Brain food: diet’s impacts on students are too big to ignore
As their children submit themselves to the ordeal of all-important end-of-year exams, parents of high school and university students may be wondering what they can do to help. One thing they ought to consider…
High intake of take-away foods, red and processed meat, soft drinks, and fried and refined food is a risk factor for poor academic performance. Jay Peg/Flickr, CC BY-NC
As their children submit themselves to the ordeal of all-important end-of-year exams, parents of high school and university students may be wondering what they can do to help. One thing they ought to consider in particular is diet and its potential impact on academic outcomes.
Unfortunately, there’s relatively little research into the effect of nutrition on scholastic performance in young adults. But we do know that what we eat affects brain power.
Research findings
Let’s start with a brief overview of what the research says. Regular meals three times a day have been linked to higher academic performance in Korean adolescents, in a study from 2003.
In Norwegian teenagers, regular meals (lunch and dinner) were negatively associated with self-reported learning difficulties in mathematics. While foods reflecting a less healthy diet (including soft drinks, sweets, snacks, pizza, and hot dogs) were linked with learning difficulties in maths.
In the same 2013 Norwegian study, regular breakfast was associated with fewer learning difficulties, not only in maths but also in reading and writing.
In a 2008 Canadian study, higher academic achievement was reported in adolescents who consumed more fruits, vegetables and milk. Increased fish consumption positively influenced academic grades in Swedish teens, according to a paper published in 2010.
Another 2010 paper showed that, in Iceland, adolescents who had poor dietary habits (with higher consumption of chips, hamburgers and hot dogs) had lower academic achievement. In contrast, adolescents with higher fruit and vegetable consumption achieved higher academic scores.
In Australia, data from the long-running Western Australian Raine study have shown teenagers’ diet impacts cognitive performance, which is a significant predictor for academic achievement.
Specifically, my colleagues and I found a “Western” dietary pattern (high intake of take-away foods, red and processed meat, soft drinks and fried and refined food) at age 14 is associated negatively with 17-year-olds’ thinking abilities, especially reaction time and memory.
We also evaluated the school performance of teenagers in the Raine study. A higher intake of the kind of unhealthy food described above was linked to worse scholastic performance. The adolescents we looked at had poorer scores in mathematics, reading and writing, even after we had corrected for their body mass index and physical activity levels.
In contrast, we found a diet richer in fruit, yellow and red vegetables and whole grains was associated with better academic performance.
Diet and the brain
How exactly does diet affect mental performance? Adolescence is a sensitive time for the developing brain, particularly for the prefrontal cortex and other important brain structures, such as the hippocampus, which are critically involved in learning and memory. Research shows diet is likely to be a significant influence on brain capacity during this stage of life.
The Western dietary pattern appears to provide particular reason for concern at this critical time. This diet correlates with a high overall intake of total fat, saturated fat, refined sugar and sodium but lower levels of significant micronutrients, including folate and iron.
More generally, the Western dietary pattern is associated in young people with biological changes linked to metabolic syndrome, a term used to refer to a range of bodily changes associated with increased risk of cardiovascular disease and diabetes.
And this as well as high levels of fat and carbohydrate consumption are linked with impaired thinking skills through changes to key areas in the brain.
All these research findings are consistent with the idea that diet has impacts on teenagers’ thinking skills. In particular, they suggest the Western dietary pattern is a risk factor for poor academic performance.
Getting young people to take any advice from their parents is always challenging. But parents who can ensure their teenagers eat well may be conferring significant benefits on their academic performance
This is an interesting and informative article. When she mentions supplements, remember that we all react differently to various supplements, so we all have to find the ones that help us best. Trial and error is the best way to find the things that agree with you.
When it comes to health, hormones, and gut bacteria have a much bigger effect than many people realize. In fact, these two factors can destroy health even if everything else (diet, supplements, etc.) is optimized.
Conversely, fixing hormones and gut bacteria can do a lot to boost health, even if not all the other factors are optimal. In fact, there are even studies about using certain hormone reactions to heal brain trauma.
If you doubt the very real power of hormones to affect everything from mood, to weight, to bowel health – ask the nearest pregnant woman if she’s noticed any difference in these areas since being pregnant. Or ask the nearest 13 year old girl… carefully…
If you have symptoms like fatigue, skin issues, weight gain, weight around the middle, trouble sleeping, always sleeping, PMS, endometriosis, infertility, PCOS or other issues, chances are you have hormone imbalance!
What are Hormones?
Hormones are your body’s chemical messengers. They travel in your bloodstream to tissues or organs. They work slowly, over time, and affect many different processes, including
Growth and development
Metabolism – how your body gets energy from the foods you eat
Sexual function
Reproduction
Mood
Endocrine glands, which are special groups of cells, make hormones. The major endocrine glands are the pituitary, pineal, thymus, thyroid, adrenal glands and pancreas. In addition, men produce hormones in their testes and women produce them in their ovaries. (source)
Hormones are produced using good fats and cholesterol, so lack of these important dietary factors can cause hormone problems simply because the body doesn’t have the building blocks to make them. Toxins containing chemicals that mimic these building blocks or that mimic the hormones themselves are also problematic because the body can attempt to create hormones using the wrong building blocks… mutant estrogen anyone?
The endocrine system is a complex system that we will probably never completely understand, but there are some basic things you can do to boost your body’s ability to create and balance hormones:
1. Avoid High Omega-6 Polyunsaturated Fats
I’ve talked about this before, but the body is simply not meant to consume these man-made fats found in vegetable oils. From that article:
“The human body is about 97% saturated and monounsaturated fat, with only 3% Polyunsaturated fats. Half of that three percent is Omega-3 fats, and that balance needs to be there. Vegetable oils contain very high levels of polyunsaturated fats, and these oils have replaced many of the saturated fats in our diets since the 1950s.
The body needs fats for rebuilding cells and hormone production, but it has to use the building blocks we give it. When we give it a high concentration of polyunsaturated fats instead of the ratios it needs, it has no choice but to incorporate these fats into our cells during cell repair and creation.
The problem is that polyunsaturated fats are highly unstable and oxidize easily in the body (if they haven’t already oxidized during processing or by light exposure while sitting on the grocery store shelf). These oxidized fats cause inflammation and mutation in cells.
In arterial cells, these mutations cause inflammation that can clog arteries. When these fats are incorporated into skin cells, their mutation causes skin cancer. (This is why people often get the most dangerous forms of skin cancer in places where they are never exposed to the sun, but that is a topic for another day!)
When these oils are incorporated into cells in reproductive tissue, some evidence suggests that this can spur problems like endometriosis and PCOS. In short, the body is made up of saturated and monounsaturated fats, and it needs these for optimal health.”
Bottom line: Don’t eat fats like Vegetable oil, peanut oil, canola oil, soybean oil, margarine, shortening, or other chemically altered fats. Choose fats like coconut oil, real butter, olive oil (don’t heat!) and animal fats (tallow, lard) from healthy sources instead and eat lots of high Omega-3 fish.
2. Limit the Caffeine
I love coffee, a lot, but the truth is that too much caffeine can wreak havoc on the endocrine system, especially if there are other hormone stressors involved too like pregnancy, presence of toxins, beneficial fat imbalance or stress.
Cut down the coffee if you can, or replace with beneficial herbal teas (here are my ten favorite DIY recipes). If you can’t or won’t cut the coffee, use it as a way to sneak in your beneficial fats by adding 1 tablespoon coconut oil to each cup and blending in the blender to emulsify. It is like a latte but with healthy fats! Here is the recipe I use and the only way I drink coffee.
3. Avoid Toxins
Toxins found in pesticides, plastics, household chemicals, and even mattresses can contain hormone disrupting chemicals that mimic hormones in the body and keep the body from producing real hormones. Things like hormonal birth control can (obviously) do the same thing.
If you have hormone imbalance or are struggling to get pregnant, avoiding these toxins is very important! Cook in glass or non-coated metal pans (no non-stick or teflon!) and avoid heating or storing foods in plastic. Find organic produce and meat whenever possible and don’t use chemical pesticides or cleaners. There are recipes for natural cleaners on this page.
Here are some additional tips for avoiding toxins:
Can’t emphasize this one enough (tried with the all-caps-yelling though)! If you aren’t getting enough sleep, your hormone will not be balanced. Period.
Use these tips to help improve your sleep and just do it! This can singlehandedly improve hormones and is even linked to longer life, less chance of disease and optimizing weight.
In a perfect world, we would be rising and sleeping with the sun, getting Vitamin D from the sun and Magnesium from the ocean while relaxing and exercising in great balance each day in a stress-free world. Since I doubt that describes any of us currently, supplements can fill in the gaps. I’ve talked about the basic supplements that I take before, but there are some specific ones that are helpful for hormone support.
Maca– A tuber in the radish family that has a history of boosting hormone production and libido. Many women notice less PMS, increased fertility, and improved skin while men notice increased sperm production, libido, and better sleep. Maca is also high in minerals and essential fatty acids, making it great for hormones. It is available in powder form (least expensive option) or in capsules.
Magnesium– Magnesium supports hundreds of reactions in the body and often contributes to better sleep (which is great for hormones!). There are several effective forms of Magnesium: In powder form with a product like Natural Calm so that you can vary your dose and work up slowly, ionic liquid form can be added to food and drinks and dose can be worked up slowly,or transdermal form by using Magnesium oil applied to skin. This is often the most effective option for those with damaged digestive tract or severe deficiency.
Fermented Cod Liver Oil– Provides many of the necessary building blocks for hormone production including Vitamins A, D, and K. It also is a great source of Omega-3s and beneficial fats.
Gelatin is a great source of calcium, magnesium and phosphate. It supports hormone production and digestive health and helps sooth inflammation, especially in joints. We use Great Lakes Kosher as I was able to verify with the company that it is sourced from grass-fed, humanely raised cows, and as such is higher in nutrients.
6. Exercise Lightly
If you have hormone imbalance, intense extended exercise can actually make the problem worse in the short term. Sleep is actually more important, at least during the balancing phase, so focus on relaxing exercises like walking or swimming and avoid the extended running, cardio, and exercise videos, for now….
While extended cardio can be bad, short bursts of heavy lifting (kettlebells, deadlifts, squats, lunges) can be beneficial since they trigger a cascade of beneficial hormone reactions. Aim for a few sets (5-7) at a weight that really challenges you, but make sure to get help with form and training if you haven’t done these before as bad form can be harmful!
8. Eat Some Coconut Oil
Coconut Oil is amazing for hormone health. It provides the necessary building blocks for hormone production, can assist weight loss, reduce inflammation, and even has antimicrobial and antibacterial properties.
Leptin is a master hormone, and if it is out of balance or if you are resistant to it, no other hormones will balance well. Fixing leptin will also help boost fertility, make weight loss easier, improve sleep, and lower inflammation
How Sex Can Improve Our Health, Besides It Being Sex
Sophia Breene Sophia Breene
@SophBreene
January 23, 2013
For healthy, consenting adults, sex can be great or even mind-blowing. But getting busy with a partner can also have some legit benefits beyond our brainwaves. Read on for more reasons to get it on (as if we needed ‘em)!
The good feelings swirling around the brain during sexytimes are due to brain chemistry, specifically dopamine and opoid chemicals. But the goodness extends beyond our brains. Studies have found that regular sex can do way more than make us feel warm and fuzzy.
Wards off cold and flu. Researchers found that university students who engaged in sexual activity a few times a week had higher levels of immunoglobulin A — an antibody that helps fight infections and the common cold — in their saliva . Interestingly enough, the IgA levels were highest in couples who consistently had sex a few times a week, but lower in people who had no sex or lots of sex.
Reduces depression and stress. No need for chocolate: Some studies show that contact with semen during intercourse can act as an antidepressant for women . But don’t worry: Doing the deed has positive mental-health associations for everyone! In general, intercourse can make blood pressure less reactive to stress and reduce overall stress levels .
Boosts brainpower. A study on adult rats found that the sexually active rodents experienced an increase in neurons in the hippocampus — a part of the brain that stores memories — compared to their virginal rat buddies. Not only that, but researchers at the University of Amsterdam found that sexual encounters may improve people’s analytical thinking.
Improves overall physical fitness. If you’re looking for more motivation to hit the gym, consider this: Working out regularly tends to improve our sex lives, and having sex regularly can improve physical fitness. Everyone who’s ever watched an R-rated movie knows sexytime can be quite the cardio workout — in fact, half an hour of sex can burn more than 144 calories. Studies have also shown that exercising frequently can enhance sexual performance.
Relieves pain. Gettin’ frisky releases a bevy of hormones that can reduce pain. Oxytocin, the “cuddling hormone” that makes folks want to snuggle up after sex, reduces stress and promotes feelings of calm and wellbeing. Sex also releases serotonin, endorphins, and phenyl ethylamine, hormones that generate feelings of euphoria, pleasure, and elation — and make people forget all about that nagging sore muscle or back twinge. Other studies have shown intercourse can stop migraines in their tracks and reduce the uncomfortable side effects of rheumatoid arthritis.
Improves sleep. It’s a cliché that dudes pass out right after sex, but intercourse actually can help both men and women nod off. Feeling relaxed and comfortable are big factors in hitting the big O, so it makes sense that there’s a tendency to want to snooze right after. During and after sex, the brain releases powerful hormones (including norepinephrine, serotonin, oxytocin, and vasopressin), which can trigger the urge to cuddle or just pass out. Men are especially likely to zonk out because the prefrontal cortex — the part of the brain responsible for interpreting and responding to new information — slows waaaay down immediately after orgasm in males.
Enhances sense of smell. Oddly enough, spending some time between the sheets can help our noses do their job even better. After sexual intercourse, the body produces the hormone prolactin, which creates new neurons in the olfactory bulb — the part of the brain that controls how we understand and react to smells.
Makes us look younger. A little afternoon (or morning) delight doesn’t just make you feel great; it can actually make you glow! A Scottish study showed that loving, supportive couples who had intercourse three or more times a week appeared on average 10 years younger than their actual age. Orgasms trigger the release of the sex hormone estrogen in both men and women. Estrogen improves hair and skin quality, making people look more attractive .
Lowers blood pressure. High blood pressure puts pressure on the blood vessels, leading to damage and narrow, hardened arteries. The same effects that endanger the cardiovascular system can also cause erectile dysfunction in men (think about it for a second…) and reduced arousal and ability to achieve orgasm in women. Testosterone, a sex hormone power player for both ladies and gents, could be a solution. Studies have shown a link between low testosterone and high blood pressure, while the spikes in testosterone associated with sexual activity might help lower blood pressure .
Decreases risk for heart disease. Good news, dudes! Studies show doing the deed actually reduces risk of stroke and coronary heart disease in men . According to the study, men who had sex once a month or less were 45 percent more likely to contract a cardiovascular disease than friskier fellows. The evidence suggested the men with better overall health had higher libidos and therefore more sex overall, which reinforced their healthy cardiovascular systems.
Regulates periods. Some athletic (hetero) lovemaking once or twice a week can, on a very basic level, make it less likely that Aunt Flow will show up unexpected. In one study, scientists found that women exposed to male sweat were calmer and more relaxed than the control group. These women also experienced smaller changes of levels of luteinizing hormone (which controls the menstrual cycle) in the blood. Getting’ jiggy with it also reduces stress, another contributing factor in keeping periods more regular.
Improves tooth health. This one’s a bit of a reach, but bear with us. In addition to sperm, semen contains minerals like calcium, magnesium, and zinc — which are also found in root canal fillings . Zinc and calcium are also ingredients in most commercially available tooth rinses. We’ll let you do the math…
Fights prostate cancer. The link between frequent ejaculation and prostate health is still up for debate. According to some studies, regular sex “flushes out” any carcinogens lurking in the prostate gland, making it less likely to become cancerous . But a more recent study showed that very frequent sexual activity in young men (20s and early 30s) could actually increase the risk of developing prostate cancer . Meanwhile, frequent ejaculation in middle-aged or older (50+) men decreased disease risk . In other words, the verdict is still out on this one — though things look pretty good for the older gents among us.
Lowers risks during pregnancy. Pregnant ladies, time to get your groove on. Frequent sexual intercourse — and exposure to semen — can reduce the risk of developing a serious pregnancy complication called preeclampsia (which can cause swollen extremities, headaches, nausea, and even seizures). A protein found in semen, called HLG-A, can regulate women’s immune systems and lower the possibility of experiencing these complications .
Makes fertilization easier. For people trying to get a bun in the oven, there’s no such thing as too much “trying.” A study at an Australian fertility center showed that men who ejaculated daily for seven days had higher-quality sperm at the end of the week. The sperm’s rate of DNA fragmentation dropped from 34 percent to 26 percent, meaning it was heartier and more likely to fertilize an egg —probably because frequent sex (and ejaculation) means sperm spend less time in the testicular ducts and are less likely to be damaged over time.
One of the criticisms of Bioidentical HRT is that it is not FDA approved. It does not need to be, as it is not synthetic. It is interesting however that there has never been a complaint of an adverse event to the FDA – yet there are numerous adverse event report about the synthetic HRT. Here is part of a transcript from a recent Press conference run by the FDA.
The FDA had a press conference on BHRT. They generally were negative about BHRT.Here is one of the questions put to Kathy Anderson of the FDA (USA)
Anna Matthews(Reporter): Hi. Couple of questions; one is have you guys received any reports of adverse events or other harm to patients from these products?
Kathy Anderson: Sorry, this is Kathy Anderson. With your respect to your question about whether we received any adverse event reports, we have not.
Another year, and here I am returning to work (Next Monday 9th). I keep getting asked "when are you going to retire?" and this has been asked for at least the last 10 years. Well the answer is"When I am well and ready to do so." I am fit and healthy ( I take my own advice, and do all the things my Blogs advise you to do) Make your new years resolution to do all the things I advise you to do. I enjoy what I do so will continue to do what I enjoy most.
Lab coats and leggings: when science and dance connect it’s quite a show
Associate Professor in Creative Industries at Queensland University of Technology
Disclosure statement
Gene Moyle does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.
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Dancing is an activity most people associate with after-hours exploits: parties, weddings, the lounge rooms of friends with great vinyl collections, a night out at the ballet – or television shows such as So You Think You Can Dance, Dancing With The Stars or Got To Dance.
But what about dancing in the classroom to teach biology to high-school students about mitosis and mitochondria? And what could leotards and leggings possibly have to do with neuroscience and physics?
For a growing number of artists, academics, researchers and scientists, dance represents a promising new frontier of exploration. Placing this intriguing nexus between dance and science in the spotlight is Queensland University of Technology’s DANscienCE Festival, which was held on the weekend as part of National Science Week. It showcased the work, research and practice of academics and dancers from around the world in fields as diverse as the environment, physics, robotics, gamification and health.
Initiated in 2013 by Liz Lea and Cris Kennedy at CSIRO in Canberra, the DANscienCE Festival provides a platform for delving into how dance can be help scientists understand more about brain function and how our bodies respond to movement. It also examines how dance can serve as a powerful teaching tool for helping those outside academia understand sophisticated academic ideas.
It’s an intersection of disciplines that’s led to fascinating collaborations with fruitful results. One of these is Queensland Ballet’s Dance for PD (Parkinson’s Disease) project, which involved a team of movement neuroscientists, psychologists, physiotherapists and dancers developing exercises to improve cognitive performance and reaction times in individuals with PD.
Significant progress has already been achieved in the application of exercise science, medicine and related allied health fields to dance, in what we would call the traditional “dance science” field. Think of the use of motion-capture technology to prevent injuries, or the use of exercise physiology to determine how choreography impacts upon the dancer and what they need to do to be best prepared to perform it.
But there are many activities happening across the globe that focus not on the use of science in dance, but instead the use of dance in science. Ballet dancers are teaching us how to address symptoms of dizziness in older populations, and dementia sufferers who participate in dance classes are shown to experience improvements in physical, social and emotional wellbeing.
Yet more research explores the psychological processes involved in creating, perceiving, and performing music and dance, and their application in the evaluation of complex systems and human-computer interactions. These interfaces involve testing learning and memory function through physical movement. Such examples only scratch the surface in what is becoming a rich area of research.
Science is also utilising dance as a means of communication, with a regular Dance Your PhD competition providing hard science with an artistic voice – 2014 winner Uma Nagendra’s film showed at DANscienCE.
As for teaching biology through dance, that involves embodying and embedding information into gestures and sequences of movement. This enables the brain to make associations with what’s being taught, in addition to linking it with fun and humour – which are also powerful ways in which to embed memory. In the words of Dr Richard Spencer:
Dance engages students as it links both body and mind, so is a holistic activity, and pairs it with music – something that all students love.
Robotics is another area that has been exploring the intersection of science with humans through dance, with the beautiful work of Huang Yi challenging people’s thinking regarding these relationships. QUT’s Robotronica, linked to the DANscienCE Festival, showcases the full range of innovative and mind-blowing developments within this field including robots dancing too.
Huang Yi & Kuka, A Duet of Human and Robot.
The connection of dance and science is one that holds significant potential in generating results that can expand far beyond the realms of the fields in which they originate. This nexus is an artform in and of itself and was showcased across both the DANscienCE Festival and QUT’s Robotronica this past weekend.
Participants and audience members alike were both challenged and inspired to consider the potential future this area of research and practice holds for all of us, dancers or otherwise
Throughout our lives, cells in our bodies turn cancerous. We are totally unaware of this, and our body’s defenses remove the cancer cells, and all is well. Along comes modern technology with ever-increasing powerful X-ray and scanning devices, which can now find these small and minute cellular changes. On being told that you have a cancer, the normal reaction is” Cut it out, cut it out!!” Doing this leads to risks from the procedure, damage to tissues, stress reactions and other unfortunate consequences. And this for something that will never have caused you any trouble in your lifetime. Of course you can tell others that you had cancer which was diagnosed early and now you are cured!. This has the effect of increasing the success rate for treating these cancers. Take the example where I, as a surgeon, had a 100% cure rate for treating cancer, but it wasn’t cancer in the first place – my reputation would be immense.
Now this brings us to Mammography and breast cancer. Many of you know my views on this by now, and it has been frequently discussed in my blogs. There is an extensive section on my web-site devoted to this issue. The latest research bears out a lot of what I have been saying. Ductal carcinoma in situ (DCIS) should not even be called a cancer, as it basically consists of some cells with changes, that probably will never become a cancer. Too many women have had mastectomies and radiation as a result of something that would never have given them any trouble at all.
So what should women do? Keep informed about the debate from blogs like this, and make decisions with the best information available. Do not be pushed into tests and procedures that may do you more harm than good. (See my post 19 November 2012, 6.10am AEST-Is routine breast cancer screening doing more harm than good?)
There will be more follow-up posts on this topic over the next few days.
Here is the latest on this topic from the NY Times:
Doubt Is Raised Over Value of Surgery for Breast Lesion at Earliest Stage
Photo
Therese Taylor of Mississauga, Ontario, had a mastectomy four years ago after a diagnosis of ductal carcinoma in situ. She now believes it was unnecessary.CreditMichelle Siu for The New York Times
As many as 60,000 American women each year are told they have a very early stage ofbreast cancer— Stage 0, as it is commonly known — a possible precursor to what could be a deadly tumor. And almost every one of the women has either alumpectomyor amastectomy, and often a doublemastectomy, removing a healthy breast as well.
Yet it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying ofbreast canceras women in the general population, and the few who died did so despite treatment, not for lack of it, researchers reported Thursday in JAMA Oncology.
Their conclusions were based on the most extensive collection of data ever analyzed on the condition, known as ductal carcinoma in situ, or D.C.I.S.: 100,000 women followed for 20 years. Thefindingsare likely to fan debate about whether tens of thousands of patients are undergoing unnecessary and sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.
Diagnoses of D.C.I.S., involving abnormal cells confined to the milk ducts of the breast, have soared in recent decades. They now account for as much as a quarter ofcancerdiagnoses made withmammography, as radiologists find smaller and smaller lesions. But the new data on outcomes raises provocative questions: Is D.C.I.S.cancer, a precursor to the disease or just a risk factor for some women? Is there any reason for most patients with the diagnosis to receive brutal therapies? If treatment does not make a difference, should women even be told they have the condition?
Such questions are unlikely to be resolved by the new study. Some doctors, including the chief breast cancer surgeon at Memorial Sloan Kettering Cancer Center, said they did not see reason to change the current approach.
The new data are helpful, said Dr. Barnett S. Kramer, director of the division of cancer prevention at the National Cancer Institute, and are consistent with other data pointing in the same direction. The new study, he added, provides, “the type of evidence that builds the justification for less morbid treatment.”
Dr. Otis W. Brawley, chief medical officer at the American Cancer Society, said he was not ready to abandon treatment until a large clinical trial is done that randomly assigns women to receive mastectomies, lumpectomies or no treatment for D.C.I.S., and that shows treatment is unnecessary for most patients. But Dr. Brawley, who was not involved in the study, also said he had no doubt that treatment had been excessive.
“In medicine, we have a tendency to get too enthusiastic about a technique and overuse it,” Dr. Brawley said. “This has happened with the treatment of D.C.I.S.”
A majority of the 100,000 patients in the database the researchers used, from a national cancer registry, had lumpectomies, and nearly all the rest had mastectomies, the new study found. Their chance of dying of breast cancer in the two decades after treatment was 3.3 percent, no matter which procedure they had, about the same as an average woman’s chance of dying of breast cancer, said Dr. Laura J. Esserman, a breast cancer surgeon and researcher at the University of California, San Francisco, who wrotean editorialaccompanying the study.
The data showed that some patients were at higher risk: those younger than 40, black women and those whose abnormal cells had molecular markers found in advanced cancers with poorer prognoses.
D.C.I.S. has long been regarded as a precursor to potentially deadly invasive cancers, analogous tocolon polypsthat can turn intocolon cancer, said Dr. Steven A. Narod, the lead author of the paper and a researcher at Women’s College Research Institute in Toronto. The treatment strategy has been to get rid of the tiny specks of abnormal breast cells, just as doctors get rid ofcolon polypswhen they see them in acolonoscopy.
But if that understanding of the condition had played out as expected, women who had an entire breast removed, or even both breasts as a sort of double precaution, should have been protected from invasive breast cancer. Instead, the findings showed, they had the same risk as those who had a lumpectomy. Almost no women went untreated, so it is not clear if as a group they did worse.
But some women who died of breast cancer ended up with the disease throughout their body without ever having it recur in their breast — many, in fact, had no breast because they had had a mastectomy. Those very rare fatal cases of D.C.I.S. followed by fatal breast cancer, Dr. Narod concluded, had most likely already spread at the time of detection. As for the rest, he said, they were never going to spread anyway.
Dr. Esserman said that if deadly breast cancers started out as D.C.I.S., the incidence of invasive breast cancers should have plummeted with rising detection rates. That has not happened, even though in the pre-mammographyera, before about 1980, the number of women found to have D.C.I.S. was only in the hundreds. Nearly 240,000 women receive diagnoses of invasive breast cancer each year.
Those facts lead Dr. Narod to a blunt view. After a surgeon has removed the aberrant cells for thebiopsy, he said, “I think the best way to treat D.C.I.S. is to do nothing.”
Others drew back from that advice.
Dr. Monica Morrow, chief breast cancer surgeon at Memorial Sloan Kettering Cancer Center, said it made more sense to view D.C.I.S. as a cancer precursor that should be treated the way it is now, with a lumpectomy or mastectomy. She questioned whether those women who were treated and ended up dying of breast cancer anyway had been misdiagnosed.
In some cases, pathologists look at only a small amount of tumor, Dr. Morrow said, and could have missed areas of invasive cancer. Even the best mastectomy leaves cells behind, she added, which could explain why a small number of women with D.C.I.S. who had mastectomies, even double mastectomies, died of breast cancer.
Dr. Brawley said the new study, by showing which D.C.I.S. patients were at highest risk, would help enormously in defining who might benefit from treatment. It could not show that the high-risk women — young, black or with tumors with ominous molecular markers — were helped by treatment because there were too few of them, and pretty much every one of them was treated. But Dr. Brawley said he would like to see clinical trials that addressed that question, as well as whether the rest of the women with D.C.I.S., 80 percent of them, would be fine without treatment or with anti-estrogendrugs like tamoxifen or raloxifene that can reduce overall breast cancer risk.
The notion that most women with D.C.I.S. might not need mastectomies or lumpectomies can be agonizing for those, like Therese Taylor of Mississauga, Ontario, who have already gone through such treatment. Four years ago, when she was 51, a doctor sent her for a mammogram, telling her he felt a lump in her right breast. That breast was fine, but it turned out she had D.C.I.S. in her left breast. A surgeon, she said, told her that “it was consistent with cancer” and that she should have a mastectomy.
“I went into a state of shock and fear,” Ms. Taylor said. She had the surgery.
She regrets it. “It takes away your feeling of attractiveness,” she said. “Compared to women who really have cancer, it is nothing. But the mastectomy was for no reason, and that’s why it bothers me.”
But if D.C.I.S. is actually a risk factor for invasive cancer, rather than a precursor, it might be possible to help women reduce their risk, perhaps with hormonal or immunological therapies to change the breast environment, making it less hospitable to cancer cells, Dr. Esserman said.
“As we learn more, that gives us the courage to try something different,” she said.
The stakes in this debate are high. Karuna Jaggar, executive director of Breast Cancer Action, an education and activist organization, said women tended not to appreciate the harms of overtreatment and often overestimated their risk of dying of cancer, making them react with terror.
“Treatment comes with short- and long-term impacts,” Ms. Jaggar said, noting that women who get cancer treatment areless likely to be employed several years later and tend toearn lessthan before. There are emotional tolls and strains on relationships. And there can be complications from breast cancer surgery, includinglymphedema, a permanent pooling of lymphatic fluid in the arm.
“These are not theoretical harms,” Ms. Jaggar said.
University of Adelaide researchers have discovered a high–fat diet may impair important receptors located in the stomach that signal fullness. Published in the journal PLOS ONE, researchers from the University’s Centre for Nutrition and Gastrointestinal Diseases (based at the South Australian Health and Medical Research Institute) investigated the association between hot chilli pepper receptors (TRPV1) in the stomach and the feeling of fullness, in laboratory studies. “It’s exciting that we now know more about the TRPV1 receptor pathway and that the consumption of capsaicin may be able to prevent overeating through an action on nerves in the stomach,” says Dr Kentish, National Health and Medical Research Council (NHMRC) Fellow from the University of Adelaide’s School of Medicine. “The next stage of research will involve investigation of the mechanisms behind TRPV1 receptor activation with the aim of developing a more palatable therapy. “We will also do further work to determine why a high–fat diet de–sensitises TRPV1 receptors and investigate if we can reverse the damage,” he says.
This is the third of my series on cancer, and in particular breast cancer and DCIS.
‘Cancer’ or ‘Weird Cells’: Which Sounds Deadlier?
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CreditKelly Blair
My friend’s mother got terrifying news after she had amammogram. She had Stage 0breast cancer.Cancer. That dreadful word. Of course she had to have surgery to get it out of her breast, followed by hormonal therapy.
Or did she?
Though it is impossible to say whether the treatment was necessary in this case, one thing is growing increasingly clear to many researchers: The word “cancer” is out of date, and all too often it can be unnecessarily frightening.
“Cancer” is used, these experts say, for far too many conditions that are very different in their prognoses — from “Stage 0 breast cancer,” which may be harmless if left alone, to glioblastomas,brain tumorswith a dismal prognosis no matter what treatment is tried.
It is like saying a person has “mental illness” when he or she might have schizophreniaor mild depression or aneating disorder.
Now, some medical experts have recommended getting rid of the word “cancer” altogether for certain conditions that may or may not be potentially fatal.
The idea of cancer as a progressive disease that will kill if the cells are not destroyed dates to the 19th century, said Dr. Otis Brawley, chief scientific and medical officer at the American Cancer Society. A German pathologist, Rudolph Virchow, examined tissue taken at autopsy from people who had died of their cancers, looking at the cells under a light microscope and drawing pictures of what he saw.
Virchow was a spectacular artist, and he ended up being the first to describe a variety of cancers — leukemia, breast cancer,colon cancer, lung cancer.
Of course, his patients were dead. So when he noted that aberrant-looking cells will kill, it made sense. The deranged cells were cancers, and cancers were fatal.
Now, Dr. Brawley said, the situation is very different. Instead of taking tissue from someone who died, a doctor takes tissue from a living patient, threading a thin needle into a woman’s breast or a man’s prostate, for example. Then a pathologist looks for abnormal cells.
Yet “how it looks under a microscope,” Dr. Brawley said, “does not always predict.” That is especially true for things like Stage 0 breast cancer or similar conditions in other areas of the body — conditions detected by screening and not by symptoms or by feel.
Researchers have come to appreciate this conundrum.
“The definition of cancer has changed,” said Dr. Robert Aronowitz, a professor of history and sociology of medicine at the University of Pennsylvania.
Many medical investigators now speak in terms of the probability that a tumoris deadly. And they talk of a newly recognized risk of cancer screening — overdiagnosis. Screening can find what are actually harmless, if abnormal-looking, clusters of cells.
But since it is not known for sure whether they will develop into fatal cancers, doctors tend to treat them with the same methods that they use to treat clearly invasive cancers. Screening is finding “cancers” that did not need to be found. So maybe “cancer” is not always the right word for them.
That happened recently with Stage 0 breast cancer, also known asductal carcinoma in situ, or D.C.I.S.It is a small accumulation of abnormal-looking cells inside the milk ducts of the breast. There’s no lump, nothing to be felt. In fact, Stage 0 was almost never detected before the advent of mammography screening.
Now, with widespread screening, this particular diagnosis accounts for about 20 percent of all breast cancers. That is, if it actually is cancer. After all, it is confined to a milk duct, has not spread into the rest of the breast, and may never spread if left alone — it might even go away.
It could also break free and enter the breast tissue. But for now, it is hard to know in many cases whether it makes any difference to treat D.C.I.S. right away or to wait to see if it spreads, treating it then.
Two years ago, an expert panel at the National Institutes of Health said the condition should be renamed. Get rid of the loaded word “carcinoma,” the panel said. A carcinoma is invasive; D.C.I.S. has not invaded the breast. If those cells do invade, they are no longer D.C.I.S. Then they are cancer. So call the condition something else, perhaps “high-grade dysplasia.”
The word “cancer” is so powerful it overwhelms any conversation about what Stage 0 breast cancer actually is, said Cynthia Pearson, executive director of the National Women’s Health Network. When women contact her group to ask about cancer treatments, “sometimes we’re well into the conversation with them before it comes out that they don’t actually have an invasive cancer.”
The pathologist Donald Gleason, who inventedGleason scoringfor prostatetumors, wanted to rename a very common tumor — the so-called Gleason 3 + 3 — “adenosis” instead of cancer, Dr. Brawley said. His idea was that by calling a 3 + 3 “cancer,” men and their doctors would feel they had to get rid of it right away.
Despite Dr. Gleason’s wishes, 3 + 3 cells are still called cancer. And despite the panel’s advice about D.C.I.S., that name has not changed either.
Cervical cancerspecialists had better luck. In 1988, they changed the name of a sort of Stage 0 of the cervix. It had been called cervical carcinoma in situ. They renamed itcervical intraepithelial neoplasia, Grades 1 to 3, taking away the cancer connotation.
But Dr. Brawley, for one, has not given up on educating doctors and patients about the general inadequacy of the word “cancer.” As he put it, “The movement is not quite dead.”
I am back to work again today, and hope you had a healthy and restful holiday season. Medical knowledge and scientific developments are rapidly growing, so I will continue to keep you up to date with the latest information, mainly dealing with healthy living and hormones.
The panel said that some premalignant conditions found in mammograms should not be identified as “carcinoma.”CreditDamian Dovarganes/Associated Press
A group of experts advising the nation’s premier cancer research institution has recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment.
The recommendations, from a working group of theNational Cancer Institute,were published on Mondayin The Journal of the American Medical Association. They say, for instance, that some premalignant conditions, like one that affects the breast called ductal carcinoma in situ, which many doctors agree is not cancer, should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the surgical removal of the breast.
The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
While it is clear that some or all of the changes may not happen for years, if it all, and that some cancer experts will profoundly disagree with the group’s views, the report from such a prominent group of scientists who have the backing of the National Cancer Institute brings the discussion to a higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.
“We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, the chief medical officer for the American Cancer Society, who was not directly involved in the report.
The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm.
The advent of highly sensitive screening technology in recent years has increased the likelihood of finding these so-called incidentalomas — the name given to incidental findings detected during medical scans that most likely would never cause a problem. However, once doctors and patients are aware a lesion exists, they typically feel compelled to biopsy, treat and remove it, often at great physical and psychological pain and risk to the patient. The issue is often referred to as overdiagnosis, and the resulting unnecessary procedures to which patients are subjected are called overtreatment.
Cancer researchers warned about the risk of overdiagnosis and overtreatment as a result of new recommendations from a government panel that heavy smokers be given an annual CT scan. While the policy change, announced on Monday but not yet made final, has the potential to save 20,000 lives a year, some doctors warned about the cumulative radiation risk of repeat scans as well as worries that broader use of the scans will lead to more risky and invasive medical procedures.
Officials at the National Cancer Institute say overdiagnosis is a major public health concern and a priority of the agency. “We’re still having trouble convincing people that the things that get found as a consequence of mammography and P.S.A. testing and other screening devices are not always malignancies in the classical sense that will kill you,” said Dr. Harold E. Varmus, the Nobel Prize-winning director of the National Cancer Institute. “Just as the general public is catching up to this idea, there are scientists who are catching up, too.”
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An expert panel says lesions found in some cancer screenings should not be called cancer but should instead be reclassified.CreditJoe Raedle/Getty Images
One way to address the issue is to change the language used to describe lesions found through screening, said Dr. Laura J. Esserman, the lead author of the report in The Journal of the American Medical Association and the director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco. In the report, Dr. Esserman and her colleagues said they would like to see a multidisciplinary panel convened to address the issue, led by pathologists, with input from surgeons, oncologists and radiologists, among others.
“Ductal carcinoma in situ is not cancer, so why are we calling it cancer?” said Dr. Esserman, who is a professor of surgery and radiology at the University of California, San Francisco.
Such proposals will not be universally embraced. Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, said the larger problem is that doctors cannot tell patients with certainty which cancers will not progress and which cancers will kill them, and changing terminology does not solve that problem.
“Which cases of D.C.I.S. will turn into an aggressive cancer and which ones won’t?” he said, referring to ductal carcinoma in situ. “I wish we knew that. We don’t have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer.”
Dr. Norton, who was not part of the report, agreed that doctors do need to focus on better communication with patients about precancerous and cancerous conditions. He said he often tells patients that even though ductal carcinoma in situ may look like cancer, it will not necessarily act like cancer — just as someone who is “dressed like a criminal” is not actually a criminal until that person breaks the law.
“The terminology is just a descriptive term, and there’s no question that has to be explained,” Dr. Norton said. “But you can’t go back and change hundreds of years of literature by suddenly changing terminology.”
But proponents of downgrading cancerous conditions with a simple name change say there is precedent for doing so. The report’s authors note that in 1998, the World Health Organization changed the name of an early-stage urinary tract tumor, removing the word “carcinoma” and calling it “papillary urothelial neoplasia of low malignant potential.” When a common Pap smear finding called “cervical intraepithelial neoplasia” was reclassified as a low-grade lesion rather than a malignancy, women were more willing to submit to observation rather than demanding treatment, Dr. Esserman said.
“Changing the language we use to diagnose various lesions is essential to give patients confidence that they don’t have to aggressively treat every finding in a scan,” she said. “The problem for the public is you hear the word cancer, and you think you will die unless you get treated. We should reserve this term, ‘cancer,’ for those things that are highly likely to cause a problem.”
The concern, however, is that since doctors do not yet have a clear way to tell the difference between benign or slow-growing tumors and aggressive diseases with many of these conditions, they treat everything as if it might become aggressive. As a result, doctors are finding and treating scores of seemingly precancerous lesions and early-stage cancers — like ductal carcinoma in situ, a condition called Barrett’s esophagus, small thyroid tumors and early prostate cancer.
But even after years of aggressively treating those conditions, there has not been a commensurate reduction in invasive cancer, suggesting that overdiagnosis and overtreatment are occurring on a large scale.
The National Cancer Institute working group also called for a greater focus on research to identify both benign and slow-growing tumors and aggressive diseases, including the creation of patient registries to learn more about lesions that appear unlikely to become cancer.
Some of that research is already under way at the National Cancer Institute. Since becoming director of the institute three years ago, Dr. Varmus has set up a list of “provocative questions” aimed at encouraging scientists to focus on critical areas, including the issue of overdiagnosis and molecular tests to distinguish between slow-growing and aggressive tumors.
Another National Cancer Institute program, the Barrett’s Esophagus Translational Research Network, or Betrnet, is focused on changes in the esophageal lining that for years have been viewed as a precursor to esophageal cancer. Although patients with Barrett’s are regularly screened and sometimes treated by burning off the esophageal lining, data now increasingly suggest that most of the time, Barrett’s is benign and probably does not need to be treated at all. Researchers from various academic centers are now working together and pooling tissue samples to spur research that will determine when Barrett’s is most likely to become cancerous.
“Our investigators are not just looking for ways to detect cancer early, they are thinking about this question of when you find a cancer, what are the factors that might determine how aggressively it will behave,” Dr. Varmus said. “This is a long way from the thinking 20 years ago, when you found a cancer cell and felt you had a tremendous risk of dying.”
More on this important issue for all women. I had a patient recently who was diagnosed with DCIS 10 years ago, and was advised to have a mastectomy with radiation treatment. She refused and had nothing done, and here she is 10 years later perfectly well. Others have made the same decision – what is known as watchful waiting. This approach may not suit everyone – women must decide for themselves armed with the knowledge that this is acceptable. Here is the follow-up to yesterday’s article:
Aggressive Treatment for Early Breast Cancer: Reporter’s Notebook
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Therese Taylor, who regrets having a mastectomy and believes it was not needed, reveals the scars where her left breast used to be.CreditMichelle Siu for The New York Times
On Tuesday, I got an e-mail from JAMA Oncology, a leading medical journal, saying that it planned to publish a paper and editorial on ductal carcinoma in situ, or D.C.I.S., a condition that has become increasingly controversial over the years. As many as 60,000 women are told each year that they have it: tiny clusters of abnormal breast cells, confined to a milk duct and too small to be felt. It’s often called stage 0 cancer, and it almost never was detected before the early 1980s when mammograms came into widespread use.
I clicked on the paper and noticed that it and the accompanying editorial seemed to be raising some provocative issues. Was the usual brutal treatment — a mastectomy or a lumpectomy with or without radiation — excessive? Was Cindy Pearson, executive director of the National Women’s Health Network, correct when she told me treating D.C.I.S. this way “is like killing a mosquito with an elephant gun?”
To be honest, stories like this frighten me.
ThearticleI wrote in today’s paper does not provide definitive answers but provokes questions about difficult treatments tens of thousands of women have had, hoping to save their lives. No one wants to make a person who already is terrified of cancer think perhaps she had her breast cut off for nothing.
It’s hard to know how you would react until something like that hits you, but it cannot be easy. I sometimes think of what it would be like to be the last woman to have had a radical mastectomy. Will the treatment of D.C.I.S. be so different in a decade that women who have undergone today’s procedures feel like they were born too soon?
Then I think about the women soon to receive a D.C.I.S. diagnosis. Shouldn’t they at least know that there are no definitive answers about treatment? Shouldn’t they know that the more cancer researchers learn about D.C.I.S., the more they wonder if the usual treatments are helping.
The problem lies in what to do with this information. Medical researchers, of course, say that more research is needed: They need more studies; they need to better understand the biology of breast cancer in general and D.C.I.S. in particular. The new data is the type “that justifies use of watchful waiting,” said Dr. Barnett Kramer, director of the division of cancer prevention at the National Cancer Institute.
But is anyone actually doing that now, I asked medical experts.
It’s big step, said Dr. Otis Brawley, chief medical officer for the American Cancer Society. It would be a big departure from decades of medical practice. He said he does not know anyone right now who is telling women with D.C.I.S. that they should just wait and be monitored. But, he said, “I anticipate that in the next decade or so people will be willing to make that leap.”
Dr Colin Holloway 
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