Friday, August 26, 2022

Wow! Who knew that your choices at tonight’s dinner buffet could transform you into a parent? Not so fast — let’s look at the new study that’s causing all the fuss.

A new study of fertility and diet

Researchers from the Harvard T.H. Chan School of Public Health and Harvard Medical School have just published a review of past studies that examined the impact of diet on fertility. Here’s what they found.

For women trying to become pregnant naturally (without “assistive reproductive technologies” such as in vitro fertilization), the following vitamins and nutrients were linked to positive effects on fertility:

folic acid
vitamin B₁₂
omega-3 fatty acids
healthy diets (such as the Mediterranean diet)

On the other hand, antioxidants, vitamin D, dairy products, soy, caffeine, and alcohol appeared to have little or no effect on fertility in this review. Trans fat and “unhealthy diets” (those “rich in red and processed meats, potatoes, sweets, and sweetened beverages”) were found to have negative effects.

Studies of men have found that semen quality improves with healthy diets (as described above), while the opposite has been linked with diets high in saturated or trans fat. Alcohol and caffeine appeared to have little effect, good or bad. Importantly, semen quality is not a perfect predictor of fertility, and most studies did not actually examine the impact of paternal diet on the rate of successful pregnancies.

For couples receiving assisted reproductive technologies, women may be more likely to conceive with folic acid supplements or a diet high in isoflavones (plant-based estrogens with antioxidant activity), while male fertility may be aided by antioxidants.

So what does this mean if you’re trying to get pregnant?

Considering the average couple trying to become pregnant naturally, this review seems less of a bombshell than the headlines might suggest. Yes, eating a healthy diet is a good idea for men and women. Extra folic acid, B₁₂, and omega-3 fatty acids might be helpful for women, but healthy diets are already recommended to everyone, and a prenatal vitamin (which includes folic acid and vitamin B₁₂) is already recommended for women trying to get pregnant. Folic acid supplementation has long been known to reduce the risk of developmental neurologic problems in the developing fetus.

Unanswered questions about diet and fertility

Even if we accept these findings as important enough to direct our dietary choices, we still need to answer some basic questions:

How much folic acid or B₁₂ is best? Is there an advantage to taking a supplement rather than relying on dietary sources?
Which sources of and how many servings of dietary omega-3 fatty acids are best? How should a woman balance the risk of fish contamination with toxins such as mercury?
Are there some people who need to pay more attention to these dietary recommendations than others?
What about other components of the diet? Fear not, researchers are hard at work looking at this question. For example, consider the results of three other recently published studies:
- Consumption of sugar-sweetened beverages (especially sodas or energy drinks) was linked to lower fertility for men and women, while drinking diet soda and fruit juice had no effect.
- Women who consumed high amounts of fast food and little fruit took longer to become pregnant than those with healthier diets.
- Couples eating more seafood were pregnant sooner than those rarely eating seafood. Most pregnant women consume far less than the recommended 2 to 3 servings of lower-mercury fish (such as salmon, scallops, and shrimp) per week.

You can probably come up with more questions. Hopefully, researchers are already busy trying to answer them.

In the meantime…

Until we know more, the take-home message of this new research is not so different than before it was published. If you’re a man or a woman trying to become a parent, eat a healthy diet.

Many doctors recommend that women of childbearing age who are not using contraception take a prenatal vitamin daily. At the very least, women who are planning a pregnancy should take a prenatal vitamin at least a month before trying to conceive. A higher than usual dose of folic acid may be recommended for certain women, depending on the medications they take and other medical conditions they have. Doctors also recommend the following to maximize the chances of a healthy pregnancy:

Try to maintain a healthy weight prior to conception. Obese women have a higher risk of complications.
Avoid excessive vitamins before conception. Too much vitamin A, for example, can be bad for a developing fetus.
Consider seeing your doctor for a “preconception” visit to review what you can do to optimize your chances of a successful pregnancy. For example, certain medications are harmful to the developing fetus and should be stopped well before planning a pregnancy.

And just in case it’s not obvious, don’t rely on research regarding diet and fertility to prevent pregnancy. An unhealthy diet and avoiding supplemental vitamins or omega-3 fatty acids is not a form of birth control.

Follow me on Twitter @RobShmerling

The post Fertility and diet: Is there a connection? appeared first on Harvard Health Blog.

From: Robert H. Shmerling, MD https://www.health.harvard.edu/blog/fertility-and-diet-is-there-a-connection-2018053113949

Dr. Jonathan Leighton: New guidelines lower colon cancer screening to age 45

From: Mayo Clinic https://www.youtube.com/watch?v=5fQUQJGi6AQ

Altruistic organ donor meets baby boy she helped save

Our series A More Perfect Union aims to show what unites us as Americans is far stronger than what divides us. In this installment, we introduce you to Rebecca LaSalle, who gave the ultimate gift. One of her organs saved the life of a 1-year-old child. Only on "CBS This Morning," Barry Petersen was there when LaSalle met the little boy she helped save.

From: http://www.cbsnews.com/video/altruistic-organ-donor-meets-baby-boy-she-helped-save/

Despite skepticism, family behind "right to try" law hopeful it will save lives

Opponents argue the bill is risky and doesn't give better access to drugs

From: http://www.cbsnews.com/news/right-to-try-bill-trump-jordan-and-laura-mclinn/

Colorectal cancer screenings should start at age 45, new guidelines say

New guidelines say most people should start colorectal cancer screenings earlier. The American Cancer Society says testing for men and women at average risk should begin at age 45 instead of 50. The change comes in response to a 51 percent rise in colon and rectal cancers since 1994 in adults younger than 50. CBS News chief medical correspondent and gastroenterologist Dr. Jon LaPook joins "CBS This Morning" to discuss the guidelines.

From: http://www.cbsnews.com/video/colorectal-cancer-screenings-should-start-at-age-45-new-guidelines-say/

World No Tobacco Day 2018: Statement by WHO Director-General Dr Tedros

From: World Health Organization https://www.youtube.com/watch?v=dF0UilMeGdc

Wednesday, May 30, 2018

What is "right to try" and will it help patients?

As President Trump signs "right to try" legislation, will it give patients the help they need or only bring false hope?

From: http://www.cbsnews.com/news/right-to-try-bill-trump-signing-will-it-help-terminally-ill-patients-today-2018-05-30/

Obesity is complicated — and so is treating it

Many people don’t think of obesity as a disease, but rather as a moral failing. But Dr. Fatima Cody Stanford, instructor of medicine at Harvard Medical School and researcher and practicing physician at the Massachusetts General Hospital Weight Center, points out that obesity is a complex, chronic disease. Stanford’s recent fascinating and informative presentation explains how the body uses and stores energy, and describes the complex interplay of the genetic, developmental, hormonal, environmental, and behavioral factors that contribute to obesity.

Obesity isn’t just “calories in versus calories burned”

Obesity isn’t just about energy balance, i.e., calories in/calories out. “That’s simplistic, and if the equation were that easy to solve we wouldn’t have the prevalence of obesity that we have today,” Dr. Stanford explains. She goes on to say that not only is the energy balance theory wrong, but the focus on that simplistic equation and blaming the patient have contributed to the obesity epidemic. Stigma, blame, and shame add to the problem, and are obstacles to treatment. Indeed, over 36% of adults in the United States have obesity, and the world is not far behind.

She describes her research and experience in the treatment of obesity, including several cases from her own clinic. These are the cases that capture my attention, as they demonstrate most clearly the effects of different treatment approaches (and combinations) to obesity: diet and lifestyle (i.e. behavioral), medications, and surgery. Stanford has seen remarkable, long-lasting positive results with all, but she always emphasizes diet and lifestyle change first and foremost. The program (called Healthy Habits for Life) offered at the MGH Weight Center is a huge commitment, but it can help reframe a person’s relationship with food, emphasizing a high-quality diet, and not calorie-counting.

The components of a successful treatment for obesity

Abeer Bader is a registered dietitian and the lead clinical nutrition specialist at the center. She described the program to me in more detail: it’s a 12-week group-based education and support program with a structured curriculum and frequent contact with patients. The classes are 90 minutes long and led by a registered dietitian, and cover everything from the causes of obesity to healthy eating to debunking popular diet myths, plus recommendations for dining out, grocery shopping, meal prep, physical activity, and more. “The goal of the HHL program is to provide patients with the education, support, and tools to lead a healthy lifestyle.”

The diet they promote is loosely based on the DASH diet and the Mediterranean diet, as these eating plans are rich in vegetables, fruit, lean protein, and whole grains. They use the Harvard Healthy Plate to illustrate a healthy, well-balanced meal.

But it’s also a highly individualized program. “We work closely with the patient to put together realistic goals. I think the most important part of approaching goal-setting and behavior change is to first determine what it is that they would like to improve. Often as providers we tell patients what they need to do, but when you allow the patient to highlight an area that they would like to work on, you may see better adherence,” says Bader.

Other similar comprehensive programs have been shown to help patients achieve lasting diet and lifestyle change, lose weight — and avoid diabetes. The Diabetes Prevention Program helps those with obesity and risk of developing diabetes lose 5% to 7% of their body weight, and decreases their risk of diabetes between 58% and 71%.

As Bader states, “I think it’s important to note that the diet that “works” is the diet that a person will adhere to for the rest of his or her life. We really emphasize the importance of lifestyle change versus short-term diet fix in order to have the greatest success in achieving a healthier weight.” This statement is evidence-based, as a recent review of multiple research studies looking at different weight loss diets found that all worked about equally as well.

Medications to treat obesity

What can surprise people (including doctors) is how helpful weight loss medications can be, though it can take some trial and error to figure out what will work for someone. “These medications affect the way the brain manages the body’s weight set point, and how the brain interacts with the environment. But sometimes there’s no rhyme or reason why one medication works for someone, but another doesn’t.” Unfortunately, as research shows, weight loss medications aren’t prescribed often enough.

In summary, obesity is a complex, chronic disease with many contributing factors. Primary care doctors and obesity specialists can guide treatments that include lifestyle approaches like diet, exercise, and addressing emotional factors that contribute to obesity. For some people weight loss surgery may be an option (a subject for another post).

Selected references

Centers for Disease Control Adult Obesity Facts.

Media and its influence on obesity. Current Obesity Reports, April 2018.

Assessing the evidence for weight loss strategies in people with or without diabetes. World Journal of Diabetes, October 2017.

The Centers for Disease Control and Prevention National Diabetes Prevention Program Information Page: The Research Behind the Program.

Safety and tolerability of new-generation anti obesity medications: A narrative review. Postgraduate Medicine, March 2018.

Low utilization of obesity medications. What are the implications for clinical care? Obesity: A Research Journal, September 2016.

The post Obesity is complicated — and so is treating it appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH https://www.health.harvard.edu/blog/obesity-is-complicated-and-so-is-treating-it-2018053013943

Tuesday, May 29, 2018

A new tool in the fight against Ebola - Ring vaccination

From: World Health Organization https://www.youtube.com/watch?v=FknjFw2h-I8

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Friday, August 26, 2022

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Thursday, May 31, 2018

Fertility and diet: Is there a connection?