Scientists reveal 'ideal diet' for peoples' and planet's health

LONDON: Scientists have unveiled what they say is an ideal diet for the health of the planet and its populations: including a doubling of consumption of nuts, fruits, vegetables and legumes, and a halving of meat and sugar intake.

Scientists have unveiled what they say is an ideal diet for the health of the planet and its people - including a doubling of consumption of nuts, fruits, vegetables and legumes, and a halving of meat and sugar intake.

If the world followed the "Planetary Health" diet, the researchers said, more than 11 million premature deaths could be prevented each year, while greenhouse gas emissions would be cut and more land, water and biodiversity would be preserved.

"The food we eat and how we produce it determines the health of people and the planet, and we are currently getting this seriously wrong," said Tim Lang, a professor at Britain's University of London who co-led the research.

Feeding a growing population of 10 billion people by 2050 with a healthy, sustainable diet will be impossible without transforming eating habits, improving food production and reducing food waste, he said. "We need a significant overhaul, changing the global food system on a scale not seen before."

Many life-threatening chronic diseases are linked to poor diets, including obesity, diabetes, malnutrition and several types of cancer. The researchers said unhealthy diets currently cause more death and disease worldwide than unsafe sex, alcohol, drug and tobacco use combined.

The proposed planetary diet is the result of a three-year project commissioned by The Lancet health journal and involving 37 specialists from 16 countries.

(For a graphic, click here)

It says global average consumption of foods such as red meat and sugar should be cut by 50 percent, while consumption of nuts, fruits, vegetables and legumes should double.

For individual regions, this could mean even more dramatic changes: People in North America, for example, eat almost 6.5 times the recommended amount of red meat, while people in South Asia eat only half the amount suggested by the planetary diet.

Meeting the targets for starchy vegetables such as potatoes and cassava would need big changes in sub-Saharan Africa, where people on average eat 7.5 times the suggested amount.

Presenting the diet at a briefing on Wednesday, the researchers said they acknowledged it was very ambitious to hope to get everyone in the world to adopt it, not least because there is vast global inequality of access to food.

"More than 800 million people have insufficient food, while many more consume an unhealthy diet that contributes to premature death and disease," said Walter Willett of Harvard University in the United States.

"If we can't quite make it, it's better to try and get as close as we can," he said.

(Reporting by Kate Kelland; Editing by Hugh Lawson)


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Scientists reveal 'ideal diet' for peoples' and planet's health

How cutting carbs – not fat – might be key to maintaining a healthy weight

It has been a fundamental tenet of nutrition: When it comes to weight loss, all calories are created equal. Regardless of what you eat, the key is to track your calories and burn more than you consume.

A new US study shows that adults who cut carbohydrates from their diets and replaced them with fat sharply increased their metabolisms.

But a large new study published on Nov 14 in the journal BMJ challenges the conventional wisdom. It found that overweight adults who cut carbohydrates from their diets and replaced them with fat sharply increased their metabolisms.

After five months on the diet, their bodies burned roughly 250 calories more per day than people who ate a high-carb, low-fat diet, suggesting that restricting carb intake could help people maintain their weight loss more easily.

The new research is unlikely to end the decades-long debate over the best diet for weight loss. But it provides strong new evidence that all calories are not metabolically alike to the body. And it suggests that the popular advice on weight loss promoted by health authorities – count calories, reduce portion sizes and lower your fat intake – might be outdated.

“This study confirms that, remarkably, diets higher in starch and sugar change the body’s burn rate after weight loss, lowering metabolism,” said Dr. Dariush Mozaffarian, the dean of the Friedman School of Nutrition Science and Policy at Tufts University, who was not involved in the research. “The observed metabolic difference was large, more than enough to explain the yo-yo effect so often experienced by people trying to lose weight.”

Mozaffarian called the findings “profound” and said they contradicted the conventional wisdom on calorie counting. “It’s time to shift guidelines, government policy and industry priorities away from calories and low-fat and toward better diet quality.”

The new study is unique in part because of its size and rigour. It is among the largest and most expensive feeding trials ever conducted on the subject. The researchers recruited 164 adults and fed them all of their daily meals and snacks for 20 weeks, while closely tracking their body weight and a number of biological measures.

The trial cost US$12 million (S$16.5 million) and was supported largely by a grant from the Nutrition Science Initiative, a nonprofit research group co-founded by Gary Taubes, a science and health journalist and proponent of low-carbohydrate diets. The study was also supported by funding from the New Balance Foundation, the National Institutes of Health and others.

The new study is unique in part because of its size and rigour. It is among the largest and most expensive feeding trials ever conducted on the subject.

While some experts praised the findings, others were more cautious. Dr Kevin Hall, a scientist and obesity expert at the National Institute of Diabetes and Digestive and Kidney Diseases, said the new study was ambitious and very well-run. But he said the researchers used methods that raise questions about the results. One method they used to track metabolism, called doubly labelled water, has not been shown to be reliable in people on low-carb diets and it may have exaggerated the amount of calories the subjects burned, he said.

Dr David Ludwig, an endocrinologist at Harvard Medical School and Boston Children’s Hospital and one of the study authors, disagreed, saying: “We used a gold standard method that has been validated across a wide range of experimental conditions and universally adopted in the field.”

Hall added, “I would love it to be true that there was a diet combination of carbs and fats that led to large increases in energy expenditure – and I really hope it is true. But I think there are reasons to question whether or not it is.”

The idea that counting calories is the key to weight loss has long been embedded in the government’s dietary guidelines. It is the driving force behind public health policies like mandatory calorie counts on restaurant menus and food labels. Many experts say that the underlying cause of the obesity epidemic is that Americans eat too many calories of all kinds, prompted by easy access to cheap and highly palatable foods, and that they need to exercise portion control.

On its website, for example, the National Institutes of Health encourages people to count calories and warns that dietary fat has more calories per gram than protein or carbs: “You need to limit fats to avoid extra calories,” it states.

But experts like Ludwig argue that the obesity epidemic is driven by refined carbohydrates such as sugar, juices, bagels, white bread, pasta and heavily processed cereals. These foods tend to spike blood sugar and insulin, a hormone that promotes fat storage, and they can increase appetite.

Ludwig and his colleague Dr Cara Ebbeling have published studies suggesting that diets with different ratios of carbs and fat but identical amounts of calories have very different effects on hormones, hunger and metabolism. He has also written a best-selling book on lower-carb diets.

Hall and others disagree. They have published studies disputing the notion that carb-restricted diets accelerate metabolism and fat loss. Hall said that low-carb diets have many benefits: They can help people with Type 2 diabetes manage their blood sugar levels, for example. But he argues that the carb and insulin explanation for obesity is too simplistic and has been “experimentally falsified” in rigorous studies.

Hall published a meta-analysis of feeding studies last year that suggested that energy expenditure was actually slightly greater on low-fat diets. But Ludwig pointed out that those studies were very short, with none lasting longer than a month and most lasting a week or less. He said the process of adapting to a low-carb diet can take a month or longer.

“A few days, or a couple weeks, is not enough time to make any meaningful conclusion about how diets affect metabolism over the long term,” he added.

To do the new study, Ludwig and his colleagues collaborated with Framingham State University, about 20 miles (46.6 km) outside Boston, where they recruited overweight students, staff members and faculty members. Each participant went through two phases of the study. First, they were put on strict diets that lowered their body weight by about 12 per cent, which was designed to stress their metabolisms.

“At that point their bodies are trying to regain the weight,” Ludwig said. “It pushes the body and predisposes to weight regain.”

The process of adapting to a low-carb diet can take a month or longer.

In the second phase of the study, the subjects were assigned to one of three diets with 20 per cent, 40 per cent or 60 per cent of their calories from carbohydrates. Protein was kept steady at 20 per cent of calories in each diet.

Over the next five months, the researchers tracked the subjects meticulously and provided them with enough daily meals and snacks to keep them from losing or gaining any weight. This was so the researchers could determine precisely how the subjects’ metabolisms responded to the different diets while their body weight remained stable.

The researchers tracked biomarkers that helped them ensure that the participants stuck to their diets. They also worked with a large food service company, Sodexo, to prepare thousands of generally healthful meals that the subjects could eat in cafeterias or take home with them.

A typical meal for the high-carb group might consist of a chicken burrito bowl with rice and vegetables, for example, or roasted turkey with green beans and mashed potatoes. The low-carb group would get a similar meal with fewer carbohydrates, like a chicken burrito lettuce wrap or roasted turkey with green beans and mashed cauliflower.

What the researchers found was striking. The roughly 250 extra calories that the subjects in the low-carb group burned each day could potentially produce a 20-pound (9kg) weight loss after three years on the diet, Ludwig said. People who tended to secrete higher levels of insulin did the best on the low-carb diet, burning about 400 extra calories a day.

The subjects on the low-carb diet also had the sharpest declines in a hormone called ghrelin, which is produced in the stomach. Ghrelin promotes hunger and body fat, and it lowers energy expenditure. Suppressing ghrelin may be one reason the low-carb diet increased metabolism, the authors noted.

Ludwig emphasised that the results need to be replicated by other investigators and he stressed that the findings do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, he said, the study suggests that reducing foods with added sugar, flour and other refined carbohydrates could help people maintain weight loss by increasing their metabolisms at a lower body weight.

"These foods seem to undermine your metabolism,” he said. “They slow metabolism in a way that may work against long-term weight loss maintenance.”

Anahad O’Connor © 2018 The New York Times


Taken from this article:
How cutting carbs – not fat – might be key to maintaining a healthy weight

Can eating organic food lower cancer risks?

People who buy organic food are usually convinced it’s better for their health, and they’re willing to pay dearly for it. But until now, evidence of the benefits of eating organic has been lacking.

Now, a new French study that followed 70,000 adults, most of them women, for five years has reported that the most frequent consumers of organic food had 25 per cent fewer cancers overall than those who never ate organic. Those who ate the most organic fruits, vegetables, dairy products, meat and other foods had a particularly steep drop in the incidence of lymphomas, and a significant reduction in postmenopausal breast cancers.

In a study, those who ate more organic produce, dairy, meat and other products had 25 per cent fewer cancer diagnoses overall, especially lymphoma and breast cancer.

The magnitude of protection surprised the study authors. “We did expect to find a reduction, but the extent of the reduction is quite important,” said Julia Baudry, the study’s lead author and a researcher with the Center of Research in Epidemiology and Statistics Sorbonne Paris Cite of the French National Institute of Health and Medical Research. She noted the study does not prove an organic diet causes a reduction in cancers, but strongly suggests “that an organic-based diet could contribute to reducing cancer risk”.

The study, published Oct 22 in JAMA Internal Medicine, was paid for entirely by public and government funds.

'MORE IMPORTANT TO SIMPLY EAT MORE FRUITS AND VEGETABLES'

Nutrition experts from Harvard University, who wrote a commentary accompanying the study, expressed caution, however, criticising the researchers’ failure to test pesticide residue levels in participants in order to validate exposure levels. They called for more long-term government-funded studies to confirm the results.

“From a practical point of view, the results are still preliminary, and not sufficient to change dietary recommendations about cancer prevention,” said Dr Frank B. Hu, one of the authors of the commentary and the chairman of the department of nutrition at Harvard’s T.H. Chan School of Public Health.

He said it was more important for people to simply eat more fruits and vegetables, whether the produce is organic or not, if they want to prevent cancer. The American Cancer Society recommends consuming a healthy diet with lots of fruits and vegetables, whole grains instead of refined grains, and limited amounts of red meat, processed meat and added sugars.

Dr Hu called for government bodies like the National Institutes of Health and the Department of Agriculture to fund research to evaluate the effects of an organic diet, saying there is “strong enough scientific rationale, and a high need from the public health point of view”.

BREAST AND LYMPHOMA CANCERS

The only other large study that has asked participants about organic food consumption with reference to cancer was a large British study from 2014. While it found a significantly lower risk of non-Hodgkin’s lymphoma among women who said they usually or always ate organic food, it also found a higher rate of breast cancers in the organic consumers – and no overall reduction in cancer risk.

The authors of that study, known as the Million Women study, said at the time that wealthier, more educated women in the study, who were more likely to purchase organic food, also had risk factors that increase the likelihood of having breast cancer, such as having fewer children and higher alcohol consumption.

The organic food market has been growing in recent years, both in Europe and the United States. Sales of organic food increased to US$45.2 billion last year in the United States, according to the Organic Trade Association’s 2018 survey.

For food to be certified organic by the Department of Agriculture, produce must be grown without the use of most synthetic fertilisers and pesticides, and may not contain genetically modified organisms. Meat must be produced by raising animals fed organic food without the use of hormones or antibiotics. Such items now represent 5.5 per cent of all food sold in retail outlets, according to the organic trade group.

LINK BETWEEN PESTICIDE AND CANCER?

A representative of the Alliance for Food and Farming, a group that seeks to allay public concerns about pesticides, said consumers should not worry about cancer risks from consuming conventionally grown fruits and vegetables.

“Decades of peer-reviewed nutritional studies largely conducted using conventionally grown produce have shown that eating a diet rich in fruits and vegetables prevents diseases, like cancer, and leads to a longer life,” its executive director, Teresa Thorne, said in an emailed statement.

For the study, researchers recruited 68,946 volunteers who were 44, on average, when the study began. The vast majority, 78 per cent, were women.

Participants provided detailed information about how frequently they consumed 16 different types of organic foods. The researchers asked about a wide range of foods, including fruits, vegetables, dairy and soy products, meat, fish and eggs, as well as grains and legumes, bread and cereals, flour, oils and condiments, wine, coffee and teas, biscuits and chocolate and sugar, and even dietary supplements. Study volunteers provided three 24-hour records of their intake, including portion sizes, over a two-week period.

The information was far more detailed than that provided by participants in the British Million Women study, who responded to only a single question about how often they ate organic.

OTHER HEALTHY BEHAVIOURS MAY HAVE HELPED

Participants in the French study also provided information about their general health status, their occupation, education, income and other details, like whether they smoked. Since people who eat organic food tend to be health-conscious and may benefit from other healthful behaviours, and also tend to have higher incomes and more years of education than those who don’t eat organic, the researchers made adjustments to account for differences in these characteristics, as well as such factors as physical activity, smoking, use of alcohol, a family history of cancer and weight.

Even after these adjustments, the most frequent consumers of organic food had 76 per cent fewer lymphomas, with 86 per cent fewer non-Hodgkin’s lymphomas, and a 34 per cent reduction in breast cancers that develop after menopause.

The reductions in lymphomas may not be all that surprising. Epidemiological studies have consistently found a higher incidence of some lymphomas among people like farmers and farmworkers who are exposed to certain pesticides through their work.

The International Agency for Research on Cancer has classified three pesticides commonly used in farming – glyphosate, malathion and diazinon – as probable human carcinogens, and linked all three to non-Hodgkin’s lymphoma.

One reason an organic diet may reduce breast cancer risk is because many pesticides are endocrine disrupters that mimic oestrogen function, and hormones play a causal role in breast cancer.

By Roni Caryn Rabin © 2018 The New York Times


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Can eating organic food lower cancer risks?

Fruits can be your diet ally or saboteur – depending on how you consume them, say dietitians

These are confusing times when it comes to sugar. While there is no grey area when it comes to the adverse effects of added sugar on your health – think diabetes, heart disease, high blood pressure and weight gain – you may not be so sure about the sugar found naturally in food like fruit.

Both fruits and soft drinks are sweet but why is one better for you than the other? Can fruits make you gain weight? CNA Lifestyle goes in search of diet answers.

But wait, how can fruit be bad for you when the Health Promotion Board (HPB) advises us to eat at least two servings of fruit a day? Should we be worried about the sugar in fruit? Are certain fruit better for you than others? Does fruit... make us fat?

DIFFERENTIATING THE SWEET STUFF

First, not all sugars are the same. “While all sugars give us energy, there are subtle differences in the way each type of sugar is absorbed and digested,” said Jaclyn Reutens, clinical dietitian and the founder of Aptima Nutrition & Sports Consultants.

What gives fruit their sweetness is fructose – a carbohydrate naturally found in them. “When you eat fruit, your blood sugar levels rise slowly,” said Reutens.

But in highly processed food, such as bubble tea, biscuits, cakes, sweets, and even savoury items like frozen dinners, sucrose and high-fructose corn syrup (HFCS) are added to improve their flavours. “When you eat these foods, your blood sugars levels soar,” said Reutens, referring to the potentially diabetes-causing situation you want to avoid.

Unfortunately, HFCS is used in many foods you see in the supermarket. Take boxed fruit juices, for example. Although juice is already naturally high in sugar, some food manufacturers sweeten it even further with HFCS, making the level of sugar comparable to the amount added to soft drinks – and in some cases, even more than soft drinks, according to the Healthline website.

Even a single serving of certain flavoured low-fat yoghurts – which you may think is healthy – could contain over 40g of sugar. The same can be said of other seemingly “healthy” foods, such as cereal and granola bars, which are heavily sweetened with HFCS, noted the website. These foods can easily bust the limit to your daily intake of added sugar, which is no more than 8 to 11 teaspoons, or 40g to 55g, according to the HPB.

SUGAR IN FRUIT

Fructose is what contributes to your calorie intake. Here’s a look at how some common fruits rank on the fructose meter, from the lowest to the highest.

A serving of fruit would give you 10g to 20g of fructose. Two servings a day, as recommended by HPB, would provide 20g to 40g, said Reutens.

"If we're consuming natural sugars within the healthy eating guidelines, for example, two servings of fruit per day, and adequate amounts of low glycaemic index carbohydrates, which do have some natural sugar in them, this is meeting the guidelines of what you're looking for," said dietitian Chloe McLeod on HuffPost Australia. "It's more about looking at added sugars. We want those added teaspoons in the day to be quite low."

If you’re thinking of clearing your fridge of fruit to help you lose weight – don’t. “Forget the notion that fruit makes you fat,” said Reutens. "It’s a fact that we do not eat enough fruit. One in four Singaporeans do not meet their recommended intake, so how can we attribute weight gain to fruit?” she said.

On the contrary, fruits are a must if you want to lose weight. “Fruits give you satiety, which enables you to control your appetite. Fruits are also naturally sweet, so they help to satisfy your sweet cravings with far fewer calories than cake or any sweets,” said Reutens. “Fruits are a source of dietary fibre in your diet. They also give you vitamins and minerals as well as phytochemicals that foods in other food groups cannot provide. Eat your two servings a day.”

But that doesn’t give you the licence to binge on fruit either. "It's not that fruit is unhealthy; it just means that if you're having (six or seven) pieces of fruit, it's unlikely you're going to meet your veggie requirements, daily nut intake, or dairy intake per day. It's about fitting it all together,” said McLeod.

Moreover, “we eat foods, not single nutrients,” said Reutens. If you avoid fruit to minimise your intake of fructose, you may run into nutrient deficiencies, she said. Take, for example, avocados. They rank high on calorie content but they are also packed with monounsaturated fats, which are good for improving the level of good cholesterol (HDL) in the body, she said.

Conversely, if you regularly eat energy-rich bananas and do not burn off the calories, you can potentially gain weight, said Reutens. But that doesn’t mean you should stay off bananas – they are also a fantastic source of potassium, which helps with muscle contractions and prevents cramps, she added.

BEST WAY TO JUICE UP

What about fruit juices then? It depends on how the juice is derived. “The majority of the nutritional value in fruits is found in the pulp and flesh, which provide fibre,” said Reutens. “If you remove them, you are left with very little nutritional value. You may get some Vitamins A and/or C, or whatever is left after oxidation.”

Should you still order a juice instead of a soft drink for lunch? “You are better off with fruit juice,” said Reutens. “The calories are much lower in fruit juices but there are no added sugars, and the juices also contain some, albeit, small amounts of vitamins and minerals. Bubble tea and blended drinks are also high in fat.”

For instance, a cup of watermelon juice has 95 calories and 20g of sugar. If you have a 330ml can of Coke, you’ll be consuming 133 calories and nearly 35g of sugar, said Reutens. Bubble tea with pearls and milk are worse at 232 calories and 24g of sugar.

The worst choice, in terms of calories and sugar intakes, are blended drinks, such as yoghurt drinks, smoothies and mixed fruit juices. Each cup can give you over 400 calories and nearly 40g of sugar if you don’t watch what you put into it.

GETTING THE MOST OUT OF FRUIT

It’s all about maximising the amount of nutrients when it comes to eating fruits. To that purpose, it is best that you eat the fruit as soon as you cut or prepare it.

“Fresh fruits have enzymes in their tissues. When a fruit is sliced, the enzymes get exposed to the oxygen in the air and oxidation occurs. That is why fruits turn brown. When oxidation occurs, Vitamin C gets lost,” explained Reutens. The longer the fruit is exposed, the less Vitamin C it will have.

However, if pre-cut, cellophane-wrapped fruit is all that you can find at the supermarket or convenience store, you will still reap the benefits of its dietary fibre, potassium and remaining vitamins,” she said. To supplement your vitamin intake, alternate pre-cut fruit with whole fruit, she advised.


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Fruits can be your diet ally or saboteur – depending on how you consume them, say dietitians

Thinning eyebrows: It could be a medical issue, not just a sign of ageing

If you've been too enthusiastic with tweezers in the past resulting in sparse eyebrows or you're just not naturally blessed with Cara Delevigne level brows, well, you're not going to look forward to getting older.

In fact, you might already have noticed your brows’ disappearing act in your 40s. One sign of that is, you are getting increasingly liberal with your eyebrow pencil or powder. Even if you don’t wear makeup, you might see bald patches, or your brow tails are getting shorter.

The rate of hair growth slows when you’re older, but certain health conditions could also be the cause of your brows looking worse for wear.

WHY BROWS THIN WITH AGE

So, what is going on? Just as the hair follicles on your scalp grow thinner and finer hair as you get older, so too, can the follicles above your eyes, said dermatologist Dr Sejal Shah, a fellow of the American Academy of Dermatology, on Self.

The rate of hair growth also slows when you’re older, said New York City-based dermatologist Joshua Zeichner on Allure. “Eyebrow hair grows actively for three to four months, followed by a resting phase, after which the hairs are released from the skin,” he said. But when the active phase shortens and the resting phase lengthens because of age, your brows will start to look patchy.

At the same time, your body starts to shut down its pigment factory, according to Medline Plus, meaning that the hairs produced won’t look so dark if you have black hair to begin with. The result? Brows start to look thinner and more sparse.

MEDICAL CAUSES OF THINNING BROWS

However, it's not just ageing that could be affecting the fullness of your eyebrows – it could be caused by certain health issues as well. Here are four reasons why thinning brows may warrant a trip to the doctor.

• Skin conditions

That itch on your face may be more than a mozzie bite if you’re losing brow hair. That’s because healthy hair needs healthy skin to grow, and if the affected area has become red and flaky, it could be a sign of eczema, psoriasis or other forms of skin conditions, noted Medical News Today. Unfortunately, the use of some medication to treat psoriasis, such as acitretin, can also cause hair loss, including the brows.

• Thyroid issues

The thyroid gland in the neck produces hormones to regulate metabolism. But when there is too little or too much of certain hormones, it disrupts many processes, including hair growth, according to Healthline. The loss of brow hair may be more pronounced in the outer third of the eyebrow in hypothyroidism (insufficient thyroid hormones), noted Medical News Today.

• Autoimmune diseases

Doctors don’t know what causes alopecia, an autoimmune disease, but it is when your immune system mistakenly identifies the hair follicles as the enemy and attacks them. Several kinds of alopecia exist, according to Healthline, including alopecia areata, which causes random spots of baldness; alopecia universalis, which causes all hair, including your brows, to completely disappear; and frontal fibrosing alopecia, which scars the scalp and also creates brow loss.

• Lack of sebum and Vitamin A

Sebum is every tropical dweller’s nightmare because it greases up everything, from the scalp to the face. But sebum has its purpose: To moisturise skin – and apparently, help hair grow. A 2011 study on Science Direct, a platform for peer-reviewed research, found that a lack of vitamin A can hinder the production of sebum, which is essential for moisturising hair and promoting its growth.


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Thinning eyebrows: It could be a medical issue, not just a sign of ageing

Are you grinding your teeth? You could be stressed or have a sleeping disorder

We cope with stress – consciously and unconsciously – in various ways. Some of us reach for some comfort food to feel better while others hit the gym or head out for a jog to get into the Zen zone. Then, there are the unconscious manners in which we react to stress, such as the peculiar odour our bodies produce under duress.

Teeth grinding and jaw clenching – also known as bruxism – could manifest during sleep and even unconsciously in the day.

Or you may be clenching your jaw or gnashing your teeth unknowingly – a condition known as bruxism – especially when your boss is breathing down your neck for a report.

As high as 38 per cent of the patients seen here were significantly depressed, too, when they reported jaw joint symptoms, which are likely a result of the effects of bruxism.

It's not just stress causing you to do that, depressed individuals may also be prone to teeth-clenching, said Dr Chua Ee Kiam, a senior consultant with the Department of Restorative Dentistry’s Prosthodontic Unit at the National Dental Centre Singapore.

“I would look at the psychological states, as in some cases, depression may also activate bruxism. As high as 38 per cent of the patients seen here were significantly depressed, too, when they reported jaw joint symptoms, which are likely a result of the effects of bruxism,” said Dr Chua.

In fact, a PubMed article, in which 470 participants were surveyed, also noted that “individuals who grind their teeth tend to report more symptoms of anxiety and depression than non-bruxers”, with bruxism seemingly “more severe during periods of heightened stress and anxiety”.

Why some people develop bruxism when stressed or depressed while others don’t depends on how they perceive and manage the stimulus, said Dr Chua. During sleep, “the subconscious mind may be more active than usual”, he said. And as the mind attempts to solve some of the day’s issues, it may result in gnashing or clamping of the teeth for some individuals.

BRUXISM IN THE DAY AND AT NIGHT

Some experts term bruxism as the clenching or grinding of the teeth, while others group them together, noted The American Academy of Oral Medicine (AAOM). But no matter what the action is, bruxism can happen in your sleep – and even during your waking hours. In adults, awake bruxism is more prevalent (22 per cent to 30 per cent) than sleep bruxism (1 per cent to 15 per cent), said Dr Chua, because patients are “often aware of the habit in the day”.

Because of this awareness in the day, awake bruxism is not as insidious as sleep bruxism, according to Dr Yue Weng Cheu, the clinical director of DP Dental and DP Dental Orchard. The nocturnal version can be caused by sleep apnoea, which one third of our population is at moderate or severe risk of, he said.

A worrisome form of it is obstructive sleep apnoea when the throat muscles relax during sleep and block the airway to the extent of interrupting breathing. What happens next is, the body sends out a stress response to raise heart and respiratory rates to get in more oxygen, said Dr Yue. Sometimes, this stress response increases muscle activity in the jaw, which in turn, leads to clenching or grinding during sleep.

In adults, awake bruxism is more prevalent (22 per cent to 30 per cent) than sleep bruxism (1 per cent to 15 per cent).

Sleep bruxism could also be caused by the way you breathe. “Mouth breathers, for instance, condition their tongues to lay low in the mouth during the day and when they continue to mouth-breathe at night, they suffer the consequences of airway obstruction or resistance, resulting in snoring and sleep bruxism,” said Dr Yue.

Almost every patient who suffers from sleep bruxism is unaware of his or her habit unless the sleeping partner complains about the noise at night, said Dr Chua.

ARE YOU PRONE TO BRUXISM?

The prevalence of bruxism is higher in individuals from ages 30 to 49 than those older than 60 years old, said Dr Ho Kok Sen, a dental specialist in oral and maxillofacial surgery at Specialist Dental Group, Mount Elizabeth Hospital. "According to AAOM, the prevalence of bruxism tends to decrease with age, with the lowest in people over 65," he said.

So, how common is bruxism? Dr Chua sees about 10 to 20 cases every month, while Dr Yue handles about four cases a week on average. Age is not a factor as both doctors have patients of various ages.

HOW DO YOU TELL IF YOU HAVE BRUXISM AND WHAT’S THE DAMAGE?

Is there pain in your temporomandibular joint (a hinge-like joint that connects your jaw to the skull) – especially in the morning when you wake up? While brushing your teeth, take a look in the mirror: Are your teeth looking shorter than before?

Take note, too, when you’re eating; is there pain or sensitivity when you chew? Do you notice a change or misalignment in your bite, or you just can’t bite properly anymore? Or you can’t fully open your mouth? If you answered “yes” to any of the above, it’s time to check in with your dentist for bruxism.

Clenching typically cracks your pearly whites and causes muscle soreness, pain and damage to the jaw. On the other hand, grinding wears off the outermost protective enamel and exposes the nerve-rich dentin, which results in tooth sensitivity, noted AAOM.

“Sometimes, we don’t see the grind marks or facets clearly but we can detect craze lines (cracks in the enamel) in the teeth,” said Dr Yue. But by the time the craze line has developed into a crack (involving the enamel, dentin and pulp of the tooth) and has joined with the other cracks, the patient has already worn down his teeth to the point of breakage, he said.

The duration it takes to wear down your teeth depends on the thickness of your teeth's enamel, said Dr Ho. "People who have weaker tooth enamel will having a higher risk of teeth breakage if bruxism persists."

Dr Yue added that it is "hard to tell how long that takes but those with the habit of cracking open crab shells, nuts, ice cubes and chicken bones with their teeth run higher risks”.

WHAT TREATMENTS ARE THERE?

Save for the scenario when you can’t fully open your mouth and require surgery to “unlock” the jaw, you’ll likely need root-canal and crown treatments, said Dr Chua, and sometimes, extraction.

Meanwhile, wearing a mouth guard may help to minimise the wear and tear. But do not grab one off the shelf. “Using a mouth guard from the sports store is like using a pair of shoes you picked up on the street,” said Dr Yue, explaining that the dentist needs to customise the fit for you. “If the fit is not good, the muscles will suffer.”

In addition, "over-the-counter mouth guards are generally made of thinner materials, which may not be able to withstand the force if your clench or grind is extremely hard", said Dr Ho.

However, a mouth guard doesn’t directly address the root cause of bruxism, said Dr Yue, which can sometimes be traced to sleep-related breathing disorders. Moreover, an upper guard should not be used during sleep if the patient has breathing disorders. “This is because the upper guard will block the tongue from lifting to the palate and that can aggravate the obstruction of the airway, leading to a more disastrous outcome,” he explained.

Botox injections to reduce the muscular actions in the jaw may help temporarily, said Dr Chua. Other than those, he suggested keeping stress levels under control and leading a balanced lifestyle.


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Are you grinding your teeth? You could be stressed or have a sleeping disorder

Weekly short walks can lower risk of dying from heart attack and cancer

A brisk stroll once or twice a week is enough to reduce the risk of dying from heart attack, stroke or cancer, according to a statistical study of nearly 90,000 people released Tuesday (Mar 19).

A brisk stroll once or twice a week is enough to reduce the risk of dying from heart attack, stroke or cancer, according to a statistical study of nearly 90,000 people.

People who walked or gardened 10 minutes to an hour each week had an 18-per cent lower risk of death from any cause compared to full-on couch potatoes, researchers reported in the British Journal of Sports Medicine.

Two-and-a-half to five hours weekly of such "moderate physical activity" - broken into segments of no less than 10 minutes - resulted in a 31 per cent reduction in risk, they found.

And those who clocked up at least 25 hours almost halved the risk.

Not everyone, however, has that much time to spend on leisure-time exercise, the authors acknowledged.

Heart-pumping and pulse-quickening activities such as biking, running and competitive sports "are more time-efficient than moderate intensity activity", they said.

For cardiovascular disease alone, there was no additional benefit to be gained by graduating from five to 25 hours, they noted.

Researchers led by Bo Xi, a professor in the Department of Epidemiology at Shandong University in northern China, sifted through data collected annually on 88,140 people in the United States between 1997 and 2008 for the National Health Interview Surveys.

That data on excercise was then matched against registered deaths through 2011.

The authors cautioned that the study was observational, meaning that no firm conclusions can be drawn about cause and effect. The fact that exercise data was self-reported was also a potential weakness.

But the large number of people covered by the research goes a long way to compensate for these methodological limitations, they added.


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Weekly short walks can lower risk of dying from heart attack and cancer

How exercise might affect our food choices – and consequently our weight

Taking up exercise could alter our feelings about food in surprising and beneficial ways, according to a compelling new study of exercise and eating. The study finds that novice exercisers start to experience less desire for fattening foods, a change that could have long-term implications for weight control.

A study shows that men and women who started an exercise programme no longer found high-calorie, fatty foods quite so irresistible.

The study also shows, though, that different people respond quite differently to the same exercise routine and the same foods, underscoring the complexities of the relationship between exercise, eating and fat loss.

I frequently write about exercise and weight, in part because weight control is a pressing motivation for so many of us to work out, myself included. But the effects of physical activity on waistlines are not straightforward and coherent. They are, in fact, distressingly messy.

Both personal experience and extensive scientific studies tell us that a few people will lose considerable body fat when they start exercising; others will gain; and most will drop a few pounds, though much less than would be expected given how many calories they are burning during their workouts.

At the same time, physical activity seems to be essential for minimising weight gain as we age and maintaining weight loss if we do manage to shed pounds.

Precisely how exercise influences weight in this topsy-turvy fashion is uncertain. On the one hand, most types of exercise increase appetite in most people, studies show, tempting us to replace calories, blunting any potential fat loss and even initiating weight creep.

But other evidence suggests that physical fitness may affect people’s everyday responses to food, which could play a role in weight maintenance. In some past studies, active people of normal weight displayed less interest in high-fat, calorie-dense foods than inactive people who were obese.

Most of those studies examined the preferences of men and women who already were or were not fit, however. They did not look at whether altering people’s exercise habits might also transform their feelings about food.

So, for the new study, which was published in November in Medicine & Science in Sports & Exercise, researchers at the University of Leeds in England and other institutions decided to ask a group of sedentary men and women about how they felt about food and to begin working out.

The researchers wound up recruiting 61 volunteers, most of them middle-aged and inactive; all were overweight or obese. The study participants completed detailed questionnaires and online tests of their food preferences and behaviours, picking, for instance, between rapid-fire, on-screen pictures of different foods and also answering questions about bingeing on food and whether they found it hard to not overeat.

Fifteen of the volunteers then were asked to continue with their normal lives as a control group, while the other 46 began exercising, working out on exercise machines at a university facility five times a week for about 45 to 60 minutes or until they had burned about 500 calories per session. They continued this training for 12 weeks, eating as they liked at home.

Then everyone returned to the lab for weigh-ins and to repeat the original tests. Most, but not all, of the exercisers had shed a few pounds, while some of those in the control group had gained weight.

The men and women in the control group also showed little alteration in their feelings about food. But the exercisers’ reactions to pictures of and questions about high-calorie, fatty foods were new. They no longer found them quite so irresistible. In psychological terms, they showed less “wanting” for the most fattening foods.

Interestingly, their scores on measures of “liking,” or how much they expected to enjoy those same foods, remained unchanged and strong. They still felt that they would enjoy a cookie but did not feel quite the same drive to seek one out. They also reported fewer instances of recent binge eating.

Taken as a whole, these results suggest that, in addition to making us healthier, “exercise might improve food reward and eating behaviour traits linked to the susceptibility to overconsume,” says Kristine Beaulieu, a research fellow and dietitian at the University of Leeds, who led the new study.

In other words, working out for a period of time could nudge us to rethink the kinds of foods we want to eat.

But the researchers did not monitor what their volunteers actually opted to eat at home, so they do not know if their eating habits shifted in real life. They also do not know if results would be different if people tried other types or amounts of exercise or how the exercise in this experiment affected food preferences, although they suspect it changed the workings of certain parts of the brain that regulate eating behaviour.

Perhaps most frustrating, they cannot explain why the final outcomes varied so much from one exerciser to another, with some developing far more disinterest in fatty foods than others. Genetics might be involved, or personality, lifestyle, body composition or other factors. The researchers hope to explore some of those issues in future studies.

But for now, the study reinforces the idea that exercise should be part of our efforts to manage our weight.

“People still liked high-fat foods to the same extent,” after four months of training, Beaulieu points out, “but they wanted to eat them less, which we view as a favourable outcome.”

Gretchen Reynolds © 2018 The New York Times


Taken from this article:
How exercise might affect our food choices – and consequently our weight