson commented. "It would be lovely to have some measurable hormones or transmitters that would put names and faces on the characters of this unfolding story. Give science another five to 10 years!"

Future Research

Dr. Eliasson intends to continue researching this subject through the Integrative Cardiac Health Project at Walter Reed Army Medical Center.

There are currently plans in the works to evaluate the impact of stress reduction on sleep. Researchers will employ mechanisms such as exercise, meditation, acupuncture and acupressure to reduce stress and assess the effect on sleep induction, sleep duration, and energy expenditure. They hope to make their findings known in the next year or two.

Work in this field goes far beyond helping people achieve the pleasant aftermath of "a good night's sleep."

A body of research over the past decade has established that sleep has "a huge impact" on heart health, Dr. Eliasson pointed out.

"The association applies to both sleep quantity and sleep quality," he said. "Not getting enough sleep makes people vulnerable to heart attacks and stroke -- perhaps mediated through impact of insufficient sleep on glucose metabolism, cholesterol levels, and stress hormones. Likewise, poor quality sleep as demonstrated by the paradigm of sleep apnea increases risks for heart disease and stroke as well.

"The statistics are staggering," Dr. Eliasson continued, "in that more than mild sleep apnea -- moderate and severe sleep apnea -- is associated with a three- to four-fold increased chance for developing heart disease and a five- to six-fold increased chance for stroke.

"Our hard-charging, on-the-go, 24/7 lifestyle carries measurable risks," Dr. Eliasson concluded. Join the discussion! Send your comments to Daily News Central.

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October is National Breast Cancer Awareness Month, but what some people want people to become more aware of is how little progress has been made in defeating this disease over the last quarter century. Since 1990, when National Breast Cancer Awareness Month was first launched, the rate of decline of breast cancer deaths has been a disappointing 2 percent per year. On average, 117 people -- mostly women -- died each day from breast cancer in 1991. Today that figure stands at 110.

In an article published in the Los Angeles Times, Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, NH, notes that breast cancer is many different diseases. Some tumors -- called "indolent" -- are basically harmless, while others grow slowly and may eventually cause trouble. However, the most dangerous forms of breast cancer are those characterized by aggressive tumors that grow fast and metastasize before they're detected.

The Detection Conundrum

Women have been encouraged for years to examine their own breasts and, after they reach a certain age -- the recommendations on age have become controversial -- to have annual mammogram screenings. The problem, according to Welch, is that these measures are best at finding the least-threatening tumors.

Treatments tend to be the same for all breast cancers, so what's happening is that many women whose tumors might never cause them any problem are being subjected to unnecessary surgeries, radiation and chemotherapy.

For every life a mammogram has saved, five to 15 lives may have been irreparably altered by mammogram findings that led to unwarranted treatments, suggested Welch in an editorial published in the New England Journal of Medicine accompanying a study on the role of mammograms in reducing the breast cancer death rate.

What Welch and others are proposing is that more attention be paid to preventing breast cancers, rather than putting all the eggs, so to speak, in the detection-and-treatment basket. That approach is complicated by the fact that a high-profile campaign such as National Breast Cancer Awareness Month is sponsored by AstraZeneca, which markets the breast cancer drugs Arimidex, Faslodex, Nolvadex and Zoladex. Welch has called the pharma's sponsorship a "huge conflict of interest."

10 Steps for Prevention

Following are some ways to reduce the risk factors for breast cancer, based on current research:

1. Consume a healthy diet that emphasizes vegetables, fruits, lean protein (chicken, fish), whole grains and vegetable oils. Avoid sugar, refined carbohydrates and foods high in animal fat.

2. Exercise at least 30 minutes a day.

3. Strive to maintain a normal weight (body mass index under 25). Obesity is linked to breast cancer.

4. Limit alcohol consumption to one drink per day or less.

5. Don't smoke.

6. Breastfeed your babies for as long as possible. Women who breastfeed for one or more years have significantly lower risk.

7. Avoid menopausal hormone replacement therapy. If you have severe symptoms, ask about other options.

8. Limit use of antibiotics.

1.9. Avoid exposure potentially carcinogenic chemicals in pesticides, cleaning supplies and other household products. 2.

3.10. Choose cosmetics and beauty supplies with natural ingredients. Choose products that are fragrance-free or are scented with essential oils over those containing synthetic "fragrance."

A new study of the cardiovascular benefit from using omega-3 enriched margarine in patients who previously suffered heart attacks turned up disappointing results, but its design may have been flawed.

The study, conducted over a period of 3 1/2 years by researchers in the Netherlands, concluded that the rate of cardiovascular problems, including resulting deaths, was substantially the same, whether the participants were consuming additional low doses of omega-3 fatty acids in their diet or not.

The 4,800 participants were mostly men, aged 60 to 80. All were taking medications during the study period to regulate blood pressure and cholesterol levels, as well as guard against clotting.

Daan Kromhout of the division of human nutrition at Wageningen University presented the findings Sunday at the European Society of Cardiology Congress in Stockholm.

Although at face value the study may seem to suggest that omega-3 supplementation provides no heart-health advantage, that conclusion might not be warranted, for several reasons. The amount of supplementation provided may have been too little. The patients consumed an average of 18.8 grams of margarine per day, which gave them an average of 226 milligrams of eicosapentaenoic acid (EPA) combined with 150 milligrams of docosahexaenoic acid (DHA), both derived from fish; and/or 1.9 grams of alpha-linolenic acid (ALA), found in plants. These amounts are considered "low dose." Heart patients are often advised to take 1,000 milligrams of omega-3 daily.The supplementation may have been provided too late for most of the study participants. Several years had intervened between the time many of them experienced their heart attacks and the beginning of the study. However, it is the period immediately following a cardiac event when a patient is most vulnerable.Some of the patients did seem to benefit from the supplementation. There was a "borderline significant reduction" in major heart events among women who consumed ALA, as well as among diabetics in the study. The supplementation appeared to protect against ventricular arrhythmia-related events, the researchers said. Unlike taking an omega-3 supplement in pill form, the study required patients to consume margarine, so a secondary food was required -- and that typically was bread. The study did not account for the possible negative effects of weight gain or increased blood pressure from eating extra bread, critics have noted. The strength of the patients' heart-protective medications may have overshadowed any potential benefit from the low-dose supplementation.The study was conducted among a population that typically consumes a lot of fish, which naturally provides omega-3. Supplementation might be of greater benefit to people who eat more meat and less fish (typical in the US).The study was not designed to consider the potential heart benefits of omega-3 supplementation among a general population of individuals who had never had a heart attack or other serious cardiovascular problems.

It's likely that more research is warranted to provide a clearer picture of the relationship between supplementation with omega-3 fatty acids and heart health.

Once again, a research study has turned up damning evidence against the hormone replacement therapy that millions of women continue to use to ease the symptoms of menopause. In brief, women who took estrogen plus progesterone for five years or more were more likely to get breast cancer; they were also more likely to get other, more serious, cancers; and they were at greater risk of dying from them.

These were the main findings of a study published this week in the Journal of the American Medical Association.

The conclusions are based on 11 years of follow-up with more than 12,000 participants in the Women's Health Initiative study, which found in 2002 that prolonged use of HRT increased the incidence of ovarian cancer, breast cancer and strokes, among other ill effects.

The study was halted when those findings came to light, and all participants stopped taking hormones; however, researchers continued to monitor the participants.

The most recent study contradicts earlier studies that concluded the increased risk connected with HRT applied only to less aggressive, more treatable tumors that some doctors considered no more than minor problems. For the first time, researchers found a link between hormone therapy and increased risk of death.

Guessing Game

All categories of breast cancer were increased among women who used HRT, and as a group, their cancers were more advanced. Twice as many of them died versus WHI participants who took a placebo instead of HRT.

Rowan Chlebowski, MD, of the Los Angeles Biomedical Research Institute, who authored the most recent analysis, has said that even though the risk of death is low -- 2.6 per 10,000 per year -- it is real.

HRT sales plummeted following the 2002 report, but doctors continue to prescribe it to millions of women, betting that lower doses taken for shorter periods of time won't be harmful to their patients. However, there is no research to support the validity of that approach.

To Die For?

Hormone replacement therapy for the treatment of menopausal symptoms seemed like one of the wonders of the modern world when it first became available. For some women, those symptoms can be severe -- even disabling.

Yet no woman has ever died from menopause. OPINION Doctors need to free themselves from the influence of big pharma and the pressures applied by patients who want a pill to cure whatever ails them -- even if it means rolling the dice.

The percentage of women who die as a consequence of seeking relief from menopausal symptoms may be tiny, but for those who represent that small slice of humanity, the consequences are significant indeed.

No drug should be prescribed merely to relieve pain or discomfort if death could be the result -- except to patients who are already terminally ill or whose lives really aren't worth living without it.

Few cases of menopausal distress would meet that standard.