A few clicks of the mouse tell visitors to the "Your Disease Risk" Web site their risk for cancer, heart disease, diabetes, stroke and osteoporosis. The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis recently launched this easy-to-use tool, which offers a wealth of information about risk factors and prevention strategies for five prominent diseases affecting millions of Americans.
On the Web site (http://www.yourdiseaserisk.wustl.edu), users can answer a series of simple questionnaires about their medical history, eating habits, exercise and other behaviors and then get a personalized estimate of their risk for 12 different cancers plus heart disease, diabetes, stroke and osteoporosis. Users will also find tips on how to lower their disease risk and convenient Web links to fact sheets that describe the origins and symptoms of each disease.
"The key message is that we already have information to prevent much of the chronic disease that affects the population," says Graham Colditz, M.D., Dr.P.H., the Niess-Gain Professor and associate director of Prevention and Control at the Siteman Cancer Center. "If we can spread the word about prevention strategies, people can start early in life to prevent disease later. We know that it can be hard to decide among all the health claims in the media, and we established this site to make it easy for people to find reliable recommendations for better health and to identify strategies that are best for them."
It is estimated that healthy lifestyles could prevent over half of cancers, 70 percent of strokes and 80 percent of heart disease and diabetes. In addition to detailing the impact of well-known risk factors like smoking, lack of exercise and being overweight, "Your Disease Risk" offers many other important health tips, such as the benefits of calcium and vitamin D for both colon and bone health, the increased risk of diabetes from eating too many refined grains and the increased risk of stroke in apple-shaped people who carry extra fat around the waist.
The site's developers tested its usability with focus groups to make sure all the components are streamlined and understandable. Visitors to the site can choose to investigate just one of the diseases, but answers given in one area carry over to all other areas to avoid the need to repeat answers when learning about more than one disease. A Spanish language version will soon be available on the site's home page.
"We think the site is very accessible and attractive," Colditz says. "We sincerely hope that people make good use of it and feel they come away with a practical, personalized list of what they can do to improve their health."
"Your Disease Risk" reflects recent evidence from the medical community to assure that users are up to date. "We have a system of review that looks at published scientific research on disease risk and makes additions or changes when significant new data become available," Colditz says. "As we go forward, the prevention and control team at the Siteman Cancer Center will continue to ensure the accuracy and relevancy of the site."
Friday, June 29, 2007
Moderate Drinkers Report Better Health
Moderate drinkers are more likely to report above-average health than lifetime abstainers, light drinkers and heavy drinkers, a new study reveals.
“Our results suggest that a moderate amount of drinking is not necessarily dangerous for most people and may actually be health-enhancing,” said study coauthor Michael French, Ph.D.
However, it is unclear whether moderate drinking leads to better health or whether moderate drinkers simply lead healthier lifestyles, he said.
This finding confirmed much of the clinical evidence on this topic. However, previous research has focused on objective health indicators such as cardiovascular disease, injuries and mortality. “We wanted to see if moderate drinkers are actually feeling better by their own assessment,” said French, professor of health economics at the University of Miami.
The study appears in the July/August issue of the American Journal of Health Promotion.
The study used 2002 data from a representative survey of U.S. households, representing more than 31,000 adults. The U.S. Census Bureau conducts the survey for the Centers for Disease Control and Prevention.
Participants answered questions about alcohol consumption, health behaviors and chronic health conditions. Researchers defined moderate drinking as four to 14 drinks weekly for men and four to seven drinks weekly for women.
Compared with lifetime abstainers and former light drinkers, moderate-drinking men were 1.27 times more likely to report above-average health. Women who were moderate drinkers were more than twice as likely to report above-average health as abstainers were.
Arthur Klatsky, M.D., a researcher and cardiology consultant at the Kaiser Permanente Medical Care Program in Oakland, Calif., suggests that the study’s results for moderate drinkers probably have something to do with healthy lifestyles. “By and large, the same people that work out and eat healthy are probably more likely to be moderate drinkers instead of heavier drinkers,” he said.
One major health benefit of moderate drinking is the ability to ward off cardiovascular disease, particularly hardening of the arteries and stroke caused by blockages in blood vessels, Klatsky added.
Both French and Klatsky warn that heavy drinking contributes to poor health. “Heavy drinking by everybody’s reckoning is bad business for health and social outcomes,” Klatsky said.
“Our results suggest that a moderate amount of drinking is not necessarily dangerous for most people and may actually be health-enhancing,” said study coauthor Michael French, Ph.D.
However, it is unclear whether moderate drinking leads to better health or whether moderate drinkers simply lead healthier lifestyles, he said.
This finding confirmed much of the clinical evidence on this topic. However, previous research has focused on objective health indicators such as cardiovascular disease, injuries and mortality. “We wanted to see if moderate drinkers are actually feeling better by their own assessment,” said French, professor of health economics at the University of Miami.
The study appears in the July/August issue of the American Journal of Health Promotion.
The study used 2002 data from a representative survey of U.S. households, representing more than 31,000 adults. The U.S. Census Bureau conducts the survey for the Centers for Disease Control and Prevention.
Participants answered questions about alcohol consumption, health behaviors and chronic health conditions. Researchers defined moderate drinking as four to 14 drinks weekly for men and four to seven drinks weekly for women.
Compared with lifetime abstainers and former light drinkers, moderate-drinking men were 1.27 times more likely to report above-average health. Women who were moderate drinkers were more than twice as likely to report above-average health as abstainers were.
Arthur Klatsky, M.D., a researcher and cardiology consultant at the Kaiser Permanente Medical Care Program in Oakland, Calif., suggests that the study’s results for moderate drinkers probably have something to do with healthy lifestyles. “By and large, the same people that work out and eat healthy are probably more likely to be moderate drinkers instead of heavier drinkers,” he said.
One major health benefit of moderate drinking is the ability to ward off cardiovascular disease, particularly hardening of the arteries and stroke caused by blockages in blood vessels, Klatsky added.
Both French and Klatsky warn that heavy drinking contributes to poor health. “Heavy drinking by everybody’s reckoning is bad business for health and social outcomes,” Klatsky said.
Thursday, June 28, 2007
Secondhand smoke = potent carcinogen absorbed
New research on secondhand smoke discovers nonsmoking workers immediately absorb potent carcinogen
Offering alarming new evidence on the dangers of permitting smoking in the workplace, scientists have found that nonsmoking restaurant and bar employees absorb a potent carcinogen—not considered safe at any level—while working in places where they had to breathe tobacco smoke from customers and co-workers. The carcinogen, NNK, is found in the body only as a result of using tobacco or breathing secondhand smoke.
In a study to be published in the August 2007 edition of the American Journal of Public Health, investigators at the Multnomah County Health Department and Oregon Department of Human Services report that elevated levels of NNK showed up in the urine of nonsmoking employees shortly after they encountered secondhand smoke during their shifts. Moreover, levels of NNK, which is known to cause lung cancer, increased by 6 percent for each hour of work.
“This is the first study to show increases in NNK as a result of a brief workplace exposure, and that levels of this powerful carcinogen continue to increase the longer the person works in a place where smoking is permitted. NNK is a major cancer causing agent from tobacco products—and workers should not have to be exposed to any dose of this very dangerous chemical,” said Michael Stark, PhD, of the Multnomah County Health Department and the study’s lead author. “The science shows that the threat of disease from secondhand smoke is no longer a distant threat. The amount of this carcinogen increases even within a single work shift.”
In a related study in the same issue of the Journal, experts in public health law note that across the country employers already are being held legally liable for exposing workers to secondhand smoke, even if state or local laws permit workplace smoking. They warn that as scientists continue to provide evidence of harm, employers could soon face a clear choice: either voluntarily ban smoking in their workplace or face an increasing wave of costly legal actions.
“When employers who allow smoking have scientists telling them that as soon as workers get on the job, they’re breathing in some of the most dangerous carcinogens around, it’s time to think about whether they want to deal with that kind of liability,” said Marice Ashe with the Public Health Law Program at the Public Health Institute in Oakland, CA. and the lead author of the legal analysis. “The science is making it easier and easier to persuade courts to sanction employers who continue to allow smoking.”
The Stark study on the effects of workplace smoking, “The Impact of Clean Indoor Air Exemptions and Preemption on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers,” was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP).
It followed 52 nonsmoking employees of bars and restaurants in Oregon communities where smoking is still permitted in such establishments and compared them to 32 nonsmoking bar and restaurant employees from other Oregon municipalities where smoking is prohibited by local ordinance. Researchers collected urine samples from both groups before and after their work-shifts and tested them for the tobacco produced lung carcinogen NNK.
What they found is that three out of four employees who worked in an establishment where smoking was permitted had detectable levels of NNK compared to fewer than half of the unexposed workers. In addition, exposure to tobacco smoke was associated with a three-fold increase in levels of the carcinogen. The study also notes that the amount of NNK in employees exposed to tobacco smoke went up in direct relationship to the number of hours worked—by 6 percent an hour on average—giving the researchers “confidence that the levels (of NNK) reported in this study do, indeed, reflect workplace exposure.”
The investigators also note that their research supports the notion that the risks of secondhand tobacco smoke in the workplace are borne disproportionately by an already vulnerable group. Employees who participated in their study are typical of foodservice workers nationwide in that the majority were women, under age 30, had relatively low household incomes, and more than one third of them lacked health insurance.
“This is already a population that tends to have fewer resources to deal with health problems than many other groups so the least we can do is protect them from harmful cigarette smoke,” Stark said. “For young women in particular, secondhand smoke can increase the risk of having breast cancer and of giving birth prematurely or having low-birth weight babies.”
In their analysis of the legal and liability issues raised by workplace smoking hazards—“Legal Risks to Employers Allowing Smoking in the Workplace”—Ashe and her colleagues said employees harmed by secondhand smoke already are using worker compensation laws, state and federal disability laws and an employer’s legal responsibility to “provide a safe workplace” to take action against secondhand smoke. While in the past such cases have not always met with success, the study notes that as the scientific evidence mounts, employers will increasingly be on the losing end.
“Employers are always talking about high costs of insurance and the need to reduce their potential liabilities,” Ashe said. “Voluntarily banning smoking and supporting state and local legislation mandating smoke-free workplaces is a relatively cheap and easy way of removing a cumbersome and costly liability.”
Offering alarming new evidence on the dangers of permitting smoking in the workplace, scientists have found that nonsmoking restaurant and bar employees absorb a potent carcinogen—not considered safe at any level—while working in places where they had to breathe tobacco smoke from customers and co-workers. The carcinogen, NNK, is found in the body only as a result of using tobacco or breathing secondhand smoke.
In a study to be published in the August 2007 edition of the American Journal of Public Health, investigators at the Multnomah County Health Department and Oregon Department of Human Services report that elevated levels of NNK showed up in the urine of nonsmoking employees shortly after they encountered secondhand smoke during their shifts. Moreover, levels of NNK, which is known to cause lung cancer, increased by 6 percent for each hour of work.
“This is the first study to show increases in NNK as a result of a brief workplace exposure, and that levels of this powerful carcinogen continue to increase the longer the person works in a place where smoking is permitted. NNK is a major cancer causing agent from tobacco products—and workers should not have to be exposed to any dose of this very dangerous chemical,” said Michael Stark, PhD, of the Multnomah County Health Department and the study’s lead author. “The science shows that the threat of disease from secondhand smoke is no longer a distant threat. The amount of this carcinogen increases even within a single work shift.”
In a related study in the same issue of the Journal, experts in public health law note that across the country employers already are being held legally liable for exposing workers to secondhand smoke, even if state or local laws permit workplace smoking. They warn that as scientists continue to provide evidence of harm, employers could soon face a clear choice: either voluntarily ban smoking in their workplace or face an increasing wave of costly legal actions.
“When employers who allow smoking have scientists telling them that as soon as workers get on the job, they’re breathing in some of the most dangerous carcinogens around, it’s time to think about whether they want to deal with that kind of liability,” said Marice Ashe with the Public Health Law Program at the Public Health Institute in Oakland, CA. and the lead author of the legal analysis. “The science is making it easier and easier to persuade courts to sanction employers who continue to allow smoking.”
The Stark study on the effects of workplace smoking, “The Impact of Clean Indoor Air Exemptions and Preemption on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers,” was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP).
It followed 52 nonsmoking employees of bars and restaurants in Oregon communities where smoking is still permitted in such establishments and compared them to 32 nonsmoking bar and restaurant employees from other Oregon municipalities where smoking is prohibited by local ordinance. Researchers collected urine samples from both groups before and after their work-shifts and tested them for the tobacco produced lung carcinogen NNK.
What they found is that three out of four employees who worked in an establishment where smoking was permitted had detectable levels of NNK compared to fewer than half of the unexposed workers. In addition, exposure to tobacco smoke was associated with a three-fold increase in levels of the carcinogen. The study also notes that the amount of NNK in employees exposed to tobacco smoke went up in direct relationship to the number of hours worked—by 6 percent an hour on average—giving the researchers “confidence that the levels (of NNK) reported in this study do, indeed, reflect workplace exposure.”
The investigators also note that their research supports the notion that the risks of secondhand tobacco smoke in the workplace are borne disproportionately by an already vulnerable group. Employees who participated in their study are typical of foodservice workers nationwide in that the majority were women, under age 30, had relatively low household incomes, and more than one third of them lacked health insurance.
“This is already a population that tends to have fewer resources to deal with health problems than many other groups so the least we can do is protect them from harmful cigarette smoke,” Stark said. “For young women in particular, secondhand smoke can increase the risk of having breast cancer and of giving birth prematurely or having low-birth weight babies.”
In their analysis of the legal and liability issues raised by workplace smoking hazards—“Legal Risks to Employers Allowing Smoking in the Workplace”—Ashe and her colleagues said employees harmed by secondhand smoke already are using worker compensation laws, state and federal disability laws and an employer’s legal responsibility to “provide a safe workplace” to take action against secondhand smoke. While in the past such cases have not always met with success, the study notes that as the scientific evidence mounts, employers will increasingly be on the losing end.
“Employers are always talking about high costs of insurance and the need to reduce their potential liabilities,” Ashe said. “Voluntarily banning smoking and supporting state and local legislation mandating smoke-free workplaces is a relatively cheap and easy way of removing a cumbersome and costly liability.”
Exercise stimulates formation of new brain cells
Exercise has a similar effect to antidepressants on depression. This has been shown by previous research. Now Astrid Bjørnebekk at Karolinska Institutet has explained how this can happen: exercise stimulates the production of new brain cells.
In a series of scientific reports, she has searched for the underlying biological mechanisms that explain why exercise can be a form of therapy for depression and has also compared it with pharmacological treatment with an SSRI drug.
The experiment studies were conducted on rats. The results show that both exercise and antidepressants increase the formation of new cells in an area of the brain that is important to memory and learning. Astrid Bjørnebekk’s studies confirm previous research results, and she proposes a model to explain how exercise can have an antidepressant effect in mild to moderately severe depression. Her study also shows that exercise is a very good complement to medicines.
“What is interesting is that the effect of antidepressant therapy can be greatly strengthened by external environmental factors,” she says.
Previous studies have shown that drug abusers have lowered levels of the dopamine D2 receptor in the brain's reward system. It has been speculated that this may be of significance to the depressive symptoms drug abusers often suffer from. These rat studies show that genetic factors may influence how external environmental factors can regulate levels of the dopamine D2 receptor in the brain.
“Different individuals may have differing sensitivity to how stress lowers dopamine D2 receptor levels, for example. This might be significant in explaining why certain individuals develop depression more readily than others,” she says.
In a series of scientific reports, she has searched for the underlying biological mechanisms that explain why exercise can be a form of therapy for depression and has also compared it with pharmacological treatment with an SSRI drug.
The experiment studies were conducted on rats. The results show that both exercise and antidepressants increase the formation of new cells in an area of the brain that is important to memory and learning. Astrid Bjørnebekk’s studies confirm previous research results, and she proposes a model to explain how exercise can have an antidepressant effect in mild to moderately severe depression. Her study also shows that exercise is a very good complement to medicines.
“What is interesting is that the effect of antidepressant therapy can be greatly strengthened by external environmental factors,” she says.
Previous studies have shown that drug abusers have lowered levels of the dopamine D2 receptor in the brain's reward system. It has been speculated that this may be of significance to the depressive symptoms drug abusers often suffer from. These rat studies show that genetic factors may influence how external environmental factors can regulate levels of the dopamine D2 receptor in the brain.
“Different individuals may have differing sensitivity to how stress lowers dopamine D2 receptor levels, for example. This might be significant in explaining why certain individuals develop depression more readily than others,” she says.
Therapeutic value of meditation unproven
Therapeutic value of meditation unproven, says study
While it's not likely to do you any harm, there is also no compelling evidence that meditation has therapeutic value
“There is an enormous amount of interest in using meditation as a form of therapy to cope with a variety of modern-day health problems, especially hypertension, stress and chronic pain, but the majority of evidence that seems to support this notion is anecdotal, or it comes from poor quality studies,” say Maria Ospina and Kenneth Bond, researchers at the University of Alberta/Capital Health Evidence-based Practice Center in Edmonton, Canada.
In compiling their report, Ospina, Bond and their fellow researchers analyzed a mountain of medical and psychological literature—813 studies in all—looking at the impact of meditation on conditions such as hypertension, cardiovascular diseases and substance abuse.
They found some evidence that certain types of meditation reduce blood pressure and stress in clinical populations. Among healthy individuals, practices such as Yoga seemed to increase verbal creativity and reduce heart rate, blood pressure and cholesterol. However, Ospina says no firm conclusions on the effects of meditation practices in health care can be drawn based on the available evidence because the existing scientific research is characterized by poor methodological quality and does not appear to have a common theoretical perspective.
“Future research on meditation practices must be more rigorous in the design and execution of studies and in the analysis and reporting of results,” Ospina explains.
But the researchers caution against dismissing the therapeutic value of meditation outright. “This report’s conclusions shouldn’t be taken as a sign that meditation doesn’t work,” Bond says. “Many uncertainties surround the practice of meditation. For medical practitioners who are seeking to make evidence-based decisions regarding the therapeutic value of meditation, the report shows that the evidence is inconclusive regarding its effectiveness.” For the general public, adds Ospina, “this research highlights that choosing to practice a particular meditation technique continues to rely solely on individual experiences and personal preferences, until more conclusive scientific evidence is produced.”
The report, published June 2007 and titled Meditation Practices for Health: State of the Research, identified five broad categories of meditation practices: mantra meditation, mindfulness meditation, Yoga, Tai Chi and Qi Gong. Transcendental Meditation and relaxation response (both of which are forms of mantra meditation) were the most commonly studied types of meditation. Studies involving Yoga and mindfulness meditation were also common.
While it's not likely to do you any harm, there is also no compelling evidence that meditation has therapeutic value
“There is an enormous amount of interest in using meditation as a form of therapy to cope with a variety of modern-day health problems, especially hypertension, stress and chronic pain, but the majority of evidence that seems to support this notion is anecdotal, or it comes from poor quality studies,” say Maria Ospina and Kenneth Bond, researchers at the University of Alberta/Capital Health Evidence-based Practice Center in Edmonton, Canada.
In compiling their report, Ospina, Bond and their fellow researchers analyzed a mountain of medical and psychological literature—813 studies in all—looking at the impact of meditation on conditions such as hypertension, cardiovascular diseases and substance abuse.
They found some evidence that certain types of meditation reduce blood pressure and stress in clinical populations. Among healthy individuals, practices such as Yoga seemed to increase verbal creativity and reduce heart rate, blood pressure and cholesterol. However, Ospina says no firm conclusions on the effects of meditation practices in health care can be drawn based on the available evidence because the existing scientific research is characterized by poor methodological quality and does not appear to have a common theoretical perspective.
“Future research on meditation practices must be more rigorous in the design and execution of studies and in the analysis and reporting of results,” Ospina explains.
But the researchers caution against dismissing the therapeutic value of meditation outright. “This report’s conclusions shouldn’t be taken as a sign that meditation doesn’t work,” Bond says. “Many uncertainties surround the practice of meditation. For medical practitioners who are seeking to make evidence-based decisions regarding the therapeutic value of meditation, the report shows that the evidence is inconclusive regarding its effectiveness.” For the general public, adds Ospina, “this research highlights that choosing to practice a particular meditation technique continues to rely solely on individual experiences and personal preferences, until more conclusive scientific evidence is produced.”
The report, published June 2007 and titled Meditation Practices for Health: State of the Research, identified five broad categories of meditation practices: mantra meditation, mindfulness meditation, Yoga, Tai Chi and Qi Gong. Transcendental Meditation and relaxation response (both of which are forms of mantra meditation) were the most commonly studied types of meditation. Studies involving Yoga and mindfulness meditation were also common.
Wednesday, June 27, 2007
Emotions Can Affect Recovery from Hip Surgery
A patient's emotional state plays a significant role in his or her recovery from hip surgery, suggests Saint Louis University research published this month.
Orthopaedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function given by the doctor, and the second is a questionnaire patients answer that considers a wide variety of factors in determining the overall success of the surgical procedure.
"We started out simply looking to see if the results of the two tests were correlated; the one doctors give has been used for decades to evaluate hip function, and the other that the patient answers is much newer," says Berton Moed, M.D., chair of the department of orthopaedic surgery at Saint Louis University School of Medicine. "What we found was surprising - the clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery."
The disparity, says Moed, can be explained by a section of questions on the self-test not addressed by the clinical test: those dealing with emotional well-being. A patient's emotional status was the second-most important factor in determining how well he or she thought recovery was going, Moed found. (Mobility was the first.)
"Patients come in for check-ups after their hip surgery and the doctor says, 'Looks like you're doing fabulously,' and they respond, 'No, I'm not. I ache,'" Moed says. "They're not doing well, but why? It appears to have a lot to do with their emotional state. It's the elephant in the exam room - that is, something doctors need to acknowledge is a real issue."
Rather than retool the established clinical test to include an emotional component, Moed says orthopaedic surgeons should make efforts to use both exams for a more comprehensive measure of the patient's recovery.
"Do we need to look at other interventions besides fixing their hip? I think we might have to," he says. "That could include bringing in social workers and psychologists to work with the patients in the areas that surgeons, who often are super subspecialists, may not be able to deal with."
Moed says both underlying depression and new depression brought on by the injury and/or surgery could be to blame for slowing a patient's recovery.
"When an active person is suddenly confined to the bed or to limited activity, it can take a toll," Moed says. "Not being able to do the things one used - and feeling powerless over it - may play a larger role than we thought in how well the patient feels they're recovering."
While Moed says some patients may be taken aback by the suggestion that they see a psychologist after surgery, he thinks developing better and more customized treatment plans has the potential to help patients recover more fully - and not just after hip surgery.
"The number one issue is recognition - we need to acknowledge that there's more going on with patients than what current clinical tests tell us," he says.
Moed and fellow researchers studied 46 patients who had been followed for at least two years after elementary posterior wall fracture surgery. The research is published in the June issue of the Journal of Bone and Joint Surgery.
Orthopaedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function given by the doctor, and the second is a questionnaire patients answer that considers a wide variety of factors in determining the overall success of the surgical procedure.
"We started out simply looking to see if the results of the two tests were correlated; the one doctors give has been used for decades to evaluate hip function, and the other that the patient answers is much newer," says Berton Moed, M.D., chair of the department of orthopaedic surgery at Saint Louis University School of Medicine. "What we found was surprising - the clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery."
The disparity, says Moed, can be explained by a section of questions on the self-test not addressed by the clinical test: those dealing with emotional well-being. A patient's emotional status was the second-most important factor in determining how well he or she thought recovery was going, Moed found. (Mobility was the first.)
"Patients come in for check-ups after their hip surgery and the doctor says, 'Looks like you're doing fabulously,' and they respond, 'No, I'm not. I ache,'" Moed says. "They're not doing well, but why? It appears to have a lot to do with their emotional state. It's the elephant in the exam room - that is, something doctors need to acknowledge is a real issue."
Rather than retool the established clinical test to include an emotional component, Moed says orthopaedic surgeons should make efforts to use both exams for a more comprehensive measure of the patient's recovery.
"Do we need to look at other interventions besides fixing their hip? I think we might have to," he says. "That could include bringing in social workers and psychologists to work with the patients in the areas that surgeons, who often are super subspecialists, may not be able to deal with."
Moed says both underlying depression and new depression brought on by the injury and/or surgery could be to blame for slowing a patient's recovery.
"When an active person is suddenly confined to the bed or to limited activity, it can take a toll," Moed says. "Not being able to do the things one used - and feeling powerless over it - may play a larger role than we thought in how well the patient feels they're recovering."
While Moed says some patients may be taken aback by the suggestion that they see a psychologist after surgery, he thinks developing better and more customized treatment plans has the potential to help patients recover more fully - and not just after hip surgery.
"The number one issue is recognition - we need to acknowledge that there's more going on with patients than what current clinical tests tell us," he says.
Moed and fellow researchers studied 46 patients who had been followed for at least two years after elementary posterior wall fracture surgery. The research is published in the June issue of the Journal of Bone and Joint Surgery.
Brain stimulation reduces risk of Alzheimer's
Frequent brain stimulation in old age reduces risk of Alzheimer's disease
How often old people read a newspaper, play chess, or engage in other mentally stimulating activities is related to risk of developing Alzheimer’s disease, according to a study published June 27, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology.
For the study, more than 700 people in Chicago, IL, with an average age of 80 underwent yearly cognitive testing for up to five years. Participants were part of the Rush Memory and Aging Project, a longitudinal study of more than 1,200 older people. Of the participants, 90 developed Alzheimer’s disease. Researchers also performed a brain autopsy on the 102 participants who died.
The study found a cognitively active person in old age was 2.6 times less likely to develop dementia and Alzheimer’s disease than a cognitively inactive person in old age. This association remained after controlling for past cognitive activity, lifetime socioeconomic status, and current social and physical activity.
Researchers say the findings may be used to help prevent Alzheimer’s disease.
“Alzheimer’s disease is among the most feared consequences of old age,” said study author Robert S. Wilson, PhD, with the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago. “The enormous public health problems posed by the disease are expected to increase during the coming decades as the proportion of old people in the United States increases. This underscores the urgent need for strategies to prevent the disease or delay its onset.”
Wilson says the study also found frequent cognitive activity during old age, such as visiting a library or attending a play, was associated with reduced risk of mild cognitive impairment, a transitional stage between normal aging and dementia, and less rapid decline in cognitive function.
How often old people read a newspaper, play chess, or engage in other mentally stimulating activities is related to risk of developing Alzheimer’s disease, according to a study published June 27, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology.
For the study, more than 700 people in Chicago, IL, with an average age of 80 underwent yearly cognitive testing for up to five years. Participants were part of the Rush Memory and Aging Project, a longitudinal study of more than 1,200 older people. Of the participants, 90 developed Alzheimer’s disease. Researchers also performed a brain autopsy on the 102 participants who died.
The study found a cognitively active person in old age was 2.6 times less likely to develop dementia and Alzheimer’s disease than a cognitively inactive person in old age. This association remained after controlling for past cognitive activity, lifetime socioeconomic status, and current social and physical activity.
Researchers say the findings may be used to help prevent Alzheimer’s disease.
“Alzheimer’s disease is among the most feared consequences of old age,” said study author Robert S. Wilson, PhD, with the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago. “The enormous public health problems posed by the disease are expected to increase during the coming decades as the proportion of old people in the United States increases. This underscores the urgent need for strategies to prevent the disease or delay its onset.”
Wilson says the study also found frequent cognitive activity during old age, such as visiting a library or attending a play, was associated with reduced risk of mild cognitive impairment, a transitional stage between normal aging and dementia, and less rapid decline in cognitive function.
Tuesday, June 26, 2007
Aspirin not as good for women as for men
A new study shows that aspirin therapy for coronary artery disease is four times more likely to be ineffective in women compared to men with the same medical history.
Historically, studies have shown that aspirin therapy is less effective in women than in men, but it has remained unclear how much less effective and whether this affects patient outcomes, said Michael Dorsch, clinical pharmacist and adjunct clinical instructor at the University of Michigan College of Pharmacy.
Dorsch is the lead author of the paper, "Aspirin Resistance in Patients with Stable Coronary Artery Disease," which appears online today in the Annals of Pharmacotherapy.
Originally, Dorsch and his team set out to determine if patients with a history of heart attacks were more apt to be aspirin resistant than those with coronary artery disease but no history of heart attack. They found that gender and not medical history was a predictor for aspirin resistance, Dorsch said. The results surprised him.
"I was surprised by how big of a difference it was for females," said Dorsch, who has appointments at the U-M Health System and the U-M College of Pharmacy, and started the study as a resident at the University of North Carolina. "This is another piece of information that affirms we need more studies in women."
Aspirin therapy is a cornerstone in managing heart disease because it inhibits blood clotting. Aspirin therapy can reduce the risk of a nonfatal heart attack or stroke by about 23 percent, and an estimated 20 million men and women take a low dose of aspirin (81-325 mg daily) to control heart disease. But despite its effectiveness, there is evidence that aspirin is less effective in some patients, and researchers don't really know why. This can be frightening because most doctors do not check for aspirin resistance before prescribing aspirin therapy and therefore presume it's working in the patient when it may not be, he said.
There isn't enough evidence to show if people who are aspirin resistant can simply take larger doses, but Dorsch warns that people taking aspirin on the advice of a doctor shouldn't stop therapy on account of these results.
Not only did the study quantify how much more effective aspirin therapy is for men than for women, it is also the first study that Dorsch knows of to measure aspirin resistance in men and women with stable coronary artery disease. Previous studies have looked at the impact of aspirin therapy on people who have had a heart attack.
For the study, researchers randomly selected 100 patients who were visiting their cardiologist for a regularly scheduled appointment. All had coronary artery disease but only half had a history of heart attack. Researchers used a device called VerifyNow Aspirin Assay to test the percentage of platelet reactivity after blood samples were exposed to a chemical that causes clotting.
Aspirin works by causing platelet inhibition in the blood, which means that platelets cannot stick together and this slows the formation of blood clots that cause a heart attack or stroke.
"This does happen in women, but it doesn't happen in as many women and it's not as effective," Dorsch said. The testing device uses an optical sensor to "see" what percentage of the platelets in the blood sample clump together. Anything less than 40 percent platelet inhibition is considered aspirin resistant.
"We really don't know the mechanism," Dorsch said. "It could be that women have a more active platelet system in the body so it's less likely that platelet action would be inhibited."
In the future, researchers hope to look at aspirin therapy outcomes in women only and see if those outcomes can be changed. The majority of testing for aspirin therapy has been on men, so not much is known about how women respond.
"Heart disease is the number one killer of women in the United States. Future research should be aimed at finding out the cause of this increase in aspirin resistance and the effect on outcomes in women with heart disease." Dorsch said.
Historically, studies have shown that aspirin therapy is less effective in women than in men, but it has remained unclear how much less effective and whether this affects patient outcomes, said Michael Dorsch, clinical pharmacist and adjunct clinical instructor at the University of Michigan College of Pharmacy.
Dorsch is the lead author of the paper, "Aspirin Resistance in Patients with Stable Coronary Artery Disease," which appears online today in the Annals of Pharmacotherapy.
Originally, Dorsch and his team set out to determine if patients with a history of heart attacks were more apt to be aspirin resistant than those with coronary artery disease but no history of heart attack. They found that gender and not medical history was a predictor for aspirin resistance, Dorsch said. The results surprised him.
"I was surprised by how big of a difference it was for females," said Dorsch, who has appointments at the U-M Health System and the U-M College of Pharmacy, and started the study as a resident at the University of North Carolina. "This is another piece of information that affirms we need more studies in women."
Aspirin therapy is a cornerstone in managing heart disease because it inhibits blood clotting. Aspirin therapy can reduce the risk of a nonfatal heart attack or stroke by about 23 percent, and an estimated 20 million men and women take a low dose of aspirin (81-325 mg daily) to control heart disease. But despite its effectiveness, there is evidence that aspirin is less effective in some patients, and researchers don't really know why. This can be frightening because most doctors do not check for aspirin resistance before prescribing aspirin therapy and therefore presume it's working in the patient when it may not be, he said.
There isn't enough evidence to show if people who are aspirin resistant can simply take larger doses, but Dorsch warns that people taking aspirin on the advice of a doctor shouldn't stop therapy on account of these results.
Not only did the study quantify how much more effective aspirin therapy is for men than for women, it is also the first study that Dorsch knows of to measure aspirin resistance in men and women with stable coronary artery disease. Previous studies have looked at the impact of aspirin therapy on people who have had a heart attack.
For the study, researchers randomly selected 100 patients who were visiting their cardiologist for a regularly scheduled appointment. All had coronary artery disease but only half had a history of heart attack. Researchers used a device called VerifyNow Aspirin Assay to test the percentage of platelet reactivity after blood samples were exposed to a chemical that causes clotting.
Aspirin works by causing platelet inhibition in the blood, which means that platelets cannot stick together and this slows the formation of blood clots that cause a heart attack or stroke.
"This does happen in women, but it doesn't happen in as many women and it's not as effective," Dorsch said. The testing device uses an optical sensor to "see" what percentage of the platelets in the blood sample clump together. Anything less than 40 percent platelet inhibition is considered aspirin resistant.
"We really don't know the mechanism," Dorsch said. "It could be that women have a more active platelet system in the body so it's less likely that platelet action would be inhibited."
In the future, researchers hope to look at aspirin therapy outcomes in women only and see if those outcomes can be changed. The majority of testing for aspirin therapy has been on men, so not much is known about how women respond.
"Heart disease is the number one killer of women in the United States. Future research should be aimed at finding out the cause of this increase in aspirin resistance and the effect on outcomes in women with heart disease." Dorsch said.
You Can Repay Your Sleep Debt
More than 60% of women don’t regularly get the recommended seven to nine hours of sleep per night. As sleep debt mounts, health consequences increase. It may take some work, but you can repay even a chronic, longstanding sleep debt, reports the July 2007 issue of Harvard Women’s Health Watch.
Sleep loss exacts a toll on the mind as well as the body, research has shown. In one study, scientists assigned groups of healthy men and women, ages 21 to 38, to get different amounts of sleep— eight, six, or four hours per night—or no sleep at all for three nights in a row. No one was allowed to sleep during the day. Every two hours during their waking periods, all the participants completed sleepiness questionnaires and took tests for reaction time, memory, and cognitive ability.
Over the course of two weeks, reaction times in the group that slept eight hours a night remained about the same, and their scores on memory and cognitive tasks rose steadily. In contrast, scores for the four- and six-hour sleepers drew closer to those of the sleepless group, whose scores had plummeted.
So how do we counter the effects of chronic sleep loss? Harvard Women’s Health Watch suggests if you’ve missed 10 hours of sleep over one week, make up for it over the weekend and the following week. If you’ve missed sleep for decades, it could take a few weeks to repay the debt. Plan a vacation with a light schedule, and sleep every night until you wake naturally. Once you’ve determined how much sleep you need, factor it into your daily schedule.
Sleep loss exacts a toll on the mind as well as the body, research has shown. In one study, scientists assigned groups of healthy men and women, ages 21 to 38, to get different amounts of sleep— eight, six, or four hours per night—or no sleep at all for three nights in a row. No one was allowed to sleep during the day. Every two hours during their waking periods, all the participants completed sleepiness questionnaires and took tests for reaction time, memory, and cognitive ability.
Over the course of two weeks, reaction times in the group that slept eight hours a night remained about the same, and their scores on memory and cognitive tasks rose steadily. In contrast, scores for the four- and six-hour sleepers drew closer to those of the sleepless group, whose scores had plummeted.
So how do we counter the effects of chronic sleep loss? Harvard Women’s Health Watch suggests if you’ve missed 10 hours of sleep over one week, make up for it over the weekend and the following week. If you’ve missed sleep for decades, it could take a few weeks to repay the debt. Plan a vacation with a light schedule, and sleep every night until you wake naturally. Once you’ve determined how much sleep you need, factor it into your daily schedule.
Antidepressant, bone loss link
Physician says published findings 'raise some concern about people taking SSRIs'
Two new studies suggest older men and women taking selective serotonin reuptake inhibitors, a class of antidepressants that includes Prozac, Paxil and Zoloft, are prone to increased bone loss.
The jointly released studies by scientists at Oregon Health & Science University, and in San Francisco, Minneapolis, San Diego and Pittsburgh, found that elderly men taking the so-called SSRIs had lower bone mineral density, and that elderly women taking the antidepressants had a higher rate of yearly bone loss.
The studies appear in today's issue of Archives of Internal Medicine, a publication of the Journal of the American Medical Association.
The studies "raise some concern about people taking SSRIs and whether they may need additional screening or extra protection for their bones," said Elizabeth Haney, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine who led the men's study and co-authored the women's study.
But Haney cautioned the studies' results don't confirm a "cause-and-effect relationship" between SSRIs and bone loss. "Both are observational studies, so without a prospective study of this issue, we're unable to make a determination of direct causality," she said.
The studies also found that use of another popular class of antidepressant medications, known as tricyclic antidepressants or TCAs, were not associated with increased bone loss in men and women. TCAs include such drugs as amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil) and nortriptyline (Pamelor).
For the men's study, which measured total bone loss, researchers analyzed health data for 5,995 men ages 65 and older who were recruited from six regions of the United States between March 2000 and April 2002. They found that bone mineral density among SSRI users was 3.9 percent lower at the total hip and 5.9 percent lower at the lumbar spine compared with men not taking the antidepressants.
For the women's study, a longitudinal study measuring bone loss rate, researchers first examined 2,722 women ages 65 and older from four regions between 1986 and 1988, and again between 1997 and 1998. Bone mineral density in the total hip decreased .47 percent among participants who didn't use SSRIs, but .82 percent among people who did take the drugs.
Michael Bliziotes, M.D., OHSU associate professor of medicine (endocrinology, diabetes and clinical nutrition) who was senior author on the men's study and co-author on the women's study, said the research team was "surprised at the degree of difference we saw. I wasn't anticipating it would be that much."
That's because there are so many other factors that could affect bone density, the researchers said. For example, older men taking SSRIs have lower physical activity or greater intake of alcohol. And older women tend to be more depressed than men, and they lose bone density at a greater rate earlier in life due to menopause.
"One of the concerns we had was depression has its own effects on bones, so depressed people probably have lower bone density independent of their SSRI use," Bliziotes said. "Still we found that the bone density was lower in SSRI users even after controlling for as many confounding variables as we could."
Haney and Bliziotes both agree the results don't mean people taking antidepressants, even SSRIs, should stop.
"Depression is a serious condition and it's important not to stop antidepressants abruptly or without talking to your physician," Haney said. "However, it may be worth paying special attention to the things we know can prevent osteoporosis, such as exercise, taking adequate calcium and vitamin D, and it might be worth consideration of screening for low bone density."
Bliziotes added, "We don't want to leave anyone with the impression that if they're on an SSRI for a valid reason, they should go off it. They have benefits, they've been demonstrated, and people have been put on them for valid reasons, so we don't want to do anything that would jeopardize that."
Haney said future studies will continue to track bone density changes over time to help researchers determine the effects of SSRI use on markers of bone cell turnover.
Two new studies suggest older men and women taking selective serotonin reuptake inhibitors, a class of antidepressants that includes Prozac, Paxil and Zoloft, are prone to increased bone loss.
The jointly released studies by scientists at Oregon Health & Science University, and in San Francisco, Minneapolis, San Diego and Pittsburgh, found that elderly men taking the so-called SSRIs had lower bone mineral density, and that elderly women taking the antidepressants had a higher rate of yearly bone loss.
The studies appear in today's issue of Archives of Internal Medicine, a publication of the Journal of the American Medical Association.
The studies "raise some concern about people taking SSRIs and whether they may need additional screening or extra protection for their bones," said Elizabeth Haney, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine who led the men's study and co-authored the women's study.
But Haney cautioned the studies' results don't confirm a "cause-and-effect relationship" between SSRIs and bone loss. "Both are observational studies, so without a prospective study of this issue, we're unable to make a determination of direct causality," she said.
The studies also found that use of another popular class of antidepressant medications, known as tricyclic antidepressants or TCAs, were not associated with increased bone loss in men and women. TCAs include such drugs as amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil) and nortriptyline (Pamelor).
For the men's study, which measured total bone loss, researchers analyzed health data for 5,995 men ages 65 and older who were recruited from six regions of the United States between March 2000 and April 2002. They found that bone mineral density among SSRI users was 3.9 percent lower at the total hip and 5.9 percent lower at the lumbar spine compared with men not taking the antidepressants.
For the women's study, a longitudinal study measuring bone loss rate, researchers first examined 2,722 women ages 65 and older from four regions between 1986 and 1988, and again between 1997 and 1998. Bone mineral density in the total hip decreased .47 percent among participants who didn't use SSRIs, but .82 percent among people who did take the drugs.
Michael Bliziotes, M.D., OHSU associate professor of medicine (endocrinology, diabetes and clinical nutrition) who was senior author on the men's study and co-author on the women's study, said the research team was "surprised at the degree of difference we saw. I wasn't anticipating it would be that much."
That's because there are so many other factors that could affect bone density, the researchers said. For example, older men taking SSRIs have lower physical activity or greater intake of alcohol. And older women tend to be more depressed than men, and they lose bone density at a greater rate earlier in life due to menopause.
"One of the concerns we had was depression has its own effects on bones, so depressed people probably have lower bone density independent of their SSRI use," Bliziotes said. "Still we found that the bone density was lower in SSRI users even after controlling for as many confounding variables as we could."
Haney and Bliziotes both agree the results don't mean people taking antidepressants, even SSRIs, should stop.
"Depression is a serious condition and it's important not to stop antidepressants abruptly or without talking to your physician," Haney said. "However, it may be worth paying special attention to the things we know can prevent osteoporosis, such as exercise, taking adequate calcium and vitamin D, and it might be worth consideration of screening for low bone density."
Bliziotes added, "We don't want to leave anyone with the impression that if they're on an SSRI for a valid reason, they should go off it. They have benefits, they've been demonstrated, and people have been put on them for valid reasons, so we don't want to do anything that would jeopardize that."
Haney said future studies will continue to track bone density changes over time to help researchers determine the effects of SSRI use on markers of bone cell turnover.
Link: depression and low levels of folate
A unique study by researchers at the University of York and Hull York Medical School has confirmed a link between depression and low levels of folate, a vitamin which comes from vegetables.
In research published in the July edition of the Journal of Epidemiology and Community Health, the York team led by Dr Simon Gilbody, concluded that there was a link between depression and low folate levels, following a review of 11 previous studies involving 15,315 participants.
In research published in the July edition of the Journal of Epidemiology and Community Health, the York team led by Dr Simon Gilbody, concluded that there was a link between depression and low folate levels, following a review of 11 previous studies involving 15,315 participants.
Friday, June 22, 2007
Omega-3s May Help Slow Prostate Cancer Growth
Research in mice suggests that a diet high in omega-3 fatty acids found in fish oil and certain types of fish could potentially improve the prognosis of men who are genetically prone to develop prostate cancer.
“This study clearly shows that diet can tip the balance toward a good or a bad outcome,” said senior researcher Yong Q. Chen, Ph.D., from Wake Forest University School of Medicine. “It’s possible that a change in diet could mean the difference between dying from the disease and surviving with it.”
In mice that were engineered with a genetic defect that caused prostate cancer, a diet high in omega-3 fatty acids beginning at birth reduced tumor growth, slowed disease progression and increased survival. The research is reported online today by the Journal of Clinical Investigation and will appear in the July 2 print issue.
Prostate cancer is the most frequently diagnosed cancer and is a leading cause of death in men in the United States. Population studies have suggested that consumption of fish or fish oil reduces prostate cancer incidence. However, these investigations have been hampered by the difficulty people have in accurately reporting their dietary intake.
The goal of the current study was to explore gene-diet interactions in prostate cancer. It involved mice that were engineered with a genetic defect – they lacked a tumor suppressor gene and spontaneously developed prostate cancer. This gene (Pten) is absent in 60 to 70 percent of metastatic cancers in humans.
The engineered mice and “wild-type” (or non-engineered) mice were fed varying levels of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs). Both are “essential” fatty acids, which means the body needs them for proper cell function but cannot produce them. Many vegetable oils contain omega-6 PUFA. Fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.
Nutritionists recommend that people consume equal proportions of omega-3 and omega-6 PUFA. However, in current western diets, the proportion of omega-6 to omega-3 is between 30 and 50 to one.
The mice were fed either a diet high in omega-3 (ratio of omega-6 to omega-3 was 1:1) a diet low in omega 3 (ratio omega-6 to omega-3 was 20:1), or a diet high in omega-6 (ratio of omega-6 to omega-3 was 40:1). The scientists compared survival rates and weighed the animals’ prostates to measure tumor progression.
Mice with the tumor suppressor gene remained free of tumors and had 100 percent survival, regardless of diet. In mice with the gene defect, survival was 60 percent in animals on the high omega-3 diet, 10 percent in those on the low omega-3 diet and 0 percent in those on the high omega-6 diet.
“This suggests that if you have good genes, it may not matter too much what you eat,” said Chen, a professor of cancer biology. “But if you have a gene that makes you susceptible to prostate cancer, your diet can tip the balance. Our data demonstrate the importance of gene-diet interactions, and that genetic cancer risk can be modified favorable by omega-3 PUFA.”
Chen said dietary changes may be particularly beneficial in people prone to prostate cancer because the disease is usually diagnosed in older men and the tumors are slow-growing. It’s possible that eating a high omega-3 diet could delay tumor development or progression long enough for the man to live out his natural lifespan with prostate cancer.
“Our data imply a beneficial effect of omega-3 PUFA on delaying the onset of human prostate cancer,” Chen said.
He noted that the mice got lifetime exposure of omega-3 and that some people may not be willing to change their diets until they develop cancer. He hopes to study whether there would be beneficial effects of adding omega-3 PUFA to the diet after tumors have developed.
He cautioned that the effects were obtained with the omega-3s found in fish oil and that omega-3s from flaxseed oil and other plants may not provide the same results.
“This study clearly shows that diet can tip the balance toward a good or a bad outcome,” said senior researcher Yong Q. Chen, Ph.D., from Wake Forest University School of Medicine. “It’s possible that a change in diet could mean the difference between dying from the disease and surviving with it.”
In mice that were engineered with a genetic defect that caused prostate cancer, a diet high in omega-3 fatty acids beginning at birth reduced tumor growth, slowed disease progression and increased survival. The research is reported online today by the Journal of Clinical Investigation and will appear in the July 2 print issue.
Prostate cancer is the most frequently diagnosed cancer and is a leading cause of death in men in the United States. Population studies have suggested that consumption of fish or fish oil reduces prostate cancer incidence. However, these investigations have been hampered by the difficulty people have in accurately reporting their dietary intake.
The goal of the current study was to explore gene-diet interactions in prostate cancer. It involved mice that were engineered with a genetic defect – they lacked a tumor suppressor gene and spontaneously developed prostate cancer. This gene (Pten) is absent in 60 to 70 percent of metastatic cancers in humans.
The engineered mice and “wild-type” (or non-engineered) mice were fed varying levels of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs). Both are “essential” fatty acids, which means the body needs them for proper cell function but cannot produce them. Many vegetable oils contain omega-6 PUFA. Fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.
Nutritionists recommend that people consume equal proportions of omega-3 and omega-6 PUFA. However, in current western diets, the proportion of omega-6 to omega-3 is between 30 and 50 to one.
The mice were fed either a diet high in omega-3 (ratio of omega-6 to omega-3 was 1:1) a diet low in omega 3 (ratio omega-6 to omega-3 was 20:1), or a diet high in omega-6 (ratio of omega-6 to omega-3 was 40:1). The scientists compared survival rates and weighed the animals’ prostates to measure tumor progression.
Mice with the tumor suppressor gene remained free of tumors and had 100 percent survival, regardless of diet. In mice with the gene defect, survival was 60 percent in animals on the high omega-3 diet, 10 percent in those on the low omega-3 diet and 0 percent in those on the high omega-6 diet.
“This suggests that if you have good genes, it may not matter too much what you eat,” said Chen, a professor of cancer biology. “But if you have a gene that makes you susceptible to prostate cancer, your diet can tip the balance. Our data demonstrate the importance of gene-diet interactions, and that genetic cancer risk can be modified favorable by omega-3 PUFA.”
Chen said dietary changes may be particularly beneficial in people prone to prostate cancer because the disease is usually diagnosed in older men and the tumors are slow-growing. It’s possible that eating a high omega-3 diet could delay tumor development or progression long enough for the man to live out his natural lifespan with prostate cancer.
“Our data imply a beneficial effect of omega-3 PUFA on delaying the onset of human prostate cancer,” Chen said.
He noted that the mice got lifetime exposure of omega-3 and that some people may not be willing to change their diets until they develop cancer. He hopes to study whether there would be beneficial effects of adding omega-3 PUFA to the diet after tumors have developed.
He cautioned that the effects were obtained with the omega-3s found in fish oil and that omega-3s from flaxseed oil and other plants may not provide the same results.
Nausea/Vomiting = Lower Risk of Breast Cancer
It may not seem so at the time, but women who suffer through morning sickness during their pregnancies actually may be fortunate.
Those women may have a 30 percent lower risk of developing breast cancer later in life than mothers-to-be who experience nine nausea-free months, a new study by epidemiologists at the University at Buffalo suggests.
"Although the exact mechanism responsible for causing nausea and vomiting during pregnancy has yet to be pinpointed, it likely is a result of changing levels of ovarian and placental hormone production, which may include higher circulating levels of a hormone called human chorionic gonadotropin," said David Jaworowicz, Jr., first author on the study.
"In vitro studies have shown that this hormone possesses several activities that have potential protective effects against cancer cells," said Jaworowicz, a doctoral candidate in the Department of Social Preventive Medicine in UB's School of Public Health and Health Professions.
Jaworowicz's research, which was presented today at the Society for Epidemiologic Research's annual meeting in Boston, Mass., found no association of other pregnancy-related medical conditions -- pregnancy-induced hypertension, preeclampsia, gestational diabetes or weight gain -- and breast-cancer risk.
The study was based on data from participants in the Western New York Exposure and Breast Cancer Study, a population-based case-control study of breast cancer conducted in women 35-79 from two Western New York counties between 1996 and 2001.
The analysis compared extensive data on pregnancy-related conditions from 1,001 women with primary breast cancer and 1,917 women without breast cancer matched to cases by age and race who served as controls.
"Pregnancy is a time when the breast undergoes a variety of cellular and anatomical changes," said Jaworowicz. "During this period, the breast tissue is exposed to varying levels of a number of hormones, which may affect the physiology of the breast.
"We were interested in the association between pregnancy-related events and characteristics, including pregnancy-induced hypertension, preeclampsia/eclampsia, gestational diabetes, high weight gain during pregnancy, and nausea and vomiting, because these markers may serve as proxies for underlying hormonal changes and altered hormone levels in blood and tissue."
Jaworowicz noted that the presence or absence of these pregnancy-related conditions may indicate a different course or extent of hormone-regulated breast tissue proliferation and differentiation during pregnancy, but also may indicate distinct hormonal profiles that persist following pregnancy.
Although pregnancy conditions other than nausea and vomiting were not associated statistically with breast cancer risk, these were only preliminary findings, he added, based mainly upon whether women "ever" experienced these conditions vs. "never" during any of their pregnancies.
More nuanced experiences regarding these pregnancy-related characteristics will be the focus of future analyses, he said.
Evidence from the current analysis did suggest that the lower risk of developing breast cancer observed with nausea and vomiting was stronger as the symptoms became more severe, or persisted longer into pregnancy. A modest trend toward increased cancer risk was observed in premenopausal women who gained more than 40 pounds during pregnancy, compared to those who gained less than 23 pounds, said Jaworowicz, but the trend didn't reach statistical significance.
"Pregnancy is a time of drastic physiological changes, including rapid development and alterations in the breast tissue," he noted. "The rapidly changing anatomy of the breast makes it more susceptible to errors in DNA replication and/or repair, which may translate into breast cancer.
"Associated with these changes are the fluctuating hormonal profiles that must be kept in a delicate balance. If the correct ratios and relative amounts between these hormones are not maintained within a normal range, certain pregnancy-related outcomes may emerge, such as high blood pressure, glucose intolerance and gestational diabetes, eclamptic conditions with seizures and/or toxemia, or extremely severe nausea.
"These pregnancy-related factors may serve as indicators of underlying biological conditions that may influence a woman's lifetime risk for breast cancer."
By recognizing that pregnancy-associated medical outcomes may provide easily accessible signals about core changes in the female physiology, future studies should continue to investigate and dissect the intricate relationship that may exist between readily observational perinatal factors, physiological characteristics and cancer risk, Jaworowicz said.
"Subsequent analyses are planned to investigate the potential association between pregnancy characteristics and genetic polymorphisms of particular enzymes responsible for estrogen metabolism.
This will help us to elucidate the potential link between pregnancy-associated conditions, hormonal exposures and breast cancer risk."
Those women may have a 30 percent lower risk of developing breast cancer later in life than mothers-to-be who experience nine nausea-free months, a new study by epidemiologists at the University at Buffalo suggests.
"Although the exact mechanism responsible for causing nausea and vomiting during pregnancy has yet to be pinpointed, it likely is a result of changing levels of ovarian and placental hormone production, which may include higher circulating levels of a hormone called human chorionic gonadotropin," said David Jaworowicz, Jr., first author on the study.
"In vitro studies have shown that this hormone possesses several activities that have potential protective effects against cancer cells," said Jaworowicz, a doctoral candidate in the Department of Social Preventive Medicine in UB's School of Public Health and Health Professions.
Jaworowicz's research, which was presented today at the Society for Epidemiologic Research's annual meeting in Boston, Mass., found no association of other pregnancy-related medical conditions -- pregnancy-induced hypertension, preeclampsia, gestational diabetes or weight gain -- and breast-cancer risk.
The study was based on data from participants in the Western New York Exposure and Breast Cancer Study, a population-based case-control study of breast cancer conducted in women 35-79 from two Western New York counties between 1996 and 2001.
The analysis compared extensive data on pregnancy-related conditions from 1,001 women with primary breast cancer and 1,917 women without breast cancer matched to cases by age and race who served as controls.
"Pregnancy is a time when the breast undergoes a variety of cellular and anatomical changes," said Jaworowicz. "During this period, the breast tissue is exposed to varying levels of a number of hormones, which may affect the physiology of the breast.
"We were interested in the association between pregnancy-related events and characteristics, including pregnancy-induced hypertension, preeclampsia/eclampsia, gestational diabetes, high weight gain during pregnancy, and nausea and vomiting, because these markers may serve as proxies for underlying hormonal changes and altered hormone levels in blood and tissue."
Jaworowicz noted that the presence or absence of these pregnancy-related conditions may indicate a different course or extent of hormone-regulated breast tissue proliferation and differentiation during pregnancy, but also may indicate distinct hormonal profiles that persist following pregnancy.
Although pregnancy conditions other than nausea and vomiting were not associated statistically with breast cancer risk, these were only preliminary findings, he added, based mainly upon whether women "ever" experienced these conditions vs. "never" during any of their pregnancies.
More nuanced experiences regarding these pregnancy-related characteristics will be the focus of future analyses, he said.
Evidence from the current analysis did suggest that the lower risk of developing breast cancer observed with nausea and vomiting was stronger as the symptoms became more severe, or persisted longer into pregnancy. A modest trend toward increased cancer risk was observed in premenopausal women who gained more than 40 pounds during pregnancy, compared to those who gained less than 23 pounds, said Jaworowicz, but the trend didn't reach statistical significance.
"Pregnancy is a time of drastic physiological changes, including rapid development and alterations in the breast tissue," he noted. "The rapidly changing anatomy of the breast makes it more susceptible to errors in DNA replication and/or repair, which may translate into breast cancer.
"Associated with these changes are the fluctuating hormonal profiles that must be kept in a delicate balance. If the correct ratios and relative amounts between these hormones are not maintained within a normal range, certain pregnancy-related outcomes may emerge, such as high blood pressure, glucose intolerance and gestational diabetes, eclamptic conditions with seizures and/or toxemia, or extremely severe nausea.
"These pregnancy-related factors may serve as indicators of underlying biological conditions that may influence a woman's lifetime risk for breast cancer."
By recognizing that pregnancy-associated medical outcomes may provide easily accessible signals about core changes in the female physiology, future studies should continue to investigate and dissect the intricate relationship that may exist between readily observational perinatal factors, physiological characteristics and cancer risk, Jaworowicz said.
"Subsequent analyses are planned to investigate the potential association between pregnancy characteristics and genetic polymorphisms of particular enzymes responsible for estrogen metabolism.
This will help us to elucidate the potential link between pregnancy-associated conditions, hormonal exposures and breast cancer risk."
Wednesday, June 20, 2007
Dietary calcium is better than supplements
Dietary calcium is better than supplements at protecting bone health
Women who get most of their daily calcium from food have healthier bones than women whose calcium comes mainly from supplemental tablets, say researchers at Washington University School of Medicine in St. Louis. Surprisingly, this is true even though the supplement takers have higher average calcium intake.
Adequate calcium is important to prevent osteoporosis, which affects an estimated 8 million American women and 2 million American men. Another 34 million Americans have low bone mass, placing them at increased risk for osteoporosis. Calcium consumption can help maintain bone density by preventing the body from stealing the calcium it needs from the bones.
The researchers' conclusions about calcium intake, published in the May issue of the American Journal of Clinical Nutrition, came from a study of 183 postmenopausal women. The researchers asked the women to meticulously detail their diet and their calcium supplement intake for a week. "We assumed that this sample represented each woman's typical diet," says senior author Reina Armamento-Villareal, M.D., assistant professor of medicine in the Division of Bone and Mineral Diseases and a bone specialist at Barnes-Jewish Hospital. "In addition to analyzing the volunteers' daily calcium intake, we tested bone mineral density and urinary concentrations of estrogen metabolites."
The researchers found that the women could be divided into three groups: one group, called the "supplement group," got at least 70 percent of their daily calcium from tablets or pills; another, the "diet group," got at least 70 percent of their calcium from dairy products and other foods; and a third, the "diet plus supplement group," consisted of those whose calcium-source percentages fell somewhere in between these ranges.
The "diet group" took in the least calcium, an average of 830 milligrams per day. Yet this group had higher bone density in their spines and hipbones than women in the "supplement group," who consumed about 1,030 milligrams per day. Women in the "diet plus supplement group" tended to have the highest bone mineral density as well as the highest calcium intake at 1,620 milligrams per day.
The hormone estrogen is known to maintain bone mineral density. But the standard form of estrogen is broken down or metabolized in the liver to other forms - some active and some inactive. Urinalysis showed that women in the "diet group" and the "diet plus supplement group" had a higher ratio of active to inactive estrogen metabolites than women in the "supplement group."
"This suggests that dietary calcium is associated with a shift in estrogen metabolism that favors production of active forms of estrogen," says Armamento-Villareal. "Although we're not yet certain what underlies this effect, it could be that nutrients other than calcium cause this shift. It's also known that dairy products, which are a major source of calcium, can contain active estrogenic compounds, and these can influence bone density and the amount of estrogenic metabolites in the urine."
Calcium supplements differ in how well their calcium can be absorbed, and this also could play a role in the study's findings, according to its authors. For example, calcium carbonate tablets need to be taken with a meal so that stomach acid can facilitate absorption, but calcium citrate tablets don't have this limitation. If the study participants taking calcium carbonate weren't conscientious about the timing of their supplements, they might not have received the highest benefit from them.
"Only about 35 percent of the calcium in most supplements ends up being absorbed by the body," Armamento-Villareal says. "Calcium from the diet is generally better absorbed, and this could be another reason that women who got a high percentage of calcium in their food had higher bone densities."
Although dairy foods are excellent sources of calcium, Armamento-Villareal suggests that individuals with dairy sensitivities could consume other calcium-rich food sources such as calcium-fortified orange juice. Dark green leafy vegetables also contain calcium, but it is not as readily absorbed as calcium from dairy sources.
Women who get most of their daily calcium from food have healthier bones than women whose calcium comes mainly from supplemental tablets, say researchers at Washington University School of Medicine in St. Louis. Surprisingly, this is true even though the supplement takers have higher average calcium intake.
Adequate calcium is important to prevent osteoporosis, which affects an estimated 8 million American women and 2 million American men. Another 34 million Americans have low bone mass, placing them at increased risk for osteoporosis. Calcium consumption can help maintain bone density by preventing the body from stealing the calcium it needs from the bones.
The researchers' conclusions about calcium intake, published in the May issue of the American Journal of Clinical Nutrition, came from a study of 183 postmenopausal women. The researchers asked the women to meticulously detail their diet and their calcium supplement intake for a week. "We assumed that this sample represented each woman's typical diet," says senior author Reina Armamento-Villareal, M.D., assistant professor of medicine in the Division of Bone and Mineral Diseases and a bone specialist at Barnes-Jewish Hospital. "In addition to analyzing the volunteers' daily calcium intake, we tested bone mineral density and urinary concentrations of estrogen metabolites."
The researchers found that the women could be divided into three groups: one group, called the "supplement group," got at least 70 percent of their daily calcium from tablets or pills; another, the "diet group," got at least 70 percent of their calcium from dairy products and other foods; and a third, the "diet plus supplement group," consisted of those whose calcium-source percentages fell somewhere in between these ranges.
The "diet group" took in the least calcium, an average of 830 milligrams per day. Yet this group had higher bone density in their spines and hipbones than women in the "supplement group," who consumed about 1,030 milligrams per day. Women in the "diet plus supplement group" tended to have the highest bone mineral density as well as the highest calcium intake at 1,620 milligrams per day.
The hormone estrogen is known to maintain bone mineral density. But the standard form of estrogen is broken down or metabolized in the liver to other forms - some active and some inactive. Urinalysis showed that women in the "diet group" and the "diet plus supplement group" had a higher ratio of active to inactive estrogen metabolites than women in the "supplement group."
"This suggests that dietary calcium is associated with a shift in estrogen metabolism that favors production of active forms of estrogen," says Armamento-Villareal. "Although we're not yet certain what underlies this effect, it could be that nutrients other than calcium cause this shift. It's also known that dairy products, which are a major source of calcium, can contain active estrogenic compounds, and these can influence bone density and the amount of estrogenic metabolites in the urine."
Calcium supplements differ in how well their calcium can be absorbed, and this also could play a role in the study's findings, according to its authors. For example, calcium carbonate tablets need to be taken with a meal so that stomach acid can facilitate absorption, but calcium citrate tablets don't have this limitation. If the study participants taking calcium carbonate weren't conscientious about the timing of their supplements, they might not have received the highest benefit from them.
"Only about 35 percent of the calcium in most supplements ends up being absorbed by the body," Armamento-Villareal says. "Calcium from the diet is generally better absorbed, and this could be another reason that women who got a high percentage of calcium in their food had higher bone densities."
Although dairy foods are excellent sources of calcium, Armamento-Villareal suggests that individuals with dairy sensitivities could consume other calcium-rich food sources such as calcium-fortified orange juice. Dark green leafy vegetables also contain calcium, but it is not as readily absorbed as calcium from dairy sources.
More women than men having mid-life stroke
More women than men appear to be having a stroke in middle age, according to a study published June 20, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology. Researchers say heart disease and increased waist size may be contributing to this apparent mid-life stroke surge among women.
For the study, researchers analyzed data from 17,000 people over the age of 18 who participated in the National Health and Nutrition Examination Survey. Of the participants, 606 people experienced a stroke.
The study found women in the 45 to 54 age range were more than twice as likely as men in the same age group to have had a stroke. There were no sex differences in stroke rates found in the 35 to 44 and the 55 to 64 age groups.
“While our analysis shows increased waist size and coronary artery disease are predictors of stroke among women aged 45 to 54, it is not immediately clear why there is a sex disparity in stroke rates among this age group,” said study author Amytis Towfighi, MD, with the Stroke Center and Department of Neurology at the University of California at Los Angeles, and member of the American Academy of Neurology. “While further study is needed, this mid-life stroke surge among women suggests prompt and close attention may need to be paid to the cardiovascular health of women in their mid-30s to mid-50s with a goal of mitigating this burden.”
In addition, Towfighi says several vascular risk factors including systolic blood pressure and total cholesterol levels increased at higher rates among women compared to men in each older age group.
“For instance, with each decade, men’s blood pressure increased by an average of four to five points, whereas women’s blood pressure increased by eight to 10 points. Similarly, men had significantly higher total cholesterol levels than women at age 35 to 44, but men’s total cholesterol remained stable while women’s total cholesterol increased by 10 to 12 points with each decade, so that by age 55 to 64, women had significantly higher total cholesterol than men,” said Towfighi.
Towfighi says the study also found a greater than expected stroke surge among men who were nearing the end of middle age. Men aged 55 to 64 were three times more likely than men aged 45 to 54 to have had a stroke. Towfighi says the reasons behind this increase warrant further investigation.
For the study, researchers analyzed data from 17,000 people over the age of 18 who participated in the National Health and Nutrition Examination Survey. Of the participants, 606 people experienced a stroke.
The study found women in the 45 to 54 age range were more than twice as likely as men in the same age group to have had a stroke. There were no sex differences in stroke rates found in the 35 to 44 and the 55 to 64 age groups.
“While our analysis shows increased waist size and coronary artery disease are predictors of stroke among women aged 45 to 54, it is not immediately clear why there is a sex disparity in stroke rates among this age group,” said study author Amytis Towfighi, MD, with the Stroke Center and Department of Neurology at the University of California at Los Angeles, and member of the American Academy of Neurology. “While further study is needed, this mid-life stroke surge among women suggests prompt and close attention may need to be paid to the cardiovascular health of women in their mid-30s to mid-50s with a goal of mitigating this burden.”
In addition, Towfighi says several vascular risk factors including systolic blood pressure and total cholesterol levels increased at higher rates among women compared to men in each older age group.
“For instance, with each decade, men’s blood pressure increased by an average of four to five points, whereas women’s blood pressure increased by eight to 10 points. Similarly, men had significantly higher total cholesterol levels than women at age 35 to 44, but men’s total cholesterol remained stable while women’s total cholesterol increased by 10 to 12 points with each decade, so that by age 55 to 64, women had significantly higher total cholesterol than men,” said Towfighi.
Towfighi says the study also found a greater than expected stroke surge among men who were nearing the end of middle age. Men aged 55 to 64 were three times more likely than men aged 45 to 54 to have had a stroke. Towfighi says the reasons behind this increase warrant further investigation.
Estrogen Good vs. Heart Disease For Some
Estrogen Use Lowered One Risk Factor for Heart Disease among Some Younger Postmenopausal Women, Stanford Researcher Says
However, risks for blood clots, stroke must be considered before starting estrogen therapy, Stefanick notes
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes. The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI--the largest-ever study of postmenopausal women's health--published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
However, risks for blood clots, stroke must be considered before starting estrogen therapy, Stefanick notes
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes. The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI--the largest-ever study of postmenopausal women's health--published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
Monday, June 18, 2007
How to Avoid Heat Stroke
Keeping cool on hot, humid summer days is good advice for more reasons than sheer comfort. It's vital for good health - even staying alive. That's the message from the Pennsylvania Medical Society, warning young and old alike that heat stroke is a deadly illness to be avoided at all costs - even if it means sacrificing a day at the beach.
"Heat stroke is not an accident," says Marilyn J. Heine, M.D., an emergency physician in Bucks County and a member of the Pennsylvania Medical Society. "Over the summer, we see too many cases of heat-related illness in the emergency room, but it's a condition that generally can be prevented with a little effort and lots of common sense."
Still, it happens all too frequently. There have been several highly publicized reports of athletes dying from heat stroke in recent years, most notably Minnesota Viking Korey Stringer, who died August 1, 2001, after developing multi-organ system failure. Players at the high school and college level fell victim in recent years too.
However, you don't need to be an athlete to be felled by heat stroke. Dr. Heine recalls a 78-year-old woman who was transported by ambulance to the emergency department after a neighbor noticed she hadn't been out of her apartment for two days. During that time, the temperature surpassed 90 degrees Fahrenheit and the humidity was stifling. The woman was dehydrated, with a temperature of 104.7 degrees and a decreased blood pressure of 100/70. Fortunately, she was resuscitated with intravenous fluids and then hospitalized.
The Pennsylvania Medical Society believes you're more likely to avoid this scenario and win the battle against the heat when armed with a little knowledge.
Heat stroke is an injury to internal organs caused by an excessively high body temperature. It can damage the central nervous system, including the brain, spinal cord, and other organs. Sometimes, as in Stringer's case, the outcome is death.
There are two types of heat stroke, and everyone is susceptible, athletes and couch potatoes alike. Classic or non-exercise-induced heat stroke affects those exposed to extremely hot environments for an intolerable length of time. Dr. Heine explains, "Most at risk are elderly persons and infants, those with chronic illness like cardiovascular disease, and people on certain medications. Individuals who drink large amounts of caffeine and alcohol during this time also are more susceptible."
Exertional or activity-induced heat stroke, on the other hand, "primarily affects athletes, laborers, and soldiers - persons who overdo physical activity in very hot temperatures," according to Dr. Heine. Football players - who wear body-covering uniforms and practice in the hottest temperatures - are especially prone to dehydration and heat stroke.
So, how can you predict when the heat is most likely to take its toll? Relative humidity of at least 70 percent and temperatures of 95 degrees Fahrenheit or 35 degrees Celsius are your first warning signs. Also, be alert to other heat-related afflictions such as heat cramps - characterized by muscle spasms and a normal temperature; and heat exhaustion - evidenced by pale, moist skin; headache; dizziness; nausea; increased heart rate; low blood pressure; elevated temperature; and profuse sweating. Any of these can be precursors to a full-blown case of heat stroke.
"If you exhibit any of these symptoms," Dr. Heine advises, "get out of the heat, rest, and drink plenty of cool fluids, preferably containing sugar and salt."
Heat stroke's symptoms, similar to those mentioned above but even more severe, initially include profuse sweating; then hot, dry, red skin; high fever; vomiting; confusion; seizures during cooling; and unconsciousness. The blood pressure may be low or high, and lack of sweating is common, though athletes may perspire. The body temperature often will be 105 degrees or higher.
The Pennsylvania Medical Society advises immediate treatment if any of these symptoms are present. "After calling 911," Dr. Heine says, "move the victim to a cooler location, remove heavy clothing, fan the body and wet it down with a cool sponge or cloth, and encourage the individual to drink cool fluids." At the hospital, the patient probably will be given fluids intravenously.
The key to beating the heat, of course, is prevention. Dr. Heine offers the following tips for keeping cool and healthy despite the sweltering sun and humidity.
• Don't overexert yourself.
• Drink a quart of fluids an hour.
• Wear loose clothing light in color and fabric, as well as a hat and sunblock, and stay in the shade or indoors if possible.
• Open windows and use fans, or turn on air conditioning. If you don't have air conditioning, go to a public place that does, like a mall, library, or movie theater.
• Avoid caffeine and alcohol, which can speed up dehydration.
• Finally, be a good neighbor - check on elderly and chronically ill persons regularly to make sure they're bearing up under the heat.
"Heat stroke is not an accident," says Marilyn J. Heine, M.D., an emergency physician in Bucks County and a member of the Pennsylvania Medical Society. "Over the summer, we see too many cases of heat-related illness in the emergency room, but it's a condition that generally can be prevented with a little effort and lots of common sense."
Still, it happens all too frequently. There have been several highly publicized reports of athletes dying from heat stroke in recent years, most notably Minnesota Viking Korey Stringer, who died August 1, 2001, after developing multi-organ system failure. Players at the high school and college level fell victim in recent years too.
However, you don't need to be an athlete to be felled by heat stroke. Dr. Heine recalls a 78-year-old woman who was transported by ambulance to the emergency department after a neighbor noticed she hadn't been out of her apartment for two days. During that time, the temperature surpassed 90 degrees Fahrenheit and the humidity was stifling. The woman was dehydrated, with a temperature of 104.7 degrees and a decreased blood pressure of 100/70. Fortunately, she was resuscitated with intravenous fluids and then hospitalized.
The Pennsylvania Medical Society believes you're more likely to avoid this scenario and win the battle against the heat when armed with a little knowledge.
Heat stroke is an injury to internal organs caused by an excessively high body temperature. It can damage the central nervous system, including the brain, spinal cord, and other organs. Sometimes, as in Stringer's case, the outcome is death.
There are two types of heat stroke, and everyone is susceptible, athletes and couch potatoes alike. Classic or non-exercise-induced heat stroke affects those exposed to extremely hot environments for an intolerable length of time. Dr. Heine explains, "Most at risk are elderly persons and infants, those with chronic illness like cardiovascular disease, and people on certain medications. Individuals who drink large amounts of caffeine and alcohol during this time also are more susceptible."
Exertional or activity-induced heat stroke, on the other hand, "primarily affects athletes, laborers, and soldiers - persons who overdo physical activity in very hot temperatures," according to Dr. Heine. Football players - who wear body-covering uniforms and practice in the hottest temperatures - are especially prone to dehydration and heat stroke.
So, how can you predict when the heat is most likely to take its toll? Relative humidity of at least 70 percent and temperatures of 95 degrees Fahrenheit or 35 degrees Celsius are your first warning signs. Also, be alert to other heat-related afflictions such as heat cramps - characterized by muscle spasms and a normal temperature; and heat exhaustion - evidenced by pale, moist skin; headache; dizziness; nausea; increased heart rate; low blood pressure; elevated temperature; and profuse sweating. Any of these can be precursors to a full-blown case of heat stroke.
"If you exhibit any of these symptoms," Dr. Heine advises, "get out of the heat, rest, and drink plenty of cool fluids, preferably containing sugar and salt."
Heat stroke's symptoms, similar to those mentioned above but even more severe, initially include profuse sweating; then hot, dry, red skin; high fever; vomiting; confusion; seizures during cooling; and unconsciousness. The blood pressure may be low or high, and lack of sweating is common, though athletes may perspire. The body temperature often will be 105 degrees or higher.
The Pennsylvania Medical Society advises immediate treatment if any of these symptoms are present. "After calling 911," Dr. Heine says, "move the victim to a cooler location, remove heavy clothing, fan the body and wet it down with a cool sponge or cloth, and encourage the individual to drink cool fluids." At the hospital, the patient probably will be given fluids intravenously.
The key to beating the heat, of course, is prevention. Dr. Heine offers the following tips for keeping cool and healthy despite the sweltering sun and humidity.
• Don't overexert yourself.
• Drink a quart of fluids an hour.
• Wear loose clothing light in color and fabric, as well as a hat and sunblock, and stay in the shade or indoors if possible.
• Open windows and use fans, or turn on air conditioning. If you don't have air conditioning, go to a public place that does, like a mall, library, or movie theater.
• Avoid caffeine and alcohol, which can speed up dehydration.
• Finally, be a good neighbor - check on elderly and chronically ill persons regularly to make sure they're bearing up under the heat.
Five Ways to Have a Stress-free Vacation
From working late the night before you leave for the beach to dealing with fighting kids and tight finances—vacations can often cause as much stress as they are supposed to relieve.
Experts from The Menninger Clinic provide the following tips to help you relax and get the benefits from your much-deserved time off.
• Allow time for departure and your return.
Nothing is worse than feeling rushed when leaving for or returning from vacation. Build in some extra time for travel in your vacation plans, keeping in consideration that flights may be delayed or that you may encounter unexpected traffic while driving. “When possible, include in your vacation plans a day to be at home before you leave to gear up for your trip, and a day at home after you return from your trip to allow for time to wind down,” says Cheryl Scoglio, a senior social worker who works with families involved in Menninger Professionals in Crisis Program.
• Be prepared for the “I wants.”
Does your daughter really need that giant stuffed shark that says Seaworld on it? Of course not. But she wants it. Really, really wants it. To deal with a chronic case of the vacation, “I wants,” Dr. Harvey suggests a fun and educational way for kids to earn their own souvenir money. “Gather spare coins from around the house,” she says. “If your children are young, sort the coins and bundle them. If they already know their coins and how to count, go together to the coin machine to cash in. Split the money into envelopes with their names on them and explain to them that this is their spending money for the trip. When they say, ‘I want,’ pull out their envelope.”
• Make time to unwind.
Remember, the purpose of a vacation is to relax—not to visit every museum and historical monument in the guidebook. “Don't fill your vacation days so full of events that you end up being more concerned about keeping your plans than having fun,” Scoglio says.
• Repeat to self, “I deserve a vacation.”
You need a vacation, so pack away any guilt you may feel about taking one. While Americans earn an average of 14 days of vacation a year, Europeans average between 24 and 36 days of vacation a year, according to the 2007 Vacation Deprivation Study published by Expedia. The study also shows that more than one-third of Americans do not use all their allotted vacation time. They should, says Jon Allen, PhD, a senior staff psychologist with Menninger who regularly treats patients with depression caused by stress. “Taking a vacation helps rest your mind and body so that you are more flexible and you have a better perspective when you come back,” he says.
Experts from The Menninger Clinic provide the following tips to help you relax and get the benefits from your much-deserved time off.
• Allow time for departure and your return.
Nothing is worse than feeling rushed when leaving for or returning from vacation. Build in some extra time for travel in your vacation plans, keeping in consideration that flights may be delayed or that you may encounter unexpected traffic while driving. “When possible, include in your vacation plans a day to be at home before you leave to gear up for your trip, and a day at home after you return from your trip to allow for time to wind down,” says Cheryl Scoglio, a senior social worker who works with families involved in Menninger Professionals in Crisis Program.
• Be prepared for the “I wants.”
Does your daughter really need that giant stuffed shark that says Seaworld on it? Of course not. But she wants it. Really, really wants it. To deal with a chronic case of the vacation, “I wants,” Dr. Harvey suggests a fun and educational way for kids to earn their own souvenir money. “Gather spare coins from around the house,” she says. “If your children are young, sort the coins and bundle them. If they already know their coins and how to count, go together to the coin machine to cash in. Split the money into envelopes with their names on them and explain to them that this is their spending money for the trip. When they say, ‘I want,’ pull out their envelope.”
• Make time to unwind.
Remember, the purpose of a vacation is to relax—not to visit every museum and historical monument in the guidebook. “Don't fill your vacation days so full of events that you end up being more concerned about keeping your plans than having fun,” Scoglio says.
• Repeat to self, “I deserve a vacation.”
You need a vacation, so pack away any guilt you may feel about taking one. While Americans earn an average of 14 days of vacation a year, Europeans average between 24 and 36 days of vacation a year, according to the 2007 Vacation Deprivation Study published by Expedia. The study also shows that more than one-third of Americans do not use all their allotted vacation time. They should, says Jon Allen, PhD, a senior staff psychologist with Menninger who regularly treats patients with depression caused by stress. “Taking a vacation helps rest your mind and body so that you are more flexible and you have a better perspective when you come back,” he says.
Screening reduces Down's births by 50 percent
Non-invasive screening of pregnant women with ultrasound early in pregnancy, combined with maternal blood analysis, has reduced the number of children born in Denmark with Down Syndrome by 50%.
In September 2004, the National Board of Health in Denmark recommended new guidelines for prenatal diagnosis. “Previously this was restricted to pregnant women over 35 years of age, but since the implementation of the new guidelines it has been available to any woman who wants it.”
The women were offered a measurement of nuchal translucency in the fetus by ultrasound. This test looks at thickness of the black space (fluid) in the neck area of the fetus. If there is more than the normal amount of fluid the risk of Down syndrome is increased. Likewise if there is a certain combination of serum markers in the maternal blood test, taken at the same time, there is the possibility of an increased risk of a chromosomal abnormality. The combined screening is carried out at 11 to 14 weeks of gestation.
Professor Brøndum-Nielsen and her team looked at the effects of the new guidelines in 2004, 2005, and 2006, in 3 counties in Denmark with a total population of 1.1 million inhabitants, or about one-fifth of the population of the country. They compared these findings with national figures obtained from the Central Cytogenetic Registry, which confirmed the reduction in invasive procedures and the number of children born with Down syndrome at national level.
“When we looked further at the history of children born with Down Syndrome, we found that their mothers had declined the offer of screening, or had taken it up too late in pregnancy”, she says. Another group had risk assessment that did not lead to invasive procedures."
Women whose test results showed an elevated risk were offered an invasive procedure (chorionic villus sampling or amniocentesis) to definitely confirm or exclude the diagnosis of Down syndrome by chromosome analysis. “We found that making non-invasive screening available to all pregnant women meant that the numbers of invasive procedures decreased by 40% between 2004 and 2006”, says Professor Brøndum-Nielsen.
“Although we have not yet studied the whole of the population, these numbers are significant enough to show that the new guidelines have been accepted by a great majority of Danish parents. However, there is a need for analysis of the psychosocial aspects, both as to the pre-test counselling and the women´s attitudes”, she says.
In September 2004, the National Board of Health in Denmark recommended new guidelines for prenatal diagnosis. “Previously this was restricted to pregnant women over 35 years of age, but since the implementation of the new guidelines it has been available to any woman who wants it.”
The women were offered a measurement of nuchal translucency in the fetus by ultrasound. This test looks at thickness of the black space (fluid) in the neck area of the fetus. If there is more than the normal amount of fluid the risk of Down syndrome is increased. Likewise if there is a certain combination of serum markers in the maternal blood test, taken at the same time, there is the possibility of an increased risk of a chromosomal abnormality. The combined screening is carried out at 11 to 14 weeks of gestation.
Professor Brøndum-Nielsen and her team looked at the effects of the new guidelines in 2004, 2005, and 2006, in 3 counties in Denmark with a total population of 1.1 million inhabitants, or about one-fifth of the population of the country. They compared these findings with national figures obtained from the Central Cytogenetic Registry, which confirmed the reduction in invasive procedures and the number of children born with Down syndrome at national level.
“When we looked further at the history of children born with Down Syndrome, we found that their mothers had declined the offer of screening, or had taken it up too late in pregnancy”, she says. Another group had risk assessment that did not lead to invasive procedures."
Women whose test results showed an elevated risk were offered an invasive procedure (chorionic villus sampling or amniocentesis) to definitely confirm or exclude the diagnosis of Down syndrome by chromosome analysis. “We found that making non-invasive screening available to all pregnant women meant that the numbers of invasive procedures decreased by 40% between 2004 and 2006”, says Professor Brøndum-Nielsen.
“Although we have not yet studied the whole of the population, these numbers are significant enough to show that the new guidelines have been accepted by a great majority of Danish parents. However, there is a need for analysis of the psychosocial aspects, both as to the pre-test counselling and the women´s attitudes”, she says.
Substance in Soy Products= Bone Density+
Substance in Soy Products Increased Bone Density Compared to Placebo
• In a randomized placebo-controlled trial involving 389 women with osteopenia, those who took 54 mg/d of genistein, a phytoestrogen derived from soy products, had greater bone mineral density and improved markers of bone metabolism after two years than women who took a pill containing only calcium and vitamin D (Article, p.839).
• Osteopenia (diminished amount of bone but not as severe as osteoporosis) is common among women after menopause. The most serious consequences of low bone density are bone fractures.
• Those who took the genistein pills did not have increased endometrial thickness, a problem with some hormone treatments for low bone density. The genistein group had more gastrointestinal side effects than the control group.
• In a randomized placebo-controlled trial involving 389 women with osteopenia, those who took 54 mg/d of genistein, a phytoestrogen derived from soy products, had greater bone mineral density and improved markers of bone metabolism after two years than women who took a pill containing only calcium and vitamin D (Article, p.839).
• Osteopenia (diminished amount of bone but not as severe as osteoporosis) is common among women after menopause. The most serious consequences of low bone density are bone fractures.
• Those who took the genistein pills did not have increased endometrial thickness, a problem with some hormone treatments for low bone density. The genistein group had more gastrointestinal side effects than the control group.
Candy cigarettes = future smokers?
New research suggests that playing with candy cigarettes may favorably set the minds of some children towards becoming future cigarette smokers. The study, reported in the July issue of Preventive Medicine, shows that in a nationally representative sample of 25,887 US adults, the percentages who had never consumed candy cigarettes were 12% in current and former smokers vs. 22% in never smokers, and the corresponding percentages of adults who had regularly (often or very often) consumed candy cigarettes were 22% in current and former smokers vs. 14% in never smokers.
Candy cigarettes are made of candy or gum, shaped into cylindrical sticks and sold in rectangular boxes roughly the size of cigarette packs. In the US they are typically displayed next to the bubble gum and the trading cards commonly sold in supermarkets and convenience stores. Make-believe cigarette smoking may be considered illicit and mature by some children, but research suggests that playing with these edible “toys” cannot be considered as a benign parody of cigarette smoking. This new research is built on past research, such as focus groups in the US with 4 to 11 year-old children and a survey of 7th graders which indicated that playing with candy cigarettes may actually desensitize children to the harm of real smoking (Pediatrics 1992: 89: 27-31).
“Candy and gum look-alike products allow children to respond to tobacco marketing and advertising long before they are old enough to smoke a cigarette,” comments Dr. Klein, the corresponding author. “The continued existence of these products helps promote smoking as a culturally or socially acceptable activity.” While countries including the UK, Australia, and Canada currently restrict candy cigarette sales, US federal and all but one state legislative efforts at banning candy cigarettes have been unsuccessful (the one exception was later repealed). Ironically, it appears that the responsibility for restricting candy cigarette sales in the US has been left up to large national retailers such as the Wal-Mart chain, which has a company-wide policy banning the sale of cigarette look-alike products to minors in all 50 states. Candy cigarettes cannot be considered simply as candy.
Candy cigarettes are made of candy or gum, shaped into cylindrical sticks and sold in rectangular boxes roughly the size of cigarette packs. In the US they are typically displayed next to the bubble gum and the trading cards commonly sold in supermarkets and convenience stores. Make-believe cigarette smoking may be considered illicit and mature by some children, but research suggests that playing with these edible “toys” cannot be considered as a benign parody of cigarette smoking. This new research is built on past research, such as focus groups in the US with 4 to 11 year-old children and a survey of 7th graders which indicated that playing with candy cigarettes may actually desensitize children to the harm of real smoking (Pediatrics 1992: 89: 27-31).
“Candy and gum look-alike products allow children to respond to tobacco marketing and advertising long before they are old enough to smoke a cigarette,” comments Dr. Klein, the corresponding author. “The continued existence of these products helps promote smoking as a culturally or socially acceptable activity.” While countries including the UK, Australia, and Canada currently restrict candy cigarette sales, US federal and all but one state legislative efforts at banning candy cigarettes have been unsuccessful (the one exception was later repealed). Ironically, it appears that the responsibility for restricting candy cigarette sales in the US has been left up to large national retailers such as the Wal-Mart chain, which has a company-wide policy banning the sale of cigarette look-alike products to minors in all 50 states. Candy cigarettes cannot be considered simply as candy.
Eating foie gras dangerous to health?
University of Tennessee Graduate School of Medicine professor and researcher Alan Solomon, M.D., director of the Human Immunology and Cancer/Alzheimer’s Disease and Amyloid-Related Disorders Research Program, led a team that discovered a link between foie gras prepared from goose or duck liver and the type of amyloid found in rheumatoid arthritis or tuberculosis.
Their experimental data, appearing in this week's edition of the Proceedings of the National Academy of Sciences, has provided the first evidence that a food product can hasten amyloid development.
Amyloidosis is a disease process involving the deposit of normal or mutated proteins that have become misfolded. In this unstable state, such proteins form hair-like fibers, or fibrils, that are deposited into vital organs like the heart, kidneys, liver, pancreas and brain. This process leads to organ failure and, eventually, death. There are many types of amyloid-related diseases in addition to rheumatoid arthritis, such as Alzheimer’s disease, adult-onset (type-2) diabetes and an illness related to multiple myeloma called primary or AL amyloidosis, an illness that has been a particular focus of study in the Solomon laboratory.
Foie gras is a culinary delicacy derived from massively enlarged fatty livers of ducks and geese. It is produced by gorging the fowl over several weeks. Solomon and his research team analyzed commercially sold foie gras from the U.S. and France and found that it contained a type of amyloid called AA. Amyloid deposits are commonly found in waterfowl, but this condition is noticeably increased in force-fed birds. In their study, mice prone to develop AA amyloidosis were injected or fed amyloid extracted from foie gras. Within eight weeks, a majority of the animals developed extensive amyloid deposits in the liver, spleen, intestine and other organs.
Based on the findings of the study, Solomon and his team concluded that this and perhaps other forms of amyloidosis might be transmissible, like “mad cow” and other related diseases. Until now, no other infectious sources of food products have been found.
“It is not known if there is an increase of Alzheimer’s disease, diabetes or other amyloid-related disease in people who have eaten foie gras,” cautioned Solomon. “Our study looked at the existence of amyloid fibrils in foie gras and showed that it could accelerate the development of AA amyloidosis in susceptible mice. Perhaps people with a family history of Alzheimer’s disease, diabetes, rheumatoid arthritis or other amyloid-associated diseases should avoid consuming foie gras and other foods that may be contaminated with fibrils.” Other investigators have reported that meat derived from sheep and seemingly healthy cattle may represent other dietary sources of this material, he said.
People develop diseases for many reasons. “Eating foie gras probably won’t cause a disease in someone who isn’t genetically predisposed to it,” Solomon explained. “More critical is determining what causes these diseases in the first place and, most important, developing new means of diagnosis and treatment designed to rid the body of harmful amyloid deposits or preventing them from occurring or progressing. Indeed, this is the very focus of the work of my team at the University of Tennessee, and we are all deeply committed to achieving this goal. I am hopeful that our research efforts and those of other scientists throughout the world will help those afflicted with these diseases, which exert such a devastating toll on patients and family members alike.”
Their experimental data, appearing in this week's edition of the Proceedings of the National Academy of Sciences, has provided the first evidence that a food product can hasten amyloid development.
Amyloidosis is a disease process involving the deposit of normal or mutated proteins that have become misfolded. In this unstable state, such proteins form hair-like fibers, or fibrils, that are deposited into vital organs like the heart, kidneys, liver, pancreas and brain. This process leads to organ failure and, eventually, death. There are many types of amyloid-related diseases in addition to rheumatoid arthritis, such as Alzheimer’s disease, adult-onset (type-2) diabetes and an illness related to multiple myeloma called primary or AL amyloidosis, an illness that has been a particular focus of study in the Solomon laboratory.
Foie gras is a culinary delicacy derived from massively enlarged fatty livers of ducks and geese. It is produced by gorging the fowl over several weeks. Solomon and his research team analyzed commercially sold foie gras from the U.S. and France and found that it contained a type of amyloid called AA. Amyloid deposits are commonly found in waterfowl, but this condition is noticeably increased in force-fed birds. In their study, mice prone to develop AA amyloidosis were injected or fed amyloid extracted from foie gras. Within eight weeks, a majority of the animals developed extensive amyloid deposits in the liver, spleen, intestine and other organs.
Based on the findings of the study, Solomon and his team concluded that this and perhaps other forms of amyloidosis might be transmissible, like “mad cow” and other related diseases. Until now, no other infectious sources of food products have been found.
“It is not known if there is an increase of Alzheimer’s disease, diabetes or other amyloid-related disease in people who have eaten foie gras,” cautioned Solomon. “Our study looked at the existence of amyloid fibrils in foie gras and showed that it could accelerate the development of AA amyloidosis in susceptible mice. Perhaps people with a family history of Alzheimer’s disease, diabetes, rheumatoid arthritis or other amyloid-associated diseases should avoid consuming foie gras and other foods that may be contaminated with fibrils.” Other investigators have reported that meat derived from sheep and seemingly healthy cattle may represent other dietary sources of this material, he said.
People develop diseases for many reasons. “Eating foie gras probably won’t cause a disease in someone who isn’t genetically predisposed to it,” Solomon explained. “More critical is determining what causes these diseases in the first place and, most important, developing new means of diagnosis and treatment designed to rid the body of harmful amyloid deposits or preventing them from occurring or progressing. Indeed, this is the very focus of the work of my team at the University of Tennessee, and we are all deeply committed to achieving this goal. I am hopeful that our research efforts and those of other scientists throughout the world will help those afflicted with these diseases, which exert such a devastating toll on patients and family members alike.”
Friday, June 15, 2007
Breast feeding protects from rheumatoid arthritis
Longer term breast feeding protects mother from risk of developing rheumatoid arthritis
Breast feeding for a period of thirteen months or more has been shown to reduce the mother’s the risk of developing rheumatoid arthritis (RA), according to new data presented today at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain. In the study, the longer the breast feeding period, the lower the mother’s risk of developing RA in later life. Comparable use of oral contraceptives (OCs) or hormone replacement therapy (HRT) did not show a significant effect on the risk of developing RA.
Lead researcher Dr Mitra Keshavarz, of Malmö Hospital University, Sweden, said of the study, “Whilst other studies suggest that hormonal factors play a part in the development of RA, and we know that pregnancy can result in an improvement in RA symptoms, we wanted to investigate the long term effect of breast-feeding. This study specifically highlights the potential of naturally-induced hormones in protecting individuals from developing RA in the future. Furthermore, it adds to the growing body of evidence in favour of breast feeding and its positive health implications – this time demonstrating its protective benefits for the mother.”
Breast feeding for a period of thirteen months or more has been shown to reduce the mother’s the risk of developing rheumatoid arthritis (RA), according to new data presented today at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain. In the study, the longer the breast feeding period, the lower the mother’s risk of developing RA in later life. Comparable use of oral contraceptives (OCs) or hormone replacement therapy (HRT) did not show a significant effect on the risk of developing RA.
Lead researcher Dr Mitra Keshavarz, of Malmö Hospital University, Sweden, said of the study, “Whilst other studies suggest that hormonal factors play a part in the development of RA, and we know that pregnancy can result in an improvement in RA symptoms, we wanted to investigate the long term effect of breast-feeding. This study specifically highlights the potential of naturally-induced hormones in protecting individuals from developing RA in the future. Furthermore, it adds to the growing body of evidence in favour of breast feeding and its positive health implications – this time demonstrating its protective benefits for the mother.”
Alcohol intake = lower risk of rheumatoid arthritis
But smoking reduces alcohol's benefits
Alcohol may protect against rheumatoid arthritis (RA), with three units a week exhibiting protective effects and ten units a week being more protective still. An alcohol consumption of three units per week or more also reduced the risk by smoking or by a genetic predisposition to RA.
An increased alcohol (ethanol) consumption of three or more units per week was associated with a decreased risk of developing RA. The findings could improve understanding of the effects of lifestyle on the risk of developing RA and pave the way for new potential treatment approaches based on the apparently beneficial effects of alcohol.
Henrik Källberg at the Karolinska Institutet, Stockholm, Sweden, who is a PhD student said, “Several previous studies have indicated a suppression of the immune system by alcohol and a recent study showed that it prevented development of destructive arthritis. However, until now, epidemiological investigations on the effects of alcohol on RA were scarce and inconsistent. These data now show not only that alcohol can protect against RA and reduce the risk conferred by smoking or susceptible genes, but also gives an idea of the relevant alcohol doses necessary.”
Professor Tore Kvien said, “These are very interesting findings and are the first observation, from epidemiological data, which now should be confirmed by further clinical studies before a firm conclusion can be achieved. Furthermore, we assert the need for caution in the interpretation of these data. The misuse of alcohol is associated with a number of social and medical problems and any positive implications of alcohol must be coupled with the importance of moderation in alcohol consumption in accordance with standard national guidelines.”
Alcohol may protect against rheumatoid arthritis (RA), with three units a week exhibiting protective effects and ten units a week being more protective still. An alcohol consumption of three units per week or more also reduced the risk by smoking or by a genetic predisposition to RA.
An increased alcohol (ethanol) consumption of three or more units per week was associated with a decreased risk of developing RA. The findings could improve understanding of the effects of lifestyle on the risk of developing RA and pave the way for new potential treatment approaches based on the apparently beneficial effects of alcohol.
Henrik Källberg at the Karolinska Institutet, Stockholm, Sweden, who is a PhD student said, “Several previous studies have indicated a suppression of the immune system by alcohol and a recent study showed that it prevented development of destructive arthritis. However, until now, epidemiological investigations on the effects of alcohol on RA were scarce and inconsistent. These data now show not only that alcohol can protect against RA and reduce the risk conferred by smoking or susceptible genes, but also gives an idea of the relevant alcohol doses necessary.”
Professor Tore Kvien said, “These are very interesting findings and are the first observation, from epidemiological data, which now should be confirmed by further clinical studies before a firm conclusion can be achieved. Furthermore, we assert the need for caution in the interpretation of these data. The misuse of alcohol is associated with a number of social and medical problems and any positive implications of alcohol must be coupled with the importance of moderation in alcohol consumption in accordance with standard national guidelines.”
Runners: Let Thirst Be Your Guide
Many people are drinking too much water, including sports drinks, when exercising, a practice that could put some individuals engaging in prolonged types of endurance exercise at risk of potentially lethal water intoxication, say international experts who study disorders of water metabolism. Such exercise includes marathons, triathlons, and long distance cycling.
This serious condition, known as exercise-induced hyponatremia (EAH), could be prevented if only people would respect their personal thirst “meter,” or would undertake a “sweat test” to determine how much water they actually need to drink in order to replace just the body fluids lost during exercising, the researchers say.
A group of experts in this condition has issued a number of papers and recommendations, including an international consensus statement on this disorder published in the Clinical Journal of Sports Medicine in 2005. Joseph Verbalis, M.D., Professor and Interim Chair of the Department of Medicine at Georgetown University Medical Center and a member of this group, recently updated the scientific community on the causes of this disorder in the May issue of Sports Medicine.
Verbalis says the goal of the group is to understand the biological basis of EAH, and in that way, assure that no athlete ever succumbs to it again. A number of marathon runners have died from EAH, including one at this year’s London Marathon in April. One recent study found that 13 percent of Boston marathon runners suffered from EAH, though most cases are mild enough so that they are not noticed by the athletes themselves.
“The tragic aspect of the deaths that have occurred from EAH is that these are healthy young people who otherwise would have lived normal, long lives,” says Verbalis, who is also Chief of the Division of Endocrinology and Metabolism at Georgetown.
“The data clearly indicate that EAH is caused by excess drinking during endurance exercise activities, and that it can be prevented by limiting fluid intake while exercising, he says. But despite this knowledge, Verbalis points out that “unfortunately, we are not seeing this condition go away."
“The public’s impression of the amount of water that is necessary to drink for good health is not based on real factual data,” he says. “Many in our society have promoted the idea that you need to continually drink a large amount of fluid, such as 8 ounces of water eight times a day. But most people don’t really need that much.”
Verbalis points out that EAH predominantly afflicts exercisers engaging in endurance activities of 4 hours in duration or longer. But “the average person who goes out for an hour or two of strenuous exercise is not going to be at risk for this,” he adds.
Verbalis also says that sports drinks, which contain some sodium and potassium and carbohydrates, are basically water with a few additives. “There’s a misconception among the sports community that consuming sports drinks rather than water will protect you from becoming hyponatremic. That’s simply not true,” he says. “Drinking too much of anything puts some people at risk for potentially dangerous levels of hyponatremia.”
The disorder occurs when endurance exercisers drink more fluid than their kidneys can excrete. The hormone that determines how much fluid a kidney can excrete is arginine vasopressin (AVP), which is released from the pituitary gland when a person is becoming dehydrated in order to force the kidneys to conserve water. At rest, a person’s AVP level is low and can be suppressed to zero when sufficient fluids are ingested so that the kidney can excrete, rather than retain, excess water. But AVP levels can rise in people who exercise strenuously over a number of hours, even if they are not dehydrated.
“A kidney can normally excrete up to a liter an hour with an AVP level of zero, but when you’re exercising, the AVP is telling your kidney to excrete a volume of fluid that is markedly less than the maximum the kidney can excrete at rest,” Verbalis says. Too much water intake in an endurance exerciser whose AVP levels are on the rise means that some of the ingested water will be retained, and that excess water can dangerously dilute the level of sodium in the blood that is needed for organs to function, he adds.
Investigators have been researching the triggers that stimulate AVP secretion during exercise, and have found several. One is a loss of fluid from the body and blood as a result of sweating during prolonged exercise. Another is nausea, a common reaction to extreme sports, which makes the body think vomiting will ensue, so water needs to be conserved, Verbalis says. Finally, a research team that included Verbalis recently reported in the American Journal of Medicine that release from muscles of a cytokine known as interleukin-6 (Il-6) is also capable of stimulating AVP secretion.
Verbalis noted in his Sports Medicine paper that since 1985, “well over 100 individual cases” of EAH have been reported from physical exercise activities as diverse as forced military marches, prolonged hiking and marathon, ultramarathon and triathlon races, and there have been at least 8 documented fatalities. Some people have been known to gain up to 6-7 pounds during a marathon due to retention of water that the kidneys cannot excrete, he says. “No one should be gaining any weight during these events,” according to Verbalis, “and if they do, it can only be due to fluid retention.”
The hyponatremia consensus panel has recommended that everyone, including endurance exercisers, should “drink to thirst” ? that is, drink only when you feel you need to. Verbalis acknowledges that this advice is controversial, because some trainers and sports physiologists contend that “by the time you’re actually thirsty, you have lost enough fluid to already be dehydrated, so they say you need to drink in anticipation of becoming dehydrated.
“We dispute that notion, and contend that thirst is a good indicator of your body’s need for fluids, and that there is a window of time over which you can rehydrate safely,” he says. While a person “needs to lose about 1-2 percent of body water before thirst will reliably remind you to drink, losing that little is not sufficient to cause any significant health problems,” Verbalis says. “Many of us are often dehydrated to such small degrees, and it does not significantly affect us.”
But he adds that endurance exercisers who don’t want to rely on their body’s thirst meter have another excellent option, and that is undertaking a sweat test. This involves recording a person’s weight digitally, then running on a treadmill for an hour and recording their ending weight after toweling off the body sweat. “Most people don’t know how much they really sweat while exercising, but this simple test can tell you approximately how much fluid losses you are generating from sweat,” he says. “There is no need to drink significantly more than that, because sweat represents the major source of fluid loss during exercise.”
A healthy person needs to be dehydrated in the range of 4-6 percent loss of body water before there’s a significant health risk problem from dehydration, Verbalis says. “So, really, if people just do things in moderation, especially including re-hydrating by drinking, they’re not going to be at risk of either dehydration from excessive sweat losses or EAH from excessive fluid ingestion.”
This serious condition, known as exercise-induced hyponatremia (EAH), could be prevented if only people would respect their personal thirst “meter,” or would undertake a “sweat test” to determine how much water they actually need to drink in order to replace just the body fluids lost during exercising, the researchers say.
A group of experts in this condition has issued a number of papers and recommendations, including an international consensus statement on this disorder published in the Clinical Journal of Sports Medicine in 2005. Joseph Verbalis, M.D., Professor and Interim Chair of the Department of Medicine at Georgetown University Medical Center and a member of this group, recently updated the scientific community on the causes of this disorder in the May issue of Sports Medicine.
Verbalis says the goal of the group is to understand the biological basis of EAH, and in that way, assure that no athlete ever succumbs to it again. A number of marathon runners have died from EAH, including one at this year’s London Marathon in April. One recent study found that 13 percent of Boston marathon runners suffered from EAH, though most cases are mild enough so that they are not noticed by the athletes themselves.
“The tragic aspect of the deaths that have occurred from EAH is that these are healthy young people who otherwise would have lived normal, long lives,” says Verbalis, who is also Chief of the Division of Endocrinology and Metabolism at Georgetown.
“The data clearly indicate that EAH is caused by excess drinking during endurance exercise activities, and that it can be prevented by limiting fluid intake while exercising, he says. But despite this knowledge, Verbalis points out that “unfortunately, we are not seeing this condition go away."
“The public’s impression of the amount of water that is necessary to drink for good health is not based on real factual data,” he says. “Many in our society have promoted the idea that you need to continually drink a large amount of fluid, such as 8 ounces of water eight times a day. But most people don’t really need that much.”
Verbalis points out that EAH predominantly afflicts exercisers engaging in endurance activities of 4 hours in duration or longer. But “the average person who goes out for an hour or two of strenuous exercise is not going to be at risk for this,” he adds.
Verbalis also says that sports drinks, which contain some sodium and potassium and carbohydrates, are basically water with a few additives. “There’s a misconception among the sports community that consuming sports drinks rather than water will protect you from becoming hyponatremic. That’s simply not true,” he says. “Drinking too much of anything puts some people at risk for potentially dangerous levels of hyponatremia.”
The disorder occurs when endurance exercisers drink more fluid than their kidneys can excrete. The hormone that determines how much fluid a kidney can excrete is arginine vasopressin (AVP), which is released from the pituitary gland when a person is becoming dehydrated in order to force the kidneys to conserve water. At rest, a person’s AVP level is low and can be suppressed to zero when sufficient fluids are ingested so that the kidney can excrete, rather than retain, excess water. But AVP levels can rise in people who exercise strenuously over a number of hours, even if they are not dehydrated.
“A kidney can normally excrete up to a liter an hour with an AVP level of zero, but when you’re exercising, the AVP is telling your kidney to excrete a volume of fluid that is markedly less than the maximum the kidney can excrete at rest,” Verbalis says. Too much water intake in an endurance exerciser whose AVP levels are on the rise means that some of the ingested water will be retained, and that excess water can dangerously dilute the level of sodium in the blood that is needed for organs to function, he adds.
Investigators have been researching the triggers that stimulate AVP secretion during exercise, and have found several. One is a loss of fluid from the body and blood as a result of sweating during prolonged exercise. Another is nausea, a common reaction to extreme sports, which makes the body think vomiting will ensue, so water needs to be conserved, Verbalis says. Finally, a research team that included Verbalis recently reported in the American Journal of Medicine that release from muscles of a cytokine known as interleukin-6 (Il-6) is also capable of stimulating AVP secretion.
Verbalis noted in his Sports Medicine paper that since 1985, “well over 100 individual cases” of EAH have been reported from physical exercise activities as diverse as forced military marches, prolonged hiking and marathon, ultramarathon and triathlon races, and there have been at least 8 documented fatalities. Some people have been known to gain up to 6-7 pounds during a marathon due to retention of water that the kidneys cannot excrete, he says. “No one should be gaining any weight during these events,” according to Verbalis, “and if they do, it can only be due to fluid retention.”
The hyponatremia consensus panel has recommended that everyone, including endurance exercisers, should “drink to thirst” ? that is, drink only when you feel you need to. Verbalis acknowledges that this advice is controversial, because some trainers and sports physiologists contend that “by the time you’re actually thirsty, you have lost enough fluid to already be dehydrated, so they say you need to drink in anticipation of becoming dehydrated.
“We dispute that notion, and contend that thirst is a good indicator of your body’s need for fluids, and that there is a window of time over which you can rehydrate safely,” he says. While a person “needs to lose about 1-2 percent of body water before thirst will reliably remind you to drink, losing that little is not sufficient to cause any significant health problems,” Verbalis says. “Many of us are often dehydrated to such small degrees, and it does not significantly affect us.”
But he adds that endurance exercisers who don’t want to rely on their body’s thirst meter have another excellent option, and that is undertaking a sweat test. This involves recording a person’s weight digitally, then running on a treadmill for an hour and recording their ending weight after toweling off the body sweat. “Most people don’t know how much they really sweat while exercising, but this simple test can tell you approximately how much fluid losses you are generating from sweat,” he says. “There is no need to drink significantly more than that, because sweat represents the major source of fluid loss during exercise.”
A healthy person needs to be dehydrated in the range of 4-6 percent loss of body water before there’s a significant health risk problem from dehydration, Verbalis says. “So, really, if people just do things in moderation, especially including re-hydrating by drinking, they’re not going to be at risk of either dehydration from excessive sweat losses or EAH from excessive fluid ingestion.”
Thursday, June 14, 2007
College Students Face Obesity, High Blood Pressure
Obesity, high blood pressure, high cholesterol, and inactivity: they’re not just your father’s problems any more, University of New Hampshire research finds. New data on the widely unstudied demographic of college students indicates that this group of 18 – 24-year-olds are on the path toward chronic health diseases. Although limited, national data suggest the trend is not unique to UNH.
The UNH data, collected from more than 800 undergraduates enrolled in a general-education nutrition course, find that at least one-third of UNH students are overweight or obese, 8 percent of men had metabolic syndrome, 60 percent of men had high blood pressure, and more than two-thirds of women are not meeting their nutritional needs for iron, calcium or folate.
“They’re not as healthy as they think they are,” says UNH lecturer Ingrid Lofgren, who is collecting and analyzing the data with her Nutrition in Health & Well Being co-teachers Joanne Burke and Ruth Reilly, both clinical assistant professors, and lecturer Jesse Morrell.
The researchers, who presented their findings at the recent Experimental Biology Annual Meeting in Washington, D.C., initially asked students to engage in a variety of health-indicator screenings like blood pressure and cholesterol to bring the class alive with interactivity. They soon realized, however, that the size of the class (525 students per semester enroll in the course; 40 percent of UNH undergraduates take the course) gave them a gold mine of health information on a group about which little is known.
“This is a very understudied population. They’re very hard to reach,” says Reilly, noting that large phone surveys of this age group, such as one conducted by the Centers for Disease Control in 2003, generally do not reach students at college or cell phones.
As part of the course curriculum, students conducted a range of health screenings on themselves, which the instructors say is an effective teaching tool. “Students feel they’re invincible; they think they’re cholesterol isn’t going to be high, that’s their dad’s,” says Burke.
“When you tell students, ‘this is your data,’ they sit up and pay attention,” adds Morrell.
Students completed questionnaires on their lifestyle behaviors and dietary habits, chronicling their smoking, exercise, alcohol consumption, and consumption of fruits and vegetables. Their body mass index (BMI) was calculated from their height and weight, their waist circumference was measured, and they were screened for blood pressure as well as glucose, triglycerides, total cholesterol, and high-density cholesterol. The students also completed a three-day food diary and analyzed their calories, carbohydrates, and nutrient intakes with nutrition software.
Individual results shocked many of the students, and the aggregated data contradicted the notion that college students are at the peak of health. Metabolic syndrome, a cluster of five risk factors (high blood pressure, excess abdominal fat, high blood glucose, high triglycerides, and low HDL or “good” cholesterol) that are predictive of future development of heart disease and diabetes, is particularly prevalent in males. Sixty-six percent of males (compared to 50 percent of females) had at least one risk for metabolic syndrome, and eight percent of males had metabolic syndrome.
“These individuals, if they continue on this trajectory, are going to be much more of a health burden at age 50 than their parents are,” says Burke.
The vast majority of students – 95 percent of women and 82 percent of men – are not meeting nutrient recommendations for fiber. Women’s intake of the important nutrients iron (23 percent meet recommendations), calcium (33 percent meet recommendations) and folate (32 percent meet recommendations) are remarkably low. Twenty-three percent of men and 34 percent of women participated in less than 30 minutes of activity per day.
The good news? “We have very few smokers,” says Reilly. Also, Morrell notes that UNH students may be slightly healthier than their peers; national rates of overweight and obesity in this group are close to 40 percent.
The other good news is that these nutritional benchmarks hit students at a time – and in an environment – when they’re susceptible to change. “Late adolescence is a great time to impart good health behaviors,” says Reilly, noting that most college students are making independent choices about food and activity for the first time in their lives.
“It was a real wake-up call,” says Heather Carmichael, a UNH senior and former Nutrition in Health & Well Being student. “I was a vegan and I thought my diet was superb, but no. I wasn’t getting enough calcium and I had one risk factor for metabolic syndrome. I was shocked.”
The UNH data, collected from more than 800 undergraduates enrolled in a general-education nutrition course, find that at least one-third of UNH students are overweight or obese, 8 percent of men had metabolic syndrome, 60 percent of men had high blood pressure, and more than two-thirds of women are not meeting their nutritional needs for iron, calcium or folate.
“They’re not as healthy as they think they are,” says UNH lecturer Ingrid Lofgren, who is collecting and analyzing the data with her Nutrition in Health & Well Being co-teachers Joanne Burke and Ruth Reilly, both clinical assistant professors, and lecturer Jesse Morrell.
The researchers, who presented their findings at the recent Experimental Biology Annual Meeting in Washington, D.C., initially asked students to engage in a variety of health-indicator screenings like blood pressure and cholesterol to bring the class alive with interactivity. They soon realized, however, that the size of the class (525 students per semester enroll in the course; 40 percent of UNH undergraduates take the course) gave them a gold mine of health information on a group about which little is known.
“This is a very understudied population. They’re very hard to reach,” says Reilly, noting that large phone surveys of this age group, such as one conducted by the Centers for Disease Control in 2003, generally do not reach students at college or cell phones.
As part of the course curriculum, students conducted a range of health screenings on themselves, which the instructors say is an effective teaching tool. “Students feel they’re invincible; they think they’re cholesterol isn’t going to be high, that’s their dad’s,” says Burke.
“When you tell students, ‘this is your data,’ they sit up and pay attention,” adds Morrell.
Students completed questionnaires on their lifestyle behaviors and dietary habits, chronicling their smoking, exercise, alcohol consumption, and consumption of fruits and vegetables. Their body mass index (BMI) was calculated from their height and weight, their waist circumference was measured, and they were screened for blood pressure as well as glucose, triglycerides, total cholesterol, and high-density cholesterol. The students also completed a three-day food diary and analyzed their calories, carbohydrates, and nutrient intakes with nutrition software.
Individual results shocked many of the students, and the aggregated data contradicted the notion that college students are at the peak of health. Metabolic syndrome, a cluster of five risk factors (high blood pressure, excess abdominal fat, high blood glucose, high triglycerides, and low HDL or “good” cholesterol) that are predictive of future development of heart disease and diabetes, is particularly prevalent in males. Sixty-six percent of males (compared to 50 percent of females) had at least one risk for metabolic syndrome, and eight percent of males had metabolic syndrome.
“These individuals, if they continue on this trajectory, are going to be much more of a health burden at age 50 than their parents are,” says Burke.
The vast majority of students – 95 percent of women and 82 percent of men – are not meeting nutrient recommendations for fiber. Women’s intake of the important nutrients iron (23 percent meet recommendations), calcium (33 percent meet recommendations) and folate (32 percent meet recommendations) are remarkably low. Twenty-three percent of men and 34 percent of women participated in less than 30 minutes of activity per day.
The good news? “We have very few smokers,” says Reilly. Also, Morrell notes that UNH students may be slightly healthier than their peers; national rates of overweight and obesity in this group are close to 40 percent.
The other good news is that these nutritional benchmarks hit students at a time – and in an environment – when they’re susceptible to change. “Late adolescence is a great time to impart good health behaviors,” says Reilly, noting that most college students are making independent choices about food and activity for the first time in their lives.
“It was a real wake-up call,” says Heather Carmichael, a UNH senior and former Nutrition in Health & Well Being student. “I was a vegan and I thought my diet was superb, but no. I wasn’t getting enough calcium and I had one risk factor for metabolic syndrome. I was shocked.”
Pills increase unhealthy behavior?
When consumers are diagnosed with a health condition such as obesity, they don’t immediately trade fries for carrot sticks or start taking brisk walks after dinner. In a forthcoming paper in the Journal of Consumer Research, Lisa Bolton and Americus Reed, both marketing professors at Wharton School of Business, and Kevin G. Volpp and Katrina Armstrong, both professors at the University of Pennsylvania School of Medicine, found that consumers who contemplate taking a prescription or over-the-counter drug for their condition become more likely to engage in bad habits like junk food and a sedentary lifestyle.
This “boomerang effect” happens for two reasons. First, drug marketing undermines motivation to live a healthy lifestyle – ‘why bother eating low-fat foods when a drug exists to fight fat for me"’ Drugs also appear to weaken consumers’ beliefs in their ability to live a healthy lifestyle by eating right and exercising.
Interestingly, in a series of experiments and test groups, the researchers found that supplements did not have this same “boomerang effect” on a healthy lifestyle: regardless of how effective the supplement actually is, consumer perceptions of supplements are that they require “supplementary” behavior in order to work.
“People appear to choose supplements almost as a matter of faith rather than science,” Bolton says. “They perceive these products as ‘natural’ and figure they can’t hurt. And our research suggests that they don’t -- at least in terms of healthy lifestyle intentions.”
These findings add to the growing debate over the regulation of drug and supplement markets and the role of direct-to-consumer advertising. Indeed, Professor Reed feels that the Alli marketing campaign – which emphasizes the pill’s role in a healthy lifestyle that also includes menu planning and exercise – may soon lead other pharmaceutical companies to follow suit and play down the effectiveness of their products.
Reed says that this more honest approach to the marketing of these kinds of products may not be what consumers want to hear, but is promising because it is so different than the typical approach used to market these kinds of products. “Usually, they are positioned as effective as some kind of easy, magic solution. This product is up front in educating consumers that the road to long term weight loss goals requires hard work and a long term commitment. Its effectiveness is maximized in conjunction with other behaviors.”
Bolton cautiously adds however, that: “Consumers won’t buy the drug if it’s seen as ineffective. But, on the other hand, the drug may have unintended consequences if it’s seen as too effective (because of the boomerang effect on a healthy lifestyle). So marketing these remedies requires a delicate balancing act.”
“Even highly educated consumers and consumers who have otherwise acknowledged the importance of a healthy lifestyle are nonetheless susceptible to the boomerang effect for drugs,” write the authors.
This “boomerang effect” happens for two reasons. First, drug marketing undermines motivation to live a healthy lifestyle – ‘why bother eating low-fat foods when a drug exists to fight fat for me"’ Drugs also appear to weaken consumers’ beliefs in their ability to live a healthy lifestyle by eating right and exercising.
Interestingly, in a series of experiments and test groups, the researchers found that supplements did not have this same “boomerang effect” on a healthy lifestyle: regardless of how effective the supplement actually is, consumer perceptions of supplements are that they require “supplementary” behavior in order to work.
“People appear to choose supplements almost as a matter of faith rather than science,” Bolton says. “They perceive these products as ‘natural’ and figure they can’t hurt. And our research suggests that they don’t -- at least in terms of healthy lifestyle intentions.”
These findings add to the growing debate over the regulation of drug and supplement markets and the role of direct-to-consumer advertising. Indeed, Professor Reed feels that the Alli marketing campaign – which emphasizes the pill’s role in a healthy lifestyle that also includes menu planning and exercise – may soon lead other pharmaceutical companies to follow suit and play down the effectiveness of their products.
Reed says that this more honest approach to the marketing of these kinds of products may not be what consumers want to hear, but is promising because it is so different than the typical approach used to market these kinds of products. “Usually, they are positioned as effective as some kind of easy, magic solution. This product is up front in educating consumers that the road to long term weight loss goals requires hard work and a long term commitment. Its effectiveness is maximized in conjunction with other behaviors.”
Bolton cautiously adds however, that: “Consumers won’t buy the drug if it’s seen as ineffective. But, on the other hand, the drug may have unintended consequences if it’s seen as too effective (because of the boomerang effect on a healthy lifestyle). So marketing these remedies requires a delicate balancing act.”
“Even highly educated consumers and consumers who have otherwise acknowledged the importance of a healthy lifestyle are nonetheless susceptible to the boomerang effect for drugs,” write the authors.
Wednesday, June 13, 2007
Extra sleep improves athletes' performance
Athletes who get an extra amount of sleep are more likely to improve their performance in a game, according to a research abstract that will be presented Wednesday at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Cheri Mah of Stanford University, was conducted on six healthy students on the Stanford men's basketball team, who maintained their typical sleep-wake patterns for a two-week baseline followed by an extended sleep period in which they obtained as much extra sleep as possible. To assess improvements in athletic performance, the students were judged based on their sprint time and shooting percentages.
Significant improvements in athletic performance were observed, including faster sprint time and increased free-throws. Athletes also reported increased energy and improved mood during practices and games, as well as a decreased level of fatigue.
"Although much research has established the detrimental effects of sleep deprivation on cognitive function, mood and performance, relatively little research has investigated the effects of extra sleep over multiple nights on these variables, and even less on the specific relationship between extra sleep and athletic performance. This study illuminated this latter relationship and showed that obtaining extra sleep was associated with improvements in indicators of athletic performance and mood among members of the men's basketball team."
The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.
The study, authored by Cheri Mah of Stanford University, was conducted on six healthy students on the Stanford men's basketball team, who maintained their typical sleep-wake patterns for a two-week baseline followed by an extended sleep period in which they obtained as much extra sleep as possible. To assess improvements in athletic performance, the students were judged based on their sprint time and shooting percentages.
Significant improvements in athletic performance were observed, including faster sprint time and increased free-throws. Athletes also reported increased energy and improved mood during practices and games, as well as a decreased level of fatigue.
"Although much research has established the detrimental effects of sleep deprivation on cognitive function, mood and performance, relatively little research has investigated the effects of extra sleep over multiple nights on these variables, and even less on the specific relationship between extra sleep and athletic performance. This study illuminated this latter relationship and showed that obtaining extra sleep was associated with improvements in indicators of athletic performance and mood among members of the men's basketball team."
The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.
Does OTC diet pill Alli live up to its name?
The first and only over-the-counter product for weight loss approved by the Food and Drug Administration will be available Friday, June 15.
Orlistat, known by the brand name Alli, works by decreasing the amount of fat absorbed by the body. It is the OTC version of Xenical, a prescription weight loss pill. The good news: Orlistat has been tested and the prescription version has been used since 1999.
Last fall Dr. James Anderson, head of the UK College of Medicine Metabolic Research Group, and his colleagues examined the effects of OTC strength (60 mg) orlistat on mildly to moderately overweight individuals. The study was the first of its kind. Previously, the drug's effects had only been studied in obese individuals. Study participants took either orlistat or a placebo three times daily with meals for 16 weeks. Results of that study showed those taking OTC-strength orlistat did lose more weight than those taking the placebo.
"Our research showed that people taking orlistat and following low-fat diets lost almost five percent of their initial body weight, about seven to 15 pounds, over four months," Anderson said. "While two to four pounds a month isn't dramatic, steady weight loss of this amount can have major health benefits. For example, the reduction in LDL-cholesterol, the bad-guy cholesterol, of 10 percent can reduce risk of heart attack by 20 percent."
Any successful dieter knows that long-term weight loss is about lifestyle changes not quick fixes. While taking Alli may help you lose weight, it won't do all of the work for you. Anderson stresses a healthy diet and exercise plan are absolutely necessary to lose the weight and keep it off.
"This is the first over-the-counter medicine that has proven effectiveness. It is my hope that people will take one capsule before each regular meal, breakfast, lunch, and supper, and alter their fat and calorie intake," Anderson said. "If they commit to exercise six days a week, most people can lose weight steadily. All of us are in this for the long haul and need to keep up healthy behaviors, not for days or weeks, but for months and years. Doing regular physical activity and making good food choices will help us be trimmer and give us more energy."
Orlistat, known by the brand name Alli, works by decreasing the amount of fat absorbed by the body. It is the OTC version of Xenical, a prescription weight loss pill. The good news: Orlistat has been tested and the prescription version has been used since 1999.
Last fall Dr. James Anderson, head of the UK College of Medicine Metabolic Research Group, and his colleagues examined the effects of OTC strength (60 mg) orlistat on mildly to moderately overweight individuals. The study was the first of its kind. Previously, the drug's effects had only been studied in obese individuals. Study participants took either orlistat or a placebo three times daily with meals for 16 weeks. Results of that study showed those taking OTC-strength orlistat did lose more weight than those taking the placebo.
"Our research showed that people taking orlistat and following low-fat diets lost almost five percent of their initial body weight, about seven to 15 pounds, over four months," Anderson said. "While two to four pounds a month isn't dramatic, steady weight loss of this amount can have major health benefits. For example, the reduction in LDL-cholesterol, the bad-guy cholesterol, of 10 percent can reduce risk of heart attack by 20 percent."
Any successful dieter knows that long-term weight loss is about lifestyle changes not quick fixes. While taking Alli may help you lose weight, it won't do all of the work for you. Anderson stresses a healthy diet and exercise plan are absolutely necessary to lose the weight and keep it off.
"This is the first over-the-counter medicine that has proven effectiveness. It is my hope that people will take one capsule before each regular meal, breakfast, lunch, and supper, and alter their fat and calorie intake," Anderson said. "If they commit to exercise six days a week, most people can lose weight steadily. All of us are in this for the long haul and need to keep up healthy behaviors, not for days or weeks, but for months and years. Doing regular physical activity and making good food choices will help us be trimmer and give us more energy."
Can a Mediterranean diet prevent colon cancer?
Are all healthy eating plans the same when it comes to cancer prevention?
Researchers at the University of Michigan Comprehensive Cancer Center are beginning a study to look at whether diet can impact a person’s risk of developing colon cancer. Specifically, the researchers will compare a Mediterranean diet – high in olive oil, nuts and fish – with a standard healthy eating plan.
“Overall eating patterns appear to be more important for cancer prevention than intakes of specific nutrients or food groups. We hope this study will give us an indication of the benefits that a person’s diet can have on health, especially in terms of reducing the risk of colon cancer,” says Zora Djuric, Ph.D., research professor of family medicine at the U-M Medical School and principal investigator on the Healthy Eating for Colon Cancer Prevention study.
The study will look at adults age 21 or older who have had colon polyps, colon cancer or a family history of colon cancer. Researchers hope to recruit 120 participants over three years. Participants will be randomly assigned to follow either the Mediterranean diet or the Healthy People 2010 diet for six months. A dietitian will work closely with each participant by telephone. Participants can choose foods they prefer from recommended food group lists.
The Mediterranean diet focuses on vegetables, whole grains, fruits, fish and olive oil. High fat meats and processed foods are limited. The comparison diet is the Healthy People 2010 diet, which is the U.S. Department of Health and Human Services’ plan for healthy eating. The Healthy People 2010 diet involves eating plenty of fruits and vegetables, whole grains and a moderate fat intake with limits on saturated fat.
Study participants assigned to the Mediterranean diet will be encouraged to limit polyunsaturated fats from foods such as corn oil in favor of monounsaturated fats from olive oil, nuts and fatty plant-based foods such as olives. Mediterranean diet participants will also be expected to eat seven to nine servings of fruits and vegetables, including herbs, and get protein primarily from low-fat sources such as poultry, fish and legumes.
Previous studies have linked the Mediterranean diet to reduced risk of heart disease, stroke and cancer. Some evidence suggests the Mediterranean diet causes changes in the colon that would prevent cancer.
U-M researchers recently concluded a study of 70 women ages 25-65 who were randomly divided between following a Mediterranean diet or following their usual dietary habits. The researchers found the study participants were able to stick to the Mediterranean diet throughout the study. The women following a Mediterranean diet decreased the amount of polyunsaturated fat they ate by 50 percent while increasing the amount of healthy monounsaturated fats by the same amount. The women also ate twice as many fruits and vegetables as those following their regular diet. This doubled the blood levels of carotenoids, which are antioxidant micronutrients from fruits and vegetables.
Researchers believe changes in dietary fatty acids from the higher monounsaturated fat intake with a Mediterranean diet will decrease the levels of certain proteins in the body that are linked to the development of colon cancer. At the same time, other cancer-protective compounds are expected to increase because of the Mediterranean diet.
Researchers at the University of Michigan Comprehensive Cancer Center are beginning a study to look at whether diet can impact a person’s risk of developing colon cancer. Specifically, the researchers will compare a Mediterranean diet – high in olive oil, nuts and fish – with a standard healthy eating plan.
“Overall eating patterns appear to be more important for cancer prevention than intakes of specific nutrients or food groups. We hope this study will give us an indication of the benefits that a person’s diet can have on health, especially in terms of reducing the risk of colon cancer,” says Zora Djuric, Ph.D., research professor of family medicine at the U-M Medical School and principal investigator on the Healthy Eating for Colon Cancer Prevention study.
The study will look at adults age 21 or older who have had colon polyps, colon cancer or a family history of colon cancer. Researchers hope to recruit 120 participants over three years. Participants will be randomly assigned to follow either the Mediterranean diet or the Healthy People 2010 diet for six months. A dietitian will work closely with each participant by telephone. Participants can choose foods they prefer from recommended food group lists.
The Mediterranean diet focuses on vegetables, whole grains, fruits, fish and olive oil. High fat meats and processed foods are limited. The comparison diet is the Healthy People 2010 diet, which is the U.S. Department of Health and Human Services’ plan for healthy eating. The Healthy People 2010 diet involves eating plenty of fruits and vegetables, whole grains and a moderate fat intake with limits on saturated fat.
Study participants assigned to the Mediterranean diet will be encouraged to limit polyunsaturated fats from foods such as corn oil in favor of monounsaturated fats from olive oil, nuts and fatty plant-based foods such as olives. Mediterranean diet participants will also be expected to eat seven to nine servings of fruits and vegetables, including herbs, and get protein primarily from low-fat sources such as poultry, fish and legumes.
Previous studies have linked the Mediterranean diet to reduced risk of heart disease, stroke and cancer. Some evidence suggests the Mediterranean diet causes changes in the colon that would prevent cancer.
U-M researchers recently concluded a study of 70 women ages 25-65 who were randomly divided between following a Mediterranean diet or following their usual dietary habits. The researchers found the study participants were able to stick to the Mediterranean diet throughout the study. The women following a Mediterranean diet decreased the amount of polyunsaturated fat they ate by 50 percent while increasing the amount of healthy monounsaturated fats by the same amount. The women also ate twice as many fruits and vegetables as those following their regular diet. This doubled the blood levels of carotenoids, which are antioxidant micronutrients from fruits and vegetables.
Researchers believe changes in dietary fatty acids from the higher monounsaturated fat intake with a Mediterranean diet will decrease the levels of certain proteins in the body that are linked to the development of colon cancer. At the same time, other cancer-protective compounds are expected to increase because of the Mediterranean diet.
Defenses Against Summer Food Poisoning
Anyone who’s ever been struck by food poisoning does not soon forget it. The Centers for Disease Control (CDC) estimates that 76 million cases of food-borne disease occur annually in the United States, though this number could be much higher due to underreporting.
“Raw or undercooked meat, fish and produce are the most common culprits of food poisoning, however, even canned or packaged foods can have bacteria present and need thorough cooking first,” says Patricia Raymond, M.D., noted board-certified gastroenterologist, author and assistant professor at Eastern Virginia Medical School. “Cases vary in severity and usually last for two to four days, but they can be the longest days of your life when you feel this badly.”
Despite how scary it seems to millions – making national news reports with every outbreak – Dr. Raymond says there are some simple steps you can take to protect yourself and your family against food poisoning this summer:
At Home Food Prep:
• Don’t Guess about Meat: Invest in a good meat thermometer and make sure all meat is heated to at least 160 degrees Fahrenheit at its thickest point. Cook ground meat until no pink shows in the center.
• Keep it Cold: Bacteria grow fastest in warm temperatures, so refrigerate leftovers if they aren’t going to be eaten within two or three hours. When barbequing, leave meat and produce in the refrigerator until you’re ready to cook, especially in the summer.
• Wash...and Wash Again: Rinse all produce under running water before consumption, even if you purchase one of the bags of veggies marked “pre-washed.”
• Change Tools: Don’t use the same cooking tools to prepare meat and produce –
bacteria from the raw meat can be transferred to the fruits and vegetables on knives, cutting boards and other cooking tools.
• Wash Your Hands: Scrub your hands with soap and warm water before preparing or eating food. If you have children, teach them the importance of washing their hands before eating and after using the bathroom. Infectious bacteria can remain in the stool for up to two weeks after symptoms end, so vigilance in hand washing is necessary to prevent food poisoning from spreading if one family member has it.
On Vacation:
• What Makes You Sick on the Road?: Traveler’s diarrhea affects between 20 and 50 percent of international travelers (an estimated 10 million people) annually, according to the CDC, and a new survey for Florastor® probiotic finds that 60% of adults have experienced this problem, even while traveling in the United States. Most, if not all, cases of traveler’s diarrhea are a result of food poisoning.
• Watch What You Eat: While traveling, avoid consuming tap water and food from street vendors, and regardless of how clean an establishment looks.
• Be Aware of “Hot Spots”: Check out the CDC Web site to see if your travel destination is an area that is high-risk for conditions like “traveler’s diarrhea.”
“Raw or undercooked meat, fish and produce are the most common culprits of food poisoning, however, even canned or packaged foods can have bacteria present and need thorough cooking first,” says Patricia Raymond, M.D., noted board-certified gastroenterologist, author and assistant professor at Eastern Virginia Medical School. “Cases vary in severity and usually last for two to four days, but they can be the longest days of your life when you feel this badly.”
Despite how scary it seems to millions – making national news reports with every outbreak – Dr. Raymond says there are some simple steps you can take to protect yourself and your family against food poisoning this summer:
At Home Food Prep:
• Don’t Guess about Meat: Invest in a good meat thermometer and make sure all meat is heated to at least 160 degrees Fahrenheit at its thickest point. Cook ground meat until no pink shows in the center.
• Keep it Cold: Bacteria grow fastest in warm temperatures, so refrigerate leftovers if they aren’t going to be eaten within two or three hours. When barbequing, leave meat and produce in the refrigerator until you’re ready to cook, especially in the summer.
• Wash...and Wash Again: Rinse all produce under running water before consumption, even if you purchase one of the bags of veggies marked “pre-washed.”
• Change Tools: Don’t use the same cooking tools to prepare meat and produce –
bacteria from the raw meat can be transferred to the fruits and vegetables on knives, cutting boards and other cooking tools.
• Wash Your Hands: Scrub your hands with soap and warm water before preparing or eating food. If you have children, teach them the importance of washing their hands before eating and after using the bathroom. Infectious bacteria can remain in the stool for up to two weeks after symptoms end, so vigilance in hand washing is necessary to prevent food poisoning from spreading if one family member has it.
On Vacation:
• What Makes You Sick on the Road?: Traveler’s diarrhea affects between 20 and 50 percent of international travelers (an estimated 10 million people) annually, according to the CDC, and a new survey for Florastor® probiotic finds that 60% of adults have experienced this problem, even while traveling in the United States. Most, if not all, cases of traveler’s diarrhea are a result of food poisoning.
• Watch What You Eat: While traveling, avoid consuming tap water and food from street vendors, and regardless of how clean an establishment looks.
• Be Aware of “Hot Spots”: Check out the CDC Web site to see if your travel destination is an area that is high-risk for conditions like “traveler’s diarrhea.”
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