The Word is 'Leakage': Accidents may happen with a new OTC diet drug

GlaxoSmithKline has a tip for people who decide to try Alli, the over-the-counter weight-loss drug it is launching with a multimillion- dollar advertising blitz-keep an extra pair of pants handy. That's because Alli, a lower-dose version of the prescription drug Xenical, could (cue the late-night talk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be good for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accident is worth it.
Unlike traditional diet pills, Alli, the first over-the-counter weight-loss product approved by the FDA, is not an appetite suppressant. Instead, it prevents the gastrointestinal system from absorbing about 25 percent of the fat a person consumes. If you eat more than the recommended 15 grams of fat at a meal, you may experience cramps and the uncontrollable escape of those extra fat grams. For New Jersey native Paula Miguel, 35, however, that's just the incentive she needed to stay on track and lose 20 pounds. "I see Alli as a disciplinarian, " says Miguel. "It keeps me accountable for everything I eat."
While many nutritionists agree that Alli can help block the absorption of fat calories, they are careful to note that if people are not dedicated to changing their eating habits, weight loss will be small or nonexistent, and the side effects will eventually cause them to stop taking the drug. "For some people who are extremely motivated and don't mind a little bit of leakage, this may work for them," says Elisa Zied, a nutritionist from New York City. Zied is quick to add that Alli users should be sure to take a multivitamin every day, since the drug also decreases the absorption of fat-soluble minerals and vitamins such as E, A, D and K.
Critics say it's the low-fat, reduced-calorie diet Alli users are encouraged to follow that results in real weight loss. A new companion book, "The Alli Diet Plan," by Dr. Caroline Apovian, aims to maximize the drug's weight-loss potential with detailed meal plans and more than 200 low-fat recipes. But there's not much in the book that can't be found in lots of other diet books that don't endorse a particular weight-loss product. Dr. Carla Wolper of the New York Obesity Research Center says Alli offers dieters a slight edge, but permanent change comes from a change in attitude and behavior.
GlaxoSmithKline says people who use Alli lose 50 percent more weight than people who follow the same regimen but forgo the drug. All joking aside, Alli, like Xenical, has been proved to be safer than the OTC appetite suppressants, which can cause heart and kidney damage and even seizures in some users.
The drugmaker hopes to stem the number of Alli dropouts by including with each $50 starter kit a weight-loss journal and a calorie and fat counter. In addition, the company is sponsoring an online behavioral support program. Dr. Vidhu Bansal, who led GlaxoSmithKline' s Alli clinical trials, says that people who are looking for a quick fix shouldn't bother buying the drug: "People have to be committed to losing weight. They have to accept that they have to make a lifestyle change to get healthy." More than 60 percent of Americans can be classified as overweight or obese. With the economic impact of obesity in the United States said to top $122 billion a year, commitment to a healthy lifestyle seems to be one thing we don't have. So perhaps we need the threat of you know what.
[AP]

What Makes People Happy? Try Aging

The trend in positive psychology suggests that as we get older, we become less fearful and more focused on quality of life.
Some things actually get better with age, and emotional stability appears to be one of them. It says so right in the authoritative Journal of Neuroscience.
Ever since Freud, psychologists have focused almost exclusively on misery - our fears, our depressions, sadness, anger, hostility, aggression, you name it. Now, thank goodness, the young discipline of "positive psychology" is gaining ground as psychologists and neuroscientists try to figure out what makes people happy.
One of the most provocative studies in this new field was published last summer in the neuroscience journal. Australian researchers studied 242 healthy people ages 12 to 79. The subjects were shown pictures of fearful faces and happy faces, while their brain responses were tracked with functional MRI scans and EEGs, or electroencephalogra ms, which show the regions of the brain active at any given moment. The findings suggest that people become less neurotic, more able to control fear and more emotionally stable as they age, an observation that fits with other data.
Specifically, the Australian team found that the amygdala - a deep brain center for processing raw feelings, especially fear - becomes less reactive to fearful stimuli between the middle and older years, while a higher brain center, the medial prefrontal cortex, which governs planning and judgment, gets more active during that same period.
This suggests that healthy, older people "are less bothered by things. They are more in control of their reactions to fear," said Dr. Andrew Leuchter, director of the laboratory of brain, behavior and pharmacology at UCLA.
The findings also suggest that aging is not only linked to "putting the brakes on" negative emotions, but also to "releasing the brakes" on positive emotions, said Lea Williams, a neuroscientist at the University of Sydney in Australia and lead author of the study. These findings, she said in an e-mail, "are consistent with people reporting that they focus more on quality of life as they get older. Our many experiences do impact our emotional brain systems in a way that helps attain a better sense of comfort with oneself and the world."
The neuroscience data fits with some epidemiological data. A 2004 study from the U.S. Centers for Disease Control and Prevention showed that young people report more sad, blue or depressed days per month than older people - 3.4 per month for 20- to 24-year-olds, versus just over two days for people 65 to 74.
Another government study, the 2003 National Health Interview Survey, asked people how often they felt sad, hopeless, worthless or that everything was an effort. The least sad were people ages 65 to 74. Only 2.6% of this group said they felt sad all or most of the time, in contrast with 3% of the 18- to 44-year-olds. But after age 75, it's not clear whether the happy trend continues - and more research is needed.
The idea that many people do indeed mellow with age makes sense to Dr. George Vaillant, a senior psychiatrist at Brigham and Women's Hospital and director of the Harvard Study of Adult Development, who for decades has studied the way people change over the years.
Older people "modulate emotion better than the young, which lets them be more 'Buddhist' and thus happier because their frontal lobes are better connected to their limbic system," the deeper region of the brain where emotions are processed, wrote Vaillant, the author of "Aging Well," in an e-mail.
The general trend toward greater happiness with age also makes sense to Harvard's chief happiness guru, Tal Ben-Shahar. Ben-Shahar, who taught one of Harvard College's most popular courses, "Positive Psychology," said in an e-mail interview that "one of the reasons why we are happier with age is that we simplify our lives. We focus on what's really important to us, while discarding things that are less personally meaningful.
"When we experience negative emotions, we are more accepting and also are secure in the knowledge that 'this, too, shall pass,' " Ben-Shahar said. Evolution may also play a role in helping people become less fearful and more sanguine with age, said biological anthropologist Helen Fisher of Rutgers University.
"A young person has everything to look forward to and everything to gain or lose," she said. It makes sense for younger people to watch out for negative things that might kill them, while older people who have already succeeded in passing on their genes have less to fear, she said. "It's now adaptive for them to be less vigilant about all the exigencies of life, to stay calm and keep others calm."
Even though the odds are good that you will get happier as you age, there's no need to wait. Younger people, like those in Ben-Shahar's Harvard classes, can learn the basic skills. The first, he said, is to give yourself permission to feel negative emotions such as sadness, fear or anxiety. The sooner you do, the faster these feelings will pass.
It's also key, he said, to engage regularly in activities that you find pleasurable and meaningful. Remember too that happiness is mostly "dependent on our state of mind, not on our status or the status of our bank account. Barring extreme circumstances, our level of well-being is determined by what we choose to focus on and by our interpretation of external events."
[AP]

Slim results for 'electric exercise'?

The products: All of our actions - blinks, hand waves, stomach crunches - start with electrical signals from the brain. If you can't stand the thought of stomach crunches, you can always bypass your brain and strap on some electrodes. When electricity hits your abs, the idea goes, the muscles will tighten - as if you were working out.
Consumers interested in "electric exercise" have plenty of options. Many health spas offer electronic muscle stimulation (EMS) as a part of their "slimming" treatments, and Internet sites sell home use EMS devices. For example, for about $150, you can slip into your own Slendertone Flex, a belt that delivers electricity to the abdominal muscles. It provides enough juice to cause intense contractions that would score an 8 or more on a 1 to 10 scale, says John Porcari, an exercise physiologist at the University of Wisconsin at La Crosse who published a company-funded clinical study of the device in 2005. "It feels like a muscle cramp."
Doctors and physical therapists use EMS to ease pain and strengthen muscles damaged by injury or stroke. Beyond this, the devices have a rocky history. In the 1970s, the Food and Drug Administration sent "wanted" posters to post offices across the U.S. to warn about the Relaxacisor, a high-voltage vest that provided more shocks than results. In 2002, the FDA reported that unapproved EMS devices might burn users or interfere with pacemakers. And in 2003, the Federal Trade Commission levied a $5-million fine against the marketers of the AbTronic, a heavily advertised belt that promised "rock-hard" abs without effort.
The claims: Infomercials, newspaper ads and Internet sites continue to promise incredible results, no workout required. The website for Body Beauté, a health spa with outlets in Beverly Hills and Newport Beach, claims its EMS treatment is "equivalent to 1,500 sit-ups per hour" and that EMS is an integral part of a weight-loss plan that can help one lose as much as 20 pounds in three weeks.
A website hawking the Vital Stim EMS 4000, a device featuring two electrified pads that can be placed practically anywhere on the body, boasts that the "revolutionary" product can "build the same rippling muscles that steroids promised."
Pitches for the Slendertone Flex are more reserved. A TV spot calls it "the clinically proven solution to get the tighter, more toned abs you've always wanted and that the Slendertone Flex is the "first ab belt ever to be cleared for sale by the FDA."
"Slender" is in the name, but the Slendertone Flex is not for weight loss, says Susan Henken, spokesperson for Slendertone USA. The belt can firm stomach muscles but "we'd never say that you'd get six-pack abs."
Bottom line: Exercise belts of the past routinely burned and shocked people without working muscles, but the Slendertone Flex really is FDA-approved for "toning, strengthening and firming abdominal muscles." Porcari's 2005 study in the Journal of Sports Science and Medicine, found that all 24 subjects who used the belt five days a week for eight weeks said their abs felt firmer and more toned. Stomach-crunch tests showed a strength gain - about 70% more than a control group. Lab measurements showed they lost more than an inch from their waistline, but they didn't shed body fat or drop pounds.
The device could be especially helpful for people who can't do regular sit-ups, including people with back trouble, Porcari says. "But anyone who expects to look like the people in the infomercials will be disappointed. " Claims of "1,500 sit-ups an hour" or "rippling muscles" from EMS are ludicrous, and no EMS device could dramatically flatten a stomach or speed weight loss, he says. A person needs to burn calories to lose weight, and it's not possible to burn significant calories through contractions alone. "You'd have to do thousands of actual sit-ups to lose any weight," adds Wayne Miller, an exercise physiologist at George Washington University. "Anyone who can do that many sit-ups probably doesn't need to."
[AP]

Emergencies in the General/Family Practice' Office

What is an office emergency?
An office emergency is when someone in the doctor's office needs emergency medical care. For example, a patient may have a stroke, or a child may be brought in with meningitis.

What can I expect if I have an emergency in the office?
Many medical problems can be treated in the doctor's office, but some problems need to be treated in an emergency room or urgent care center. If you or your child has a medical problem that is more urgent than you thought, your doctor may send you to the emergency room or urgent care center, or call an ambulance.

How can I prevent office emergencies?
Usually, emergencies can't be prevented. But you can ask your doctor what medical emergencies might happen to you or your family. Your doctor can tell you if they can be treated in the office. Call your doctor and tell him or her about your symptoms. Some medical emergencies can be taken care of better in the emergency room than in an urgent care center, but an urgent care center may have a shorter wait time. Ask your doctor where you should be treated.

How can I prepare for medical emergencies?

• Find out if you or your family are at risk of any medical problems.
• Talk to your doctor about what you should do if an emergency happens.
• Find out which emergency room or urgent care center you should go to in an emergency.
• Know when your doctor's office is open and how to contact your doctor when the office is closed.
• Keep a list of the medicines you take and your medical problems.
• Know how to call an ambulance.
• Learn basic first aid skills.

[AAFP]

Dysmenorrhea: Painful Menstrual Periods

Why do some women have painful periods?
Most women have some pain with their periods. The pain can start just before your period or at the beginning of your period. It can last 1 to 3 days. The pain can be bad enough to keep you from doing your normal activities. Painful periods, or dysmenorrhea (say: dis-men-oh-ree- ah), are not usually serious. However, sometimes painful periods can be caused by an infection or by ovarian cysts (fluid-filled sacs in the ovary). Pain also can be caused by endometriosis (say: en-doe-me-tree- oh-sis). This is a problem with the lining of the uterus.

How are painful periods treated?
You can try using heating pads or taking a warm bath. You can buy medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or paracetamol with caffeine, antihistamines or diuretics.
Over-the-counter pain relievers can also help with the pain. These include ibuprofen, ketoprofen and naproxen. These medicines work well for mild or moderate pain. If these don't help, you can talk to your family doctor about a stronger pain reliever.
Your family doctor might want you to try using birth control pills or a birth control shot. These medicines can make your periods less painful.

What if these treatments don't work?
If none of these treatments work, your family doctor might want to check for ovarian cysts or endometriosis. An ultrasound test lets your doctor see if you have ovarian cysts. A minor surgery called a laparoscopy (say: lap-ah-ross- ca-pee) is used to check for endometriosis. This is a way of looking inside your uterus by making a small cut in your skin and putting a thin tube inside.

How can I tell if I have a more serious problem?
Talk to your family doctor if you have any of the following symptoms:
Painful periods that started later in life
Pain at times other than the first couple of days of your period
Unusual vaginal discharge or bleeding
Pain that doesn't go away when you take medicine to relieve it

[AAFP]

The Toxic Republic: For profit's sake, China's people are getting poisoned

Wang Hai's phone won't stop buzzing. Everyone in China seems to want urgent help from the country's No. 1 consumer-rights advocate. He helps not only ordinary buyers of defective goods but whistle-blowers who risk their lives by outing unscrupulous firms. "A good system for guaranteeing quality control simply doesn't exist in China," says Wang, who has spent more than 10 years trying to clean up the Chinese marketplace. "Even confidential informants can wind up dead, under suspicious circumstances. I personally know of two."
Americans may suppose they have worries about Chinese products these days: killer pet food, antifreeze-laced toothpaste, lead-painted toy trains, unsafe tires, seafood contaminated with unapproved drugs and additives-the list keeps growing. Authorities in Panama announced recently that at least 93 people have died there since July 2006 from cough syrup containing Chinese-made diethylene glycol. But last week Chinese authorities pointed out that only 1 percent of foodstuff exported to the West failed to meet quality standards. By contrast, nearly 20 percent of domestically sold goods flunked. What the world should really be concerned about, says Asian Development Bank (ADB) economist Chris Spohr, "are the implications for food and product safety in [China] itself." Until attitudes change in China-among regulators, manufacturers and consumers alike-goods produced there will continue to be suspect everywhere.
Activists like Wang are badly outnumbered. Entrepreneurs across China are cashing in on murky regulation, rampant corruption and consumer ignorance. "The regime is particularly weak at regulating a cutthroat market economy with millions of private enterprises, " says Wenran Jiang, a Sinologist at the University of Alberta. It's not unlike America in the age of the robber barons, more than a century ago. In 1906, ordinary Americans' outrage over unsafe medicines and foodstuffs-and books like Upton Sinclair's "The Jungle," with its horrific portrait of Chicago's meatpacking industry-led to passage of the landmark Pure Food and Drug Act. Right now, though, most Chinese are busy earning a living.
And they're paying the price. At least 300 million Chinese are affected by food-borne illness every year, according to a recent report by the ADB and the World Health Organization, and mass poisonings by adulterated and mislabeled products recur constantly. Unsafe infant formula killed at least 50 babies three years ago and left 200 others severely malnourished, according to local media. The ADB/WHO report adds: "Despite stepped-up measures, a string of similar infant formula problems emerged in February 2006, indicating that systemic issues remain unresolved."
Chinese writer Zhou Qing has even produced a book that evokes "The Jungle." His "What Kind of God," a 2006 finalist for the Lettre Ulysses Award, tells of monstrous abuses: soy sauce bulked up with arsenic-tainted human hair; hormone-infused snack foods that grow facial hair on 6-year-old boys and breasts on 7-year-old girls; dangerous drugs fed to pigs to make their meat look better. Zhou's book concludes: "While cracking down on the immediate perpetrators of food-safety incidents, it's even more critical that we crack down on the officials who bear responsibility. "
Bad publicity has forced Beijing to make at least a show of getting tough. Zheng Xiaoyu, the first head of China's State Food and Drug Administration, was sentenced to death in May for approving fake medicines in exchange for bribes. And at the factories whose chemical melamine was implicated in at least 16 U.S. pet deaths, two managers have been jailed. But Zhou remains skeptical. "Zheng Xiaoyu was [sentenced] because of America's dogs and Panama's cough syrup," he says. His book, which finally reached stores early this year, was edited heavily by its state-owned publishers and released with minimal fanfare.
Product-safety jitters will probably bypass at least a few export sectors. The chip industry, for one, is likely to remain unscathed, predicts Dan Heyler, a Merrill Lynch tech analyst in Hong Kong, since it's strictly supervised by the multinationals that dominate the field. But food, medicine and lower-end manufactured goods may need serious regulatory measures to win back the world's confidence. When we asked his thoughts on "The Jungle," Zhou said he had never heard of the book. But, he added, it sounded like something he should read. The men who run China might also want to take a close look.
[Newsweek]

Jiffy Boobs

Can you really get your breasts enlarged on your lunch hour? Here's the real story behind those reports-and a look at the research that could make fat your friend.
The headlines were irresistible: "Lunch Break Boob Jobs Headed to Europe." According to some news outlets that carried the story, doctors would be using women's own belly fat for a one-hour breast-augmentation procedure that could be available as early as next year. But if you think getting a flatter stomach and bigger cup size in the time it takes to eat a sandwich sounds too good to be true, you're right. So let us set the record straight: there's no such thing as the one-hour boob job-unless you count some of the architectural wonders now being sold at Victoria's Secret.
So how did the news-that's- not get such, um, pick up? Well, there is a globule of truth in that a small San Diego-based biotech company called Cytori Therapeutics has developed a system that uses the stem cells in fat to make fat grafts more viable. That's important if you're going to have surgery involving relocation of fat cells. (Left to its own devices, transplanted fat often dies or gets re-absorbed. If used to boost breasts, it can calcify in a way that can make make cancer detection more difficult.) But not only is the Cytori technique still in clinical trials, the procedure
will not take place at drive-by speed.
"No one is going to leave for lunch, have the procedure and go back to work like it's no problem," says Marc Hedrick, president of Cytori Therapeutics and former director of the Laboratory of Regenerative Bioengineering and Repair for the Department of Surgery at UCLA. Hedrick expects the procedure to take two or more hours under general anesthesia, plus recovery time. "This is surgery and it carries all the potential risks of any surgical procedure," he says. And, says Hedrick, Cytori's focus, at the moment, is breast reconstruction for cancer patients who can't tolerate artificial implants-though it could someday be used for cosmetic breast enlargements.
Back to the hype. The sensationalized reports began with an article entitled "Breast boost in your lunch hour," in the July 9 issue of the British trade magazine "Chemistry & Industry." That piece was then picked up by blogs and news Web sites. Soon, publicity-seeking plastic surgeons were offering up interviews to discuss a procedure that they'd never seen. When the article appeared, Cytori contacted Chemistry & Industry about the errors and the piece was pulled from the magazine's Web site. The magazine's editor, Neil Eisberg, told that "an earlier, uncorrected draft of the story was published by mistake," and he notes that the magazine is working with Cytori on an in-depth follow-up piece about the Cytori system that will clarify matters.
The quickie boob-boost story, though, didn't just raise more hopes than bra sizes. It overshadowed some truly exciting research into ways that fat can be created and moved around the body for everything from reconstruction in the aftermath of a trauma, to the correction of birth defects, use in injectable wrinkle fillers and breast or buttock enlargements. So while there may be legions of scientists pursuing ways to melt fat, or prevent it from growing in the first place, a growing group of researchers around the country are striving to keep fat alive. "The ultimate goal in plastic surgery is to restore form with your own natural tissue," explains Stephen B. Baker, a Georgetown University associate professor of plastic surgery who is working on a variety of strategies to improve the reliability of fat grafts under a grant from the National Institutes of Health and the Plastic Surgery Education Foundation. "Artificial materials are more prone to getting infected, moving, or not aging well with the body," he says.
And though natural fat grafts are being used in some reconstructive procedures, graft viability can vary so much that many surgeons hesitate to use it for purely cosmetic purposes. "It's not just unpredictable, " says Baker. "It's unpredictably unpredictable. " And in February, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery announced jointly that they did not recommend fat grafts for cosmetic breast augmentation because of the low survival rate of the transferred cells and long-term problems with cancer detection.
Those who want to boost their busts still have the FDA-approved option of saline or silicone breast implants. But, says Baker, plastic surgeons would love to have the option of a more natural substance that wouldn't have the disadvantages of man-made materials. And he says he doesn't hesitate to detail those disadvantages to prospective patients: "I feel it's my responsibility to tell the 22-year-olds who come in asking for breast implants that this is a lifetime commitment-you' ll age, but your implants won't," he says. "In 10 or 20 years, as your natural tissue loses elasticity it can hang over the implant like Snoopy's nose. Then you need to get a bigger implant to fill out the skin-and you can only go so big-or you'll have to get a breast lift."
For post-treatment breast-cancer patients who have had partial mastectomies followed by radiation, artificial materials may not even be an option. Because radiated tissue usually can't tolerate implants, patients either have to live with the altered breast, or in some cases they can have a flap of skin, muscle and fat taken from someplace else in the body. But that leaves scarring and may not be a realistic option for women who have only had a small part of the breast excised. There are about 300,000 new cases of breast cancer being diagnosed every year in Europe and about 213,000 cases in the United States. A large portion of those women will have either lumpectomies or partial mastectomies.
Those are precisely the patients that Cytori's new technology is designed for. "We wanted to focus on the unmet medical needs of women who've had the terrible diagnosis of breast cancer. There are millions of women who haven't had any real reconstructive option," says Hedrick.
But for Cytori's technique to be reimbursable by either insurance or government programs in Europe or the U.S., the company says it needs clinical evidence that doctors can actually put the technique into practice in the operating room in a safe and viable way. The process, which Cytori calls "celution," involves a device that extracts regenerative and stem cells from fat that has been removed via liposuction from the belly or thighs. Those cells are then mixed back in with regular fat and the new "supercharged, " and hopefully more viable, fat can be injected into an area that needs filling out.
The company has gotten approval in the European Union for the system that does the turbo-charging, but it is still awaiting the results of clinical trials to make the push for commercial applications. Cytori points to encouraging preliminary data from a November 2006 Japanese study of 11 women who were injected with the supercharged fat to restore breast tissue after partial mastectomies. In addition, they will be launching a multi-site study of post-partial mastectomy patients in Europe later this year. A spokesman says the company has spent seven years and about $100 million developing the stem-cell-extractin g technology-includin g a $45 million investment from the imaging-technology manufacturer Olympus, which will help produce the device if it goes into wider use in 2009, as hoped.
Hedrick admits that while the current focus of 'celution' is cancer patients and heart-disease patients (the technique has also shown promise in reviving damaged heart muscle), the company can't help but look ahead at the lucrative cosmetic market. Last year there were more than 329,000 breast- enlargement procedures in the United States, according to the American Society of Plastic Surgeons. "There will certainly be enormous cosmetic opportunities later on, he says. "For instance, there may be women who would never consider a silicone implant, but might consider this."
Baker's team at Georgetown University is pursuing another intriguing and potentially less invasive method of fat grafting. Researchers were looking into a neurochemical pathway that stimulates fat growth and plays a role in obesity. They found that Neuropeptide Y (NPY) rises in stressed mice, accelerating the growth of fat and promoting the blood vessels necessary to sustain fat tissue. By blocking the receptors for NPY they could prevent the stressed mice from gaining fat even if they were fed a high-fat diet-and could even reduce fat deposits by 40 to 50 percent in a matter of weeks.
Baker looked at that research and wondered whether the process could work the other way. Was it possible to get fat to grow if you stimulated NPY? The answer was yes-at least in mice where they were able to produce a halo of fat in a targeted area. But will the technique work in humans? Baker says it has great potential because the NPY receptors in mice are very similar to that of humans-and because the fat that they grew in the mice was human fat.
"Everyone is talking about the stress factor and fat, but if we are able to add fat via injections without doing surgery, and if 99 percent of it stays, that will be the really big news in five or 10 years," says Baker.
Both Baker and Hedrik know that the cosmetic applications of any new fat-grafting procedure will have to undergo extensive testing before they can be widely used. "We'll have to meet a higher bar to expand into [the] cosmetic market," says Hedrick. "There's a very big difference between treating someone who's been sick and someone who's well and just wants improvement. Patients who come in for cosmetic reasons expect zero complications. " In the meantime, anyone dreaming of a one-hour breast boost should remember that old axiom: there's no such thing as a free lunch.
[Newsweek]

Good Diet May Not Help Breast Cancer

While breast cancer survivors - like everyone else - should eat healthy foods, going overboard doesn't necessarily improve your chances of avoiding a recurrence of cancer, a new study suggests. Appearing in this week's issue of the Journal of the American Medical Association (JAMA), the study, called the Women's Healthy Eating and Living (WHEL) Randomized Trial, found that diets very high in fruits and vegetables do not appear to reduce the risk of breast cancer recurrence. This latest paper is one of several recent inquiries into the role of diet in cancer risk. Despite the widely held belief that the right diet can help fight cancer, recent findings have failed to definitely prove that.
The WHEL study, led by researchers at the University of California, San Diego, was designed to be more rigorous than previous research. It tracked 3,088 women aged 18 to 70, who had been treated for early stage breast cancer. The women were divided into two groups. The first group was asked to eat five servings a day of fruits and vegetables, a diet the National Cancer Institute recommends for everyone. The other group of women received intensive nutritional counseling - including cooking classes - to help them decrease their fat intake to 15% a day and increase their regular fiber intake to 30 grams a day. These women were instructed to ramp up their fruit and vegetable intake to about 12 servings a day.
Researchers tracked the women's diets between 1995 and 2000, and followed cases of breast cancer recurrence until 2006. By the end of the study, both groups of women had about the same number of breast cancer relapses and deaths. There were 518 relapses, with 256 in the "five-servings- a-day" group and 262 in the intervention group.
Of the 315 deaths reported, more than 80% were due to cancer. Among those deaths, 160 were in the "five-a-day" group and 155 were in the high-fruits- and-veggies group. "The main conclusion is that a woman who has been diagnosed with breast cancer doesn't need to go to extraordinary lengths to eat fruit and vegetables," says Dr. Cheryl Rock, a co-investigator of the study and professor of nutrition at the University of California, San Diego. "But this study doesn't negate what we've been recommending, which is five servings a day."
In an accompanying editorial, authors Dr. Susan Gapstur and Dr. Seema Khan, point out the WHEL study's limitations. In particular, they question the accuracy of the self-reporting: given that both groups of women gained weight during the study, Gapstur and Khan say they must have underreported their caloric intake. Had the women reduced their total calories, they would have lost weight. The editorial authors also note that the high-vegetable group never quite reached the 15% mark for daily fat consumption.
"At the end of the day, conducting these types of dietary interventions can be challenging, in part because monitoring the goals of the study can be difficult," says Gapstur, professor of preventive medicine at Northwestern University's Feinberg School of Medicine.
Two recent studies suggest, however, that certain foods may increase the risk of cancer. Publishing in the July issue of Cancer Epidemiology, Biomarkers & Prevention, researchers analyzed data from the Shanghai Breast Cancer Study and found that postmenopausal Asian women who had adopted more Western-style diets - high in red meat, bread, desserts and candy - had a two times greater risk of breast cancer than peers who stuck with traditional Asian diets consisting of vegetables, soy and fish. A separate study of 50,000 postmenopausal women, published in the current British Journal of Cancer, found that women who ate a quarter of a grapefruit or more a day were up to 30% more likely to develop breast cancer than women who ate no grapefruit at all. But the findings are preliminary and the study's authors say more research is necessary before they can make any claims about individual foods and their effect on cancer risk.
But diet is only one component of breast cancer prevention, and in their JAMA editorial, Gapstur and Khan call for further studies into the influence of a woman's overall physical lifestyle. "If you look at current literature on the subject, it suggests that overall energy balance - not just diet - plays a role in cancer recurrence," Gapstur says. And researchers at the University of California, San Diego, who ran the WHEL Study, are already planning to study how exercise and weight loss impact cancer prevention, according to co-author Rock.
Until that data is available, women and their doctors should operate under the assumption that a healthy, balanced lifestyle is key to fighting off breast cancer. Says Gapstur: "It's never a bad thing to live a healthy lifestyle."
[AP]

Sexually Transmitted Infections in Pregnancy

At the beginning of pregnancy, your family doctor will test you for sexually transmitted infections (STIs) that could hurt you or your baby. These tests are very important.

What tests will I have?
At the first visit, your family doctor may do a Pap smear to check for cervical cancer and signs of human papillomavirus (HPV) infection. Your family doctor may also test for chlamydia (kluh-MID-ee- uh) and gonorrhea (gah-nuh-REE- uh). These tests may be repeated near the end of your pregnancy.
Your blood will be tested for syphilis (SIFF-uh-liss) , hepatitis B, and HIV (the virus that causes AIDS). The family doctor will check your skin for signs of herpes.

Why do I need these tests?
You can have many of these infections without having symptoms. These infections can be passed on to your baby, and some of them can cause you to go into labor early.

What if I have an infection?
Chlamydia, gonorrhea, and syphilis can be treated with antibiotics. Medicines can help keep your baby from getting herpes and HIV viruses. If you have hepatitis B, your baby can be given medicine at birth to keep him or her from getting the disease.
Your sex partner may also need to be treated for some infections (for example, chlamydia and gonorrhea) so you don't get the infection back. You should not have sex with your partner until your partner has been treated, too.

How can I protect myself?
The safest way is to have only one sex partner, and for your partner not to have sex with anyone else. Condoms give you some protection. You should always use condoms if you have more than one partner or if your partner may have other partners.
[AAFP]

What is Diabetes?

Madhumehari Granules: This describes the merits of Madhumehari Granules in the Context of modern life style. Herbs and Minerals which are known for their valuable antidiabetic activity are described in detail, in Ayurveda. According to Ayurveda, Prameha is of 20 types. One of them is Vataj Prameha (Madhumeha). In Modern Science, Madhumeha is known as Diabetes mellitus.

What is Diabetes? : If the level of blood Glucose rises above its normal level, this condition is known as diabetes, it gets increased. Normal values of Blood Glucose: Fasting 80 to 129 mg/100ml, Post Prandeal 120-150 mg/100ml.

How it occurs in the body: The body receives energy from food & strength by the diet or food. The food undergoes metabolism inside the body. The food constitutes Carbohydrates, Proteins& fats, which are responsible for giving energy to the body.

Unctuous food produces more energy. Blood sugar increases due to the following factors.

• If we are talking calories in more quantity.
• If we secretion of insulin is less.
• If the function of the pancreas gets disturbed. In many cases, diabetics may pass sugar in their urine. This increases sugar level in the blood gives rise to many complications and in such cases diabetes can attack the body easily.

Symptoms of Diabetes:

* Weight loss,

*Increased Hunger (Polyphagia) ,

*Increased Thirst (Polydypsia) ,

*Increased Urination (Polyurea),

*Weakness,

*Non feet,

*Leg Cramps,

*Itching around genitalia, in females (Vaginitis),

*Difficulty in retracting of fore skin of penis (Balanitis).

Clinical Trial Report:

The first clinical trial was conducted by Lt Dr.Varadpande and Dr. Maridkar. Then the trial was conducted by Dr. Shard Pendesey’s (Famous diabetologist) clinic at Dhantoli, Nagpur .

30 Patients of both sexes in age of group of 25 to 40 years, who were freshly diagnosed as a case of NIDDM &who had not responded to dietary restrictions for a period of three months, were selected.

Conclusion:

Madhumehari Granules shows a significant hypoglycemic action after three months. The papers were presented on Madhumehari granules. In 1995, at Banaras University , in 1998, at K.E.M Mumbai.

Madhumehari Granules: Shree Baidyanath Ayurved Bhawan Pvt. Ltd.Bagpur. Has brought out Madhumehari Granules, which is a combination of Herbs * Minerals and it is being used by large number of NIDDM diabetics, successfully.

Composition with Salient Properties of Ingredients.

Gudmar (Gymnema Sylvestre):

Effective in Diabetes. Regulates blood sugar level. It’s Leaves known to increase insulin level.

Gulvel (Tinospora Cordifolia): Gives energy & Strength to the body has and antioxidant activity. After extensive research, Bitter gourd (Momordica Charantia) exhibited a consistent hypoglycemic activity.

Jambu (Syzygium 0 Cummi): Regulates Blood Sugar Level.

Haldi+Amala: Gives energy and Strength to the body, has an Antioxidant properly.

Shilajit (Asphaltum): Markedly helps in the assimilation of Sugar.

Methi (Trigonella Foenum Graecum): Hypoglycemic activity is exhibited in Diabetics

Gularphal Ficus Glomerata: Boosts energy in diabetic patients.

Khadir Churna (Acacia catechu): Increases the secretion of insulin.

Kutaki (Picrorhiza Kurroa): Cholagogue in nature. Helps to tone up the metabolism.

Triwang Bhasma: Combination of oxides of Lead, Zinc and Tin Regulates blood sugar.

Tejpatrak & Chitrak: Helps in the digestion of food. Increases the insulin level.

Bijak and Neem: Regulates Blood sugar Level.

Indications:

1) Controls excess sugar of the blood.

2) Gives energy and strength to the body.

3) Strengthens the kidneys, eyes & liver.

4) Effective in the complications associated with Diabetes I.e., thirst, Numbness etc.

Dosages: 5 gm. twice a day before meal.

Reference:

1) Clinical Applications of Ayurvedic and Chinese herbs-Kerry Bone.

2) Herbal Options –Tapan Kumar Chatterjee.

3) Practical Management of Diabetes-Dr. Sharad Pendsey.

4) Bhavaprakash.

5) Indian Materia Medica –K.N.Nadkarni.

6) Research Papers from Internet.

SUGGESTIONS ABOUT DIET:

The simple exchange list is provided so that one can choose from a variety of food items, having approximately the same calorie value.

A) Cereals:

1 chapati =1 small puri =1/2 parotha =1 katori cooked rice.

B) Pulses:

1 Katori plain Dal =1/2 katori usal.

C) Vegetables (Cooked):

1 cup of cauliflower, bhendi, tomato, Cabbage, leafy vegetables is equivalent to a cup of potato, carrot, onion, green peas & beetroot. Provided the oil content is kept same.

D) Fruits :

1 apple =1 orange =1 mango =1 banana =12 grapes

E) Fats:

1 teaspoon (5gms) oil =1 teaspoon butter =1teaspoon ghee =1 tablespoon cream.

F) Snacks:

1 plate upama =1 plate poha =2 idlis+katori sambar =1 small dosa (plain) +1 katori sambar=1 kachori =1 Samos +1 katori sambar =1/2 plate chiwada (Provided the oil content is same.)

Precautions for Diabetics:

1) Obesity is one of the causes of Madhumeh.

2) Avoid intake of oily and spicy food, excess milk, & Fresh wine

3) After forties chances of prameh are more. So regular health check up is advised.

4) Invariably mental tension produces bad effects. So Mediation and yoga is advised.

In Chronic cases, for better results take Baidyanath Madhumehari Yog (Swarna Bhasma Yukta) along with Madhumehari Granules.

MADHUMEHARI YOG (Swarna Bhasma yukta): Swarna Bhasma is used in it. Gold is a nervine tonic. It therefore helps in combating Diabetic Neuropathy, commonly encountered in Diabetes. Diabetics are prone to infections, while Gold is known to improve immunity & metabolism.

BAIDYANATH BASANT KUSUMAKAR RAS (Swarna Bhasma Yukta): Debility occurs due to Diabetes. To over come it, take Baidyanath Basant kusumakar Ras (Swarna Bhasma Yukta) along with Baidyanath Madhumehari Granules. As it contains Swarna Bhasma, it improves Immunity & working efficacy, Gives energy and strength to the body & also helps to relieve the complications associated with Diabetes i.e., increased thirst, increases urination , numbness etc. Ideal for both men and women.

Note: For the use of Medical Practitioners.

Thimerosal in vaccines has no link to autism

Exposure to thimerosal, a mercury-containing chemical previously used as a preservative in vaccines, does not increase the risk of autism.
"Fierce debate" continues over whether thimerosal exposure raises the risk of autism, the authors point out. In the last two decades, there has been a rise in autism cases, which coincided with increased usage of vaccines containing thimerosal. Although studies have shown no evidence of an association, thimerosal was removed from all routine childhood vaccines in the U.S. in 2002.
The present study involved a telephone survey of 214 mothers of 230 children with autism or a related disorder. Exposure to thimerosal-containi ng Rh immune globulin, a vaccine administered to some women to avoid pregnancy complications, was compared between this group and the general population.
The researchers found that autistic children were no more likely than unaffected children to have been exposed to Rh immune globulin, lead author Dr. Judith Miles, from the University of Missouri-Columbia, and colleagues report.
These findings provide more evidence that childhood autism is not caused by thimerosal, the authors conclude. They hope this report will encourage all parents to adhere to immunization recommendations. A lack of compliance is known to increase the risk of serious complications and death in children who may contract infectious diseases.
[Am J of Med Genetics]

Inflammatory Bowel Diseases

In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal cramps and diarrhea.
The two primary types of inflammatory bowel disease are Crohn's disease and ulcerative colitis. These two diseases have many similarities and sometimes are difficult to distinguish from each other. However, there are several differences. For example, Crohn's disease can affect almost any part of the digestive tract, whereas ulcerative colitis almost always affects only the large intestine. The cause of these diseases is not known but may involve an overactive immune reaction to intestinal bacteria or other agents in people with a genetic predisposition. More recently recognized inflammatory bowel diseases include collagenous colitis, lymphocytic colitis, and diversion colitis.
To make a diagnosis of inflammatory bowel disease, a family doctor must first exclude other possible causes of inflammation. For example, infection with parasites or bacteria may cause inflammation. Therefore, the family doctor performs several tests. Stool samples are analyzed for evidence of a bacterial or parasitic infection (acquired during travel, for example), including a type of bacterial infection (Clostridium difficile infection) that can result from antibiotic use. A family doctor also checks for sexually transmitted diseases of the rectum, such as gonorrhea, herpesvirus infection, and chlamydial infection. Tissue samples (biopsies) may be taken from the lining of the rectum during a sigmoidoscopy (an examination of the sigmoid colon using a viewing tube) and examined microscopically for evidence of other causes of colon inflammation (colitis). Other possible causes of similar abdominal symptoms that a family doctor tries to exclude are ischemic colitis, which occurs more often in people older than 50; certain gynecologic disorders in women; celiac disease; and irritable bowel syndrome.
[Merck]

Flatulence

Flatulence is the sensation of an increased amount of gas in the digestive tract.
Increased amounts of gas can gather in the stomach or farther along the digestive tract. Excess gas is expelled through the mouth (belching) or through the anus (known colloquially as farting and called flatus by doctors), or it is absorbed through the walls of the digestive tract into the blood and then excreted by the lungs. Bacteria in the digestive system also break down (metabolize) some gases.
Air is a gas, which can be swallowed with food. Swallowing small amounts of air is normal, but some people unconsciously swallow large amounts (aerophagia) , especially when they feel anxious. Most swallowed air is later belched up, so only some air passes from the stomach into the rest of the digestive system. Swallowing large amounts of air may make a person feel full, and the person may belch excessively or pass the air through the anus.
Other gases are produced in the digestive system by several means. Hydrogen, methane, and carbon dioxide are produced by bacterial metabolism of food in the intestine, especially after a person eats certain foods such as beans and cabbage. People who have deficiencies of the enzymes that break down certain sugars also tend to produce large amounts of gas when they eat foods containing these sugars. Lactase deficiency, tropical sprue, and pancreatic insufficiency all may lead to the production of large amounts of gas. People with irritable bowel syndrome do not produce large amounts of gas, although the passage of normal volumes of gas through the bowel may be changed. Almost anyone who eats large amounts of proteins or fruits will develop some degree of flatulence.

Symptoms
Flatulence is often associated with abdominal pain and bloating; however, the exact relationship between flatulence and any of these symptoms is not really known. Some people appear to be particularly sensitive to the effects of gas in the digestive system; others can tolerate large amounts without developing any symptoms.
Belching is more likely to occur shortly after eating or during periods of stress. Drinking carbonated beverages sometimes leads to belching. Some people feel a tightness in their chest or stomach just before belching that is relieved as the gas is expelled.
People normally pass gas through the anus more than 10 times a day, but flatulence may cause a person to pass gas more often. Gas passed through the anus may or may not have an odor. On occasion, fecal incontinence occurs as a person tries to pass gas, only to be surprised by the expulsion of stool as well.
Infants with crampy abdominal pain sometimes pass excessive amounts of gas. Whether these children actually produce more gas than others or are simply more sensitive to gas is not clear.

Treatment
Bloating and belching are difficult to relieve. If belching is the main problem, reducing the amount of air being swallowed can help, which is difficult because people generally are not aware of swallowing air. Avoiding chewing gum and eating more slowly in a relaxed atmosphere may help.
People who belch or pass gas excessively may need to change their diet by avoiding foods that are difficult to digest. Discovering which foods are causing the problem may require eliminating one food or one group of foods at a time. A person can start by eliminating milk and dairy products, then fresh fruits, and then certain vegetables and other foods. Avoiding carbonated beverages helps some people. Although drugs generally are not very effective, simethicone, which is present in some antacids and is also available separately, can provide a little relief. Sometimes other drugs-including other types of antacids (including those that contain baking soda), metoclopramide, and bethanechol- may help. Aromatic oils, such as peppermint oil, help some people, especially those who experience cramps with flatulence. Eating more fiber helps some people but worsens the symptoms in others. Chlorophyll, an ingredient in many over-the-counter products, and charcoal tablets do not ecrease flatulence but help reduce its offensive odor.
[Merck]

What's a Fart?

P.U.! What's that smell? How can your body make something so stinky?
Farts - also called flatus (say: flay-tus) or intestinal (say: in-tes-tuh-null) gas - are made of, well, gas!
When you eat, you don't swallow just your food. You also swallow air, which contains gases like nitrogen (say: ny-truh-jen) and oxygen (say: ahk-sih-jen) . Small amounts of these gases travel through your digestive system as you digest your food. Other gases like hydrogen (say: hy-droh-jen) , carbon dioxide (say: kar-bon dy-ahk-side, the gas that makes soda fizzy), and methane (say: meth-ain) are made when food is broken down in the large intestine. All of these gases in the digestive system have to escape somehow, so they come out as farts!
Gases are also what can make farts smell bad. Tiny amounts of hydrogen, carbon dioxide, and methane combine with hydrogen sulfide (say: suhl-fide) and ammonia (say: uh-mow-nyuh) in the large intestine to give gas its smell.
Phew!
All people fart sometimes, whether they live in France, the Fiji islands, or Fresno, California! If you have a dog, you may have even been unlucky enough to have heard (or smelled) Fido farting. Intestinal gas is totally normal, and it's very rare for farting to be a sign that something is wrong in the body.
If you want to be less farty, try cutting back on foods like beans, onions, and fried foods. These can release larger amounts of gas as they break down in your body. If you have a lot of gas after you eat ice cream, yogurt, or milk, talk to your parent about it - your body may have a difficult time digesting the natural sugar called lactose, which is found in dairy foods.
And don't forget that farting can sometimes be your body's sign that it's time to take a trip to the bathroom.
The bathroom is also a good place to go if you're feeling particularly gassy because it's not polite to fart in social settings, like in class or at the dinner table (Yuck!). But don't worry if this happens accidentally. Just remember to say "excuse me!"
[AAFP]

Should You Have a CT Scan?

A new study published today in the Journal of the American Medical Association shows that radiation from a high-resolution cardiac CT scan-the newest, noninvasive test for detecting heart disease-may slightly raise patients' lifetime risk of developing cancer. In general, the study found, the elevated risk of cancer was greatest for women and younger patients. Led by Dr. Andrew Einstein, a cardiologist at the Columbia University College of Physicians and Surgeons, researchers calculated the lifetime attributable cancer risk associated with radiation exposure from a single scan (called computer tomography coronary angiography, or CTCA), based on the patient's sex and age. For example, the lifetime cancer risk following one CTCA was just 1 in 3,261 for an 80-year-old man; that risk jumped to 1 in 284 for a 40-year-old woman, and climbed higher still to 1 in 143 for a 20-year-old woman. At all ages for women, the risk of breast and lung cancers accounted for up to 85% of the total cancer risk from one scan.
However, by using a radiation dose-reduction strategy during the CTCA, researchers were able to reduce overall cancer risks by 35%. The question clinicians will need to consider is whether the benefits of CTCA outweigh the risks. In absolute terms, the lifelong attributable risk of cancer per CTCA scan was low, ranging from 0.02% (for an 80-year old man, with the dose-reduction strategy) to 1% (for a 20-year-old woman, with a regular heart and aorta scan). The benefits of CTCA are that it is noninvasive, quick (the test takes about 10 minutes), requires that the patient ingest less contrast dye than with other scans and can be performed immediately in an emergency room when someone is admitted with chest pain.
According to the study's authors, emergency departments evaluate about 6 million patients each year for chest pain. "This is the only technology available that will really define the presence or absence of calcified or non-calcified plaque," says Dr. Norman Lepor, a professor at UCLA's Geffen School of Medicine, referring to the tell-tale build-up on artery walls that signifies heart disease. Lepor says that CTCA gives off no more radiation than the routinely used diagnostic nuclear stress test, which also detects plaque deposits, but only those that are big enough to block 70% of the artery. "The risk-benefit assessment is in favor of cardiac CT to be used in a judicious fashion," says Lepor, who describes good candidates for the scan as male, over age 40 with at least one risk factor. But there's no need to image patients who don't have any risk factors. "This is not a test that should be done in any routine or repetitive fashion," says Lepor.
Einstein expects that the new study's findings will have several implications in the everyday practice of medicine. "I think this can reassure a lot of patients that CTCA is a good test-and a safe test particularly for older patients," says Einstein. "On the other hand, for younger women, I think it may affect physicians' thinking in terms of the risk-benefit ratio of the test."
Because of the potential hazards involved with radiation exposure, Einstein warns patients against attempts to "get pretty pictures of their heart" without a doctor's recommendation. Otherwise, he says, the CTCA can be an excellent noninvasive alternative to the current gold standard test for heart disease, the coronary angiography, which involves threading a catheter from the groin to the heart's blood vessels, and can cause complications such as blood clots, infection and even death. CTCA is also a good substitute for the time-consuming diagnostic tests in use in emergency departments; with CTCA physicians can find out sooner when there is a problem with the patient's heart.
Down the line, Einstein believes his team's conclusions will boost cardiac diagnostic technology and prompt major manufacturers to improve it. "This is an impetus toward accelerating the pace of research in cardiac CT scans so as to reduce the dose to patients," says Einstein.
Lepor agrees. Though such technology is still in its early phases, he says, "Perhaps in five or seven years, we may have technologies using magnetic resonance that may allow us to see plaque without [radiation] exposure."
[AP]

Vain Pursuits

Vain Pursuits: Most people go to the gym to look better but exercise can have unintended consequences

If there is one glaring false assumption made by the fitness industry in its attempts to lure us to the nearest gym, it is that we sign up purely to get fit and healthy. What really drives those who flock to these temples of body worship is vanity.
According to a survey by the British health insurer BCWA, what we see in the mirror is a far greater incentive than the promises of lower blood pressure or reduced cholesterol made in public health campaigns. But what happens when the good intentions backfire? What if one step-up too many leaves you with calf muscles like footballs or non-stop spinning gives you thunder-thighs? For the narcissist's guide to working out, read on.

Muscle imbalances
Possible cause Golf, tennis and other racquet sports involve the predominant use of one side of the body (or one playing arm), which can cause problems.
A study at the Union Memorial Hospital in Baltimore in the United States showed that the most common problems include damage to the lower back caused by the repetitive swinging of a club or racquet to one side.
Solution Physiotherapist Sammy Margo suggests using weights to strengthen the non-dominant side. Golf coach Chris Baron says that in golf, as well as other sports, "the spine is the first area of the body that comes under attack from the swinging if your core muscles are weak. The best way to improve this is through Pilates-style exercises."

One leg shorter than the other
Possible cause Always running on the same side of a road. The average road camber is 7 to 9 degrees, which means you are running on a sloping surface so one foot is hitting the ground at a higher level than the other.
"Effectively it makes the leg nearest to the side of the road 'longer'," says Martin Haines, a physiotherapist and adviser to Runner's World magazine. "The body naturally compensates for this by trying to shorten the leg to reduce the pressure on your body, in particular on the back and the knee."
The more you pound the tarmac, the worse it becomes. Running in one direction on a beach can have the same adverse effect if you do it for a prolonged period Solution "Avoid running consistently on a camber by varying your route and terrain as much as possible," Haines says.

Broad back and shoulders
Possible cause Certain activities, such as swimming, rowing and weight training to strengthen the trapezius and rhomboid muscles in the upper back can result in a "triangular" appearance (broad shoulders and a narrow waist), says Robin Gargrave, executive director of YMCA Fitness Industry training. "Some yoga moves - such as those that support the whole body on the arms - also require the bracing of these muscles in an isometric contraction that, over time, could lead to an overdeveloped upper back."
Solution If you are exercising the upper body, try to balance things out with lower body activities, too. With swimming, vary the strokes or hold a kickboard so that for a few lengths you are using only your legs. "Remember that any aspect of fitness is entirely reversible," Gargrave says. "If you don't like what you see, stop the activity that is causing it."

Potbelly
Possible cause "Having very tight back muscles can tilt the pelvis forward too much, giving the impression of an enlarged belly," Gargrave says. "Poor technique in abdominal exercises can also cause a bulging of muscles in that area."
Eating too little can also backfire on your attempts to get into shape. According to personal trainer Kevin Barclay-Webb, whose clients include Annie Lennox and Ivana Trump, cutting calories too drastically increases the production of the stress hormone cortisol and insulin, which controls blood sugar levels.
As a result, "the body responds by storing excess calories in the abdominal region," he says. Mostly the calories are stored as fat, "which is why otherwise very thin people can still have a roly-poly belly".
Solution Gargrave recommends spine-flexing exercises that improve flexibility of the back but says you should first seek the advice of a personal trainer or physiotherapist. Avoid repetitive sit-ups, which can cause muscles to pop up in an unsightly fashion. Instead, join a Pilates class to learn a variety of core-strengthening exercises instead. Eat a well-balanced diet and don't cut out meals.

Rounded shoulders
Possible cause Over-using the pectoral, or chest, muscles. Personal trainer and postural expert Jo Tuffrey says, "The chest muscles are used in a lot of activities, and things like sitting at a computer or driving keep them activated at a low level all day." Add in chest-strengthening exercises at the gym and the pectoral muscles "become tight and short, translating to weak back muscles and rounded shoulders".
Solution Tuffrey advises stretching out the chest muscles on a regular basis. Sit with your feet hip-width apart and elbows tucked into the waist, hands on your knees with palms facing upwards. Breathe in and sit up straight, keeping neck relaxed. Breathe out, gently pulling navel to spine.
Breathe in again and, keeping the elbows at the waist, draw your forearms sidewards to open out the chest. Don't let the shoulders rise. Repeat.
"Chest exercises need to be integrated into a whole-body workout including other major muscle groups, especially the abdominals," she says. "Think of working muscles in pairs, doing equal amounts of exercises with opposing muscle groups. If you're working the chest, you should also work the back. If you're working biceps, you should also work triceps, etc."

Big calves
Possible cause Running uses both the gastrocnemius - the big calf muscle at the back - and the soleus, which is the smaller one lower down, with every stride, so most runners have well-developed lower legs. Overusing the step-machine or doing too many calf-raises can also cause the calf muscles to bulge.
"Your muscles are not usually getting bigger," Gargrave says. "They are just better defined because they are more visible when fat disappears."
Solution Stretch the calf muscles regularly to prevent tightness, Margo says. Place your toes against a wall with your heel on the floor so your foot is at a 45-degree angle. Bring your hip closer to the wall, by pushing off the back foot. Uphill running, in particular, builds the gastrocnemius muscle so try to factor in some downhill running.

Bulging thighs
Possible cause Cycling, spinning, squats and lunges predominantly work the hamstrings and quadriceps - muscles that make up the thigh - and can quite quickly lead to a more toned appearance in the legs.
"A lot of people mistake this improvement in muscle tone for an increase in muscle size, thinking it is making their thighs look bigger," Gargrave says. "In fact, with less fat, the legs are actually more streamlined. " Solution Thigh stretches and more cross-training. "Vary your activities if you don't want to develop one muscle group above all others," Gargrave says. "Incorporate some weight or resistance training for the upper body to balance your overall muscle development. "
[AP]