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Church And Your Health

worship-in-prayerIf you belong to an organized religion, you probably know some people who attend church twice a year—Christmas and Easter. Of course, you know about the men who attend church regularly, or almost so, just to avoid a day-long argument. You might be one of them. What’s all the hoopla about going to church, anyway? This is not about religion, spiritual beliefs, or faith, but about your health.

Religiosity is not the same thing as spirituality. Religiosity implies the embodiment of certain aspects of religious activity to an exaggerated state of involvement, zeal that stretches the norms of a person’s faith or beliefs. Religiosity can be fake, an external display of unwarranted righteousness that is not truly characteristic of a follower of the truth. Religion is the way we practice our beliefs, and is a source of enlightenment, discipline, encouragement, and service to self and to others. It’s the challenge to become more like the One we choose to follow.

The social aspect of religion cannot be ignored. Sociable people say that their lives are satisfying, and that they even expect to outlive their less convivial colleagues. Sharing exuberant fun buoys the body, mind and spirit, the last of these including one’s communication with his Creator. Isolated individuals are more likely to get sick than those who have a social network. The connected folks perform better under stress, and often have lower cholesterol, better glucose control, and enhanced self-esteem. Friendships can strengthen the immune system (Capitanioa. 2010) and contribute to good physical and mental health. (Graham. 2007) Establishing friendships, which are portable, might be a legitimate reason to attend a church.

Belief in God can comfort patients who face terminal illness because they believe they will be in His presence after death. Such has also been shown to improve quality of life for those with disabilities or chronic, painful medical conditions. But could there be a bit of science to believing? Consider a study that says, “Spirituality generally relates to better mental health, greater well-being, and higher quality of life.” (Koenig. 2004) Support from the faith community can help people better cope with health stressors. Naturally, one would expect it to enhance compliance with medical treatment, as well.

A recent Norwegian study wondered if belief in God conferred any health benefits. Using a longitudinal approach with more than 35,000 subjects, researchers found their answer. The more often people went to church, the lower their blood pressure, even when the study was controlled for other possible explanations. (Sørensen. 2011) Previous research in the United States had shown the same link. A difference between the Norwegian and American populations is that more than ninety percent of Norwegians belong to the state church, which is confessedly Lutheran and part of the Porvoo Communion, a harmonious group that includes northern European Lutherans and Anglicans. Americans show a wider distribution in their religious preferences. Whether or not there is a direct translation between the Norwegians and the Americans is yet to be established. But it has been accepted that the salutary effect of religion on blood pressure can at least be partially explained by religion’s promotion of healthful behaviors, the psychosocial aspects, and above all, faith. (Levin. 1989)

In an earlier study, investigators from Duke University examined the association of religious activity and blood pressure in older adults living in a community setting, finding also that the religiously active tended to have lower blood pressures than their less active peers. This relationship applied to actual attendance at services and to personal prayer time, but not to watching services on television or listening on the radio. (Koenig. 1998) It’s common knowledge that blood pressure is related to cardiovascular health, the assessment of which is also gauged by certain markers, namely C-reactive protein, fibrinogen, and white cell count. These three markers were found to be elevated in those who didn’t go to church, even after adjusting for demographic variables, health status, and body mass index. The only deviant factor was smoking. (King. 2001)

You might expect church goers to be a forgiving lot, but that’s something easier to talk about than to do. Those who are able to forgive are happier and healthier. (vanOyen 2001) Their blood pressures and heart rates rarely stray from normal. Regardless of beliefs, almost all religions include forgiveness among the behaviors they preach. Not surprisingly, the neurotic, the perpetually angry, and the hostile are less likely to forgive, even after considerable time has passed.

Religion and church attendance are matters that the medical community is advised to consider when treating the whole person, especially the geriatric populace. Religiousness for the patients is related to fewer depressive symptoms, better quality of life, less perceived pain, and lower incidence of cognitive impairment. It’s not uncommon for the medical professional to find benefits for himself after counseling the ill. (Lucchetti. 2011)

We might as well have a sense of humor about going to church, a place that needn’t be filled with fun-busters. It’s a place to let your guard down, where you can find a hunting or fishing buddy, or someone who shares a hobby (almost wrote hubby), or even a mate. Besides, a sense of humor can help you to live longer. (Svebak. 2010) See you in church?

References

Anna C. Buck, David R. Williams, Marc A. Musick, , Michelle J. Sternthal
An examination of the relationship between multiple dimensions of religiosity, bloodpressure, and hypertension
Social Science & Medicine. 68(2); Jan 2009: 314-322

J.P. Capitanioa, J. Jianga
Psychosocial Influences on Immunity
Encyclopedia of Behavioral Neuroscience. . 2010: Pages 132-137

Koenraad Cuypers, Steinar Krokstad, Turid Lingaas Holmen, Margunn Skjei Knudtsen, Lars Olov Bygren
Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway
Journal of Epidemiology and Community Healthjech. 2011, May 23

Jennifer E. Graham, Lisa M. Christian, Janice K. Kiecolt-glaser
Chapter 36 – Close Relationships and Immunity
Psychoneuroimmunology (Fourth Edition) 2007, Pages 781-798

Karen A. Hixson Ph.D., Harvey William Gruchow Ph.D., Don W. Morgan Ph.D.
The Relation between Religiosity, Selected Health Behaviors, and Blood Pressure among Adult Females
Preventive Medicine. 27(4); July 1998: 545-552

Brenda R. Jacksona, C.S. Bergemana
How Does Religiosity Enhance Well-Being? The Role of Perceived Control
Psychology of Religion and Spirituality. Vol 3, Iss 2, May 2011, Pp 149-161

Dana E. King, Md, Arch G. Mainous, Iii, Ph.D., Terrence E. Steyer, Md, William Pearson, Mha
The relationship between attendance at religious services and cardiovascular inflammatory markers
The International Journal of Psychiatry in Medicine. 31(4); 2001: 415-425

Harold G. Koenig, Harvey Jay Cohen, Linda K. George, Judith C. Hays, David B. Larson, Dan G. Blazer
Attendance at Religious Services, Interleukin-6, and Other Biological Parameters of Immune Function in Older Adults
The International Journal of Psychiatry in Medicine. Vol 27, Num 3 / 1997: 233 – 250

Harold G. Koenig, Linda K. George, Judith C. Hays, David B. Larson, Harvey J. Cohen, Dan G. Blazer
The Relationship Between Religious Activities and Blood Pressure in Older Adults
The International Journal of Psychiatry in Medicine. 28(2); 1998: 189-213

Harold G. Koenig M.D.
Spirituality, wellness, and quality of life
Sexuality, Reproduction and Menopause. Volume 2, Issue 2, June 2004, Pages 76-82

Levin JS, Vanderpool HY.
Is religion therapeutically significant for hypertension?
Soc Sci Med. 1989;29(1):69-78.

Lucchetti G, Lucchetti AG, Badan-Neto AM, Peres PT, Peres MF, Moreira-Almeida A, Gomes C, Koenig HG.
Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.
J Rehabil Med. 2011 Mar;43(4):316-22.

Torgeir Sørensen, Lars J. Danbolt, Lars Lien, Harold G. Koenig, Jostein Holmen
The Relationship between Religious Attendance and Blood Pressure: The Hunt Study, Norway
The International Journal of Psychiatry in Medicine. 42(1); 2011: 13-28

Sven Svebak, Solfrid Romundstad, Jostein Holmen
A 7-Year Prospective Study of Sense of Humor and Mortality in an Adult County Population: The Hunt-2 Study
The International Journal of Psychiatry in Medicine. 40(2), 2010: 125-146

vanOyen Witvliet C, Ludwig TE, Vander Laan KL.
Granting forgiveness or harboring grudges: implications for emotion, physiology, and health.
Psychol Sci. 2001 Mar;12(2):117-23.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Menopause and Memory

Coping with the menopauseFor eras women’s physical and mental suffering has been trivialized when it is associated with the condition of menopause.  But the reality of hot flashes, fatigue, sleep disturbance, moodiness, and discomfiting cerebral performance during menopause is virtually tangible.   Various traditional and alternative therapies are used to address these symptoms, from hormone replacement therapy at the allopathic end to black cohosh and essential fatty acids at the complementary end. The brain fog, on the other hand, has been viewed with less fervor until recently.

The Department of Neurology at the University of Rochester, In New York, reported that the memory problems described by women as menopause approaches are real (Weber, Mapstone, et al, 2012). Of course, this is nothing new to the millions of women who have had periods of forgetfulness or fogginess in their 40s and 50s.  Their experiences have been validated by a rigorous battery of cognitive tests administered by researchers at Rochester and the U. of Illinois at Chicago.  The goal of the study was to find a relationship between subjective reports of memory complaints and objective tests of cognitive function, described as the intellectual process by which a person perceives and comprehends ideas.   Included here are all aspects of thought, reason, and recollection.   Antipodal is the brain misstep that affects all ages and is characterized by confusion, decreased clarity of thought, and forgetfulness.  In some folks this can lead to minor depression on the one hand and delinquency on the other.  For as often as this happens to women all over the globe, it still is barely seen as a “real” condition.

The subjects who participated in the study completed a comprehensive neuropsychological battery of tests that measured attention, working memory, verbal memory and fluency, visual-spatial skills, and fine motor dexterity.  Self-report inventories of perceived memory symptoms were included.  The findings indicated a link between the subjective memory faults and actual memory deficits in some, but not all, realms.  Working memory and complex attention tasks were most affected.  Working memory is the ability to hold information in the mind long enough to perform a complex task regardless of interfering processes and distractions.  If this operation is hindered, the person is frustrated.  If this recurs, the presentation of depressive symptoms should not be a complete surprise.  The physical changes of menopause are identifiable, but the mental changes are not to be identified with the mental aberrations of dementia.  Menopausal women can rate their own memory skills; demented ones cannot.

Brain fog can be triggered by physical, psychological, biochemical and even spiritual factors.  Some of these are adrenal exhaustion, food and chemical reactions, stress, and nutritional deficiencies.  There are, however, age-related cognitive changes that, though of non-dementia origin, can interfere with a person’s daily functioning, which makes this a relevant clinical issue.  Overcoming this situation may be as simple as getting enough sleep, exercising, or eating the right foods.  Meditation and prayer have been used as first-line treatment in some venues.  While the complex relationship of mood, memory and hormones is not identical in every case, it is inferred that the amount of attention paid to a novel situation or perception influences the persistence of memory (Weber & Mapstone, 2009).  Overall, if a woman says she experiences disconcerting bouts of forgetfulness, she deserves confirmation that these cognitive signs are part of the array of menopause symptoms (Schaafsma, 2010).

There are factors in the aging process that interact with menopause itself, among them  homocysteine values, hypercholesterolemia, metabolic syndrome or type 2 diabetes, hypertension, and depression.   If drugs are used to address any of these concerns, and if a drug has anticholinergic properties, there likely will be cognitive impairment to some degree.  This compounds the matter, and may lead to improper diagnoses and unneeded treatment for a condition that does not really exist.  This class of drugs—the anticholinergics—is used to treat gastric disturbances, urinary problems, respiratory matters, and insomnia, among others disorders that may display themselves as menopause signs in the first place.

The use of hormones to improve mental function in menopause has been hit and miss.  Observational studies say one thing, while randomized clinical trials report something else.   In a Wake Forest University study it was concluded that using estrogen with progestin to mediate global cognitive function in women over age 65 was less effective than the placebo.  In fact, it increased cognitive decline (Rapp, 2003).  While no clinically relevant adverse effects were reported, the trial was stopped because of “certain increased health risks for women” (Ibid.).  Hedging its bets, another study, following a similar protocol, found a negative effect on verbal memory, but a “trend to” a positive impact on figural memory, with other domains unaffected by the combination of estrogen and progestin (Resnick, 2006).  For those who put all their eggs into one basket—the basket of allopathic medicine and Big Pharma—this is an eye-opener.

Walking down the primrose path, we stumble upon complementary medicine or functional medicine or integrative medicine, all of which are supported by evidence-based science, none of which is a sham.  Because it can’t be a money-maker for mega-corporations, since natural substances cannot be patented, complementary medicine raises a jaundiced eye.  And because your physician has little time to examine the research for himself, being directed by the verbal testimonies of the pharmaceutical representative, he knows little or nothing about the efficacy of alternative modalities.

It’s uncertain whether money, time, compassion, or philosophy drives the Euro-Asian medical community to study alternatives to allopathic treatment more earnestly than happens in the States.  Studies on ginkgo biloba that were performed in the last century in the UK have determined that this extract has profound impact on working memory and psychomotor performance at doses of 120 mg a day, with those between ages 50-59 reaping the most benefit (Rigney, 1999).  An earlier study, employing 600 mg of ginkgo extract, found significant improvement in memory one hour after administration (Subhan, 1984).  If there is concern that these studies are too old to carry any weight, work done in this century agrees (Scholey, 2002) (Kennedy, 2000) In order to “kick it up a notch,” scholars of neuroscience and cognition, also in the UK, decided to combine ginkgo with Panax ginseng—the adaptogen that purportedly increases the body’s resistance to stress, anxiety and fatigue—and to measure the combined efficacy on cognitive benefit in tests of serial arithmetic tasks with varying cognitive load and in tests of memory quality.  Two studies found this phytopharmaceutical blend to offer substantial cognitive profit (Wesnes, 2000) and (Scholey, 2002)

Why settle for cognitive improvement alone when the whole body can capitalize on a protocol?  Ever hear of phosphatidylcholine?  It’s the number one phospholipid from which you are made.  It’s a component of each of the trillions of cells that make you, you.  You’ve heard the expression, “When Mama’s happy, everybody’s happy?”  When the cells are healthy, everything is healthy.  That’s what phosphatidylcholine (PC) does:  it restores and elevates cellular function and stability.    And it enhances learning and memory, and improves cognitive disorders (Nagata, 2011) (Fioravanti, 2005)  As an unseen but additional benefit, PC is accompanied in its extraction by phosphatidylethanolamine, a phospholipid that helps to manufacture phosphatidylserine, an ingredient known to attenuate many neuronal effects of aging, and to restore normal memory on a variety of tasks (McDaniel, 2003)  It’s possible to lift that fog, after all.

References

Fioravanti M, Yanagi M.
Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000269.

Kennedy DO, Scholey AB, Wesnes KA.
The dose-dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers.
Psychopharmacology (Berl). 2000 Sep;151(4):416-23.

McDaniel MA, Maier SF, Einstein GO.
“Brain-specific” nutrients: a memory cure?
Nutrition. 2003 Nov-Dec;19(11-12):957-75.

Nagata T, Yaguchi T, Nishizaki T.
DL- and PO-phosphatidylcholines as a promising learning and memory enhancer.
Lipids Health Dis. 2011 Jan 28;10:25.

Park DC, Smith AD, Lautenschlager G, Earles JL, Frieske D, Zwahr M, Gaines CL.
Mediators of long-term memory performance across the life span.
Psychol Aging. 1996 Dec;11(4):621-37.

Rapp SR, Espeland MA, Shumaker SA, Henderson VW, Brunner RL, Manson JE, Gass ML, Stefanick ML, Lane DS, Hays J, Johnson KC, Coker LH, Dailey M, Bowen D; WHIMS Investigators.
Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial.
JAMA. 2003 May 28;289(20):2663-72.

Resnick SM, Maki PM, Rapp SR, Espeland MA, Brunner R, Coker LH, Granek IA, Hogan P, Ockene JK, Shumaker SA; Women’s Health Initiative Study of Cognitive Aging Investigators.
Effects of combination estrogen plus progestin hormone treatment on cognition and affect.
J Clin Endocrinol Metab. 2006 May;91(5):1802-10. Epub 2006 Mar 7.

Rigney U, Kimber S, Hindmarch I.
The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers.
Phytother Res. 1999 Aug;13(5):408-15.

Schaafsma M, Homewood J, Taylor A.
Subjective cognitive complaints at menopause associated with declines in performance of verbal memory and attentional processes.
Climacteric. 2010 Feb;13(1):84-98.

Scholey AB, Kennedy DO.
Acute, dose-dependent cognitive effects of Ginkgo biloba, Panax ginseng and their combination in healthy young volunteers: differential interactions with cognitive demand.
Hum Psychopharmacol. 2002 Jan;17(1):35-44.

Subhan Z, Hindmarch I.
The psychopharmacological effects of Ginkgo biloba extract in normal healthy volunteers.
Int J Clin Pharmacol Res. 1984;4(2):89-93.

Weber M, Mapstone M.
Memory complaints and memory performance in the menopausal transition.
Menopause. 2009 Jul-Aug;16(4):694-700.

Weber MT, Mapstone M, Staskiewicz J, Maki PM.
Reconciling subjective memory complaints with objective memory performance in the menopausal transition.
Menopause. 2012 Mar 12. [Epub ahead of print]

Wesnes KA, Ward T, McGinty A, Petrini O.
The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers.
Psychopharmacology (Berl). 2000 Nov;152(4):353-61.

Wilson RS, Beckett LA, Barnes LL, Schneider JA, Bach J, Evans DA, Bennett DA.
Individual differences in rates of change in cognitive abilities of older persons.
Psychol Aging. 2002 Jun;17(2):179-93.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Reduce Inflammation through Weight Loss

acute-pain-in-a-woman-kneeSome of us know inflammation too well. When getting out of bed in the morning becomes an auditory event in your joints that rivals a flamenco dancer’s castanets, you know inflammation. What you may not know, or at least not realize, is that your weight has something to do with it. For many of us, the seeds of inflammation were planted years ago. Our genes, body weight, diet, lifestyle and fitness determine our states of wellness and non-wellness, some of which we cannot sense. Silent inflammation is probably worse than that we can feel from getting cut or hit by a baseball. If it hurts or is uncomfortable, we’ll take care of it right away. If it’s not noticeable, it can smolder for years, eventually exploding into a chronic illness.

Inflammation is the response of tissue to injury or insult, occasionally caused by an invading pathogen. Characteristics, which you can sense, include increased blood flow to the injured area, elevated temperature, redness, swelling and pain. Inflammatory responses to what should have been a harmless agent include allergies and autoimmune diseases, states where the response is either out of proportion to the threat it faces or is directed against an inappropriate target, such as self. In these cases, the response is worse than anything the agent itself could have generated, and is often insensate. The cascade of cellular and molecular signals that accompany inflammation can perpetuate it and make it chronic, in which case monocytes and macrophages take over the management. This may sound cool, but the chemicals they create inside the tissues wreak havoc. Macrophages begin to swallow everything that appears derelict, including senescent cells and whatever is deemed a pathogen, whether it truly is or not.

At some point in this chronology, chemical mediators are released, including things like Interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-a) and prostaglandins that keep the ball rolling…on and on. When the body tries to control all this nefarious activity it replaces damaged tissue with replacement cells of the same type, but occasionally fails and results in diseased states, such as asthma, rheumatoid arthritis, tendonitis, celiac and inflammatory bowel diseases.

Inflammation is recognized as causal to several chronic diseases and all-cause mortality, and is prevalent among those who have a body mass index above 30.0.  Biomarkers of inflammation are used to examine the relationship of inflammation to chronicity, with C-reactive protein (CRP), IL-6, TNF-a, and IL-8 as indicators. CRP probably is the first one your doctor will interpret, since it’s a prime marker of inflammation. It just doesn’t pinpoint the location. CRP is a native protein made by the liver in response to factors released by fat cells. In acute inflammation, such as from an infection, levels can rise in less than six hours and be hundreds of times higher than normal, which is lower than 10 mg per liter. With a severe bacterial infection, it can reach 200 or more. The absolutely perfect reading is 1.0. Levels above 2.4 are supposed to be associated with increased risk of cardiovascular events, but that’s debatable because the studies were done with people who had unstable angina (Pepys, 2003).

Human adipose tissue expresses and releases the pro-inflammatory artifacts, inducing low-grade systemic inflammation in people with too much body fat. Pediatricians in the Netherlands looked at overweight children in their country and saw higher levels of CRP than in normal-weight children (Visser, 2001), accompanied by higher white cell counts. In 2007, the Archives of Internal Medicine published an analysis of more than thirty separate studies, concluding that weight loss is a major factor in the reduction of CRP, adding that a loss of one kilogram (2.2 lbs) equates to a 0.13 mg/L drop in CRP (Selvin, 2007).

Many parents think that their kids will outgrow the chubby stage. Sometimes, yes; often, no. We now see 400-pound 20-year-olds who were obese at age eight, whose parents ignored admonitions to address the foreboded tragedy at the early age. That collection of fat that hangs over the belt, sometimes reaching the thighs, is called a panniculus, and is more than just a dormant spare tire. It secretes adipokines, or chemical signals, to other parts of the body, increasing risk of serious disease through disrupted homeostasis (Rosenow, 2010). If this describes someone you know, eventually you’ll likely see diabetes, heart disease, and maybe even some form of cancer (Ibid).

There are plenty of overweight seniors, some of whom achieve that senior designation at age 40, others above 70. Just by virtue of their age, they’re more likely to report joint pain, but obesity at any age is a predictor of low-grade chronic inflammatory state.  Whether by diet or exercise, or both, weight loss is extremely vital to maintaining one’s health. In comparisons, the low-carb folks lost more weight than the low-fat. Think about this.  The knee pain in the 50-year-old guy is so bad he can’t walk behind his lawnmower. The problem is that he’s carrying 375 pounds on a frame designed to carry 150-180, and his femur is squeezing the cushions at the tibia. Yes, it’s distinctly possible that thyroid issues are causative of the extra weight. There may be other factors that include lack of sleep, too much stress, certain medications, uncontrolled cortisol (kinda rare), and menopause in women. Some of these can be managed and can be worked out with the family physician and maybe a visit to a dietitian. However, looking more closely at his eating habits, we see carbohydrates as the main source of gustatory input, with beneficial fats and lean protein given the back seat. Self-inflicted obesity has no excuse. Inflammatory biomarkers can be attenuated with even a small reduction in weight (Miller, 2008) (You, 2006).  Now, get this. The physical movement required to mow the lawn might be just enough to reduce inflammation, despite the immediate discomfort, which will eventually taper off. (Ford, 2002) (Miller, 2008).

Obesity is a problem of epidemic proportions. Certain people are perceived as anathema, bête noir, pariah, and may pay for self-destructive behavior. If cigarette cessation clears the lungs, could weight reduction clear the blood? Yep. Dietary interventions will help both, but sticking a finger into the dike doesn’t quite do it.

References

Clément K, Viguerie N, Poitou C, Carette C, Pelloux V, Curat CA, Sicard A, Rome S, Benis A, Zucker JD, Vidal H, Laville M, Barsh GS, Basdevant A, Stich V, Cancello R, Langin D.
Weight loss regulates inflammation-related genes in white adipose tissue of obese subjects.
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Mary Elizabeth Dallas
Losing Weight May Lower Cardiac Risks
Study finds both low-carb and low-fat diets help overweight people reduce inflammation
NIH, 5 Nov, 2012
MedlinePlus Trusted Health Information for You A service of the U.S. National Library of Medicine
From the National Institutes of HealthNational Institutes of Health
http://www.nlm.nih.gov/medlineplus/news/fullstory_131011.html

Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, Giugliano D.
Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial.
JAMA. 2003 Apr 9;289(14):1799-804.

Ford, Earl S.
Does Exercise Reduce Inflammation? Physical Activity and C-Reactive Protein Among U.S. Adults
Epidemiology:. September 2002 – Volume 13 – Issue 5 – pp 561-568

Gilbert CA, Slingerland JM.
Cytokines, Obesity, and Cancer: New Insights on Mechanisms Linking Obesity to Cancer Risk and Progression.
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Kawasaki N, Asada R, Saito A, Kanemoto S, Imaizumi K.
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Stephen P Messier, Claudine Legault, Shannon Mihalko, Gary D Miller, Richard F Loeser, Paul DeVita, Mary Lyles, Felix Eckstein, David J Hunter, Jeff D Williamson and Barbara J Nicklas
The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale
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Miller GD, Nicklas BJ, Loeser RF.
Inflammatory biomarkers and physical function in older, obese adults with knee pain and self-reported osteoarthritis after intensive weight-loss therapy.
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Mohamed-Ali V, Goodrick S, Rawesh A, Katz DR, Miles JM, Yudkin JS, Klein S, Coppack SW.
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Nicklas BJ, Ambrosius W, Messier SP, Miller GD, Penninx BW, Loeser RF, Palla S, Bleecker E, Pahor M.
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Pepys MB, Hirschfield GM.
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Anja Rosenow, Tabiwang N. Arrey, Freek G. Bouwman, Jean-Paul Noben, Martin Wabitsch, Edwin C.M. Mariman, Michael Karas, and Johan Renes
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Roth CL, Kratz M, Ralston MM, Reinehr T.
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Elizabeth Selvin, PhD, MPH; Nina P. Paynter, MHS; Thomas P. Erlinger, MD, MPH
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André Tchernof, PhD; Amy Nolan, RD; Cynthia K. Sites, MD; Philip A. Ades, MD; Eric T. Poehlman, PhD
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You T, Nicklas BJ
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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.