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Por Mariza Tavares

Jornalista, mestre em comunicação pela UFRJ e professora da ... ver mais

Câncer: é preciso mirar também na atitude, e não somente nos tumores

Pesquisadores de Stanford afirmam que mudança de mentalidade do paciente pode ser capaz de alterar a experiência da doença

Ninguém é o mesmo depois de um diagnóstico de câncer, que representa um fardo emocional para os pacientes e suas famílias. A sensação de instabilidade e insegurança não persiste apenas durante o tratamento; na verdade, se estende pelos anos seguintes e pode acompanhar os sobreviventes até o fim. Não é à toa que ansiedade e depressão acometem pacientes com a doença numa proporção bem maior do que em relação ao restante da população.

Para enfrentar esse quadro, em estudo divulgado esta semana na revista científica “Trends in Cancer”, pesquisadores propõem uma nova frente de batalha: mirar não somente os tumores, mas a mentalidade e a atitude dos pacientes. Segundo eles, o impacto dessa abordagem poderá se traduzir em benefícios para o tratamento e o bem-estar da pessoa. “Gastamos milhões de dólares tentando prevenir e curar o câncer, mas ele é mais do que uma doença física”, afirma Alia Crum, professora de psicologia na Universidade de Stanford e coautora do trabalho. “Ao mesmo tempo em que miramos as células malignas com tratamentos de ponta, deveríamos também garantir que as ramificações sociais e psicológicas da doença fossem tratadas”, completa.

Alia Crum, professora de Stanford e coautora da pesquisa — Foto: Divulgação

Numa palestra dada no Fórum Econômico Mundial, em fevereiro do ano passado, ela citou o efeito placebo: o medicamento não tem qualquer princípio ativo, mas, ao tomá-lo e acreditar em sua eficácia, a mente do indivíduo é capaz de ativar os mecanismos que o organismo tem para se curar. Na sua opinião, esse poder deve ser utilizado na luta contra o câncer. “Nossas mentes mudam a realidade. A forma como pensamos, como enxergamos as coisas, influencia nosso foco, nossa atenção e afeta o resultado final”, enfatizou na ocasião.

Décadas de estudos nos campos da neurociência e da psicologia trouxeram o reconhecimento do poder do “mindset”: a forma como cada um enxerga seu entorno é única, tanto que, diante de um diagnóstico perturbador, as reações são diferentes. Os pesquisadores argumentam que empoderar os pacientes para que mudem sua atitude em relação ao câncer é capaz de alterar a experiência da enfermidade. Em vez do pensamento negativo da iminência de uma catástrofe, ou de que pouco ou nada há para se fazer, é possível trabalhar uma perspectiva de que o corpo é capaz e resiliente. Dessa forma, a pessoa ficará mais engajada, terá menos medo dos efeitos colaterais e se motivará a comer, fazer exercícios e mudanças em seu estilo de vida.

“Não estamos falando de pensamento positivo”, ressalta Alia Crum. “Ter uma atitude em relação ao câncer de que ele pode ser administrado e vencido não significa dizer que se trata de algo positivo ou que deveríamos ficar felizes”, completa. Os pesquisadores propõem as chamadas “intervenções inteligentes” (“wise interventions”), que buscam desconstruir visões, estigmas e estereótipos negativos que cercam e influenciam o julgamento das pessoas. A abordagem tem sido empregada com êxito na área da educação, auxiliando estudantes de baixo desempenho, mas não foi explorada na área da oncologia. É a missão que o time de Stanford tomou para si e a professora está confiante: “a pesquisa ainda engatinha, mas estamos trabalhando duro para mapear os mindsets que interferem na capacidade de os pacientes serem resilientes no enfrentamento do câncer. Principalmente, queremos descobrir que estados mentais podem ser cultivados para aumentar seu bem-estar”.

https://g1.globo.com/bemestar/blog/longevidade-modo-de-usar/post/2019/09/26/cancer-e-preciso-mirar-tambem-na-atitude-e-nao-somente-nos-tumores.ghtml?fbclid=IwAR3AJWzje6P0sNbfYuCLH9-zr_5-PJcXdsPmRG0xxFyWn_L_oOKCvWXYQBo

Five Reasons the Diet Soda Myth Won’t Die

Repeated studies on a health bogeyman help explain wider problems with food research.

By Aaron E. Carroll

Published Oct. 14, 2019Updated Oct. 15, 2019

There’s a decent chance you’ll be reading about diet soda studies until the day you die. (The odds are exceedingly good it won’t be the soda that kills you.)

The latest batch of news reports came last month, based on another studylinking diet soda to an increased risk of early death.

As usual, the study (and some of the stories) lacked some important context and caused more worry than was warranted. There are specific reasons that this cycle is unlikely to end.

1. If it’s artificial, it must be bad.

People suspect, and not always incorrectly, that putting things created in a lab into their bodies cannot be good. People worry about genetically modified organisms, and monosodium glutamate and, yes, artificial sweeteners because they sound scary.

But everything is a chemical, including dihydrogen monoxide (that’s another way of saying water). These are just words we use to describe ingredients. Some ingredients occur naturally, and some are coaxed into existence. That doesn’t inherently make one better than another. In fact, I’ve argued that research supports consuming artificial sweeteners over added sugars. (The latest study concludes the opposite.)

2. Soda is an easy target

In a health-conscious era, soda has become almost stigmatized in some circles (and sales have fallen as a result).

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It’s true that no one “needs” soda. There are a million varieties, and almost none taste like anything in nature. Some, like Dr Pepper, defy description.

But there are many things we eat and drink that we don’t “need.” We don’t need ice cream or pie, but for a lot of people, life would be less enjoyable without those things.

None of this should be taken as a license to drink cases of soda a week. A lack of evidence of danger at normal amounts doesn’t mean that consuming any one thing in huge amounts is a good idea. Moderation still matters.

3. Scientists need to publish to keep their jobs

I’m a professor on the research tenure track, and I’m here to tell you that the coin of the realm is grants and papers. You need funding to survive, and you need to publish to get funding.

As a junior faculty member, or even as a doctoral student or postdoctoral fellow, you need to publish research. Often, the easiest step is to take a large data set and publish an analysis from it showing a correlation between some factor and some outcome.

This kind of research is rampant. That’s how we hear year after year that everyone is dehydrated and we need to drink more water. It’s how we hear that coffee is affecting health in this way or that. It’s how we wind up with a lot of nutritional studies that find associations in one way or another.

As long as the culture of science demands output as the measure of success, these studies will appear. And given that the news media also needs to publish to survive — if you didn’t know, people love to read about food and health — we’ll continue to read stories about how diet soda will kill us.

4. Prestigious institutions and the press

To do the kinds of analyses described here, you need large data sets that researchers can pore over. Building the data set is the hardest part of the work.

Analyzing the numbers on hundreds of thousands of people isn’t child’s play. But gathering the data is much more expensive and time-consuming.

Because of this, a few universities produce a disproportionate amount of the research on these topics. They also tend to be the universities with the most resources and the most recognizable names. Because they’re also usually prestigious, they attract more researchers and more funding to build bigger and newer data sets.

They also get more media attention because of having access to more researchers, prestige and funding. If the research is coming out of a super-respected institution, it must be important.

Lather. Rinse. Repeat.

Moderation in all things is still a good principle. High sugar consumption is linked to obesity, diabetes and tooth decay. — Credit...Hannah Yoon for The New York Times

5. We still don’t understand the limitations of observational studies

No matter how many times you stress the difference between correlation and causation, people still look at “increased risk” and determine that the risk is causing the bad outcome. For reporting on hundreds of thousands of people, observational studies are generally the only realistic option. With very few exceptions, they can tell us only if two things are related, not whether one is to blame for the other (as opposed to randomized control trials).

With respect to diet sodas, it’s plausible that the people who tend to drink them also tend to be worried about their weight or health; it could be a recent heart attack or other health setback that is causing the consumption rather than the other way around. But you shouldn’t assume that diet sodas cause better health either; it could be that more health-conscious people avoid added sugars.

Many of these new observational studies add little to our understanding. At some point, a study with 200,000 participants isn’t “better” than one with 100,000 participants, because almost all have limitations — often the same ones — that we can’t fix.

Dr. John Ioannidis wrote in a seminal editorial: “Individuals consume thousands of chemicals in millions of possible daily combinations. For instance, there are more than 250,000 different foods and even more potentially edible items, with 300,000 edible plants alone.”

And yet, he added, “much of the literature silently assumes disease risk” is governed by the “most abundant substances; for example, carbohydrates or fats.” We don’t know what else is at play, and using observational studies, we never will.

(Observational research is still the best way to study population-wide risk factors; sophisticated techniques like regression discontinuity can even create quasi-randomized groups to try to get closer to understanding causality. Too few employ such techniques.)

Moreover, too many reports still focus only on the relative risk and not on the absolute risk. If a risk increases by 10 percent, for example, that sounds bad. But if the baseline risk is 0.1 percent, that 10 percent increase winds up moving the baseline to only 0.11 percent.

It would probably be a public service if we stopped repeating a lot of this research — and stopped reporting on it breathlessly. If that’s impossible, the best people can do is stop paying so much attention.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute who blogs on health research and policy at The Incidental Economistand makes videos at Healthcare Triage. He is the author of “The Bad Food Bible: How and Why to Eat Sinfully.” @aaronecarroll

https://www.nytimes.com/2019/10/14/upshot/diet-soda-health-myths.html?fbclid=IwAR3h2abWB8fbKlXk2yKs0PQHDnSKaADPtVHN8pclA2Qka7VBmxP1-ao-jQw

Does Sugar Lead to Weight Gain?

Michael Greger M.D. FACLM October 14th, 2019 Volume 48

https://nutritionfacts.org/video/does-sugar-lead-to-weight-gain/?fbclid=IwAR0berqyrKUbs7h6uLKoQXYeSxgtmZsW0-kvdxDeqXe3gokOLzP3aOTUGBc

TRANSCRIPT

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The obesity epidemic may just be the tip of the iceberg in terms of excess body fat. It’s been estimated that 91 percent of adults—9 out of 10 of us—and 69 percent of children in the United States are quote-unquote “overfat,” “defined as excess body fat sufficient to impair health” that can occur even in “normal-weight” individuals, often due to excess abdominal fat. The way to tell if you’re “overfat” is if your waist circumference is more than half your height. What’s causing this epidemic? One primary cause may be all the added sugars we’re eating.

A century ago, sugar was heralded as “one of the cheapest [forms of calories] in the dietary.” Just ten cents’ worth of sugar could furnish thousands of calories. “Harvard’s sugar-pushing nutritionist” bristled at the term “empty calories.” The calories in sugar were “not empty but full of energy.” In other words, full of calories, which we now are getting too many of. “The excess body weight of the US population corresponds to [about a] 350–500 [calorie] excess [daily caloric] intake on average.” So, to revert the obesity epidemic, that’s how many calories we have to reduce. Okay, so which calories should we cut? That’s just how many calories the majority of Americans who fail to meet the Dietary Guidelines’ sugar limit get in added sugars every day. 25 teaspoons is about 400 calories.

Even the most diehard sugar defenders, like James Rippe, who was reportedly paid $40,000 a month by the high-fructose corn syrup industry, on top of the $10 million they paid for his research. Even Dr. Rippe considers it indisputable that sugars contribute to obesity. “It is also [indisputable] that sugar reduction should be part of any weight loss program.” And, of all sources of calories to limit, since sugar is just empty calories, contains no essential nutrients, reducing sugar consumption is obviously the place to start. And again, this is what the researchers funded by the likes of Dr. Pepper and Coca-Cola are saying. The primary author, Richard Kahn, is infamous for his defense of the American Beverage Association—the soda industry. He was chief science officer at the American Diabetes Association when they signed a million-dollar sponsorship deal with the world’s largest candy company. “Maybe the American Diabetes Association should rename itself the American Junk Food Association.” What do you expect from an organization that was started with drug industry funding?

REPUBLISH

TRANSCRIPT

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The bottom line is that “randomized, controlled trials show that increasing sugars intake increases calorie intake,” and this leads to “body weight gain in adults, and…sugar reduction leads to body weight loss in children.” For example, when researchers randomize individuals to either increase their intake of table sugar or decrease their intake, the added sugar group gained about three and a half pounds over 10 weeks, whereas the reduced sugar group lost about two and a half pounds. A systematic review and meta-analysis of all such “ad libitum diet” studies (meaning real-life studies where sugar levels were changed but people could otherwise eat whatever they wanted) showed that reduced intake of dietary sugars resulted in a decrease in body weight, whereas increased sugars intake resulted in a comparable increase in weight. The researchers conclude that “considering the rapid weight gain that occurs after an increased intake of sugars, it seems reasonable to [advise people to cut down.]”

Findings from observational studies have been more ambiguous, though, with an association found between obesity and sweetened beverage intake, but failing to show consistent correlations with sugary foods. Most such studies rely on self-reported data, however, and obese people tend to under-report sugar-rich foods. One can measure trace sucrose levels in the urine, however, to not only get an objective measure of actual sugar intake, but to exclude contributions from other sweeteners, such as high-fructose corn syrup. When researchers have done this, they discovered that sugar intake is indeed not only associated with greater odds of obesity and greater waist circumference on a snapshot-in-time cross-sectional basis, but in a prospective cohort study over time. “Using urinary sucrose as the measure of sucrose intake,” those in the highest versus the lowest fifth for sucrose intake had more than a 50 percent greater risk of being overweight or obese.

“Denying evidence that sugars are harmful to health has [evidently] always been at the heart of the sugar industry’s defense.” But when the evidence is undeniable, like the link between sugar and cavities, they switch from denial to deflection, like trying to switch attention from restricting intake to coming up with some kind of “vaccine against tooth decay.” We seem to have reached a similar point with obesity, with the likes of the Sugar Bureau switching from denial to deflection by commissioning research suggesting obese individuals would not benefit from losing weight, a stance contradicted by hundreds of studies across four continents involving more than ten million participants.

The Carpenters - We've only just begun

https://m.youtube.com/watch%3Fv%3D__VQX2Xn7tI&ved=2ahUKEwjV0fz2o-vmAhV2K7kGHYrqBFMQwqsBMAB6BAgDEAU&usg=AOvVaw3qHKTX_TINNPjChiX3BC2P