Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside.  In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives.  This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation.  However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.

Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20^th century in certain populations and locations [1].  Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3].  Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC.  The question is: How?

In  2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions.  Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA).  Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).

Table 1. Our interdisciplinary team

To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1).  Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2).   Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.

Table 2. Team backgrounds

As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change.   Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.

We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:

• While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
• Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
• Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.

Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.

Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.

The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research

This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD    Read more about the team here in a Northwestern University press release.

1.         Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.

2.         Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.

3.         Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.

It is no wonder why the weight-loss industry is a $20 billion per year industry.  Dieters spend money on diet books, diet drugs and weight-loss surgery.  108 million people in the United States are on diets and typically attempt four or five diets a year.  85% of dieters are women.

Some diets preach low-calorie, some are low-carbohydrate.  Some allow for only eating grapefruit or cabbage soup.  Some say it’s only about how much you eat and the amount of time spent exercising, while others say not all calories are created equal and it is about what we eat as well as how much of it.  We are constantly bombarded by different information and different diets.  No wonder we cannot keep the weight off.

A promising study published in the Journal of the American Medical Association may finally set the record straight.  It found that a specific mix of carbohydrate, fat and protein might be ideal.  It also suggested that not all calories are created equal, meaning that calories can have different effects on the body.

The study followed 21 adults ages 18 through 40 for four years to determine the effects of various diets on the ability to burn calories following weight loss. At the start of the study, the participants had a BMI over 27, which is considered overweight or obese.  The participants were originally placed on a diet to lose 10%-15% of their body weight.  After the initial weight loss, researchers placed the participants on three different diets in a random order each for four weeks at a time.  All diets maintained the same total number of calories.  However, they did differ in their carbohydrate, fat and protein content.

The low-fat diet required that 60% of calories came from carbohydrates, 20% from fat and 20% from protein.  The low-glycemic diet required that 40% of calories be derived from carbohydrates, 40% from fat and 20% from protein in order to prevent spikes in blood sugar.  The very low-carbohydrate diet (“Atkins”) required that 10% of calories came from carbohydrate, 60% from fat and 30% from protein.

Researchers measured participants’ energy expenditure as well as other aspects of metabolism and concluded that the total number of calories burned daily differed with each diet.  Researchers also studied hormone levels and metabolic measures concluding that they too varied by diet.

On average the very-low carbohydrate diet burned calories most efficiently with participants burning 3,137 calories daily.  The low-glycemic diet burned 2,937 calories per day, 200 less than the very-low carbohydrate.  The low-fat diet burned 2,812 calories daily.

While researchers did conclude that it improved metabolism the best, don’t switch to the very-low carbohydrate diet just yet.  The participants showed higher levels of risk factors for diabetes and heart disease, including the stress hormone cortisol.

The low-glycemic diet resulted in only a 200 calorie difference and showed similar benefits to the very-low carbohydrate diet, with less negative effects.  A low-glycemic diet consists of less-processed grains, vegetables and legumes.  According to researchers, this may be the best diet for both long-term weight loss and heart disease prevention when coupled with exercise.

A low-glycemic index diet emphasizes foods based on how they affect blood sugar levels.  Foods, specifically carbohydrates since they have the most effect on blood sugar, are given a score between 0 and 100.  High scores of 70 and up include white and brown rice, white bread, white skinless baked potato, boiled red potatoes and watermelon.  Medium scores between 56-69 include sweet corn, bananas, raw pineapple, raisins and some ice creams.  Examples of low scoring foods of 55 and under include raw carrots, peanuts, raw apple, grapefruit, peas, skim milk, kidney beans and lentils.

The diet does not require counting carbs, counting calories or reducing portion sizes.  It only directs dieters to the right kind of carbohydrates in order to keep blood sugar levels balanced.  Specifically, lower glycemic diets are digested less rapidly by the body, which raises the blood sugar in a regulated, balanced way; whereas higher glycemic foods and beverages are digested more rapidly causing a blood sugar spike followed by a drastic decline.  Since low-glycemic index foods are digested more slowly, they remain in the digestive tract longer, potentially controlling appetite and hunger.  This can also reduce the risk of insulin resistance.

The study shows that a low-glycemic diet can work for long-term weight-loss, as it is easily sustainable because whole food groups are not removed.  Furthermore, it may reduce the risk of serious diseases such as diabetes and cardiovascular disease.

Sources:

Weight-Loss Stats: http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197#.UBBfZo7p7ao

NIH: http://www.nih.gov/researchmatters/july2012/07162012weight.htm

Mayo Clinic on the Low-Glycemic Diet: http://www.mayoclinic.com/health/glycemic-index-diet/MY00770

Maintaining a healthy lifestyle from young adulthood into your 40s is strongly associated with low cardiovascular disease risk in middle age, according to a new Northwestern Medicine® study.

“The problem is few adults can maintain ideal cardiovascular health factors as they age,” said Kiang Liu, PhD, first author of the study. “Many middle-aged adults develop unhealthy diets, gain weight, and aren’t as physically active. Such lifestyles, of course, lead to high blood pressure and cholesterol, diabetes and elevated cardiovascular risk.”

“In this study, even people with a family history of heart problems were able to have a low cardiovascular disease risk profile if they started living a healthy lifestyle when they were young,” Liu said. “This supports the notion that lifestyle may play a more prominent role than genetics.”   Published Feb. 28 in the journal Circulation, this is the first study to show the association of a healthy lifestyle maintained throughout young adulthood and middle age with low cardiovascular disease risk in middle age.

The majority of people who maintained five healthy lifestyle factors from young adulthood (including a lean body mass index (BMI), no excess alcohol intake, no smoking, a healthy diet and regular physical activity) were able to remain in this low-risk category in their middle-aged years.

In the first year of the study, when the participants’ average age was 24 years old, nearly 44 percent had a low cardiovascular disease risk profile. Twenty years later, overall, only 24.5 percent fell into the category of a low cardiovascular disease risk profile.    Sixty percent of those who maintained all five healthy lifestyles reached middle age with the low cardiovascular risk profile, compared with fewer than 5 percent who followed none of the healthy lifestyles.

If the next generation of young people adopt and maintain healthy lifestyles, they will gain more than heart health, Liu stressed.

“Many studies suggest that people who have low cardiovascular risk in middle age will have a better quality of life, will live longer and will have lower Medicare costs in their older age,” he said. “There are a lot of benefits to maintaining a low-risk profile.”

Liu is a professor and the associate chair for research in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine.

Source:  Erin White, Northwestern NewsCenter