Tuesday, July 12, 2011

How to get a flat stomach: REAL MODEL DIETS ON 2011

How-To-Get-A-Flat-Stomach today - best abs diet1 Who doesn't want a flat, firm stomach? Many people believe that sit-ups are the answer, but the truth is that they're only a part of the solution - you can't "spot reduce" belly fat in that way.

The key to killer abs and a flat stomach is to reduce your overall fat levels and minimize bloating. You can do this with a combination of cardiovascular exercise, diet and lifestyle.

Shake off that excess belly fat

The most important step towards a flat, toned tummy is to reduce your overall fat percentage, and a clean, healthy diet is the best way to embark on this mission. If you learn to love natural food, you're halfway there. Create healthy eating habits, and you'll probably find you won't even want to go back to your old unhealthy ways.


There's no reason you can't eat an interesting and varied diet while you're losing weight. Switch to whole grains such as brown rice, wholewheat pasta, wholewheat bread and oatmeal. Get your protein from good low-calorie sources such as chicken or turkey (without the skin), water-packed tuna, steamed/baked fish, and eggs. Fruits, veggies (maybe not legumes as they can cause bloating) and nuts are all OK. You can even have dairy products - just make sure they're low fat and unsweetened like cottage cheese, yogurt, and low fat milk.

One thing to watch out for though - food intolerances can cause the bloating (see below) that is one of the main barriers between you and a flat stomach.

Lastly, reducing fat is not all about your diet. A little Cardiovascular exercise is just as important. Breaking a sweat for 30 minutes, 5 times a week, should be enough to burn off that top layer of fat.


So you've lost weight but your stomach isn't shaped the way you'd like it. If you think its due to bloating, see our tips below. If not, then it probably time to start with the crunches! Here are 3 simple exercises to work your abs.

  • The Plank
    1. Lie face down on a mat, resting on your forearms and with your palms flat on the floor.
    2. Push off the floor, raising up onto toes and resting on the elbows.
    3. Keep your back flat, in a straight line from head to heels.
    4. Tilt your pelvis and contract your abdominals to prevent your rear end from sticking up in the air.
    5. Hold for 20 to 60 seconds, lower and repeat for 3-5 reps.
  • Reverse Crunch
    1. Lie on your back and place your hands on the floor or behind the head.
    2. Bring your legs up into the air, with your feet crossed and knees bent to 90 degrees.
    3. Contract your abs to curl the hips off the floor, pushing your legs further up towards the ceiling.
    4. Lower and repeat for 12-16 reps.
  • Bicycle Crunch
    1. Lie on your back and place your fingers behind your head.
    2. Bring your knees up towards your chest and lift your shoulders off the ground.
    3. Straighten your left leg out while simultaneously turning the upper body to the right. Your left elbow should almost touch your right knee.
    4. Switch sides, bringing the right elbow towards the left knee.
    5. Continue alternating sides in a 'bicycle' motion for 12-16 reps.
Tackle bloating and constipation

All the dieting and sit-ups in the world won't get you a flat stomach if you're suffering from bloating and constipation. So its important to address any digestive issues you may have if you want to start seeing those abs!

With some smart food choices you can really give your system a helping hand. Yogurt, and especially probiotic yogurt, provides friendly bacteria that help your digestive system work properly. Fiber can also fight the bloating effects of constipation. Be sure to include plenty of whole grain foods, fresh fruits and veggies. Supplement your diet with Psyllium husk to keep things moving, and drink at least 8 glasses of water a day.

There are a few things you should avoid too if you want to keep bloating to a minimum. The usual culprits are carbonated drinks, broccoli, cauliflower, legumes, wheat, and lactose (in dairy products). These intolerances vary from person to person, so try eliminating each of these items then reintroducing the ones you like, one at a time.

Also be careful not to go overboard with too many high sodium foods. Excess sodium causes bloating and water retention. This means you should avoid soft drinks, processed food, and meats such as sausages, hot dogs, bologna, corned beef and ham. Restaurant food is almost all high in sodium, as are canned soup and packaged meals. Check ingredients at the supermarket and go for the low sodium items.

Reduce your stress

Studies have shown that stress itself can cause weight gain. The body releases excess Cortisol in response to stress, which increases your reserves of stored abdominal fat. Try de-stressing with some meditation, Tai Chi or Yoga. A hot bath to soothing music and candlelight will also reduce your stress levels.

Cfr: More and More

Monday, July 11, 2011

In Defense of Antidepressants (Could this be true?) By PETER D. KRAMER

IN terms of perception, these are hard times for antidepressants. A number of articles have suggested that the drugs are no more effective than placebos.

Last month brought an especially high-profile debunking. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

For instance, not long ago, I received disturbing news: a friend had had a stroke that paralyzed the right side of his body. Hoping to be of use, I searched the Web for a study I vaguely remembered. There it was: a group in France had worked with more than 100 people with the kind of stroke that affected my friend. Along with physiotherapy, half received Prozac, and half a placebo. Members of the Prozac group recovered more of their mobility. Antidepressants are good at treating post-stroke depression and good at preventing it. They also help protect memory. In stroke patients, antidepressants look like a tonic for brain health.

When I learned that my friend was not on antidepressants, I suggested he raise the issue with his neurologists. I e-mailed them the relevant articles. After further consideration, the doctors added the medicines to his regimen of physical therapy.

Surprised that my friend had not been offered a highly effective treatment, I phoned Robert G. Robinson at the University of Iowa’s department of psychiatry, a leading researcher in this field. He said, “Neurologists tell me they don’t use an antidepressant unless a patient is suffering very serious depression. They’re influenced by reports that say that’s all antidepressants are good for.”

Critics raise various concerns, but in my view the serious dispute about antidepressant efficacy has a limited focus. Do they work for the core symptoms (such as despair, low energy and feelings of worthlessness) of isolated episodes of mild or moderate depression? The claim that antidepressants do nothing for this common condition — that they are merely placebos with side effects — is based on studies that have probably received more ink than they deserve.

The most widely publicized debunking research — the basis for the Newsweek and New York Review pieces — is drawn from data submitted to the Food and Drug Administration in the late 1980s and the 1990s by companies seeking approval for new drugs. This research led to its share of scandal when a study in The New England Journal of Medicine found that the trials had been published selectively. Papers showing that antidepressants work had found their way into print; unfavorable findings had not.

In his book “The Emperor’s New Drugs: Exploding the Antidepressant Myth,” Dr. Kirsch, a psychologist at the University of Hull in England, analyzed all the data. He found that while the drugs outperformed the placebos for mild and moderate depression, the benefits were small. The problem with the Kirsch analysis — and none of the major press reports considered this shortcoming — is that the F.D.A. material is ill suited to answer questions about mild depression.

As a condition for drug approval, the F.D.A. requires drug companies to demonstrate a medicine’s efficacy in at least two trials. Trials in which neither the new drug nor an older, established drug is distinguishable from a placebo are deemed “failed” and are disregarded or weighed lightly in the evaluation. Consequently, companies rushing to get medications to market have had an incentive to run quick, sloppy trials.

Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression.

THIS improvement may have nothing to do with faith in dummy pills; it is an artifact of the recruitment process. Still, the recoveries are called “placebo responses,” and in the F.D.A. data they have been steadily on the rise. In some studies, 40 percent of subjects not receiving medication get better.

The problem is so big that entrepreneurs have founded businesses promising to identify genuinely ill research subjects. The companies use video links to screen patients at central locations where (contrary to the practice at centers where trials are run) reviewers have no incentives for enrolling subjects. In early comparisons, off-site raters rejected about 40 percent of subjects who had been accepted locally — on the ground that those subjects did not have severe enough symptoms to qualify for treatment. If this result is typical, many subjects labeled mildly depressed in the F.D.A. data don’t have depression and might well respond to placebos as readily as to antidepressants.

Nonetheless, the F.D.A. mostly gets it right. To simplify a complex matter: there are two sorts of studies that are done on drugs: broad trials and narrow trials. Broad trials, like those done to evaluate new drugs, can be difficult these days, because many antidepressants are available as generics. Who volunteers to take an untested remedy? Research subjects are likely to be an odd bunch.

Narrow studies, done on those with specific disorders, tend to be more reliable. Recruitment of subjects is straightforward; no one’s walking off the street to enter a trial for stroke patients. Narrow studies have identified many specific indications for antidepressants, such as depression in neurological disorders, including multiple sclerosis andepilepsy; depression caused by interferon, a medication used to treat hepatitis and melanoma; and anxiety disorders in children.

New ones regularly emerge. The June issue of Surgery Today features a study in which elderly female cardiac patients who had had emergency operations and were given antidepressants experienced less depression, shorter hospital stays and fewer deaths in the hospital.

Broad studies tend to be most trustworthy when they look at patients with sustained illness. A reliable finding is that antidepressants work for chronic and recurrent mild depression, the condition called dysthymia. More than half of patients on medicine get better, compared to less than a third taking a placebo. (This level of efficacy — far from ideal — is typical across a range of conditions in which antidepressants outperform placebos.) Similarly, even the analyses that doubt the usefulness of antidepressants find that they help with severe depression.

In fact, antidepressants appear to have effects across the depressive spectrum. Scattered studies suggest that antidepressants bolster confidence or diminish emotional vulnerability — for people with depression but also for healthy people. In the depressed, the decrease in what is called neuroticism seems to protect against further episodes. Because neuroticism is not a core symptom of depression, most outcome trials don’t measure this change, but we can see why patients and doctors might consider it beneficial.

Similarly, in rodent and primate trials, antidepressants have broad effects on both healthy animals and animals with conditions that resemble mood disruptions in humans.

One reason the F.D.A. manages to identify useful medicines is that it looks at a range of evidence. It encourages companies to submit “maintenance studies.” In these trials, researchers take patients who are doing well on medication and switch some to dummy pills. If the drugs are acting as placebos, switching should do nothing. In an analysis that looked at maintenance studies for 4,410 patients with a range of severity levels, antidepressants cut the odds of relapse by 70 percent. These results, rarely referenced in the antidepressant-as-placebo literature, hardly suggest that the usefulness of the drugs is all in patients’ heads.

The other round of media articles questioning antidepressants came in response to a seemingly minor study engineered to highlight placebo responses. One effort to mute the placebo effect in drug trials involves using a “washout period” during which all subjects get a dummy pill for up to two weeks. Those who report prompt relief are dropped; the study proceeds with those who remain symptomatic, with half getting the active medication. In light of subject recruitment problems, this approach has obvious appeal.

Dr. DeRubeis, an authority on cognitive behavioral psychotherapy, has argued that the washout method plays down the placebo effect. Last year, Dr. DeRubeis and his colleagues published a highly specific statistical analysis. From a large body of research, they discarded trials that used washouts, as well as those that focused on dysthymia or subtypes of depression. The team deemed only six studies, from over 2,000, suitable for review. An odd collection they were. Only studies using Paxil and imipramine, a medicine introduced in the 1950s, made the cut — and other research had found Paxil to be among the least effective of the new antidepressants. One of the imipramine studies used a very low dose of the drug. The largest study Dr. DeRubeis identified was his own. In 2005, he conducted a trial in which Paxil did slightly better than psychotherapy and significantly better than a placebo — but apparently much of the drug response occurred in sicker patients.

Building an overview around your own research is problematic. Generally, you use your study to build a hypothesis; you then test the theory on fresh data. Critics questioned other aspects of Dr. DeRubeis’s math. In a re-analysis using fewer assumptions, Dr. DeRubeis found that his core result (less effect for healthier patients) now fell just shy of statistical significance. Overall, the medications looked best for very severe depression and had only slight benefits for mild depression — but this study, looking at weak treatments and intentionally maximized placebo effects, could not quite meet the scientific standard for a firm conclusion. And yet, the publication of the no-washout paper produced a new round of news reports that antidepressants were placebos.

In the end, the much heralded overview analyses look to be editorials with numbers attached. The intent, presumably to right the balance between psychotherapy and medication in the treatment of mild depression, may be admirable, but the data bearing on the question is messy.

As for the news media’s uncritical embrace of debunking studies, my guess, based on regular contact with reporters, is that a number of forces are at work. Misdeeds — from hiding study results to paying off doctors — have made Big Pharma an inviting and, frankly, an appropriate target. (It’s a favorite of Dr. Angell’s.) Antidepressants have something like celebrity status; exposing them makes headlines.

It is hard to locate the judicious stance with regard to antidepressants and moderate mood disorder. In my 1993 book, “Listening to Prozac,” I wrote, “To my mind, psychotherapy remains the single most helpful technology for the treatment of minor depression and anxiety.” In 2003, in “Against Depression,” I highlighted research that suggested antidepressants influence mood only indirectly. It may be that the drugs are “permissive,” removing roadblocks to self-healing.

That model might predict that in truth the drugs would be more effective in severe disorders. If antidepressants act by usefully perturbing a brain that’s “stuck,” then people who retain some natural resilience would see a lesser benefit. That said, the result that the debunking analyses propose remains implausible: antidepressants help in severe depression, depressive subtypes, chronic minor depression, social unease and a range of conditions modeled in mice and monkeys — but uniquely not in isolated episodes of mild depression in humans.

BETTER-DESIGNED research may tell us whether there is a point on the continuum of mood disorder where antidepressants cease to work. If I had to put down my marker now — and effectively, as a practitioner, I do — I’d bet that “stuckness” applies all along the line, that when mildly depressed patients respond to medication, more often than not we’re seeing true drug effects. Still, my approach with mild depression is to begin treatments with psychotherapy. I aim to use drugs sparingly. They have side effects, some of them serious. Antidepressants help with strokes, but surveys also show them to predispose to stroke. But if psychotherapy leads to only slow progress, I will recommend adding medicines. With a higher frequency and stronger potency than what we see in the literature, they seem to help.

My own beliefs aside, it is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.

As for my friend, he had made no progress before his neurologists prescribed antidepressants. Since, he has shown a slow return of motor function. As is true with much that we see in clinical medicine, the cause of this change is unknowable. But antidepressants are a reasonable element in the treatment — because they do seem to make the brain more flexible, and they’ve earned their place in the doctor’s satchel.

Peter D. Kramer is a clinical professor of psychiatry at Brown University.


Tuesday, July 5, 2011

A América e a Europa estão a ir ao fundo – Riscos para todo o mundo

Em Washington discute-se o tecto da dívida; em Bruxelas olha-se para o fosso da dívida. Mas o problema é mais ou menos o mesmo.

Os EUA e a União Europeia andam com as finanças públicas fora de controlo e os seus sistemas políticos mostram-se demasiado disfuncionais para resolver o problema. A América e a Europa estão no mesmo barco, um barco que se está a afundar.

De ambos os lados do Atlântico ficou agora bem patente que grande parte do crescimento económico registado nos anos que precederam a crise se ficou a dever a esse ‘boom' insustentável e perigoso do crédito. Nos EUA as vítimas da crise foram as pessoas que adquiriram casa própria; na Europa foram países inteiros como a Grécia e a Itália, países que aproveitaram as baixas taxas de juro para contraírem empréstimos de uma forma que se revelaria insustentável.

O choque financeiro de 2008 e tudo o que se seguiu foi um rude golpe para as finanças públicas quando a dívida pública começou a subir vertiginosamente. E tanto na Europa como nos EUA a este choque vieram juntar-se pressões demográficas, pressões que assumem cada vez mais a forma de pressões orçamentais, numa altura em que a geração dos ‘baby boomers' começa a reformar-se.

E, em ambos os lados do Atlântico, a crise económica está a dividir os políticos, o que torna ainda mais difícil encontrar soluções racionais para o problema da dívida. E, por outro lado, começamos a assistir também à ascensão de movimentos populistas, como é o caso do Tea Party nos EUA, do partido Dutch Freedom na Holanda ou do partido True Finns na Europa.

A ideia de que a Europa e os EUA representam duas faces da mesma crise tem sido lenta a assimilar, isto porque, durante muitos anos, as elites de ambos os lados do Atlântico não se cansaram de apontar as diferenças entre os modelos norte-americanos e europeus. Já perdi a conta ao número de conferências em que participei e aos debates entre as duas facções: uma partidária dos "mercados laborais flexíveis" ao estilo norte-americano e outra que defendia de forma apaixonada um modelo europeu, contrário ao americano. Na Europa o debate político era semelhante.

Um grupo queria que Bruxelas copiasse Washington e se tornasse na capital de uma verdadeira união federal; e tínhamos aqueles que insistiam que era impossível ter uns Estados Unidos da Europa. Mas ambos os lados partilhavam a convicção de que, em termos económicos, estratégicos e políticos os EUA e a Europa era dois planetas diferentes - "Marte e Vénus", nas palavras do académico norte-americano Robert Kagan.

O debate político norte-americano continua a usar as diferenças da Europa como ponto de referência. A acusação de que Barack Obama está a importar um "socialismo à europeia" é usada para acusar o presidente de ser pouco americano. À esquerda há quem olhe para a Europa como um lugar que faz as coisas de forma diferente e melhor em certas áreas - como é o caso dos cuidados universais de saúde.

Mas estas duas regiões do planeta têm agora mais dilemas do que diferenças em comum - dívidas que não param de aumentar, um estado social cada vez mais caro e difícil de reformar, medo do futuro e estrangulamento político são agora os grandes pontos em comum.
Gideon Rachman, Colaborador do fanancial Times