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[check mark] Chewing Gum to Help Colon Surgery?


[check mark] Low-Fat Diet Does Not Cause Weight Gain


[check mark] Obesity Link to Alzheimer's Disease


Gum Chewing Gets Things Moving Again

Gum chewing after colon surgery, such as elective surgery of the colon, reduced postoperative ileus and shortened hospital stays, according to a small study. In a prospective randomized study of the simple inexpensive treatment, 17 of 34 patients having open sigmoid resection for recurrent diverticulitis or cancer were randomized to postoperative gum chewing while the other half served as controls, Kenneth Waxman, MD, and colleagues at Santa Barbara Cottage Hospital reported in the Archives of Surgery.


Starting on the first postoperative day, the gum group chewed sugarless gum 3 times a day for 1 hour at a time until the return of bowel function. All the gum chewers tolerated the gum. Early postoperative feeding may stimulate the bowel, they said, but many patients cannot tolerate food or even water. "Gum chewing," Dr Waxman and colleagues said, "may activate both the cephalic-vagal mechanism and increase levels of neural and humoral hormones that stimulate bowel motility in the stomach."


Patients who chewed gum passed flatus earlier than the controls at a mean of 65.4 hours versus 80.2 in the control group (P = .05).The first bowel movement occurred a mean of 63.2 postoperative hours for the gum chewers versus 89.4 for the controls (P = .04).


The gum chewers also got hungry earlier at 63.5 hours versus 72.8 hours in the control group (P = .27). Patient demographics and intraoperative and postoperative care were the same in the 2 groups, and there were no major complications, the researchers reported.


The patients who chewed gum were discharged an average of 4.3 postoperative days versus 6.8 days for the controls. As such, the researchers said, gum chewing is extremely cost effective. With an estimated 79,219 colectomies performed each year and the cost of an average hospital room estimated at $1,500 a day, cutting hospital stays by 2 days would amount to considerable savings. After all, they noted, "the cost of gum is four cents per stick." The researchers also suggested that gum containing sugar or different flavors or textures might be tried. Teachers still say no no to gum chewing, but if this study is successfully repeated, colon surgeons may say yes yes! Source: MedPage Today/Archives of Surgery


High-Carbohydrate, Low-Fat Diet and Weight Gain in Postmenopausal Women

In a clinical trial of over 48,000 postmenopausal women, a low-fat diet that includes increased consumption of fruits, vegetables, and whole grains is not associated with weight gain over an average of 7.5 years, according to a study in JAMA. This is good news since over the years most of us creep up in weight.


Barbara V. Howard, PhD, of the MedStar Research Institute, Washington, DC, and colleagues examined long-term data on the relationships between weight changes and specific changes in dietary components and macronutrient composition. The data were from the Women's Health Initiative (WHI) Dietary Modification Trial, which was designed to examine the long-term benefits and risks of a dietary pattern low in fat, with increased vegetable, fruit, and grain intake, on breast and colorectal cancers and cardiovascular disease in postmenopausal women. Between 1993 and 1998, 48,835 postmenopausal women were randomly assigned to either a low-fat dietary intervention or self-selected dietary control group. The data included body measurements and nutrient data, with an average follow-up of 7.5 years. Forty percent (19,541) of the participants were randomized to the intervention and 60% (29,294) to a control group. The intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable, fruit, and grain consumption and did not include weight loss or caloric restriction goals. The control group received diet-related education materials.


The results show that after losing 2.2 kg (4.8 lbs) in the first year, women in the intervention group maintained a modest weight loss, compared with the control group, during an average 7.5 years of follow-up, and showed no increase from their baseline weight at any point during the study. Weights in the intervention group were lower than those of the control group, who followed their usual eating pattern during the follow-up period, suggesting that a low-fat dietary pattern may help attenuate the tendency for weight gain commonly observed in postmenopausal women.


No tendency toward weight gain was observed in intervention group women overall or when stratified by age, ethnicity, or body mass index. Weight loss was greatest among women in either group who decreased their percentage of energy from fat. A similar but lesser trend was observed with increases in vegetable and fruit servings, and a nonsignificant trend toward weight loss occurred with increasing intake of fiber.


In summary, the results of this long-term trial of diverse postmenopausal women demonstrated that long-term recommendations to achieve a diet lower in total and saturated fat with increased consumption of fruits, vegetables, and whole grains, and without focus on weight loss, do not cause weight gain. Source: JAMA. 2005;295:39-49.


Obesity Link to Alzheimer's Disease

If heart disease and diabetes aren't bad enough, now comes another reason to watch your weight. According to a study just released, packing on too many pounds can increase the risk of developing Alzheimer's disease.


A team led by researchers at the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia and Edith Cowan University in Joondalup, Western Australia has shown that being extremely overweight or obese increases the likelihood of developing Alzheimer's. They found a strong correlation between body mass index and high levels of beta-amyloid, the sticky protein substance that builds up in the Alzheimer's brain and is thought to either play a major role in destroying nerve cells or to mark their destruction, and thus, to be involved in the cognitive and behavioral problems associated with the disease.


According to the researchers, evidence has emerged over the last 5 years that many of the conditions that raise the risk for heart disease, such as obesity, uncontrolled diabetes, hypertension, and hypercholesterolemia, also increase the risk for Alzheimer's. Yet exactly how such factors made an individual more likely to develop Alzheimer's remained a mystery.


The researchers measured body mass index and beta-amyloid levels in the blood. They also looked at several other factors associated with heart disease and diabetes, such as the inflammatory marker C-reactive protein, insulin, and high-density lipoprotein in 18 healthy adults who were either extremely overweight or obese. They found a statistically significant correlation between body mass index and beta-amyloid.


One implication of these findings could be that by losing excess weight and maintaining normal body weight, an individual might reduce the risk of developing Alzheimer's, although the researchers note that this has not been proven. However there are many other reasons for weight control. Source: Journal of Alzheimer's Disease


What is Healthy When it is on a Food Label

The USDA's Food Safety and Inspection Service (FSIS) recently announced that individual meat and poultry products bearing the claim "healthy" must contain no more than 480 mg of sodium and that meal-type products bearing this claim must contain no more than 600 mg of sodium. FSIS's intentions to adopt more restrictive levels (of 360 mg of sodium for individual meat and poultry products and 480 mg for meal-type products) are postponed indefinitely. FSIS is taking this action partly to have labeling regulations consistent with FDA; FDA amended its regulations to establish sodium requirements for products labeled as "healthy" in September 2005.


Low-Carb and Low-Fat are Equal Low-Fat for Weight Loss but Differ in Cholesterol Raising

Low-carbohydrate and low-fat diets are equally effective for weight loss, but the low-carb, high-fat route raises total and low-density lipoprotein cholesterol levels, according to researchers here. In a meta-analysis of 5 controlled clinical trials, the investigators found that an increase in total cholesterol and low-density lipoprotein cholesterol for low-carb dieters offset an increase in HDL cholesterol and a decrease in triglyceride levels.


The analysis involved trials with 222 individuals on low-carb diets and 225 on low-fat diets, all with BMIs of 25 or higher, as reported in the Archives of Internal Medicine.


The low-carb diets held some advantages at 6 months, but at 12 months the differences evened out, with a mean difference of -1.0 kg (95% CI -3.5 to 1.5 kg). There was also no difference in blood pressure levels between the 2 groups. Low-carb dieters were restricted to a maximum of 60 g of carbohydrates a day without energy restriction. In contrast, low-fat diets allowed a maximum of 30% of daily energy intake from fat.


At 6 months, the researchers reported that the low-carb dieters were more likely to stick with the diet, and they lost more weight than the low-fat dieters. The weighted mean difference favored the low-carb group at -3.3 kg (95% CI -5.3 to -1.4 kg).


Beyond 6 months, there was some good news for the low-carb dieters: Compared with the low-fat group, their triglycerides were lower with a weighted mean difference of -22.1 mg/dL (95% CI 38.1 to 5.3 mg/dL). Desirable HDLs were up at a mean difference of 4.6 mg/dL (95% CI 1.2 to 10.1 mg/dL). But on the downside for the low-carb diets, which tend to be high in protein and fat, LDL levels and total cholesterol were higher compared with the low-fat diets. For low-fat dieters, the mean downward change for LDL cholesterol was 5.4 mg/dL (95% CI, 1.2 to 10.1 mg/dL). Total cholesterol was also better for the low-fat dieters with a mean decrease of 10.1 mg/dL (95% CI 3.5 to 16.2 mg/dL), the researchers reported. Source: Archives of Internal Medicine