Saturday, July 28, 2012

Anxiety Makes Brain Poor At Math For Some Children

A study from the Stanford University School of Medicine is published this week in Psychological Science showing that children who experience difficulty with math exhibit an altered brain function from anxiety.

When it comes to equations and formulas, all you have to fear is fear itself it seems, with second and third grade students showing brain activity associated with panicky or frightened feelings, decreasing activity in the part of the brain that handles math.

It's certainly an interesting theory and if put into action, could provide a means of counseling children that have problems with math by way of improving their abilities.

As Vinod Menon, PhD, the Stanford professor of psychiatry and behavioral sciences who led the research confirms:

"The same part of the brain that responds to fearful situations, such as seeing a spider or snake, also shows a heightened response in children with high math anxiety."

Menon and his team used functional magnetic resonance imaging brain scans on nearly 50 students with low and high math anxiety. The children were also assessed for math anxiety with a modified version of a standardized questionnaire for adults, and also received standard intelligence and cognitive tests.

As Menon continues, math anxiety has been known about for a long time, but has never really been studied in terms of its effect on students, and especially younger ones, when maths skills are built:

Menon said:

"It's remarkable that, although the phenomena was first identified over 50 years back, nobody had bothered to ask how math anxiety manifests itself in terms of neural activity ... You cannot just wish it away as something that's unreal. Our findings validate math anxiety as a genuine type of stimulus- and situation-specific anxiety."

Essentially what he is saying is that his team's observations show that math anxiety is neurobiologically similar to other kinds of anxiety or phobias. In theory, the process may work for many other issues that children and even adults have difficulty dealing with.

Menon says that's its also possible for someone who is considered good at maths to have a bad day and feel the anxiety that blocks his or her skills.

Victor Carrion, MD, a pediatric psychiatrist at Lucile Packard Children's Hospital and an expert on the effects of anxiety in children. Carrion, who was not involved in Menon's research, is also an associate professor of psychiatry and behavioral sciences at Stanford, said:

"The results are a significant step toward our understanding of brain function during math anxiety and will influence development of new academic interventions,"

The two groups of good math and bad math / anxious students showed differences in performance: Children with high math anxiety were less accurate and significantly slower at solving math problems than children with low math anxiety. These results indicate that math anxiety, basically math-specific fear, jams the brain's information-processing capacity along with the ability to reason through a math problem. Perhaps the process of being fearful, by way of the animal type survival mechanism it originates from, has evolved the brain to be spontaneous and intuitive rather than logical and mathematical in frightening situations.

Menon is excited about the future of his research and thinks that in addition to examining possible treatments and doing further research into the trajectory of math anxiety from early childhood throughout school, future research could provide insight into how the brain's information-processing capacity is affected by performance anxiety in general.
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Easy To Pronounce Names Help Win Friends And Influence People

Here is something Dale Carnegie didn't mention in his self-help bestseller "How to Win Friends and Influence People": having a name that is easy to pronounce appears to confer a subtle advantage. Apparently, it helps people gain promotions, ascend in politics, and make it big as lawyers, according to a study that analysed how the pronunciation of names influences impression formation and decision-making.

Lead author of the study, Dr Simon Laham from the University of Melbourne in Australia told the press last week that people are often not aware of subtle biases when they make decisions and choices. He and his colleagues write about their findings in the Journal of Experimental Social Psychology.

The study builds on earlier work by co-author Dr Adam Alter, from the New York University Stern School of Business. In a previous study, Alter found that financial stocks with simpler names tend to perform better just after they appear on the stock market than similar stocks with more complex names.

For the new study, the researchers worked in lab settings and in a natural environment using names from Anglo, Asian, and Western and Eastern European backgrounds.

They found that the subtle effect of name is "not due merely to the length of a name or how foreign-sounding or unusual it is, but rather how easy it is to pronounce," said Laham.

In particular they found that:
  • Candidates with more pronounceable names were more likely to be be favoured for job promotion and political office.

  • In a mock ballot, political candidates whose names were easier to pronounce were more likely to win than counterparts whose names were not so easy to say.

  • Attorneys with easy to pronounce names ascended more quickly to senior positions in their firms.
Alter carried out the law firm analysis, which involved investigating 500 first and last names of US laywers. He said the effect is probably at work in other industries as well, and in many day to day contexts:

"People simply aren't aware of the subtle impact that names can have on their judgments," said Alter.

The authors write that:

"This work demonstrates the potency of processing fluency in the information rich context of impression formation."

Laham said the study, thought to be the first of its kind, is significant because it suggests there is subtle bias and discrimination at work in our society, and that it's important to realize how it shapes our choices and judgement of others:

"Such an appreciation may help us de-bias our thinking, leading to fairer, more objective treatment of others," he urged.
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More Vigilance Needed To Prevent Children Having Food Allergy Reactions

Everyone knows the old story of the peanut allergy that seems to affect around one in 500 people, and can cause severe, even life threatening allergic reactions. There are, however, many other foods that can cause children to experience allergic reactions. They range from honey that can provoke asthma, to lactose and dairy products causing constipation, indigestion and intolerance, through to the more severe types of reactions that often seem to come from peanuts and other nuts.

A new study"Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study," published this week in the July issue of Pediatrics had researchers looking at some 500 children diagnosed with risks of reactions to milk or eggs.

Allergies seem to be becoming more widespread, or we are simply more aware of the problem. Another common and increasingly seen allergy is to gluten, which rather inconveniently includes all wheat products, bread, pies, pasta, oats, barley, malt, and most baked products.

Researchers found a rather sloppy approach to protecting children from allergic reactions, with more than 10% of all exposures to egg, milk products or peanuts, being non-accidental: ie. the parent or care giver was aware of both the child's allergy problem and the ingredients of the food, but went ahead and gave the meal to the child just the same.

Half of allergic reactions were caused by food not given by the child's parents and whilst only a third of the allergic reactions were so severe they needed to be treated with epinephrine (also known as adrenaline, a powerful hormone that increases heart rate, blood vessel dilation), overall, there appeared to be lack of food safety. with not enough attention to ingredients, the children's needs or double checking labeling.

Obviously, it can be extremely difficult at times to avoid some of these common foods that maybe hidden ingredients in a product. An allergy to milk, peanuts or gluten, does require a strict discipline and vigilance. This becomes even more difficult with children who want to try the things their friends eat, or are simply out and about in the park or the mall, where food options are more limited. Any parent can understand the problem of needing to find something to feed a hungry and irritated young child. Nonetheless, the researchers felt that more education is needed in regards to allergies.

The 11% of cases where the child was deliberately given food they were allergic to, doesn't necessarily show malice of any kind, simply a lack of education and a deficiency on the part of the care giver to understand the ramifications and seriousness of a child who is allergic.

The authors continue, that there is also a need to better educate parents and care givers as to the use of epinephrine, providing them with reassurance about the safety of administering it, as well as offering basic teaching as to its proper use. During the study it seemed that correct and proper administration of epinephrine was not being carried out in for every case that it was needed for.

Dr. David Fleischer, assistant professor at National Jewish Health in Denver, the lead author of the study concluded:

"In terms of purposeful exposures, those percentages haven't been reported before ... Maybe parents were testing their children to see if they had outgrown their allergy. There's going to be a follow-up study, going back to families and asking exactly why caretakers were giving these foods on purpose."

The number of reactions from the 500+ children on the study was surprisingly high, with some 70% having at least one reaction and more than 50% having more than one reaction, and this, in spite of parents and caregivers being informed of the child's problems. The issue is even more pressing once you understand that some 8% of children in the United States have allergies of some kind.

Dr. Scott Sicherer, professor at Mount Sinai Hospital and co-author of the study concluded that their article should serve as a wake-up call in regards to children and allergies:

"The bottom line is that you have to maintain a high level of vigilance ... That applies to the parents, but also to other people taking care of the child: grandparents, siblings, babysitters, teachers. Basically everyone who is around the child needs to know about the allergy and understand what to do to keep the child safe."

It can be very difficult to avoid common foods, but once the discipline and awareness is in place it ought to become fairly straight forward. With such a high number of allergies around, it's clearly no longer a case where there's only one child, in a school of 500, who represents the awkward exception that has to be handled with kid gloves at meal times. Rather, dairy free, nut free, gluten free and other options should be becoming virtually standard fare.
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Dieting During Pregnancy Is Safe And Helpful

A study in BMJ reports that the risk for serious complications, such as pre-eclampsia, diabetes and premature birth can be safely reduced even in overweight and obese pregnant women by following a healthy calorie controlled diet during pregnancy.

Over half of the UK's female population of reproductive ages is overweight or obese, and up to 40% of European and American women gain more than the recommended weight in pregnancy, which has been associated with numerous serious health problems. Health professionals believe that a woman's pregnancy is the perfect time to discuss weight management, given that pregnant women are generally more motivated to make changes that benefit both themselves and their baby.

Research leader, Dr Shakila Thangaratinam from Queen Mary's University of London assessed the impact of diet, exercise, or both on weight gain during pregnancy and any adverse effects on the expectant mother and their unborn baby by analyzing data from over 7,000 women obtained from 44 randomized controlled trials. The team accounted for the study's designs and quality for minimum bias. 

They found that weight management interventions during pregnancy proved effective in reducing the mother's weight gain, and that diets achieved the largest average weight loss of almost 4 kg in comparison with only 0.7 kg for exercise and 1 kg for a combination of both, diet and exercise. They also discovered that diet was the most effective option in preventing pregnancy complications, including pre-eclampsia, diabetes, high blood pressure and premature birth, although the researchers highlight the fact that the overall evidence rating for these significant results was classed as 'low to very low'.

However, the findings did prove that interventions are indeed safe and have no adverse impact on the baby's weight. The researchers conclude that dietary and lifestyle interventions in pregnancy improve outcomes for both mother and infant, but acknowledge that their study was subject to limitations in terms of the lack of data on risk factors, including age, ethnicity and socioeconomic status.

According to experts at London's St Thomas Hospital in London, opinion in an associated editorial, the evidence to support any specific intervention is still insufficient. Although Lucilla Poston and Lucy Chappell agree that this study is "timely and welcome", it fails to provide the necessary evidence required for the National Institute for Health and Clinical Excellence (NICE) to re-evaluate the guidelines for weight management during pregnancy. Poston and Chappell refer to various ongoing trials that will provide a greater understanding of effective interventions in pregnant overweight and obese women

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Eating Berries May Lower Men's Parkinson's Risk

Men who regularly consume foods rich in flavonoids, such as berries, apples, certain vegetables, tea and red wine, may significantly reduce their risk for developing Parkinson's disease, according to a study published in the journal Neurology this week that saw no such effect among women.

Flavonoids are naturally occurring, bioactive compounds present in many plant-based foods and drinks.

In this study, the main protective effect appeared to come from a subclass of flavonoids known as anthocyanins, which are present in berries such as blackcurrants and blackberries, and other fruits, and also certain vegetables, such as aubergines.

The research was led by Dr Xiang Gao, a nutrition research scientist at Harvard School of Public Health in the US, and Dr Aedin Cassidy, a professor of nutrition at University of East Anglia's Norwich Medical School in the UK.

The study adds weight to the growing body of evidence that regular consumption of certain flavonoids may lower the risk for developing a wide range of human diseases, such as high blood pressure, heart disease, dementia, and some cancers.

However, it is the first to show the compounds may protect neurons against brain diseases such as Parkinson's, as Cassidy explained in a statement:

"This is the first study in humans to look at the associations between the range of flavonoids in the diet and the risk of developing Parkinson's disease and our findings suggest that a sub-class of flavonoids called anthocyanins may have neuroprotective effects."

Parkinson's is a neurological disease where the death of certain cells in the brain means it does not have enough dopamine, which in turn affects ability to control movement so that it takes longer to do things.

The disease is progressive, so symptoms, such as tremor, rigidity and slowness of movement, gradually get worse with time.

The disease affects around one in 500 people, which equates to 127,000 people in the UK. There is no cure, and very few effective drug therapies.

For the study, the researchers analyzed data from 49,281 men who took part in the Health Professional Follow-up Study and 80,336 women who took part in the Nurses' Health Study. Both cohorts are based in the US.

Over the 20 to 22 years of follow-up, 805 of the participants (438 men and 367 women), developed Parkinson's Disease.

The data was sufficiently detailed to allow the researchers to assess habitual intake of five major sources of flavonoid-rich foods (tea, berry fruits, apples, red wine, oranges, and orange juice), both in terms of total flavonoid intake, and also in terms of subclasses of flavonoids.

For the analysis, the researchers ranked participants according to flavonoid intake, into quintiles: that is the 20% with the lowest intake, then the 20% with the next lowest intake and so on, and after taking into account potential confounders such as age, lifestyle, and so on, looked at the link between the quintiles and risk for Parkinson's Disease.

They found that in men, participants in the highest quintile of total flavonoid intake had a signifincat 40% lower risk for Parkinson's Disease than those in the lowest quintile of total flavonoids (the Hazard Ratio, HR, was 0.60; with 95% confidence interval ranging from 0.43 to 0.83, and p trend = 0.001).

No such significant relationship for total flavonoids was seen in women (p trend = 0.62).

However, pooled analyses (men and women together) that examined subclasses of flavonoids, did show some significant reductions in risk for Parkinson's, as Gao explained:

"Interestingly, anthocyanins and berry fruits, which are rich in anthocyanins, seem to be associated with a lower risk of Parkinson's disease in pooled analyses."

The analysis showed that those participants who consumed the most anthocyanins had a 24% lower risk for developing Parkinson's disease compared to those who consumed the least.

The most common source of anthocyanins in the participants' diet were strawberries and blueberries.

Also, "Participants who consumed one or more portions of berry fruits each week were around 25 per cent less likely to develop Parkinson's disease, relative to those who did not eat berry fruits," said Gao.

Gao said these findings, together with the other potential health benefits of eating berry fruits shown in other studies, such as lowering blood pressure, suggest "it is good to regularly add these fruits to your diet".

He, Cassidy and colleagues said they can't rule out that these protective effects may have come from other compounds, and the findings must now be confirmed by other large epidemiological studies and clinical trials.

Dr Kieran Breen, director of research at Parkinson's UK, said the results look interesting, but there are still a lot of questions to answer: there is a lot "more research to do before we really know how important diet might be for people with Parkinson's", he added.
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Diesel Exhaust Fumes Cause Cancer, WHO

Following a week-long meeting of international experts, the World Health Organization's (WHO's) cancer panel has classified diesel engine exhaust as carcinogenic or cancer-causing to humans, more than 20 years after it was classified as "probably carcinogenic to humans".

The International Agency for Research on Cancer (IARC) told the press on Tuesday that it had based its decision on "sufficient evidence that exposure is associated with an increased risk for lung cancer".

The new decision follows an IARC Monographs Meeting that took place from 5 to 12 June in Lyon, France, and places diesel engine exhaust in Group 1, alongside more than 100 other agents such as tobacco products, asbestos, benzene, UV rays and secondhand smoke.

The panel also noted that there was a link between exposure to diesel engine exhaust and higher risk of bladder cancer.

In 1988, IARC classified diesel exhaust as "probably carcinogenic to humans" (Group 2A). An advisory group said in 1998 that this classification should be reviewed.

Concerns about the cancer-causing potential of diesel exhaust have been rising, particularly after the publication of a number of epidemiological studies of workers in various settings.

The most recent evidence came in March 2012, when the Journal of the National Cancer Institute (JNCI) published a large study by the US National Cancer Institute and the National Institute for Occupational Safety and Health of underground miners' exposure to diesel engine emissions, that showed an increased risk of death from lung cancer in exposed workers.

Dr Christopher Portier, who chaired the IARC working group that reviewed the evidence, said:

"The scientific evidence was compelling and the working group's conclusion was unanimous: diesel engine exhaust causes lung cancer in humans."

"Given the additional health impacts from diesel particulates, exposure to this mixture of chemicals should be reduced worldwide," said Porter, who is Director of the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry at the US Centers for Disease Control and Prevention (CDC).

Diesel exhaust fumes in traffic
People are exposed to diesel engine exhaust every day, whether at work or just through ambient air, says the IARC. These fumes come not only from cars and buses but also from other engines such as those in diesel trains, ships and power generators.

The panel also reviewed the evidence on gasoline (petrol) exhaust and concluded it should remain in the "possibly carcinogenic to humans" category (Group 2B), where it has been since 1989.

The IARC says there is now sufficient evidence for governments and decision makers to formulate environmental standards for diesel exhaust emissions and to work with engine and fuel manufacturers to attain these targets.

Dr Christopher Wild, Director of IARC, said the new ruling "sends a strong signal" for action to protect public health. He said action is "needed globally, including among the more vulnerable populations in developing countries where new technology and protective measures may otherwise take many years to be adopted".

More developed countries in North America, Europe and elsewhere have already been tightening up emission standards for diesel and gasoline/petrol engines, and as standards become more stringent, so the technology improves, which in turn allows standards to tighten further. Such changes have reduced sulfur content in fuel, increased efficiency in diesel engines, and led to reductions in exhaust emissions.

But fuels and engines that don't have these modifications are still around, and it may be many years before they are replaced, particularly in less developed countries with less stringent standards, said the IARC panel, noting that many developing countries don't have any regulation at all.

They also said there was limited information on the amount and health impact of diesel exhaust emissions on the general public.

Dr Kurt Straif, Head of the IARC Monographs Program, said that most of the evidence they reviewed was from studies that examined highly exposed workers.

"However, we have learned from other carcinogens, such as radon, that initial studies showing a risk in heavily exposed occupational groups were followed by positive findings for the general population. Therefore actions to reduce exposures should encompass workers and the general population", he added

Since 1971, the IARC has evaluated more than 900 agents, of which more than 400 have been identified as carcinogenic, probably carcinogenic, or possibly carcinogenic to humans.

A summary of the panel's evaluation is due to be published in an early online issue of The Lancet Oncology on 15 June.
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Gerber Baby Foods Recalled Because Of Strange Smell

The FDA and the Gerber Products Company yesterday announced the recall and replacement of Gerber Good Start Gentle powdered infant formula, in 23.2 ounce plastic packaging. The FDA (Food and Drug Administration) wrote on its website that the recall is limited to batch GPX1684, expiring on March 5th, 2013. According to authorities, there have been reports of bad odors.

Gerber and the FDA emphasized that for those who have consumed the product, is not dangerous for health and poses no safety risk. There have also been some reports of babies spitting the food up, as well as some minor gastrointestinal signs and symptoms.

Of you have purchased the above-mentioned product with the same batch code and expiration date, you can call 1-800-487-7763 (Gerber Parents Resource Center), and a replacement will be offered.

Gerber says it is liaising closely with retail outlets to get any remaining products off the shelves.

Gerber stresses that this recall is limited only to Gerber Good Start Gentle powder, with the above-mentioned batch number and expiration date - all other baby products are fine.

Gerber® Good Start® Infant Formula

Batch number and expiration date
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How Many Calories Should I Eat?

The number of calories people should eat each day depends on several factors, including their age, size, height, sex, lifestyle, and overall general health. A physically active 6ft 2in male, aged 22 years, requires considerably more calories than a 5ft 2ins sedentary woman in her 70s.

Recommended daily calorie intakes also vary across the world. According to the National Health Service (NHS), UK, the average male adult needs approximately 2,500 calories per day to keep his weight constant, while the average adult female needs 2,000. US authorities recommend 2,700 calories per day for men and 2,200 for women. It is interesting that in the UK, where people on average are taller than Americans, the recommended daily intake of calories is lower. Rates of overweight and obesity among both adults and children in the USA are considerably higher than in the United Kingdom.

The NHS stresses that rather than precisely counting numbers (calories), people should focus more on eating a healthy and well balanced diet, being physically active, and roughly balancing how many calories are consumed with the numbers burnt off each day.

According to the United Nation's Food and Agriculture Organization (FAO), the average person's minimum calorie requirement per day globally is approximately 1,800 kilocalories.

Worldwide food consumption
Daily calorie consumption varies considerably around the world (countries in gray indicates "no data available")

What is the difference between calories and kilocalories?

Scientifically speaking, one kilocalorie is 1,000 calories. However, the term calorie in lay English has become so loosely used with the same meaning as kilocalorie, that the two terms have virtually merged. In other words, in most cases, a calorie and kilocalorie have the same meaning.

A kilocalorie is the amount of energy required to raise the temperature of 1 kilogram of water from 15° to 16° Celsius (centigrade) at one atmosphere.

A "small calorie" refers to the traditional scientific term of calorie, meaning one-thousandth of a kilocalorie.

Internationally, most nations talk about food energy in kJ (kilojoules). 1 kcal (kilocalorie) = 4.184 kJ.

In this article, the term "calorie" means the same as "kilocalorie" or "kcal".

Portion sizes

In industrialized nations and a growing number of emerging economies, people are consuming many more calories than they used to. Portion sizes in restaurants, both fast food ones as well as elegant places, are far greater today.
Comparing cheeseburger sizes over the last 20 years
The average cheeseburger in the USA 20 years ago had 333 calories, compared to the ones today with over 600 calories

The human body and energy usage

For the human body to remain alive, it requires energy. Approximately 20% of the energy we use is for brain metabolism. The majority of the rest of the body's energy requirements are taken up for the basal metabolic requirements - the energy we need when in a resting state, for functions such as the circulation of the blood and breathing.

If our environment is cold, our metabolism increases to produce more heat to maintain a constant body temperature. When we are in a warm environment, we require less energy.

We also require mechanical energy for our skeletal muscles for posture and moving around.

Respiration, or specifically cellular respiration refers to the metabolic process by which an organism gets energy by reacting oxygen with glucose to produce carbon dioxide, water and ATP energy. How efficiently energy from respiration converts into physical (mechanical) power depends on the type of food eaten, as well as what type of physical energy is used - whether muscles are used aerobically or anaerobically.

Put simply - we need calories to stay alive, even if we are not moving, and need calories to keep our posture and to move about.

How many calories do I need per day?

The Harris-Benedict equation, also known as the Harris-Benedict principle, is used to estimate what a person's BMR (basal metabolic rate) and daily requirements are. The person's BMR total is multiplied by another number which represents their level of physical activity. The resulting number is that person's recommended daily calorie intake in order to keep their body weight where it is.

This equation has limitations. It does not take into account varying levels of muscle mass to fat mass ratios - a very muscular person needs more calories, even when resting.

How to calculate your BMR
  • Male adults
    66.5 + (13.75 x kg body weight) + (5.003 x height in cm) - (6.755 x age) = BMR
    66 + ( 6.23 x pounds body weight) + ( 12.7 x height in inches ) - ( 6.76 x age) = BMR

  • Female adults
    55.1 + (9.563 x kg body weight) + (1.850 x height in cm) - (4.676 x age) = BMR
    655 + (4.35 x kg body weight) + (4.7 x height in inches) - (4.7 x age) = BMR
You can use our BMR calculator below to work out your BMR.

BMR calculator

1) Metric Calculator
Age (in years):
(in cm, e.g: 183)
(in kg, e.g: 63)
2) Imperial Calculator
Age: (in years)
feet: inches:
stones: pounds:

Applying levels of physical activity to the equation
  • Sedentary lifestyle - if you do very little or no exercise at all
    Your daily calorie requirements are BMR x 1.2

  • Slightly active lifestyle - light exercise between once and three times per week
    Your daily calorie requirements are BMR x 1.375

  • Moderately active lifestyle - if you do moderate exercise three to five days per week
    Your daily calorie requirements are BMR x 1.55

  • Active lifestyle - if you do intensive/heavy exercise six to seven times per week
    Your daily calorie requirements are BMR x 1.725

  • Very active lifestyle - if you do very heavy/intensive exercise twice a day (extra heavy workouts)
    Your daily calorie requirements are BMR x 1.9

How much should I weigh?

As with how many calories you should consume each day, your ideal body weight depends on several factors, including your age, sex, bone density, muscle-fat ratio, and height.
  • BMI (Body Mass Index) - some say BMI is a good way of working out what you should weigh. However, BMI does not take into account muscle mass. A 100-metre Olympic champion weighing 200 pounds (about 91 kilograms), who is 6 feet (about 1mt 83cm) tall, who has the same BMI as a couch potato of the same height, is not overweight, while the couch potato is overweight.

  • Waist-hip ratio - this measurement is said to be more accurate at determining what your ideal weight should be, compared to BMI. However, waist-hip ratio does not properly measure an individual's total body fat percentage (muscle-to-fat ratio), and is also limited.

  • Waist-to-height ratio - this new way of determining ideal body weight is probably the most accurate one available today. It was presented by Dr. Margaret Ashwell, ex-science director of the British Nutrition Foundation, and team at the 19th Congress on Obesity in Lyon, France, on 12th May, 2012. It is also a very simple calculation; easy for lay people to work out.
Dr. Ashwell's team found that:

"Keeping your waist circumference to less than half your height can help increase life expectancy for every person in the world."

Put simply, to achieve and/or maintain your ideal body weight:
    "Keep your waist circumference to less than half your height."
If you are a 6ft (183cm) tall adult male, your waist should not exceed 36 inches (91 cm).
If you are a 5ft 4 inches (163 cm) tall adult female, your waist should not exceed 32 inches (81 cm)

How do I measure my waist? - according to the World Health Organization (WHO), you should place the tape-measure half-way between the lower rib and the iliac crest (the the pelvic bone at the hip).

Not all calories are the same, not all diets are the same

Simply counting calories, and ignoring what you put in your mouth might not lead to good health. Insulin levels will rise significantly more after consuming carbohydrates than after eating fats (no rise at all) or protein. Some carbohydrates, also known as carbs, get into the bloodstream in the form of sugar (glucose) much faster than others. Refined flour is a fast carb, while coarse oatmeal is slow. Slow-release carbs are better for body weight control and overall health than fast carbs.

A 500-calorie meal of fish/meat, salad, and some olive oil, followed by fruit, is much better for your health and will keep you from being hungry for longer than a 500-calorie snack of popcorn with butter or toffee.

A chef's salad
Taking 500 calories from this dish is much better for the health, preventing hunger, and maintaining a healthy body weight than the equivalent calories in popcorn with butter or toffee

There are several diets today which claim to help people lose or maintain their body weight. Some of them have been extremely successful and good for participants, but are notoriously difficult to adhere to long-term.
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What Causes Leg Pain?

Leg pain refers to any kind of pain that occurs between the heels and the pelvis. There are many reasons for leg pain, and not all of them are caused by a problem that originates in the leg; some injuries or spinal problems can cause aches and pains in the leg(s).

Leg pain can be long-term, transitory, intermittent, acute, or slowly progressive. Pain may affect just part of the leg, such as the knee, or the whole limb. Leg pain may be felt as tingling, sharp, dull, an ache, or a stabbing sensation.

Some leg pains may be just a nuisance, in some cases the cause may never be found, other leg pains may be a sign of a more serious disease or condition, even a life-threatening one.

Leg pain caused by trauma

Trauma has a medical and psychiatric meaning. In this text, it refers to the medical meaning. Trauma is a serious injury, wound or shock, and can include broken bones, damage to bones, damage to muscles, joint injury, or a combination.

Even trauma to the back, if the sciatic nerve becomes inflamed, can cause pain that makes its way down the leg along the sciatic nerve (sciatica). Overusing some part of the leg can also lead to injuries.
  • Fractures - fracture refers to any kind of break in bone, and sometimes cartilage. Not all bone fractures are caused by trauma - patients with osteoporosis may have such weak bones that they fracture with the minimum of pressure. Fractures are common causes of leg pain, and occur when nerve endings in the tissue that surround the bone (periosteum) send pain messages to the brain. Sometimes, a bone fracture can cause muscles to spasm, which further exacerbates the pain.
  • US Navy 090207-N-7090S-066 Lt. j.g. Gina Shaw treats shin splints by wrapping her leg in ice after her 8 Kilometer run after competing in the 2009 Armed Forces Cross Country Championship
    A runner wraps leg in ice to treat shin splints after running 8 kilometers in the 2009 Armed Forces Cross Country Championship

  • Shin splints - medically known as medial tibial stress syndrome, refers to pain just behind the tibia (shinbone) or along it. Shin splints occur when too much force bears down on the shinbone and connective tissue that connect muscle to the bone. Runners and those who take part in stop-start activities, such as squash, tennis, soccer or basketball are more likely to suffer from shin splints. Symptoms may include soreness, pain or tenderness, and sometimes mild swelling in the affected area.
  • Strains and/or sprains - strains are injuries to tendons or muscles, while sprains are injuries to ligaments. Strains occur when you tear, twist, or pull a muscle. People with a sprain commonly experience acute pain, weakness and muscle spasms. Sprains usually occur as a result of trauma, such as a fall. The area may bruise and the pain can be intense, especially when moving.
  • Compartment syndrome - this is when an increase in pressure and swelling affects a compartment (limited space); the blood vessels, nerves and possibly also the tendons that run through the compartment are affected. Symptoms typically include tingling, numbness, sometimes severe pain, as well as loss of movement in a foot. Eventually, in time, the nerve can become compressed, there may be paralysis, contracture, and even death.
  • Bleeding - an injury to the leg that causes internal bleeding can lead to pain. A build-up of blood can press against tissue, bone and nerve endings. Blood itself is irritating, and can cause inflammation, which is painful.

Other causes of leg pain

Peripheral artery disease (PAD), also known as peripheral arterial disease, or peripheral artery occlusive disease, refers to blockages in large arteries which are not located within the brain, coronary, or aortic arch vasculature. PAD can be caused by atherosclerosis, an embolism or thrombus, or any inflammatory process that leads to stenosis (narrowing of a blood vessel).

Put simply, the blood vessels to the leg become narrower, restricting the blood supply. Pain is felt with physical activity. Pain, weakness, numbness, or cramping in muscles caused by decreased blood flow is known as claudication.

Poor blood supply can lead to several complications, such as ulcers, which can be very painful. (Read the "David Dow" story further down)

Deep vein thrombosis - also known as DVT occurs when a thrombus (blood clot) develops in a deep vein, nearly always in a leg. The clot tends to occur in leg veins, such as the femoral or popliteal veins, but can also develop within the pelvis. The thrombus can break off and make its way to the lung, causing a pulmonary embolism.

Some patients may have a DVT and not be aware of it; there are no symptoms. If symptoms do emerge, they will include swelling, pain, tenderness, and warmth in the affected area. Usually, the pain starts in the calf. In some cases the skin may go red, especially at the back of the leg below the knee. Surface veins may become engorged.

Sciatica - this occurs when the sciatic nerve is irritated. Pain radiates from the lower back, all the way down to below the knee, via behind the thigh and buttocks. Sciatica can have a number of causes, such as a herniated disc that presses directly on the nerve. The pain, which can be severe, is sometimes accompanied by numbness, muscular weakness, tingling and problems controlling or moving the leg. When the weather is very cold, pain may become worse.

Peripheral neuropathy - refers to a problem with function of nerves outside the spinal column, such as in the legs. Symptoms include burning pain (especially when lying down), problem with reflexes, numbness, pins and needles, and weakness. Peripheral neuropathy can be caused by certain medications, kidney failure, vitamin deficiency, and diabetes.

In severe cases, the patient's feet can become too sensitive to touch (even lightly touching the skin hurts). Eventually, the patient may become housebound if shoes and socks cannot be worn and the feet are too sensitive to touch the ground (extreme cases).

Diabetes - patients with diabetes have a higher risk of experiencing leg and/or foot pain - these are due to diabetes complications, such as peripheral neuropathy or some vascular problem that results in poor blood circulation.

Alcoholism - excessive alcohol can have a damaging effect on the brain, peripheral nerves and muscles. Common symptoms linked to alcoholism include (in the leg) burning pain, tingling, muscle weakness, sensitivity to heat, and tingling.

Cancer - the most common symptom of bone cancer is pain. Other cancers, such as prostate cancer that has spread (metastasized), may also cause pain in the pelvic area and upper leg area. Ovarian or cervical cancer may also cause leg pain.

Shingles - symptoms of shingles include pain in various parts of the body, including the legs.

Arthritis - affects the musculoskeletal system, especially the joints. Arthritis is the main cause of disability among individuals aged over 55 years in wealthy nations. It is not a single disease, but a term that covers over 100 medical conditions, of which osteoarthritis is the most common.
    Rheumatoid arthritis joint
  • Osteoarthritis - the cartilage loses elasticity, becomes stiff and consequently damages more easily. The cartilage will gradually wear away in some areas, causing tendons and ligaments to become stretched, resulting in pain. Joints in the leg may start rubbing against each other, causing intense pain.
  • Rheumatoid arthritis - this is a form of arthritis with inflammation. The synovium (synovial membrane) is attacked, causing swelling and pain. Symptoms can come and go, and may include stiffness, swelling, and pain in the joints.
  • Infectious arthritis (sebptic arthritis) - the synovial fluid and tissues of a joint become infected; usually by bacteria, but possibly by a virus or fungus. The pathogen spreads through the bloodstream of nearby infected tissue, and infects a joint. The patient may experience chills, general weakness, fever, problems moving the limb, severe pain in the infected joint, especially when trying to move. The joint will also swell and feel warm.
Myalgia - muscle pain. This could be caused by an infection, overusing or overstretching a muscle or group of muscles. Sometimes it is a symptom of chronic fatigue syndrome.

Muscle cramps - these may be extremely painful and can have many causes, such as not stretching properly, an electrolyte imbalance, exposure to large changes in temperature, or dehydration.

Hamstring injury - this occurs when one of the hamstring muscles is pulled or strained. Hamstring muscles run along the back of the thigh. In some cases, the muscle tears completely or partially. The patient may feel a sharp, sudden pain in the back of the thigh during physical activity. Some describe it as a tearing or popping sensation. A few hours after the injury, there may be some tenderness or swelling, as well as bruising.

Torn hammie
Bruising caused by strained hamstring. The horizontal lines were caused by the bandaging

The story of David Dow and his leg pains

David Dow thought his leg pains were due to a back problem. As you will read further on, the pain actually saved his life. David was a seemingly healthy male, aged 57. He suspected nothing serious, and thought that perhaps some back-strengthening exercises with a personal trainer would be good for him.

Workouts were done perfectly, and his back got stronger. However, the leg pain just got worse - so much so, that eventually it became a struggle to make it from his car to the grocery store entrance. David, and also his trainer wondered whether there might be something more serious going on.

He saw his doctor, who ordered some diagnostic tests. It turned out that he had blockages in the blood vessels in his legs. He was astonished to discover that the arteries that went to his lower extremities were almost 100% blocked. Why? The doctor told him that after years of regular smoking, consuming meals high in animal fats, and some other factors, cholesterol, scar tissue, and blood clots accumulated inside the blood vessels.

Most lay people do not associate clogged artery disease and/or arteriosclerosis with the legs, but rather the heart. In David's case, this was developing all over his body - he had PAD (peripheral arterial disease).

PAD can cause leg pain. In fact, experts say it is an "early warning" that a heart attack or stroke is looming.

James Stanley, M.D., a director of the University of Michigan CVC, and the vascular surgeon who operated on David, said:

"This is the hallmark of a disease that's all over. It's like gray hair you don't just get it on one side of your head. So if you've got this kind of blockage in your leg, you're going to have it other places."

Dr. Stanley explained that almost one quarter of those with PAD-associated leg pain die within five years, mainly from a heart attack or some other heart problem. Those with David's symptoms - hardly able to walk to the shop from his car - are even more likely to die within five years.

David was lucky. He was diagnosed and treated in time. He has a bypass operation to open his blocked leg arteries. His doctor says he is fine now.

David said:

"For sure, it's a wake-up call. You know that old saying, 'Where there's smoke, there's fire'? I'm sure that I not only have the vascular issues in my lower extremities, but I'm sure I have them in other parts of my body."

David gave up smoking and has adopted some urgently needed lifestyle changes.

Dr. Stanley explained that nearly 30 million Americans have some kind of PAD, and most of them without any symptoms. Nearly one in every five 70 year-old American has PAD.
PAD can lead to tissue loss, ulcerations, and even gangrene

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