What does “dead” mean?

Should death be defined in strictly biological terms — as the body’s failure to maintain integrated functioning of respiration, blood circulation, and neurological activity? Should death be declared on the basis of severe neurological injury even when biological functions remain intact? Or is it essentially a social construct that should be defined in different ways?

❝ These are among the wide-ranging questions explored in a new special report, “Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death,”…The special report is a collaboration between The Hastings Center and the Center for Bioethics at Harvard Medical School.

Sometimes, these days, I think of death and dying. Some of us must. The old ones. I think of Dylan Thomas. I must needs think of science. Most of me pretty worn; but, I may provide a jot of knowledge simply for what I have experienced and survived.

Some Americans getting more physically fit, some growing more obese


The exercise part of the story

❝ It may seem like a contradiction, but more adults in the U.S. say they are exercising at the same time more of them are becoming obese.

About 24 percent of adults last year said they exercise enough each week to meet government recommendations for both muscle strengthening and aerobic exercise, according to a large annual health survey. That was up from 21 percent in 2015.

The same survey says 31 percent of adults indicated they were obese last year, up slightly. Another, more rigorous government study has also found adult obesity is inching up.

❝ In a report…released Thursday, Centers for Disease Control and Prevention looked at survey responses from 2010 through 2015 and found that level of leisure-time exercise was more common in some states than others.

Nearly a third of non-elderly adults in Colorado, Idaho, and New Hampshire met exercise guidelines. Only about one-seventh in Mississippi, Kentucky and South Carolina did.

Higher levels of exercise were more common in people who were working than those who weren’t, the study also found.

❝ Of course, unhealthy eating has a lot to do with obesity. Research indicates that “a change in diet is needed to see any dent or reduction in obesity,” said the CDC’s Tainya Clarke…

RTFA. Better yet, get off your butt and go for a walk. There are more than graphic reasons for reports like this to be called a dumbbell curve.

The Unrelenting American Disease

❝ The U.S. is big, and getting bigger. Since the 1980s, American adults’ obesity is at epidemic proportions, and there does not seem to be an end in sight…

The U.S. Centers for Disease Control and Prevention looked at data from the National Health and Nutrition Examination Survey…which takes various measures of the health and nutrition of children and adults in the U.S…using interviews and physical exams.

❝ The CDC results were mixed: in the young, the prevalence of obesity was 16.8 percent in 2007; it was 18.5 percent 10 years later.

There were no significant differences when looking at age or gender, but that’s still nearly 2 out of every 10 kids weighing in as obese. Our youth aren’t in the clear just yet.

For adults, it was a more stark story: obesity increased from 33.7 percent to 39.6 percent over 10 years — it stood out most in women, and in adults over 40. That’s a shocking 2 out of 5 adults.

If you can find the right switch to turn on in your personality, I believe you can turn this around. Yes, you need all the tools: better nutrition, exercise – many levels and qualities of exercise – support from folks most important to your personal life [my wife makes more difference than anything]. But, if I can make changes at my advanced age, anyone can. I took off 60 lbs in the last 16 months. I now weigh what I did in 1955.

Yes, my iPhone, iPad, Apple’s Health Kit – along with linked software and a Bluetooth scale all helped. I’ve always been a geek. 🙂

Even in the wildest corner of your yard (or prairie) mice will run on wheels

Yes, I know this is a couple years old. But, I somehow missed it first time round.

In 2009, neurophysiologist Johanna Meijer set up an unusual experiment in her backyard. In an ivy-tangled corner of her garden, she and her colleagues at Leiden University in the Netherlands placed a rodent running wheel inside an open cage and trained a motion-detecting infrared camera on the scene. Then they put out a dish of food pellets and chocolate crumbs to attract animals to the wheel and waited.

Wild house mice discovered the food in short order, then scampered into the wheel and started to run. Rats, shrews, and even frogs found their way to the wheel—more than 200,000 animals over 3 years. The creatures seemed to relish the feeling of running without going anywhere.

The study “puts a nail in the coffin” of the debate over whether mice and rats will run on wheels in a natural setting, says Ted Garland, an evolutionary physiologist at the University of California, Riverside, who was not involved in the work. More importantly, he says, the findings suggest that like (some) humans, mice and other animals may simply exercise because they like to. Figuring out why certain strains of mice are more sedentary than others could help shed light on genetic differences between more active and sedentary people…

On average, the backyard mice she and colleagues observed ran in 1 to 2 minute stints, roughly the same duration as that seen in lab mice, they reported online…in the Proceedings of the Royal Society B. The team also set up a second wheel in a nearby nature preserve of grassy dunes and attracted a similar crowd of enthusiasts.

Why are these countries obese? Let’s start with walking

❝ A recent study found that more than 2 billion adults and children globally are overweight or obese and suffer health problems because of that — but this is nothing new.

There are, however, pockets of the global population who remain somewhat unaware of this public health crisis, despite the growth of waistlines all around them, and this lack of awareness is just one of the underlying problems, according to Frank Hu, professor of nutrition and epidemiology at Harvard…

Different countries have different issues,” Hu said. “You need to mobilize (their) whole society to tackle the problem. … it’s not just a medical problem.”

❝ The Pacific Islands, Middle East and Americas lead the way in terms of regions with the greatest obesity rates. In 2014, more than 48% of the population of the Cook Islands was classified as obese. Qatar led the way in the Middle East with 34%, followed closely by the United States at 33%, according to the World Health Organization…

❝ When assigning blame, two factors are common: diet and physical activity, namely poor diets and a lack of physical activity. But a number of smaller factors combine to fill these two large umbrellas, and those need to be understood to truly tackle the problem, Hu believes.

RTFA. Pretty halpful analysis, methods of analysis that can be appreciated by pretty much anyone.

I’m not making recommendations. I can only speak to what works for me – and it’s exactly what I’ve known all my life. Good nutrition reducing sugars, easily accessible exercise – and for me, tracking meal-by-meal, day-by-day. The health app built into the operating system of Apple iPhones works fine for me. I combine it with a daily calorie tracker that has a ginormous database.

Taking a look, right now, year over year, I’ve averaged 3.1 miles per day walking, 9146 steps per day. That’s every day – averaging in high summer temperatures or the occasional blizzard mid-winter. Not too many of either at our altitude in northern New Mexico. Being an ancient creaky old Leftie is no copout.

I’m happy about weighing what I weighed in 1956 – and aiming for less.

Looks like exercise turns white fat into brown — that’s a good thing!

❝ Exercise may aid in weight control and help to fend off diabetes by improving the ability of fat cells to burn calories, a new study reports. It may do this in part by boosting levels of a hormone called irisin, which is produced during exercise and which may help to turn ordinary white fat into much more metabolically active brown fat…

❝ Irisin…entered the scientific literature in 2012 after researchers from Harvard and other universities published a study in Nature that showed the previously unknown hormone was created in working muscles in mice. From there, it would enter the bloodstream and migrate to other tissues, particularly to fat, where it would jump-start a series of biochemical processes that caused some of the fat cells, normally white, to turn brown.

Brown fat, which is actually brown in color, burns calories. It also is known to contribute to improved insulin and blood sugar control, lessening the risk for Type 2 diabetes. Most babies, including human infants, are plump with brown fat, but we humans lose most of our brown fat as we grow up. By the time we are adults, we usually retain very little brown fat.

❝ In the 2012 study, the researchers reported that if they injected irisin into living mice, it not only turned some white fat into brown fat, it apparently also prevented the rodents from becoming obese, even on a high-fat, high-calorie diet.

But in the years since, some scientists have questioned whether irisin affects fat cells in people to the same extent as it seems to in mice — and even whether the hormone exists in people at all.

❝ A study published last year in Cell Metabolism by the same group of researchers who had conducted the first irisin study, however, does seem to have established that irisin is produced in humans. They found some irisin in sedentary people, but the levels were much higher in those who exercise often

❝ So for the new study, which was published in August in the American Journal of Physiology — Endocrinology and Metabolism, researchers at the University of Florida turned to white fat tissue from women who had undergone breast reduction surgery at the university hospital (with permission) and also to a very small amount of brown fat from people who had had surgery to treat kidney cancer. Most of our meager stores of brown fat cluster around our kidneys.

The researchers, who had previously studied irisin’s effects in mice, had a form of the human hormone available and now set out to marinate the fat cells with it, using three different dosages…

❝ The results strongly indicate that irisin nudges human white fat to become brown and also suppresses the formation of new white fat, says Li-Jun Yang, a professor of hematopathology at the University of Florida and senior author of the study (which was funded by the scientists themselves). It also seems to promote the formation of bone…

But these were living cells, not living bodies, and the effects of irisin in actual people still need to be established, she says, especially since many studies have shown that exercise rarely results in significant weight loss. Scientists also do not know what types of exercise lead to the greatest production of irisin or what amount of irisin might be ideal for health purposes…

❝ But even now, the science related to irisin is compelling enough, she says, that “my advice is, exercise as much as you can. We know it’s healthy and now we’re beginning to understand better why.”

RTFA for the details. Nothing unsurprising if you’ve read along from earlier studies. I blogged about the original study, hopes, conjecture. And I agree wholeheartedly with Dr. Yang.

We’re getting healthier, living longer – and no one really knows why!

evolution_of_woman

Something strange is going on in medicine. Major diseases, like colon cancer, dementia and heart disease, are waning in wealthy countries, and improved diagnosis and treatment cannot fully explain it.

Scientists marvel at this good news, a medical mystery of the best sort and one that is often overlooked as advocacy groups emphasize the toll of diseases and the need for more funds. Still, many are puzzled.

Of course, these diseases are far from gone. They still cause enormous suffering and kill millions each year.

But it looks as if people in the United States and some other wealthy countries are, unexpectedly, starting to beat back the diseases of aging. The leading killers are still the leading killers — cancer, heart disease, stroke — but they are occurring later in life, and people in general are living longer in good health.

Colon cancer is the latest conundrum. While the overall cancer death rate has been declining since the early 1990s, the plunge in colon cancer deaths is especially perplexing: The rate has fallen by nearly 50 percent since its peak in the 1980s, noted Dr. H. Gilbert Welch and Dr. Douglas J. Robertson…in a recent paper…

Screening, they say, is only part of the story. “The magnitude of the changes alone suggests that other factors must be involved,” they wrote. None of the studies showing the effect of increased screening for colon cancer have indicated a 50 percent reduction in mortality, they wrote, “nor have trials for screening for any type of cancer.”

The discussion is ongoing throughout the scientific world. Physicians, researchers, pharmaceutical types – of course. Most specialists are trying to discover if their specialty gets credit. I’m of the school that presumes a truly complex dialectic of improvements in lifestyle provide the base for this change.

I look at this over the span of 60 years or more. What I’ve witnessed in my adult life:

Causes outside of lifestyle innovation include vaccines – removing the stresses of illnesses from diphtheria, measles, mumps, scarlet fever, influenza, etc.. Add in fluoridation of water – fewer dental stressors, removing lead from gasoline, diminishing acid rain, ending coal in home heating.

Causes within lifestyle personal choice include aerobic exercise – especially jogging and walking – fitness including lifetime sports [this more so outside the US excepting racquet sports], myriad of diets – even fad diets – all mostly increase dietary fibre.

The sum of all this is a healthier lifestyle in the United States. A change taking place over a longer scale than most examinations. While other smaller countries may surpass the US model – for the same reasons – medium and large educated nations are fast accomplishing the same. And we affect each other – again, reinforcing the dialectic sum.

Fruit and veggies lead to happiness

This study is one of the first major scientific attempts to explore psychological well-being beyond the traditional finding that fruit and vegetables can reduce risk of cancer and heart attacks.

Happiness benefits were detected for each extra daily portion of fruit and vegetables up to 8 portions per day.

The researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and veg a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment. The well-being improvements occurred within 24 months.

The study followed more than 12,000 randomly selected people. These subjects kept food diaries and had their psychological well-being measured. The authors found large positive psychological benefits within two years of an improved diet.

Professor Andrew Oswald said: “Eating fruit and vegetables apparently boosts our happiness far more quickly than it improves human health. People’s motivation to eat healthy food is weakened by the fact that physical-health benefits, such as protecting against cancer, accrue decades later. However, well-being improvements from increased consumption of fruit and vegetables are closer to immediate.”

I’ll second that emotion.

Scholars at the University of Warwick, England and the University of Queensland, Australia performed the research – in Australia. Their best guess this early on is to conduct further study on antioxidants which indicate a potential link between optimism and carotenoid in the blood.

Go for it. I’ve noted before the benefits I’ve accrued from the wonderful life I lead with my wife. A student of many disciplines, she’s succeeded in moving my daily diet up to seven portions of fruit and veg – while I’ve been working at returning my exercise level to that of a period 35-40 years ago.

I wonder if love counts as a nutritional benefit, as well.

Hope for reversing type 2 diabetes


Allan Tutty on the beach in SunderlandRobert Ormerod/NYTimes

Many experts believe Type 2 diabetes is an incurable disease that gets worse with time. But new research raises the tantalizing possibility that drastic changes in diet may reverse the disease in some people.

Recently, a small clinical trial in England studied the effects of a strict liquid diet on 30 people who had lived with Type 2 diabetes for up to 23 years. Nearly half of those studied had a remission that lasted six months after the diet was over. While the study was small, the finding offers hope to millions who have been told they must live with the intractable disease…

It is not the first time that people have reversed type 2 diabetes by losing a lot of weight shortly after a diagnosis. Studies have also shown that obese individuals who have bariatric surgery frequently see the condition vanish even before they lose very much weight.

But the new study, published in Diabetes Care, proved the reversal after diet can persist for at least half a year as long as patients keep weight off, and can occur in people who have had the disease for many years.

Another conclusion that losing weight and exercising is good for you.

The researchers followed the participants after they had completed an eight-week low-calorie-milkshake diet and returned to normal eating. Six months later, those who had gone into remission immediately after the diet were still diabetes-free. Though most of those who reversed the disease had had it for less than four years, some had been diabetic for more than eight years.

❝ When Allan Tutty, 57, learned five years ago that he had Type 2 diabetes, he asked health care providers if there was a cure. “It was a case of, look, you’ve got it, deal with it, there’s no cure,” said Mr. Tutty, who manages a home for people with brain injuries in Newcastle.

Later, Mr. Tutty spotted a notice recruiting volunteers for a diabetes study that asked, “Would you like the opportunity to reverse your condition?”

Mr. Tutty said he jumped at the chance, becoming one of 30 men and women ages 25 to 80 to sign up. Mr. Tutty was one of 13 participants whose fasting plasma glucose dropped, and during the six-month follow-up remained below the seven millimole per liter (or 126 milligrams per deciliter) that defines diabetes. Although Mr. Tutty completed the study nearly three years ago, his fasting blood sugars continue to range from 5.2 to 5.6 mmol/L, he said…

Going on a very-low-calorie diet may allow the body to use up fat from the liver, causing fat levels to drop in the pancreas as well. That “wakes up” the insulin-producing cells in the pancreas, normalizing blood glucose levels.

While some previous studies have shown that blood sugars can normalize after significant weight loss, endocrinologists said they were impressed by the persistence of the lower blood sugar levels for months after the diet.

The participants in the Newcastle trial, who ranged from overweight to extremely obese, were told to stop their diabetes medications and start a 600- to 700-calorie-a-day diet, consisting of three diet milkshakes a day at mealtimes and half a pound of nonstarchy vegetables a day.

Mr. Tutty, who weighed about 213 pounds before the trial, lost a little more than 30 pounds, the average weight loss in the trial. The people in the study most likely to respond to the treatment were in their early 50s on average and younger than the nonresponders, and they had had diabetes for fewer years…

Good news is good news even when it hasn’t yet been carried forward to a point when more generalized conclusions may be made.

Good news for many folks in this trial. Especially those who learned a new “normal” diet and maintained exercise.