5 small diet changes that can contribute to big weight loss

 

There’s no one-size-fits all approach to eating better. As a nutritionist, some clients I meet with are ready and willing to dive head first into a complete dietary overhaul, and, most important, can actually stick with it.
Others— especially those who, in the past, have tried to make too many changes too fast that ultimately fizzled out— find it easier to transition slowly into eating differently. Folks in this group will often ask, “Okay, if I can only focus on one thing what should it be?” My response varies based on their goals, but if you want to lose weight, here’s my list of five simple diet tweaks that can ultimately make a huge difference. The strategy: Start with just one change, and when it feels like part of your usual eating routine, add another. Once that change feels like second nature, add another, and so on. It may take a little longer to see big results, but for many, a stepladder approach to transforming your eating means making changes that really stick down the road.

Eat more fiber
A recent National Institutes of Health (NIH) study found that people who were simply asked to eat more fiber (30 grams a day from food, not supplements) lost almost as much weight as those asked to follow a more comprehensive eating plan with over a dozen different directives. There was also, unsurprisingly, a lower drop-out rate in the fiber-eating group. Plus, researchers found that by focusing on fiber alone, the participants naturally ate fewer fatty and sugary foods, because those were “crowded out” by fiber-rich choices. To try doing this yourself, up your intake of fresh veggies and fruit, especially those with edible stalks, skins, membranes and seeds (e.g. broccoli, artichokes, raspberries, apples, and oranges); snack on nuts and seeds; switch from refined grains (like white rice) to whole grains (brown or wild), and make pulses— that is, peas, lentils, and beans— menu staples by adding them to salads or serving them a side dish to an omelet, in a soup, or as a bed for grilled fish.


Nix diet drinks and artificial sweeteners
Many clients I work with are amazed at how their appetites change once they’ve stopped consuming artificial sweeteners. I’ve heard things like “My constant cravings for sweets are gone” and “I always felt hungry, even an hour after eating, but now I know what actual hunger feels like.” Effects like these are backed by recent animal research. For example, a Yale study found that when hungry mice were given a choice between artificial and real sugar, they tended to choose the real thing, even if the artificial sweetener was much sweeter. The scientists’ conclusion: The brains of mice— and possibly humans— can’t be tricked with the fake stuff, and relying on artificial sweetener may actually up cravings for sweets overall. Artificial sweeteners have also been shown to disrupt gut bacteria in ways that may up the risk of obesity. Can’t seem to kick your soda habit? Try doctoring water up by adding in lemon or lime, sprigs of fresh mint, fresh grated ginger, or a bit of mashed fruit.

Swap some of your starches for non-starchy veggies
I recently talked to a client who eats at Chipotle often. While his choice of a tortilla-free burrito bowl was a good one, he was still consuming too many carbs to get the scale moving downward. Switching to a salad with greens as the base and asking for smaller scoops of brown rice and black beans on top left him just as full and satisfied, but with half the carbs. You can make the same kind of tweak at home. Rather than a cup of cooked whole-grain penne, cut back to a half-cup, and add a quarter-cup each of fresh spinach, chopped tomato, sliced mushrooms, and minced onion. This switch will save you about 15 grams of carbohydrate and increase the volume of your meal so you actually feel fuller after eating it. Other ways to cut back on carbs without cutting them out completely include ordering a chopped salad with a small scoop of quinoa or chickpeas in it, rather than a wrap, and using lettuce in place of a bun for your burger paired with a small side of starch, like baked sweet potato “fries.”
Make dark chocolate your dessert
This one change has helped many of my clients shave hundreds of surplus calories from their diets each week, and start to slim down as a result. Half of a three-ounce bar of one of my favorite brands of dark chocolate contains just 200 calories and 21 grams of carbs. Compare that to a chocolate-chip cookie from Panera bread (440 calories, 58 grams of carbs) or chocolate croissant from Starbucks (370 calories, 46 grams of carbs). Bonus: Research has shown that making dark chocolate a daily treat can help curb cravings for both sweet and salty foods.


Cut back on booze
In addition to the calories they add to your diet— way more than you probably think— alcoholic beverages tend to be major diet derailers. I’ve had countless clients tell me that after a drink or two, they suddenly adopt an “Oh, screw it” attitude about eating, and wind up not only nibbling on foods within arm’s reach (chips and salsa, or bread and butter at a restaurant, pretzels at the bar), but also eating foods they wouldn’t reach for sober, and downing much larger portions to boot. You don’t have to become a teetotaler to shed pounds, but consciously cutting back to, say, one night per week, setting a max of two drinks, and downing a tall glass of water with every cocktail can help you shed serious pounds.
Cynthia Sass is a registered dietitian and Health’s contributing nutrition editor. She privately counsels clients in New York, Los Angeles, and long distance, and is the sports nutrition consultant to the New York Rangers NHL team and the New York Yankees MLB team.

Tests for new cancer drugs not reliable enough, doctors say

Drugmakers including Bristol-Myers Squibb Co and Merck & Co are testing which patients will most benefit from new cancer treatments based on a protein found in their tumors, but that guide, known as a biomarker, may be too unreliable, researchers and health experts said.
Bristol's Opdivo and Merck's Keytruda are both therapies designed to block a protein known as Programmed Death receptor (PD-1) that tumors use to evade the body's natural defenses. Competitors Roche Holding, AstraZeneca and Pfizer also have similar drugs in an earlier stage of development. The drugmakers are conducting clinical trials that test patient tumors for a related protein called PD-L1.
The new drugs are mainly aimed at patients with so-called solid tumors suffering from diseases including lung cancer and liver cancer. Lung cancer, the most common type, claims 1.8 million new cases each year worldwide. Sales of drugs to block PD-1 could reach $33 billion a year by 2022, according to Morningstar.
New data published on Friday showed that Opdivo was most helpful to lung cancer patients with the highest levels of PD-L1 in their tumors, adding to evidence of a link. That would suggest that doctors routinely test for the protein before giving a patient Opdivo. The approach is already used for some cancer drugs that are prescribed only if a patient has a specific genetic mutation.
Cancer experts interviewed by Reuters at the American Society of Clinical Oncology meeting in Chicago, however, said that use of protein levels in a tumor as a guide for treatment cannot be counted on in the same way as a genetic variation.
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Test results can vary depending on which part of the tumor was biopsied and the degree to which the cancer has spread. In addition, tests developed by drugmakers don't follow the same standards.
So while clinical trials show that drugs like Opdivo and Keytruda work best in people who test positive for PD-L1, some patients who test negative have benefited from the treatment.
"We shouldn't withhold immunotherapy from patients based on a biomarker yet," said Dr Roy Herbst, chief of medical oncology at Yale Cancer Center in New Haven, Connecticut, referring to Opdivo. "We don't even know if PD-L1 is the right biomarker."
Dr. Richard Pazdur, the U.S. Food and Drug Administration's oncology chief, also cautioned that there is still a great deal of uncertainty about how to best measure for PD-L1.
"The key issue is whether the biomarker is essential for safe and effective use of the drug," Pazdur said. "If not, then it is probably not going to be an essential element in the indications for the drug. But it would be useful information."
WHO GETS A COSTLY DRUG?  
Health insurers would also be keen to have a surefire test of when a novel, and expensive, cancer drug is most likely to work. Treatment with Opdivo or Keytruda alone costs about $12,500 a month in the United States, or $150,000 a year.
Pfizer's Xalkori, another new, expensive drug, is approved by the FDA only for patients with a mutation of the ALK gene. A diagnostic test must be used to identify the estimated 4 percent of patients with non-small cell lung cancer who are likely to improve using Xalkori.
Current approvals for PD-1 drugs do not require tumor testing. Bristol's Opdivo, or nivolumab, was approved by the FDA in December to treat advanced melanoma. In March, it was cleared to treat a form of lung cancer, giving Bristol an early advantage in the much larger market. Merck's Keytruda, or pembrolizumab, has been approved for advanced melanoma since September and is awaiting approval as a lung cancer treatment.
Another confounding factor is that drugmakers are combining Opdivo and Keytruda with other treatments to boost their effect, from well-established medications like chemotherapy to experimental compounds.
In a small trial of patients with advanced lung cancer, AstraZeneca's experimental PD-L1 antibody, MEDI4736, was given in combination with tremelimumab, which targets a different immune system inhibitor. Nearly half of patients who were negative for PD-L1 responded to the treatment.
"It seems like the PD-L1 negative patients are now responding as well," said Bahija Jallal, executive vice president at AstraZeneca's MedImmune unit. "That was the whole point of doing the combination."
A Bristol-Myers trial found melanoma patients whose tumors contained PD-L1 fared just as well with Opdivo alone as with a combination of Opdivo and a second immunotherapy, Yervoy. But patients without PD-L1 detected in their tumors lived more than twice as long without their disease getting worse when treated with both drugs.
Around 80 percent of melanomas test positive for PD-L1, compared with around 50 percent of lung cancers, said Eric Rubin, Merck vice president, global clinical oncology. At the same time, levels of PD-L1 are not static.
"If I check it today, it might change tomorrow. It might be different in one area of the tumor than in another area," said Dr. Richard Carvajal, director of melanoma service at Columbia University Medical Center in New York.
Drug companies are working to refine and standardize their PD-L1 testing, as well as exploring other ways to identify which patients will benefit from immunotherapies.
Data presented at ASCO showed that Opdivo helped patients with certain cancers, including colon cancer, whose tumors exhibited an uncommon defect in genes needed for DNA repair. Drugmakers are also trying to discover if there are any "negative" biomarkers to indicate which patients should not be treated with immunotherapies.
"We are taking account of how the immune system is interacting with the tumor. It's a completely different type of biomarker and understanding," said Sandra Horning, chief medical officer at Roche's Genentech unit.

What is gastric banding?

Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach using a laparascope. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin of the abdomen. This port is used to introduce or remove saline into the band.

LAGB ultimately restricts the size of the stomach and the amount of food it can hold. It also slows the passage of food to the intestine. By doing so, signals to the brain from the gut allow for a sensation of fullness and satiety with the consumption of less food. This signal is sent from a small pouch created by the band in the upper stomach. When the pouch fills, the same signal is sent to the brain that occurred previously when the entire stomach filled.

What is a lap band?

The LAP BAND® is a specific device brand name and is made by Allergan Inc. The term is often used in the lay community interchangeable with gastric banding (similar to the way we interchange the brand name Kleenex for facial tissue). There are different sizes and models of the LAP BAND. There are also other companies that make gastric banding devices such as the REALIZE® adjustable gastric band (by Ethicon), the MIDBAND®, and the Heliogast® gastric band (which are not available in the US).

Who are candidates for the lap band system?

Generally, candidates for LAGB have a body mass index over 40 kg/m2, or are more than 45 kilograms over their ideal body weight. LAGB can be performed on a person with a BMI of 35-40 kg/m2 if there are problematic medical conditions that are weight-related, such as high blood pressure (hypertension) ordiabetes.

Most surgeons and programs will want to note a history of failed weight lossin the past using more conventional approaches. The procedure is indicated for adults only, and is not to be performed on those less than 18 years old. All patients must demonstrate an understanding of the procedure, and be willing to adhere to the lifestyle changes that are needed to make this procedure successful. Most large centers have a psychological assessment to assure that this last criteria is met.

LAGB is usually contraindicated if the potential patient has difficulty understanding the procedure, is emotionally unstable, or is dependent on drugs or alcohol. Those potential cases with a history of gastrointestinal problems such as ulcers need to be reviewed carefully. Similarly, those that have underlying medical conditions that make them high risk for surgery- such as heart or lung conditions- may be refused the procedure. Associated with these risks is a BMI of greater than 50kg/m2. In this group, there may be a request to lose weight prior to the procedure (although this seems paradoxical). Again, the risks of the procedure in this subgroup of obese patients may outweigh the benefits of surgery. By dropping the BMI under 50 kg.m2, outcomes may be better.

While there is growing discussion about offering LAGB to those with a BMI of 30-35 who have diabetes, there are no current guidelines to allow for this.

How is the lap band (LAGB) procedure performed?

Lap band or LAGB is a surgical procedure done under full general anesthesia and takes about 1 to 2 hours to perform. It is done using a laparoscopic technique. This involves making 3 to 5 small incisions, each about 1 inch in length. The surgeon inserts a small camera attached to a tube into one of these incisions and views the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band. The gastric band is placed around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.

How do I prepare for lap band surgery?

Depending on the surgeon or the program, the preparation for surgery will vary. Many centers like to see a commitment from the patient to the necessary lifestyle changes even before surgery. It may be suggested that the patient start eating 5 to 6 small meals a day to prepare for the changes ahead. It may be recommended to wean off "slippery" high calorie foods such as ice cream or milk shakes (since these will continue to be easily absorbed after the procedure).

If the BMI is greater than 50, or if there are other medical issues, medical risk reduction may be needed preoperatively and should be discussed in detail. In addition, a weight loss of 5% to 10% prior to surgery has been shown to improved post operative outcomes, and may be a goal that your surgeon or preoperative care team will discuss with you.

How long is the recovery after lap band surgery?

Recovery varies with each individual. However, in general, LAGB offers a shorter hospitalization and quicker recovery than gastric bypass procedures. In general, most people can return to work 1 week after surgery (if their job is not too physically demanding). Normal activity can usually resume after 6 weeks. 

What is a lap band fill?

A lap band "fill" is the common term for gastric band adjustments. Once surgery is performed, there is a period of healing that must take place before the first adjustment. Usually, the first fill takes place around 6 to 8 weeks. It involves injecting saline into the port just under the skin which is connected to the band. Prior to this, there may be little change in appetite. Fills are painless and are usually performed by the surgeon who performed the procedure. These adjustments may take place to enhance weight loss, especially if there is a plateau phase in weight loss, and they may to performed to overcome side effects such as nausea and vomiting (in this latter case, the band is loosened).

What can I expect my lifestyle to be after lap band surgery (LAGB)?

Immediately after surgery, there will be some pain and discomfort that can be controlled with medications. This is part of the normal recovery phase after any surgical procedure. After 6 to 8 weeks, one can generally return to normal activities. Weight loss with LAGB is a gradual process. Initially, the weight loss may be more dramatic- say 2 to 3 pounds per week. However, this generally slows to a pound or so weekly over the long-term. Naturally, the food choices made will govern this weight loss rate. After about 18 months, the weight loss tends to slow significantly. The average weight loss for this procedure is 40% of excess body weight in the first year, with an additional 10% to 20% in the second year. Patients are usually asked to keep in contact with their surgeon regularly during this time period as further band adjustments may be needed. 

What are the side effects of lap band surgery (LAGB)?

Side effects include nausea and vomiting, ulceration at the band site, esophageal reflux (indigestion), weight regain, anddehydration. Since this type of surgery is restrictive and does not cause malabsorption of nutrients, vitamin deficiencies are not usually seen. However, many centers recommend multivitamin supplementation. Constipation is commonly encountered.

What are the risks and complications of lap band surgery (LAGB)?

LAGB has a low risk of surgical complications compared to other weight reduction procedures. The mortality (death) rate is about 1 in 2000. There is the possibility of the band slipping or eroding into the stomach and of mechanical malfunction. Other complications may include infection, bleeding, and/orabdominal pain.

What type of surgeon performs lap band surgery (LAGB)?

When choosing a surgeon, it is important to search for one who is a qualified bariatric surgeon. In general, practice makes perfect, and the more surgeries performed the better. A surgeon performing 100 or more procedures annually is likely going to have better outcomes. A surgeon who is part of a clinical team of nutritionists, nurses, psychologists, and physicians in general can provide better counseling and support in the pre- and postoperative period.

Medically reviewed by Martin E Zipser, MD; American board of Surgery

REFERENCES:

Dixon JB., O'Brien PE. Changes in comorbidities and improvements in quality of life after LAP-BAND placement. The American Journal of Surgery, December 2002; Vol 184: pp S51-S54.

Favretti F., Ashton D., Busetto L., Segato G., De Luca M. The Gastric Band: First-Choice Procedure for Obesity Surgery. World Journal of Surgery, October 2009; Vol 33(10): pp 2039-48.

Ren CJ., Horgan S., Ponce J. US experience with the LAP-BAND system. The American Journal of Surgery. December 2002; 184(6B): pp 46S-50S.

Why the Weight Gain?

Obvious reasons for weight gain are taking in more calories than usual or reducing the amount of physical activity in your life. However, some people seem to gain weight even when they are eating and exercising the same as always. Let's look deeper at possible reasons for weight gain.

Part Of Gastric Bypass Benefit Could Be Change In Gut Microbes

A new study suggests some of the weight loss that patients experience after gastric bypass surgery could be a result of changes in the mix of microbes in their gut. The researchers say manipulating microbe populations may offer an alternative treatment for obesity, for instance for patients who can't have gastric surgery.

Lee Kaplan, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital (MGH), and colleagues, write about their findings in the 27 March online issue of Science Translational Medicine.

Previous studies have shown that the gut microbes of obese people and rats are different to those of slim individuals. 

And experiments in mice have also demonstrated that transferring samples of gut microbes from obese individuals into germ-free mice causes increase in weight and body fat.

"Our study suggests that the specific effects of gastric bypass on the microbiota contribute to its ability to cause weight loss and that finding ways to manipulate microbial populations to mimic those effects could become a valuable new tool to address obesity," says Kaplan in a statement.

Effects of Gastric Bypass Go Beyond Reducing Food Intake

Gastric bypass refers to a range of surgical procedures that rearrange the stomach and small intestine so they handle food differently. After a gastric bypass the patient's stomach is smaller and the food they eat no longer enters some parts of the stomach and small intestine. 

The result is the patient feels full with less food, and their body can't absorb all the calories from the food they eat.

But curiously, the effects of a gastric bypass go beyond those of just reducing the amount of food the patient can eat.

For instance, if you try to lose weight by dieting, you are likely to feel hungry and less satisfied after eating and crave high-fat and high carbohydrate foods. And your body may undergo metabolic changes that make it stubbornly hang on to that excess weight.

But patients who undergo gastric bypass surgery experience almost the opposite: they report feeling less hungry and more satisfied after eating, and they show more interest and desire for low-calorie foods. Plus they use up more energy after eating, and their hormone levels change to reflect those of appetite and hunger.

Previous studies have show that the mix of microbes in the gut of humans and mice change after gastric bypass surgery, and become more like those seen in slimmer individuals. But what is not clear is whether this is a result of the surgery or the subsequent weight loss.

The Study In Mice

So Kaplan and colleagues decided to investigate how the gut microbes change after bypass surgery. And to find out whether the changes result from the surgery, and how they contribute to the benefits of having the surgery.

For their study they bred obese mice by feeding them a high-fat, high-carbohydrate diet, then put them into three groups. One group underwent a version of a common gastric bypass procedure known as the Roux-en-Y, while the other two had sham operations where some of their gut was cut away then reattached.

One of the groups of mice that had the sham procedure continued on the high-fat, high-carbs diet, while the other group was put on a weight reducing lower calorie diet.

By one week after surgery, the bypass mice were showing significant differences in their gut microbe population. There was a shift toward more of the bacteria found in slim individuals and less of those found in obese individuals.

By three weeks after surgery, the bypass mice had shed 30% of their body weight.

And the two groups of mice who had the sham operations showed no change in their gut microbes, even though the group on the calorie-restricted diet shed the same amount of weight as the bypass mice. 

Tests on the mice's metabolism also showed that the bypass mice were using up more energy than the mice who had the sham operations, even though their physical activity levels were the same.

Kaplan and colleagues then took gut samples from each of the three groups of mice and transferred them into mice that had been bred to have no microbes in their gut.

After two weeks, the germ-free mice that had received gut samples from the bypass mice had shed a significant amount of weight.

But the germ-free mice that received gut samples from the mice that had sham operations (including the group that had lost the same amount of weight as the bypass mice) stayed the same weight.

Clue May Lie In Short-Chain Fatty Acids

The researchers did not investigate how changes in gut microbes cause weight loss, and suggest this is a question that needs to be answered with further studies.

But they did find some clues. For instance, there were differences in the amounts of short-chain fatty acids in the guts of the mice, causing the researchers to wonder if different mixes of microbes process food differently and in such a way that this causes differences in overall metabolism; particularly since we already know short-chain fatty acids help regulate metabolism.

Kaplan, who is also associate professor of Medicine at Harvard Medical School, says we need to find out a lot more about how changes in gut microbes brought about by gastric bypass cause changes in metabolism. 

For instance, gastric bypass surgery results in improvements to diabetes and other metabolic disorders. So to what extent are these improvements the result of changes in gut microbes?

"... and then, we we need to learn if we can produce these effects, either the microbial changes or the associated metabolic changes, without surgery," says Kaplan.

"The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity, one that could help patients unable or unwilling to have surgery," he adds.

Funds from the National Institutes of Health and Ethicon Surgical Care helped finance the study.

In another recent study involving gut microbes and the gases they produce, researchers found that a breath test may indicate how susceptible a person is to developing obesity. 

From bad breath to car accidents, dehydration is a real health threat

It doesn't take much to become dehydrated. Lose just 1.5% of the water in your body (the human body is usually about 60% H2O), and you've reached the tipping point of mild dehydration. It can be brought on by many things — and it can do much more to your body than just make you feel thirsty. Dehydration also brings on health effects ranging from fatigue and smelly breath to more dangerous consequences like distracted driving.

 

It gives you bad breath

It's easy to forget to drink water during a busy workday, but at the end of the day you may find people standing unusually far from you when you open your mouth. "Dehydration can give you bad breath," says Marshall Young, DDS, a dentist in Newport Beach, Calif. "Saliva has important antibacterial properties. When dehydrated, the decreased saliva in the mouth allows bacteria to thrive, resulting in bad breath." So drink up for your own sake, and for those around you as well.

It makes you crave sugar

Dehydration can mask itself as hunger, particularly sugar cravings. This may happen particularly if you've been exercising, says Amy Goodson, RD, sports dietitian for the Dallas Cowboys. "When you exercise in a dehydrated state, you use glycogen (stored carbohydrate) at a faster rate, thus diminishing your stores more quickly." So once you finish exercising, you will likely crave carbs to help you replenish those glycogen levels and get you ready for your next exercise bout.

Related: How to stop eating sugar: 9 easy steps

It wrecks your workout

Even being slightly dehydrated affects your ability to put effort into your workout. "A 2% dehydration level in your body causes a 10% decrease in athletic performance," says Goodson. "And the more dehydrated you become, the worse performance gets." Measured by "perceived exertion," how hard you feel you're exercising, you might be working at a 6 but you feel like you are working at an 8, says Goodson.

It dries your skin out

Keeping skin healthy and glowing requires drinking enough water, says Anne Marie Tremain, MD, a dermatologist with Laser Skin Care Center Dermatology Associates in Long Beach, Calif. "It's best to hydrate from the inside out," she says. "Depending on your lifestyle you may need to adjust your water intake." If you work out every day or are a caffeine fiend, for instance, then you'll need to drink more., because workouts make you sweat and caffeine is a diuretic, which can dehydrate you. For smooth, moisturized skin, Dr. Tremain also suggests keeping showers short (less than five minutes) and using only lukewarm water as hot water can dry your skin out even more.

It may affect your ability to drive safely

Few things are more uncomfortable than being stuck in traffic or on a long drive when you need to use the restroom. Logically, it makes sense to simply not drink water before hitting the road. But new research published in Physiology and Behavior shows that the number of driving errors doubled during a two-hour drive when drivers were dehydrated versus hydrated—an effect similar to driving while drunk (defined by most states as .08% blood alcohol). Since often people purposely avoid drinking prior to a long road trip to prevent bathroom stops, dehydration could increase the risk of traffic accidents.

It makes you tired

A mid-afternoon slump may have more to do with hydration than you think. "When you're dehydrated your blood pressure drops, heart rate increases, blood flow to the brain slows -- all of which can make you tired," says Luga Podesta, MD, sports medicine specialist at Kerlan-Jobe Orthopaedic Clinic in Los Angeles, Calif. A lack of water to muscles also makes physical tasks feel more difficult and tiring.

Related: 14 reasons you're always tired

It sours your mood

Cranky much? Drink a glass of water and your mood may change. "Neurological effects of dehydration can cause irritability," says Dr. Podesta. A small study published in the Journal of Nutrition tested mood and concentration in 25 young women who were either given enough fluids to remain properly hydrated, or who became mildly dehydrated by taking diuretics and exercising. The dehydrated women—who were at a level that was just 1% lower than optimal—reported headaches, loss of focus, and irritability.

It can give you the chills

It may seem counterintuitive, but dehydration can bring on chills. "This occurs because your body starts to limit blood flow to the skin," says Dr. Podesta. In addition, water holds heat, so if you become hydrated it can be more difficult to regulate your body temperature, which can make you become chilled faster, even when you're not in a cold environment.

It can cause muscle cramps

A lack of water causes less blood circulation, which can make muscles cramp up, says Ray Casciari, MD, medical director of the La Amistad Family Health Center in Orange, Calif. "The body will protect its vital organs, so it shifts fluid away from muscles and anything that's not vital," he says. Muscle cramps can be extremely painful, making muscles feel harder than normal to the touch. Changes in sodium and potassium through sweat loss can also contribute to cramping.

It constipates you

Your body needs water to keep things moving through your colon. When you're not getting enough H2O, your body compensates by withdrawing more fluid from stool, making it harder and more difficult to pass. That said, it's worth noting that drinking more water when you're already properly hydrated won't necessarily relieve constipation caused by other factors, like the medications you're taking, medical conditions, or a lack of fiber in your diet.

Related: 15 foods that help you poop

It makes you feel dizzy and foggy

Along with muscles, your brain also gets less blood circulation when you're low on water, which can make you dizzy, says Dr. Casciari. Additionally, mild dehydration may affect your ability to take on mental tasks and cause you to feel foggy headed, according to a study from the British Journal of Nutrition. Interestingly, a study that appeared in the Journal of Nutrition showed greater mood changes in women than in men, both at rest and during exercise.

It can give you a headache

Dehydration can cause headaches in a couple of different ways. "Lack of water affects your body's serotonin levels, which can give you headaches," says Dr. Casciari. In addition, small blood vessels in the brain respond quickly to hydration levels (which is also behind hangover headaches), leading to dull aches and even full-blown migraines. Try downing a glass or two of water the next time you have a headache and you may discover it disappears. You could also eat fruit, which contains a high percentage of water, Dr. Casciari suggests.

 

Drug may boost radiotherapy effect on several cancers

Some tumors grow so fast that their cells become oxygen-starved from inability to hook up to the body's blood supply. Oxygen-starvation usually triggers signals that cause cell suicide, but in some cancers with a faulty p53 tumor suppressor gene - which is found in around half of cancers - the cells carry on growing because the cell-suicide signals fails.

Now, researchers have discovered that giving a class of drugs called AKT inhibitors in combination with radiotherapy may boost the effectiveness of the treatment on tumors with the faulty p53 gene by restoring cell suicide in oxygen-starved cancer cells and making them more radiation-sensitive.
The team - from Cancer Research UK - reports the findings in the Journal of Clinical Investigation.
Dr. Ester Hammond, study leader and Cancer Research UK scientist based at the University of Oxford, says:

"This exciting discovery sheds light on the role of oxygen-starvation in cancer development and suggests that drugs already being trialed in cancer patients could potentially boost the effectiveness of radiotherapy across a range of cancers."
In their study, Dr. Hammond and colleagues found that six genes that normally protect the body against cancer are less active in oxygen-starved cancer cells with a faulty p53 gene.
They found the six genes from analyzing lab-grown cancer cells, and then showed they were also affected by p53 in a range of human cancers, including breast, brain, colorectal, kidney, bladder and melanoma cancers.

Active AKT prevents cell suicide even under oxygen-starvation

The team also found that when two of the genes are inactivated - PHLDA3 and INPP5D - another gene called AKT becomes permanently switched on, which prevents cell suicide, even though the cancer cells are oxygen-starved.
They then tested the effect of AKT inhibitors in lab-grown cancer cells and mice lacking the p53 gene when treated with radiotherapy. The results showed the radiotherapy killed more tumor cells.
The researchers conclude that their results identify a number of factors that influence cell suicide via the p53 gene, and suggest "AKT inhibition may improve radiotherapy response in p53-deficient tumors." Dr. Hammond adds:

"We hope that this important piece of the jigsaw will support ongoing efforts to develop drugs that enhance radiotherapy, so that even more patients can benefit from this cornerstone of cancer treatment."

As more than half of cancer patients receive radiotherapy as part of their treatment, says Eleanor Barrie, senior science information manager for Cancer Research UK, anything that improves the effectiveness of radiotherapy is "great news for patients."
In their discussion of the results, the researchers suggest it is likely that under oxygen-starvation, p53 also has other anticancer roles, other than driving cells to commit suicide, and note it "would be interesting to investigate" whether any of the targets they identified in their study affect other anticancer cell functions under oxygen starvation.
Meanwhile, MNT recently reported how a form of permanent radiotherapy may prolong prostate cancer survival. For that study, researchers compared low-dose-rate prostate brachytherapy (LDR-PB), where seeds of radioactive material are implanted in the prostate - to dose-escalated external beam radiotherapy (EBRT), where beams of radiation are focused on the prostate gland from outside the body.
Five years after treatment, they found that the men treated with LDR-PB were more than twice as likely to be free of prostate cancer as those treated with DE-EBRT.

Tattoos may cause years of infection, itching and swelling

Resarchers at NYU Langone Medical Center in New York find that as many as 6% of New Yorkers who get a tattoo have experienced tattoo-related rash, severe itching or swelling that has lasted more than 4 months and for some, many years.

According to Dr. Marie Leger, senior study investigator and NYU Langone dermatologist, an estimated one in five adults in the US has at least one tattoo.

"Given the growing popularity of tattoos," says Leger, "physicians, public health officials and consumers need to be aware of the risks involved."

Leger, an assistant professor in NYU Langone's Ronald O. Perelman Department of Dermatology, and team's findings appear online in the journal Contact Dermatitison May 27.

The study findings resulted from survey interviews with some 300 adults in New York's Central Park in June 2013. The findings reflect those discovered in studies conducted by European countries - which have only recently begun to monitor medical complications associated with tattoos.

Survey participants ranged in age from 18-69 years, with a majority claiming to have no more than five tattoos (one having 53), with the arm being the most popular tattoo site, at 67%.

"We were rather alarmed at the high rate of reported chronic complications tied to getting a tattoo," comments Leger. She adds that while some adverse skin reactions can be treated with anti-inflammatory steroid drugs, others may require laser surgery.

Surgery is sometimes necessary in extreme cases to remove the tattooed areas of the skin or built-up scar tissue and granular skin lesions, which can rise several millimeters on the skin and cause considerable itching and emotional distress.

The study revealed that areas of skin injected with two of the most common tattoo ink colors, red and black, experienced the most long-lasting complications.

Chemical composition of colored tattoo inks is "poorly understood and not standardized"

Almost half (44%) of chronic reactions were due to red ink, even though only slightly more than a third (36%) had tattoos with red ink. One third of chronic cases involved black ink, while over 90% of the participant's tattoos used black coloring.

Leger states:

"It is not yet known if the reactions being observed are due to chemicals in the ink itself or to other chemicals, such as preservatives or brighteners, added to them or to the chemicals' breakdown over time. The lack of a national database or reporting requirements also hinders reliable monitoring."

Leger indicates that the reality of complications tied to tattooing are partly due to lack of regulatory oversight, and also the fact that the chemical composition of colored inks used in the process is poorly understood and not standardized among dye manufacturers.

"The skin is a highly immune-sensitive organ, and the long-term consequences of repeatedly testing the body's immune system with injected dyes and colored inks are poorly understood," says Leger. She adds:

"Some of the reactions appear to be an immune response, yet we do not know who is most likely to have an immune reaction to a tattoo."

Another key finding from the study indicates that similar types of short-term complications, including delayed healing, pain, swelling and infection within weeks of getting tattooed, occur in 10% of individuals.

Additionally, the data showed that only a third of those who experienced a reaction sought medical advice or assistance. Many instead, revisited the tattoo parlor for guidance.

Leger and team have future plans to conduct a larger survey to determine specifically what color inks and dye components are most closely linked to adverse reactions. They anticipate that their investigations might reveal other factors that may put people at a greater risk of suffering chronic complications from getting "inked."

Back in 2012, Medical News Today reported that some tattoo inks are tainted with nontuberculous Mycobacteria, which can cause serious infections, including lung diseases, eye problems, several organ infections and infection of the joints.

Scientific discovery may stop breast cancer spreading to the bones

Researchers from the UK and Denmark have discovered a protein that encourages breast cancer to spread to the bone - a finding that could pave the way for treatments that halt progression of the disease.

Breast cancer is the most common cancer among American women after skin cancer. This year, it is estimated that more than 231,000 new cases of invasive breast cancer will be diagnosed in the US.

When cancer cells spread from the breast tumor - the "primary site" - to other parts of the body, this is known as metastatic or secondary breast cancer. Most commonly, breast cancer cells spread to the bones, accounting for around 85% of all secondary breast cancers.

In this latest study, recently published in the journalNature, study co-leader Dr. Alison Gartland, of the University of Sheffield in the UK, and colleagues found that a protein called lysul oxidase (LOX) drives the spread of breast cancer cells to the bone.

The team says finding a way to block the activity of LOX may lead to new ways to prevent this type of secondary cancer in patients with breast cancer.

"This is important progress in the fight against breast cancer metastasis and these findings could lead to new treatments to stop secondary breast tumors growing in the bone, increasing the chances of survival for thousands of patients," says Dr. Gartland.

LOX prepares bone for the arrival of cancer cells

To reach their findings, Dr. Gartland and colleagues used mass spectrometry to analyze the protein secretion of tumors among patients with estrogen receptor negative (ER-) breast cancer.

They found that when breast cancer cells are deprived of oxygen, they release high levels of LOX. This protein makes holes in the bone of breast cancer patients as a way of preparing it for the arrival of cancer cells.

"We show that these lesions subsequently provide a platform for circulating tumor cells to colonize and form bone metastases," the authors explain.

In another part of the study, the team found that introducing LOX to tumor-free mice also led to bone damage. However, they found an existing drug called bisphosphonate - used to treat bone diseases such as osteoporosis - prevented such damage in these mice.

As such, the authors suggest that administering similar treatments to patients with breast cancer could stop the disease spreading to the bone.

Commenting on the findings, study co-leader Dr. Janine Erler, of the University of Copenhagen in Denmark, says:

"Once cancer spreads to the bone it is very difficult to treat. Our research has shed light on the way breast cancer cells prime the bone so it is ready for their arrival. If we were able to block this process and translate our work to the clinic, we could stop breast cancer in its tracks thereby extending patients' lives."

The researchers say their next step is to determine how LOX interacts with bone cells to drive cancer metastasis, which will bring us closer to finding drugs that stop the process. "This could also have implications for how we treat other bone diseases too," adds Dr. Gartland.

Earlier this month, Medical News Today reported on a study published in the British Journal of Surgery, which suggests women with hereditary breast cancer are at no higher risk of poor treatment outcomes than breast cancer patients without a family history of the disease.