Calcium May Cut Cancer Risk

Higher Calcium Intake May Reduce Risk of Colorectal and Other Types of Digestive Cancers
Here’s yet another reason to bone up on calcium. It may help reduce your risk of cancer. A new study shows that older men and women who got the most calcium from food and supplements had a 16% lower risk of colorectal and other cancers of the digestive system than those who got the least calcium.

Among women, those cancer-fighting benefits were even stronger. Women who got the most calcium from food and supplements had a lower risk of all cancer and a 23% lower risk of cancers of the digestive system than those who got the least.

Calcium is already known to boost bone health, but researchers say previous studies on calcium’s effect on cancer have produced mixed results.

“Our study suggests that calcium intake is associated with a lower risk of total cancer and cancers of the digestive system, especially colorectal cancer,” write researcher Yikyung Park, ScD, of the National Cancer Institute and colleagues in the Archives of Internal Medicine.

Calcium May Lower Cancer Risk

The Institute of Medicine recommends 1,200 milligrams of calcium per day for men and women over age 50. Dietary guidelines also call for adults to eat three cups of fat-free or low-fat dairy foods, such as milk, yogurt, and cheese to meet their daily calcium needs. This does not include conditions or diseases that my limit the absorption of the Calcium such as weight loss surgical procedures.

One 8-ounce serving of skim milk or yogurt contains about 300 milligrams of calcium. Other nondairy sources of calcium include beans, broccoli, spinach, and other green, leafy vegetables.

In the study, researchers analyzed data from nearly 300,000 men and 200,000 women 50 to 71 who participated in the National Institutes of Health-AARP Diet and Health Study. Participants answered a questionnaire about the foods and supplements they ate, and cancer rates were linked through state cancer registries over seven years of follow up.

The results showed that total calcium intake was not associated with a lower risk of cancer in general in men, but women who got up to 1,300 milligrams of calcium per day had a lower risk of cancer overall.

However, total calcium intake from both food and supplements was linked to a lower risk of colorectal cancer and other cancers of the digestive system in both men and women.

Men who got the highest levels of total calcium per day through food and supplements had a 16% lower risk of these cancers than those who got the least amount per day. Women who get the most calcium per day had a 23% lower risk than those with the least reported intake per day.

Researchers conclude that “our findings suggest that calcium intake consistent with current recommendations is associated with a lower risk of total cancer in women and cancers of the digestive system, especially colorectal cancer, in both men and women.”
SOURCES: Park, Y. Archives of Internal Medicine, Feb. 23, 2008; vol 169: pp 391-401.

Opinion and Commentary: The above two articles that were taken from internet sites, reflect the continues and ever evolving nature of the science behind most of the recommendations made.
Just imagine the treatment of a patient with a disease process. Almost certainly the surgical and medical treatment that may have been recommended years ago may not be an option today.
This is why it is important for us, providers and patients alike to continue to stay vigilant with our surveillance of our health condition and adapt to any pertinent information that may have an impact on it. One of the most commonly asked question is about the type and the amount of the calcium that patients are required to take.
The issue of the types of the calcium supplement is discussed in great length in the FAQ section of our website (dssurgery.com, weightlossinla.com). The table outlines the differences between the types. The bottom line is that for most patients there may not be much of a difference as long as the patients are consistently taking them. There are cases however when we have recommended one type or another.
The most recommended dose is 2000-3000 mg per day in divided dose. Before some of you start calling or emailing us as to how come you were told to only take 1500 and not 2000, remember what I said earlier in this section that this is an ever evolving field. If you have taken 1500mg in divided doses and have had your yearly lab work with no further recommendation from us, do not make any changes unless instructed so.
The other most common concern regarding the calcium, is its relationship with kidney stones. Most common Kidney stone is Calcium Oxalate in post weight loss surgical patients. The treatments Does not include cutting back on Calcium. Calcium Oxalate search of our website will provide further detail.
Ara Keshishian Md, FACS

In a new study, aged laboratory animals that ate a diet rich in the berry and grape compound pterostilbene performed better than those in a group that did not eat the enriched diet, scientists with the Agricultural Research Service (ARS) have reported. Pterostilbene reversed measurable negative effects of aging on brain function and behavioral performance.

Neuroscientist James Joseph, psychologist Barbara Shukitt-Hale and colleagues at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Mass., collaborated on the study with chemist Agnes Rimando of the ARS Natural Products Utilization Research Laboratory in Oxford, Miss. For the two-part study, the researchers wanted to determine if pterostilbene would be effective in reversing the effects of aging on mature rats.

For the first part of the study, they tested seven stilbene compounds in cell cultures and found that pterostilbene was the most effective at preventing oxidative stress. For the second part of the study, they fed aged rats one of three diets: control, or control adjusted to include either low or high concentrations of pterostilbene. The results indicated that in aging rats, pterostilbene was effective in reversing cognitive decline and that improved working memory was linked to pterostilbene levels in the hippocampus region of the brain.

The study results are the latest in a series of ARS cell culture and animal model studies published in the last decade that shed light on relationships between various dietary components and brain function while aging. The authors noted that there are additional berry compounds showing similar
potential, which they continue to investigate in animal and cell models. The researchers followed protocols approved by the Frederick, Md.- based Association for Assessment and Accreditation of Laboratory Animal Care International and a Boston, Mass.-based Internal Animal Care Review Committee.

The study was published recently in the Journal of Agricultural and Food Chemistry.

Avocado- Can I have some?

“Avocados Are Not Just a Pretty Face, They’re Good for You, Too.” According to a in the LA Times, a “functional food” is defined as one that helps maintain a healthy physique and improves the body. Now that’s a little vague, but primarily this definition is being used to single out those foods that seem to be naturally blessed with combinations of phytochemicals that may help fight certain chronic diseases such as cancer and heart disease. Now avocados have been elevated to “functional food” status. According to the director of the UCLA Center for Human Nutrition, avocados include a cholesterollowering agent and are said to act as an antioxidant. Although naturally high in fat (monounsaturated like olive oil) they can be added to diabetic and heart-healthy diets. Avocados have more potassium than a banana and contain almost 10 % of an adult’s daily requirement of iron. They are low in sodium, and provide good quantities of betacarotene, vitamins B6, C and E, folic acid and copper. Because they are a vegetable product, they have no cholesterol. The average avocado contains 112-177 calories depending on size and type. A slice of avocado on a low-fat cracker can provide extra protein as well. Bon Appetite!!

How to Calculate the amount of Calories used?

EXERCISE AND CALORIES—To determine the number of calories burned for a specific activity, enjoy the information from below and use it to help you burn calories!

How much water is enough?

Most of us do not adequately hydrate our bodies, especially in the summertime and after we work out. This is critical for our post-op patients. To find out how much water you really need: take your weight, divide it in half and divide by 8.

Example:

A 300lb person — divided in half = 150 divided by 8 = 18 ½ glasses of water/ day.
A 150 lb person, divided in half = 75 divided by 8 = 9 glasses water/day.
Drinks containing caffeine and alcohol will only dehydrate you more.

Teaching Our Children Healthy eating Habits

As I am sure you have all heard in the media, the largest group of US population that is getting larger is the youngest member of the society.

There are some common sense reasons why our children are becoming overweight. These include excess calories, sedentary lifestyle (being in front of computer, and video games.) Children however can easily be taught healthy habits. It is much easier to avoid the disease of the obesity, rather than try to correct it later in life. I am not discounting the genetic predisposition to obesity which may be present in some cases.

Looking over some of our very first newsletters I came across the following list that I believe is worthwhile sharing again.

Teaching Kids to Eat Right and Get Moving
Studies cite sedentary pastimes and poor eating habits as the main factors behind childhood obesity. Experts see prevention as the remedy. Much of the latest research on childhood obesity is focused on prevention and intervention: breaking children of their bond to television, guiding them toward more physical
activity and improving their eating habits. Nurturing Good Habits: For a child, family eating patterns and parental pressures can make the difference between a healthy body and a sensible outlook on meals or a lifetime of bad eating habits. Experts recommend that parents establish good habits and pass them on to their kids.

• Don’t restrict eating by making certain foods off-limits
• Don’t tell children to clean their plates.
• Don’t put children on a diet unless recommended by an experienced health professional who realizes that obesity is not all about overeating and lack of activity.
• Don’t use food to regulate moods-reward children with love, attention and parental time.
• DO realize that three meals a day works for adults, but children need healthy snacks too.
• DO try to serve meals to the whole family that meet heart-healthy guidelines-<30% fat.
• DO try to introduce healthy foods to children—they may learn to love it!
• DO become educated about the food types, their nutritional values as well as portion sizes.
• DO make exercise a part of daily life— walk to and from school with them if you can.
• DO limit television viewing, playing video games, surfing the internet, and being on the computer. They will find fun active things to do.
• DO join your children outdoors for fresh air. Once outside stress seems to release easier.
• DO down at dinner with your family— conversations will happen!

Food should be healthy, and be valuable and nutritional. Our children will mimic what we do on daily basis. By making the same changes in our life style, we will set example for our children to follow.

Am I Going Bald?

“My hair is thin. My hair is falling out. My hair is dry and brittle. I just run out of energy…..”These are some of the most common reasons bariatric surgery patients come to see me. Typically they are eating between 2 and 4 of the vending machine peanut butter crackers for one meal and a few noodles at the other meal. Many times they just simply aren’t hungry, and this is a welcome feeling for them. Well, thinner is greater, but thinner hair isn’t usually as well received.

The hair problem is reflective of protein malnutrition, (and possibly vitamin deficiency if the patient is not taking their vitamin mineral supplement as directed.) This can happen several year’s post –op when patients simply stop paying attention to their intake.

Here are some of our suggestions for quick and easy protein:

• Purchase low fat peanut butter and low fat crackers and keep handy in
  your car or desk at work.
• Try hard-boiled eggs—coloring them is helpful in keeping track of each
  batch’s freshness.
• Low fat cheese is a possibility.Watch the portion size.
• Skim milk (or 1% milk) is a great source of protein. Add 1/3 cup of nonfat dry milk powder to 1 cup of milk—this will give you twice the protein. Lactose intolerant? Try Lactaid milk, Lactaid tablets to help
  with the gas, cramping, or diarrhea.
• Beans and bean soup. If gas is a problem try BEANO—this is an enzyme sold over the counter in the drugstore.
• Sliced or shaved deli meat, Teriyaki turkey jerky, sliced almonds are quick protein sources.
• Remember to try and get 80 grams of protein/day.

Trans-fatty Acids

Trans-fatty acids occur in semi artificial fats created by pumping hydrogen through liquid fats. This process adds hydrogen atoms and alters the molecular bonds of fatty acids that are liquid at room temperature. This process was first used to produce margarine, which has the texture of butter. It gives the “crunch” in cookies, and most importantly (for manufacturers)
prolongs the shelf life.

One of the many problem with these acids is that they increase LDL (low density lipoproteins) and lower the HDL (high density lipoproteins) that are good for you. Studies conducted by scientists in the last 25 years confirm that two percent increase in consumption of trans-fatty acids double the risk of developing heart disease.

As much as 25 to 50 percent of the fat in baby biscuits, cookies, chips, croissants and fish sticks contain appreciable amounts of trans-fatty acids.

Many of the major fast food chains have now committed to removing Trans fats rom their menu. Enjoy your dinner.

Cases of esophageal cancer in patients who had been taking oral bisphosphonate drugs for osteoporosis have been reported by an official from the Food and Drug Administration (FDA) in the January 1 issue of the New England Journal of Medicine.

Twenty-three cases (of which 8 were fatal) have been reported in the United States, all of them in association with alendronate (Fosamax, Merck), which was cited as the suspect drug in 21 cases and as a concomitant drug in 2 cases. These reports were received by the FDA in the 12-year period between October 1995 (when alendronate was launched in the United States) and mid-May 2008. No reports were received about esophageal cancer and any of the other oral bisphosphonate products.

A further 31 cases (6 fatal) have reported in Europe and Japan, with lendronate as the suspected drug in 21 cases. Of the remainder, 6 cases were associated with risedronate (Actonel, Procter & Gamble/Sanofi- Aventis), ibandronate (Boniva, Roche/ GlaxoSmithKli ne), etidronate (Didronel, Procter & Gamble), or a combination of these, and 4 cases cited bisphosphonates as concomitant drugs.

Writing in a letter to the journal, Diane Wysowski, PhD, from the FDA, gives few further details but points out that 4 of the patients had Barrett’s esophagus, which is a precursor of esophageal adenocarcinoma. “Physicians should avoid prescribing oral bisphosphonates to patients with Barrett’s esophagus,” she writes.

Dr. Wysowski also points out that esophagitis has been associated with oral bisphosphonates, usually when the drugs are not taken according to directions. “Crystalline material similar to ground alendronate tablets has been found in patients with erosive esophagitis, and persistent mucosal abnormalities have been noted in some of these patients, suggesting a potential for carcinogenic effects,” she writes.

Merck said in a statement that data from its clinical trials and postmarketing reports do not suggest any association between alendronate and esophageal cancer. The company pointed out that alendronate has been marketed for 13 years, during which time more than 150 million prescriptions have been written in the United States alone. Merck also noted that its clinical database includes more than 17,000 patients, of whom about 3000 osteoporosis patients took alendronate for 3 to 5 years and about 800 patients took alendronate for 8 to 10 years.

N Engl J Med. 2009;1360:89
Thank you VICKI BLACKBURN for sharing this information .

What are Biphosphonates?

These drugs are usually prescribed to prevent or treat Osteoperosis, and also to long time steroid users (cancer patients) to prevent bone loss. It is also prescribed to patients suffering from Paget’s Disease. Bisphosphonates are antiresorptive medications, which means they slow or stop the natural process that dissolves bone tissue. Fosamax, a member of this particular group of medications, has recently been linked to a condition called Osteocrenosis of the Jaw (ONJ). Individuals taking Bisphosphonates are also advised to avoid any unnecessary unvasive dental procedures (cleanings are OK).

Biphosphonates have been advocated strongly for treatment or prevention of osteoporosis. It has become evident that there are significant risk associated with this class of medication.

We strongly suggest that patients discuss these with the prescribing physician before taking this class of medication. When it comes to weight loss surgery and Biphosphonates, it is imperative that the patient has a normal serum Ca, PTH, Alk. Phos, before starting on this class of medication.

Newsmaker
The past year has gone by very rapidly. A lot or new changes and improvements were instituted. We continue to make changes and strive to do better. We wish every one a happy and healthy new year.
The staff and Ara Keshishian, MD, FACS

New Anti-cancer Components Of Extra virgin Olive Oil Revealed
Good quality extra-virgin olive oil contains health relevant chemicals, phytochemicals’, that can trigger cancer cell death. New research sheds more light on the suspected association between olive oil-rich Mediterranean diets and reductions in breast cancer risk.

A team of researchers set out to investigate which parts of olive oil were most active against cancer. Their findings revealed for the first time that all the major complex phenols present in extra-virgin olive oil drastically suppress over expression of the cancer gene HER2 in human breast cancer cells.

Extra-virgin olive oil is the oil that results from pressing olives without the use of heat or chemical treatments. It contains phytochemicals that are otherwise lost in the refining process. Menendez and colleagues separated the oil into fractions and tested these against breast cancer cells in lab experiments. All the fractions containing the major extra-virgin phytochemical polyphenols (lignans and secoiridoids) were found to effectively inhibit HER2.

Although these findings provide new insights on the mechanisms by which good quality oil, i.e. polyphenol-rich extra-virgin olive oil, might contribute to a lowering of breast cancer risk in a HER2- dependent manner, extreme caution must be applied when applying the lab results to the human situation. As the authors point out, “The active phytochemicals (i.e. lignans and secoiridoids) exhibited tumoricidal effects against cultured breast cancer cells at concentrations that are unlikely to be achieved in real life by consuming olive oil”.

Nevertheless, and according to the authors, “These findings, together with the fact that that humans have safely been ingesting significant amounts of lignans and secoiridoids as long as they have been consuming olives and extra-virgin oil, strongly suggest that these polyphenols might provide an excellent and safe platform for the design of new anti breast-cancer drugs”.

Fat consumption after Duodenal Switch
The addition of moderate amount of fat in to your diet, after Duodenal Switch operation will result in loose bowel movement. By reducing the fat absorptive capacity in the small bowel after surgery, more fat is found in the colon. This results in loose bowel movements. In some patients who have had problem with constipation before surgery, and continue to have the same problem after DS, addition of some fat can be helpful. Excessive amount of fat however, will create problem.

Types of olive oil
Generally, olive oil is extracted by pressing or crushing olives. Olive oil comes in different varieties, depending on the amount of processing involved. Varieties include:

• Extra virgin – considered the best, least processed, comprising the oil from the first pressing of the olives.
• Virgin – from the second pressing.
• Pure – undergoes some processing, such as filtering and refining.
• Extra light – undergoes considerable processing and only retains a very mild olive flavor.

When buying olive oil you will want to obtain a high quality EXTRA VIRGIN oil. The oil that comes from the first “pressing” of the olive, is extracted without using heat (a cold press) or chemicals, and has no “off” flavors is awarded “extra virgin” status. The less the olive oil is handled, the closer to its natural state, the better the oil. If the olive oil meets all the criteria, it can be designated as “extra virgin”.

What is pure and light olive oil? “Pure” olive oil is made by adding a little extra virgin olive oil to refined olive oil. It is a lesser grade oil that is also labeled as just “olive oil” in the U.S.

“Light” olive oil is a marketing concept and not a classification of olive oil grades. It is completely unregulated by any certification organizations and therefore has no real precedent to what its content should be. Sometimes, the olive oil is cut with other vegetable oils.

Newsmaker
This year has gone by very fast. One of the most significant changes that have taken place is the deployment of our electronic medical record system. We are on schedule to have the medical records of our new patients on a secured server stored electronically. This has been a on-going project and now we are aiming for a January 2009 complete deployment.
Ara Keshishian, MD, FACS

Calcium And Vitamin D May Not Be The Only Protection Against Bone Loss Diets that are high in protein and cereal grains produce an excess of acid in the body which may increase calcium excretion and weaken bones, according to a new study.

The study found that increasing the alkali content of the diet, with a pill or through a diet rich in fruits and vegetables has the opposite effect and strengthens skeletal health. “Heredity, diet, and other lifestyle factors contribute to the problem of bone loss and fractures,” said Bess Dawson-Hughes, M.D., of Tufts University in Boston, Mass. and lead author of the study. “When it comes to dietary concerns regarding bone health, calcium and vitamin D have received the most attention, but there is increasing evidence that the acid/base balance of the diet is also important.”

Average older adults consume diets that, when metabolized, add acid to the body, said Dr.Dawson-Hughes. With aging, we become less able to excrete the acid. One way the body may counteract the acid from our diets is through bone resorption, a process by which bones are broken down to release minerals such as calcium, phosphates, and alkaline (basic) salts into the blood. Unfortunately, increased bone resorption leads to declines in bone mass and increases in fracture risk.

“When fruits and vegetables are metabolized they add bicarbonate, an alkaline compound, to the body,” said Dr. Dawson Hughes. “Our study found that bicarbonate had a favorable effect on bone resorption and calcium excretion. This suggests that increasing the alkali content of the diet may attenuate bone loss in healthy older adults.”

In this study, 171 men and women aged 50 and older were randomized to receive placebo or doses of either: potassium bicarbonate, sodium bicarbonate, or potassium chloride for three months. Researchers found that subjects taking bicarbonate had significant reductions in calcium excretion, signaling a decrease in bone resorption.

“In this study, we demonstrated that adding alkali in pill form reduced bone resorption and reduced the losses of calcium in the urine over a three month period,” said Dr. Dawson- Hughes. “This intervention warrants further investigation as a safe and well tolerated supplement to reduce bone loss and fracture risk in older men and women.”

Other researchers working on the study include Susan Harris, Nancy Palermo, Helen Rasmussen, and Gerard Dallal of Tufts University in Boston, Mass., and Carmen Castaneda-Sceppa of Northeastern University in Boston, Mass.

Bariatric Surgery Before Pregnancy Benefits Moms, Babies

Women who get pregnant after having weight-loss surgery have a lower risk of maternal and newborn complications than pregnant women who are obese, according to U.S. researchers who analyzed 75 studies.

Data from those studies showed that bariatric surgery in the United States increased by 800% between 1998 and 2005 (from 12,480 to 113,500). Women accounted for 83% of procedures among patients ages 18 to 45. Between 2003 and 2005, more than 50,000 women in this age group had inpatient bariatric surgery each year, which accounted for 49% of all bariatric surgeries.

The review authors found that pregnant women who’d had bariatric surgery had lower maternal complication rates than obese women, including gestational diabetes (0% vs. 22.1%) and preeclampsia (0% vs. 3.1%). In addition, maternal weight gain was reduced in women who’d had bariatric surgery.

Newborn outcomes among women who’d had laparoscopic adjustable band surgery were similar or better than outcomes among obese women: premature delivery, 7.7% vs. 7.1%; low birth weight, 7.7% vs. 10.6%; overly large body (macrosomia), 7.7% vs. 14.6%.

The findings were published in the Nov. 19 issue of the Journal of the American Medical Association.

“Research is needed to better delineate the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes,” the review authors wrote. “Optimizing success for contraception and producing healthy neonates following surgery will require a multidisciplinary effort by surgeons, primary care physicians, reproductive fertility specialists, obstetricians, and patients.”

Having bariatric surgery during childbearing years may change a woman’s fertility following weight loss, alter nutritional requirements during pregnancy, or impact contraception, the researchers noted. — Robert Preidt

Source: Journal of the American Medical Association, news release, Nov. 18, 2008