Don’t Wait Until You’re Older to Fight Getting Old

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Research shows aging can start surprisingly early—but there are ways to counteract declines in hearing, sight and bone and muscle mass

You might not qualify for any senior-citizen discounts yet. But aging starts sooner than you might expect.

Age-related hearing starts going downhill at 25, though it isn’t noticeable until decades later. We start losing bone mass as early as our 30s. And a recent study by Duke University researchers found that some types of physical decline—particularly lower-body strength and balance—often begin in the 50s.

“Every function of the human body declines 5% every 10 years,” says Michael Roizen,chairman of the Wellness Institute at the Cleveland Clinic. “That’s brain function, heart function, liver function. The difference is when you sense it and when it hits the critical level where it decreases functioning for you.”

The physical performance study, published in July in the Journals of Gerontology: Medical Sciences, looked at 775 people from their 30s to over 90. The participants took five functional tests measuring strength, balance and endurance, including standing on one leg for a minute and rising from a chair repeatedly for 30 seconds.

In general, younger people performed better than older people and men better than women, as expected, says Miriam Morey, a professor of medicine at Duke University School of Medicine and senior author of the study. But researchers were surprised to find a marked decline in performance on the balance and chair test starting when participants were in their 50s.

“We should consider measuring these things over the full lifespan and not assume that these are problems of the aged, but rather a problem of aging,” Dr. Morey says.

This Is 40

When it comes to cognitive decline, there is a gradual loss of different functions. Speed of processing and working memory peak in the 20s and gradually start declining.

Learning new information after 40 can be harder, says Kathy Wild, an associate professor of neurology and psychiatry at Oregon Health and Science University in Portland, Oregon. Tasks that require concentration should be done with minimal interruptions or distractions, she says. “Do just one thing until you’re done with it,” she says. “It’s really structuring the environment to minimize distractions.”

The Eyes Don’t Have It

By the 40s, even people without glasses may have trouble focusing on objects that are very close, like text in a book, says Rebecca Taylor, clinical spokesperson for the American Academy of Ophthalmology and an ophthalmologist in Nashville, Tenn. It’s called presbyopia, and it’s the gradual loss of the eyes’ ability to focus actively on close objects.

For women in particular, dry eye becomes a common problem in the late 40s and early 50s, she says. Glaucoma and the development of cataracts are common problems in the 50s and 60s. By 75, about 70% of people will have developed a cataract, which causes a loss of ability to see at night but is easily treated with surgery.

The most serious vision problem is age-related macular degeneration. There is no cure for it, so prevention, beginning with a healthy diet, is key, Dr. Taylor says. She recommends diets high in vitamin C and vitamin E, zinc and copper, and lutein and zeaxanthin, found in leafy greens. Not smoking and wearing sunglasses with 100% UV protection are musts.

Did You Hear a Whistle?

High-pitched sounds are first to go. Our hearing is best between ages 18 and 25, says Ian Windmill, clinical director of audiology at Cincinnati Children’s Hospital Medical Center. “It actually starts going down after that, but it’s so slow, so you don’t notice it for many years.”

The medical term for age-related hearing loss is presbycusis.

It usually becomes noticeable around age 50, he says.

There’s no way to restore such hearing loss, since it’s caused by both genetics and environmental factors, such as exposure to loud noises and chemicals, as well as your diet and medications.

Avoiding loud noises is impossible, but you can reduce their impact by taking measures such as wearing hearing protection when mowing the lawn or attending a rock concert, he says.

Core Concerns

Lower-body, core and postural strength are especially critical, says Katherine S. Hall, an assistant professor of medicine at Duke and first author of the study. “The earlier you start an exercise program the better.”

One of the hallmarks of aging is sarcopenia, which is the progressive loss of skeletal muscle that starts in the 30s, says Nathan LeBrasseur, associate professor of physical medicine and rehabilitation at Mayo Clinic in Rochester, Minn.

It becomes noticeable in the late 30s and early 40s, when losing weight often becomes more difficult, he says.

The loss of muscle mass happens at a rate of about 10% per decade, he says, while muscle strength and power—the ability to generate force over time—declines even more dramatically. Dr. LeBrasseur says this may go beyond muscle loss, and be related to impaired brain signals and changes to the circulatory system.

Kyle Jeray, vice chairman of academics in the department of orthopaedic surgery at Greenville Health System in South Carolina, says bone mass peaks at about age 30.

Men and women have equal rates of loss between 30 and 50. Then at menopause, women experience a rapid increase in bone loss for as long as 10 years before it normalizes. Bone loss is compounded by muscle loss, leading to problems with balance and gait.

“When you lose core strength, you start having more and more trouble with balance,” says Dr. Jeray, who is chairman of the American Orthopaedic Association’s Own the Bone committee, which works to prevent osteoporosis-related fragility fractures. “Going up and down stairs without holding a handrail, for example, becomes harder.”

The combination of muscle and bone loss becomes a real problem when people reach their 60s and 70s, which is why maintaining muscle strength when in your 40s and 50s is so important, he says.

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Fitness Helps Improve Lipid Profile

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Exercise may delay age-related elevated cholesterol, among men.

A measure of the ability of the body’s circulatory and respiratory systems to supply oxygen to the skeletal muscles during sustained physical activity, cardiorespiratory fitness (CRF) may be achieved by plentiful aerobic exercise. Yong-Moon Mark Park, from the University  of South Carolina (South Carolina, USA), and colleagues analyzed data collected on 11,418 men enrolled in the Aerobics Center Longitudinal Study, ages 20 to 90 years, without known high cholesterol, high triglycerides, cardiovascular disease, and cancer at the study’s and during follow-up averaging 36 years.  The researchers conducted blood tests to ascertain cholesterol levels, and administered treadmill tests to measure cardiorespiratory fitness.  The team observed that the better men did on the fitness tests, the more likely they were to have lower total cholesterol, lower levels of low-density lipoprotein (LDL, “bad” cholesterol), and higher levels of high-density lipoprotein (HDL, “good” cholesterol).  Men with higher cardiorespiratory fitness levels had better cholesterol profiles than less fit men from their early 20s until at least their early 60s, though the difference diminished with older age. As well, men with lower fitness levels reached abnormal cholesterol levels before age 40. The study authors write that: “Our investigation reveals a differential trajectory of lipids and lipoproteins with aging according to [cardiorespiratory fitness] in healthy men and suggests that promoting increased  [cardiorespiratory fitness] levels may help delay the development of dyslipidemia.”

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Breast Tissue in Men

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A breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Breast cancer occurs mainly in women, but men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer.

Normal breast structure

To understand breast cancer, it helps to have some basic knowledge about the normal structure of the breasts.

The breast is made up mainly of lobules (glands that can produce milk if the right hormones are present), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Until puberty (on average around age 9 or 10), young boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola (area around the nipple). At puberty, a girl’s ovaries make female hormones, causing breast ducts to grow, lobules to form at the ends of ducts, and the amount of stroma to increase. Even after puberty, men and boys normally have low levels of female hormones, and breast tissue doesn’t grow much. Men’s breast tissue has ducts, but only a few if any lobules.

Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because they normally have lower levels of female hormones that affect the growth of breast cells.

The lymph (lymphatic) system of the breast

The lymph system is important to understand because it is one of the ways that breast cancers can spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes under the breast bone (internal mammary nodes) and either above or below the collarbone (supraclavicular or infraclavicular nodes).

If the cancer cells have spread to these lymph nodes, there is a higher chance that the cells could have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs as well. Because of this, finding cancer in one or more lymph nodes often affects the treatment plan. Still, not all men with cancer cells in their lymph nodes develop metastases to other areas, and some men can have no cancer cells in their lymph nodes and later develop metastases.

Benign breast conditions

Men can also have some benign (not cancerous) breast disorders.


Gynecomastia is the most common male breast disorder. It is not a tumor but rather an increase in the amount of a man’s breast tissue. Usually, men have too little breast tissue to be felt or noticed. Gynecomastia can appear as a button-like or disk-like growth under the nipple and areola (the dark circle around the nipple), which can be felt and sometimes seen. Some men have more severe gynecomastia and they may appear to have small breasts. Although gynecomastia is much more common than breast cancer in men, both can be felt as a growth under the nipple, which is why it’s important to have any such lumps checked by your doctor.

Gynecomastia is common among teenage boys because the balance of hormones in the body changes during adolescence. It is also common in older men due to changes in their hormone balance.

In rare cases, gynecomastia occurs because tumors or diseases of certain endocrine (hormone-producing) glands cause a man’s body to make more estrogen (the main female hormone). Men’s glands normally make some estrogen, but not enough to cause breast growth. Diseases of the liver, which is an important organ in male and female hormone metabolism, can change a man’s hormone balance and lead to gynecomastia. Obesity (being extremely overweight) can also cause higher levels of estrogens in men.

Some medicines can cause gynecomastia. These include some drugs used to treat ulcers and heartburn, high blood pressure, heart failure, and psychiatric conditions. Men with gynecomastia should ask their doctors if any medicines they are taking might be causing this condition.

Klinefelter syndrome, a rare genetic condition, can lead to gynecomastia as well as increase a man’s risk of developing breast cancer. This condition is discussed further in the section “What are the risk factors for breast cancer in men?”

Benign breast tumors

There are many types of benign breast tumors (abnormal lumps or masses of tissue), such as papillomas and fibroadenomas. Benign tumors do not spread outside the breast and are not life threatening. Benign breast tumors are common in women but are very rare in men.

General breast cancer terms

Here are some of the key words used to describe breast cancer.


This term describes a cancer that begins in the lining layer (epithelial cells) of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).


An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are glandular tissue (they make breast milk in women), so cancers starting in these areas are sometimes called adenocarcinomas.

Carcinoma in situ

This is an early stage of cancer, when it is confined to the layer of cells where it began. In breast cancer, in situmeans that the abnormal cells remain confined to ducts (ductal carcinoma in situ, or DCIS). These cells have not grown into (invaded) deeper tissues in the breast or spread to other organs in the body. Ductal carcinoma in situ of the breast is sometimes referred to as non-invasive or pre-invasive breast cancer because it might develop into an invasive breast cancer if left untreated.

When cancer cells are confined to the lobules it is called lobular carcinoma in situ (LCIS). This is not actually a true pre-invasive cancer because it does not turn into an invasive cancer if left untreated. It is linked to an increased risk of invasive cancer in both breasts. LCIS is rarely, if ever seen in men.

Invasive (or infiltrating) carcinoma

An invasive cancer is one that has already grown beyond the layer of cells where it started (as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas, either invasive ductal carcinoma or invasive lobular carcinoma.


Sarcomas are cancers that start in connective tissues such as muscle tissue, fat tissue, or blood vessels. Sarcomas of the breast are rare.

Types of breast cancer in men

Breast cancer can be separated into several types based on the way the cancer cells look under the microscope. In some cases a single breast tumor can be a combination of these types or be a mixture of invasive and in situ cancer. And in some rarer types of breast cancer, the cancer cells may not form a tumor at all.

Breast cancer can also be classified based on proteins on or in the cancer cells, into groups like hormone receptor-positive and triple-negative. These are discussed in the section “How is breast cancer in men classified?”

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is considered non-invasive or pre-invasive breast cancer. In DCIS (also known as intraductal carcinoma), cells that lined the ducts have changed to look like cancer cells. The difference between DCIS and invasive cancer is that the cells have not spread (invaded) through the walls of the ducts into the surrounding tissue of the breast (or spread outside the breast). DCIS is considered a pre-cancer because some cases can go on to become invasive cancers. Right now, though, there is no good way to know for certain which cases will go on to become invasive cancers and which ones won’t. DCIS accounts for about 1 in 10 cases of breast cancer in men. It is almost always curable with surgery.

Infiltrating (or invasive) ductal carcinoma (IDC)

Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. At least 8 out of 10 male breast cancers are IDCs (alone or mixed with other types of invasive or in situ breast cancer). Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so they are more likely to spread to the nipple. This is different from Paget disease as described below.

Infiltrating (or invasive) lobular carcinoma (ILC)

This type of breast cancer starts in the breast lobules (collections of cells that, in women, produce breast milk) and grows into the fatty tissue of the breast. ILC is very rare in men, accounting for only about 2% of male breast cancers. This is because men do not usually have much lobular tissue.

Paget disease of the nipple

This type of breast cancer starts in the breast ducts and spreads to the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. There may also be an underlying lump in the breast.

Paget disease may be associated with DCIS or with infiltrating ductal carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers.

Inflammatory breast cancer

Inflammatory breast cancer is an aggressive, but rare type of breast cancer. It makes the breast swollen, red, warm and tender rather than forming a lump. It can be mistaken for an infection of the breast. This is very rare in men. This cancer is discussed in detail in our document Inflammatory Breast Cancer.

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Half the planet will need glasses by 2050 because of screens

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Half of the world’s population could be short-sighted by 2050, research shows.

That’s a surge from the current 34 per cent that currently struggles with seeing distances.

The reason for the sudden decline in eyesight abilities is too much time spent looking at computer and smartphone screens and not enough time spent outside, according to the research published in the Opthalmology journal.

It predicts that 4.8 billion people – or 49.8 per cent of the world’s population – will require glasses by 2050. In 2010, 28.3 per cent of the global populus – or 2 billion people – suffered from short-sightedness, also known as myopia. So technology is nearly doubling the myopic population.

The changes “are widely considered to be driven by environmental factors,” said the researchers. “Principally lifestyle changes resulting from a combination of decreased time outdoors and increased near-work activities,” the term for time spent looking at screens.


The study shows that people living in high income countries, such as North America, Europe and parts of Asia, are more likely to be short sighted – as they spend more time looking at screens.

A separate study recently found that British children are twice as likely to be short-sighted now than 50 years ago. The research from Ulster University found 16.4 per cent of British children now suffer with short-sightedness compared with 7.2 per cent in the 1960s.

But the jury is still out on whether screen time is actually making our eyesight worse. Researchers at Ohio State University found staring at a computer screen for hours “does not cause short-sightedness”. The two decades study, which concluded last April, found “no association” between screen time and eyesight in 4,500 children.

“Near work has been thought to be a cause of myopia, or at least a risk factor, for more than 100 years,” said Karla Zadnik, dean of the College of Optometry at Ohio State University and lead author of the April study. “In this large dataset from an ethnically representative sample of children, we found no association.”

The two contradictory studies both agreed that children who spend more time outside are less likely to be short-sighted, but it is unknown what causes the protective effect, or if it’s related to screen time.

What is Myopia?

Short- or near-sightedness is a common eye condition that causes distant objects to appear blurred, while close objects can be seen clearly

  • Up to one in three people in the UK are affected
  •  The condition can range from mild, where treatment may not be required, to severe, where a person’s vision is significantly affected
  • Short-sightedness can develop in very young children but it usually starts around puberty and gets gradually worse
Signs that your child may be short-sighted can include:
  • Sitting too close to the TV
  • Complaining of headaches or tired eyes
  • Regularly rubbing their eyes
  • Needing to sit near the front of the class at school because they find it difficult to read the whiteboard

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Test Your Genes to Find Your Best Diet

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Your genes can help tell you what to eat and influence how diet affects your health.

Variants in some of our genes determine how we metabolize and utilize nutrients, a field of study known as nutrigenomics. Nutritional genetic testing is offered by a handful of companies and clinics, though it is currently expensive and generally not covered by insurance, limiting its usage.

People who have an impaired ability to metabolize iron, for instance, might have an iron deficiency, even if they eat the same diet as others who process the mineral more efficiently. Similarly, some people don’t adequately absorb calcium, and they might benefit from a bone-density test and specialized nutritional advice.

Gene variants also can help explain why people choose the foods they do—a greater propensity for sweets or salt, for instance. And the tests also can show how our bodies respond to different types of exercise.

Genetic testing has gained widespread use in other areas, especially in helping to determine our risk for developing various diseases, from cancer to cardiovascular conditions. Another, more recent use for genetic testing is known as pharmacogenomics, which can help doctors predict which of various medications are most likely to benefit individual patients.

CAFFEINE: People with certain variants on gene CYP1A2 are slow metabolizers of coffee, putting them at greater risk for high blood pressure or a heart attack when caffeine intake is high. 1 in 2 people is at risk. SPINACH: Deficiency in folate, found in greens, is linked to greater risk of heart disease and stroke. It can result from variants on gene MTHFR that slow the conversion of dietary folate into an active form of the nutrient. 2 in 3 people are at risk. PHOTO: GETTY IMAGES (2)

Some experts say genetic science is too young to be able to provide nutritional advice. “We still have a long way to go in the development of practical tools,” says José M. Ordovás, director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and a leading researcher in nutrigenomics.

Dr. Ordovás says most nutritional genetic tests look at just a handful of genes, which isn’t enough to guide dietary decisions. His own research is aimed at evaluating the entire human genome, which consists of 20,000 to 25,000 genes.

The Academy of Nutrition and Dietetics—a professional organization of nutrition professionals—published a position statement in 2014 in the group’s journal saying it was too early to use nutritional genomics to manage chronic disease or provide dietary advice.

Nutrigenomix Inc., started by scientists at the University of Toronto, offers a test of seven genes, which provides insight into some basic nutritional properties, and another, more comprehensive test of 45 genes. The tests are offered through various clinical partners, including the Wellness Institute at the Cleveland Clinic. Dietitians and others buy the 45-gene test from the company for $300 and usually charge another $100 to $200 for a follow-up consultation.

“We’re talking about nutrition advice. We’re not talking about predicting disease,” saysAhmed El-Sohemy, chief scientific officer of Nutrigenomix. “This is about healthy eating and how you metabolize.”

The company only provides testing, which can be ordered online, if done through a health professional, says Dr. El-Sohemy, who is also a professor and research chair in nutrigenomics at the University of Toronto. For people who already eat a healthy diet, nutritional genetic testing might not be that useful, he says.

SALT: Gene ACE produces an enzyme to help regulate the body’s response to sodium intake. People with certain variants are at greater risk for high blood pressure when eating lots of salt. 7 in 10 people are at risk. SUGAR: Gene GLUT2 helps regulate glucose, or sugar. People with certain variants prefer sweet foods and drinks, putting them at greater risk for being overweight and developing cardiometabolic disease. 1 in 5 people is at risk. PHOTO: FROM LEFT: GETTY IMAGES; ISTOCK

Other companies that offer similar tests are 23andMe, Interleukin Genetics and Vitagene, among others. Some companies such as DNAFit also focus on genes related to exercise.

Mary Pipino ordered tests by Nutrigenomix through her nutritionist at the Cleveland Clinic’s Wellness Institute. Ms. Pipino, chief executive of an insurance-risk management firm, says she eats a healthy diet and is an avid exerciser and a certified group and personal trainer. She got the seven-gene test initially and recently also did the 45-gene test.

Ms. Pipino’s nutritionist helped her interpret the results. She says she learned her body doesn’t digest dairy or absorb iron well, and that she’s a slow metabolizer of caffeine. She also learned she is genetically predisposed to strength and endurance training, which she gravitates to anyway.

The 58-year-old says she eliminated yogurt from her diet, which made her feel less bloated. She also changed some of the vitamin supplements she takes, adding more iron but reducing B-12, which she absorbs adequately from her food.

“It’s much easier to put together your personal lifestyle plan after you have this information because it gives you the blueprint of your body,” she says.

“I don’t think it leads to a change in behavior in every single aspect of your diet,” saysKristin Kirkpatrick, manager of wellness nutrition services at the Wellness Institute, and Ms. Pipino’s nutritionist. “But it definitely changes behavior in more specific areas.”

Dr. Ahmed El-Sohemy, research chair in nutrigenomics at the University of Toronto, is also chief scientific officer of Nutrigenomix Inc., which offers nutritional genetic testing through various clinical partners. ‘This is about healthy eating and how you metabolize,’ he says. PHOTO: JAMES BRYLOWSKI

Genetic testing can also reveal, for example, how quickly people metabolize caffeine by examining a gene known as CYP1A2. Heavy coffee drinkers who are slow caffeine metabolizers retain more of the stimulant in the body, putting them at increased risk of having a heart attack and developing diabetes and hypertension, studies have found.

People who metabolize caffeine quickly receive a protective effect from moderate consumption of coffee, some studies have found. One theory is that because those people eliminate the bad parts of coffee faster they may be able to benefit from the good ingredients, such as polyphenols.

Another gene, GLUT2, can show how well the body regulates sugar, or glucose. People with certain variants of the gene could have a greater preference for sweet foods and drinks—a sweet tooth—which could put them at increased risk of being overweight.

Nutrition scientists have looked at whether genetic testing ends up improving eating behaviors. The evidence is mixed. A recent large randomized controlled study found there was little apparent benefit.

The six-month study, funded by the European Union, followed 1,269 people in seven countries. Three groups of participants were given personalized dietary advice, with variations based on their regular diet; their phenotype, including blood biomarkers such as cholesterol; and genetic variants. A control group was given conventional dietary advice.

“This was built on the idea that if you personalize advice and support for people they will pay more attention and be more likely to act on that in a sustained way,” says John Mathers, director of the Human Nutrition Research Centre at Newcastle University in England and senior author of the study, which was published in August in the International Journal of Epidemiology.

At the end of the study, the three groups that received personalized nutrition advice had all improved their eating habits, compared with the control group. But the improvements in each of the three groups were about the same. “It didn’t seem to matter whether you personalized based on current diet, phenotype or genotype,” Dr. Mathers says.

J. Bruce German, a professor and director of the Foods for Health Institute at the University of California, Davis, believes some people can benefit from nutritional genetic testing.

For example, some genetic variants on the MTHFR gene result in reduced activity of an enzyme that converts dietary folate into an active form of the nutrient. People with these genetic variants could have a folate deficiency, which has been linked to a greater risk for heart disease and stroke.

Dr. German is a slow folate absorber, he says, so he has increased the amount of greens in his diet. “Most people know that they should eat more green matter but they don’t anyway,” he says. “Being told you are genuinely at risk makes green vegetables a more convincing food choice,” says Dr. German, who is on a Nutrigenomix advisory board, a voluntary position.

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Researchers Propose New Treatment to Prevent Kidney Stones

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Researchers have found evidence that a natural fruit extract is capable of dissolving calcium oxalate crystals, the most common component of human kidney stones. This finding could lead to the first advance in the treatment of calcium oxalate stones in 30 years.

Jeffrey Rimer, associate professor of chemical engineering at the University of Houston, was lead author of the study, published Aug. 8 in the online edition of Nature. The work offers the first evidence that the compound hydroxycitrate (HCA) is an effective inhibitor of calcium oxalate crystal growth that, under certain conditions, is actually able to dissolve these crystals. Researchers also explain how it works.

The findings are the result of a combination of experimental studies, computational studies and human studies, Rimer said.

Kidney stones are small, hard mineral deposits that form inside the kidneys, affecting up to 12 percent of men and seven percent of women. High blood pressure, diabetes and obesity can increase the risk, and the reported incidence is on the rise.

Preventive treatment has not changed much over the last three decades. Doctors tell patients who are at risk of developing stones to drink lots of water and avoid foods rich in oxalate, such as rhubarb, okra, spinach and almonds. They often recommend taking citrate (CA), in the form of potassium citrate, a supplement that can slow crystal growth, but some people are unable to tolerate the side effects.

The project grew out of preliminary work done by collaborator John Asplin, a nephrologist at Litholink Corporation, who suggested HCA as a possible treatment. HCA is chemically similar to CA and is also available as a dietary supplement.

“HCA shows promise as a potential therapy to prevent kidney stones,” the researchers wrote. “HCA may be preferred as a therapy over CA (potassium citrate).”

In addition to Rimer and Asplin, authors on the paper include Giannis Mpourmpakis and his graduate student, Michael G. Taylor, of the University of Pittsburgh; Ignacio Granja of Litholink Corporation, and Jihae Chung, a UH graduate student working in Rimer’s lab.

The head-to-head studies of CA and HCA determined that while both compounds inhibit the growth of calcium oxalate crystals, HCA was more potent and displayed unique qualities that are advantageous for the development of new therapies.

The team of researchers then used atomic force microscopy, or AFM, to study interactions between the crystals, CA and HCA under realistic growth conditions. According to Rimer, the technique allowed them to record crystal growth in real time with near-molecular resolution.

Chung noted that the AFM images recorded the crystal actually shrinking when exposed to specific concentrations of HCA. Rimer suspected the initial finding was an abnormality, as it is rare to see a crystal actually dissolve in highly supersaturated growth solutions. The most effective inhibitors reported in the literature simply stop the crystal from growing.

It turned out that Chung’s initial finding was correct. Once they confirmed it is possible to dissolve crystals in supersaturated solutions, researchers then looked at reasons to explain why that happened.

Mpourmpakis and Taylor applied density functional theory (DFT) – a highly accurate computational method used to study the structure and properties of materials – to address how HCA and CA bind to calcium and to calcium oxalate crystals. They discovered HCA formed a stronger bond with crystal surfaces, inducing a strain that is seemingly relieved by the release of calcium and oxalate, leading to crystal dissolution.

HCA was also tested in human subjects, as seven people took the supplement for three days, allowing researchers to determine that HCA is excreted through urine, a requirement for the supplement to work as a treatment.

While Rimer said the research established the groundwork to design an effective drug, questions remain. Long-term safety, dosage and additional human trials are needed, he said.

“But our initial findings are very promising,” he said. “If it works in vivo, similar to our trials in the laboratory, HCA has the potential to reduce the incidence rate of people with chronic kidney stone disease.”

More information: Molecular modifiers reveal a mechanism of pathological crystal growth inhibition, Nature, DOI: 10.1038/nature19062

Journal reference: Nature

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Scientists challenge recommendation that men with more muscle need more protein

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Sports nutrition recommendations may undergo a significant shift after research from the University of Stirling has found individuals with more muscle mass do not need more protein after resistance exercise.

Health and exercise scientists from Scotland’s University for Sporting Excellence found no difference in the muscle growth response to protein after a full body workout between larger and smaller participants.

Kevin Tipton, Professor of Sport, Health and Exercise Science in the Faculty of Health Sciences and Sport, said: “There is a widely-held assumption that larger athletes need more protein, with nutrition recommendations often given in direct relation to body mass.

“In our study, participants completed a bout of whole-body resistance exercise, where earlier studies — on which protein recommendations are based — examined the response to leg-only exercise. This difference suggests the amount of muscle worked in a single session has a bigger impact on the amount of protein needed afterwards, than the amount of muscle in the body.”

Experts also found participants’ muscles were able to grow and recover from exercise better after a higher dose of protein.

Consuming 40 grams of protein after exercise was more effective at stimulating muscle growth than 20 grams. This increase occurred irrespective of the size of the participants.

Professor Tipton continued: “Until now the consensus among leading sports nutritionists, including the American College of Sports Medicine and the British Nutrition Foundation, is that weightlifters do not need more than around 25 grams of protein after exercise to maximally stimulate the muscle’s ability to grow.

“In order for nutritionists to recommend the correct amount of protein we first need to consider specific demands of the workout, regardless of athletes’ size. This throws commonly held recommendations into question and suggests the amount of protein our muscles need after exercise may be dependent on the type of workout performed. These results are limited to younger, trained men so we may see different results with other groups, such as older individuals or females digesting different amounts of protein.”

Young, resistance-trained males were recruited for the study and divided into two groups, one with lower lean body mass of less than 65 kilograms and one with higher lean body mass of more than 70 kilograms.

Each volunteer participated in two trials where they consumed protein after resistance exercise. In one trial participants consumed 20 grams of whey protein and in the second, they consumed 40 grams of whey protein after exercise. Scientists measured the muscle’s ability to grow at an increased rate with metabolic tracers and muscle biopsies.

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