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Dermatology, Public Health, Stanford News

It’s never too early to protect your skin from sun damage

It's never too early to protect your skin from sun damage

I’m not ashamed to admit that I dork out for Disneyland. I was there a few weeks ago, wearing a Minnie Mouse T-shirt and sprinting from one thrill ride to the next. But this trip was different in one respect: I made sure to apply a broad-spectrum sunscreen to my face and limbs before heading into the Magic Kingdom and then brought along the tube so that I could reapply it throughout the day.

Growing up, I was happy that my skin picked up a tan easily, with only occasional sunburn. As an adult, I watched the evidence pile up about the hazards of sun exposure and tried to remember to use sunscreen in the summer months when I was outside for long periods of time. But after speaking with several Stanford dermatologists for a story about skin protection for the recent issue of Stanford Medicine magazine, I resolved to be more vigilant year-round.

As my story notes, one in five Americans will develop skin cancer in their lifetime. One good way of warding off that threat is to use a broad-spectrum sunscreen, many of which are now much lighter and less greasy that the sunscreens of old.

“Your sunscreen should be considered your facial lotion,” dermatology professor Susan Swetter, MD, told me. “It works to moisturize the skin as well as to prevent photoaging and skin cancer.”

The story also includes tips for protecting your skin and for encouraging children to develop good skin-protection habits at an early age. Parents seem to be taking the message to heart: As I made my way through the crowded streets of Disneyland, one scent stood out among all of the others. The unmistakable smell of sunscreen.

Previously: This summer’s Stanford Medicine magazine shows some skinBeat the heat – and protect your skin from the sunWorking to protect athletes from sun dangers and The importance of sunscreen in preventing skin cancer
Illustration by Aleksandar Velasevic

Nutrition, Research, Stanford News

Stanford study spoils hopes that raw milk can aid those who are lactose-intolerant

Stanford study spoils hopes that raw milk can aid those who are lactose-intolerant

milk in fridge

I have a few friends who can tell pretty quickly when they’ve eaten a food that contains milk or lactose, the sugar found in milk. The signs are unpleasant — mostly gas and diarrhea (yuck!). So they were interested when I told them that a nutrition researcher at Stanford was conducting a clinical trial to test the validity of claims that people who are lactose-intolerant can digest raw milk more easily than pasteurized milk.

Unfortunately for them, the claims don’t hold up.

In my news release about the study, which was published today in the Annals of Family Medicine, professor of medicine Christopher Gardner, PhD, found no difference in digestibility between the two.

Although the study was small — just 16 participants who were lactose-intolerant — the results were highly consistent among all the participants. As Gardner notes in the press release, “It’s not that there was a trend toward a benefit from raw milk and our study wasn’t big enough to capture it; it’s that there was no hint of any benefit.”

One thing that surprised Gardner was how many people believe they are lactose-intolerant because of the symptoms they experience, yet don’t meet the clinical standard for the condition. In fact, Gardner originally recruited 63 potential study participants, but only 43 percent of them actually met the standard.

So, what’s causing the discomfort that this group of people feel when they consume milk products? And would raw milk — which hasn’t been pasteurized and which proponents say contains “good” bacteria that may aid digestion — help folks who don’t meet the clinical definition of being lactose-intolerant? Gardner says he hopes other researchers will try to answer those questions.

Previously: Stanford pediatrician and others urge people to shun raw milk and products
Photograph by chrisdat

Health and Fitness, Stanford News

Having a (volley)ball

Having a (volley)ball


It’s not hard to have a ball – or at least play with one – around the Stanford School of Medicine’s campus. As long as you know where to look.

For those who are interested in making a few friends and getting in a bit of exercise during lunchtime, there’s a group of people who have been playing volleyball for the past 12 years and they’re always looking for more players.

As you’ll read in my story today in Inside Stanford Medicine, the volleyball games take place on the lawn behind the Medical School Office Building on Wednesdays at noon and Thursdays at 12:30 p.m.

The games are organized by a few of the people who work at the Stanford Prevention Research Center, but they’re open to anyone of any skill level who wants to play. Camaraderie and teamwork matter more than the score in these games.

As longtime player Allison Akana told me, “You don’t necessarily get props for scoring points; you get props for setting up your teammates and being a good team member.”

So if you want to brush up on your volleyball skills and you’re local, stop by. Organizer Christopher Gardner says he’s pining for the day when there are enough players for two simultaneous games. “We’re ready to expand,” he says.

Photo by Norbert von der Groeben

Health and Fitness, Research, Stanford News

Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows

Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows

Michaela Kiernan

All of us who have struggled with our waistlines over the years know that sometimes losing weight isn’t the hardest part. Keeping it off is.

But an approach that sounds a bit odd might be the solution: Before you try shedding any pounds, learn the skills that will help you maintain your weight.

In a study published today in the Journal of Consulting and Clinical Psychology, researchers at Stanford’s medical school reported that women who spent eight weeks mastering weight-maintenance skills before embarking on a weight-loss program shed the same number of pounds as women who started a weight-loss program immediately. More importantly, the “maintenance-first” women had regained only 3 pounds on average a year later, compared to the average 7-pound gain for the immediate dieters.

“Those eight weeks were like a practice run. Women could try out different stability skills and work out the kinks without the pressure of worrying about how much weight they had lost,” lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center, said in our news release about the study.

Among the weight-maintenance skills the women learned were:

  • Searching out low-fat or low-calorie foods that taste as good as high-fat/high-calorie options to avoid feelings of deprivation.
  • Occasionally eating and savoring small amounts of favorite high-fat/high-calorie foods.
  • Weighing daily to see how their body weight naturally fluctuates from day to day.
  • Identifying a personalized weight-fluctuation range of about 5 pounds to account for common disruptions, such as water gain and vacations.
  • Strategically losing a few pounds before a known disruption (such as a vacation) to minimize its effects.
  • Eating a little more when reaching the lower limit of the personalized 5-pound range.

Kiernan said the maintenance-first approach, though sounding a bit unorthodox, could be a useful tool for those who are trying to slim down and be healthier. “This approach helps people learn how to make small, quick adjustments that can help them maintain their weight without requiring a lot of effort,” she said.

You can also listen to this podcast with Kiernan as she explains the study.

Previously: Can a food-tracking app help promote healthy eating habits?Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by Norbert von der Groeben

Health Policy, Stanford News

Stanford experts argue need for health care, not sick care

Stanford experts argue need for health care, not sick care

healthy agingDiscussions about U.S. health-care reform have largely focused on broadening insurance coverage. That’s unfortunate, says a Stanford researcher, because we should spend more time looking for ways to truly improve health.

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, says the health-care system needs to be re-engineered to help people stave off conditions like obesity and diabetes in the first place.

“Increasing health-care coverage has the potential to make the inefficiencies of the current system more visible and worsen the current financial stresses in the system,” Stafford says. “We need to think about more fundamental changes in the way that health care is delivered.”

Stafford lays out his position in this perspective piece published in the Sept. 6 issue of the New England Journal of Medicine. He and co-author, Farshad Marvasti, MD, MPH, an adjunct clinical instructor of medicine, write that although policy-makers have highlighted the need to develop better methods of preventing disease, “efforts to expand prevention continue to be thwarted by a system better suited to acute care.”

They point out that the current model for medical care arose 100 years ago when people didn’t live as long and infectious diseases caused large numbers of deaths. Laboratory research helped develop treatments and technologies to combat these diseases, and a payment structure evolved that compensated doctors for prescribing pills and procedures to treat the conditions.

But the picture has changed drastically today. More Americans are living longer and are dealing with the results of progressive, chronic diseases brought on by factors such as smoking and obesity. Yet the health-care payment structure hasn’t adapted. Strategies for preventing disease — such as coaching patients on how to make meaningful changes that will enhance their health — may be cost-effective, but they can’t be patented or made profitable, which gives researchers little incentive to explore the field, the authors write.

And the way doctors are trained must change as well, Stafford and Marvasti write. Medical students should be taught disease-prevention strategies, and residencies in primary care should be shifted away from hospitals (where acutely ill patients are treated) into alternative settings, such as “medical homes” where a full team of health-care professionals work with patients and their family members to get the care they need at the appropriate time.

These kinds of wholesale changes to encourage disease prevention are “the only way to thwart the emerging pandemic of chronic disease,” they write.

Previously: Does the Affordable Health Care Act address our health-cost problem?, Physician organizations offer free curriculum to educate medical students on reducing health costs
Photo by Shutterstock

Nutrition, Stanford News

The not-so-sweet findings on non-nutritive sweeteners

The not-so-sweet findings on non-nutritive sweeteners

Using aspartame or stevia instead of sugar will help you lose weight, right? Well, the answer isn’t quite so simple. A scientific statement released today by the American Heart Association and the American Diabetes Association shows that there’s inconclusive evidence that non-nutritive sweeteners will help people lose excess weight.

Stanford nutrition expert Christopher Gardner, PhD, who chaired the writing committee for the group that prepared the scientific statement, says the problem is that many people who use the sweeteners end up compensating for those calories later in the day. In short, as a reward for using stevia in their coffee, they reward themselves with a cookie.

In this just-published Q&A, Gardner talks about why non-nutritive sweeteners aren’t more effective in the effort to cut sugar intake. His advice? Stick to eating “real” food and cut down on the sodas and snack food. “There’s no aspartame in broccoli,” he notes.

Photo by Steve Snodgrass

Medicine and Society, Patient Care, Stanford News

Testing medical 'truths'

Testing medical 'truths'

You might want to ask your doctor a few questions the next time he or she hands you a prescription. An interesting commentary in this week’s Journal of the American Medical Association points out that many physicians prescribe treatments for which there is little or no evidence to support their use. Instead, the doctors are simply following long-established prescribing patterns and haven’t checked to see whether there is solid evidence suggesting that the treatment will achieve the desired effect.

John Ioannidis, MD, director of the Stanford Prevention Research Center, is the senior author of the commentary. Check out my Q&A with him, and read why he thinks doctors should “abandon ship” on treatments that aren’t supported by strong evidence. He points out that “trust is likely to be strengthened when patients are more knowledgeable, when they question their physicians about the evidence pertaining to their condition and when physicians give them the full, unbiased picture about this evidence.”

Previously: Convincing physicians to change their prescribing patterns

Health Policy, Nutrition, Stanford News

How fast-food restaurants respond to limits on free toys with kids' meals

How fast-food restaurants respond to limits on free toys with kids' meals
Jennifer Otten

Stanford nutrition researcher Jennifer Otten and some of the promotional items given away with children's meals.

Do ordinances that restrict the ability of restaurants to give away toys with unhealthy kids’ meals have an impact? A new Stanford study looks at what happened in Santa Clara County in the months after the nation’s first such policy was enacted.

The study, published today in the American Journal of Preventive Medicine, examines the actions taken by a small number restaurants immediately after Santa Clara’s ordinance took effect in August 2010.

Although none of the restaurants in the study added healthier offerings for children, two of the restaurants removed toy marketing posters and two offered toys separately at an additional cost. One restaurant singled out the children’s meals that met the ordinance criteria as “promoting good nutrition” on its menu boards.

“Before, parents had no idea which meals met the nutritional criteria. After the law was implemented, one restaurant made it clear which ones did,” said lead researcher Jennifer Otten. “In addition, there was a clear decrease in toy marketing and advertising at some of the affected restaurants.”

With an increasing number of communities looking at ways to curb the rising rates of childhood obesity, Otten and her team want to gather objective data on the effects of policies like the one in Santa Clara County. “This ordinance gave us the opportunity to study a real-world example of a private-sector response to a public health policy,” she said.

But the effort won’t end there. The researchers surveyed almost 900 families before and after the ordinance took effect to determine whether it affected their fast-food purchases. The team is also collecting data from families and fast-food restaurants in San Francisco, where a similar law took effect on Dec. 1. They plan to publish the findings related to the family surveys and the longer-term restaurant responses in future papers.

Previously: Toying with Happy Meals and Are Happy Meals illegal? A public health lawyer says, yes
Photo by Norbert von der Groeben

In the News, Nutrition, Obesity, Parenting, Pediatrics, Public Health

Toying with Happy Meals

Toying with Happy Meals

As you may have heard, a new San Francisco law forbids fast-food restaurants from giving away toys with children’s meals that don’t meet specific nutritional standards. And, as reported in today’s San Francisco Chronicle, some McDonald’s franchisees have opted to charge customers 10 cents if they want a toy with their Happy Meal. They said they would give the money to a charity.

Judging from the comments on the Chronicle story, many people believe McDonald’s is circumventing the law, which was aimed at making children’s fast-food meals healthier. But while some are calling the law a failure, Jennifer Otten, PhD, doesn’t see it that way. Otten, a postdoctoral scholar at the Stanford Prevention Research Center, has been tracking the legislation in San Francisco as well as a similar 2010 law in Santa Clara County.

“This particular legislation has gotten the conversation going about what we as a society are marketing and feeding to our children,” Otten told me today. “The way McDonald’s is responding invites more conversation.”

Otten’s interest is in evaluating policies aimed at helping families make choices that improve their health in order to see which approaches actually work. “We want to gather data on legislation with the potential to move the public health needle in the right direction,” she said.

Otten has already interviewed more than 500 San Francisco families prior to the implementation of the new law, and she’ll conduct later interviews to determine whether it affected the awareness and choices of parents in buying fast-food meals for their children. She’s already analyzing similar survey data from almost 900 families in Santa Clara County.

As for Otten’s view of McDonald’s actions, she said it appears the franchisees are “complying with the law, but not necessarily the spirit of the law.” But regardless of what the fast-food outlets do, she said these types of policies are part of a bigger movement to identify the best levers for addressing childhood obesity.

Previously: Are Happy Meals illegal? A public health lawyer says, yes
Photo by Pengrin

Addiction, Clinical Trials, Stanford News

Kicking the smoking habit for good

Kicking the smoking habit for good

I still smile when I remember talking with a friend who told me he had quit smoking a few years back. “But I saw you smoking on Saturday,” I reminded him.

After a pause, he murmured that he had given up his daily habit and now only smoked an occasional cigarette when he was feeling stressed. “But you’re still smoking, right?” I said. After another pause, he said, “Well, if you want to look at it that way, I guess I am.”

It just goes to show how strong nicotine’s grip can be, and how hard it can be to truly kick the habit. And it’s toward that goal that researchers at the School of Medicine are launching a study that explores the effectiveness of long-term, one-on-one counseling in helping smokers quit.

For the study, all participants will undergo six months of one-on-one therapy, and will receive smoking-cessation medications. At the end of the six months, the participants will be randomly assigned to one of two groups. The first will continue to receive individual counseling sessions for another six months, while the second will receive monthly follow-up phone calls for the same period of time. My news release gives more details about those who are eligible to participate in the study.

Principal investigator Sean David, MD, DPhil, says most people who try to quit on their own end up failing, and so he and his colleagues are looking for better approaches to help people stay off cigarettes for good.

And the study comes along at an opportune time, since the Great American Smokeout will take place on Nov. 17.

Previously: Can daily texts help smokers kick their nicotine addiction?
Photo by Qfamily

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