AI is everywhere, has real advantages....BUT...is it real?

Hallucinations – it’s a technical term in the Artificial Intelligence (AI) community for “making s*** up”.  It’s a big problem in the healthcare space when you’re trying to get AI to legitimately move a process forward.  There have been studies now that show AI can be more empathic and more helpful than a doctor.  That’s great news, unless of course, you’re the doctor.  What these studies don’t share is the downside risk – what’s being made up?  It turns out that a study of the MSUQ (my term – Making S*** Up Quotient, or a percentage of material presented that’s made up) for ChatGPT was around 20%.  The more specific the “question”, the higher the percentage of MSU.  Yikes!  

AI is the future – unfortunately, it’s still in the future.  With careful consideration, AI can help now, but CAREFUL CONSIDERATION best be the guiding principle.  What does that mean?  Dr. Google still has nothing on me!

FROM JAMA NETWORK / BY ANJUN CHEN AND DRAKE O. CHEN

Accuracy of Chatbots in Citing Journal Articles

Introduction

The recently released generative pretrained transformer chatbot ChatGPT from OpenAI has shown unprecedented capabilities ranging from answering questions to composing new content. Its potential applications in health care and education are being explored and debated. Researchers and students may use it as a copilot in research. It excels at creating new content but falls short in providing scientific references. Journals such as Science have banned chatbot-generated text in their published reports. However, the accuracy of reference citing by ChatGPT is unclear; therefore, this investigation aimed to quantify ChatGTP’s citation error rate.

Methods

This study tested the value of the ChatGPT copilot in creating content for training of learning health systems (LHS).5 A large range of LHS topics were discussed with the latest GPT-4 model from OpenAI from April 20 to May 6, 2023. We used prompts for broad topics, such as LHS and data, as well as specific topics, such as building a stroke risk prediction model using the XGBoost library. Since chatbot responses depended on the prompts, we first asked questions about specific LHS topics, then requested journal articles as references. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline.

We verified each cited journal article by checking its existence in the cited journal and by searching its title using Google Scholar. The article’s title, authors, publication year, volume, issue, and pages were compared. Any article that failed this verification was considered fake. To determine a reliable error rate, over 300 article references were produced on the LHS topics. For comparison, we chatted with OpenAI’s default GPT-3.5 model for the same LHS topics. Exact 95% CIs for error rate were constructed. The error rate between the GPT-4 and GPT-3.5 models was compared using the Fisher exact test, with 2-sided P < .05 indicating statistical significance.

Results

From the default GPT-3.5 model, 162 reference journal articles were fact-checked, 159 (98.1% [95% CI, 94.7%-99.6%]) of which were verified as fake articles. From the GPT-4 model, 257 articles were fact-checked, 53 (20.6% [95% CI, 15.8%-26.1%]) of which were verified as fake articles. The error rate of reference citing for GPT-4 was significantly lower than that for GPT-3.5 (P < .001) but remains non-negligible. Narrower topics tended to have more fake articles than broader topics.

GPT-4 provided answers that could be used as supplementary materials for LHS training after fact-checking and editing. However, it failed to provide information about the latest LHS developments.

Discussion

Our findings suggest that GPT-4 can be a helpful copilot in preparing new LHS education and training materials, although it may lack the latest information. Because GPT-4 cites some fake journal articles, they must be verified manually by humans; GPT-3.5–cited references should not be used.

When asked why it returned fake references, ChatGPT explained that the training data may be unreliable, or the model may not be able to distinguish between reliable and unreliable sources. As generative chatbots are deployed as copilots in health care education and training, understanding their unique abilities (eg, the ability to answer any questions) and inherent defects (eg, the inability to fact-check responses) will help make more effective use of the new GPT technology for improving health care education and training. Additionally, potential ethical issues such as misinformation and data bias should be considered for GPT applications.

This study has some limitations, such as the chat topics not representing all subject areas. However, since the LHS topics covered many subject areas of health care, the findings should be applicable in the health care domain. Furthermore, the findings should be more applicable to deeper discussions with ChatGPT as opposed to superficial discussions.

The question is not "Am I toxic?, but rather "How Toxic am I?"

We are continually exposed to toxic agents (known technically as toxicants).  These toxicants throughout our history on this planet were essentially natural and our bodies evolved to rid our systems of them, as would be appropriate, according to their toxic levels.  Of course, over the last 100 years or so, technology has allowed mankind to create chemicals that never existed before.  Many of these substances will not reliably leave our bodies without help, causing increasing damage, such as cancer and chronic disease.  Some report that about 10 million chemicals have been created, virtually none have be tested for safety.  (My favorite government certification is GRAS – “generally regarded as safe”, which you can read as “seems okay, we don’t need to test it”). This article is the latest in seriously scary stuff that has been approved as “safe”, or maybe safe enough?  UGH.

FROM THE GUARDIAN & PRO-PUBLICA / BY SHARON LERNER

EPA approved fuel ingredient with sky-high lifetime cancer risk, document reveals

Chevron component approved even though it could cause cancer in virtually every person exposed over a lifetime

The Environmental Protection Agency approved a component of boat fuel made from discarded plastic that the agency’s own risk formula determined was so hazardous, everyone exposed to the substance continually over a lifetime would be expected to develop cancer.

Current and former EPA scientists said that threat level is unheard of. It is a million times higher than what the agency usually considers acceptable for new chemicals and six times worse than the risk of lung cancer from a lifetime of smoking.

Federal law requires the EPA to conduct safety reviews before allowing new chemical products on to the market. If the agency finds that a substance causes unreasonable risk to health or the environment, the EPA is not allowed to approve it without first finding ways to reduce that risk.

But the agency did not do that in this case. Instead, the EPA decided its scientists were overstating the risks and gave Chevron the go-ahead to make the new boat fuel ingredient at its refinery in Pascagoula, Mississippi. Though the substance can poison air and contaminate water, EPA officials mandated no remedies other than requiring workers to wear gloves, records show.

ProPublica and the Guardian in February reported on the risks of other new plastic-based Chevron fuels that were also approved under an EPA program that the agency had touted as a “climate-friendly” way to boost alternatives to petroleum-based fuels. That story was based on an EPA consent order, a legally binding document the agency issues to address risks to health or the environment. In the Chevron consent order, the highest noted risk came from a jet fuel that was expected to create air pollution so toxic that one out of four people exposed to it over a lifetime could get cancer.

In February, ProPublica and the Guardian asked the EPA for its scientists’ risk assessment, which underpinned the consent order. The agency declined to provide it, so ProPublica requested it under the Freedom of Information Act. The 203-page risk assessment revealed that, for the boat fuel ingredient, there was a far higher risk that was not in the consent order. EPA scientists included figures that made it possible for ProPublica to calculate the lifetime cancer risk from breathing air pollution that comes from a boat engine burning the fuel. That calculation, which was confirmed by the EPA, came out to 1.3 in 1, meaning every person exposed to it over the course of a full lifetime would be expected to get cancer.

Such risks are exceedingly unusual, according to Maria Doa, a scientist who worked at EPA for 30 years and once directed the division that managed the risks posed by chemicals. The EPA division that approves new chemicals usually limits lifetime cancer risk from an air pollutant to one additional case of cancer in a million people. That means that if a million people are continuously exposed over a presumed lifetime of 70 years, there would likely be at least one case of cancer on top of those from other risks people already face.

When Doa first saw the one-in-four cancer risk for the jet fuel, she thought it must have been a typo. The even higher cancer risk for the boat fuel component left her struggling for words. “I had never seen a one-in-four risk before this, let alone a 1.3-in-1,” said Doa. “This is ridiculously high.”

Another serious cancer risk associated with the boat fuel ingredient that was documented in the risk assessment was also missing from the consent order. For every 100 people who ate fish raised in water contaminated with that same product over a lifetime, seven would be expected to develop cancer – a risk that’s 70,000 times what the agency usually considers acceptable.

When asked why it didn’t include those sky-high risks in the consent order, the EPA acknowledged having made a mistake. This information “was inadvertently not included in the consent order”, an agency spokesperson said in an email.

Nevertheless, in response to questions, the agency wrote, “EPA considered the full range of values described in the risk assessment to develop its risk management approach for these” fuels. The statement said that the cancer risk estimates were “extremely unlikely and reported with high uncertainty.” Because it used conservative assumptions when modeling, the EPA said, it had significantly overestimated the cancer risks posed by both the jet fuel and the component of marine fuel. The agency assumed, for instance, that every plane at an airport would be idling on a runway burning an entire tank of fuel, that the cancer-causing components would be present in the exhaust and that residents nearby would breathe that exhaust every day over their lifetime.

In addition, the EPA also said that it determined the risks from the new chemicals were similar to those from fuels that have been made for years, so the agency relied on existing laws rather than calling for additional protections. But the Toxic Substances Control Act requires the EPA to review every new chemical – no matter how similar to existing ones. Most petroleum-based fuels were never assessed under the law because existing chemicals were exempted from review when it passed in 1976. Studies show people living near refineries have elevated cancer rates.

“EPA recognizes that the model it used in its risk assessments was not designed in a way that led to realistic risk estimates for some of the transportation fuel uses,” an agency spokesperson wrote. For weeks, ProPublica asked what a realistic cancer risk estimate for the fuels would be, but the agency did not provide one by the time of publication.

New chemicals are treated differently under federal law than ones that are already being sold. If the agency is unsure of the dangers posed by a new chemical, the law allows the EPA to order tests to clarify the potential health and environmental harms. The agency can also require that companies monitor the air for emissions or reduce the release of pollutants. It can also restrict the use of new products or bar their production altogether. But in this case, the agency didn’t do any of those things.

Six environmental organizations concerned about the risks from the fuels – the Sierra Club, Natural Resources Defense Council, Moms Clean Air Force, Toxic-Free Future, Environmental Defense Fund and Beyond Plastics – are challenging the agency’s characterization of the cancer risks. “EPA’s assertion that the assumptions in the risk assessment are overly conservative is not supported,” the groups wrote in a letter sent Wednesday to EPA administrator Michael Regan. The groups accused the agency of failing to protect people from dangers posed by the fuels and urged the EPA to withdraw the consent order approving them.

Chevron has not started making the new fuels, the agency said.

Separately, the EPA acknowledged that it had mislabeled critical information about the harmful emissions. The consent order said the one-in-four lifetime cancer risk referred to “stack air” – a term for pollution released through a smokestack. The cancer burden from smokestack pollution would fall on residents who live near the refinery. And indeed a community group in Pascagoula sued the EPA, asking the US court of appeals in Washington to invalidate the agency’s approval of the chemicals.

But the agency now says that those numbers in the consent order do not reflect the cancer risk posed by air from refinery smokestacks. When the consent order said stack emissions, the EPA says, it really meant pollution released from the exhaust of the jets and boats powered by these fuels.

“We understand that this may have caused a misunderstanding,” the EPA wrote in its response to ProPublica.

Based on that explanation, the extraordinary cancer burden would fall on people near boats or idling airplanes that use the fuels – not those living near the Chevron refinery in Pascagoula.

Each of the two cancer-causing products is expected to be used at 100 sites, the EPA confirmed. ProPublica asked for the exact locations where the public might encounter them, but Chevron declined to say. The EPA said it didn’t know the locations and didn’t even know whether the marine fuel would be used for a Navy vessel, a cruise ship or a motorboat.

In an email, a Chevron spokesperson referred questions to the EPA and added: “The safety of our employees, contractors and communities are our first priority. We place the highest priority on the health and safety of our workforce and protection of our assets, communities and the environment.”

Doa, the former EPA scientist who worked at the agency for three decades, said she had never known the EPA to misidentify a source of pollution in a consent order. “When I was there, if we said something was stack emissions, we meant that they were stack emissions,” she said.

During multiple email exchanges with ProPublica and the Guardian leading up to the February story, the EPA never said that cancer risks listed as coming from stack emissions were actually from boat and airplane exhaust. The agency did not explain why it initially chose not to tell ProPublica and the Guardian that the EPA had mislabeled the emissions.

The agency faced scrutiny after the February story in ProPublica and the Guardian. In an April letter to Regan, Senator Jeff Merkley, the Oregon Democrat who chairs the Senate’s subcommittee on environmental justice and chemical safety, said he was troubled by the high cancer risks and the fact that the EPA approved the new chemicals using a program meant to address the climate crisis.

EPA assistant administrator Michal Freedhoff told Merkley in a letter earlier this year that the one-in-four cancer risk stemmed from exposure to the exhaust of idling airplanes and the real risk to the residents who live near the Pascagoula refinery was “on the order of one in a hundred thousand,” meaning it would cause one case of cancer in 100,000 people exposed over a lifetime.

Told about the even higher cancer risk from the boat fuel ingredient, Merkley said in an email: “It remains deeply concerning that fossil fuel companies are spinning what is a complicated method of burning plastics, that is actually poisoning communities, as beneficial to the climate. We don’t understand the cancer risks associated with creating or using fuels derived from plastics.”

Merkley said he is “leaving no stone unturned while digging into the full scope of the problem, including looking into EPA’s program”.

He added: “Thanks to the dogged reporting from ProPublica we are getting a better sense of the scale and magnitude of this program that has raised so many concerns.”

The risk assessment makes it clear that cancer is not the only problem. Some of the new fuels pose additional risks to infants, the document said, but the EPA did not quantify the effects or do anything to limit those harms, and the agency would not answer questions about them.

Some of these newly approved toxic chemicals are expected to persist in nature and accumulate in living things, the risk assessment said. That combination is supposed to trigger additional restrictions under EPA policy, including prohibitions on releasing the chemicals into water. Yet the agency lists the risk from eating fish contaminated with several of the compounds, suggesting they are expected to get into water. When asked about this, an EPA spokesperson wrote that the agency’s testing protocols for persistence, bioaccumulation and toxicity are “unsuitable for complex mixtures” and contended that these substances are similar to existing petroleum-based fuels.

The EPA has taken one major step in response to concerns about the plastic-based chemicals. In June, it proposed a rule that would require companies to contact the agency before making any of 18 fuels and related compounds listed in the Chevron consent order. The EPA would then have the option of requiring tests to ensure that the oil used to create the new fuels doesn’t contain unsafe contaminants often found in plastic, including certain flame retardants, heavy metals, dioxins and PFAS. If approved, the rule will require Chevron to undergo such a review before producing the fuels, according to the EPA.

But environmental advocates say that the new information about the plastic-based chemicals has left them convinced that, even without additional contamination, the fuels will pose a grave risk.

“This new information just raises more questions about why they didn’t do this the right way,” said Daniel Rosenberg, director of federal toxics policy at NRDC. “The more that comes out about this, the worse it looks.”

You don't have to Squat 400 pounds -- just your body weight will work great.

Here we are again talking about exercise.  Why?  Because it’s the single most important thing you can do to extend your life and healthspan.  Recently discussions supported that isometric exercise actually has a little advantage (time-wise and effectiveness) over other forms (HIIT, aerobic, etc), while pointing out that the best benefit is really seen in combination.  In any case, here’s an easy way to get going – squat against a wall for a couple of minutes.  Rest. Repeat.  Can’t do two minutes – work up to it.  Do it every day, do a little more every day.  Soon you’ll be stronger, your belly won’t stick out as much, your butt will be firmer, and chances are your blood pressure will be lower.  What have you got to loose?  I mean really?  I’ve been saying it’s just not that hard – IT’S NOT!  Get MOVING (or still, whichever the case may be)!

FROM THE NY TIMES / BY DANI BLUM

A Simple 14-Minute Workout That Could Lower Your Blood Pressure

A new study points to the humble wall squat as the most effective tool to fight hypertension.

It has become almost a cliché across doctor’s offices: One of the most trusted tools to lower blood pressure is to exercise.

A jog or stroll around the block, experts consistently find, can have big payoffs in terms of heart health. A new study, however, points to a somewhat surprising exercise that may be able to dramatically reduce someone’s blood pressure: the wall squat.

A team of researchers based in Britain analyzed 270 previous studies that examined the link between exercise and blood pressure. They found that, predictably, exercises like running, walking, cycling, strength training and high-intensity interval workouts all helped to reduce blood pressure; mixing cardio and strength training also appeared to help.

But the most effective type of workout they looked at, especially for those who already had some form of hypertension, was isometric exercise, which involves contracting a set of muscles without moving — think planks.

This new research adds to a growing body of evidence that quick bursts of exercise — like speeding up your walk during a commute or carrying groceries with a bit more vigor — can have significant benefits for people’s overall health.

“Everybody feels this incredible threat to their time — everybody feels like they don’t have enough time,” said Dr. Tamanna Singh, co-director of the Sports Cardiology Center at Cleveland Clinic, who was not involved with the study. “It’s so interesting to see more studies coming out showing, actually, time really is not the limiting factor.”

The British researchers looked at three kinds of isometric workouts in particular: squeezing a handgrip, holding a leg extension machine in place and squatting with your back against a wall. The wall squat (sometimes called a wall sit) is probably the easiest option for people to try, as it doesn’t require any equipment, said Jamie J. Edwards, a researcher at Canterbury Christ Church University and the lead author on the study.

Even though isometric exercises may appear relatively easy, they are often quite intense, Dr. Edwards said — as you hold yourself in place, sweating and straining. He recommends a 14-minute routine you can add to your regular workout perhaps three times a week: a two-minute wall squat, followed by two minutes of rest, repeated four times in total.

You should stay at the same squat height for all four rounds, but the exercise will feel more challenging the more times you do it, said Jim Wiles, a principal lecturer at Canterbury Christ Church University who was also an author on the study. The first bout should feel as if you are exerting yourself at a level of four (out of a possible 10, with 10 feeling as if you could not hold it any longer). The last bout should be around an eight, he said. You should feel reasonably exhausted by the end.

And be careful to not hold your breath while you do it, Dr. Edwards added.

The researchers aren’t entirely sure why isometric exercises seem to be so effective for combating hypertension. One prominent theory, Dr. Edwards said, is that when you clench your muscles without moving, the local blood vessels around them compress — and then when you release, blood flushes back, causing the vessels to widen or dilate if you perform the exercise frequently enough, in a way they don’t during a dynamic exercise like a run.

That change can be critical, because over time, high blood pressure can stiffen our arteries and prevent them from dilating properly, which restricts how much oxygen-rich blood they can deliver. This increases the risk of having a heart attack or stroke, Dr. Singh said.

The study doesn’t mean you should ditch your run and go straight for wall squats — isometric exercise should complement, not replace, your favorite workout, Dr. Edwards said, whether that’s cardio or weight lifting. And if you have any underlying medical conditions, you should consult with your doctor to check that isometric exercise is safe for you, Dr. Wiles suggested.

But if you are looking for a heart-healthy addition to your workout, you could do worse than the humble wall squat.

“You truly only need your body,” Dr. Singh said. “You don’t even need shoes.”

Kombucha COULD be good for diabetics...maybe

The medical “literature” has become largely polluted with “quick-as-you-can” “let’s get something published” so we can claim some part of the zeitgeist.  Huh?  

Ok – I got this idea that something might have utility, so we devise a study that could test the idea.  But, we don’t really have any money, or staff, or time, so we’re gonna do it on the cheap and hope it pans out.  

That’s kind of what this study looks like.  Take 12 people, have them drink kombucha, test blood sugar a couple of times, don’t drink kombucha for a while and test blood sugar again a couple of times.  And guess what?  The kombucha seems to help control blood sugar.  Or at least on a couple of measurements they were better.  And there’s some statistical significance.  

Mark Twain said it best – “There are three kinds of lies: lies, damned lies, and statistics.”

What am I saying?  Yes, there are reasons to believe that kombucha could be good for a diabetic, despite it being “sugary”.  It’s a cool idea, and it might end up being true.  But this study does very little to support the idea, other than telling us that more study is needed.  But that’s never going to be the headline.  Who wants to read – “well, it MIGHT be good, but we don’t really know”

FROM FRONTIERS IN NUTRITION / BY Chagai Mendelson, Sabrina Sparkes, Daniel J. Merenstein, Chloe Christensen, Varun Sharma, Sameer Desale, Jennifer M. Auchtung, Car Reen Kok, Heather E. Hallen-Adams, Robert Hutkins

Kombucha tea as an anti-hyperglycemic agent in humans with diabetes – a randomized controlled pilot investigation

Introduction: Kombucha is a popular fermented tea that has attracted considerable attention due, in part, to its suggested health benefits. Previous results from animal models led us to hypothesize kombucha may reduce blood sugar levels in humans with diabetes. The objective of this pilot clinical study was to evaluate kombucha for its anti-hyperglycemic activities in adults with diabetes mellitus type II.

Methods: The study was organized as a prospective randomized double-blinded crossover study at a single-center urban hospital system. Participants (n = 12) were instructed to consume either a kombucha product or a placebo control (each 240 mL) for 4 weeks. After an 8-week washout period, participants consumed the alternate product. Fasting blood glucose levels were self-determined at baseline and at 1 and 4 weeks during each treatment period. Secondary health outcomes, including overall health, insulin requirement, gut health, skin health, mental health, and vulvovaginal health were measured by questionnaire at the same time points. The kombucha microbiota was assessed by selective culturing and 16S rRNA gene (bacteria) and ITS (fungi) sequencing. Fermentation end products were assessed by HPLC. Statistical significance of changes in fasting blood glucose was determined using paired, two-tailed student’s t-tests.

Results: Kombucha lowered average fasting blood glucose levels at 4 weeks compared to baseline (164 vs. 116 mg/dL, p = 0.035), whereas the placebo did not (162 vs. 141 mg/dL, p = 0.078). The kombucha microbiota, as assessed by cultural enumeration, was mainly comprised of lactic acid bacteria, acetic acid bacteria, and yeast, with each group present at about 106 colony forming units (CFU)/mL. Likewise, 16S rRNA gene sequencing confirmed that lactic acid and acetic acid bacteria were the most abundant bacteria, and ITS sequencing showed Dekkera was the most abundant yeast. The primary fermentation end products were lactic and acetic acids, both less than 1%. Ethanol was present at 1.5%.

Discussion: Although this pilot study was limited by a small sample size, kombucha was associated with reduced blood glucose levels in humans with diabetes. Larger follow-up studies are warranted.

Clinical trial registration: ClinicalTrials.gov, identifier NCT04107207.

TO SEE COMPLETE CLINICAL TRIAL CLICK HERE

Couch Potatoes CAN Cut Cancer Risk

Unless you’ve been under a rock, you probably heard about this one. 

In the past we’ve discussed that exercise is the single greatest thing you can do for your health (yes, more than diet!), and of course there’s always push back as to how much do I have to do?  The key concept is MED – minimal effect dose.  What’s the LEAST I have to do to see an effect?  Great general concept, really needs to be applied broadly.  

This study shows that literally 4 ½ minutes a day of moderate to vigorous activity (hard to really call it “exercise”) will significantly lower your risk of cancer (20% reduction).  If you just look at the cancers known to be related to low activity, this 4 ½ minutes translates to a 31% reduction in cancer development.  The very least you can get away with is 3.4 minutes daily total, with a 17% reduction in the incidence (new diagnosis) of cancer.  And the activity can be up to 1 minute at a time – we’re talking fast walking or stair climbing. And if you’re feeling lazy, know that there was no significant difference between 1 minute “exertions” and 2 minute “exertions”.  

So what’s your excuse now?

By the way, we have lots of similar things we can do to help you LIVE BETTER.

FROM MEDPAGE TODAY / BY MIKE BASSET

Couch Potatoes Take Note: Climb Some Stairs to Cut Cancer Risk

— Short bouts of vigorous activity may be a "promising" intervention for those who can't exercise

For adults who can't or don't like to exercise, short periods of vigorous activity as simple as climbing a flight of stairs may be enough to lower their risk of cancer, according to a large cohort study.

Compared with no vigorous intermittent lifestyle physical activity, the median daily duration of periods of vigorous activity up to 1 minute (totaling 4.5 minutes per day) was associated with a 20% reduction in total cancer risk (HR 0.80, 95% CI 0.69-0.92), reported Emmanuel Stamatakis, PhD, of the University of Sydney in Australia, and colleagues.

Moreover, there was also a 31% reduction in the risk of a physical activity (PA)-related cancer -- a composite of cancer sites known to be possibly associated with low physical activity (HR 0.69, 95% CI 0.55-0.86), they noted in JAMA Oncology.

"Daily VILPA [vigorous intermittent lifestyle physical activity] may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time," Stamatakis and colleagues wrote. "Long-term trials with cancer-related biomarker outcomes and well-designed cohort studies with wearable devices should further explore the potential of VILPA as a cancer prevention intervention for nonexercising individuals and for those who find structured exercise unappealing."

The researchers also found that a "minimal dose" of 3.4 minutes of vigorous activity per day was associated with a 17% reduced risk of total cancer incidence (HR 0.83, 95% CI 0.73-0.93), while 3.7 minutes daily was associated with a 28% reduced risk of physical activity-related cancer incidence (HR 0.72, 95% CI 0.59-0.88).

In an editorial accompanying the study, Linda S. Lindström, MSc, PhD, of Karolinska University Hospital in Stockholm, and colleagues, noted that studies have suggested that physical activity can also improve physical fitness, muscle strength, cancer-related fatigue, and quality of life among cancer survivors, adding that whether the results of this study can be extrapolated to cancer patients needs to be evaluated.

In any event, they said that it is clear that most individuals benefit from physical activity, "and the key is to make exercise a habit."

However, based on the findings of this study, they pointed out that even sporadic episodes of brief, vigorous physical activity can positively affect health and reduce the risk of disease, adding that "any physical activity is better than none."

This analysis included 22,398 adults from the U.K. Biobank accelerometry subsample (mean age 62 years, 54.8% women, 96.0% white). Only individuals who reported no leisure time exercise and one or fewer recreational walks a week were included.

Vigorous intermittent lifestyle physical activity is defined as short periods of vigorous physical activity such as bursts of fast walking or stair climbing. Stamatakis and colleagues said that it should only be measured with wearable trackers, such as the wrist-worn accelerometers used by participants in the U.K. Biobank accelerometry studyopens in a new tab or window.

Participants with cancer, cancer in remission, a cancer event during the first year after accelerometry baseline, or inadequate wear time were excluded.

Analyses were adjusted for age, sex, body mass index, education level, smoking status, alcohol consumption, sleep duration, fruit and vegetable consumption, medications, parental cancer history, prevalent cardiovascular disease, daily durations of light- and moderate-intensity physical activity, and daily duration of longer vigorous exercise bouts.

During a mean follow-up of 6.7 years (149,650 person-years), 2,356 new cancer events were reported (1,084 in physical activity-related cancer sites).

Most (92.3%) vigorous activity occurred in bouts of up to 1 minute; the results related to 1-minute bouts were similar to those for up to 2 minutes, the authors noted.

Cut Cancer by Keeping to a Schedule?

Everybody has an internal clock.  It’s called your Circadian rhythm.  When you keep to a regular schedule (assuming of course it’s not an insane schedule), your body can work out when it’s best to do the things that are necessary to keep itself healthy.  If you’re all over the map from a timing perspective, varying activities like eating and sleeping wildly from day to day, you’re body literally won’t know what to do when.  And this sort of thing can lead to cancer.  So….don’t do that.  Work toward a regular schedule – the main issues involve rising and sleeping at relatively consistent times, as this could legitimately decrease your risk of cancer.  Not that hard to do…

FROM SCIENTIFIC AMERICAN / BY LYDIA DENWORTH

Adjusting Your Body Clock May Stave Off Cancer

Research shows that disrupting the body’s circadian rhythm raises cancer risk, and resetting it may bring that risk down

I usually get up by 7 A.M. and am in bed by 10 P.M. I tend to eat meals at the same times of day, too. This may sound a little dull, but it's essential for my productivity. It's also a schedule that rarely disrupts my body clock. And a steady clock, it turns out, just might help me and many other people avoid cancer and some other diseases, according to new research.

What I call a body clock really means circadian rhythms, from the Latin for “about” and “day.” These are the body's internal biological pacemakers, physiological fluctuations that help us adjust to the phases of a 24-hour day by synchronizing with environmental cues such as light, dark, temperature and food intake. These rhythms affect sleeping and waking, feeding and fasting, endocrine cycles, immune function, and cell growth.

For some time now epidemiological studies of night-shift workers have linked disruptions in circadian rhythms to cancer and other diseases. Much of the evidence concerned breast cancer and to a lesser extent prostate cancer. Duration of shift work made a difference—nurses who worked night shifts for up to 30 years were at moderately increased risk for breast cancer compared with those who did shorter stints, and those who worked such shifts for more than 30 years had the highest risk. In 2019 the World Health Organization reaffirmed and updated a research statement from the agency showing that shift work is a probable carcinogen.

Now there is even more evidence involving other types of malignancies, including liver, lung and colorectal cancers, from a spate of new studies. “We're starting to understand the reasons these things happen,” says Selma Masri, a circadian biologist at the University of California, Irvine, who has shown how circadian disruption pushes colon cancer progression by interfering with the way certain genes are expressed.

The cancer connection comes about through several mechanisms. Circadian disruption affects metabolic pathways, the chemical reactions that produce energy in the body. It tampers with immune function. It also compromises the fidelity of DNA repair in cells. Adult human cells divide every 18 to 24 hours, and one function of the circadian clock is to tell cells to do that at night to avoid DNA damage from sunlight. “When the clock gets disrupted, cells don't know when to divide,” says circadian biologist Satchidananda Panda of the Salk Institute for Biological Studies. “They can divide faster and become a tumor.”

Circadian disruption doesn't only occur in shift workers. It happens when we consistently don't get a good night's sleep—scientists say this can mean waking up for two or three hours between 10 P.M. and 5 A.M. at least once a week. Wakeful episodes can be caused by jet lag, staying out late, or looking at blue-light-emitting phone screens—which mimic daylight—at night. When and what we eat also cues our rhythms, just as light and dark do, so add snacking at midnight to the list of things to avoid.

The growing understanding of circadian rhythms also could offer help through what's known as chronotherapy. Certain chemotherapy treatments, for example, are more effective when given in accordance with a patient's rhythms. Now researchers are exploring differences in the timing of radiation therapy. Drugs that bolster natural rhythms are also under investigation.

Shift work is critical and not going away, says Katja Lamia, a circadian biologist at Scripps Research, but there might be ways of reducing its toll on the body. Her research suggests that subtle increases in body temperature might be an important factor in circadian disruption. If that turns out to be right, Lamia says, “we can use noninvasive monitoring of body temperature in shift workers to evaluate who's at risk and take a personalized scheduling approach.”

For those who don't work at night, changing some routines might be enough. A good night's sleep should be a priority. Eating habits can also play a role. Panda and his colleagues are investigating a practice known as time restricted eating (TRE) or intermittent fasting. That might mean delaying breakfast by an hour or two until cortisol levels drop and eating dinner at least three hours before your habitual bedtime. In a 12-week study of firefighters, TRE benefited their metabolic health and improved their sleep. In mice, it has been shown to reduce the risk of cancer or to slow the growth of tumors.

Maybe, Panda says, respecting our circadian rhythms can help protect our time-sensitive bodies.

What's the Best Time to Exercise?

20 years ago I would tell patients that they’re best time to exercise would be pre-dinner.  I figured that as the body’s metabolism starts to slow, and we would exercise at that time, we could get a double benefit – push the metabolism back up, and if you time it before a meal, that metabolism will use the soon to be delivered calories.  (Peak occurs normally after late morning – peak metabolism occurs as a spike in response to the cortisol surge that typically wakes people up, and the metabolism rise follows that spike) This timed combination would improve people’s weight management, as well as keeping their input matching the body’s needs.  

This study suggests that for those with the biggest issues around calorie utilization (diabetics), moving exercise to the afternoon will have better results than those exercising in the morning.  It just goes to show that if you pay attention, it’s not hard to anticipate what the “real research” will show.  Like I’ve said before, it’s not that hard to be ahead of the curve.

FROM CNN ONLINE/ BY AMY WOODYATT

People with type 2 diabetes may benefit from exercising in the afternoon, study shows. Researchers concluded that "timing does seem to matter" when it comes to physical exercise.

People with type 2 diabetes should exercise in the afternoon instead of the morning to manage their blood sugar, a new study has found.

“In this study, we (have) shown that adults with type 2 diabetes had the greatest improvement in glucose control when they were most active in the afternoon,” co-corresponding author Dr. Jingyi Qian, from the Division of Sleep and Circadian Disorders at Massachusetts’ Brigham and Women’s Hospital, said in a statement.

“We’ve known that physical activity is beneficial, but what our study adds is a new understanding that timing of activity may be important too,” Qian added.

A team of researchers from Brigham and Joslin Diabetes Center studied data from more than 2,400 people who were overweight and diagnosed with type 2 diabetes, and were wearing a waist accelerometry recording device – something that measures vibration or acceleration of motion – to measure their physical activity.

After reviewing data from the first year of the study, researchers found that those who did “moderate-to-vigorous” physical activity in the afternoon had the greatest reduction in blood glucose levels.

According to Harvard’s School of Public Health, examples of “moderate” activity include brisk walking, mowing the lawn with a power mower and playing badminton recreationally, while “vigorous” activity includes hiking, fast jogging, a basketball or soccer game or cycling at 14-16 miles per hour.

You can tell if you are exercising at a moderate aerobic level if you’re able to talk but not sing your favorite song, according to the US Centers for Disease Control and Prevention.

When looking at data from the fourth year of the study, the team found that those who exercised in the afternoon maintained a reduction in blood glucose levels, and had the highest chance of being able to stop taking glucose-lowering diabetes medication.

Type 2 diabetes is the most common type of diabetes, and occurs when the body becomes resistant to insulin, or doesn’t make enough insulin, according to the World Health Organization.

Mostly found in adults, it is associated with older age, obesity, family history, physical inactivity and race/ethnicity.

People with diabetes are at risk of complications including nerve damage, vision and hearing problems, kidney disease, heart disease and premature death.

The study’s authors note that the observational study does come with limitations, as it didn’t measure sleep or diet.

“Timing does seem to matter,” said co-corresponding author Dr. Roeland Middelbeek, assistant investigator at Joslin Diabetes Center. “Going forward, we may have more data and experimental evidence for patients to give more personalized recommendations.”

Dr. Lucy Chambers, Head of Research Communications at Diabetes UK, said of the study: “Keeping physically active can help people with type 2 diabetes manage their blood sugar levels and reduce their risk of developing serious diabetes-related complications such as heart disease and kidney failure, as well as improving their overall wellbeing.

Chambers, who was not involved with the study, emphasized the need for people to exercise where they can.

“This new research found that regular ‘moderate-to-vigorous’ physical activity – whether in the morning, midday, afternoon or evening – was associated with lower average blood sugar levels in people with type 2 diabetes. Afternoon exercise was linked with the greatest benefits but the reasons for this are unclear and current evidence on optimal times for exercising is mixed.

“If you’re living with type 2 diabetes, the most important thing is to find an exercise you enjoy and that you can incorporate into your routine in the long-term – whether it’s before work, on your lunch break, or in the evening,” she added.

The team’s findings are published in the journal Diabetes Care.

Bitten by a Tick: What's My Risk of Getting Sick?

Climate change is causing the increase in toxic encounters (I don’t mean those people you can’t spend time with), especially during the warmer months, and into the fall.  That means more mosquitoes, more ticks, more chances of getting sick from these insect bites.  But how do you know when it’s reasonable to worry about it?  This article tells a pretty clear story – essentially, the key is 24 hours.  IF you can find the tick BEFORE it’s been on you for a full day, you will most likely NOT get infected with Lyme or similar tick-borne diseases.  BUT YOU’VE GOT TO CHECK!  When you come back inside from being out in nature, give yourself a once-over.  It’s helpful if you don’t expose skin, but it it’s super hot out and you want to be out, that can be tough.  But it’s all a balancing act, after all.

FROM MEDPAGE TODAY / BY KRISTINA FIORE

Here's when you need to call a healthcare provider -- and when you don't

While tickborne diseases have been on the rise across the U.S.opens in a new tab or window, outdoor enthusiasts can take comfort knowing that most common infections aren't transmitted quickly, researchers said.

For instance, Borrelia burgdorferi, the bacteria that cause Lyme disease -- which is "far and away the most common tickborne disease in the U.S." -- take more than 24 hours to be transmitted from the tick to the host, according to Jonathan Oliver, PhD, a public health entomologist at the University of Minnesota.

"If you do tick checks every day and make sure you remove any attached ticks, your risk of Lyme disease is very low, even if the tick was infected," Oliver told MedPage Today.

That's because Borrelia don't live in the salivary glands of the tick. Instead, they live in the mid-gut and "need to be activated by the tick taking a blood meal," he explained. Only then can they migrate to the salivary glands and be transmitted to the host, he said.

Infectious disease physician Del DeHart, MD, of the University of Michigan Health-West, agreed that there's "no need to seek medical care after most tick bites, particularly if you see them and remove them."

"If you catch them early, then you really decrease the risk that they're going to transmit anything to you," DeHart said.

There are many types of ticks and they transmit "a greater diversity of pathogens than any other vector," Oliver noted, from bacteria and viruses to protozoans. The ticks of greatest concern for disease transmission are those with broad host ranges, including the blacklegged tick (Ixodes scapularis), the lone star tick (Amblyomma americanum), and the American dog tick (Dermacentor variabilis).

The blacklegged tick -- also known as a deer tick -- transmits Borrelia burgdorferi, the bacteria Anaplasma phagocytophilum, which cause anaplasmosis, and the protozoan Babesia microti, which causes babesiosis, Oliver said. It can also transmit Powassan virus, which is "pretty rare but can be very bad," he added. "It can cause encephalitis and meningitis and can be lethal."

The lone star tick can transmit the bacteria Ehrlichia, which cause ehrlichiosis, as well as Bourbon virus and Heartland virus, Oliver said. Both viral diseases are "extremely rare as far as we know, but they can cause encephalitis-type symptoms."

The American dog tick can transmit Rickettsia rickettsii, which cause Rocky Mountain spotted fever. "There are a variety of spotted fever diseases of varying severity, but Rocky Mountain spotted fever is the really bad one," he explained.

Luckily for humans, infection risk is not just a function of time the tick has been attached, but also by the proportion of the tick population that's infected with any given disease. Lyme is the most common disease, Oliver said, partly because a third to a half of adult blacklegged ticks carry Borrelia. About a quarter to a third of nymph blacklegged ticks will carry the bacteria, but they're smaller than adults so can be more difficult to spot.

Other diseases are far less common. Oliver estimated that less than 10% of lone star ticks will carry Ehrlichia species that cause ehrlichiosis, and less than 1% of American dog ticks will carry Rickettsia rickettsii.

Nonetheless, "if a tick attached long enough, it will eventually transmit whatever diseases it is carrying," he said.

That's why prevention is of utmost importance, DeHart said, noting that using tick repellent and wearing long pants -- and tucking them into your socks -- are two key ways to prevent tick bites when outdoors. In addition to tick checks after being outside, people should also check themselves periodically "so you can pick them off," he said.

"Make sure to check places you may not think of -- the groin area, between your butt cheeks," DeHart added. "Ticks love to go to warm places, so doing a really thorough tick check is important."

There's no need to call a doctor after most tick bites, DeHart said, particularly if you find them and remove them. If the tick is engorged or has been attached a long time, however, it's not a bad idea to have it identified for potential future reference.

Academic labs can do the identification, or some services can even do identification via images alone, he added.

"If it can be identified and it's a dog tick and you're not in an area where worries about that are significant, then you don't need to worry much about it. If you're in an area with Rocky Mountain spotted fever, then you would," DeHart said. "If it's not a blacklegged tick, you don't need to worry about Lyme disease. So it can be helpful if you get it identified."

People who've been bitten by a tick should seek medical attention if they develop a significant rash, or flu-like symptoms including a fever or a headache, he said, as those are common signs of infection with many of the tickborne diseases.

DeHart noted that CDC's reference manual for healthcare providersopens in a new tab or window on tickborne diseases in the U.S. is particularly helpful for physicians, as it contains images for tick identification, geographic distribution of the most common tickborne diseases, and their most frequent symptoms.

If you just keep moving, diabetes is a lot harder to get!

Here’s another study that demonstrates the benefit of exercise in avoiding the development of diabetes.  And as I’ve mentioned before, the benefit starts to accrue at literally 5 minutes a day, but has the highest benefit at more than 1 hour a day.  Any activity exceeding a walk of 3 mph, like vacuuming, or walking stairs qualifies.  If you think about being active around an hour a day compared to doing essentially nothing (tv, etc), that drops your risk of developing diabetes by 3/4s.  Get up, get moving.  It’s just not that hard – and it’s just not really exercise!

From british journal of sports medicine / by Mengyun Luo, Chenhao Yu, Borja Del Pozo Cruz, Liangkai Chen, Ding Ding

Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study

Abstract

Objective Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk.

Methods This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013–2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models.

Results During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3–25.9 min/day, 0.41 (0.34 to 0.51) for 26.0–68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk.

Conclusion Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D.

Why I Always Look Ahead When it Comes to Patient Health

We've been doing this for years! Now the American Heart Association thinks it might be a good idea.

As you may have heard, I think of myself as “ahead of the curve”.  Of course, in US medicine, the curve is around 20 yrs long, so, in itself, that might not be saying much!  Regardless, a recent article in the Journal of the American Heart Association suggests that testing the population for NT-proBNP might be a good idea.  Well, I started doing that ABOUT 10 YEARS AGO!  

NT-proBNP is a small protein that is made in the heart muscle that is released in response to the stretch of the muscle.  Too much stretch, too much NT-proBNP, and as “too much” might suggest, that’s bad.  Long ago it was found that high levels of NT-proBNP are tied to heart failure, and the rise in levels can predict upcoming episodes.  But even modest elevations can show the stretch, and give a window into general heart health.  

The study suggests that the levels may tie to overall mortality, not just cardiovascular deaths.  

I guess I’ll keep doing it.

FROM JAHA / By Justin B. Echouffo‐Tcheugui, Sui Zhang, Natalie Daya, John W. McEvoy, Olive Tang, Stephen P. Juraschek, Chiadi E. Ndumele, Josef Coresh, Robert H. Christenson and Elizabeth Selvin

NT‐proBNP and All‐Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study

Background

NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle‐aged and older populations, have suggested that NT‐proBNP has prognostic value in ambulatory adults.

Methods and Results

We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT‐proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT‐proBNP with all‐cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self‐reported history of CVD). There were 3155 deaths (1009 CVD‐related) over a median 17.3 years of follow‐up. Among individuals without prior CVD, elevated NT‐proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all‐cause (hazard ratio [HR], 1.67 [95% CI, 1.39–2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61–5.11]). Associations of NT‐proBNP with all‐cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05).

Conclusions

In a representative sample of the US adult population, NT‐proBNP was an important independent risk factor for all‐cause and CVD mortality. NT‐proBNP may be useful for monitoring risk in the general adult population.