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Real learning in a virtual world How VR can improve learning and training outcomes

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​How can corporate trainers prepare employees for dangerous or extraordinary workplace scenarios? VR technology offers immersive learning opportunities for an increasingly broad range of experiences.

Introduction: Total immersion

At THE oil refinery, emergency sirens begin to wail. A shift supervisor races to the scene of the emergency and sees smoke already billowing from the roof of a distillation unit. He needs to get the fire under control, but when he opens the door to the control room, a wall of flame greets him. The situation is worse than anything in his training manual. How can he locate the shut-off button when he can’t see through the flames? He hesitates—and in that moment, the pressure built up in the distillation tower releases in a massive explosion, ripping apart the building and scattering debris across the whole refinery.

 

A red message flashes before the supervisor’s eyes: Simulation failed. A voice comes over the intercom and says, “All right—let’s take two minutes, and then we’ll reset from the beginning.” He is covered in sweat as he takes off the headset. It had been a virtual reality (VR) simulation, but the stress was real; more importantly, the lessons on how to respond to a crisis had been real.

For decades, trainers have faced a difficult trade-off: How can you adequately prepare learners to make good decisions when facing dangerous or extraordinary situations? You can provide simple learning materials like books and classes, but these are likely inadequate preparation for stressful and highly complex situations. Or you can expose the learners to those situations in live training, but this can be extremely costly—not to mention hazardous. For many jobs and situations, training has long offered an unappealing choice between easy but ineffective, or effective but expensive and risky.

VR promises a third way: a method of training that can break this trade-off of learning and provide effective training in a safe, cost-effective environment.1 Certainly, the technology is not optimal for every learning activity. But VR has been shown to offer measurable improvement in a wide array of immersive learning outcomes, in tasks that range from flying advanced jets to making a chicken sandwich to handling dangerous chemicals.2

This article is intended to help trainers identify whether VR is right for their particular learning needs and chart a path toward successful adoption of the technology. Ultimately, learning-focused VR can turn novices into experts more swiftly, effectively, and smoothly than ever before.

It’s all about expertise

Success in business often rests on having the right expertise in the right places: having the IT expert on hand when the system goes down, or the best shift manager on duty when a huge order comes in. The more experts in an organization, the more likely an expert will be around when needed.

Of course, expertise can be purchased by hiring established experts. But their numbers are finite, and with needs constantly shifting, training often makes far more sense. Corporate learning, then, aims to create expertise as quickly and effectively as possible. We want people to learn better and more quickly. This begs a question: What exactly is expertise? Just what is it that we want people to be able to do after training?

Expertise is easiest to define in terms of what it is not. Expertise is not merely the number of years one has studied or how many academic degrees—or corporate training certificates—one has earned or even the results one has achieved. For example, simply tabulating wins and losses in tennis turns out to be a poor way of ranking the best players.3 And notwithstanding some popular theories, thousands of hours of practice don’t always generate expertise. For example, deliberate practice accounts for only 29.9 percent of the variance in expertise in music.4

Experts are not only better at executing particular tasks—they tend to think about things fundamentally differently than amateurs. In fact, they can execute better precisely because they think about things differently. Experts typically see more when looking at a situation than an amateur. Research comparing a world champion chess player with amateurs showed that the champion was better not only at playing chess but at knowing the game. The champion had a better understanding of a chessboard setup after viewing it for five seconds than a skilled amateur did after 15 minutes of studying the board.5

That result came about not because the chess champion was any smarter or had faster visual acuity than his amateur opponents—it was a product of expertise itself. Experts are able to recognize patterns behind the data we all see. Academic research has found a similar pattern-recognition story in nearly every industry from medicine to chess.6 Experts in diverse domains are better able to reorganize and make sense of scrambled information.7 Where knowledgeable amateurs rely on rules and guidelines to make decisions, experts are able to quickly read and react to situations by recognizing indicators that signal how a situation is behaving.8 A key to creating experts, it seems, is not the memorization of facts or knowledge but, rather, instilling flexible mental models that help explain why systems act the way they do.

How can we learn better?

In hindsight, trainers may have had it easy in offering certifications based on hours of study. Creating deeper expertise can be far more challenging. How can we train people to see deeper patterns in data? How do we know whether they are using flexible mental models?

For most people, experiences that expose trainees to tough or atypical cases force them to create more refined or specialized reasoning than that found in a book or procedure manual.9 The most effective learning may come from unexpected scenarios, a challenge to present in a book or classroom.10 But unpredictable, experience-based learning has obvious limitations: It is easy to learn from experience when failure simply means losing a chess match, but what about fighting a fire, unloading hazardous chemicals, or configuring a wind turbine—all tasks for which failure means huge costs or even death? The problem facing trainers is how to create the benefits of learning from experience without incurring the costs of facing rare or dangerous experiences. The answer is to re-create those experiences.

Take medical training, for example. A cardiologist may practice for years, continually training, before reaching the peak of her profession. One reason: Many of the most serious medical problems are extremely rare, meaning that a doctor must often work for years before encountering them and building expertise in how to recognize and treat them. With some procedures requiring doctors to practice on 100 patients before reaching a critical level of skill, this means that some doctors may retire before even having the opportunity to become an expert in treating certain rare conditions.11

VR training offers a shortcut. Given its ability to present immersive, realistic situations over and over again, the technology can give doctors the opportunity to potentially build expertise on conditions before they see them for the first time in real patients (see figure 1). VR can also offer the ability to learn in new ways—not only simulating what a doctor might see but presenting it in 3D or in more detail. For example, a cardiologist could see a heart defect, not just from symptoms or test results but as a 3D model, allowing her to peek inside the heart and understand the problem more deeply and how to treat it more accurately.12

Virtual reality is one technological component of digital reality that can help solve real-world business problems and create competitive advantage

Virtual reality: Better training faster, safer, and at less cost

VR technology can enable more effective learning at a lower cost and in less time than many traditional learning methods. This is because VR can allow for more training repetitions, especially when dealing with costly, rare, or dangerous environments. For example, the skills of aviation maintenance personnel can degrade when budget constraints limit flying hours; if jets are not in the air, there is nothing to be fixed. But without that practice, critical maintenance skills can slip, leading to increased accidents.13 VR can allow maintenance staffers to keep up their skills by learning from experience, at a fraction of the cost of putting an actual jet in the sky.

VR is not just about saving money—it can provide better outcomes than many traditional learning methods. Most research examining the technology’s effectiveness have found that it reduces the time taken to learn, decreases the number of trainee errors, increases the amount learned, and helps learners retain knowledge longer than traditional methods.14 These effects apply to the general population as well as specialists training for unique tasks. One experiment compared how prepared airline passengers were for an emergency from reading the ubiquitous seatback safety card versus completing a brief immersive game. Passengers who used the game seemed to learn more and retain their knowledge longer than those who merely read the safety card. These better outcomes are almost certainly linked to the fact that the game was more successful than the card at engaging passengers and arousing fear, both incentivizing participants to learn and providing the neurological surprise to support that learning.15

Beyond simply improving how well learners retain information, VR-based training can help learners when they get it wrong. The ability to track all of a trainee’s actions and inputs as he or she moves through a scenario can reduce the cost of providing individual feedback and giving tailored feedback. Experts need not sift through all the data and tell a trainee where he or she went wrong—the system itself may be able to determine likely causes of error and best strategies for avoiding those errors in the future.16

All of these capabilities mean that VR can be a valuable learning tool for a variety of tasks in any industry—and some real-world applications are already catching up to predictions that academic research has suggested:

  • Better learning. Some major retailers have begun training workers using VR simulations. Staff are able to repeatedly take on new tasks such as managing the produce department or annual challenges such as dealing with Black Friday.17 Working through these challenges is designed to help people directly see the impact of their actions on customer experience. And simulations can even allow staff to virtually travel to other stores to see how operations are managed there, spreading good ideas and offering paths to improvement.18 As a result, some companies have found that not only do people seem to retain more compared to traditional methods—they appear to learn more as well.19
  • Faster learning. In 2017, KFC debuted a VR training simulation to help trainees learn the chain’s “secret recipe” for preparing chicken. Using the simulation, trainees were able to master the five steps of making fried chicken in 10 minutes, compared with 25 minutes for conventional instruction.20

Linde’s experience with VR-based training illustrates the technology’s potential benefits. One of the world’s largest suppliers of industrial gases, Linde delivers hazardous chemicals to thousands of locations daily, meaning that truck drivers must handle materials that may be explosive or, at -320° F, cold enough to instantly freeze hands solid. When one slip-up can mean injury or death, how can new drivers build their skills and expertise? For Linde, VR-based training provides an answer. In the virtual environment, new drivers can get dozens of repetitions, building safe habits before stepping out on their first delivery.21 VR can even give drivers an X-ray view of what is happening inside the tanks as they work. Not only are drivers practicing the right skills—they are learning the underlying concepts of why they are the right skills. That is what can create expertise—allowing drivers to react to unexpected situations quickly and with confidence.

Linde is experimenting with more ambitious VR training environments as well. The company used CAD files for a plant currently under construction to create an immersive VR environment, aiming to train the operators who will eventually manage that plant.22 As with the earlier oil-refinery example, operators can practice emergency procedures or dangerous tasks, but they can also explore the environment, understand how all systems fit together, and even peek inside operating machinery to have a better view of the plant for which they will soon be responsible.23

When can VR enhance training?

As with any technology, VR is a tool, not a magic bullet. Incorporating VR into a training program hardly guarantees quality improvements; indeed, the coming years will doubtless bring anecdotes of VR disappointments along with successes. Trainers should bring the same careful planning in program design and learning goals to VR as to any other training effort—including focusing programs around understanding the knowledge that an organization needs learners to acquire and what they should then do with that knowledge.

The knowledge that learners must acquire can cover a wide range, but several factors are particularly relevant to VR technology: how rare the knowledge is, how observable, and how easily it can be replicated physically. A cardiologist may struggle to learn about uncommon heart defects exactly because they are rare, limiting learning opportunities. Many find organic chemistry challenging to learn partly because one can’t directly observe molecular bonds with human senses; landing on an aircraft carrier is tricky to perfect because repetitions are both costly and dangerous.

Another attribute to consider: what trainers expect learners to do with the knowledge once they have it. Do people simply need to recognize and apply it, as with reading the defense in football, or do they need to perform complicated actions such as synthesizing it with other knowledge and adjusting to context? All of these factors play into how best to present knowledge to learners.

By understanding the different factors that go into learning, a trainer can make informed decisions about when VR is appropriate and design the best training possible to maximize performance (see figure 2). For example, if learners need only acquire relatively simple information—that is, information that is common, obvious, or easy to represent—VR may be superfluous and no more effective than books, classroom instruction, or job aids.

Similarly, if learners need to do more complex tasks involving simple information, VR may help, but there may be easier, cheaper ways to accomplish the learning. Take the simple knowledge of a workflow: Workers need to understand the workflow and apply it in different contexts. VR might certainly help in learning such workflows, but it may not always be necessary. If the various contexts of the work are not rare, dangerous, or costly to recreate, using case studies or job aids may be cost-effective alternatives.

The decision framework can help determine when and how to use VR in learning

Where VR moves into a class of its own is when the knowledge that learners must acquire is complex: where trainees must try to grapple with difficult-to-observe phenomena that occur rarely or in dangerous situations. In these cases, VR-based training may well be an effective choice, offering the advantages of faster and better learning at lower cost.

Indeed, VR’s ability to allow for collaboration and for repeated simulation opens up entirely new learning possibilities:

  • Shared scenarios. Consider a military squad that needs its members not only to individually do the right thing but to coordinate and work together. Shared scenarios can allow members to practice individual actions and communication within the squad in a variety of combat situations they could not normally face.
  • Seeing the unseen. VR may be even more helpful for research scientists. Not only do they often need to collaborate within teams—they regularly struggle with concepts not easily visualized. But imagine if a team of scientists could share ideas while all looking at a 3D model of the molecules they are studying. They could come up with new ideas inspired by finally seeing the previously unseen—and they could then easily share those ideas with their colleagues.
  • Test and re-test. VR technology allows trainees to test ideas as well as share them. Many Formula 1 auto racing teams use VR extensively in preparation for races, going far beyond drivers simply learning the track—after all, they already know it by heart. Instead, the teams use simulations to test different setups for their car and different race strategies.24 The aim is to prepare team members for any eventuality during the race, helping them react swiftly. This type of virtual testing represents a deeper form of learning, one in which the drivers and the teams are using VR to see into the future and discover the deeper patterns in what is likely to happen. In short, they are building expertise.

Getting started is less daunting than it may seem

Many trainers no doubt find exciting the description of VR as a new technology that can bring revolutionary benefits, though CFOs and CTOs—worried about complex technical integration, high up-front costs, and years of headlines about VR hype—may express less initial enthusiasm. The good news: Implementing VR technology may be far less daunting than it might seem. With standardized development kits, training design and technical integration have never been easier, as the costs of hardware, computing power, and storage continue to fall. As a result, many will find the cost of VR-based training applications increasingly reasonable. Especially when companies consider the increases in performance and the cost savings from time lost to longer, traditional training methods, VR can show a rapid return on investment.

With technology improving and prices dropping, the major steps to consider for creating successful VR learning resemble those typically involved in designing any good learning program:

  • Understand your training needs. Determine the type of knowledge that learners must absorb and how they must use that knowledge during the job to help understand whether VR is right for your need and how it should be used.
  • Create your business case. Quantify the expected benefit from the training in terms of increased performance, decreased errors, and productivity gains from fewer days lost to training. Array those benefits against expected costs to understand the ROI for the project.
  • Pilot the training. Start small. Begin with a pilot program to evaluate the effectiveness of the VR training and its adoption within the organization.
  • Quantify the benefit and scale the program. Use the results of the pilot program to validate initial estimates of ROI, modify the program based on what worked and what did not, and scale in scope or size of deployment.

Following these steps, companies adopting VR should get more than a shiny new technology—they can get better learning at lower cost than other options. Ultimately, the applications of VR and its ROI are limited not by dollars or technology but purely by imagination.

Medical students’ job offers withdrawn after exam ‘scoring errors’.

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Junior doctor

Thousands of students are left in dark after mistake, which may leave hospitals needing extra cover this summer

Thousands of final year medical students have been left in the dark after their first hospital job offers were withdrawn because of “scoring errors” in a critical final year exam.

A day after 7,200 students were, in effect, given their initial jobs as junior doctors, the examining body was forced to contact them – nearly every student in that year – to rescind the offers because of apparent marking mistakes.

The position of hundreds of these students could now change, leaving almost the entire batch of medical students with an anxious week before the examining body goes through all the papers again.

Students contacted the Guardian to express alarm that with just two weeks before their final written exams take place many were in limbo – unsure in which city they would be living from the summer.

One final year student in Wales summed up the mood saying: “I had many hours of lost sleep and anxiety waiting for the announcement on Monday and then found out I had been placed in my first choice location only to be told 36 hours later that that may not be the case … Revising for finals is stressful enough without any added misery!”

There is speculation that the errors were caused by ink-stained photocopied sheets that could not be read by the automated marking system. The examining body, the UK Foundation Programme Office (UKFPO), says it will resort to manual marking of an estimated 1,200 papers and clear the backlog within seven days.

There is some concern that hospitals will need to provide extra cover in the summer if medical students they thought would arrive are instead sent elsewhere. New medical graduates could miss the August start date as they wait for criminal record and other employer checks that cannot be carried out until a final-year student has been placed. These checks can take up to eight weeks.

Unions representing doctors said “mistakes needed to be corrected urgently”. The co-chairs of the BMA medical students committee, Alice Rutter and Will Seligman, and the chair of the BMA junior doctors committee, Ben Molyneux, said they would express their anger at the “unacceptable situation” in a joint letter to UKFPO.

Rutter said: “Students who initially will have been delighted to receive their foundation school allocation may now be concerned that their job could be at risk. This is completely unacceptable. We view this problem very seriously indeed and will be taking action to ensure students who are affected are kept updated and supported.”

The Department of Health said that this error “should not have happened” and said that the examining body was “working urgently to resolve this”.

The BMA said it expected to be kept fully informed of what steps the UKFPO and the Medical Schools Council, which discovered the error, were taking.

The union said there were already concerns with the system as almost 300 medical students had been placed on a reserve list “because of a third year of oversubscription”. Critics say that medics failed to get jobs because of NHS cuts.

The examining body has admitted it has had problems with the “computerised scoring of the new SJT (situational judgment test)”. The test, a multiple-choice exam, is a key factor in getting a good first job – the higher the score, the more chance medical students have of securing their first-choice foundation school.

In fact the test was only introduced this year with students sitting the exam in December and January – and represents say students 50% of the marks required for the their first job. The SJT was dubbed a “personality rest” which required candidates to read through clinical scenarios and rank a set of given actions in order of preference. The BMA has called for a telephone helpline for affected students, and for a clear timetable for new offers to be made, supported by regular emails and updates on the UKFPO website.

The UKFPO, which only this week in the British Medical Journal had proclaimed its new test “a success”, attempted to temper criticism with a promise that it would fix the error quickly.

Case studies

Lyndon James, a final-year medical student at UCL, described it as “an appalling affair”. He wrote: “Along with many of my colleagues, I simply cannot understand why this wasn’t discovered in the six weeks between the exam date and the release of results. What’s worse, the email we received informing us of the debacle did not even contain an apology.

“It’s an eagerly awaited result because it gives us the rough geographical area we will be working in for the next two years. This is a huge consideration for important life decisions. I know of people whose partners were putting in offers for properties on the day of the results, and I have even heard that some partners of our prospective junior doctors were planning to quit their jobs to move to where the applicants had been placed. With so many knock-on effects, this really is a shambles. Why, oh why wasn’t it dealt with weeks ago?!”

Chris, a final-year medical student in Sheffield, said: ” I don’t think they realise the rebound effect this error will have – people have bought train tickets for welcome days, people’s partners have accepted jobs or further training places as a result of this decision.”

Matthew, a former student at Newcastle university, said: “Having been separated by 350 miles a year ago due to a similarly farcical situation, my girlfriend and I were overjoyed on Monday that we would finally be living together again as she received confirmation that she would be working in London. A day later, and we’re back in emotional limbo. Medical students are treated as anonymous cogs in an uncaring machine. Absolutely disgusting.”

A student in Hull said: “The additional failings of this week reinforce the widely-held opinion that the system is still unfair and does not judge students on merit. It seems like the UKFPO have been unwilling to carry out the necessary checks, for reasons they are yet to provide.

“The latest letter released by the BMA indicates that these issues were known about as early as last week, yet they still ran the allocation algorithm and allowed students to begin making financial commitments on the basis of these allocations, before taking FPAS offline. I had ranked all of my jobs on the first day. This takes a considerable amount of time if you have to rank every job from 1-500+ in order of preference and is not ideal when we are supposed to be revising for exams. This is particularly the case when some students will change areas as a result of any re-run decision.”

Another student said: “The UKFPO has been to the medical schools and asked if they can return all students SJTs back to their unis for them to manually remark them. Being such a huge task and with many of them running finals exams, most medical schools have refused. This now means that the UKFPO is unlikely to even make the second deadline it gave us. The number of affected papers is believed to be around 1250, or 1 in 6, leaked by various foundation programme staff around the country.”

In Warwick, one student said: “I was really happy to get my first choice on Monday. It meant my partner could hand in his notice and accept a job offer he had already been given in the area, which he did on Tuesday morning. Now we don’t know where in the country we will end up, or if he will have to ask for his job back after handing in his notice!! I’m mostly angry about the way they have handled it; mistakes happen but telling us at 6pm by email without telling our medical schools what was going on is unacceptable.”

Source: guardian.co.uk

Diagnostic Radiologist Carol Lee Discusses What Women Should Know about Breast Density.

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breast-imaging

 

A new law requires radiologists to inform women if dense breast tissue is found on a mammogram.

To help improve breast cancer detection and prevention, New York Governor Andrew Cuomo recently signed legislation that requires radiologists to inform women if dense breast tissue is found on a mammogram. The law, which went into effect this month, is raising awareness among women about this topic.

In an interview, we discussed the concept of breast density with diagnostic radiologist Carol H. Lee. Dr. Lee suggests that if you find out you have dense breasts, you should discuss potential next steps with your doctor. Each individual woman’s risk for breast cancer is different, and many factors – such as family history and lifestyle – must be taken into account when determining whether additional forms of breast cancer screening are necessary.

What are dense breasts?

Breasts are made up of different types of tissue: fatty, fibrous, and glandular. Fibrous and glandular tissues appear as white on a mammogram and fatty tissue shows up as dark. If most of the tissue on a mammogram is fibrous and/or glandular, the breasts are considered to be dense.

Because cancer cells also appear as white on a mammogram, it may be harder to identify the disease on a mammogram in women with dense breasts.

How common are dense breasts?

Breast density is classified into one of four categories, ranging from almost entirely fatty (level 1) to extremely dense (level 4). Dense breasts are completely normal. About half of all women have breasts that fall into the dense category (levels 3 and 4). Dense breasts tend to be more common in younger women and in women with smaller breasts, but anyone – regardless of age or breast size – can have dense breasts.

How does a woman know she has dense breasts?

The only way to determine whether a woman has dense breasts is with a mammogram. A breast exam cannot reliably tell whether a breast is dense.

What does having dense breasts do to a woman’s risk for breast cancer?

If you compare the 10 percent of women who have extremely dense breasts with the 10 percent of women who have very little breast density, the risk for breast cancer is higher in those with very dense breasts.

However, most women fall somewhere in between in terms of breast density, so it’s nearly impossible to determine whether a particular woman’s breast density is a risk factor for the disease.

What should women who are told they have dense breasts do?

Women found to have dense breasts should talk to their doctors about their individual risk for breast cancer and together decide whether additional screening makes sense.

Tests such as ultrasound or MRI can pick up some cancers that may be missed on a mammogram, but these methods also have disadvantages. Because they are highly sensitive, they may give a false-positive reading, resulting in the need for additional testing or biopsy that turns out to be unnecessary. There is also no evidence to show that using screening tests other than mammography in women with dense breasts decreases the risk of death from breast cancer.

Ultimately, women who have dense breasts should weigh the pros and cons of additional screening with their doctor.

Should women who do not have dense breasts make any changes to their regular screenings?

Women who do not have dense breasts may still develop breast cancer, and should continue to receive regular mammograms. Regular mammography is the only screening method that has been shown to decrease deaths from breast cancer, and all women of appropriate age should have mammograms, regardless of their breast density.

Memorial Sloan-Kettering provides comprehensive, individualized breast cancer screening services that include mammography, ultrasound, and MRI, through our Breast Screening Program, located in Manhattan.

source: MSKCC

 

Blood Test Could Predict Which Patients with Pancreatic Cancer May Benefit from Chemotherapy.

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Pancreatic cancer is one of the most difficult cancers to treat. Because the disease does not cause symptoms in its early stages, pancreatic cancer is usually diagnosed only after it has spread to other parts of the body.

Though progress against pancreatic cancer has been slow, new combinations of chemotherapy drugs have helped to slow the advancement of the disease and extend patients’ lives. However, as the number of effective treatments for pancreatic cancer increases, new challenges emerge as physicians are left guessing which combination of drugs will benefit an individual patient.

Research led by medical oncologist Kenneth H. Yu, presented on January 25 at the American Society of Clinical Oncology’s annual Gastrointestinal Cancers Symposium, suggests that a simple blood test may be able to predict which chemotherapy regimen will work for some patients with pancreatic cancer.

Predicting Sensitivity to Chemotherapy

Dr. Yu and colleagues observed patients who had received one of 12 different chemotherapy combinations as directed by their doctor. They used a new test developed by CellPath Therapeutics that analyzes specific genetic changes found in circulating tumor cells (CTCs) – cells that have broken away from a patient’s primary tumor and entered the bloodstream.

The results of the test predicted how effective a chemotherapy regimen would be. Blood samples for testing were taken before chemotherapy treatments started and again when the cancer progressed.

In this observational study, researchers found that patients on a chemotherapy regimen predicted by the test to be highly effective did not experience cancer progression until they were about seven and a half months into treatment. When the test predicted the chemotherapy would be less effective, patients had progression of their cancer in an average of less than four months.

They also found that when samples were tested later in the treatment process, the specific genetic changes found in patients’ CTCs had shifted, suggesting that this tool can be used throughout the course of therapy to predict when treatment should be altered.

A Step toward Personalized Medicine

Dr. Yu says that the research is encouraging because it “offers a new strategy to personalize cancer therapy. The ability to less invasively predict which patients will respond to treatment as well as provide a signal when treatment resistance occurs is extremely valuable.”

Source:MSKCC.

Also read URL: http://consumer.healthday.com/Article.asp?AID=672734

Physicians Pioneer Less Invasive Approach for Treating Spine Tumors.

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cordtum1When cancer metastasizes, or spreads, to a patient’s spine from another part of the body, it can compress the spinal cord, causing pain and movement difficulties. Until recently, the only way to relieve these symptoms and keep the tumor from growing back was to surgically remove the entire tumor.

This major operation pushed back the timing of treatments – such as chemotherapy – for the patient’s primary cancer while the patient recovered from surgery. What’s more, the benefit was often fleeting; in approximately 70 percent of patients, the spinal tumor returned within a year.

Now physicians in Memorial Sloan-Kettering’s Spine Tumor Center have shown that metastatic spine tumors compressing the spinal cord can be controlled quite effectively using a less invasive operation known as separation surgery combined with an intense form of radiation therapy called stereotactic radiosurgery. A new study, published online January 22 in the Journal of Neurosurgery: Spine, reports that this dual approach can reduce spine tumor recurrence from 70 percent to less than 10 percent.

“The impact on spine tumor control and the improved quality of life for this group of patients has been nothing short of miraculous,” says neurosurgeon Mark Bilsky, director of the Spine Tumor Center and senior author of the study. “These patients now avoid a major operation, and most importantly, their tumors don’t return.”

A New Standard Treatment

Over the past decade, stereotactic radiosurgery has revolutionized the management of metastatic spine tumors. Using this approach, radiation oncologists receive guidance from advanced imaging technology to deploy precise, intense radiation using multiple beams that converge on the tumor. This restricts the radiation to the tumor target without harming the spinal cord. In 90 percent of patients with spine tumors, stereotactic radiosurgery alone is sufficient to destroy the tumor.

In patients with spinal cord compression, however, there is too much risk of the radiation damaging the spinal cord, so the standard treatment had been to remove the entire tumor. This extensive operation meant that virtually all patients needed a blood transfusion and five to seven days of recovery time in the hospital — effects that delayed the resumption of treatment for the primary cancer.

About ten years ago, experts in Memorial Sloan-Kettering’s Spine Tumor Center began investigating whether a less aggressive surgical procedure could be more effective if followed with stereotactic radiosurgery. Rather than removing the entire tumor, in this approach the surgeon performs separation surgery, which involves creating a small space (2 to 3 millimeters) between the tumor and spinal cord to relieve pressure, and then stabilizing the spine with specialized bone screws.

This gap allows the tumor to be treated safely with intense radiation. Patients undergoing this less invasive procedure need fewer days to recover in the hospital, and many do not require a blood transfusion.

Advancing Care through Collaboration

Dr. Bilsky, in collaboration with radiation oncologist Josh Yamada and colleagues, report that a retrospective analysis of 186 patients shows that combining separation surgery and stereotactic radiosurgery controlled more than 90 percent of metastatic spine tumors at one-year follow-up. The control was evident regardless of where the cancer originated — for example, the kidney, the lungs, or the colon – and further analysis suggests that the control persists throughout the person’s lifetime.

“This represents a new paradigm in spine tumor treatment,” Dr. Yamada says. “Patients are receiving less-extensive surgery so we can get them back to systemic therapy much more quickly, and the tumor control is lasting. A success rate increasing from 30 percent to more than 90 percent is striking. Our medical oncologists know that once their patients go through this treatment, they usually do not have to worry about another spine tumor interrupting their care.”

The Spine Tumor Center now uses this technique on about 120 metastatic spine tumor patients a year. Drs. Bilsky and Yamada emphasize that this advance in treatment was made possible by Memorial Sloan-Kettering’s collaborative approach, especially the close interaction among neurosurgeons and radiation oncologists.

“The interplay of the two disciplines has been critical,” Dr. Bilsky says. “Sitting down together every day to discuss treatment plans for patients allows us to develop a deep trust for one another’s judgment and a willingness to recognize how a patient will best be served.”

Source: MSKCC

Drug Reverses Radioiodine Resistance in Some People with Advanced Thyroid Cancer.

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Many patients with advanced thyroid cancer have tumors that are difficult to treat because they are unable to absorb radioactive iodine, or radioiodine, the most effective therapy for the disease. Recent findings from Memorial Sloan-Kettering researchers, published in the February 14 issue of the New England Journal of Medicine, may indicate a new treatment strategy for these patients.

The phase II clinical trial found that selumetinib, an investigational drug that works by inhibiting a protein pathway called MAPK in tumor cells, reverses radioiodine resistance in some patients with advanced thyroid cancer.

“Blocking this key pathway increased the uptake of iodine, making radioiodine therapy potentially effective for patients who had a resistance,” says James A. Fagin, Chief of Memorial Sloan-Kettering’s Endocrinology Service and senior author of the study. Dr. Fagin pioneered this research in cells and in mice.

Testing Selumetinib’s Potential

Therapeutic radioiodine is often given to patients with thyroid cancer after surgery to destroy any remaining cancer cells or thyroid tissue. Taken orally, usually only one or two doses of radioiodine are needed to treat a patient.

This therapy has been shown to increase survival in some patients with certain thyroid cancers that have spread to other parts of the body. Resistance to radioiodine can have an impact on a patient’s course of treatment.

Memorial Sloan-Kettering researchers had previously demonstrated in cells and in mice that the MAPK pathway controls a cell’s ability to absorb radioiodine. As a result of this work, Dr. Fagin and his colleagues examined whether selumetinib, an MAPK pathway inhibitor, could reverse a patient’s resistance to radioiodine by inhibiting the signaling of particular genetic mutations in this pathway.

In the study, 20 patients with tumors resistant to radioiodine were given two doses of selumetinib every day for four weeks. To determine whether selumetinib reversed their tumors’ inability to retain radioiodine, researchers administered a form of iodine that, when absorbed, makes tumors visible on a PET scan. This diagnostic form of iodine has much less radiation than that of therapeutic radioiodine.

While most of the patients’ tumors were able to retain at least some of this diagnostic form of iodine, only eight patients absorbed a large enough amount to be eligible for radioiodine therapy. These eight patients, including all five of the patients with a mutation in a gene known as NRAS, were then given the therapeutic radioiodine.

During six months of follow-up, seven of the eight patients experienced either tumor shrinkage or a stop in tumor growth. All eight had a decreased level of serum thyroglobulin – a protein in the blood used to screen for advanced thyroid cancer – and none experienced serious side effects from selumetinib.

Determining the Benefit for Other Types of Advanced Thyroid Cancer

One advantage of selumetinib is that only a few weeks of therapy are required to improve a patient’s ability to absorb radioiodine.

“The initial results show promise for patients with a mutation in the RAS family of genes, particularly the NRAS gene, but the hope is that a larger clinical trial will shed light on whether selumetinib can be effective for people with other types of advanced thyroid cancer,” Dr. Fagin says.

Memorial Sloan-Kettering will lead the international, multicenter phase III clinical trial of selumetinib, which will begin in mid-2013. The trial, which will be sponsored by AstraZeneca, will enroll patients who have recently had their thyroid gland removed – a procedure known as total thyroidectomy – due to thyroid cancer that has spread to nearby tissue or lymph nodes.

This study was supported by grants from the American Thyroid Association, The Society of Memorial Sloan-Kettering Cancer Center, the National Institutes of Health (under award numbers CA50706 and CA72598), AstraZeneca, and Genzyme.

Source: MSKCC

Researchers Identify Key Element of Nerve Cell Development.

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Memorial Sloan-Kettering researchers have shed light on the process by which developing nerve cells, or neurons, are directed to split into two distinct parts — a long, slender axon that conducts electrical impulses away from a cell, and shorter dendrites that receive signals from other cells and conduct them into the cell body.

Investigators in the laboratory of developmental neurobiologist Songhai Shi gained an important insight into how a protein called mPar3 guides this asymmetrical formation of a neuron, known as neuronal polarization. Axon/dendrite polarity is essential for the one-directional flow of information in the nervous system.

The mPar3 protein was found to regulate microtubules — microscopic, threadlike structures inside cells that help them maintain shape and movement. Although it was already known that mPar3 plays a key role in neuronal polarization, the discovery that the protein directs this process through microtubule regulation was unexpected.

“This is the first time that mPar3 has been linked to microtubules and this relationship has been shown to be critical to proper development of a nerve cell,” says Dr. Shi, the senior author.

The study, reported in the January 14 issue of Developmental Cell, was led by She Chen, who recently completed a fellowship in Dr. Shi’s laboratory.

Unbalanced Activity

mPar3 is the mammalian form of the Par3 protein, which has long been recognized as an important factor in cell polarity from studies in a variety of animals, including worms, fruit flies, and mice. Earlier research performed in mice by Dr. Shi and others found that during embryonic development mPar3 accumulates in the part of the neuron destined to become an axon, suggesting that the protein spurs axon growth and neuron polarization. But it was unclear how mPar3 produces this outcome.

In the latest study, the researchers analyzed embryonic mouse brain cells in culture and found that mPar3 guides polarization by selectively binding to, bundling, and stabilizing microtubules in particular parts of the neuron at specific times. Increased microtubule stabilization at one site, such as the region that gives rise to the axon, allows that part of the cell to grow faster than other regions.

When mPar3’s regulation of microtubules is disrupted, the neuron cannot correctly differentiate into axon and dendrites. The researchers demonstrated this by blocking and boosting mPar3 function, which in both cases resulted in improperly developed neurons.

Polarization of Human Cells

Dr. Shi says that his lab’s discoveries could have broad implications beyond the development of neurons.

“Both mPar3and microtubules have been conserved by evolution across many species, so this relationship is likely to hold true for polarization in other cell types, including human cells,” he explains.

Source: MSKCC

Vivid Snake Photos Come at a Cost — A Bite From a Black Mamba.

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Mark Laita is not a snake owner or enthusiast but his admiration of snakes’ textures and formal qualities rivals that of any herpetologist. It’s an admiration that is on display in his new book, Serpentine, out next week. The book is a collection of gorgeously lit snakes against a black backdrop.

“My intention was to explore color, shape and movement, using snakes as a subject, but of course herpetologists will probably enjoy these photographs as well,” says Laita, a Los Angeles photographer known for his stunning studio compositions.

During the making of Serpentine, Laita visited dozens of locations in the U.S. and Central America essentially exporting his studio to zoos, venom labs and to the home and workplaces of breeders and collectors.

“I shot everything from the most venomous — an Inland Taipan — to a harmless garter snake,” says Laita. “As for the most dangerous, though, I would think a king cobra is the most capable of doing serious harm to a human. Very big, fast and angry.”

The king cobra is the world’s longest venomous snake and chiefly feeds on other snakes. Despite relying on the help of trained snake handlers, Laita didn’t complete Serpentine unscathed.

“I was bitten a few times by non-venomous species,” chirps Laita. “I had one venomous bite, but I’m still around.”

Source: http://www.wired.com

Challenge the Establishment — Dispelling Five Common Health and Fitness Misconceptions .

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In life we take many things for granted. People are told to go on a low fat diet and do some aerobic training, and yet they still gain body fat. Your blood work shows slightly altered cholesterol and thyroid levels and right away you’re told to go on medication. The trainer at your local gym rips out a copy of Everyday Stretches (reproduced from a 1987 poster) and says: “Do this before your next workout.”

If you’ve been spinning your wheels and going nowhere in your pursuit for optimal health and fitness, then stop! Doing something simply because you’ve been told to is not good enough.

It’s time to question authority and challenge the establishment!

Five Common Health and Fitness Misconceptions

Let’s start by dispelling five common health and fitness misconceptions. Dare I suggest that…

1.      A high fat intake can actually lower body fat!

Two reasons: a) If low fat is consumed, your body retains body fat as a protective/survival mechanism, and b) a high fat intake upregulates key (lipase) enzymes, which not only break down dietary fat but also body fat.

Of course, a high fat and high carb diet will result in body fat accumulation so this only applies to a low carbohydrate intake.

“The lipase enzyme is a naturally occurring enzyme found in the stomach and pancreatic juice, which is also found within fats in the foods you eat.

Lipase enzyme digests fats and lipids, helping to maintain correct gall bladder function. As such, these constitute any of the fat-splitting or lipolytic enzymes, all of which cleave a fatty acid residue from the glycerol residue in a neutral fat or a phospholipid. The lipase enzyme controls the amount of fat being synthesized and that which is burned in the body, reducing adipose tissue (fat stores).

The lipase enzyme belongs to the esterases family of proteins. The lipase enzyme is found widely distributed in the plant world (beans and legumes), as well as in molds, bacteria, milk and milk products, and in animal tissues, especially in the pancreas.

In sufficient quantities of lipase enzyme production, lipase can help use fat-stores to be burned as fuel. Indeed, lipase is a rate-determining enzyme, which not only activates the burning of stored body fats but also effectively inhibits fatty acid synthesis, or fat storage!

Hormone-Sensitive Triacyclglycerol Lipase, as it is also known, actually stimulates lipolysis in fat tissues, safely raising blood fatty acid levels, which ultimately activates the beta-oxidation pathway in other tissues, such as liver and muscle. In the liver, lipolysis leads to the production of ketone bodies that are secreted into the bloodstream for use as an alternative fuel to glucose by peripheral tissues.”

2.      Reduced thyroid levels (i.e. TSH levels above 5) for a lean individual following a low-carb diet may be normal and healthy!

Now before you throw your chair at the computer, hear me out. As Dr. Ron Rosedale notes in the excerpt below, reduced thyroid levels are not necessarily synonymous with hypothyroidism. Your body chooses to lower thyroid hormones due to an increased efficiency of energy use and hormonal signaling. It is yet another example of how your body adapts and should not be viewed as abnormal.

The knee-jerk reaction in many cases would be thyroid medication, which could potentially decrease your lifespan.

“Metabolic rate and temperature has long been connected with longevity. Almost all mechanisms that extend lifespan in many different organisms result in lower temperature. Flowers are refrigerated at the florist to extend their lifespan. Restricting calories in animals also results in lower temperature, reduced thyroid levels, and longer life.

It should be noted that reduced thyroid levels in this case are not synonymous with hypothyroidism. Here, the body is choosing to lower thyroid hormones because the increased efficiency of energy use and hormonal signaling (including perhaps thyroid) is allowing this to happen.

Anything will dissolve faster in hot water than cold water. Extra heat will dissolve, disrupt and disorganize. This is not what I try to do to make someone healthy. It is commonly advised to increase metabolism and increase thermogenesis for health and weight loss.

Yet how many of you would put a brand of gasoline in your car that advertised that it would make your engine run hotter? What would that do to the life of your car? It is not an increase in metabolism that I am after; it is improved metabolic quality.”

3.      Low cholesterol levels will promote aging.

Cholesterol is the raw material for many hormones. If you lower your cholesterol you will also lower your hormone production … and if you lower hormone production, you increase aging! To make matters worse, low cholesterol has been associated with a broad complex of emotional, cognitive and behavioral symptoms including aggressiveness, hostility, irritability, paranoia, and severe depression.

There is also an increase in deaths from trauma, cancer, stroke, and respiratory and infectious diseases among those with low cholesterol levels.

Furthermore, a study in the British medical journal, Lancet, indicates that elderly men die earlier with low blood cholesterol levels.

“The human organism is in a state of dynamic equilibrium, know as homeostasis. One of the main roles in normal homeostasis belongs to multiple feedback loop mechanisms.

Cholesterol is the precursor or the building block for the basic hormones: pregnenolone, DHEA, progesterone, estrogen, testosterone.

Deterioration of the reproductive function, one of the most striking endocrine alterations occurring in aging, is related to a complex interplay of factors. Target organs may become less sensitive to their controlling hormone or may break them down at a slower rate. Hormone levels may change; some increasing, some decreasing and some remaining unchanged.

Many of the diseases that middle-aged persons begin experiencing including depression, abdominal weight gain, prostate, breast and heart disease, are directly related to hormone imbalances.

Conventional doctors are prescribing drugs to treat depression, elevated cholesterol, angina and other diseases that may be caused by hormone imbalance.

A few years ago we found out that some patients who had high cholesterol levels before hormonorestorative therapy (HT) were free of cholesterol problems during therapy. We started pondering as to why this had happened?

In our opinion, when the production of hormones starts to decline our body tries to correct this problem by increasing the production of cholesterol. A similar situation happens to women during pregnancy. When a female’s body needs more hormones for herself and her baby, cholesterol levels are elevated significantly. If a woman’s body is unable to increase the production of cholesterol the risk of an abortion and miscarriages is increased.

Another situation is a low level of cholesterol. If your total cholesterol is less than 160, you have nothing to worry about. Wrong opinion!

A low level of cholesterol means a low production of basic hormones (because of a limited amount of building blocks). Patients with a low level of hormones have life problems that include suicides, criminal behavior, depression, attention deficit disorder, cancer at young age, etc. Low cholesterol is a marker for poor underlying health.

When patients take cholesterol-lowering drugs (CLD) we can surmise that hormonal production will decrease. That’s why many patients on CLD have severe fatigue, fibromyalgia-like pain, depression, high risk of cancer, suicides, weight gain and impotency.

Normally our body tries to keep a normal ratio between different hormones: DHEA/cortisol, estrogen/progesterone, female/male hormones. When we have a malfunction in a feedback loop mechanism we start to have the problems related to the imbalance of hormones (for example: male or female dominance, estrogen dominance, etc.).

Once again, when the production of hormones starts to decline, our body tries to correct the deficiency of hormones by the extra production of cholesterol. It looks like the elevation of total cholesterol serves as a compensatory mechanism for hormonal deficiency.”

Source

4.      Aerobic training can increase body fat.

Specifically, long distance, low intensity, rhythmic-type aerobics done for a long duration/distance on a frequent basis can signal your body to store fat.

Your body prefers fat for fuel at lower intensities. It adapts to aerobic activity by storing fat (usually in the hips and thighs) to become more efficient for future use. The more fat you store, the more you can use.

Furthermore, aerobics are associated with increased cortisol levels without a concomitant increase in testosterone (as occurs during strength training) disrupting an optimal testosterone:cortisol ratio. In fact, average testosterone levels are significantly lower in endurance athletes. This, of course, equates to a decrease in muscle and strength along with an increase in (android) body fat, i.e., midsection fat.

5.      Static stretching will make you weak.

This has been well documented in the literature, and yet a typical warm-up usually contains some form of (you guessed it) static stretching. The classic Bob Anderson style of stretching before exercise tends to sedate muscles, and research shows that it will decrease power and strength by as much as 30 percent for up to 90 minutes. By that time, your workout is over!

Sometimes you need to take a sledgehammer and crush what’s written in stone!

We’ve been told to reduce fat in our diets, lower our cholesterol levels, improve reduced thyroid production with medication, perform aerobic training almost daily, and definitely start each workout with some static stretching.

Dare I suggest otherwise?

You better believe it!

Source: Mercola.

How Intermittent Fasting Stacks Up Among Obesity-Related Myths, Assumptions, and Evidence-Backed Facts .

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Is it a good idea to “starve” yourself just a little bit each day? The evidence suggests that yes, avoiding eating around the clock could have a very beneficial impact on your health and longevity.

What we’re talking about here is generally referred to as intermittent fasting, which involves timing your meals to allow for regular periods of fasting.

It takes about six to eight hours for your body to metabolize your glycogen stores and after that you start to shift to burning fat. However, if you are replenishing your glycogen by eating every eight hours (or sooner), you make it far more difficult for your body to use your fat stores as fuel.

It’s long been known that restricting calories in certain animals can increase their lifespan by as much as 50 percent, but more recent research suggests that sudden and intermittent calorie restriction appears to provide the same health benefits as constant calorie restriction, which may be helpful for those who cannot successfully reduce their everyday calorie intake (or aren’t willing to).

Unfortunately, hunger is a basic human drive that can’t be easily suppressed, so anyone attempting to implement serious calorie restriction is virtually guaranteed to fail. Fortunately you don’t have to deprive yourself as virtually all of the benefits from calorie restriction can be achieved through properly applied intermittent fasting.

Three Major Mechanisms by which Fasting Benefits Your Health

While fasting has long gotten a bum rap for being one of the more torturous ways to battle the bulge, it really doesn’t have to be an arduous affair. We’re NOT talking about starving yourself for days on end. Simply restricting your daily eating to a narrower window of time of say 6-8 hours, you can reap the benefits without the suffering. This equates to 16-18 hours worth of fasting each and every day — enough to get your body to shift into fat-burning mode.

Many studies have evaluated daily intermittent fasting, and the results are compellingly positive. Three major mechanisms by which fasting benefits your body, as it extends lifespan and protects against disease, include:

  1. Increased insulin sensitivity and mitochondrial energy efficiency – Fasting increases insulin sensitivity along with mitochondrial energy efficiency, and thereby retards aging and disease, which are typically associated with loss of insulin sensitivity and declined mitochondrial energy.
  2. Reduced oxidative stress – Fasting decreases the accumulation of oxidative radicals in the cell, and thereby prevents oxidative damage to cellular proteins, lipids, and nucleic acids associated with aging and disease.
  3. Increased capacity to resist stress, disease and aging – Fasting induces a cellular stress response (similar to that induced by exercise) in which cells up-regulate the expression of genes that increase the capacity to cope with stress and resist disease and aging.

Is Daily Fasting the Key to Permanent Weight Loss?

As reported by George Dvorsky1 in a recent article, one of the most important studies in support of daily intermittent fasting was published just last year by biologist Satchidananda Panda and colleagues at Salk’s Regulatory Biology Laboratory. They fed mice a high-fat, high-calorie diet but altered when they were able to eat.

One group had access to food both day and night, while the other group had access to food for only eight hours at night (the most active period for mice). In human terms, this would mean eating only for 8 hours during the day. Despite consuming the same amount of calories, mice that had access to food for only eight hours stayed lean and did not develop health problems like high blood sugar or chronic inflammation2. They even had improved endurance motor coordination on the exercise wheel. The all-day access group, on the other hand, became obese and were plagued with health problems including:

  • High cholesterol
  • High blood sugar
  • Fatty liver disease
  • Metabolic problems

This suggests that your body may benefit from the break it receives while fasting, whereas constant eating may lead to metabolic exhaustion and health consequences like weight gain. Researchers said their latest work shows it’s possible to stave off metabolic disease by simply restricting when you eat with periodic fasting, or even by just keeping to regular meal schedules rather than “grazing” off and on all day. They concluded:

“[Time-restricted feeding] is a nonpharmacological strategy against obesity and associated diseases.”

What the Research Says about Intermittent Fasting

Dvorsky highlights other research into fasting that point to similar conclusions, such as:

  • Research by Valter Longo3 at the University of Southern California’s Longevity Institute shows that intermittent fasting has a beneficial impact on IGF-1, an insulin-like growth factor that plays a role in aging. When you eat, this hormone drives your cells to reproduce, and while this is good for growth, it’s also a factor that drives the aging process. Intermittent fasting decreases the expression of IGF-1, and switches on other DNA repair genes. In this way, intermittent fasting switches your body from “growth mode” to “repair mode.”
  • Krista Varady with the University of Illinois has been researching the impact of fasting on chronic diseases like cardiovascular disease, type 2 diabetes, and cancer. Her work also compares the effects of intermittent fasting with caloric restriction, which is known to benefit health and longevity. Animal studies using alternate-day fasting4 have shown it lowers the risk of diabetes, at rates comparable to caloric restriction. Alternate-day fasting has also been shown to reduce cancer rates by reducing cell proliferation.
  • Research by Mark Hartman and colleagues5 indicates short-term fasting can trigger production of human growth hormone (HGH) in men, and reduce oxidative stress that contributes to disease and aging; benefits brain health, mental well-being, and clarity of thought

Review Debunks Myths about Weight Loss, Obesity

Intermittent fasting is one of the latest weight management strategies to get a lot of press. Meanwhile, other weight loss myths are being debunked. Dr. David B. Allison, director of the Nutrition Obesity Research Center at the University of Alabama, and colleagues recently published a paper on Myths, Presumptions, and Facts about Obesity6, stating:

“Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.”

The team identified:

  • Seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. These include:
    • Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.
    • Set a realistic goal to lose a modest amount.
    • People who are too ambitious will get frustrated and give up.
    • You have to be mentally ready to diet or you will never succeed.
    • Slow and steady is the way to lose. If you lose weight too fast, you will lose less in the long run.
  • Six presumptions that have yet to be proven true or false about the effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment, such as:
    • Diet and exercise habits in childhood set the stage for the rest of life.
    • Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
    • Yo-yo diets lead to increased death rates.
    • People who snack gain weight and get fat.
    • If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.
  • Nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations, including:
    • Heredity is important but is not destiny.
    • Exercise helps with weight maintenance.
    • Weight loss is greater with programs that provide meals.
    • Some prescription drugs help with weight loss and maintenance.
    • Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate

What I feel is missing here is the focus on an all-around healthy lifestyle pattern. Can you lose weight on prescription drugs? Yes. Does the research support this as “fact”? Yes. But this does NOT automatically mean that recommending diet drugs is good public health policy! Will diet drugs have a beneficial impact on your health in the long run? Do potential side effects of the drugs outweigh the benefit of losing weight?

Ditto for bariatric surgery. Does it lead to weight loss? Yes! But the side effects can be severe, including death, and several studies have shown the long-term outcome in terms of overall health is not that great…

Some of the items listed as myths and presumptions are simply common-sense guidelines and “helpful tips” that can help you maintain a healthier lifestyle, which will inevitably form the foundation of good health. So I would advise you to differentiate between “established scientific fact” (such as: weight loss surgery leads to weight loss) and what amounts to holistic healthy lifestyle guidelines, as the two are not necessarily interchangeable.

If your goal is to promote health, then supporting the addition of bike paths in your communities is not a crazy idea at all. In fact, some of these myths and presumptions are sort of silly, as when you talk about things like “can adding jogging trails and parks promote healthier weight?” You also have to consider the fact that there is social conditioning at work, and people have to start to rethink how they live their daily lives in order to see a change. This can take time. Having a public policy that tells you to get bariatric surgery instead of going for a walk every day is nothing short of crazy if you really think about it…

Clinical Trial to Be Conducted to Test Whether Skipping Breakfast Leads to Weight Loss

According to the New York Times7:

“… people often rely on weak studies that get repeated ad infinitum. It is commonly thought, for example, that people who eat breakfast are thinner. But that notion is based on studies of people who happened to eat breakfast. Researchers then asked if they were fatter or thinner than people who happened not to eat breakfast — and found an association between eating breakfast and being thinner. But such studies can be misleading because the two groups might be different in other ways that cause the breakfast eaters to be thinner. But no one has randomly assigned people to eat breakfast or not, which could cinch the argument.

… The question is: ‘Is it a causal association?’ To get the answer, he added, ‘Do the clinical trial.’

He decided to do it himself, with university research funds. A few hundred people will be recruited and will be randomly assigned to one of three groups. Some will be told to eat breakfast every day, others to skip breakfast, and the third group will be given vague advice about whether to eat it or not.”

Is Intermittent Fasting Right for You?

If you’re already off to a good start on a healthy diet and fitness plan, then intermittent fasting might be just the thing to bring you to the next level. However, you need to pay careful attention to your body, your energy levels, and how it makes you feel in general.

Please keep in mind that proper nutrition becomes even MORE important when fasting, so addressing your diet really should be your first step. Common sense will tell you that fasting combined with a denatured, highly processed, toxin-rich diet is likely to do more harm than good, as you’re not giving your body proper fuel to thrive when you DO eat.

If you’re hypoglycemic, diabetic, or pregnant (and/or breastfeeding), you are better off avoiding any type of fasting or timed meal schedule until you’ve normalized your blood glucose and insulin levels, or weaned the baby. Others categories of people that would be best served to avoid fasting include those living with chronic stress, and those with cortisol dysregulation.

Signs and Symptoms of Hypoglycemia

Hypoglycemia is a condition characterized by an abnormally low level of blood sugar. It’s commonly associated with diabetes, but you can be hypoglycemic even if you’re not diabetic. Common symptoms of a hypoglycemic crash include:

  • Headache
  • Weakness
  • Tremors
  • Irritability
  • Hunger

As your blood glucose levels continue to plummet, more severe symptoms can set in, such as:

  • Confusion and/or abnormal behavior
  • Visual disturbances, such as double vision and blurred vision
  • Seizures
  • Loss of consciousness

One of the keys to eliminating hypoglycemia is to eliminate sugars, especially fructose from your diet. It will also be helpful to eliminate grains, and replace them with higher amounts of quality proteins and healthful fats. However it will take some time for your blood sugar to normalize. You’ll want to pay careful attention to hypoglycemic signs and symptoms, and if you suspect that you’re crashing, make sure to eat something.The ideal food would be coconut oil as it will not worsen your insulin levels and is metabolized relatively quickly for energy. You can try some coconut candy, for example. Ideally, you should avoid fasting if you’re hypoglycemic, and work on your overall diet to normalize your blood sugar levels first. Then try out one of the less rigid versions of fasting and work your way up.

Fasting While Pregnant is Not a Good Idea…

As for pregnant and/or lactating women, I don’t think fasting would be a wise choice. Your baby needs plenty of nutrients, during and after birth, and there’s no research supporting fasting during this important time. On the contrary, some studies8 suggest it might be contraindicated, as it can alter fetal breathing patterns, heartbeat, and increase gestational diabetes. It may even induce premature labor.  I don’t think it’s worth the risk.

Instead, my recommendation would be to really focus on improving your nutrition during this crucial time. A diet with plenty of raw organic, biodynamic foods, and foods high in healthful fats, coupled with high quality proteins will give your baby a head start on good health. You’ll also want to be sure to include plenty of cultured and fermented foods to optimize your — and consequently your baby’s — gut flora. For more information, please see this previous article that includes specific dietary recommendations for a healthy pregnancy, as well as my interview with Dr. Natasha Campbell-McBride.

Finding a Lifestyle Plan that Works for You Requires Trial and Error

While intermittent fasting can provide valuable health benefits, remember that fasting does not mean abstaining from ALL food for extended periods of time. Rather it involves a dramatic reduction of calorie intake at regular intervals — whether you opt for a 16, 20, or 24 hour fast once or twice a week, or fasting every other day, or simply delaying certain meals, such as skipping breakfast.

Just remember, it takes about six to eight hours for your body to metabolize your glycogen stores and only after that do you start to shift to burning fat, but only if you are already adapted to burning fat by having your fat burning enzymes upregulated by the strategy discussed above, which takes anywhere from a few weeks to a few months, depending on how healthy you are.

Always listen to your body, and go slow; work your way up to 16-18 hour fasts if your normal schedule has included multiple meals a day. Also be sure to address any hypoglycemic tendencies, as it can get increasingly dangerous the longer you go without eating to level out your blood sugar.

If you have already addressed your diet, cutting out fructose and grains and replacing them with healthful fats, then intermittent fasting could further boost weight loss and provide additional health benefits. If you’re engaged in a regular fitness program and feel like you’ve hit a plateau, then working out in a fasted state might help rev things up. For more information about exercise while fasting,

Source: Mercola.