I’m in what feels like a total free fall, so here are some interesting NY Times articles to keep you entertained while I’m unable to write: The Claim: Fibromyalgia Is Affected by Weather, How Accurate Are Fitness Trackers?, Don’t Take Your Vitamins, Researchers Find Biological Evidence of Gulf War Illnesses. The latter has many quotes that we will all find familiar:
“After leaving the Army in 1992, he said his health continued to deteriorate, to the point where he could not hold jobs. Doctors gave him diagnoses of migraines, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. They gave him medications that did not seem to help and offered treatment for post-traumatic stress disorder, he said. ‘I was told I had these problems because I was depressed. And yes, I was depressed,’ Mr. Brown said. ‘But that’s part of having so many things wrong. That’s not what caused it.'”
Really? The Claim: Fibromyalgia Is Affected by Weather
By ANAHAD O’CONNOR
JUNE 10, 2013
No one really knows precisely what causes the debilitating fatigue and muscle pain of fibromyalgia. But some people who have the disorder say they know what can make it worse: changes in the weather.
Cold, damp days and drops in barometric pressure are widely associated with flare-ups in symptoms of the condition, which affects mostly women. In one study by the National Fibromyalgia Association, people with the condition ranked weather changes as one of the leading aggravating influences on pain and stiffness.
Unlike the reported connection between arthritis and changes in temperature and pressure – which has mostly been debunked – the belief that fibromyalgia symptoms fluctuate with the weather has not been the subject of thorough research. The few studies that have investigated ithave mostly found little evidence of a link.
In the latest report, published this month in the journal Arthritis Care & Research, Dutch researchers followed 333 middle-aged women who had fibromyalgia, looking for relationships between environmental conditions and their levels of pain and fatigue. Over the course of a month, the researchers monitored humidity levels, atmospheric pressure, precipitation, temperature and sunshine duration, using data from a meteorological institute.
In some cases, they did find that weather variables had “significant but small” effects on pain and fatigue. But for the most part, they concluded, there was “more evidence against than in support of a uniform influence of weather on daily pain and fatigue.”
THE BOTTOM LINE
Most studies have not found much evidence of a link between fibromyalgia symptoms and weather patterns.
How Accurate Are Fitness Trackers?
By GRETCHEN REYNOLDS
JUNE 12, 2013
Nate Meckes recognized that he needed to study the accuracy of activity monitors after wearing one. A shipment of the devices, known technically as accelerometers and designed to measure a person’s movement and energy expenditure, had arrived at Arizona State University, where Dr. Meckes was a researcher. To ensure they were operational, he slipped one over his hip and wore it throughout the day, including to an interminable meeting where he stood up and paced. “I’m not good at sitting still,” he says.
Checking his monitor afterward, though, he was flabbergasted. “It had recorded that I was not moving at all,” says Dr. Meckes, now an assistant professor at Azusa Pacific University in Azusa, Calif. The experience inspired him to set up an experiment examining how reliable such devices are.
Until recently, accelerometers, which use electronics to determine bodily movement and intensity, had been confined to research laboratories. But now, at-home users can choose from a variety of devices, sold under such brand names as Fitbit and Nike+ FuelBand. Some are worn on the hip; others on the arm or wrist. All sense movement and feed data into the device’s electronic brain, where proprietary equations determine how much energy someone is expending, meaning, in practical terms, how many calories they burn.
But by and large, users have had to take such measurements on faith. Unbiased, comparative studies of the devices haven’t been available.
Which makes Dr. Meckes’s experiment useful and timely, particularly since his results, presented last month in Indianapolis at the annual meeting of the American College of Sports Medicine, join those of a number of other new studies in raising concerns about just how well today’s activity monitors do their job.
For his experiment, Dr. Meckes gathered 16 adult volunteers and fitted each with three different monitors, two worn on the hip and one around the arm. The volunteers also donned portable masks that measure oxygen consumption, the gold standard in determining energy output.
The volunteers then threw themselves into a variety of activities in the university’s physiology lab, including walking on a treadmill, cleaning a simulated kitchen, standing up, typing at a computer and playing a board game.
All three of the devices accurately measured energy expenditure when the volunteers walked briskly, Dr. Meckes and his colleagues found; their estimates closely matched those of the oxygen-consumption monitor.
But the devices were far less reliable in tracking the energy costs of light-intensity activities like standing or cleaning, often misinterpreting them as physical immobility. Only the calorie cost of typing was overestimated, and only by the armband monitor, which considered the arm movements involved to be far more dynamic than they actually are.
These miscalculations echo those of the findings from several other new studies. One, also reported at the sports medicine meeting, involved 74 adults, young and old, who wore an armband accelerometer and a portable oxygen-consumption gauge while walking, jogging, riding a stationary bicycle, windmilling an arm ergometer, and completing so-called activities of daily living, like lifting boxes and sweeping.
Again, the accelerometer measured the more strenuous bodily movements, like jogging, fairly accurately. But it significantly underestimated subtler activities, like sweeping, and was “terrible” at measuring bicycle pedaling, which involves no arm movement, says Glenn Gaesser, the director of the Healthy Lifestyles Research Center at Arizona State University in Phoenix, who oversaw the study.
So, too, a study published last month in Medicine & Science in Sports & Exercise found that several hip-mounted accelerometers underestimated the energy involved in standing up, bicycling and walking or jogging uphill, says Ray Browning, an assistant professor of exercise science at Colorado State University in Fort Collins, who led the study.
The question, of course, is whether it matters if the devices are inaccurate, especially if they underestimate daily energy expenditure, and perhaps fiendishly spur some at-home users to move more, thinking that they’ve expended less energy than they actually have.
The studies’ researchers think the inaccuracies do matter. “There’s a growing consensus” among exercise scientists, Dr. Meckes says, “that people should spend less time in sedentary activities, like sitting,” and instead stand up, stroll or sweep more. But if people get the idea from their activity monitors that such activities don’t really count, in terms of movement and calorie expenditure, “it may be harder to get that message across,” he says.
The good news is that accelerometers are improving, Dr. Browning says. The algorithms underlying the devices’ measurements — which are developed by engineers using data from people wearing the devices — are constantly being refined. And researchers, including Dr. Browning, are exploring better monitor placement.
At Colorado State, for instance, he and his colleagues have created a prototype shoe-based accelerometer, which embeds the electronics in an insole. In his recent study, this device better captured changes in posture and foot pressure than hip-level accelerometers.
Still, the lesson at the moment for anyone who owns an accelerometer is that the device’s measurements are likely to be imperfect — which, says Dr. Gaesser, does not mean you should stash yours in a drawer. “They may not be accurate” for counting calories, he says. “But for many people, they’re inspirational, and if using one gets someone to move more, then as far as I’m concerned, it’s serving a good purpose.”
Don’t Take Your Vitamins
By PAUL A. OFFIT
June 8, 2013
PHILADELPHIA — LAST month, Katy Perry shared her secret to good health with her 37 million followers on Twitter. “I’m all about that supplement & vitamin LYFE!” the pop star wrote, posting a snapshot of herself holding up three large bags of pills. There is one disturbing fact about vitamins, however, that Katy didn’t mention.
Derived from “vita,” meaning life in Latin, vitamins are necessary to convert food into energy. When people don’t get enough vitamins, they suffer diseases like scurvy and rickets. The question isn’t whether people need vitamins. They do. The questions are how much do they need, and do they get enough in foods?
Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better. Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.
In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta carotene, both or a placebo. The study found that those who had taken beta carotene for five to eight years were more likely to die from lung cancer or heart disease.
Two years later the same journal published another study on vitamin supplements. In it, 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.
Then, in 2004, a review of 14 randomized trials for the Cochrane Database found that the supplemental vitamins A, C, E and beta carotene, and a mineral, selenium, taken to prevent intestinal cancers, actually increased mortality.
Another review, published in 2005 in the Annals of Internal Medicine, found that in 19 trials of nearly 136,000 people, supplemental vitamin E increased mortality. Also that year, a study of people with vascular disease or diabetes found that vitamin E increased the risk of heart failure. And in 2011, a study published in the Journal of the American Medical Association tied vitamin E supplements to an increased risk of prostate cancer.
Finally, last year, a Cochrane review found that “beta carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A.”
What explains this connection between supplemental vitamins and increased rates of cancer and mortality? The key word is antioxidants.
Antioxidation vs. oxidation has been billed as a contest between good and evil. It takes place in cellular organelles called mitochondria, where the body converts food to energy — a process that requires oxygen (oxidation). One consequence of oxidation is the generation of atomic scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer and heart disease.
To neutralize free radicals, the body makes antioxidants (good). Antioxidants can also be found in fruits and vegetables, specifically in selenium, beta carotene and vitamins A, C and E. Some studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious. If fruits and vegetables contain antioxidants, and people who eat fruits and vegetables are healthier, then people who take supplemental antioxidants should also be healthier. It hasn’t worked out that way.
The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders. Researchers call this the antioxidant paradox.
Because studies of large doses of supplemental antioxidants haven’t clearly supported their use, respected organizations responsible for the public’s health do not recommend them for otherwise healthy people.
So why don’t we know about this? Why haven’t Food and Drug Administration officials made sure we are aware of the dangers? The answer is, they can’t.
In December 1972, concerned that people were consuming larger and larger quantities of vitamins, the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would now have to prove that these “megavitamins” were safe before selling them. Not surprisingly, the vitamin industry saw this as a threat, and set out to destroy the bill. In the end, it did far more than that.
Industry executives recruited William Proxmire, a Democratic senator from Wisconsin, to introduce a bill preventing the F.D.A. from regulating megavitamins. On Aug. 14, 1974, the hearing began.
Speaking in support of F.D.A. regulation was Marsha Cohen, a lawyer with the Consumers Union. Setting eight cantaloupes in front of her, she said, “You would need to eat eight cantaloupes — a good source of vitamin C — to take in barely 1,000 milligrams of vitamin C. But just these two little pills, easy to swallow, contain the same amount.” She warned that if the legislation passed, “one tablet would contain as much vitamin C as all of these cantaloupes, or even twice, thrice or 20 times that amount. And there would be no protective satiety level.” Ms. Cohen was pointing out the industry’s Achilles’ heel: ingesting large quantities of vitamins is unnatural, the opposite of what manufacturers were promoting.
A little more than a month later, Mr. Proxmire’s bill passed by a vote of 81 to 10. In 1976, it became law. Decades later, Peter Barton Hutt, chief counsel to the F.D.A., wrote that “it was the most humiliating defeat” in the agency’s history.
As a result, consumers don’t know that taking megavitamins could increase their risk of cancer and heart disease and shorten their lives; they don’t know that they have been suffering too much of a good thing for too long.
Researchers Find Biological Evidence of Gulf War Illnesses
By JAMES DAO
June 14, 2013
In the two decades since the 1991 Persian Gulf war, medical researchers have struggled to explain a mysterious amalgam of problems in thousands of gulf war veterans, including joint pain, physical malaise and gastrointestinal disorders. In some medical circles, the symptoms were thought to be psychological, the result of combat stress.
But recent research is bolstering the view that the symptoms, known collectively as gulf war illness, are fundamentally biological in nature. In the latest example, researchers at Georgetown University say they have found neurological damage in gulf war veterans reporting symptoms of the disease.
Using magnetic resonance imaging to study the brains of gulf war veterans before and after exercise, the researchers discovered evidence of damage in parts of their brains associated with heart rate and pain. Such damage was not evident in the control group, which included nonveterans and healthy veterans.
Such neurological damage, the researchers theorize, caused the veterans to be more sensitive to pain, to feel easily fatigued and to experience loss of short-term “working memory,” all symptoms associated with gulf war illness.
Their study, published by the online medical journal PLoS One on Friday, does not try to explain the causes of the damage. It also found different patterns of damage in two groups of veterans, indicating that the disease — if it is indeed a single ailment — takes different paths in different people.
But the authors said the findings, along with other recent research, may offer clues in developing treatments and diagnostic tests for the illness, which currently is diagnosed through self-reported symptoms and has no definitive treatment.
Two other studies released by Georgetown this year have also pointed to neurological damage in the brains of veterans reporting symptoms of gulf war illness, including one that showed abnormalities in the nerve cells linking parts of the brain involved in processing feelings of pain and fatigue.
The research makes clear that “gulf war illness is real,” said Rakib U. Rayhan, the principal author of the new study. “There is objective evidence that something is wrong in the brains of these veterans.”
Other experts offered more tempered views, noting that most of the subjects in the Georgetown study were self-selected and that their number was relatively small: 28 veterans with symptoms and 10 participants without symptoms.
Dr. Drew A. Helmer, director of the Department of Veterans Affairs’War-Related Illness and Injury Study Center in New Jersey, called the Georgetown studies “very preliminary” but also “a very important step forward.”
But Dr. John Bailar, an emeritus professor at the University of Chicago who led a group that studied gulf war illness in 1996, said the new study did not provide enough data to determine whether the veterans’ symptoms were linked to their deployments to Kuwait, or something entirely different.
“I am not questioning whether a substantial proportion of veterans of Desert Storm have symptoms related to their service,” Dr. Bailar said in an e-mail. “I am questioning whether those symptoms have any cause other than the stress of war itself.”
Studies by the Department of Veterans Affairs have estimated that as many as 250,000 of the nearly 700,000 service members who served in the Middle East in 1990 and 1991 have reported symptoms of gulf war illness, which is also known as chronic multisymptom illness.
Gulf war illness has been the source of much frustration and dispute practically since veterans first reported symptoms in the 1990s. Many veterans say that their complaints were initially dismissed as psychological. Many also believe that their problems are the result of exposure to nerve agents, pesticides, herbicides and other chemicals, but that the government has been slow, or unwilling, to pinpoint causes.
Even some government researchers have made that case. At a Congressional hearing in March, Dr. Steven S. Coughlin, an epidemiologist who once worked for the Department of Veterans Affairs, asserted that the department had systematically played down the neurological basis of gulf war illness. At the same hearing, a member of an advisory panel to the department said the agency still seemed guided by the view that symptoms of gulf war illness were stress-induced.
“This is a throwback to early speculation from the 1990s that there was no problem, or that veterans just had random, disconnected symptoms,” testified Dr. Lea Steele, a Baylor University epidemiologist who was a member of the Research Advisory Committee on Gulf War Veterans’ Illnesses.
USA Today reported on Friday that Eric K. Shinseki, the secretary of veterans affairs, had taken steps to replace members of the advisory committee and reduce its independence. Advocates for gulf war veterans say the changes are meant to rein in a committee that has consistently been more aggressive than the department in saying that gulf war illness is a physical condition related to exposure to toxins.
In a statement, the department defended its research into gulf war illness. “V.A. is clear in its commitment to treating these health issues and does not endorse the notion some have put forward that these physical health symptoms experienced by gulf war veterans arise as a result of PTSD or other mental health issues from military service,” the statement said, referring to post-traumatic stress disorder.
Still, many veterans, like Ronald Brown, who was part of the Georgetown study, say their problems after returning from Kuwait in 1991 were not taken seriously.
An infantryman with the 82nd Airborne Division, he was at a base in southern Iraq when engineers destroyed the nearby Kamisiya ammunition depot containing nerve gas. The Pentagon has said that as many as 100,000 American troops could have been exposed to the toxic gas in that demolition.
Mr. Brown, 45, says that before the invasion, he was in top physical condition, regularly scoring high on Army physical fitness tests. But after Kamisiya was destroyed, he began experiencing headaches, nausea and shortness of breath. When he returned to the United States, he says he failed a fitness test badly. “I plain and simple couldn’t get enough air,” he said.
After leaving the Army in 1992, he said his health continued to deteriorate, to the point where he could not hold jobs. Doctors gave him diagnoses of migraines, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. They gave him medications that did not seem to help and offered treatment for post-traumatic stress disorder, he said.
“I was told I had these problems because I was depressed. And yes, I was depressed,” Mr. Brown said. “But that’s part of having so many things wrong. That’s not what caused it.”