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* Cancer Survivors and CAM


* Childrens' Beverage Intakes


* Osteoporosis Treatment



A stunning one-third of people with a cancer diagnosis use complementary and alternative medicines (CAMs) such as meditation, yoga, acupuncture, herbal medicine, and supplements. In a new study, data from a nationwide survey were used to estimate how many patients with cancer and cancer survivors use CAMs in addition to or instead of conventional therapies and how many do not disclose that to their physicians.


Among about 3100 survey participants reporting a history of cancer, 33% used CAMs in the past 12 months. Younger patients are more likely to use CAMs, and women were more likely to as well. The most commonly used were as follows:


* herbal supplements (36%),


* chiropractic or osteopathic manipulation (25%),


* massage (14%),


* yoga/tai chi/qigong (8%),


* mantra/mindfulness/spiritual meditation (7%),


* special diets (3%), and


* acupuncture (2%).



The bad news is that among the 1023 participants who reported using CAM, almost a third (288 [29%]) did not disclose that to their physicians. Many participants said they did not disclose their CAM use because physicians did not ask or they did not think their physicians needed to know. Patients avoid using them because of possible interactions with medications and treatments. With radiation, there is concern based on the results from a study that very high levels of antioxidants could make radiation less effective.


While doctors are highly cautious about the use of herbs and other supplements during treatment because of their possible adverse effects due to interactions with other medications or treatments, they are much more open to meditation and yoga as practices that can help patients cope with the shock of a cancer diagnosis and the stress of chemotherapy, radiation, and surgery. The bottom line is that it is best to always let the doctor know about all therapies, conventional medicine or CAM, including over-the-counter medications that are being used, just to make sure that they will not do more harm than good.


Source: Sanford NN, Sher DJ, Ahn C, Aizer AA, Mahal BA. Prevalence and nondisclosure of complementary and alternative medicine use in patients with cancer and cancer survivors in the United States. JAMA Oncol 2019; doi 10.1001/jamaoncol.2019.0349



New international guidelines for protein intake among track and field athletes form part of the updated International Association of Athletics Federations' consensus statement on Sports Nutrition for Track and Field Athletes. Those athletes engage in vigorous training that stresses body tissues and requires nutritional support for optimal recovery. The article highlights the benefits of protein intake for training adaptation, manipulating body composition, and optimizing performance in track and field athletes.


The researchers recommend that if the rebuilding of muscle mass proteins is the goal, they should aim for a protein intake around 1.6 g/kg of body weight each day. Muscle proteins are turning over rapidly due to high training volume. The report also offers guidance to athletes in these sports who are aiming to optimize their ratio of strength, power, or endurance to body weight for a performance advantage. It suggests that track and field athletes who are restricting energy intake and want to minimize the loss of lean body mass should target protein intakes of 1.6 and 2.4 g/kg of body weight per day. High-performance athletes now have access to up-to-date guidelines that inform best practice in protein nutrition for optimizing body composition. The previous International Association of Athletics Federations consensus statement was published in 2007, and since then, evidence underpinning nutrition strategies for adaptation and physique manipulation in athletes has evolved considerably. However, there is still a need for more research on the exact amounts of protein that are required.


Source: Witard OC, Garthe I, Phillips SM. Dietary protein for training adaptation and body composition manipulation in track and field athletes. Int J Sport Nutr Exerc Metab 2019; doi 10.1123/ijsnem.2018-0267



Sugar-sweetened beverages (SSBs) add empty calories to children's diets, and some studies suggest that they may add so many extra calories that they increase the risk of weight gain, obesity, and diabetes. Substituting water for SSBs may reduce total energy intake, and in some school-based interventions, displacing SSBs by increasing water access were associated with decreased body mass index. A new study sheds light on how water consumption in daily life might be associated with children's caloric intake from SSBs. It examined whether the number of calories and percentage of total energy intake from SSBs differed among US children by how much water they drank on a given day. The researchers analyzed data from 8400 children and young adults included in the 2011 to 2016 cross-sectional survey waves of the National Health and Nutrition Examination Survey and who had complete valid dietary and covariate data. Of these, 51% were male, and 49% were female. The mean age was 11 years. On a given day, 80% of participants said they drank plain water, leaving more than 20% of US children and young adults who said they drank no water on that day and also reported that they consumed almost twice as many calories from SSBs as those who drank water that day. Interactions between water consumption status, race/ethnicity, and age were statistically significant but not for sex or federal income to poverty ratio. Researchers noted that "kids [who] did not consume any plain water (from tap or bottled water) consumed almost twice as many calories and percent of total calories from sugary drinks than kids [who] consumed water." For the sample overall, that translated to nearly 100 extra calories on a given day. Whether the children compensated by eating less calories from other foods remains to be determined.


Source: Rosinger AY, Bethancourt H, Francis LA. Association of caloric intake from sugar-sweetened beverages with water intake among US children and young adults in the 2011-2016 National Health and Nutrition Examination Survey. JAMA Pediatr Published online April 22, 2019. doi:10.1001/jamapediatrics.2019.0693



Many postmenopausal women do not receive treatment for osteoporosis, although some helpful treatments are now available. One in 2 postmenopausal women will break a bone due to osteoporosis in their lifetime, making them at high risk of subsequent fractures.


The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued by the Endocrine Society introduced during the ENDO 2019 Annual Meeting. The guideline, titled "Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline," provides evidence for the benefits of treating postmenopausal women with osteoporosis. The recommendations cover the newest, most effective medication options and answer patient questions regarding the duration of therapy and monitoring. Among the common drugs used are the bisphosphonates. These include alendronate (Fosamax); risedronate (Actonel), Ibandronate (Boniva), and zoledronic acid (Reclast). Another newer class of drugs that is also being used is called denosomac, which goes by the trade names of Prolia and Xgeva.


Although the adverse effects of the bisphosphonates are relatively rare, they are still enough to cause concern, but concerns may have been overblown. With ongoing reports of atypical femoral fractures and osteonecrosis of the jaw associated with some medications, many patients and healthcare providers are uncertain about the benefits and risks of treating osteoporosis, and so this up-to-date review is welcome to shed light on these important questions. In fact, as a result of these worries, there has been a recent decline in the use of bisphosphonates and an increase in hip fractures due to osteoporosis among postmenopausal women. Many women are so afraid that they will not take antiosteoporosis therapies despite their efficacy and those that do often stop because they become concerned about the risks. As a result, the rate of hip fractures has leveled off and may be increasing. In addition, bone density screening has declined. This amounts to throwing the baby out with the bathwater. Recommendations from the guidelines are based on 2 evidence-based reviews that carefully evaluate both the risks and the benefits. They suggest better paths to take than quitting use of these medications, including the following:


* Treating postmenopausal women at high risk of fractures, especially those who have experienced a recent fracture, with pharmacological therapies, because the benefits outweigh the risks. Using denosumab as an alternative to bisphosphonates for the initial treatment of high-risk individuals is also suggested.


* Prescribing initial treatment of postmenopausal women with bisphosphonates to reduce fracture risk.


* Reassessing fracture risk after 3 to 5 years among women who are taking bisphosphonates. Women who remain at high risk of fractures should continue therapy, whereas those who are at low to moderate risk of fractures should be considered for going on a "bisphosphonate holiday" and halting the drug temporarily.



While each person's response to treatment varies, overall the guideline finds benefits of most treatment outweigh the rare and manageable adverse effects.


Source: The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 5, May 2019, Pages 1595-1622,