Be Active Against Cancer: Diet and Lifestyle Tips

The conditions in which we live and work, and our 21st century lifestyles, influence our health and quality of life, increasing the risk of many chronic diseases, including cancer. Although cancer is a difficult and emotive subject, talking about it can improve outcomes at an individual, community and policy level. Many people know of the usual risk factors. Tobacco use is the most common risk factor, as well as alcohol which current trends show an increase in consumption which results in many more cancers, even more so in women. Overweight and obesity is increasing globally at an alarming rate, including among children and adolescents. Also of concern is the high proportion of overweight people living in low resource settings (two-thirds of the global total). Overweight and obesity is also strongly linked to increased risks of bowel, breast, uterine, pancreatic, oesophagus, kidney and gallbladder cancers. Rising rates of obesity will lead to increased cancer rates unless policies and actions are taken to improve people’s diets and levels of physical activity.

On the occasion of World Cancer Day, I am going to dispel the myth that there is nothing we can do about cancer. Research shows that, with a healthier diet and lifestyle a third of the most common cancers can be prevented. I will discuss lifestyle and food choices that can help prevent cancer.

You can join me either at East Sheen Library on the 4th of February at 2:30 or at East Sheen Primary School on the 12th of February at 6pm.

Be active against cancer School talk copy          Be active against cancer copy

If “food is medicine”, why not prescribe it?

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Published in e-hospice online on the 13th of December (click here)

People with a terminal illness often look for ways to help themselves. Dr Philip Lee, a consultant physician, who passed away in 2011 was treating people with metabolic diseases, many of who needed to make significant changes in their diets in order to survive. Following his diagnosis of metastatic lung cancer and knowing the therapeutic power of food, he changed his diet. See his video on the Help the Hospices website.

Dr Lee was an advocate of the consensus statement on nutritional care for palliative patients, now endorsed by many healthcare professional bodies to improve the training of staff in nutritional care.

Palliative care patients may also suffer from nutritional problems due to late consequences of cancer treatment, such as: anorexia-cachexia, diarrhoea, constipation, nausea, abdominal pain and other digestive problems.  A recent conference at the Royal Marsden Hospital considered dietary changes to help these problems, along with other interventions, e.g. antibiotic treatment of small bowel bacterial overgrowth, a major cause of diarrhoea or sometimes constipation. The wife of a patient related how after admission to a hospice her husband’s low fat diet for fat malabsorption was ignored. The sausages and other fatty food he ate worsened his symptoms of diarrhoea and abdominal pain. She could not forget his experience.

Recently, a hospice patient disclosed that she drank her own rice milk because of her allergy to dairy products. When told this ‘special milk’ could be provided by the hospice, she was astonished. She hadn’t thought her dietary needs would be considered part of her care. Other patients in the hospice told us how wonderful they find desserts in small shot cups. With their reduced appetite, they could now manage these portions and no longer felt guilty leaving food uneaten.

Over 2,500 years ago, Hippocrates said: ‘Food is medicine’. Even now research into illness rarely considers food as a factor in our health or recovery. However, there is a greater awareness and evidence:

  • The ‘China Study’ by Dr Colin Campbell showed that diet plays a major role in our health.
  • Michal Pollen in his book In Defense of Food says “don’t eat something your grandmother would not recognise”.
  • Even President Clinton has become a vegan after 2 major heart operations (watch video).

Food is overlooked, taken for granted and people say, without checking, that there is no evidence for food as medicine.  As scientists, our duty is to resist any prejudgement, to delve deeper and ask the question: can nutritious food be prescribed as medicine? After all, this is what patients want.

Dr Eleni Tsiompanou, MSc Nutritional Medicine

 

Not all calories are the same

Do you think you need to eat low fat foods to avoid heart disease? Think again.
What is important is WHERE the fat in your food comes FROM and WHAT ELSE you eat. Which is why it helps to think in terms of food groups, not  calories. What’s more important is where your calories come from, than how many you have in a day.

Consider dairy products as an example. If you are not intolerant to dairy products (and many people are without knowing it) and you can find good quality butter, milk, cheese, yoghurt, then eat them without second thought. Dairy products which come from animals that roam freely and eat green grass have more omega-3 fatty acids and hence have an anti-inflammatory effect when they’re eaten.

At the same time, be very careful what else you eat.

Reduce refined carbohydrates, as they can fuel metabolic syndrome, diabetes, heart disease and other conditions. In other words, avoid sugar, white bread, sweets, cakes etc.

All in good moderation, as the Ancient Greeks said: ΠΑΝ ΜΕΤΡΟΝ ΑΡΙΣΤΟΝ

Dr Assem Malhotra, talks about these issues in the British Medical Journal.

Also, Greek-American dietitian Bill Lagakos explains in detail the relative importance of calories in his book “This poor, misunderstood calorie’.

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Hippocrates Timeless Still

My article in the Journal of the Royal Society of Medicine 

J R Soc Med. 2013 Jul;106(7):288-92

can also be read in full here in the James Lind Library online

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The special interest in each person’s particular characteristics distinguishes Hippocratic medicine significantly from modern medicine. Hippocrates put the person at the center of his attention, while modern medicine focuses on the disease. Hippocrates was first and foremost interested in finding out what led to the development of the symptoms experienced by the person. He distinguished lifestyle patterns and personal characteristics that predisposed to certain conditions. Although modern medicine is increasingly accepting the importance of lifestyle in the development of chronic diseases, it continues to give priority to examining the illness and treating the symptoms. Hippocratic therapies involved primarily changes in food, exercise and other lifestyle patterns while modern medical treatments concentrate on pharmacological and surgical interventions.

In The Art, the writer gives general advice on how a patient should be treated. He explains that medical treatment consists of much more than drugs:

The most famous doctors cure by changing the diet and lifestyle of their patient and, by using other substances. Such capable doctors have the knowledge and ability to use 
the therapeutic properties of most natural or man-made products (The Art 2.6; Jones 1923)

 

 

Vegan truffles on prescription: “Jewelled Date & Walnut Truffles”

I made this recipe today with two of the ladies who attended the Ladies Lunch Group at Princess Alice Hospice. These are ladies with metastatic breast cancer, who attend our monthly social-get-together-and-have-lunch event that the social work team at the hospice organise. One of them told us that she never cooks, the other one is a highly accomplished cook who wanted to learn how to take the seeds of a pomegranate. They stood side by side and prepared with me this very easy recipe, giggling with excitement and enjoying every bit of it. This was for me another proof how cooking recipes and a cooking demonstration from a doctor can not only educate, connect and give nice food-is-your-medicine to patients, but can also help to lift the spirits and bring a smile to peoples’ face.

And it tastes delicious!!

Jewelled Date & Walnut Truffles

Date paste
Walnuts
Desiccated coconut
Pomegranate seeds

Method:
Use 2 tsps of the paste for each truffle. Add half a walnut in the mixture and shape into a ball.
Roll balls in coconut to coat.
Decorate with pomegranate seeds.
Keep in the fridge until you serve

POFTĂ BUNĂ! (Enjoy your meal, in Romanian)

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Sardines on prescription: “Sardine & Watercress Pâté”

At the Ladies Lunch Group at Princess Alice Hospice today, ladies with metastatic breast cancer met to have lunch and listen to my presentation on

‘Cooking on Prescription from the Doctor’.

I made this pâté in front of them to demonstrate how easy it is to prepare a healthy meal with readily available ingredients. Perhaps the most exotic ingredient in it is turmeric, which is however very easy to find and is one of the most important spices for health. A number of studies have demonstrated its’ antioxidant/anti-inflammatory properties. More research is underway to investigate its’ potential against cancer, Alzheimer’s disease, arthritis, diabetes and other illnesses.

So, another straightforward recipe to make in your kitchen. You will need a food processor for this one, which will do most of the hard work for you. The combination of the ingredients in this recipe make it a most healthy food to have as a snack or main meal with a side salad or some cooked vegetables. Full of omega 3 fatty acids, calcium, magnesium, phosphorus and hundreds of other micronutrients that work together to help your body and mind function well.

Sardine & Watercress Pâté

Tinned sardines in springwater or brine
One small baked sweet potato
A handful of watercress leaves or cabbage
Parsley and chives (optional)
1 tsp turmeric
1-2 tsps mustard
Lime juice
Pepper

Method
Add all the ingredients in a food processor and mix until smooth
Serve on rye or wholemeal bread with a side salad of tomatoes and watercress.

Καλή όρεξη (enjoy your meal, in Greek)

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Green soup on prescription: “Watercress & Broccoli Soup”

A wonderful, tasty soup that is full of healthy ingredients. It won’t take you more than 20 minutes to prepare it. Just make sure you don’t overcook the greens. Add some parsley also if you have it. Eat it with some white fish and you have everything you need for a whole meal, full of nutrients that your body and mind need to function well.

Watercress & Broccoli Soup

Broccoli cut into small pieces
A handful of watercress leaves
A handful of spinach leaves
1 small sliced onion
2 garlic cloves, crushed
1cm piece of fresh root ginger, peeled and cut into small pieces
Olive oil
Thai fish sauce
Lime juice
Salt and pepper

Method
Gently sweat the onions, garlic, ginger, fish sauce and tamari sauce in a little water.
Add the broccoli and enough water to cover and bring to the boil. Simmer until the broccoli is just tender.
Add the watercress and spinach and leave to boil for another minute.
Blend the soup in a food processor until smooth and thick.
Add oil, some lime juice, season with salt and pepper and serve.

Bon appétit (enjoy your meal, in French)

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Cooking on prescription

Doctors teaching cooking? Why not. More and more physicians turn to this simple measure to inspire people to get back to their kitchen. This is a place where a treatment for any illness can start, a cure can be found and a sense of community and connection can begin to heal the mind and soul of every person.

Cooking can change lives, can even save lives. This is why in my hospice we have started giving cooking demonstrations for patients and bereaved relatives. And they are such fun, both for staff and for patients and relatives! To paraphrase Andrew Boorde from his 1547 medical book ‘Breviary of Health’: ‘A Good Physician Is Half A Cook’.

As a doctor with specialisation in nutritional medicine I am delighted to be putting on my apron at work and taking part in the new revolution in medicine and healthcare which starts from real food in our kitchens!

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Recipes to improve your health, boost your energy and lift your spirits

Once again, I am returning to the mental health charity Stuart Low Trust with a selection of recipes and information on how cooking can save your life.

I believe that a good physician is half a cook. Of course, science and experience are important. I will bring all these elements into my presentation trying to persuade you that your efforts to improve your health start in your kitchen.

I hope to see you there:

Friday 27 Sept 2013 6:30 – 9.00 pm. Refreshments provided at 6:30, presentation begins at 7:30

St Mary’s Community Centre, Upper Str, Islington N1 2TX. FREE EVENT

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Full article: Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway

Read the full paper here: LCP submitted paper Clinical Medicine

Overfeeding and overhydration in elderly medical patients – Lessons from the Liverpool Care Pathway. Eleni Tsiompanou; Caroline Lucas; Mike Stroud. Clinical Medicine 2013;13(3):248-251

and our rapid response in the BMJ http://bit.ly/134SV6h

Overfeeding, overhydration, elderly patients & the LCP – Clinical Medicine article

Article published in the Royal College of Physicians journal Clinical Medicine 2013;13(3):248-251

Overfeeding and overhydration in elderly medical patients – Lessons from the Liverpool Care Pathway.

Eleni Tsiompanou; Caroline Lucas; Mike Stroud

‘If a convalescent while taking nourishment remains weak, it is a sign that the body is being overnourished’ Hippocratic Aphorism – 4th century BC

Abstract 

This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.

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“Food as Medicine” – Hippocratic Ancient Mediterranean Diet

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“Food as Medicine: Exploring Nutritional Knowledge in Hippocrates Books”. My published thesis on the Hippocratic Ancient Mediterranean Diet.

Abstract

The Hippocratic writings are the first written evidence of the significance that ancient doctors placed on nutrition for maintenance and restoration of health. The views of the Hippocratic doctors on health and disease and their nutritional interventions influenced medical practice and shaped medical views on the role of diet in the prevention and treatment of illness, for more than 2,500 years.

The Hippocratic writers advocated the use of diet to treat illnesses. They also paid great significance to the factors that maintained health, amongst which nutrition was one of the most important. By taking a broad view on life they advocated preventative (prophylactic) medicine.

The aim of my study was to assemble, critically appraise and produce a synthesis of nutritional guidelines and views found in the Hippocratic books. I did so by searching and reviewing the primary source: the Hippocratic Corpus. I also put the Hippocratic ideas under the light of modern nutritional knowledge, in order to assess the factual value and effectiveness of dietetic approaches and treatments proposed in the Hippocratic books.

Were the Hippocratic physicians the first to practise Nutritional Medicine in a scientific way? We all know the famous saying ‘Let Food be thy Medicine and Medicine be thy Food’. Were they right in saying that food can be used as medicine? What are the nutritional principles that they promoted? Can Hippocratic hypotheses/observations be validated with what research has found today?

The Hippocratic doctors weren’t aware of the human genome, but they understood that each person is different and should be treated as such. They therefore advocated the use of a meticulous medical history, which included the individual’s previous state of being, health and illness, their environment and their previous known reaction to foods. Could we then argue that they were practicing the equivalent of modern nutrigenomics? Lastly, could the review of the observational data and views concentrated in the Hippocratic books help us plan further research and ask new questions, opening new possibilities into our therapeutic approach?

All these themes are explored in detail in my book.

THE TREASURE OF HIPPOCRATES

Delphi
An Invitation to Book Club at PENNY BROHN CANCER CARE
in BRISTOL

 

 THURSDAY 21 MARCH 2013, 4.30 p.m. – 6.00 p.m.

 

“THE TREASURE OF HIPPOCRATES:
Ancient knowledge on health and medicine
applied in the 21st Century”

 

Speaker: Dr ELENI TSIOMPANOU

 

 

 

2,500 years ago Hippocrates said ‘Health is the greatest gift given to man’. Starting as an itinerant physician, he travelled from his home on the Greek island of Cos, through Greece and Asia Minor practising the gentle art of physical observation, using his medical knowledge to show that disease was the product of environment and lifestyle. He believed that the body contained within itself the benign power of nature to rebalance and heal. His medical ethics included the instruction to treat the whole, not just the afflicted part in order to help, and to do no harm.

 

Here in the 21 century, Dr Eleni Tsiompanou also bases her medical practice on such ethics: ‘my job is to inspire, empower, support, rebalance and help patients to rediscover a quality of life’ she says. The writer of many books and articles, with a special interest in nutrition for the health-compromised, she has worked in palliative medicine, integrative oncology and general medicine. Living in London, she regularly makes her way to Bristol to work as one of Penny Brohn Cancer Care’s doctors. Her interest in the history and philosophy of medicine originates from her native Greece. ‘ I believe that food, exercise, lifestyle and the environment all contribute to health’ she says ‘and I have seen how spiritual practice, music, the arts, singing and harmonious living can restore balance. Health is much more than the absence of disease: it can be vibrant, dynamic and long lasting when we live in harmony with our true nature’.

 

I am sure that this Book Club will be fascinating and informative. In bringing the date forward to 21st of March to avoid clashing with Easter, I hope that as many of you as possible will come and bring your friends.

 

Pat Pilkington
Co-Founder, Penny Brohn Cancer Care
Bristol BS20 0HH

 

 

Google Effects on Memory and the Art of Medicine

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On the occasion of an interesting article published in Science in July 2012:

‘Google Effects on Memory: Cognitive Consequences of

Having Information at Our Fingertips’

(Betsy Sparrow, Jenny Liu and Daniel M. Wegner; 15 July 2011: Vol. 333 no. 6040 p. 277).

Two thousand five hundred years ago, Plato wrote that reading had created

a generation of pedants who believe they know everything but master nothing:

“For this <the art of writing> will cause forgetfulness in the minds of those who have learned,

because they will neglect their memory.

Having put their trust in writing, they will recall to memory things from outside,

by means of external marks; not from inside themselves, by themselves.

You have invented a pharmakon not for memory, but for reminding” (Totelin, 2009).

In Ancient times, doctors did not have the luxury of easy access to information, as we do today.

Before the 5th century BC no book on medicine really existed.

This meant that oral tradition was very important.

People had to pay attention and remember what they heard.

A good memory was necessary and, when combined with experience in the practice of medicine,

it distinguished a good from a bad doctor.

As Plato said, if you experience something, know it from within yourself,

then you have a memory of it. 

 The art of medicine can be acquired through practicing it,

not through reading about it. 

This is even more relevant today with the available technology and information overload. 

 

 

 

The Art of Medicine and Writing

Hippocratic_corpys_lugdunum_1665

A doctor’s aim, Hippocrates argues, should be to push medicine forward, taking what has already been discovered and improving it further, to advance the Art of Medicine:

In my opinion, however, to discover what was unknown before is the ambition and task of intelligence, and so is to bring to completion what was already accomplished in part (The Art 2.1; Jones 1923).

Hippocrates called for physicians to engage with research in health and disease, as today. Every new discovery opens up another level of inquiry that goes deeper into understanding how the human body functions.

An aspect of Hippocratic Medicine that was innovative at the time relates to the practice of collecting detailed records of the patients Hippocrates cared for. This practice marked a significant shift from the then traditional oral transmission of knowledge. Plato commented on this new movement of the written word, in his work Phaedrus:

For this [the art of writing] will cause forgetfulness in the minds of those who have learned, because they will neglect their memory. Having put their trust in writing, they will recall to memory things from outside, by means of external marks; not from inside themselves, by themselves. You have invented a pharmakon not for memory, but for reminding (Plato, Phdr. 275a; Totelin, 2009).

Perhaps these records were used for teaching purposes. We do not really know what their purpose was. Hippocrates challenged the then oral tradition, by recording his observations. When a person came to see him about their illness, he examined details about their habits, lifestyle, food intake and their symptoms and signs of disease. With his companions and disciples, he recorded his findings, analysed them and later developed his theories. Through this system, which was based on clinical observation, he drew original conclusions and pushed medicine forward to a new era, influencing physicians more than anyone else before him.

The case histories written in some of the books, such as the Epidemics, are only epigrammatic recollection of certain patients. It is possible that the information presented was only a summary of the actual cases and its purpose was primarily for teaching. Yet, what these writings show is a discrimination of cases and a search for understanding of what determines disease progression and prognosis:

The most acute diseases, the most severe, difficult and fatal belong to the continuous fevers. The least fatal and least difficult of all, but the longest of all, is the quartan… It is necessary also to consider the person’s mode of life and to take it into account when prescribing. Many other important symptoms there are which are akin to these… These must be duly weighed when considering and deciding who is suffering from one of these diseases in an acute, fatal form, or fatal illness, or one from which he may recover… (Epidemics I 1.XXIV-V; Jones 1923).

The woman suffering from angina who lay sick in the house of Aristion began her complaint with indistinctness of speech. Tongue red, and grew parched. First day: Shivered, and grew hot. Third day: Rigor; acute fever; a reddish, hard swelling in the neck, extending to the breast on either side; extremities cold and livid, breathing elevated; drink returned through the nostrils –she could not swallow- stools and urine ceased. Fourth day: general exacerbation. Fifth day: Death (Epidemics III, 1.Case VII; Jones, 1923).

Bibliograpy

Chalmers I (2007) The lethal consequences of failing to make full use of all relevant evidence about the effects of medical treatments: the importance of systematic reviews. In: Rothwell P, ed. Treating individuals: from randomised trials to personalised medicine. London:Elsiever, pp 37-58. 

Jones WHS (1923). Hippocrates. Volume I. With an English Translation by WHSJ. Cambridge, Mass & London: Loeb Classical Library. 

 Plato, Phaedrus 275a. In: Totelin LMV (2009) Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece, Leiden: Brill, p 1.

 

 

 

Hippocrates and Darwin

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In 1868, Charles Darwin, already famous for his radical theory on evolution, made a surprising admission, acknowledging the similarities between his theories and those of Hippocrates, the famous Greek physician of the 5th century BC. In reply to a letter, now unfortunately lost,  sent by Dr William Ogle (Superintendent of Statistics to the Registrar-General) Darwin declares the following:

…I wish I had known of these views of Hippocrates before I had published, for they seem almost identical with mine – merely a change of terms – and an application of them to classes of facts necessarily unknown to the old philosopher. The whole case is a good illustration of how rarely anything is new.

…Hippocrates has taken the wind out of my sails, but I care very little about being forestalled. I advance the views merely as a provisional hypothesis, but with the secret expectation that sooner or later some such view will have to be admitted.

…I do not expect the reviewers will be so learned as you otherwise, no doubt, I shall be accused of wilfully stealing Pangenesis from Hippocrates, for this is the spirit some reviewers delight to show (Darwin 1887, p 82).

Having grown up in a family of doctors and having attended medical school only to drop out after a couple of years, Darwin may have had some knowledge of the Hippocratic writings. He however denies it in his letter, leaving us only to guess whether he had read any of the books in the Corpus. 

Darwin F (ed) (1887). The Life and Letter of Charles Darwin, Vol II. (John Murray Publ., London)

 

“From Hippocrates to 21st Century Nutritional Medicine”

You are invited to an event organised by the Hellenic Medical Society UK, on Friday 19th of October at the Hellenic Centre in London:  

The 2012 Hippocratic Oration:  

“From Hippocrates to 21st Century Nutritional Medicine” 

The President of the Hellenic Medical Society UK Dr Dimitris Paschos & the HMS Committee will honour:

  Prof Joe Millward PhD, DSc RPHNutr, Emeritus Professor of Human Nutrition,  Institute of Biosciences and Medicine, University of Surrey, Guildford, UK 

 who will deliver his lecture with 

 Dr Eleni Tsiompanou MD, MSc Nutritional Medicine, Researcher in History of Medicine, Physician 

 7pm: Friday 19th October 2012

At the Great Hall of The Hellenic Centre,  16-18 Paddington Street, London W1U 5AS

 The event is open to the general public  

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Health – the greatest of human blessings

More than 50 people attended my talk last Friday, organised by the Stuart Low Trust.

The audience wanted to know how by their own efforts they could improve their health.

Food, physical activity, singing, music, the arts, lifestyle habits and having a spiritual practice, were some of the Hippocratic practices that I explored as ways to restore ‘balance’ and hence a more healthy condition in the body.

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“Physical Activity Needed in Order to Reap Benefits of Dietary Restriction”

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Research in flies points to enhanced fatty acid metabolism in muscle 
as a key driver of the lifespan extending process 

Fruit flies on  restriction (DR) need to be physically active in order to get the lifespan extending benefits that come from their Spartan diet.

If the same axiom holds true in humans, those practicing caloric restriction in hopes of living longer need to make sure they eat enough to avoid fatigue.

According to research at the Buck Institute, flies on DR shift their metabolism toward increasing fatty acid synthesis and breakdown, specifically in muscle tissue.

“Dietary restriction is known to enhance spontaneous movement in a variety of species including primates, however this is the first examination of whether enhanced physical activity is necessary for its beneficial effects,” said Buck faculty Pankaj Kapahi, PhD, who runs the lab where the research took place.

“This study establishes a link between DR-mediated metabolic activity in muscle, increased movement and the benefits derived from restricting nutrients,” he said, adding that flies on DR who could not move or had inhibited fat metabolism in their muscle did not exhibit an extended lifespan.

“Our work argues that simply restricting nutrients without physical activity may not be beneficial in humans,” said Kapahi.

The research was published in the July 3, 2012 edition of Cell Metabolism.

For more information: www.thebuck.org

http://www.cell.com/cell-metabolism/abstract/S1550-4131(12)00242-2