Small changes, big results

If your New Year’s resolution was to lose weight, don’t despair; it does not have to be stressful or complicated! The secret to success is taking one small step at a time.

It’s the end of January and most people’s New Year resolutions have already failed dismally – again! If your New Year’s resolution was to lose weight, don’t despair; it does not have to be stressful or complicated! The secret to success is taking one small step at a time. A few simple changes could make a big difference – over the long term.

We tend to forget that habits (both good and bad) are formed over years, and can’t expect to make a dozen changes in just a few weeks. According to experts, changing or forming a new habit takes at least 30 days and re-affirming the new habit requires another 30 days. The best way to achieve your goal is to break it down into small parts.

One reason small changes to habits work is because you build success quickly, experts say. Each time you follow through on a small habit, you build your confidence and feel more in control. As one habit becomes routine, you can add another small one to it. And soon those small habits turn into a big lifestyle change that you can be really proud of.

Here are four simple changes you could try – one at a time. This way you won't feel overwhelmed. With time, these changes will not only improve your health; they will also help to melt away the extra kilos.

Eat more fruit and vegetables. If you’ve never liked fruit and vegetables much, you can’t expect to start munching away on these foods all day long, forgetting about the existence of the less healthy snacks overnight. Start your new habit by eating one piece of fruit for breakfast and including at least one vegetable for lunch or dinner. Visit your nearest fresh produce market and choose a few brightly coloured fruits and veggies. Not everyone likes all fruit and vegetables, but by experimenting you are bound to find something you like. Gradually increase your portions per day, until you reach your 5-a-day requirement. Popular fruits to try are: strawberries, watermelon, bananas, apples, grapes, pineapple and sweet melon. When it comes to veggies, easy pleasers include carrots, baby tomatoes, cucumber, peas, sweet potato and mealies.

Stop drinking kilojoules. Fizzy drinks, sweetened tea and coffee, alcohol and even fruit juice are high in kilojoules – liquid kilojoules. Yes, even “healthy” fruit juice can be a kilojoule trap. Instead of drinking orange juice, for example, rather eat the fruit. The fresh orange will not only give you more nutrients, it will also fill you up more because of the fibre content. Many cups of sweetened coffee and tea, as well as alcohol contain lots of sugar which significantly adds to your daily kilojoule/energy intake. Rather fill up on water. Water is the perfect kilojoule-free weight-loss drink, while keeping your body hydrated and functioning in top form.

Plan your meals and remember to pack healthy snacks for work. If you plan in advance, you will be less tempted to buy quick kilojoule-laden fixes at the vending machine or corner shop. Opt for whole grains, low-fat protein, nuts, seeds, fruit and veg. Regular healthy snacks will also help to keep the hunger pangs at bay and make fatty, sugar snacks less appealing. Best of all, packing your own food will help you save money!

Get daily exercise. If you haven’t exercised for a while, start with just 10 minutes a day. It can be a brisk walk around the block, only taking the stairs at work, doing jumping jacks or rediscovering the fun of a skipping rope at home. Whatever you choose, make sure it’s a fun activity that you are willing to do once every day – whether morning, noon or night. Ten minutes of exercise might not sound like much, but it is far easier to achieve than attempting one-hour gym sessions from day one. Exercise helps to burn kilojoules, tone your body and up your energy levels. Soon you will feel more confident – and ready to increase your daily activity with five-minute additions until you can do 30 minutes a day comfortably. 

These are just four suggestions. There are many more simple ideas, such as eating breakfast every day, cutting your salt intake and avoiding fatty, fried foods. Will they take you from overweight to slim and sexy in a month? No, of course not! But these small changes will all act as building blocks to gradual and sustainable changes, leading to permanent weight loss and a healthier lifestyle.

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Top tips to downsize your portions

As portions have supersized over the years, so have our waistlines. Did you know that a large coffee shop muffin can equal up to five slices of bread? Here's help.

South Africans are eating too much and they’re eating the wrong foods. As portions have grown larger over the past decades, so have South Africans.  Statistics show that increasing numbers of South Africans are overweight or obese with the problem at its worst among adult women and preschool children.

According to dietitian Celynn Erasmus, we are being hoodwinked into eating more than they need. "Dietitians refer to this trend as 'portion creep' as it takes only an additional 1 000 kilojoules (240 calories) a day to gain about 10kg over a year. 1 000 kilojoules are equivalent to a 50g chocolate bar, a sparsely buttered bread roll, a small kiddies milkshake, a quarter of a tramezzini or a small portion of 10 chips."

Many South Africans eat food prepared by someone else more than we realise -  be it eating out, using the cafeteria at work every day, having take-aways, dinner parties and lunch with family. 

Eating away from home is often difficult and means less control over the food that is available. According to the 2012 Sanhanes report (South African National Health and Nutrition Examination Survey) 28.3% of South Africans eat outside the home every week.

Test yourself

Dietitian Karlien Smit says that people often overeat when there is a large selection of food available, like finger foods at cocktail parties, picnics and buffets. "Dish up a small plate of snacks and then move away from the food; focus instead on conversation with other guests."

According to Johannesburg-based dietitian, Cheryl Meyer, many people are not familiar with the appropriate serving sizes. "Everyone should test themselves every now and again – pour your usual bowl of cereal and then transfer it to a measuring cup!"

She suggests always using smaller plates, bowls and glasses allowing for less food on the plate and encouraging better portion control. "And never eat out of the box – put your snack in a small bowl or other container or alternatively opt for single-serving treat."

'Sharing is caring'

Supersizing is all around us. A coffee shop muffin can be equal to five slices of buttered bread and jam and provides almost 5000 kilojoules if served with a small portion of cheese, jam and a pad of butter. Sobering if you consider that an average adult woman that are inactive should consume only 6 400 kilojoules daily to maintain her weight.

Even salads can be distorted. Although perceived as healthy, those with generous protein toppings and dressing can be equivalent to a restaurant main meal. Dietitian Brigitte LeClercq suggests always asking for separate dressing, so you can control how much is used.

Celynn Erasmus says: "Sharing is caring – don’t buy into the idea that what the restaurant is serving you is an appropriate amount of food to eat as it is possible you are getting three to four servings at one meal. Most restaurant meals or take-aways can in fact be shared between two people."

Rather than cutting out food groups and going on extreme deprivation diets, South Africans should learn to downsize when they eat out, but also at home, where they have complete control over portion sizes, cooking methods and the type of food they eat.

Water at every meal

Dietitian, Mariam Forgan suggests including water at every meal as the body confuses thirst with hunger. "A tall glass before and a tall glass of water during the meal will make you feel fuller faster, avoiding over indulgence. "

Association for Dietetics in South Africa (Adsa) spokesperson, Maryke Gallagher’s top tips include: don’t cook more than what the family will eat otherwise everyone will have seconds and maybe thirds; eat slowly, so that you eat less; never place dishes of food on the table when having dinner and don’t keep unhealthy snacks somewhere visible – out of sight, out of mind!

Apart from using smaller plates and bowels, dietitian Jade Campbell suggests that lean protein portions should not be bigger than a deck of cards, carbohydrates the size of a tennis ball and fat the size of a dice – and don’t forget that half your plate should be filled with salads or vegetables!

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Daily exercise does wonders for kids' health

In an after-school exercise programme that included 70 minutes of physical activity five times per week kids lost body fat and improved their heart and lung health.

A nine-month after-school exercise programme helped young kids lose body fat and improve heart and lung strength compared to kids who didn't do the programme, according to a new trial.

It's clear that activity is good for kids, lead author Naiman A. Khan told Reuters Health. But he was surprised at just how much of a difference this programme made.

"We saw their overall body fat, abdominal fat go down, and in the absence of the programme kids actually increased in overall body fat," said Khan, from the University of Illinois at Urbana-Champaign.

Moderate to vigorous physical activity

For their study, the researchers randomly divided 220 kids ages eight and nine into two groups. One group participated in the FITKids programme, which includes 70 minutes of moderate to vigorous physical activity five times per week for nine months, and the other group did not.

In the exercise group, kids did 20 to 25 minutes of health-related fitness activities plus 50 minutes of organised non-competitive games meant to keep their hearts beating at 55 to 80% of their maximum heart rate. That's higher than most previous exercise studies have aimed for, which may be why this study got such good results, according to Dianne Stanton Ward of the University of North Carolina Gillings School of Global Public Health in Chapel Hill.

Ward studies obesity prevention in children. She was not involved in the new research. During exercise, kids wore heart rate watches so the researchers could monitor their activity levels.

After nine months, the kids in the exercise group had lost an average of close to one percent of their total body fat and more than one percent of the fat around their belly area, as reported in Paediatrics. Both kids who were a healthy weight and overweight or obese kids lost fat mass, but overweight or obese kids tended to lose a bit more relative to their starting size.

Staying active

Kids in the comparison group gained a small amount of fat over the nine-month period, and didn't get any more or less fit. The researchers "did a lot of things right in this study", including measuring physical fitness as well as body composition, Ward told Reuters Health.

The results indicate that staying active at this age influences the development of body fat and produces measurable changes in physical fitness. "And the kids must have had fun, because they didn't have to do this," she said, noting that few kids skipped days of the programme.

"It doesn't really matter the particulars of what the kids are doing as long as they get up to a moderate or vigorous heart rate," Ward said. Better fitness means a healthier heart and increased bone density, too, she said.

"As kids move up from the pre-pubertal age, sedentary pursuits often take over and their willingness to be involved in active pursuits is reduced," she said. That can lead to greater weight gain later on.

Less and less activity in school

It would be reasonable for policymakers to put more emphasis on physical education (PE) classes or for more after-school programmes to make time for physical activity, she said. "The recommendation is that children get at least 60 minutes of activity per day, but those don't have to occur at the same time," Khan said. "It could be incorporated throughout the school day."

The curriculum used to develop the FITKids program was originally designed for use in PE classes, Ward noted. FITKids has been available for kids in Illinois for six years and is still an option for kids in that area.

There are likely similar after-school options in other areas of the country, Khan said. "We know children are getting less and less activity in school," he said. But no matter where it happens, he added, "Providing children with opportunities to be physically active is beneficial to their health."

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Aspirin may help colon cancer patients live longer

Adding aspirin to the regular treatment of people whose tumour cells give off a specific antigen, or defence mechanism, may help them to live longer.

Recent research has raised the possibility that low-dose aspirin could add extra years to the lives of colon cancer patients. Now, a new study suggests that only certain patients may gain a survival benefit by taking aspirin after diagnosis.

The study of about 1,000 patients found that people whose tumour cells give off a specific antigen, or defence mechanism, gained most from adding aspirin to their regular treatment.

The findings, published online in JAMA Internal Medicine, aren't conclusive, and patients who develop colon cancer while already taking aspirin may not get any benefit. Also, aspirin, while inexpensive, comes with its own risks.

More research required
Experts asked if colon cancer patients should begin taking aspirin as a result of these findings were divided.

"Absolutely not," said study lead author Dr Marlies Reimers, a doctoral student at Leiden University Medical Centre in the Netherlands. She believes more research is necessary.

But the author of a commentary accompanying the study, Dr Alfred Neugut, said he now plans to recommend aspirin therapy for specific patients.

The study adds to growing evidence that aspirin is helpful for certain colon cancer patients, said Neugut, an oncologist and epidemiologist at Columbia University Medical Centre in New York City.

In his commentary, Neugut writes he himself would add aspirin to his chemotherapy treatment regimen if he had a stage III colon cancer tumour, and he's ready to recommend that patients do, too. Stage III means the cancer has spread to nearby lymph nodes, but has not yet spread to other parts of the body.

Bleeding in the digestive system
Together, this research and other recent studies "paint a very sound picture that warrants a change in standard of care – that aspirin can and should be recommended for use for stage III patients," he said in an interview.

But what about aspirin's well-known risks, especially the possibility of bleeding in the digestive system?

"Stage III patients have a 40 percent to 70 percent chance of dying. I don't think the possibility that 1 percent to 2 percent will have some significant bleeding should deter aspirin's use, given a potential 20 percent to 30 percent improvement in survival," Neugut said.

Aspirin is a "much easier and safer drug than chemotherapy, which we use without reservation," he added.

Neugut said, however, that he doesn't recommend aspirin as a way to prevent colon cancer.

Survival rates notably higher
The study examined tissue samples of 999 patients in the Netherlands who had surgery for colon cancer, mostly stage III or lower. Researchers then compared death rates for patients who were prescribed low-dose aspirin after diagnosis to those without the prescription, which is required in the Netherlands.

The death rate was 38 percent among those who took low (80-milligram) doses of aspirin after diagnosis compared to 49 percent among the non-aspirin users, the study found.

Survival rates were notably higher among aspirin-taking patients whose tumour cells gave off what's called HLA class I antigen – a type of substance that alerts the immune system to defend the body. About two-thirds of 963 patients whose tumours were analyzed fell into this category.

Aspirin had no apparent effect on the other patients who took it, the researchers said.

It's unclear why aspirin might help some colon cancer patients but not others. Reimers said researchers believe aspirin may affect a process involving tumour cells and the components of blood known as platelets.

Effective for other cancers
What's next? Neugut said researchers have launched studies to get a better understanding of aspirin's perceived effect on colon cancer. But the results won't be available for at least 10 years, he noted.

"There is a good chance that aspirin may also prove effective for other cancers in the future," Neugut said, "but there is much less data for any cancer other than colon."

Patients are not routinely tested for HLA class I antigens, but Reimers said it wouldn't be expensive to do so.

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New app alerts doctors when diabetics need help

A French doctor is testing a smartphone app which will alarm doctors if their diabetes 1 patients need them to help them to manage their disease.

Dr Guillaume Charpentier believes a smartphone app he is testing on people with diabetes in France works best when it alerts doctors that frustrated patients need help managing their disease.

The Diabeo mobile phone programme, which recommends insulin dosages, helped people with type 1 diabetes lower their blood-sugar levels in a six-month study. Now a new analysis of the data shows the app markedly improved glucose levels among patients who used it relatively infrequently, raising red flags for their healthcare providers who then intervened.

"What the electronic system is not able to do is the magic of the doctor – to give motivational support to the patient, to encourage the patient to do what the patient does not want to do," Charpentier told Reuters Health. "This system is a very good tool to improve the contact between the patient and the doctor when the patient really needs the doctor. The system can alarm the doctor at the right time," he said.

Poorly controlled type 1 diabetes

Charpentier, from Sud-Francilien Hospital in Corbeil-Essonnes, France, co-authored a recent analysis published in Diabetes & Metabolism reviewing the results of a prior study he led on the Diabeo system, a smartphone coupled to a website.

The first study, completed in 2009, included 180 patients seen at 17 French hospitals with poorly controlled type 1 diabetes. The app, given to two-thirds of the patients, analysed self-monitored blood-glucose levels, carbohydrate counts, planned physical activity and other personal variables to calculate recommended insulin doses. Half of the app users regularly discussed their diabetes management on the phone with their doctors, who tracked information from the app online.

Those who used the app had significantly lower glucose levels than those who recorded their blood-glucose levels and other variables on paper, that study found. But the researchers wondered how much the automated advice on the insulin dose contributed to the improvement and how much the telephone consultations contributed.

To answer that question, Charpentier and his team re-examined the results and divided the patients who were given the app into one group that frequently used it and another that infrequently used it. Frequent users consulted the app for insulin doses at 90 percent of their meals, whereas infrequent users consulted it at less than one third of meals.

The app seemed to be most beneficial for infrequent users who had telephone consultations with their doctors, the study found. Low users reduced their glucose levels by more than 1 percent about 42% of the time, whereas high users lowered their glucose levels by the same amount only 16% of the time. However, the average drop in blood sugar was not significantly different between high and low users.

Patients veering off course

Charpentier believes the results highlight the benefits of doctors monitoring glucose levels in their patients with diabetes, particularly for patients struggling to comply with diet and exercise recommendations. In the current study, doctors reached out to patients in the group with phone consultations whenever the patients seemed to be veering off course, on average every 20 days, he said.

Generally-compliant patients tended to take advantage of the smartphone system to help them monitor their insulin needs, while noncompliant patients often did not. But doctors frequently could talk their patients into compliance when they tracked their progress online, saw they were not using the system and contacted them, Charpentier said.

"It appears that for a number of patients – most likely those who have the greatest difficulty in coping with diabetes and its constraints – the primary benefit of the device was to facilitate interaction with a caregiver. This aspect is essential to ensure that the tool is not viewed by patients as simply a gadget, but as a valid means of providing proper medical support," the authors write.

"What this really speaks to is personalizing medicine," said Dr Latha Palaniappan, from the Stanford University School of Medicine in California. "This could help us figure out who's going to need the telephone consultation. It's just better tailoring of therapy for the right patient population," Palaniappan told Reuters Health. She studies diabetes and cardiovascular disease but was not involved in the current study.

Past research has been mixed on the use of telemedicine, or diagnosing and treating patients using telecommunications technology, for diabetes. A review of 16 studies suggested that computer and mobile phone programmes that tailor advice and support to people with diabetes may do little to improve their health and quality of life.

Depressed and discouraged

But Charpentier said he believes the Diabeo system, currently being tested on 700 patients in France, will prove itself so useful that the French National Health Insurance system will pay to give it to all of the country's 200 000 people with type 1 diabetes. The system is not currently available in the United States, he said.

Palaniappan noted that the Diabeo system cut glucose levels in the current study by more than another common system has done in previous trials. "This is at least as good as continuous glucose monitoring, which is currently reimbursed by insurance," she said. A continuous glucose monitor helps patients detect when their glucose values are approaching dangerous levels.

People with diabetes frequently feel "depressed, discouraged", Charpentier said. With the app, he said, "You can help your patient at the right time. It is the best way to use the time of the doctor when the patient really needs it."

"Telemedicine is improving at a rapid rate," Palaniappan said. "As our technology is getting better, we're seeing better effects on chronic health conditions," she said. "We can't be stuck in the old conclusions. We have to continuously re-evaluate because there's some cool stuff going on with technology now."

Sanofi-Aventis and CERITD, a French nonprofit diabetes research organization, funded the study. Charpentier said neither he nor any of his colleagues on the research team have financial ties to the Diabeo system.

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Six million South Africans living with HIV/Aids

In South Africa the estimated prevalence of HIV increased by almost 2% from 2008 to 2012, largely because of new infections and a higher survival rate.

An estimated 6.4 million people were living with HIV/Aids in 2012 in South Africa, a study by the Human Sciences Research Council (HSRC) revealed.

The findings of the SA National HIV Prevalence, Incidence and Behaviour Survey 2012, was officially launched in Pretoria. Over 38 000 people were interviewed and almost 29 000 agreed to be tested for HIV.

The estimated overall prevalence of HIV increased from 10.6% in 2008 to 12.2% in 2012.

According to the survey, the increased prevalence of HIV in 2012 was largely due to the combined effects of new infections and a successfully expanded antiretroviral treatment (ART) programme.

The availability and use of ART had increased survival among HIV-infected individuals.

HIV-prevalence in the 15-49 year age group was 18.8% but was significantly higher in females (23.2%) than in males (14.5%).

"I am pleased to see that more people with HIV are living longer, because of the hugely expanded treatment programme launched by the government," said HSRC CEO Olive Shisana.

Universal access to treatment

"The disproportionately high HIV-prevalence levels among females in the country and high HIV-prevalence in unmarried cohabiting people however, require a rethinking of conventional approaches of HIV prevention towards strategies that address the underlying socio-cultural norms in the affected communities."

The survey noted a slight decline of HIV-prevalence among youth aged 15-24 years, from 8.7% in 2008 to 7.3% in 2012.

As a result of the country’s successful Prevention of Mother to Child Transmission (PMTCT) programme, HIV infection levels also further decreased in infants 12 months and younger, from 2.0% in 2008 to 1.3% in 2012.

Another key finding of the 2012 Survey was that over two million people were on ART by mid-2012, suggesting that the country was on its way towards universal access to treatment.

The HIV incidence rate among female youth aged 15-24 years was over four times higher than for males in this age group (2.5% vs. 0.6%).

Compared with 2008 data, there were trends toward a decline in condom use in all age groups, except for the 50 years and older group, and an increase in multiple sexual partnerships among sexually active people aged 15 years and older in 2012.

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Test accurately measures heart attack risk

A study found that a blood test plus an electrocardiogram are 99 percent accurate at showing who is at risk of a heart attack and who can safely be sent home.

A simple test appears very good at ruling out heart attacks in people who go to emergency rooms with chest pain, a big public health issue and a huge worry for patients.

A large study in Sweden found that the blood test plus the usual electrocardiogram of the heartbeat were 99% accurate at showing which patients could safely be sent home rather than be admitted for observation and more diagnostics.

Of nearly 9 000 patients judged low risk by the blood test and with normal electrocardiograms, only 15 went on to suffer a heart attack in the next month, and not a single one died.

Admissions may be avoided

"We believe that with this strategy, 20 to 25% of admissions to hospitals for chest pain may be avoided," said Dr Nadia Bandstein of the Karolinska University Hospital in Stockholm.

She helped lead the study, published in the Journal of the American College of Cardiology and presented at the cardiology college's annual conference in Washington.

Chest pain sends more than 15 million people to emergency rooms in the United States and Europe each year, and it usually turns out to be due to anxiety, indigestion or other less-serious things than a heart attack. Yet doctors don't want to miss one – about 2% of patients having heart attacks are mistakenly sent home.

People may feel reassured by being admitted to a hospital so doctors can keep an eye on them, but that raises the risk of picking up an infection and having expensive care they'll have to pay a share of, plus unnecessary tests.

The study included nearly 15 000 people who went to the Karolinska University hospital with chest pains over two years. About 8 900 had low scores on a faster, more sensitive blood test for troponin, a substance that's a sign of heart damage. The test has been available in Europe, Asia and Canada for about three years, but it is not yet available in the United States.

A huge waste of resources

The patients were 47 years old on average and 4% had a previous heart attack. About 21% of them wound up being admitted.

Researchers later looked back to see how the blood test and electrocardiogram would have predicted how they fared over the next month.

They figured that in order to find one heart attack in patients like this, 594 would have to be admitted – a huge waste of resources.

A test like this would be "enormously useful", and the study's results are "almost too good to be true", said Dr Judd Hollander, an emergency medicine specialist at the University of Pennsylvania.

He believes the test should be available in the US and that the amount of evidence that regulators are requiring to approve it is too high.

Unnecessary tests

Dr Allan Jaffe, a cardiologist at the Mayo Clinic, said the problem is not what the test rules out, but what it might falsely rule in. It's so sensitive that it can pick up troponin from heart failure and other problems and cause unnecessary tests for that.

"I think the strategy long-term will be proven," but more studies underway now in the US are needed to show that, he said.

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A stronger joint isn't necessarily more addictive

A Dutch study found that in marijuana smokers THC dose is not the main determinant of who becomes dependent – their style of pot smoking is a better predictor.

Marijuana smokers' behaviour is more important than the potency of their pot or how much of the psychoactive ingredient THC they take in for predicting who will become dependent, according to a small new study.

Researchers have debated whether smokers of high-potency cannabis varieties are at greater risk of addiction because they get more THC, or if they compensate for the pot's strength by using or inhaling less of it.

That doesn't really matter, say the authors of the new report. Smokers of potent pot do get more THC than smokers of traditional varieties, they found. But it's their style of pot smoking that predicted who was most likely to become dependent.

Determinant of dependence

"No drug use is without risk," said lead author Peggy van der Pol, a doctoral candidate at the Trimbos Institute of the Netherlands Institute of Mental Health and Addiction. "When using stronger cannabis you will likely take in more THC than when using less potent cannabis," she told Reuters Health in an email.

Most previous research into cannabis dependence has looked mainly at how frequently a person uses cannabis, Van der Pol and her team note in the journal Addiction. But the assumption that heavier THC exposure leads to greater addiction risk ignores the possibility that THC dose is not the main determinant of who becomes dependent, they write.

Van der Pol and her team analysed data on 98 young adults taking part in an ongoing long-term study of frequent marijuana users in the Netherlands. The participants were recruited from coffee houses where the sale and use of cannabis is permitted and via referrals. Each person reported smoking marijuana on at least three days a week for more than a year.

At the start of the study, three quarters of the participants were men and 23 years old, on average. One in three met the criteria for marijuana dependence at that point. A year and a half after recruitment, and then a year and a half after that, the participants were interviewed about their cannabis use and asked to smoke a joint in a comfortable setting while researchers documented details of their behaviour.

Exposed to more THC

To simulate real-world conditions, smokers were asked to bring their own cannabis and to roll their own joints. Contrary to the authors' original predictions, the smokers of the more potent pot varieties did not roll weaker joints. They used more cannabis in each joint than their peers who smoked lower-strength cannabis. Smokers of potent varieties did inhale less smoke and they smoked at a slower pace than their peers, the study team found.

"Users seem to partly adjust, or 'titrate' their THC intake, but not sufficiently so to fully compensate for the THC-strength," van der Pol told Reuters Health. "So users of more potent cannabis are generally exposed to more THC." These adjustments in smoking behaviour may not be intentional, she added.

"On average, users seem not to fully compensate for cannabis strength by inhaling less smoke. Yet, as the smoking behaviour may be an unconscious process, users are likely unaware whether or not they (partly) compensate their intake." Taking smaller and less frequent puffs on their marijuana joints did not appear to alter their risk of dependence either, the results indicate.

The decreased volume of marijuana puffs – determined by a device that measured puff volume, duration, and related factors – and the total number of puffs was associated with more severe marijuana dependence, both at the start of the study and at follow up, the researchers note. Total monthly exposure to THC did predict the severity of dependence at the three-year mark, but not independent of a person's dependence status at the beginning of the study.

Increasing blood levels of THC

Only smoking behaviours – like how much of a joint people smoked, or how frequently they puffed – predicted dependence at the three-year mark regardless of THC exposure or dependence status at the start, the researchers report.
Dr Wilson Compton, Deputy Director of the National Institute on Drug Abuse (NIDA) told Reuters Health via email, "This is an important study that helps to understand that increasing potency of marijuana may be related to increasing blood levels
of THC, despite some reductions in how much people smoke when the marijuana is stronger."

Compton, who was not involved in the study, added, "This is an important area of research, and we do need a better understanding of it, but we remain concerned particularly for new and young users who may not titrate in the same way as experienced users, and thus may be exposing their brains to higher levels of THC from the outset."

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