Most of us wouldn’t be excited about the prospect of a camera mounted on the side of our face.

But then again, most of us aren’t doctors.

Google Glass uses augmented reality and voice activation to project data into our field of vision. And while the technology is still in its early (and annoying) stages, it holds a lot of promise in the medical field.

One obvious use includes looking up drug data. Doctors could easily perform a search for a drug or disease using Glass’s voice-recognition commands: “OK, Glass, Google ‘What’s the correct dose of Temazepam?’” Likewise, the gadget could also document a patient visit, such as storing a photo of a skin rash or an audio recording of a conversation.

Indeed, Google Glass may be the butt of jokes for consumers, but it represents some exciting possibilities for health care. As Arun Matthews, the chief medical information officer at Texas Tech University and a full-fledged Glass enthusiast, puts it: “I dream about technology being seamless and invisible, but constantly present, anticipating my needs with point-of-care decision support — but getting out of the way so that physicians can be physicians.”

What ideas are entrepreneurs already cooking up?

It’s still early days for the technology — Google only recently began shipping the gadget to a carefully selected group of people, and it won’t sell the device until the end of the year. But already developers are buzzing with ideas, and many of them are related to health care.

Ian Shakil [top, left] is one of the first entrepreneurs developing a Google Glass app for doctors. Shakil hit on the idea for his startup, Augmedix, while working at wearable electronics company MC10 and trying Glass for the first time.

“I had an epiphany moment and committed to drop everything,” he said.

To buy him some time to test the merits of the idea, Shakil applied for funding from Upstart, a startup that asks wealthy backers to fund individuals rather than projects. With the $55,000 he raised, Shakil incorporated the company and began to experiment with Google Glass at hospitals.

The first app is still in development — so Shakil wouldn’t reveal much at this stage — but he did tell me both patients and doctors were open to wearing Glass in a clinical setting. “We see all kinds of applications for health care providers,” he explained.

Shakil has a point — physicians are already avidly discussing potential applications on LinkedIn forums. Some of their most plausible medical scenarios include:

•  Video sharing and storage:      Physicians could record medical visits and store them for future reference      or share the footage with other doctors.
• A diagnostic reference: If Glass is integrated with an      electronic medical record (EMR), it could provide a real-time feed of the      patient’s vital signs.
• A textbook alternative: Rather than referring to a medical      textbook, physicians can perform a search on the fly with their Google      Glass.
• Emergency room/war zone care: As storied venture capitalist Marc      Andreessen proposed in a recent interview, consider ”dealing      with wounded patients and right there in their field of vision, if they’re      trying to do any kind of procedure, they’ll have step-by-step instructions      walking them through it.” In a trauma situation, doctors need to keep      their hands free.
• Helping medical students learn: As suggested by one blogger, a surgeon might live      stream a live — and potentially rare — surgery to residents and students.
• Preventing medical errors: With an electronic medical record      integration, a nurse can scan the medication to confirm whether it’s       the correct drug dose and right patient.

Is Google Glass the future of connected health?

The “quantified self” movement — the idea that tracking your own health can help you live longer and better — is gathering steam. A small but growing segment of the population is hooked on fitness apps and trackers like FitBit One, Jawbone Up, and Nike+ FuelBand.

For them, Google Glass is the logical next step. Beyond tracking your daily movement with apps like FitBit, you could potentially track your social interactions and analyze how that affects your mood. Healthy eaters — or those looking to improve their diets — could get a real-time feed of nutritional information when they shop, which would help them make better food choices.

“Google Glass has the potential to fundamentally change the way we track and gamify health,” VentureBeat guest author Chris Hollidale recently wrote. Hollidale argues that tracking your steps via today’s current suite of fitness tracking devices isn’t enough and that Glass provides more meaningful metrics.

An unintended benefit of the widespread adoption of health and fitness tracking devices is that patients routinely use devices in the doctor’s office. They frequently show their primary care provider how much they exercise daily and how well they eat by referring to a FitBit, for instance. Likewise, doctors will often use a medical app on a tablet or smartphone device as a research tool.

“I used to be worried that patients would be concerned that I didn’t know everything — but now I look something up whenever I see patients in the exam room,” said Dr. Roni Zeiger, a practicing physician and Google’s former health chief.

Zeiger sees immediate value in Glass to improve the quality of care. “It would be great to more fluidly pull up relevant information,” he said.

For example, he recently saw a patient at an urgent care center with a skin problem and realized that “no workflow currently exists to take and store an image for a doctor to see.” Zeiger had to describe the rash in writing and draw a doodle so he could track the patient’s progress — a practice that could be replaced by Glass.

When will we see Glass at the doctor’s office?

Before committing to fund the next wave of Google Glass apps, investors need to see evidence of traction.

Only time will tell whether hospitals and health practitioners will invest $1,500 into purchasing Glass when most doctors already have a smartphone or tablet device. As the price of Glass falls over time (and the technology improves to justify the added cost), developers writing Glass apps may find success more easily.

Meanwhile, developers will need to tackle compliance and regulatory issues as well as deal with potential patient privacy concerns.

“Industry giants will not be willing to gamble on such a venture until there is either a huge public outcry or the government mandates this level of innovation as the front-end standard for electronic health records,” said Matthews. “I’d say we’re looking at at least five years.”

Obstacles aside, Silicon Valley’s venture firms will be looking for investment opportunities in the near future. Andreessen Horowitz, Google Ventures, and Kleiner Perkins recently formed a partnership known as the “Glass Collective” to help fund the development of apps.

“I used to work at a neurobiology lab, and scientists are excited about being able to interact with their experiments without having to remove layers of gloves,” said Google Ventures’ Bill Maris in a recent interview with VentureBeat.

And Maris is just one of the investors who is intrigued by health-specific applications.

“We are excited about the possibilities,” said Missy Krasner, an entrepreneur in residence at Morgenthaler Ventures and a former cofounder of Google Health.

However, Krasner pointed out another obstacle: Physicians may be reluctant to record sessions due to increased risk of medical liability.

On a fundamental level, there’s another risk: Google Glass developers would be basing their fledgling businesses on the intellectual property of another company. If Google decides to discontinue Glass (not wholly out of the realm of possibility — just ask anyone whose company relied on Google Reader), then anything those developers invested in Glass-based apps would be a bust.

“My feeling is that it’s futuristic and forward thinking — but a little early,” Krasner explained.

Would you feel comfortable if your physician examined you while wearing Google Glass? Or would you record your own doctor’s visit using Glass? Please let us know in the comments section below. 

Source for Story:

http://venturebeat.com/2013/05/13/google-glass-healthcare/#77bS38K8BUz00jiP.99

Not much has changed, and alcohol is as much a part of culture as it’s ever been. However, this isn’t necessarily a good thing. Just because you’re used to something being around doesn’t always mean it should be there.

Alcoholism is a major cause for concern in this country. About 18 million Americans have alcohol-related disorders, whether it’s dependence or abuse. Alcohol can lead to far greater problems than addiction, abuse and dependence. It can take a toll on your body that increases risk for several diseases. What’s scary is that drinking can catch up to you in a hurry, so knowing your limit is important.

It’s very easy to drink too much because most people don’t exactly know what constitutes one drink. For example, is a big glass of wine, pint of beer or vodka-tonic counted as a single drink? Not always.

A drink is measured based on its alcohol content; having said that, one standard U.S. drink is roughly 14 grams of pure alcohol. Serving sizes, however, reflect the content of various sources of booze. Here’s the breakdown of how popular drinks are measured:

· Beer: 12-oz glass, or one standard-sized can (about 355mL) at five-percent alcohol

· Wine: 5-oz glass, or slightly more than half a standard-sized glass at 12% alcohol

· Spirits: 1.5 oz, or a standard shot glass at 40% alcohol

· Malt Liquor: 8–9-oz glass or about 2/3 of a 12-oz glass at seven percent alcohol

Those small numbers may surprise you, but they illustrate how easy it is to drink too much. For example, it’s not uncommon for a couple to drink a bottle of wine with dinner.

When I was a university student, I took a course called “Drugs and Behavior,” and it covered the affects of a number of drugs from heroin to alcohol. I remember being surprised by how devastating the affects of alcohol are. It surprised me, because alcohol is so common in American culture, yet it causes countless health problems. Booze really does wage an all-out attack on your body.

There are studies indicating both negative and positive affects of drinking. For example, some research shows that a drink or two per day can assist in cardiovascular function, while others show that as little as one drink per day can substantially increase the risk of some forms of cancer. If you’re a moderate drinker, having about one to two drinks per day, the health impacts can go either way; it really depends on your individual case.

Alcohol can impact your brain, heart, liver, immune system, pancreas and put you at greater risk for certain types of cancer. The affects can be cumulative from years of drinking, or immediate. They can happen while you drink and can stick around for a few days, too. For example, while drinking, alcohol cuts off pathways from the brain, affecting how it functions. Motor skills, memory and judgment suffer.

The next day, the body may experience withdrawal, and because booze shuts down your immune system, you are more prone to becoming sick while drinking. This can be short-term, like contracting a cold, or long-term. Chronic drinkers are much more likely to contract diseases like tuberculosis and pneumonia.

Although there is research showing small amounts of alcohol can have health benefits, I still think the negatives greatly outweigh the positives. If you can abstain from alcohol, or at least limit intake to special occasions, it will be to your benefit.

Source for Story:             

Doctors Health Press [e-bulletin@doctorshealthpress.com]

The Sitting Sickness

If you’ve heard that life is movement, it’s true.  If you’ve heard that just sitting around can kill you, it’s also true.  Physical inactivity is the fourth leading cause of death worldwide![1] You may have heard the media reporting recently on several studies showing that prolonged sitting significantly increases the risk for death, including death from heart disease and cancer, but I’m not sure this news has really hit home yet[2],[3],[4].

Most people know that exercise is critical for health and preventing disease, but the issue of physical activity and inactivity is much bigger than exercise.  Regardless of the amount of exercise one performs, the level of aerobic fitness one exhibits, or whether a person is thin or overweight, stillness still kills[5].  Apparent health and leading an otherwise healthy lifestyle does not compensate for extended periods of sitting around, and we Americans do a great deal of sitting around.[6],[7],[8].  We’ve even built over 4 million miles of roads so we can sit still while we go places!  In fact, the infrastructures and cultures of most developed nations seem to be perfectly designed for physical inactivity.

The average American watches around 40 hours of television per week, while those over 65 watch an average of 48 hours per week.  I’ve already written about the harms of television, computer, and tablet use as well as the related media consumed through these devices on GreenMedInfo (see “Do You Have Facebook Affective Disorder“).  Sitting is certainly one factor that contributes to the negative health consequences of these technologies.  But there is another gigantic part of modern life in which sitting is the dominant physical activity (or inactivity!).  I’m talking about work!  The average American spends 40 hours per week watching television, 50 hours per week sleeping, and about 45 hours working (unless unemployed/retired).  That leaves about 33 hours per week for other things, many of which also involve sitting (eating, checking Facebook and email, texting, driving/traveling…  sometimes all together, but that is a different newsletter).

Many people, of course, work longer hours and, while some types of work are physically intense, “sitting jobs” are common.  One study showed that office workers spend 95% of their time at work sitting and 82% of this time was nearly motionless[9]!  For many people, then, work contributes 45 hours of or so of physical inactivity per week embedded within 168 hours of mostly physical inactivity per week!  Yet, work can also be 45 hours or so of physical activity per week if one chooses!  While it is obvious that television viewing and other sedentary leisure activities can easily be replaced by more physically active leisure pursuits, we have overlooked the workplace as an additional source of potential physical activity!

This is a rather recent realization, and you may have observed, in response, the growing trend of treadmill desks and stand up desks.  However, it is not that simple.  Standing, per se,  is not really the answer and we don’t all need treadmill desks either.  In this article, I want to explore the fascinating physiology of physical inactivity and muscle endocrinology a bit, and then focus in on the key to avoiding the harms of physical inactivity.  Throughout the article, I’ll use the term “low-amplitude low-intensity movement”.  This term refers to very small movements with minimal to no displacement of the body (low-amplitude) and which produce minimal to no sense of effort (low intensity). The bottom line is, physical activity in the form of low-amplitude low-intensity movement is critical for health and no supplement regimen, dietary modification, or exercise plan can compensate for its lack!  It is time that we stand up to our sitting culture and demand opportunities to move!

The Many Faces of Sitting:

The data is solid; prolonged sitting is unhealthy and it doesn’t matter so much whether that stillness is in front of a television or a desk, at home or work, or in a car or airplane.  Not surprisingly, the harmful consequences of prolonged sitting are numerous.  Studies have shown that prolonged sitting shortens life expectancy[10], increases fat accumulation around the heart[11], and is associated with metabolic syndrome (abnormal cholesterol or triglycerides, high blood pressure, insulin resistance, and abdominal obesity)[12],[13].

In an excellent article from 2009, Bente Petersen describes what he calls the “diseasome of physical inactivity”.  He says, “the diseasome of physical inactivity [is] mediated through an interdependent cycle of myokine imbalance or deficiency, immuno-endocrine dysfunction, and abdominal obesity”[14].  His argument needs little additional justification as it is thoroughly supported by modern physiology.  The physical and physiological derangements which underlie Petersen’s diseasome of physical inactivity include abdominal obesity, chronic inflammation, insulin resistance, atherosclerosis, neurodegeneration, and tumor growth.  The resulting cluster of diseases includes type 2 diabetes, cardiovascular disease, depression, dementia, colon cancer, and breast cancer.   These relationships are illustrated in “figure 1″ below[15].  Remember, by physical inactivity, we are not just referring to a lack of exercise.   Instead, we are referring to prolonged periods of sitting still, regardless of how much exercise is done.

The Myokines, Mitochondria, and Metabolic Hormones of Movement:

With every new day, we glimpse the complexity of the human body a bit more, and we laugh (or cry) at the embarrassingly simple assumptions we held in the past.  This is certainly true for muscle physiology.  It was once thought that skeletal muscle cells were just the energy-using, mechanical end-organ of movement.  Yet, today, we realize that skeletal muscle has the capacity to express several hormones and chemical messengers which influence a number of other tissues in the body (probably ALL of the tissues in the body).  Scientists are calling these muscle messengers “myokines” and they are critical to explaining the “diseasome of physical inactivity.” It appears that this “diseasome” results from a myokine deficiency!  The list of known myokines includes lipoprotein lipase, interleukin (IL)-6, IL-8, IL-15, brain-derived neurotrophic factor (BDNF), leukemia inhibitory factor (LIF), fibroblast growth factor 21 (FGF21), and follistatin-like-1[16],[17],[18].  I know, the scientific jargon is beautiful and exciting!  What is more exciting, though, is that most of these myokines are released as a result of muscle contraction.  Simply by contracting a muscle, one can get a micro-boost of disease preventing myokines!  This is a rather radical realization, as it points out that a part of our endocrine system is directly under conscious control!  So, let us explore a few myokines briefly so that we might better appreciate the endocrine effects of movement and muscle contraction on our bodies.

Lipoprotein Lipase[19]: Lipoprotein lipase (LPL) is critical for the cellular uptake of triglycerides and the production of “good” HDL-cholesterol.  Scientists have long searched for a drug to increase LPL activity in order to treat high triglycerides, cholesterol disorders, and cardiovascular disease.  Well, it turns out that a scientific breakthrough is not needed at all, just some muscle contraction. Studies have shown that specific gene mutations that reduce LPL function or production are associated with a 5-fold increase in the odds for heart disease and death[20].  This gene mutation can essentially be mimicked by inactivity.  If the muscles do not contract, LPL production is minimized.  On the other hand, muscle contraction in the form of low-intensity low-amplitude physical activity increased muscle LPL production by 10-fold.  Many of the lipid benefits of exercise (improved HDL cholesterol and particle size) may be mediated by the same mechanism. The implications of this may be far-reaching.  For example, since LPL insufficiency is associated with abnormalities in blood lipoproteins, and abnormalities in blood lipoproteins are associated with abnormal hormone levels (eg. Low testosterone, etc.), a lack of LPL may contribute to hormone imbalance.  Can regular muscle contraction and the avoidance of prolonged sitting naturally improve hormone levels?  Hopefully the research on this will continue and inform us more clearly in the future.

Interleukin (IL)-6:  In response to muscle contractions, muscle cells release IL-6 both locally in the muscle and into the circulation.  In the muscle, IL-6 appears to improve glucose uptake and fat oxidation.  At the same time, it may travel through the blood to the liver to increase glucose synthesis and to the fat cells to increase lipolysis (fat break down)[21].  This is a nice little system here; through IL-6, the muscle enables itself to better utilize glucose and fat while it simultaneously improves the availability of these fuels in the blood.  Through this mechanism, muscle contraction may lower blood glucose and help reduce body fat, from which a number of positive physiological changes follow.  Additionally, IL-6 may be responsible for the anti-inflammatory cascade seen as a result of exercise.  This suggests that muscle contraction in the form of low-intensity low-amplitude movement throughout the workday, might have a chronic anti-inflammatory effect as well.

IL-15: Less is known about this myokine.  IL-15 appears to play a role in muscle growth and lipid metabolism, possibly affecting cardiovascular disease risk.  Additionally, a mouse study found that elevated circulating levels of IL-15 resulted in significant reductions in body fat and increased bone mineral content[22]!

Brain Derived Neurotrophic Factor (BDNF): BDNF was named based on its ability to stimulate the growth of new brain cells.  However, like many hormone-like compounds, it is produced by, and has effects on, many tissues in the body, including those outside of the brain.  Muscle cells appear to produce BDNF, but researchers are not sure that significant amounts are released into the circulation.  Within the muscle, it appears to increase fat oxidation and, thus, helps with muscle energy production[23].  If a significant amount of muscle BDNF is actually released into the circulation, it may help reduce the risk of several disorders including Alzheimer’s disease, major depression, impaired cognitive function, cardiovascular disease, and type 2 diabetes, and obesity[24],[25],[26]!  More research is needed!

Erythropoetin (EPO):  This hormone, now infamous due to its use in sports doping, is known mostly for its ability to stimulate the production of red blood cells.  Traditional physiology teaches that this hormone is secreted from the kidneys in response to hypoxemia (limited oxygen in the blood) or ischemia (limited blood flow). Both conditions can be generated through exercise, and hypoxemia occurs at high altitude as well.  However, it appears that EPO may have additional effects on the body beyond red blood cell production and may be produced by tissues other than the kidneys.  While the evidence is not conclusive, it appears that contracting muscle cells may produce and secrete EPO[27],[28].  This muscle derived EPO may then have significant effects on body fat, lean muscle mass, insulin sensitivity, and muscle vascularization.  In one study, a gene which enhances EPO production was inserted into a leg muscle in mice.  The increase in EPO from that single leg muscle had effects on the entire body, including a 28% reduction in total body fat, a 14% increase in total muscle mass, and a 25% increase in vascularization of the “transfected” muscle.  Muscle fat oxidation was increased and insulin levels were normalized as well[29].  While there has been limited research on whether low amplitude, low intensity muscle contraction increases circulating levels of EPO, it remains a very real possibility, making EPO a potentially powerful myokine of movement.

Mitochondria:  Mitochondria are the source of cellular energy, and cellular energy is the source of body energy and life itself!  Declines and dysfunction in these energy generating cellular compartments may underlie a number of diseases, including Alzheimer’s disease, diabetes, chronic fatigue syndrome and fibromyalgia, and various cancers.  In contrast, higher mitochondrial numbers and excellent mitochondrial function are associated with reduced disease risk, improved energy and vitality, and greater aerobic capacity.  While mitochondria are very different than myokines, they have one very important thing in common; that is muscle contraction.  A cascade of events that increases the number of mitochondria (mitochondrial biogenesis) in a cell is triggered by calcium ion flux and, in short, calcium ion flux occurs with muscle contraction[30].  Thus, muscle contraction alone can stimulate mitochondria to expand and proliferate.  Muscle inactivity, on the other hand, is associated with a reduction in key mitochondrial metabolic proteins as well as a reduction in the replication of mitochondrial DNA and mitochondrial proliferation[31],[32]. There is intense interest in nutraceutical, herbal, and pharmaceutical interventions which can increase mitochondria number and function, but let’s not forget about movement, the most cost-effective intervention!

Grehlin and Leptin:  These two hormones are central to the regulation of food energy intake and metabolism.  Grehlin promotes hunger and caloric intake, while leptin promotes satiety (fullness) and fat metabolism.  Grehlin should rise during fasted states (like before a meal) while leptin should rise during fed states (like after a meal).  However, one study showed that sitting (compared to standing) resulted in greater hunger and less fullness despite identical food energy intake.  Interestingly, the mechanism was different between genders, with sitting males showing higher levels of grehlin compared to standing males, and sitting females showing lower levels of leptin compared to standing females[33].  One likely outcome of increased hunger is excess caloric intake and weight gain over time.  Indeed, another study demonstrated that office workers who had more frequent interruptions in sitting time had significantly lower waist circumference than other workers with fewer interruptions[34].  In addition to the grehlin and leptin effects of frequent movement and interruption in sitting time, weight loss and leanness may be promoted simply from increased energy expenditure.  A study comparing the energy expenditure of office workers while sitting at a traditional desk vs. walking very slowly at a treadmill desk showed that the walking desk required 119 more calories per hour.  Therefore, an overweight person could lose 1 pound per week (3500 calories), or around 45-50 pounds per year, by using a treadmill desk for 6 hours per day during the weekdays.  Yet, treadmill desks are not the only option.  Another study showed that simply standing at a computer instead of sitting increased caloric expenditure by 81.6 calories per hour[35].  That amounts to almost ¾ of a pound per week of weight loss or 30 to 35 pounds of weight loss per year, with 6 hours of standing per day during the weekdays. However, considering the above discussion about myokines and muscle contraction, our goal will be not simply to stand instead of sit, but to maximize muscle contraction while still effectively working.  Hopefully you are already convinced that muscle contraction is the key to avoiding the harms of physical inactivity but, before we talk about how to contract muscles at work, there are a few more very important benefits of muscle contraction that I want to mention.

Don’t Just Sit (or Stand) There, Move Something!

In addition the role muscle contraction plays in the optimal function of the endocrine system and human physiology in general, the mechanical forces from muscles contracting in the setting of gravity provide numerous direct benefits as well.  For example, the articular cartilage in the joints and intervertebral discs in the spine require these mechanical forces for nourishment and waste product removal.  These tissues have no direct blood supply and rely on the “milking” or “pumping” action of movement for health.  Without movement, these tissues desiccate (dry) and degenerate (crack and thin), resulting in osteoarthritis and degenerative disc disease.  Many are surprised to realize that movement prevents arthritis rather than contributes to it.

Similar to joint cartilage and intervertebral disc health, skeletal health also requires mechanical forces from gravity and muscle contraction, which stimulate bone mineralization.  With sitting, the force of gravity begins in the pelvis and transmits up the spine, leaving the lower extremities isolated in anti-gravity.  The result may be reduced bone mineralization in the lower extremities, including the hips, contributing to osteopenia or osteoporosis of the hips over time.

As if this were not enough, sitting and physical inactivity promote deconditioning of the abdominal and lower back muscular while at the same time placing exaggerated and imbalanced forces on non-muscular lumbar (lower back) structures like ligaments and intervertebral discs[36].  The result is an increased vulnerability to lower back injuries, degenerative disc disease, disc herniations, nerve impingement syndromes, and lower back pain. Regular co-contraction of truck flexors and extensors (abdominal and lower back muscles) is critical to maintaining optimal lumbar spine curvature and protecting intervertebral discs from desiccation and herniation.

Finally, no discussion of the mechanical benefits of movement would be complete without mentioning the other half of the circulatory system, the venous pump.   We all care a great deal about keeping our hearts pumping.  After all, it is critical that blood goes through the lungs and out to our organs.  Yet, why don’t we care so much about that blood getting back to the heart?  The heart does not suck blood back up, it just relaxes and relies on venous pressure to fill it up all the way.  Some of this pressure is created by breathing and most people fail to breathe correctly, but I’ll save that discussion for another day.  The rest of this filling pressure largely relies on muscle contraction and venous valves.  The muscles of the lower extremities, especially, work against gravity like a heart for the veins, squeezing blood back up to the heart for the arteries, in the chest.  Without regular muscle contraction, the system breaks down.  Blood flow slows down, venous blood volume and pressures build, arterial and capillary pressure builds in response to “drive the blood through”, cells are under nourished and have a hard time getting rid of waste products, venous valves get stressed and fail, varicosities develop and enlarge, legs and muscles may ache, platelets and clotting factors mingle, blood clots can form, and it only gets worse from there.

Disorders Associated with Physical Inactivity:

Join the Movement Movement:

It should be clear that regular movement, in addition to exercise, is critical for health and that physical inactivity, despite exercise, is a major driver of our increasing prevalence of disease.  The goal should also be clear; replace sedentary time with active time.  While the opportunities for activity during leisure time are endless, the opportunities for activity in a work environment are much more restricted.  Yet, office work is a major contribution to physical inactivity that needs to be addressed.  So, now to the practical question, “how can we promote regular low-amplitude low-intensity movement in an office environment?”

Classic office ergometry has tended to pursue supposedly healthier sitting postures and chair geometries, but it now appears that we can make much more profound leaps in office ergometry by eliminating sitting all together and replacing it with some form of regular muscle contraction.  The treadmill desk movement is a good one.  These workstations accomplish the goal of regular low-amplitude low-intensity movement while fully preserving the ability to type, talk on the phone, read documents, and etc.   Yet, these workstations are expensive and may not be compatible with offices which serve clients in person.

There may be several alternatives to treadmill desks, but I’ll just share the approach I have taken as an example of one alternative.  My desk now features a “desk extension” which holds a keyboard, phone, mouse pad, and monitor and may be used in a sitting or standing position.  There appear to be several of these on the market, and I expect that more will be appearing over the next several years.  I am currently using the Kangaroo Pro Junior by Ergodesktop.  For other ideas, simply search the internet for “standing desks” or “standing desk extension” and you’ll find a great deal of alternatives!

Yet, it has been mentioned several times that simply standing is not the best option.  This stand up desk extension needs to be combined with something that promotes regular muscle contraction.  An unstable surface of some sort does a wonderful job in this regard.  Enter the wobble board.

Wobble While You Work

Wobble boards have been used for years by athletes and trainers to increase lower extremity and core strength, as well as proprioception (dynamic sensation and control of the body’s position), with the intention of preventing  injuries and enhancing performance.  They have also been used in physical therapy and rehabilitation work to improve the balance, proprioception, strength, and agility after injury, surgery, and stroke.  The technology is simple, consisting of a flat standing surface with some type of grip and a rounded rocker or “wobble” underneath.  Most are made of plastic or wood, and the wobble height varies in order to provide different degrees of difficulty.  Some boards have adjustable wobble heights, which is a nice feature for beginners.

Wobble  boards engage the neuro-musculo-skeletal system from the feet through the legs, into the trunk/core and even into the upper extremities and head.  This not only improves balance and proprioception, but enhances core strength and reverses hip and lower back instability, both causes of injury and pain.  Studies have shown that the use of wobble boards significantly improves the speed of muscle reflexes, enhances the synergistic coordination of the body’s muscular system, and develops the precision of the complex neuromuscular interactions which determine balance and agility[37].

Most relevant to the above discussion, however, is the fact that wobble boards (and most other unstable surface devices) stimulate continuous very low-amplitude and low-intensity muscle contraction through the body.  These movements are very small and one can quickly learn to type and perform routine office work while standing on a wobble board.  In fact, most will eventually be able to stand on the board with one foot and do such work!   One’s control of the board might become so great that smaller and smaller movements and adjustments are needed, which reduces the muscle contraction involved. Since the intention is to maximize muscle contraction,  the goal at this advanced stage is to continue to introduce movement by intentionally wobbling the wobble board, trying different stances (heel to toe, switching left and right foot forward, etc.), doing deep knee bends on occasion, and raising the arms above the head.  Keeping the knees slightly bent at all times helps to maintain a balanced posture and promote movement.  Start with 1 hour a day on the wobble board, always listen to your body, and increase your time slowly as you feel able.

Wobble boards are not the only option for creating an unstable surface.  Various types of “balance boards” are available and all offer various degrees of movement and difficulty.  Rocker-roller type boards like Indo Boards and curved boards like Spooner Boards are just two examples.  Whatever you choose, be sure to start slowly and carefully, and try it in a safe and soft space before taking it to the office!

Resources

• [1] Kohl HW 3rd, Craig CL, Lambert EV, Inoue      S, Alkandari JR, Leetongin G, Kahlmeier S. The pandemic of      physical inactivity: global action for public health. Lancet. 2012      Jul 21;380(9838):294-305. doi: 10.1016/S0140-6736(12)60898-8.

• [2] Katzmarzyk PT, Church TS, Craig CL, Bouchard C.      Sitting time and mortality from all causes, cardiovascular      disease, and cancer. Med Sci Sports Exerc. 2009 May;41(5):998-1005. doi: 10.1249/MSS.0b013e3181930355.

• [3]van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman      A. Sitting time and all-cause mortality risk in 222 497 Australian      adults. Arch Intern Med. 2012 Mar 26;172(6):494-500

• [4] Matthews CE, George SM, Moore SC, Bowles      HR, Blair A, Park Y, Troiano RP, Hollenbeck      A, Schatzkin A.
• Amount of time spent in sedentary      behaviors and cause-specific mortality in US adults. Am J Clin      Nutr. 2012 Feb;95(2):437-45. Epub 2012 Jan 4.

• [5] Pedersen BK (2007). Body mass index-independent effect of      fitness and physical activity for all-cause mortality. Scand J Med      Sci Sports 2007; 17, 196–204.

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• [13] Dunstan DW, Kingwell BA, Larsen R, Healy      GN, Cerin E, Hamilton MT, Shaw JE, Bertovic      DA, Zimmet PZ, Salmon J, Owen N.      Breaking up prolonged sitting reduces postprandial glucose and insulin responses.      Diabetes Care. 2012 May;35(5):976-83. doi: 10.2337/dc11-1931. Epub      2012 Feb 28.

• [14] Pedersen BK.The diseasome of physical inactivity–and the role of      myokines in muscle–fat cross talk. J Physiol. 2009 Dec 1;587(Pt      23):5559-68. doi: 10.1113/jphysiol.2009.179515. Epub 2009 Sep 14.

• [15] Pedersen BK.The diseasome of physical inactivity–and the role of      myokines in muscle–fat cross talk. J Physiol. 2009 Dec 1;587(Pt      23):5559-68. doi: 10.1113/jphysiol.2009.179515. Epub 2009 Sep 14.

• [16] Broholm C, Mortensen OH, Nielsen S, Akerstrom T, Zankari A, Dahl B      & Pedersen BK. Exercise induces expression of leukaemia inhibitory      factor in human skeletal muscle. J Physiol 2008;      586, 2195–2201.

• [17] Izumiya Y, Bina HA, Ouchi N, Akasaki Y, Kharitonenkov A & Walsh      K. FGF21 is an Akt-regulated myokine. FEBS Lett 2008;582, 3805–3810.

• [18] Ouchi N, Oshima Y, Ohashi K, Higuchi A, Ikegami C, Izumiya Y &      Walsh K. Follistatin-like 1, a secreted muscle protein, promotes      endothelial cell function and revascularization in ischemic tissue through      a nitric-oxide synthase-dependent mechanism. J Biol Chem      2008;283, 32802–32811

• [19] Bey L, Hamilton MT. Suppression of skeletal muscle lipoprotein      lipase activity during physical inactivity: a molecular reason to maintain      daily low-intensity activity. J Physiol. 2003 Sep 1;551(Pt 2):673-82.      Epub 2003 Jun 18.

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• [21] Pedersen BK & Febbraio MA. Muscle as an endocrine organ:      focus on muscle-derived interleukin-6. Physiol Rev      2008;88, 1379–1406.

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The research comes from Australia’s University of Western Sydney and the Beijing University of Chinese Medicine. The researchers analyzed and reviewed 2,964 human clinical studies that involved 253,434 cancer patients. Among these were 2,385 randomized controlled studies and 579 non-randomized controlled studies.

These studies covered most of the cancer types, but the cancers most studied were lung cancer, liver cancer, stomach cancer, breast cancer, esophageal cancer, colorectal cancer and nasopharyngeal (throat and sinus) cancer. Yes, breast cancer was the fourth most-studied type of cancer among these thousands of clinical studies.

The researchers discovered that the overwhelming majority of studies – 90% of the clinical studies – utilized herbal medicine.

The researchers found that 72% of these studies applied Traditional Chinese Medicine alongside conventional treatment, but a full 28% applied Traditional Chinese Medicine separately to experimental groups.

In terms of cancer patients, about 64% were given both TCM and conventional medical treatments. The rest were given TCM therapy alone, but a little over half of them did not qualify whether the patient was given conventional treatment at some point in the past.

Because of the large number of studies, there were different types of results, depending upon the type of study, the type of treatment, and the outcome measures tested. Still, in a full 1,015 studies or 85% of those that reported on symptoms, TCM treatment resulted in improvement of cancer symptoms with many of those reporting reduced pain. Another 883 studies – 70% – showed increased survival rates. Another 38% showed reduced tumor size, and 28% showed increased quality of life. Another 19% showed lower relapse rates and another 7% showed reduced complications.

The researchers also found that only a few studies tested TCM acupuncture treatment in cancer therapy. In their discussion they qualified that acupuncture treatment in cancer therapy to alleviate pain is quite popular in the U.S., but in Chinese cancer studies, herbal medicine therapy is the leading type of holistic treatment for cancer.

This study follows another extensive review of research published in 2012 on TCM cancer treatment. This study comes from Norway’s National Research Center in Complementary and Alternative Medicine and the University of Tromsø, Norway, also with collaboration with the Beijing University of Chinese Medicine.

This earlier study reviewed significantly fewer studies, compiling 716 trials that included 1,198 cancer patients with either leukemia, stomach cancer, liver cancer or esophageal cancer.

Among these studies, 98.5% used herbal medicine, and again, acupuncture therapy was rare. In this study, symptom improvement was achieved in 85% of the patients that used the TCM therapy.

In yet another study – this one much larger than the second – 1,217 clinical studies between 1958 and 2011, involving 92,945 patients were analyzed and reviewed by researchers from the Beijing University of Chinese Medicine. Among these studies, 66% of the patients were treated with TCM therapy alone, while 34% of the patients were treated with a combination of TCM and conventional cancer therapy. Also, 82% of the patients were given herbal medicines orally.

Only 5% of the patients were given more than one type of TCM therapy. This means that 95% were treated with only one type of TCM therapy – typically with a precise combination of herbs.

This study found that among the studies treating cancer, symptom relief was the prominent result among 88% of the studies and among 88% of the patients tested with TCM therapy. Increased survival rates resulted in 73% of patients. Among all the rest of the studies, 96% of the trials resulted in symptom relief and 92% of the patients reported cancer symptom relief.

Did we get this right? Was that 88% and 92% symptom improvement or relief among thousands of studies and nearly 100,000 cancer patients? And 85% improvement of cancer symptoms among 716 clinical studies? And 85% symptom improvement among 1,015 clinical studies among a review involving over 250,000 cancer patients that tested the effectiveness of Chinese herbal medicine against cancer?

It sounds pretty solid that Chinese herbal medicine does indeed treat cancer and overwhelmingly results in the improvement or relief of symptoms as well as longer survival rates and reduced metastases.

Now why again is Western conventional medicine still refusing to at least consider herbal medicine therapy in cancer treatment? Could there be a profit motive involved? Could it have to do with the fact that herbal medicines cannot be patented? In other words, is Western conventional medicine ignoring inexpensive natural treatments that could help millions of cancer patients simply because of profits?

Actions speak louder than words.

References

• Li X, Yang G, Li X, Zhang Y, Yang J,      Chang J, Sun X, Zhou X, Guo Y, Xu Y, Liu J, Bensoussan A. Traditional      chinese medicine in cancer care: a review of controlled clinical studies      published in chinese. PLoS One. 2013;8(4):e60338.
• Liu J, Li X, Liu J, Ma L, Li X,      Fønnebø V. Traditional Chinese medicine in cancer care: a review of case      reports published in Chinese literature. Forsch Komplementmed.      2011;18(5):257-63.
• Yang G, Li X, Li X, Wang L, Li J,      Song X, Chen J, Guo Y, Sun X, Wang S, Zhang Z, Zhou X, Liu J. Traditional      chinese medicine in cancer care: a review of case series published in the      chinese literature. Evid Based Complement Alternat Med. 2012;2012:751046.

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The problem with this approach is that, if we do it often enough, we may kill ourselves along with the pain…

Take ibuprofen as an example. This petrochemical-derivative has been linked to significantly increased risk of heart attack and increased cardiac and all-cause mortality (when combined with aspirin), with over two dozen serious adverse health effects, including:

1. Anemia[1]
2. DNA Damage[2]
3. Hearing Loss[3]
4. Hypertension[4]
5. Influenza Mortality[5]
6. Miscarriage[6]

Ibuprofen is, in fact, not unique in elevating cardiovascular disease risk and/or mortality. The entire category of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have this under-recognized dark side; of the 100 unintended adverse health effects associated with their use, cardiovascular disease and cardiac mortality score highest on the list.

So, what does one do? Pain is pain. Whether it happens to you, or you witness it in another (which can be worse), finding relief is a top priority.

Research on Natural Alternatives To Ibuprofen

Here is some evidence-based research on alternatives to ibuprofen, sourced from the National Library of Medicine:

1. Ginger – A 2009 study found that ginger capsules (250 mg, four times daily) were as effective as the drugs mefenamic acid and ibuprofen for relieving pain in women associated with their menstrual cycle (primary dysmenorrhea). [7]
2. Topical Arnica – A  2007 human study found that topical treatment with arnica was as effective as ibuprofen for hand osteoarthritis, but with lower incidence of side   effects.[8]
3. Combination: Astaxanthin, Ginkgo biloba and Vitamin C – A 2011 animal study found this combination to be equal to or better than ibuprofen for reducing      asthma-associated respiratory inflammation.[9]
4. Chinese Skullcap (baicalin) – A 2003 animal study found that a compound in Chinese skullcap known as baicalin was equipotent to ibuprofen in reducing pain.[10]
5. Omega-3 fatty acids: A 2006 human study found that omega-3 fatty acids (between 1200-2400 mg daily) were as effective as ibuprofen in reducing arthritis pain, but with the added benefit of having less side effects.[11]
6. Panax Ginseng – A 2008 animal study found that panax ginseng had analgesic and anti-inflammatory activity similar to ibuprofen, indicating its possible anti-rheumatoid arthritis properties.[12]
7. St. John’s Wort – A 2004 animal study found that St. John’s wort was twice as effective as ibuprofen as a pain-killer.[13]
8. Anthrocyanins from Sweet Cherries & Raspberries – A 2001 study cell study found that anthrocyanins extracted from raspberries and sweet cherries were as effective as ibuprofen and naproxen  at suppressing the inflammation-associated enzyme known as cyclooxygenase-1 and 2.[14]
9. Holy Basil – A 2000 study found that holy basil contains compounds with anti-inflammatory activity comparable to ibuprofen, naproxen and aspirin.[15]
10. Olive Oil (oleocanthal) – a compound found within olive oil known as oleocanthal has been shown to have anti-inflammatory properties similar to ibuprofen.[16]

There are, of course, hundreds of additional substances which have been studied for their pain-killing and/or anti-inflammatory effects, and there are also aromatherapeutic approaches that do not require the ingestion of anything at all, but there is also a danger here. When we think of taking an alternative pain-killer to ibuprofen, we are still thinking within the palliative, allopathic medical model: suppress the symptom, and go on about our business. It would behoove us to look deeper into what is causing our pain. And when possible, remove the cause(s). And that often requires a dramatic dietary shift away from pro-inflammatory foods, many of which most Westerners still consider absolutely delightful, e.g. wheat, dairy, nighshade vegetables and even wheat-free grains, etc.

[1] Direct cytotoxicity of non-steroidal anti-inflammatory drugs in acidic media: model study on human erythrocytes with DIDS-inhibited anion exchanger. Pharmazie. 2002 Dec;57(12):848-51. PMID: 12561250

[2] Genotoxicity of ibuprofen in mouse bone marrow cells in vivo. Drug Chem Toxicol. 2012 Jan 27. Epub 2012 Jan 27. PMID: 22283434

[3] Analgesic use and the risk of hearing loss in men. Am J Med. 2010 Mar;123(3):231-7. PMID: 20193831

[4] Effect on blood pressure of lumiracoxib versus ibuprofen in patients with osteoarthritis and controlled hypertension: a randomized trial. J Hypertens. 2008 Aug;26(8):1695-702. PMID: 18622250

[5] The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis. J R Soc Med. 2010 Oct;103(10):403-11. PMID: 20929891

[6]  Taking non-aspirin NSAIDs in early pregnancy doubles risk of miscarriage, study shows. BMJ. 2011 ;343:d5769. Epub 2011 Sep 9. PMID: 21908536

[7] Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med. 2009 Feb 13. PMID: 19216660

[8] Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007 Apr;27(6):585-91. Epub 2007 Feb 22. PMID: 17318618

[9] Summative interaction between astaxanthin, Ginkgo biloba extract (EGb761) and vitamin C in suppression of respiratory inflammation: a comparison with ibuprofen. Phytother Res. 2011 Jan;25(1):128-36. PMID: 20632299

[10] The antiinflammatory and analgesic effects of baicalin in carrageenan-evoked thermal hyperalgesia. Anesth Analg. 2003 Dec;97(6):1724-9. PMID: 14633550

[11] Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. PMID: 16531187

[12] Potential analgesic and anti-inflammatory activities of Panax ginseng head butanolic fraction in animals. Food Chem Toxicol. 2008 Dec;46(12):3749-52. Epub 2008 Oct 1. PMID: 18930781

[13] Antinociceptive activity of methanolic extracts of St. John’s Wort (Hypericum perforatum) preparation. Pak J Pharm Sci. 2004 Jul;17(2):13-9. PMID: 16414593

[14] Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9. PMID: 11695879

[15] Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine. 2000 Mar;7(1):7-13. PMID: 10782484

[16] Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal. Curr Pharm Des. 2011 ;17(8):754-68. PMID: 21443487

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