Here’s How Much Caffeine Is in a Cup of Coffee


The answer may change depending on the cup.
coffee with callistephus flowers in a jam jar

Knowing how much caffeine is in a cup of coffee can be really helpful when you’re trying to limit your caffeine intake. While being dependent on the stimulant isn’t exactly life-threatening, it can leave you sleepy, grumpy, and jittery. Some people with certain health conditions may find their doctors even suggesting cutting back. And since drinking coffee can become so habitual, it’s easy to go a little overboard without even noticing it.

To be able to monitor caffeine intake, you first have to get a general idea of much caffeine is in a cup of coffee.

According to the USDA, regular, brewed coffee contains about 95 milligrams of caffeine per 8-ounce cup. “This is based on average values of home-brewed and fast-food coffee,” Beth Witherspoon, M.P.H., R.D.N., registered dietitian consultant for Community Coffee Company, tells SELF.

A 2014 study that analyzed caffeine content from multiple sources, including two USDA databases, found that an 8-ounce cup of regular brewed coffee can range in caffeine content from about 75 to 165 milligrams. Flavored coffees tend to have less caffeine, with about 48 milligrams per 8-ounce cup. (Espresso, which you’re probably not drinking a full 8 ounces of at a time, can have as much as 500 milligrams of caffeine per 8-ounce serving.)

There are a lot of things that can influence exactly how much caffeine is in a cup of coffee.

“Caffeine content varies between types and species of coffee beans, and can depend on where the beans were grown, and how the coffee is roasted and then prepared,” Witherspoon says. “All of these factors contribute to the variation in caffeine content between cups of coffee.”

The Mayo Clinic explains that even the same type of coffee from the same coffee shop can vary in caffeine content from day to day. If the beans were ground differently, or an extra scoop was put into the coffee maker, the caffeine content can fluctuate.

Witherspoon adds that light roast coffee usually has more caffeine in it than dark roast. “When measured by volume, light roast beans are denser, weigh more, and thus contain more caffeine than dark roast beans (which lose more water in roasting and weigh less when measured by volume),” she explains.

While most people don’t need to account for every last bit of caffeine they take in daily, a close estimate can help those who are trying to cut back on the stimulant.

Drinking too much caffeine can cause headaches, restlessness, and anxiety in some people. For others, too much after a certain time in the afternoon can cause insomnia.

For the average healthy adult, experts recommend consuming a maximum of 400 milligrams of caffeine each day. That’s three to five 8-ounce cups, depending on specific caffeine content, Witherspoon says. “Individuals should adjust this moderate amount based on how it makes them feel,” she adds.

For example, if you have a hard time falling asleep at night, try cutting yourself off sometime between noon and 2 P.M. to avoid insomnia later on. Everyone has their own level of tolerance, though, so you may need to do some experimenting to find what works for you.

If you’re pregnant or have a heart condition, talk to your doctor about what caffeine limits are appropriate for you. There’s a lot of conflicting evidence about what’s safe during pregnancy, so until more conclusive evidence is available, experts recommend limiting intake to 200 milligrams per day.

What Is the ‘Aussie Flu,’ Exactly, and How Worried Should You Be About It?


Yet another reason to get your flu shot, like, yesterday.
aussie-flu-symptoms-h3n2

It feels like pretty much every year medical experts say that it’s going to be an awful season for the flu. And this year is no exception. The dominant flu strain that’s circulating this year is something that’s been dubbed the “Aussie flu,” and it’s especially serious.

The Aussie flu (a.k.a. H3N2) got its name after causing several hospitalizations and deaths in Australia, which has its winter during our summer months. The country had more than 233,400 confirmed cases of the flu, which was more than double the number of cases it saw the year before, according to The Sydney Morning Herald. The paper also reports that 745 people with confirmed cases of the flu died in 2017, which is significantly higher than the five-year average of 176 flu deaths per year.

And, lucky us, the Aussie flu has made its way to America.

The ‘Aussie flu’ is just a fancy name for H3N2, a serious flu strain we’ve seen before.

This year, about 80 percent of confirmed flu cases so far are due to this strain of the flu, The New York Times reports. Last year, experts warned that H3N2 would cause a rough flu season, too. “H3N2 is a nastier virus than some of the other influenza viruses,” William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells SELF. “We anticipate that there will be more healthy children and young adults who find themselves in the ER this year.”There isn’t really anything special about the symptoms of H3N2—they’re are the same as other strains of the flu. That means that if you’re infected, you might feel fever, chills, muscle aches, cough, congestion, a runny nose, headaches, nausea, vomiting, and fatigue, infectious disease expert Amesh A. Adalja, M.D., senior scholar at the John’s Hopkins Center for Health Security, tells SELF.

However, H3N2 cases tend to be more severe than other strains and people are more likely to develop serious complications, such as pneumonia and even death, he says. “This is a moderately severe flu strain,” Dr. Adalja says. “We’re seeing increasing cases in hospitals and increasing rates of death.”

The flu vaccine protects against several strains of the flu, but it’s not super effective against H3N2.

The flu vaccine changes from year to year to try to protect the general public against what doctors suspect will be the predominant flu strains of the season. This year’s vaccine targets an H1N1-like virus, a virus with a B/Victoria lineage, and an H3N2-like virus known as A/Hong Kong/4801/2014, per the Centers for Disease Control and Prevention.

Given that H3N2 is on the list, it seems like you’d be good to go with this vaccine, but it’s not that simple. “Traditionally, vaccines don’t work quite as well against the H3N2 strain,” Dr. Schaffner says. When the H3N2 vaccine is made, the H3N2 part of the vaccine tends to mutate slightly, leaving people with some protection against the virus but not as much as you’d probably like, he explains. The flu vaccine was only 10 percent effective against H3N2 in Australia, but the CDC says that it will likely be 30 percent effective against the virus here.

You should definitely still get your flu shot.

No, getting the flu shot isn’t a guarantee that you won’t get the flu, and that kind of sucks. But experts still stress that you should get the vaccine. “The best prevention is still the influenza vaccine,” Dr. Adalja says. “Even though it’s not optimal, it’s still the best we’ve got.” The vaccine may even help reduce the severity of the Aussie flu, if you happen to catch it, Dr. Schaffner says. (By the way, if you haven’t gotten your flu vaccine yet, there’s still time given that season peaks in February, Dr. Adalja says.)

The flu isn’t easy to avoid, but you can do a lot by washing your hands carefully and often (especially after you visit high-traffic areas like malls and public transportation), using hand sanitizer, and trying to keep your distance from people who are coughing and sneezing, Dr. Schaffner says.

If you do get sick, it’s important to stay home for at least your first 24 hours after your fever wears off, the Mayo Clinic explains. “Don’t go to work or the gym—you’ll become a spreader,” Dr. Schaffner says. From there, most cases of the flu in healthy adults resolve on their own with adequate rest and liquids within a week or two.

But if your symptoms are particularly severe (e.g. you’re having difficulty breathing or persistent vomiting), or you’re at risk for complications due to your age or a chronic illness, call your doctor. You may be prescribed an antiviral drug like Tamiflu, which can make your infection less severe and shorter, Dr. Schaffner says. But those are at their most effective when taken in the first 48 hours of the infection, so don’t hesitate to get medical attention if you’re at risk.

Why The Best Hospitals Are Managed by Doctors.


Healthcare has become extraordinarily complex — the balance of quality against cost, and of technology against humanity, are placing ever-increasing demands on clinicians. These challenges require extraordinary leaders. Doctors were once viewed as ill-prepared for leadership roles because their selection and training led them to become “heroic lone healers.” But this is changing. The emphasis on patient-centered care and efficiency in the delivery of clinical outcomes means that physicians are now being prepared for leadership. The Best Hospitals The Mayo Clinic is America’s best hospital, according to the 2016 US News and World Report (USNWR) ranking. Cleveland Clinic comes in second.

The CEOs of both — John Noseworthy and Delos “Toby” Cosgrove — are highly skilled physicians. In fact, both institutions have been physician-led since their inception around a century ago. Might there be a general message here? A study published in 2011 examined CEOs in the top-100 best hospitals in USNWR in three key medical specialties: cancer, digestive disorders, and cardiovascular care. A simple question was asked: are hospitals ranked more highly when they are led by medically trained doctors or non-MD professional managers? The analysis showed that hospital quality scores are approximately 25% higher in physician-run hospitals than in manager-run hospitals. The findings of course do not prove that doctors make better leaders, though the results are surely consistent with that claim. Other studies also find this correlation. Research by Nick Bloom, Raffaella Sadun, and John Van Reenen revealed how important good management practices are to hospital performance. But they also found that it is the proportion of managers with a clinical degree that had the largest positive effect; in other words, the separation of clinical and managerial knowledge inside hospitals was associated with worse management. Support for the idea that physician-leaders are advantaged in healthcare is consistent with observations from multiple other sectors. Domain experts – “expert leaders” (like physicians in hospitals) — have been linked with better organizational performance in settings as diverse as universities, where scholar-leaders enhance the research output of their organizations, to basketball teams, where former

Research by Nick Bloom, Raffaella Sadun, and John Van Reenen revealed how important good management practices are to hospital performance. But they also found that it is the proportion of managers with a clinical degree that had the largest positive effect; in other words, the separation of clinical and managerial knowledge inside hospitals was associated with worse management. Support for the idea that physician-leaders are advantaged in healthcare is consistent with observations from multiple other sectors. Domain experts – “expert leaders” (like physicians in hospitals) — have been linked with better organizational performance in settings as diverse as universities, where scholar-leaders enhance the research output of their organizations, to basketball teams, where former All Star players turned coaches are disproportionately linked to NBA success, and in Formula One racing where former drivers excel as team leaders. Why doctors make good managers… What are the attributes of physician-leaders that might account for this association with enhanced organizational performance? As leaders, do physicians create a more sympathetic and productive work environment for other c

Why doctors make good managers… What are the attributes of physician-leaders that might account for this association with enhanced organizational performance? As leaders, do physicians create a more sympathetic and productive work environment for other clinicians, because they are “one of them”? Does being a physician inform leadership through a shared understanding about the motivations and incentives of other clinicians? When asked this question, Dr. Toby Cosgrove, CEO of Cleveland Clinic, responded without hesitation, “credibility … peer-to-peer credibility.” In other words, when an outstanding physician heads a major hospital, it signals that they have “walked the walk,” and thus have earned credibility and insights into the needs of their fellow physicians. But we would argue that credibility may also be signaled to important external stakeholders — future employees, patients, the pharmaceutical industry, donors, and so on. The Mayo website notes that it is physician-led because, “This helps ensure a continued focus on our primary value, the needs of the patient come first.” Having spent their careers looking through a patient-focused lens, physicians moving into executive positions might be expected to bring a patient-focused strategy.

In a recent study that matched random samples of U.S. and UK employees with employers, we found that having a boss who is an expert in the core business is associated with high levels of employee job satisfaction and low intentions of quitting. Similarly, physician-leaders may know how to raise the job satisfaction of other clinicians, thereby contributing to enhanced organizational performance. Our research suggests that if a manager understands, through their own experience, what is needed to complete a job to the highest standard, then they may be more likely to create the right work environment, set appropriate goals and accurately evaluate others’ contributions. Having an expert leader at the helm, such as an exemplary physician, may also send a signal to external stakeholders, such as new hires or patients, about organizational priorities.

These factors are revealed in new work soon to be released. Finally, we might expect a highly talented physician to know what “good” looks like when hiring other physicians. Cosgrove suggests that physician-leaders are also more likely to “tolerate crazy ideas” (innovative ideas like the first coronary artery bypass, performed by René Favaloro at the Cleveland Clinic in the late ‘60s). Cosgrove believes that the Cleveland Clinic unlocks talent by giving safe space to people with extraordinary ideas and importantly, that leadership tolerates appropriate failure, which is a natural part of scientific endeavor and progress. …and how training can make them even better ones. Physician-leaders appear to be the most effective leaders precisely because they are physicians. Yet, great leadership also takes social skills. Medical care is one of the few sectors where lack of teamwork might actually cost lives, yet physicians are not trained to be team players.

Nor is there evidence that it is the team players who select into medicine. Indeed, the favored nature of physician leadership of hospitals is even more remarkable for the leadership and followership handicaps that physicians must overcome in becoming doctors. In view of this handicap, Dr. Victor Dzau, President of the National Academy of Medicine, considers those successful physician-leaders (who largely lack formal leadership training) as “accidental leaders.” Physicians have traditionally been trained in “command and control” environments as “heroic lone healers” who are collaboratively challenged. In the context of this paradox, that medical training on the whole conspires against great leadership, there is a clear need to train physicians more systematically. One model has been pioneered by Paul Taheri, CEO of Yale Medicine, who has been engaging doctors in management training for some time. He has focused on a two-tier approach: the first introduces physicians to the fundamental principles of business in the delivery of healthcare, and personal leadership development, through a day a month programme spread over a year. Taheri sends around 40 medical faculty annually.

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For those physicians who stand out as emergent leaders, the next step is an MBA. Taheri insists that in the executive programs physicians are always trained with other physicians, but by design they are taken away from their hospital environment into the safe learning environment of the business school. The Cleveland Clinic has also been training physicians to lead for many years. For example, a cohort-based annual course, “Leading in Health Care,” began in the early 1990s and has invited nominated, high-potential physicians (and more recently nurses and administrators) to engage in 10 days of offsite training in leadership competencies which fall outside the domain of traditional medical training. Core to the curriculum is emotional intelligence (with 360-degree feedback and executive coaching), teambuilding, conflict resolution, and situational leadership.

The course culminates in a team-based innovation project presented to hospital leadership. 61% of the proposed innovation projects have had a positive institutional impact. Moreover, in ten years of follow-up after the initial course, 43% of the physician participants have been promoted to leadership positions at Cleveland Clinic. In-house programs have been developed in many healthcare institutions (including Virginia Mason, Hartford Healthcare, the University of Kentucky, etc.), by medical societies like the American Association of Physician Leadership, and by business schools (including Wharton, Harvard Business School, the Weatherhead School of Management, and soon at Cass Business School in London).

There seems to be a widening consensus that training physicians for leadership matters. Such training promises to enhance the pipeline of physician-leaders so that the benefits of physician leadership can be more broadly realized. Source

Source: https://forum.facmedicine.com

Researchers Use Electrical Stimulation and Intense Physical Therapy to Help Paralyzed Man Move His Legs


Mayo Clinic and UCLA research supports growing evidence of benefits of electrical stimulation; similar research under way at Shepherd Center.

 Mayo Clinic researchers in Rochester, Minn., used electrical stimulation on the spinal cord and intense physical therapy to help a man intentionally move his paralyzed legs, stand and make steplike motions for the first time in three years.

The case, the result of collaboration with UCLA researchers, was published this week in Mayo Clinic Proceedings. Researchers say these results offer further evidence that a combination of this technology and rehabilitation may help people with spinal cord injuriesregain control over previously paralyzed movements, such as steplike actions, balance control and standing.

“We’re really excited because our results went beyond our expectations,” said neurosurgeon Kendall Lee, M.D., Ph.D., principal investigator and director of Mayo Clinic’s Neural Engineering Laboratory. “These are initial findings, but the patient is continuing to make progress.”

The 26-year-old patient sustained a T-6 complete spinal cord injury three years ago. The injury left him unable to move or feel anything below the middle of his torso.

The Mayo study started with the patient going through 22 weeks of physical therapy. He had three training sessions a week to prepare his muscles for attempting tasks during spinal cord stimulation. He was tested for changes regularly. Some results led researchers to characterize his injury further as discomplete, suggesting dormant connections across his injury may remain.

Following physical therapy, he underwent surgery to implant an electrode in the epidural space near the spinal cord below the injured area. The electrode is connected to a computer-controlled device under the skin in the patient’s abdomen. This device, for which Mayo Clinic received permission from the U.S. Food and Drug Administration for off-label use, sends electrical current to the spinal cord, enabling the patient to create movement.

After a three-week recovery period from surgery, the patient resumed physical therapy with stimulation settings adjusted to enable movements. In the first two weeks, he intentionally was able to:

  • Control his muscles while lying on his side, resulting in leg movements
  • Make steplike motions while lying on his side and standing with partial support
  • Stand independently using his arms on support bars for balance

Intentional, or volitional, movement means the patient’s brain is sending a signal to motor neurons in his spinal cord to move his legs purposefully.

“This study supports the growing evidence that when a small amount of electrical stimulation is added to the spinal cord, it can increase the ability of the spinal cord to carry information from the brain to the muscles,” said Edelle Field-Fote, PT, Ph.D., FAPTA, director of spinal cord injury research at Shepherd Center in Atlanta.

The earliest published record of this type of research dates back to the 1980s. Shepherd Center research scientist William (Barry) McKay made significant contributions to this work during its early development. Now, Shepherd Center researcher Stephen Estes, Ph.D., is performing similar studies using more clinically available types of electrical stimulation that do not require surgical implantation.

“The goal of the study is to determine whether this more accessible, non-invasive type of stimulation, combined with physical therapy, can improve the ability to voluntarily move the legs and reduce spasticity in people with spinal cord injury,” Dr. Field-Fote explained.

Source: Mayo Clinic

20 percent of patients with serious conditions are first misdiagnosed, study says


More than 20 percent of patients who sought a second opinion at one of the nation’s premier medical institutions had been misdiagnosed by their primary care providers, according to new research published Tuesday.

Twelve percent of the people who asked specialists at the Mayo Clinic in Rochester, Minn., to review their cases had received correct diagnoses, the study found. The rest were given diagnoses that were partly in line with the conclusions of the Mayo doctors who evaluated their conditions.

The results are generally similar to other research on diagnostic error but provide additional evidence for advocates who say such findings show that the health-care system still has room for improvement.

“Diagnosis is extremely hard,” said Mark L. Graber, a senior fellow at the research institute RTI International and founder of the Society to Improve Diagnosis in Medicine. “There are 10,000 diseases and only 200 to 300 symptoms.”

Graber was not involved in the Mayo Clinic research, which appears in the Journal of Evaluation in Clinical Practice.

 In 2015, the National Academy of Medicine reported that most people will receive an incorrect or late diagnosis at least once in their lives, sometimes with serious consequences. It cited one estimate that 12 million people — about 5 percent of adults who seek outpatient care — are misdiagnosed annually. The report also noted that diagnostic error is a relatively under-measured and understudied aspect of patient safety.

According to previous research cited in the new study, diagnostic errors “contribute to approximately 10 percent of patient deaths” and “account for 6 to 17 percent of adverse events in hospitals.” Graber estimates that the rate of misdiagnosis, although difficult to determine, occurs in 10 percent to 20 percent of cases.

“Diagnostic error is an area where we need more research, more study and more information,” said James M. Naessens, a professor of health services research at the Mayo Clinic, who led its study. “The second opinion is a good approach for certain patients to figure out what’s there and to keep costs down.”

The researchers looked retrospectively at 286 patients who had seen primary-care physicians, physician assistants and nurse practitioners in 2009 and 2010. Nearly two-thirds were younger than 64, and most were female.

 “It’s not going to be 20 percent wrong every time” a patient goes to see a doctor, Naessens said.

In 62 cases (21 percent), the second diagnosis was “distinctly different” from the first, the researchers reported. In 36 cases (12 percent), the diagnoses were the same. In the remaining 188 cases, the diagnoses were at least partly correct but were “better defined/refined” by the second opinion, according to the study.

Naessens and Graber said a second opinion is valuable any time a patient is told he or she has a serious condition, such as cancer, or needs surgery — even if an extra visit initially means more expense. In the long run, additional advice can save lives and money, they said.

“Doctors are humans, and they make the same cognitive mistakes we all make,” Graber said. “If you are given a serious diagnosis, or you’re not responding the way you should [to medication], a second opinion is a very good idea. Fresh eyes catch mistakes.”

Source:www.washingtonpost.com

Endometriosis and Heart Disease: Is There a Link?


A new study suggests that women with endometriosis, a painful gynecologic disease, may be at higher risk for coronary heart disease. Mayo Clinic reproductive endocrinologistDr. Gaurang Daftary says the 20-year study of nurses in Massachusetts is the first study to investigate whether these two conditions are related. He says, “The analysis shows the possibility that coronary artery disease later in life may be associated with a history of endometriosis earlier in life. So, it is an intriguing finding.”

Dr. Daftary says the study also showed “that hysterectomies in younger women definitely change the overall risk profile and increase the risk of heart disease. Women with endometriosis often end up with a hysterectomy. What women can take away from the study is to be their best advocate to prevent a hysterectomy — especially the removal of ovaries as they are the critical hormone producing organs that should not be lost — even if it means making lifestyle changes.”

Watch the video discussion. URL:https://youtu.be/qThNxJkZ8OM

Mayo Clinic developing a device that could stop seizures.


Doctors at Mayo Clinic are working to develop a medical device that could change the lives of people who suffer from seizures due to epilepsy.

The implantable device is for patients who don’t respond to medication. The device will deliver stimulation to the brain to keep a seizure from happening, it will also allow doctors to access data they’ve never had before.

“With that information we’ll have for the very first time, very clear analytics of how many seizures a person had, whether they’re having seizures at night that they might not be aware of,” explains Gregory Worrell, M.D., Ph.D a neurologist at Mayo Clinic.

But that’s not all the information these devices will collect.

“For the first time we may be able to forecast seizures for people so they’ll know that today is a day where I’m at higher risk of having seizures. With that information, they might take more medication they might take different medications.”

The development is made possible through a $6.8 million grant and a partnership between Mayo Clinic, The University of Minnesota, The University of Pennsylvania, and Medtronic.

The hope is to have the devices ready for use in patients within 5 years.

Monosodium glutamate (MSG): Is it harmful?


Monosodium glutamate (MSG) is a flavor enhancer commonly added to Chinese food, canned vegetables, soups and processed meats. The Food and Drug Administration (FDA) has classified MSG as a food ingredient that’s “generally recognized as safe,” but its use remains controversial. For this reason, when MSG is added to food, the FDA requires that it be listed on the label.

MSG has been used as a food additive for decades. Over the years, the FDA has received many anecdotal reports of adverse reactions to foods containing MSG. These reactions — known as MSG symptom complex — include:

  • Headache
  • Flushing
  • Sweating
  • Facial pressure or tightness
  • Numbness, tingling or burning in the face, neck and other areas
  • Rapid, fluttering heartbeats (heart palpitations)
  • Chest pain
  • Nausea
  • Weakness

However, researchers have found no definitive evidence of a link between MSG and these symptoms. Researchers acknowledge, though, that a small percentage of people may have short-term reactions to MSG. Symptoms are usually mild and don’t require treatment. The only way to prevent a reaction is to avoid foods containing MSG

Motivating Patients to Move


Robert (R Jay) Widmer, MD, PhD: I am Jay Widmer, cardiovascular fellow at the Mayo Clinic. Today on theheart.orgat Medscape Cardiology, I will be discussing the best amount and type of exercise for cardiovascular (CV) prevention with Dr Thomas Allison, director of the sports cardiology program and an expert in CV prevention at Mayo. What should we tell our patients? Should they walk? Should they run? How often? What is your opinion?

Thomas G Allison, PhD: Let’s say this simply. I haven’t seen any type of physical-activity that has been studied and not been proven to be beneficial to reduce total mortality and CV risk. There are two specific activities, sitting time and watching television,[1,2] that are actually CV risk factors. We encourage people to move and do whatever they like to do.

We also have data that putting a little zip into it now and then—in other words, doing some interval training or some higher-intensity activity, even if it is jogging just once a week, seems to further reduce the CV risk.

As far as how much to do, the recommendations are at least 30 minutes a day, 5 days a week, and probably an hour a day would be optimal if you had the time to do it.

Dr Widmer: A problem that we face in practice is motivating our patients. How do you motivate your patients to move?

Dr Allison: We have to go back to the Prochaska Stages of Change. If I have a patient who wants to exercise, I help him or her overcome the barriers to exercise—whether to join a gym or buy equipment at home, how to deal with the cold weather.

If I have a patient who is having trouble staying on the program, often I have them get a physical-activity monitor. When you begin to observe behavior, it changes. If you have a little device clipped to your belt or in your pocket that tells you how many steps you have taken, guess what? You start taking more steps.

Dealing with the patient who is not motivated to exercise, that is where we have to do some education about the benefits. I sometimes appeal to their inner athlete. I say, “Did you do sports?” “Oh, yes, I was on the football team in high school. I ran track. I played basketball.” I try to appeal to that and say, “Look at you now,” more or less.

If we have a stress test result, it can sometimes be helpful to say, “You are 40. You are performing like a 58-year-old on the stress test.” We use different techniques at different stages of change.

Dr Widmer: What about the opposite problem from what you just described? If you have a patient is overweight or obese, but also are fit, is it okay to be fat?

Dr Allison: I would refer you to our publication in the December Mayo Clinic Proceedings on just this topic.[3] As it turns out, at every level of body mass index [BMI] we see reduced risk with increased fitness.

In other words, if I could draw a 1-over-X curve, at every level of BMI, the more fit you are, the lower your risk, with the biggest change coming from the least fit to the slightly fit people, but the risk continues to decline. However, at every level of fitness, increasing obesity characterizes a higher level of risk. If you are going to be fat, it’s better to be fit. If you are not going to be fit, it’s better to be lean, but it’s best to be lean and fit, if that answers the question.

Dr Widmer: That sounds very appropriate. What will it take for exercise to be prescribed to the level and intensity that medications are prescribed here in the United States?

Dr Allison: Mike Joyner came up with an idea that I support. We have to get sedentary lifestyle declared to be a disease. Look what happened when we had a medical model for smoking. Suddenly, health insurances were reimbursing people for smoking-cessation programs. Companies were working on drugs to help people quit smoking. When we considered obesity a disease, there was much greater media influence on it. Programs were being supported.

If we declare sedentary lifestyle and poor fitness not only to be a harbinger of future disease, but to be a disease in itself with associated medical, social, and physical cost, then we might get down to the nitty-gritty and say it’s in our best interest to treat that disease. That means let’s get more people active and put resources behind it. Let’s put the shoulder to the wheel and start pushing, start training physicians and professionals how to do this, and start paying for programs. That is what needs to be done.

Dr Widmer: These are great insights. Thank you very much, Dr Allison. Thanks to our readers as well. We hope that you continue to check out our future content on Mayo Clinic’s page at theheart.org on Medscape.

Mayo Clinic Physicians Say High-definition Scopes Accurately Assess Polyps, Costly Pathological Examinations May Not Be Necessary


It may not be necessary for experienced gastroenterologists to send polyps they remove from a patient’s colon to a pathologist for examination, according to a large study conducted by physician researchers at the Jacksonville campus of Mayo Clinic.

The benign hyperplastic polyp appears very pale and bland on imaging.

Their 522-patient study, published in the December issue ofGastrointestinal Endoscopy, found that physicians correctly evaluated whether a polyp was precancerous or benign using high-definition optical lenses during a colonoscopy. Their assessment was 96 or 97 percent accurate — depending on which of two generations of scopes was used — compared with a standard pathological evaluation of the polyps.

The Mayo Clinic researchers conclude that the pathological polyp examination now required by national practice guidelines may not be necessary — an advance they say could result in substantial cost savings for the patient and the health care system, as well as more rapid information and recommendations for follow-up for the patient.

“A colonoscopy is a fairly expensive procedure, and a large portion of the cost is the pathological analysis of polyps that are removed to check whether they are precancerous or benign — a check that determines when a patient needs another colonoscopy,” says the study’s senior investigator and gastroenterologist, Michael Wallace, M.D., MPH.

“We discovered that gastroenterologists using high-definition optical scopes can provide excellent care and diagnoses of polyps without the added step of a pathological examination,” Dr. Wallace says.

The adenoma is darker with dilated blood vessels on the surface.

The research team examined use of the Exera II 180 colonoscope and the Exera III 190 colonoscope to assess 927 polyps. Both are high-definition scopes, and the earlier generation (180) is in wide use.

An optical diagnosis, sometimes referred to as a “virtual biopsy” was sufficient, in the hands of the experienced physicians, to determine that benign (hyperplastic) polyps were indeed benign, and that potentially precancerous (adenoma) polyps were the ones at risk for cancer development.

Investigators also found that physicians in the study had an extremely high adenoma detection rate using the scopes — 50 percent for the 180 model and 52 percent for the 190. “A high adenoma detection rate is considered a good measure of a quality colonoscopy. Studies have shown that a rate of 33 percent — meaning that of 100 people who undergo a colonoscopy, adenomas are found in 33 percent — is excellent,” says Dr. Wallace. “Current national benchmarks recommend an adenoma detection rate of at least 20 percent. We found substantially more adenomas.”

“The more adenoma polyps that are detected, the lower the risk is of getting colon cancer. So this study shows that it is possible to use an optical scope to perform a highly accurate colonoscopy and bypass the pathology laboratory, reducing cost,” he says. “Another advantage is that we can tell the patient immediately after the procedure what we found and when the next examination should be done, as opposed to waiting one to two days for a pathology result.”

The Mayo study is now being used by the American Society for Gastrointestinal Endoscopy to review current colonoscopy guidelines to assess whether or when pathological examination of polyps is necessary, he says.

The study was funded by Olympus Corporation of America, a manufacturer of endoscopes.

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