Because we lose elasticity with age and don't have elastin as part of our diet, stretching is imperative. It increases our flexibility while helping to decrease back and joint pain.

Stretching Key to Yoga's Back Pain Relief

By Kristina Fiore, Staff Writer, MedPage Today Published: October 24, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner = Yoga can help improve symptoms of chronic lower back pain, but it's likely not the meditation component that does the trick, researchers found. There were no differences in functional improvement between yoga and plain stretching exercises, although both were better than self-care, Karen Sherman, PhD, MPH, of Group Health Research Institute in Seattle, and colleagues reported online in the Archives of Internal Medicine. "We expected back pain to ease more with yoga than with stretching, so our findings surprised us," Sherman said in a statement. "The most straightforward interpretation of our findings would be that yoga's benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles" and not the discipline's focus on mindfulness. Sherman and colleagues explained that there are few effective treatments for low back pain. Some studies have shown that yoga may be beneficial, though these had considerable limitations, they said. So they conducted a trial of 228 adults with moderate chronic low back pain, who were randomized to one of three interventions: 12 weekly yoga classes devoted largely to stretching and strengthening the back and leg muscles Conventional stretching exercises also focused on back and leg muscles A self-care book giving advice on exercise and lifestyle modifications Overall, 63% of yoga attendees and 82% of stretching class attendees said they practiced at home three or more days per week. About half of those in the self-care book group said they read at least two-thirds of the book. Sherman and colleagues found that function improved over time in all groups, but there were significant differences among the three groups at all time points. After adjustment, yoga was superior to self-care at 12 weeks in terms of improved function, and remained superior at 26 weeks (P<0.001 for both). Yet it wasn't superior to conventional stretching at any time point, the researchers found. Sherman noted that the stretching classes included a lot more stretching than in most such classes, and the style of stretching may have been more like that of yoga. "People may have actually begun to relax more in the stretching classes than they would in a typical exercise class," Sherman said in the statement. "In retrospect, we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be." The researchers noted that except at 12 weeks, when yoga proved superior to self-care, there were no differences among treatment groups when rating how much their symptoms bothered them. But compared with self-care, those who did yoga or stretching were more likely to rate their back pain as better, much better, or completely gone at all follow-up times. Also, more patients in the yoga and stretching groups were able to decrease their medications compared with the self-care group. The study was limited because all of the patients were selected from a single site, were relatively well-educated and functional, and had no follow up beyond 26 weeks. It was also limited because "disappointed self-care participants might have been more likely to report worse outcomes," the researchers cautioned. Still, Sherman said the results "suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain." Yet, she noted, that it's "important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants' individual physical limitations." In an accompanying editorial, Timothy Carey, MD, MPH, of the University of North Carolina in Chapel Hill, said the results of the trial are actionable for practice. "Healthcare providers should feel comfortable referring patients to either yoga or physical-therapy-led classes," Carey wrote. "Either seems to be helpful." Still, he noted that more high-quality studies are needed to help patients and clinicians determine which types of physical treatments are most appropriate. The study was supported by the National Center for Complementary and Alternative Medicine. Neither the researchers nor the editorialist reported any conflicts of interest.   Primary source: Archives of Internal Medicine Source reference: Sherman KJ, et al "A randomized trial comparing yoga, stretching, and a self-care book for chronic low-back pain" Arch Intern Med 2011; DOI: 10.1001/archinternmed.2011.524. Additional source: Archives of Internal Medicine Source reference: Carey TS "Comparative effectiveness studies in chronic low back pain" Arch Intern Med 2011; DOI: 10.1001/archinternmed.2011.519.

Good news for cell phone users (but just in case, I'm posting this story from my computer rather than from my phone):

Study Finds No Cell Phone-Brain Cancer Link

By Kristina Fiore, Staff Writer, MedPage Today Published: October 20, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

For those who remain unconvinced, a team of Danish researchers reported that long-term data do not support a link between use of mobile phones and risk of brain cancer. During an additional five years of follow-up, there was no association between central nervous system tumors and subscription to a mobile phone service, Patrizia Frei, PhD, of the Danish Cancer Society, and colleagues reported online in BMJ. "In general, our findings are in line with most of the epidemiological research that has been conducted to date," Frei told MedPage Today. "They are also in line with in vitro and [animal] studies that show no carcinogenic effects on the cellular level." Nor were there any associations when assessed by length of subscription or tumor type, they reported. "I'm impressed with the quality and size [of the study], so I think it significantly weakens the idea that cell phones can cause brain cancer," Timothy Jorgensen, MD, of Georgetown Lombardi Comprehensive Cancer Center, told MedPage Today and ABC News. Several epidemiological studies have turned up no increased risks of brain cancer with mobile phone use. The largest of these, the INTERPHONE study, found no risk of glioma or meningioma in general with use of the devices, although it did find a greater risk of glioma in those with the greatest levels of use. However, those levels were criticized as "implausible" -- a word many used to describe the study overall, given findings in the same study that cell phone use appeared to be protective against cancer in certain groups. And last spring, a work group of the WHO declared the radiofrequency electromagnetic fields emitted by cell phones to be "possibly carcinogenic to humans" -- a mild category that includes progestins and anti-epileptic drugs. Still, epidemiologists say the weight of the evidence has shown that cell phone chatting doesn't cause cancer. Earlier results from the Danish study found no evidence of an increased risk of brain or nervous system tumors or any cancer among cell phone users. In their updated report, Frei and colleagues looked at data on 358,403 subscribers followed through 2007 who had accrued 3.8 million person-years of usage. During that time, there were 10,729 cases of tumors of the central nervous system. Overall, the researchers found that there was no risk of brain or central nervous system tumors for men or women. When assessed by the longest length of use -- 13 years of subscription or more -- there was no significant association with tumors (incidence rate ratio 1.03 for men, 0.91 for women). Nor did those who'd been subscribed for 10 or more years have an increased risk of meningioma or glioma, they reported, noting that these data clarify earlier findings showing a diminished risk for this group. However, those results were based on only 28 cases and the researchers suspected they were due to chance, Frei said. When she and colleagues looked at the data by tumor subtype, they found a slight but nonsignificant increased incidence rate ratio for glioma in men -- though there was no relationship with this type of cancer for women, they found. Men also had a 22% reduced risk of meningioma, but there was no association for women, they added, although the numbers were small. They added that further subdivision of gliomas in men by site showed a marginally increased risk for cancer in the temporal lobe, but it wasn't significant -- an "important" finding given that the temporal lobe "has been described as the region of the brain with the highest absorption of energy emitted from mobile phones." The study was limited by a potential misclassification of exposure, as those who have a subscription but do not use it may be misclassified. Nor did the researchers have information on actual phone usage, so they couldn't determine the risk of the subgroup of heaviest users. Still, researchers pointed out that using subscription plan data had a number of advantages. "They assumed that people who subscribe to cell phone plans are using their phones, and I think that's a reasonable assumption," Jorgensen said. "The alternative is to talk to people and ask them to tell you about their cell phone use. But people are notoriously inaccurate." In an accompanying editorial, Anders Ahlbom, PhD, and Maria Feychting, MD, PhD, of the Karolinska Institute in Stockholm, said not relying on self-report is certainly an advantage of the study. Yet they cautioned that "having a mobile phone subscription is not equivalent to using a mobile phone, and conversely some users will be nonsubscribers." Still, they said the findings are in line with numerous other epidemiological studies that have found no increased risk of brain cancer with cell phone use. "The research that has been conducted for the safety of public health with regard to this new and rapidly spreading technology is now extensive," Ahlbom and Feychting wrote. "The question is how much more research is needed." "Continued monitoring of health registers and prospective cohorts is warranted," they wrote, "but more case-control or other studies with built-in selection and recall bias are not needed." The study was supported by the Danish Strategic Research Council and by grants from the Swiss National Science Foundation. Neither the researchers nor the editorialists reported any conflicts of interest. This article was developed in collaboration with ABC News.

Primary source: BMJ Source reference: Frei P, et al "Use of mobile phones and risk of brain tumors: update of Danish cohort study" BMJ 2011; DOI: 10.1136/bmj.d6387. Additional source: BMJ Source reference: Ahlbom A, Feychting M "Mobile telephones and brain tumors" BMJ 2011; DOI: 10.1136/bmj.d6387.

Perhaps its a matter of common sense - parents should inspect their child's sleep area to make sure nothing is present that could inadvertently harm their baby....including making sure nothing is present that could suffocate or choke a child.

AAP: New SIDS Guideline Says No to Bumper Pads

By Charles Bankhead, Staff Writer, MedPage Today Published: October 18, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. BOSTON -- Breastfeeding and immunization protect babies against sudden infant death syndrome (SIDS) but bumper pads don't, according to updated guidelines from the American Academy of Pediatrics. The recommendations -- last revised in 2005 -- go beyond SIDS and focus on providing a safe sleeping environment for infants to reduce the risk of all sleep-related deaths, such as suffocation. Supine sleeping position, first recommended by the AAP in 1992, remains the cornerstone of SIDS prevention, along with a firm sleeping surface, and no bed sharing.   "Overall, we are making good progress in understanding SIDS and the importance of the infant's environment in preventing suffocation deaths," Rachel Moon, MD, who chaired the guideline writing committee, said during an AAP press briefing. "However, we still see evidence of unsafe sleeping practices, and we hoped to address those in these new guidelines." The recommendation against bumper pads is part of the focus on providing infants with safe sleeping environments. Moon and co-authors said no evidence exists to support the view that bumper pads reduce SIDS risk. The AAP also recommends avoidance of any commercial devices purported to prevent SIDS, as "there is no evidence that these devices reduce the risk of SIDS or suffocation or that they are safe." The guidelines and a related technical report are published in the November issue of Pediatrics. Since AAP launched its "Back to Sleep" campaign in 1992, SIDS deaths have declined by 50%. However, 4,600 sudden unexpected infant deaths (SUID) still occur each year, half of which are ultimately classified as SIDS. A study reported at the AAP meeting showed that half of SIDS deaths involved infants placed in nonsupine sleeping positions, and 71% of the deaths involved unsafe sleeping surfaces. In more than half the deaths involving unsafe sleeping areas, a crib (recommended by the AAP) was available in the household but was not used or was being used for other purposes. A breastfeeding recommendation is based on multiple studies showing a lower rate of SIDS among breastfed babies. The AAP encourages exclusive breastfeeding or feeding with expressed milk. Similarly, recent studies have provided evidence that immunization affords protection against SIDS. The AAP previously joined with the CDC in concluding that "there is no evidence that there is a causal relationships between immunizations and SIDS." In addition to its traditional support for supine sleeping position and firm sleeping surface, the AAP recommends: Room-sharing with an infant -- but not bed-sharing Keeping cribs free of soft objects and loose bedding Offering a pacifier at naptime and bedtime Avoidance of overheating No use of home cardiorespiratory monitors Expansion of the national SIDS campaign to include the focus on a safe sleeping environment Supervised awake "tummy time" for infants to facilitate development The guidelines also offer recommendations for pregnant women: regular prenatal care, no smoking, and avoidance of alcohol and elicit drugs. The caution against smoking, alcohol, and drugs carries over after birth. The AAP guidelines urge support for the SIDS/safe sleeping environment campaign from healthcare professionals, media support for the campaign in messages and announcements, and continued research to learn more about the causes, risk factors, and pathophysiology of SIDS and other sleep-related deaths in infants. Moon and co-authors had no relevant disclosures. Primary source: Pediatrics Source reference: Moon R, et al "SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment" Pediatrics 2011; DOI:10.1542/peds.2011-2284.

An interesting, but perhaps flawed study concludes that vitamins cause death apparently mostly due to oxidative stress (something which occurs far more by chronic use of statin drugs.) The following report leaves many questions to be asked.

Dietary Supplements Linked to Higher Death Risk

By Todd Neale, Senior Staff Writer, MedPage Today Published: October 10, 2011 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner In postmenopausal women, the use of several common vitamin and mineral supplements was associated with an increased risk of death, researchers found. After adjustment for multiple potential confounders, use of multivitamins and vitamin B6, folic acid, iron, magnesium, zinc, and copper supplements was associated with greater all-cause mortality through 19 years of follow-up (HRs 1.06 to 1.45), according to Jaakko Mursu, PhD, of the University of Eastern Finland in Kuopio, and colleagues. Use of a daily calcium supplement, on the other hand, was associated with a lower risk of death (HR 0.91, 95% CI 0.88 to 0.94), the team reported in the Oct. 10 issue of the Archives of Internal Medicine. Activate MedPage Today's CME feature and receive free CME credit on medical stories like this one "Based on existing evidence, we see little justification for the general and widespread use of dietary supplements," they wrote, citing a body of literature generally supporting no association with mortality, with some suggestions of harm. "We recommend that they be used with strong medically based cause, such as symptomatic nutrient deficiency disease." Agreeing in an invited commentary were Goran Bjelakovic, MD, DMSc, and Christian Gluud, MD, DMSc, of Copenhagen University Hospital. "We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population," they wrote. "Those supplements do not replace or add to the benefits of eating fruits and vegetables and may cause unwanted health consequences." Taking dietary supplements to improve health and prevent diseases is widespread, with about half of U.S. adults using one or more in 2000, according to Mursu and colleagues. Annual sales top $20 billion. The long-term impact of supplementation is unknown, however, and some studies have suggested a relationship between supplements and increased mortality. As Rita Redberg, MD, of the University of California San Francisco, wrote in an editor's note, "manufacturers are not required to disclose to the FDA or to consumers the evidence they have regarding their products' safety, nor must they empirically back up claims of purported benefits." In light of this uncertainty, Mursu and colleagues examined the use of vitamin and mineral supplements among 38,772 postmenopausal women participating in the Iowa Women's Health Study. The mean age of the women at baseline in 1986 was 61.6. The participants reported their use of supplements in 1986, 1997, and 2004. The percentage who reported using at least one supplement daily increased from 62.7% to 85.1% during the study. In 2004, more than one-quarter of the women (27%) said they used four or more. The most commonly used supplements were calcium, multivitamins, vitamin C, and vitamin E. Through 2008, 40.2% of the women died. After adjustment for demographics, dietary and lifestyle factors, comorbidities, and use of hormone replacement therapy, the following supplements were associated with a greater risk of death during follow-up: Multivitamins: HR 1.06 (95% CI 1.02 to 1.10) Magnesium: HR 1.08 (95% CI 1.01 to 1.15) Zinc: HR 1.08 (95% CI 1.01 to 1.15) Iron: HR 1.10 (95% CI 1.03 to 1.17) Vitamin B6: HR 1.10 (95% CI 1.01 to 1.21) Folic acid: HR 1.15 (95% CI 1.00 to 1.32) Copper: HR 1.45 (95% CI 1.20 to 1.75) Absolute increases in risk ranged from 2.4% with multivitamins to 18% with copper. After multivariate adjustment, use of calcium supplementation was associated with a lower risk of death (HR 0.91, 95% CI 0.88 to 0.94). The absolute risk reduction was 3.8%. To account for the multiple comparisons made, however, the researchers set a P value of less than 0.003 to establish significance. Only the increase associated with multivitamins, calcium, and copper remained significant using this threshold. "However, many of the additional statistical tests were confirmatory, strengthening confidence that findings were not explainable by chance," Mursu and colleagues noted. In particular, the findings related to iron and calcium remained consistent when the analysis was restricted to follow-up from 1986 to 1996, from 1997 to 2003, and from 2004 to 2008. In addition, the mortality risk associated with iron supplementation increased in a dose-response fashion. The relationship was not significant for doses of 200 mg/day or less, but was significant for a dose of 201 to 400 mg/day (HR 1.35) and for a dose of 400 mg/day or more (HR 1.57). "Iron is suggested to catalyze reactions that produce oxidants and thus promote oxidative stress," the authors noted, acknowledging that they did not examine possible mechanisms in the current study. "However, we cannot rule out the possibility that the increase in total mortality rate was caused by illnesses for which use of iron supplements is indicated," they wrote. "Chronic disease, major injury, and/or operations may cause anemia, which is then treated with supplemental iron. However, we could find no evidence for such reverse causality." In their commentary, Bjelakovic and Gluud said that "one should consider the likely U-shaped relationship between micronutrient status and health," with risks associated with both insufficient and excessive intake. "Therefore, we believe that politicians and regulatory authorities should wake up to their responsibility to allow only safe products on the market," they wrote. Added Redberg, "A better investment in health would be eating more fruits and vegetables, among other activities. Because commonly used vitamin and mineral supplements have no known benefit on mortality rate and have been shown to confer risk, this article has been given our 'Less Is More' designation." Mursu and colleagues noted that their study was limited by the possibility of residual confounding and changes in supplement use during the study, the inability to exclude the chance that some supplements were taken in response to symptoms or clinical disease, the lack of data on nutritional status or detailed information on the supplements used, and the study sample comprised of white women, which limits the generalizability of the findings. The study was partially supported by grants from the National Cancer Institute and the Academy of Finland, by the Finnish Cultural Foundation, and by the Fulbright program's Research Grant for a Junior Scholar. One of Mursu's co-authors is an unpaid member of the scientific advisory board of the California Walnut Commission. Bjelakovic and Gluud reported that they had no conflicts of interest. Primary source: Archives of Internal Medicine Source reference: Mursu J, et al "Dietary supplements and mortality rate in older women: the Iowa Women's Health Study" Arch Intern Med 2011; 171: 1625-1633. Additional source: Archives of Internal Medicine Source reference: Bjelakovic G, Gluud C "Vitamin and mineral supplement use in relation to all-cause mortality in the Iowa Women's Health Study" Arch Intern Med 2011; 171: 1633-1634.

Study shows four risk factors predict childhood obesity. I might add that serving your toddler Big Macs is no help either.

OBESITY: Mother, Baby Risk Factors Predict Child's Obesity

By Todd Neale, Senior Staff Writer, MedPage Today Published: October 03, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner               ORLANDO -- Targeting four modifiable maternal and infant risk factors may make a large impact on reducing childhood obesity, researchers found. The four factors were maternal smoking during pregnancy, gestational weight gain, breastfeeding duration, and infant sleep duration, according to Matthew Gillman, MD, of Harvard Medical School in Boston. At age 7, children with adverse levels of all four risk factors had a substantially greater risk of obesity than those with healthy levels of all four (28% versus 4%). Gillman reported those findings at the Obesity Society meeting here.   "These four factors, which are potentially modifiable, explain a large proportion of obesity in childhood, and the implication is that, if we can mount interventions to change these things, we can go a long way toward preventing childhood obesity," Gillman said. Several pre- and postnatal risk factors for childhood obesity have been identified, Gillman said, but there have been few studies that have examined the predictive value of combinations of risk factors. To explore the issue, he and his colleagues turned to Project Viva, a longitudinal cohort study in Massachusetts looking at the health of women and their children. The current analysis included 948 mother-child pairs who provided information both at baseline and when the child was 7-years-old. The researchers chose to examine four factors -- all dichotomized for adverse and healthy conditions -- for their relationship with childhood obesity: Maternal smoking during pregnancy (yes/no) Gestational weight gain (excessive/not excessive) Breastfeeding duration (less than 12 months/at least 12 months) Infant sleep duration (less than 12 hours a day/at least 12 hours a day) During pregnancy, 9% of the mothers smoked and 58% gained excessive weight. Most of the infants (71%) were breastfed for less than one year and 31% slept less than 12 hours a day. All four of the risk factors were individually associated with an increased likelihood of obesity when the child was 7 (ORs 1.55 to 2.01), although the relationship reached statistical significance for infant sleep duration only (OR 2.01, 95% CI 1.24 to 3.25). Overall, 6.9% of the children had adverse levels of none of the risk factors, 36.1% had one risk factor, 40.8% had two, 14.5% had three, and 1.9% had all four. The overall rate of obesity at age 7 was 10.8%, ranging from a low of 4% for children with healthy levels of all four risk factors to a high of 28% for adverse levels of all four risk factors. Similar trends were seen for body mass index (BMI) z-score, which ranged from 0.07 to 0.79, and percent body fat, which ranged from 23.2% to 26.5%. The model was adjusted for maternal BMI and education, child race/ethnicity, and household income. Further adjustment for sugary drink intake, fast food intake, TV screen time, and physical activity did not have substantial effect on the findings. The researchers calculated that if the population shifted from having two to four of these adverse risk factors to zero or one, 55% of the cases of childhood obesity would be avoided. Gillman said that some studies of interventions to modify these factors have been performed and some are ongoing. Infant sleep is modifiable, at least on a population level, by adjusting how parents put their babies to sleep, he said. An example would be teaching parents to rock their babies until they are almost asleep, putting them in their cribs, and allowing them to put themselves to sleep, rather than rocking them until they fall sleep. More work needs to be done on reducing smoking during pregnancy, Gillman said. Most mothers will stop smoking when they know they are pregnant, but there is room for interventions for smoking cessation at or before the time of conception. Support interventions using lactation consultants have been shown to be effective for increasing the initiation and duration of breastfeeding. Although there is not one strategy proven to reduce gestational weight gain, many trials are ongoing, and Gillman said that he expects to see some consensus about effective approaches develop in the coming years. Gillman reported that he had no conflicts of interest. Primary source: The Obesity Society Source reference: Gillman M, et al "Early origins of childhood obesity: prediction, attributable risk, and potential public health impact" OBESITY 2011; Abstract 382-P.

With obesity in America reaching epidemic proportions and the media focusing continually on weight loss, the pros and cons of diets are often discussed. One such discussion involves diet soda:

Does Diet Soda Cause Weight Gain?

According to an article published in the Huffington Post (http://www.huffingtonpost.com/2011/06/29/diet-soda-weight-gain_n_886409.html) two cited studies found there to be a correlation between drinking diet soda and weight gain.  However, WebMd (http://www.webmd.com/diet/features/diet-sodas-and-weight-gain-not-so-fast) cites the same two studies to report that diet soda does not necessarily cause weight gain.

Of the two studies, one involved feeding artificial sweeteners to rats to see if the sweetener use would fool the body's evaluation of caloric intake while the second study was an observational study of 9000 men and women asked to drink carbonated beverages and whose weight gain was compared to people not drinking carbonated beverages.

As the study methodology of the first trial has not yet been conducted on humans and the study methodology of the second not quite scientific, the results are somewhat inconclusive.

So do diet sodas cause weight gain?  Perhaps one explanation can be understanding how current eating habits adversely effect weight gain through altering metabolism.  Watch the following video and judge for yourself: http://www.youtube.com/watch?v=hpoAtwVyzZI