Research shows that folks who shop for food when they're hungry tend to buy higher-calorie items.

The following post was adapted from our Health-e-Weight enewsletter.

Summer is a few weeks away, and many of us are looking for ways to slim down.  The challenge is that food is everywhere, making it easy to overeat. Often hunger and taste appeal are further down the pecking order of why we eat. Much has been written and studied regarding the concept of mindless eating. Here’s a summary of tips to help us not overconsume calories.

• Pay attention to plate/bowl and utensil sizes. Using smaller items generally results in smaller amounts.
• Keep calorie-dense foods less visible. If it is around, you are more likely to eat. On the other hand, keep lesser-calorie items like fruits and vegetables more handy.
• Be the first to order at a restaurant. We sometimes get derailed if we follow the not-so-healthy ordering tendencies of others dining with us.
• Keep food off the table at dinner. Studies show that if it is left on the counter or stove, less is eaten.
• Don’t be fooled by some product advertising. Items touted as organic or low-fat should not suggest an abandonment of amount.
• Don’t snack from the box or package. Pre-portion an amount out. Even though it is possible to go back for extra servings, it won’t be as convenient.
• Eat in a limited number of areas. Refrain from eating in the car, at your work desk, or near computer or TV at home. Aim for all eating to be in the dining room or kitchen.
• Limit shopping when hungry. Newer data shows you may not necessarily buy more, but may be likely to buy processed, convenient-style items that often come with more calories.

Eating for hunger and enjoyment is the key. Calories can add up quickly, so you want to make them truly count. Take the time to savor every bite, flavor, and texture. Not only will this make for a more rewarding eating experience but go a long way in helping thwart unwanted pounds.

Consider preparing this healthy and delicious recipe:
Heart-Healthy Stuffed Portabella Mushrooms

Subscribe to our Health-e-Weight newsletter for more tips on healthier living.

- JCL

Drinking soda, even at modest levels, may lead to a higher risk of developing kidney stones.

The copious consumption of sugary drinks already has been linked to an increased risk of developing type 2 diabetes, obesity, and heart disease. And now, new research from Brigham and Women’s Hospital suggests that consuming sugar-sweetened beverages, even at modest levels, could put folks at greater risk for developing yet another health issue, a quite painful one – kidney stones.

“Our study found that the relation between fluid intake and kidney stones may be dependent on the type of beverage consumed,” explains Gary Curhan, MD, ScD, a physician in the Channing Division of Network Medicine at BWH and senior author of this study. “We found that higher consumption of sugar-sweetened drinks was associated with a higher incidence of kidney stones.”

After analyzing the data of nearly 200,000 participants from three large-scale studies – the Health Professionals Follow-Up Study, the Nurses’ Health Study I, and Nurses’ Health Study II – researchers found that people who consumed one or more sugar-sweetened cola servings per day had a 23 percent higher risk of developing kidney stones than those who consumed less than one serving per week. Similarly, drinking other types of sugar-sweetened beverages, such as fruit punch, were found to carry just as great a risk as soda for developing kidney stones. On the other hand, there also was strong evidence that some beverages, such as coffee, tea and orange juice, were associated with a lower risk of stone formation.

And choosing the right beverage could be particularly significant for patients who already have been treated for kidney stones, as these people are often advised to drink more fluids as a way to prevent future stone formation.

As Pietro Manuel Ferraro, MD, a physician at the Catholic University of the Sacred Heart of Rome and corresponding author of this study, explains:  “Although higher total fluid intake reduces the risk of stone formation, this information about individual beverages may be useful for general practitioners seeking to implement strategies to reduce stone formation in their patients.”

The full study was published in the May 15, 2013 online edition of the Clinical Journal of the American Society of Nephrology.

- Chris P., Jessica M.

Knee replacement patient Rick Litavis (center) enjoys a post-surgery family stroll.

With three torn ligaments and no cartilage left in his right knee, 49-year-old Rick Litavis of Hopkinton, MA, had two options – continue to live in pain and suffer through sleepless nights, or get a knee replacement.

Rick was ready for relief.

And thanks to surgical expertise, teamwork, and an innovative approach to improving knee replacement outcomes, Rick was not only pain-free within days after his January 2013 operation, but also walking and biking within weeks.

“I was completely floored,” says Rick. “The first night after my surgery I was standing, the next day I was using a walker without pain, and I was home the day after that.”

After playing football at Northeastern University, Rick continued to play competitive, high-impact sports throughout his 20s and 30s. But such a lifestyle also comes with risks, and Rick managed to severely injure his right knee several times over the years.

Those mounting knee injuries led to increasing pain, decreasing physical activity, and sleeplessness. The lack of sleep, in turn, sapped his motivation and energy.

When he was ready for help, Rick turned to orthopedic surgeon Thomas Thornhill, MD, the same physician who had replaced both of his father’s knees during a single operation several years before.

Dr. Thornhill introduced Rick to a new and improved knee replacement process, developed through extensive research by the Department of Orthopedic Surgery’s Care Improvement Team.

The process started with emphasizing patient education – helping Rick prepare mentally and physically for the procedure – and making sure that Rick realized that he also was an important part of the care team. By adhering to best practices on his end (e.g., proper nutrition and exercise), Rick could contribute significantly to improving his recovery.

Next, according to the new protocol, Rick was given long-acting pain medications immediately before surgery instead of short-acting pain medications immediately after surgery. Long-acting medications, which can work for up to 12 hours, produce fewer side effects than short-acting medications and provide steady, continuous pain relief after surgery. Short-acting medications, on the other hand, only provide intermittent relief. Thus, Rick was in minimal pain immediately after surgery – step one to a quicker recovery.

But recovery didn’t mean relaxation.

The former stan­dard of care was to have a patient’s knee moved for them by a continuous passive motion machine shortly following surgery. Research by the Care Improvement Team, however, has demonstrated that this tech­nique actually increases the amount of pain and slows recovery. The orthopedic surgery team now uses a rehabilitation protocol that literally gets patients back on their feet within hours after surgery.

Rick stood up on the first night after his surgery. A few days after that, he was participating in active physical therapy – flexing his knee, picking his leg up off the floor and onto his bed, and walking.

Now, only months later, Rick, who turned 50 in March, enjoys frequent walks around a local lake with his son and wife and is looking forward to visiting, and trying to keep up with, his daughter who’s at school in New York City. He also has been golfing again and hopes to be able to walk 18 holes by the end of the year.

Based on his experience, Rick wonders why a qualified candidate for knee replacement surgery would wait.

“Why torture yourself for 10 more years?” explains Rick. “Why put yourself through pain and aggravation when you can live happily and do the things that you want to do?”

• Learn more about Rick’s story.
• Learn more about the new knee replacement process.

- Chris P.

Prostate Cancer Education Center Offers Comprehensive Information

Prostate cancer is the second most common and deadly cancer among American men, with nearly 29,000 dying from the disease each year. However, the five-year survival rate for men diagnosed with prostate cancer has increased from 67 percent to 99 percent in only the past 20 years. Learn about prevention, screening tests, treatment options and follow-up.

Serious News for Couch Potatoes

According to the Centers for Disease Control and Prevention, over 50 percent of men 18 years and over met the 2008 federal physical activity guidelines for aerobic activity.  A recent study by BWH researchers found that physical inactivity can leads to a shorter life expectancy and increased risks of many chronic diseases.

Multivitamins May Reduce Cancer Risk in Men

Ever wonder if those multivitamins you’ve been taking actually benefit your health?  A large scale clinical trial by researchers at Brigham and Women’s Hospital may provide the answer. Read more to find out what they learned about the long-term health impacts of multivitamins taken by men.

What to Do When the Blue Pill Doesn’t Come Through

The first line of treatment for men with erectile dysfuction is an oral medication.  However, these medications only work in about 50 percent of ED patients, which leaves about two million U.S. men searching for another option. Dr. Michael O’Leary, Director of the Men’s Sexual Health Clinic, explains your options.

The Other Half of Fertility Equation: Male Infertility

Infertility is a unique medical condition because it often involves a couple, not an individual. In 20-25% of cases, infertility can be attributed exclusively to male factor problems and an additional 10% of couples have male infertility in addition to other factors.  Learn more about the causes and treatments for male infertility.

Don't forget the other half of the fertility equation - male fertility.

Today’s post was written by Dr. Elena Yanushpolsky, an infertility specialist with the Center for Infertility and Reproductive Services at Brigham and Women’s Hospital (BWH). Dr. Yanushpolsky is also the Director of the BWH Center for Infertility and Reproductive Services at South Shore Hospital in South Weymouth.

A couple, both about 33 years old, recently came to my clinic after trying to conceive for 18 months without success. After evaluating both of them, we learned that their inability to conceive was due to the husband’s infertility. This couple’s situation is not unusual. In 20-25 percent of cases, infertility can be attributed exclusively to male factor problems, and an additional 10 percent of couples have male infertility in addition to other factors.

The first step in evaluating whether male infertility is a factor is a detailed health history. Once adequate sexual performance has been confirmed, the next step is a semen analysis. This test measures several characteristics of a man’s sperm, including the number of sperm (volume and concentration), the shape of the sperm (morphology), and the ability of sperm to move (motility). If the results of the semen analysis are abnormal, the test is repeated in three to four weeks. If the second test is abnormal, a man will be referred to a urologist for further evaluation.

Male infertility may be due to a complete lack of sperm in the semen (azoospermia) or abnormalities in sperm characteristics.  Azoospermia occurs in up to 10 percent of patients with male infertility. It may be caused by obstruction or absence of ducts that transport sperm (ejaculatory ducts), failure of sperm production in the testes, or the result of chemotherapy for cancerous conditions.

Abnormalities in sperm characteristics occur much more commonly than azoospermia. These abnormalities include low sperm concentrations in the semen (oligospermia), low movement of sperm (asthenospermia), or abnormal sperm shape (teratospermia).

Unfortunately, in most cases, no specific cause can be identified to explain sperm abnormalities; however, a thorough health evaluation is recommended to rule out treatable conditions before beginning fertility treatments.

Causes of male infertility include:

• Obstruction of Ejaculatory Ducts: Blockages in the ducts that transport sperm can be caused by infection and/or inflammation, but also may not have any obvious cause.

• Genetic Factors: Chromosome abnormalities can be associated with low sperm counts. Y-chromosome gene deletions and cystic fibrosis gene mutations may be associated with azoospermia. Cystic fibrosis gene mutations also may result in an absence of the ducts that transport sperm. Genetic testing is recommended for all men with a lack of sperm (azoospermia) or low sperm counts.

• Hormonal Abnormalities: Testing blood levels of testosterone, follicle-stimulating hormone, and luteinizing hormone will help your doctor identify possible causes of sperm abnormalities.

• Health Conditions: Male infertility may be the result of minor health conditions, such as an enlargement of the veins in the scrotum (varicoceles), or more serious illnesses, such as cancer or diabetes. Evaluation by a urologist or primary care provider is recommended for all men experiencing infertility.

Other factors that can affect the number and quality of sperm are marijuana use, heavy cigarette smoking, heavy alcohol intake, use of illegal drugs, prolonged heat to the testicles (hot tubs), and use of testosterone products (testosterone injections, or androgel topical treatments, or anabolic steroids). All of these practices should be stopped before starting fertility treatments.

There are several options for successfully managing male infertility. The highest pregnancy success rates are achieved through in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In the most serious cases, such as men with azoospermia, sperm can be surgically extracted from a man’s testes and injected into his partner’s eggs in the laboratory to achieve fertilization. For men with very low sperm count, sperm can be collected from the semen. Even very small numbers of sperm can be sufficient for successful IVF/ICSI procedures.

For men with milder cases of infertility, intrauterine inseminations (IUI) with sperm that has been washed, spun down to extract the best moving sperm, and injected directly into the female partner’s uterus also can be effective. For these patients, IUI is attempted first, followed by IVF/ICSI.

As for my patients, further testing revealed that the husband tested positive for cystic fibrosis gene mutations. A testicular biopsy produced enough sperm for IVF/ICSI, and the couple became parents after a successful pregnancy.

Learn more about male infertility:

• BWH Center for Infertility and Reproductive Surgery
• When to See a Fertility Specialist

Figure 1 - The underside of the patch has rows of tiny, cone-shaped needles.

When giving thanks to Mother Nature for the bounty that she provides, a parasitic worm may not be on your top 10 list. But a Brigham and Women’s Hospital (BWH) research team has seen the beauty in a spiny-headed worm, the Pomphorhynchus laevis, and used this creature as inspiration for designing an adhesive patch that safely and strongly secures human skin grafts.

This unique worm establishes long-term residency in the intestines of fish by plunging head-first into the host’s intestinal wall and then swelling its head to create a secure hold in the intestinal tissue. Impressed by the strength and simplicity of this technique, a research team led by Jeffrey Karp, PhD, Division of Biomedical Engineering, Department of Medicine, developed a micro-needle patch that mimics the worm’s anchoring mechanism.

On the underside of the patch are rows of tiny, cone-shaped needles (Figure 1). Each needle features a solid core that retains its form whether wet or dry, and a tip that is sharp and rigid when dry, but swells when exposed to water (Figure 2). The fine micro-needles easily penetrate tissue and then maintain a strong hold after the tips are swollen through hydration.

“The adhesion strength of the micro-needle tips are more than three times stronger than conventional surgical staples used for skin graft fixation,” says BWH research fellow and study author Seung Yun Yang, PhD.

And just as easily as the patch can be strongly secured, the swollen tips can be deformed and easily removed through the holes created by the needles. This easy-in, easy-out technology softens the impact on a patient’s tissue.

Figure 2 - Each needle features a tip that swells when exposed to water.

“The unique design allows the needles to stick to soft tissues with minimal damage to the tissues,” says Dr. Karp. “Moreover, when it comes time to remove the adhesive, compared to staples, there is less trauma inflicted to the tissue, blood, and nerves, as well as a reduced risk of infection.”

Along with its potential to provide a safer and stronger hold, researchers suggest that the patch’s design also could enable physicians to deliver therapeutics into damaged tissue.

“I envision that this device will be very effective in treating patients, both by skin graft fixation, but also by delivery of active substances into the surface of the wound,” says study author Bohdan Pomahac, MD, Director, Plastic Surgery Transplantation and Burn Center. “These substances may be for example, antibiotics, growth-promoting compounds, or anti-inflammatory molecules.”

Further details of the study are available in the April 16, 2013 issue of Nature Communications.

• Karp’s lab: The Laboratory for Advanced Biomaterials and Stem-Cell Based Therapeutics
• More nature-inspired research: “Capturing Cancer Like a Jellyfish”, “Lizard Inspires “Ouchless” Medical Tape”, “Prickly Porcupine: Medicine’s Next Top Model?

- Chris P

Sunscreen lotion and shade are two good tools for helping to prevent non-melanoma skin cancer.

Did you know that non-melanoma skin cancer, which includes basal cell and squamous cell cancer, is the most common form of cancer in the US?  In 2012 alone, more than two million new cases of non-melanoma skin cancer were identified, according to the National Cancer Institute. Though non-melanoma cell skin cancer is treatable, new research suggests that the damage it causes may be more than skin deep. Non-melanoma cancer may also play a role in the development of other types of cancer.

A recent study by researchers at Brigham and Women’s Hospital (BWH) demonstrates an association between non-melanoma skin cancer and future cancer risk among white men and women. Researchers found that people with a history of non-melanoma skin cancer had a modestly higher risk of getting cancer in the future – specifically, breast and lung cancer in women and melanoma in both men and women – compared to those without a history of non-melanoma skin cancer.

Researchers studied data from approximately 46,000 men who participated in the Health Professionals Follow-up Study from 1986 to 2008, and about 107,000 women who participated in the Nurses’ Health Study from 1984 to 2008.

When people with melanoma were excluded from the data, a history of non-melanoma skin cancer was associated with an 11 percent higher risk of other primary cancers in men and a 20 percent higher risk of other primary cancers in women.

“Because our study was observational, these results should be interpreted cautiously and do not yet provide enough evidence to alter current clinical recommendations,” said Dr. Jiali Han, BWH Department of Dermatology and Channing Division of Network Medicine. “Nevertheless, these data support a need for continued investigation of the potential mechanisms underlying this relationship.”

So next time you leave home, don’t forget the sunblock  – it may do more than prevent sunburn, it can also prevent non-melanoma skin cancer.

More information about skin cancer:

• Learn the ABCDEs of Skin Cancer
• Melanoma Myths and Facts
• American Academy of Dermatology

- MMQ

Patient education is an important tool in the fight against prostate cancer.

With about one man in six being diagnosed with prostate cancer during his lifetime, there’s a great need for patient education. This is why Brigham and Women’s Hospital (BWH) has developed the Prostate Cancer Education Center at brighamandwomens.org  — providing comprehensive information on prostate cancer, including:

• Statistics
• Risk factors
• PSA testing
• Diagnosis
• Grading and staging
• Treatment options and outcomes
• Risks
• Patient Stories
• Research at Brigham and Women’s Hospital

Prostate cancer is the second most common and deadly cancer among American men, with nearly 29,000 dying from the disease each year. However, the five-year survival rate for men diagnosed with prostate cancer has increased from 67 percent to 99 percent in only the past 20 years.

Because prostate cancer can be prevented through regular screenings and care, having all the information you and your loved ones need is crucial.

Additional brighamandwomens.org resources:

• Learn more about the BWH Division of Urology
• Watch BWH surgeons perform bilateral nerve sparing radical prostatectomy for prostate cancer and robot-assisted laparoscopic partial nephrectomy
• Listen to a prostate cancer podcast from Dr. Anthony D’Amico, Chief of Genitourinary Radiation Oncology at BWH.

• Take this prostate health quiz
• Watch a prostate biopsy animation

- JCL

A great deal of clinical research takes place at our Watkins Cardiovascular Clinic.

Do you ever wonder why most doctors now recommend aspirin for heart attack prevention? The answer is more straightforward than you think: clinical research.

Clinical research at Brigham and Women’s Hospital revealed the effectiveness of aspirin as a first-line defense against heart attack in people who are at risk. Once broadly proven, the treatment was adopted and has helped thousands avoid the devastating effects of heart attack.

BWH is an international leader in cardiovascular research. With over 150 cardiovascular clinical research studies being conducted at any one time, there are opportunities for patients to participate in studies that may change cardiovascular care for millions. Before making a decision on whether to participate in clinical research, it’s important to understand what’s involved.

Clinical research involves studies led by doctors and researchers who are trying to answer specific scientific questions with the goal of finding better ways to prevent, diagnose, or treat diseases, and improve health care. Trials also are conducted to collect information on the safety and effectiveness of various treatments.

Based on the type of treatment being investigated and the stage of its development, researchers first enroll a small number of healthy patients into pilot studies. Pilot studies are followed by studies that involve comparing the new treatment with the currently prescribed treatment in a large number of patients. Clinical research studies vary in size and can take place at a single medical center or multiple medical centers in numerous locations.

All clinical research in the United States is strictly approved and monitored by an institutional review board (IRB) that makes sure the risks are as low as they can be and are worth any potential benefits. The research follows a carefully controlled study plan, called a protocol, and is reviewed regularly. Any new medicine or medical device must then be submitted to the U.S. Food and Drug Administration (FDA) for approval to meet certain set guidelines. Once the medicine or medical device is approved by the FDA, it is deemed safe and appropriate for specific conditions.

If you’re eligible for enrollment in a clinical research study, your doctor’s office may contact you or – if you see a study you’re interested in participating in – you can speak with your doctor. Clinical research studies have very strict criteria that all participants must meet in order to participate. Once accepted to a clinical research study and you have provided your consent to participate, you will be given detailed information on the structured plan that you need to follow. This may include a schedule of tests, visits to the doctor, and treatment.

Even though a clinical research study may not provide you with a direct benefit, it’s worth considering since it may help other patients in the future who have the same condition as you.

More information about clinical trials:

• Watkins Cardiovascular Clinic

- Jamie R

Dr. Edward Laws and his team perform an operation to remove a patient's pituitary tumor.

In observation of Brain Tumor Awareness Month, today’s blog post was written by Dr. Edward Laws and nurse practitioner Sherry Iuliano, from the Pituitary and Neuroendocrine Center at Brigham and Women’s Hospital. Directed by Dr. Laws, the Pituitary and Neuroendocrine Center specializes in the diagnosis and treatment of pituitary disorders, including pituitary tumors, the third most common primary brain tumor.

The normal pituitary is about the size of a pea, and is considered the “master gland”.  The pituitary secretes many essential hormones, including growth hormone.  As children, we need growth hormone and as adults we require some, but in large amounts this can be harmful, causing a condition known as acromegaly.  The most common reason for overproduction of growth hormone is the presence of a pituitary adenoma, which is a benign (noncancerous) tumor of the pituitary gland.

Compared to the healthy population, patients with untreated acromegaly have a 10-15 year reduction in life expectancy. Untreated, this disease is associated with a mortality rate 2 to 4 times greater than the general population, and is associated with hypertension, diabetes mellitus and cardiovascular disease.

Patients with acromegaly can go undiagnosed for many years before being successfully treated, such as a young man we recently saw in the Pituitary and Neuroendocrine Center.  Our patient had been evaluated elsewhere for severe headaches which were accompanied by occasional blurred vision and sensitivity to light. His daily headaches had started three years before he came to our clinic, occurred mainly on the right side of his head and interfered with his daily life.  He would awake with moderate pain that increased in severity by late afternoon.  An MRI of his brain revealed a very large benign pituitary tumor (macroadenoma) compressing his optic nerves.

The day we met him in our clinic, our patient was quite concerned about the MRI findings, although relieved to have an answer to his symptoms.  When questioned about his past medical history, we discovered he also had elevated triglycerides, blood pressure and blood sugars.  He snored, but had never been evaluated for obstructive sleep apnea.  He also experienced excessive sweating and mild fatigue and his lower jaw had enlarged over the years, increasing the spacing between his teeth.  When questioned about the size of his hands and feet, he agreed that he had noticed some enlargement in both, but assumed this was related to his weight gain. His appearance and symptoms led us to believe he had acromegaly. Endocrine blood tests confirmed high levels of growth hormone and another hormone, Insulin-like Growth Factor-1 (IGF-1).

We were able to successfully remove his pituitary tumor using endoscopic trans-nasal surgery.  After the surgery our patient’s growth hormones returned to normal, he was headache free and his energy returned to normal.  Most importantly, he was able to resume his normal activities, enjoying life with his wife and young children.  Though pituitary tumors can cause significant health problems, the good news is that they can be treated and many patients will resume normal lives.

To learn more about pituitary tumors:

• BWH Pituitary and Neuroendocrine Center
• Pituitary Network Association