Artificial light from digital devices lessens sleep quality

There's no doubt we love our digital devices at all hours, including after the sun goes down. Who hasn't snuggled up with a smart phone, tablet or watched their flat screen TV from the comfort of bed? A new study by researchers at the University of Houston College of Optometry, published in Ophthalmic & Physiological Optics, found that blue light emitted from those devices could contribute to the high prevalence of reported sleep dysfunction.

Study participants, ages 17-42, wore short wavelength-blocking glasses three hours before bedtime for two weeks, while still performing their nightly digital routine. Results showed about a 58 percent increase in their nighttime melatonin levels, the chemical that signals your body that it's time to sleep. Those levels are even higher than increases from over-the-counter melatonin supplements, according to Dr. Lisa Ostrin, the UH College of Optometry assistant professor who lead the study.

"The most important takeaway is that blue light at night time really does decrease sleep quality. Sleep is very important for the regeneration of many functions in our body," Ostrin said.

Wearing activity and sleep monitors 24 hours a day, the 22 study participants also reported sleeping better, falling asleep faster, and even increased their sleep duration by 24 minutes a night, according to Ostrin.

The largest source of blue light is sunlight, but it's also found in most LED-based devices. Blue light boosts alertness and regulates our internal body clock, or circadian rhythm, that tells our bodies when to sleep. This artificial light activates photoreceptors called intrinsically photosensitive retinal ganglion cells (ipRGCs), which suppresses melatonin.

Ostrin recommends limiting screen time, applying screen filters, wearing computer glasses that block blue light, or use anti-reflective lenses to offset the effects of artificial light at nighttime. Some devices even include night mode settings that limit blue light exposure.

"By using blue blocking glasses we are decreasing input to the photoreceptors, so we can improve sleep and still continue to use our devices. That's nice, because we can still be productive at night," Ostrin said.

According to the most recent findings from the National Sleep Foundation's Sleep Health Index®, while three quarters of Americans are satisfied with their sleep over the past week, more than four in ten Americans reported that their daily activities were significantly impacted by poor or insufficient sleep at least once during the past seven days.

New study by running experts: Don't change your stride

USA Track and Field consultant Iain Hunter and U.S. Olympian Jared Ward have a message for runners: Don't mess with your stride.

A new study by the duo of BYU professors finds the stride length people naturally choose is the best for them, whether they are experienced or inexperienced runners. That means whatever shape you are in -- marathon warrior or weekend jogger -- stick with what you're doing.

"Don't worry about changing your stride length," said Hunter, a professor of exercise science at BYU. "You should just leave it alone or you're going to use more energy in the end."

The study, published in the International Journal of Exercise Science, measured the energy use of 33 runners while carrying out various strides during a 20-minute run. Of those runners, 19 were experienced runners (meaning they averaged at least 20 miles a week) while 14 were inexperienced runners (people who have never run more than 5 miles in a week).

During their runs participants used five different stride lengths: their natural stride, and then strides of plus and minus 8 and 16 percent of their normal stride. Subjects maintained the adjusted strides thanks to the assistance of a computer-based metronome, which beeped each time their foot should've hit the treadmill. Meanwhile, researchers measured the energy output of the runners with masks that recorded the amount of oxygen used.

The results found both the experienced and the inexperienced runners were most efficient when they were using their preferred stride. Thus, athletes and coaches don't need to alter a runner's stride length when economy is the main concern.

"Just let it happen; it doesn't need to be coached," Hunter said. "Your body is your best coach for stride length."

Hunter and Ward would know -- both are experienced runners and both have trained and researched high-level distance runners for years. Ward, of course, finished 6th in the marathon at the 2016 Olympics and recently finished in the top 10 of the 2017 Boston Marathon.

Ward, an adjunct faculty in the BYU statistics department, said the takeaway is similar to that of elite runners: Be very careful if you're trying to alter your stride if efficiency is your main concern.
"Many people are advocating for various 'optimal' running forms, but this study shows even novice runners shouldn't try to run any different than their body naturally does," he said. "Enjoy running and worry less about what things look like."

Hunter's expertise has led him to carry out biomechanical analyses for USA Track and Field for the past 14 years. He is headed to London this August with Team USA for the World Championships, where he will help film and analyze U.S. athletes during competitions.

Resistance training recovery takes much longer than endurance training

James Cook University sports scientists are warning that fatigue from weight training can carry over to endurance training and the two activities must be better coordinated to maximise athletes' performance.

JCU's Dr Kenji Doma was part of a team examining concurrent training - which features both resistance (eg weights) and endurance training (eg running) on the same or separate days.

"The consensus is that concurrent training is beneficial for endurance development. But we found that if appropriate recovery is not accounted for between each training mode, then it may impair endurance development," he said.

Dr Doma and colleagues have a new paper out in the journal Sports Medicine. He said they found studies showing reduced performance by athletes, including runners and cyclists, even several days after a single resistance training session.

He said the physiological stress caused by a typical resistance training bout of 40 to 60 minutes can continue for several days post-exercise, as opposed to a full recovery within 24 hours following a typical endurance training bout.

"We want to increase the awareness of resistance training-induced fatigue in the hope of encouraging coaches to think about aspects such as the order of the training, the recovery period, training intensity, etc. We're trying to limit the carry-over effects of fatigue from resistance to endurance training sessions," he said.

Dr Doma said the group was not saying that concurrent training should be discontinued.
"There are great benefits to it, but there can be some hidden dangers too. What we want to see is fatigue from resistance sessions minimised so there can be even more benefits gained."
He said the group could not tell athletes a specific recovery time as that was dependent on the individual, the code, and where the athlete was in the training cycle.

Talking to yourself in the third person can help you control emotions

The simple act of silently talking to yourself in the third person during stressful times may help you control emotions without any additional mental effort than what you would use for first-person self-talk -- the way people normally talk to themselves.
A first-of-its-kind study led by psychology researchers at Michigan State University and the University of Michigan indicates that such third-person self-talk may constitute a relatively effortless form of self-control. The findings are published online in Scientific Reports, a Nature journal.
Say a man named John is upset about recently being dumped. By simply reflecting on his feelings in the third person ("Why is John upset?"), John is less emotionally reactive than when he addresses himself in the first person ("Why am I upset?").

"Essentially, we think referring to yourself in the third person leads people to think about themselves more similar to how they think about others, and you can see evidence for this in the brain," said Jason Moser, MSU associate professor of psychology. "That helps people gain a tiny bit of psychological distance from their experiences, which can often be useful for regulating emotions."
The study, partially funded by the National Institutes of Health and the John Temple Foundation, involved two experiments that both significantly reinforced this main conclusion.

In one experiment, at Moser's Clinical Psychophysiology Lab, participants viewed neutral and disturbing images and reacted to the images in both the first and third person while their brain activity was monitored by an electroencephalograph. When reacting to the disturbing photos (such as a man holding a gun to their heads), participants' emotional brain activity decreased very quickly (within 1 second) when they referred to themselves in the third person.

The MSU researchers also measured participants' effort-related brain activity and found that using the third person was no more effortful than using first person self-talk. This bodes well for using third-person self-talk as an on-the-spot strategy for regulating one's emotions, Moser said, as many other forms of emotion regulation require considerable thought and effort.

In the other experiment, led by U-M psychology professor Ethan Kross, who directs the Emotion and Self-Control Lab, participants reflected on painful experiences from their past using first and third person language while their brain activity was measured using functional magnetic resonance imaging, or FMRI.

Similar to the MSU study, participants' displayed less activity in a brain region that is commonly implicated in reflecting on painful emotional experiences when using third person self-talk, suggesting better emotional regulation. Further, third person self-talk required no more effort-related brain activity than using first person.

"What's really exciting here," Kross said, "is that the brain data from these two complimentary experiments suggest that third-person self-talk may constitute a relatively effortless form of emotion regulation.

"If this ends up being true -- we won't know until more research is done -- there are lots of important implications these findings have for our basic understanding of how self-control works, and for how to help people control their emotions in daily life."

Moser and Kross said their teams are continuing to collaborate to explore how third-person self-talk compares to other emotion-regulation strategies.

Lutein may counter cognitive aging,

Spinach and kale are favorites of those looking to stay physically fit, but they also could keep consumers cognitively fit, according to a new study from University of Illinois researchers.

The study, which included 60 adults aged 25 to 45, found that middle-aged participants with higher levels of lutein - a nutrient found in green leafy vegetables such as spinach and kale, as well as avocados and eggs -- had neural responses that were more on par with younger individuals than with their peers. The findings were published in the journal Frontiers in Aging Neuroscience.

"Now there's an additional reason to eat nutrient-rich foods such as green leafy vegetables, eggs and avocados," said Naiman Khan, a professor of kinesiology and community health at Illinois. "We know these foods are related to other health benefits, but these data indicate that there may be cognitive benefits as well."

Most other studies have focused on older adults, after there has already been a period of decline. The Illinois researchers chose to focus on young to middle-aged adults to see whether there was a notable difference between those with higher and lower lutein levels.

"As people get older, they experience typical decline. However, research has shown that this process can start earlier than expected. You can even start to see some differences in the 30s," said Anne Walk, a postdoctoral scholar and first author of the paper. "We want to understand how diet impacts cognition throughout the lifespan. If lutein can protect against decline, we should encourage people to consume lutein-rich foods at a point in their lives when it has maximum benefit."

Lutein is a nutrient that the body can't make on its own, so it must be acquired through diet. Lutein accumulates in brain tissues, but also accumulates in the eye, which allows researchers to measure levels without relying on invasive techniques.

The Illinois researchers measured lutein in the study participants' eyes by having participants look into a scope and respond to a flickering light. Then, using electrodes on the scalp, the researchers measured neural activity in the brain while the participants performed a task that tested attention.

"The neuro-electrical signature of older participants with higher levels of lutein looked much more like their younger counterparts than their peers with less lutein," Walk said. "Lutein appears to have some protective role, since the data suggest that those with more lutein were able to engage more cognitive resources to complete the task."

Next, Khan's group is running intervention trials, aiming to understand how increased dietary consumption of lutein may increase lutein in the eye, and how closely the levels relate to changes in cognitive performance.

"In this study we focused on attention, but we also would like to understand the effects of lutein on learning and memory. There's a lot we are very curious about," Khan said.

Mediterranean-style diets linked to better brain function in older adults

Eating foods included in two healthy diets--the Mediterranean or the MIND diet--is linked to a lower risk for memory difficulties in older adults, according to a study published in the Journal of the American Geriatrics Society.

The Mediterranean diet is rich in fruits, vegetables, whole grains, beans, potatoes, nuts, olive oil and fish. Processed foods, fried and fast foods, snack foods, red meat, poultry and whole-fat dairy foods are infrequently eaten on the Mediterranean diet.

The MIND diet is a version of the Mediterranean diet that includes 15 types of foods. Ten are considered "brain-healthy:" green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, seafood, poultry, olive oil, and wine. Five are considered unhealthy: red meat, butter and stick margarine, cheese, pastries, sweets and fried/fast foods.

Researchers examined information from 5,907 older adults who participated in the Health and Retirement Study. The participants filled out questionnaires about their eating habits. Researchers then measured the participants' cognitive abilities--mostly on their memory and attention skills.

The researchers compared the diets of participants to their performance on the cognitive tests. They found that older people who ate Mediterranean and MIND-style diets scored significantly better on the cognitive function tests than those who ate less healthy diets. In fact, older people who ate a Mediterranean-style diet had 35% lower risk of scoring poorly on cognitive tests. Even those who ate a moderate Mediterranean-style diet had 15% lower risk of doing poorly on cognitive tests. The researchers noted similar results for people who ate MIND-style diets.

This study suggests that eating Mediterranean and MIND-style diets is linked to better overall cognitive function in older adults, said the researchers. What's more, older adults who followed these healthy diets had lower risks for having cognitive impairment in later life, noted the researchers.

Using money to buy free time linked to increased happiness

New research is challenging the age-old adage that money can't buy happiness.

The study, led by researchers at the University of British Columbia and Harvard Business School, suggests that using money to buy free time -- such as paying to delegate household chores like cleaning and cooking -- is linked to greater life satisfaction.

"People who hire a housecleaner or pay the kid next door to mow the lawn might feel like they're being lazy," said study lead author Ashley Whillans, assistant professor at Harvard Business School who carried out the research as a PhD candidate in the UBC department of psychology. "But our results suggest that buying time has similar benefits for happiness as having more money."

The researchers surveyed more than 6,000 adults in the United States, Denmark, Canada and the Netherlands. Respondents were asked if and how much they spent each month to buy themselves free time. They also rated their life satisfaction, and answered questions about feelings of time stress.

Respondents who spent money on time saving purchases reported greater life satisfaction. The effect held up even after controlling for income.

"The benefits of buying time aren't just for wealthy people," said UBC psychology professor and the study's senior author Elizabeth Dunn. "We thought the effects might only hold up for people with quite a bit of disposable income, but to our surprise, we found the same effects across the income spectrum."

To test whether buying time actually causes greater happiness, the researchers also conducted a field experiment. Sixty adults were randomly assigned to spend $40 on a time saving purchase on one weekend, and $40 on a material purchase on another weekend. The results revealed that people felt happier when they spent money on a time saving purchase than on a material purchase.

Despite the benefits, the researchers were surprised to discover how few people choose to spend their money on time saving purchases in daily life. Even in a sample of 850 millionaires who were surveyed, almost half reported spending no money outsourcing disliked tasks. A survey of 98 working adults asking how they would spend a windfall of $40 also revealed that only two per cent would use it in a way that saved them time.

"Although buying time can serve as a buffer against the time pressures of daily life, few people are doing it even when they can afford it," said Dunn. "Lots of research has shown that people benefit from buying their way into pleasant experiences, but our research suggests people should also consider buying their way out of unpleasant experiences."

275,000 calls to poison control centers for dietary supplement exposures

U.S. Poison Control Centers receive a call every 24 minutes, on average, regarding dietary supplement exposures, according to a new study from the Center for Injury Research and Policy and the Central Ohio Poison Center, both at Nationwide Children's Hospital.

The study, published online today in the Journal of Medical Toxicology, found the rate of calls regarding dietary supplement exposures increased (46.1%) during 2000 to 2002, decreased (8.8%) during 2002 to 2005 and increased again (49.3%) from 2005 to 2012. The decrease from 2002 to 2005 most likely resulted from the U.S. Food and Drug Administration's (FDA) ban of the botanical stimulant ma huang previously found in some dietary supplements.

Seventy percent of dietary supplement exposure calls occurred among children younger than six years old and the majority of these were unintentional. Most exposures (97.3%) occurred at home, and in more than 97 percent of the cases, the child swallowed the substance. Serious medical outcomes accounted for 4.5 percent of exposures and the most serious outcomes (95.0%) occurred among children six years and older.

"Many consumers believe dietary supplements are held to the same safety and efficacy standards as over-the-counter medications," said Gary Smith, MD, DrPH, senior author of the study and director of the Center of Injury Research and Policy at Nationwide Children's. "However, dietary supplements are not considered drugs, thus they are not required to undergo clinical trials or obtain approval from the FDA prior to sale, unless the product is labeled as intended for therapeutic use."

Miscellaneous substances found in commonly used dietary supplements accounted for the majority of exposure calls (43.9%). Other substances involved in exposures included botanicals (31.9%), hormonal products (15.1%), and other supplements (5.1%). Amino acids, cultural medicines and energy products each account for less than (2.0%) of exposures.

The dietary supplements with the highest proportion of serious medical outcomes were energy products, botanical and cultural medicines. Within the botanical category, yohimbe accounted for the largest proportion of serious medical outcomes (28.2%).

Nearly 30 percent of yohimbe exposure calls resulted in moderate or major effects. Yohimbe can cause heart beat rhythm changes, kidney failure, seizures, heart attack, and death.

Energy products, including drinks, advertised to increase energy and mental performance, can cause bad clinical effects as well. Many energy product exposures were unintentional and occurred among young children, causing heart and breathing problems, seizures, and other clinical problems. Findings support the need for improved energy product regulation, child-resistant packaging, and caregiver information, according to the study authors.

"Lack of federal oversight has led to inconsistencies in the quality of dietary supplements, product mislabeling and contamination with other substances," said Henry Spiller, MS, D.ABAT, a co-author of the study and director of the Central Ohio Poison Center at Nationwide Children's. "Although the majority of these exposure calls did not result in serious medical outcomes, exposures to yohimbe and energy products can be dangerous, suggesting the need for child-resistant packaging, caregiver education and FDA regulation of these substances."

Neuroticism may postpone death for some

Data from a longitudinal study of over 500,000 people in the United Kingdom indicate that having higher levels of the personality trait neuroticism may reduce the risk of death for individuals who report being in fair or poor health. The research, published in Psychological Science, a journal of the Association for Psychological Science, further revealed that a specific aspect of neuroticism related to worry and feelings of vulnerability was associated with lower mortality, regardless of self-reported health.

"Our findings are important because they suggest that being high in neuroticism may sometimes have a protective effect, perhaps by making people more vigilant about their health," says lead researcher Catharine R. Gale of the University of Edinburgh and University of Southampton.

By definition, people with high levels of neuroticism are more likely to experience negative emotions--including irritability, frustration, nervousness, worry, and guilt--compared with their peers who have lower levels of neuroticism. Studies investigating links between neuroticism and mortality have produced inconsistent results, with some showing higher risk of death and others showing no relationship or even lower risk of death.

Drawing from existing evidence, Gale and colleagues hypothesized that the relationship between neuroticism and risk of death may depend on how people rate their health.

The researchers examined UK Biobank data collected from 502,655 people ages 37 to 73. Participants completed a validated personality assessment measuring neuroticism and indicated whether they thought they were in excellent, good, fair, or poor health overall. The data also included information on participants' health behaviors (e.g., smoking, physical activity), physical health (e.g., body mass index, blood pressure), cognitive function, and medical diagnoses (e.g., heart problems, diabetes, cancer).

Examining death certificates from the National Health Service Central Registry, the researchers found that a total of 4,497 participants had died in the follow-up period (which was about 6.25 years, on average). In general, the data showed that mortality was slightly higher among participants with higher levels of neuroticism. However, when Gale and colleagues adjusted for participants' self-rated health, they found that the direction of the relationship reversed, with higher neuroticism being linked with slightly lower risk of death from all causes and from cancer.

"When we explored this further, we found that this protective effect was only present in people who rated their health as fair or poor," explains Gale. "We also found that people who scored highly on one aspect of neuroticism related to worry and vulnerability had a reduced risk of death regardless of how they rated their health."

Intriguingly, these relationships did not seem to vary according to participants' health behaviors or medical diagnoses at the time they completed the neuroticism questionnaire, a finding which surprised the researchers.

"Health behaviors such as smoking, exercise, diet and alcohol consumption did not explain any part of the link between high scores on the worry/vulnerability facet and mortality risk. We had thought that greater worry or vulnerability might lead people to behave in a healthier way and hence lower their risk of death, but that was not the case," Gale says.

Following on these findings, Gale and colleagues plan to further investigate the different facets of neuroticism to understand why worry and vulnerability may have specific protective effects.

Study finds 90 percent of American men overfat

Does your waist measure more than half your height?

If so, you may be part of the global overfat pandemic. A recent article, published in Frontiers in Public Health, suggests it to be even more prevalent in developed countries where up to 90 percent of adult males and 50 percent children may suffer from this condition. In the top overfat countries, 80 percent of women fall into this category.

The problem is particularly pervasive in the English-speaking countries of the United States and New Zealand, but also in Iceland and even Greece where people are generally thought to be healthy. This trend may be bad news for developing countries as well, since they have followed the trend of developed nations in the growing overfat pandemic.

The term overfat refers to the presence of excess body fat that can impair health, and may include even normal-weight non-obese individuals. Excess body fat, especially abdominal fat, is associated with increased risk of chronic diseases, increased morbidity and mortality, and reduced quality of life.

Researchers Philip Maffetone, Ivan Rivera-Dominguez and Paul B. Laursen reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world's population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings.

In addition, a recent rise in the incidence of abdominal adiposity, the unhealthiest form of excess body fat, has been observed in both adults and children, indicating a direct link to insulin-resistance, the body's natural propensity to convert and store carbohydrate foods as fat.

The relationship between the overfat condition and poor health is a spectrum or progression in which the vicious cycle of excess body fat, insulin resistance and chronic inflammation lie at one end, causing abnormal blood fats (cholesterol and triglycerides) and glucose, and elevated blood pressure, which then produces a variety of common diseases at the other end.

Being overfat is linked to hypertension, dyslipidemia, coronary heart disease, stroke, cancer, Type 2 diabetes, gallbladder disease, osteoarthritis and gout, pulmonary diseases, sleep apnea and others.

Many physically active people, including professional athletes in various sports and active U.S. military personnel, also may fall into the overfat category.

Traditional means of assessment, such as stepping on a scale or calculating Body Mass Index (BMI), are ineffective at determining whether someone is overfat. Instead, researchers recommend taking a measure of the waistline (at the level of the belly button) and comparing it to height.

Tai chi may help prevent falls in older and at-risk adults

An analysis of published studies indicates that tai chi may help reduce the number of falls in both the older adult population and at-risk adults. The findings, which are published in the Journal of the American Geriatrics Society, offer a simple and holistic way to prevent injuries.

Tai chi is an ancient Chinese practice focused on flexibility and whole body coordination that promotes harmonized motion in space. Previous research has shown that tai chi is an effective exercise to improve balance control and flexibility in older individuals. This suggests that the practice might help protect against falls, which are a primary cause of traumatic death for older adults.

To investigate, Rafael Lomas-Vega, PhD of the University of Jaén in Spain and his colleagues searched the medical literature for relevant studies. The team identified 10 randomized controlled trials analysing the effect of tai chi versus other treatments (such as physical therapy and low intensity exercise) on risk of falls in at-risk and older adults.

There was high-quality evidence that tai chi significantly reduced the rate of falls by 43% compared with other interventions at short-term follow-up (less than 12 months) and by 13% at long-term follow-up (more than 12 months). Regarding injurious falls, there was some evidence that tai chi reduced risk by 50% over the short term and by 28% over the long term. Tai chi did not seem to influence when an older or at-risk adult was likely to experience their first injurious fall.

"Tai chi practice may be recommended to prevent falls in at-risk adults and older adults. The length of the interventions ranged from 12 to 26 weeks. The frequency of the 1-hour sessions ranged from one to three times per week," said Dr. Lomas-Vega. "Due to the small number of published studies, further research is needed to investigate the effect of tai chi on injurious falls and time to first fall."

Weight in adolescence may affect colorectal cancer risk

A new study has uncovered a link between being overweight or obese in adolescence and an increased risk of developing colon cancer in adulthood. Obesity was also associated with an elevated risk of developing rectal cancer. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings come at a time of growing concern about the impact of adolescent overweight and obesity on chronic disease later in life.

Study results on a potential link between adolescent obesity and the risk of colorectal cancer are conflicting, and many of the studies' designs have been limited. To provide more clarity, Zohar Levi, MD, of the Rabin Medical Center and the Tel Aviv University in Israel, and his colleagues analyzed information on 1,087,358 Jewish males and 707,212 Jewish females who underwent health examinations, including measures of body mass index (BMI), at age 16 to 19 years (predominantly aged 17 years) between 1967 and 2002. Individuals were followed to 2012.

Over a median follow-up of 23 years, 2967 new cases of colorectal cancer were identified, including 1977 among men (1403 colon, 574 rectum) and 990 among women (764 colon, 226 rectum). Overweight and obesity were associated with 53% and 54% higher risks of colon cancer for men and women, respectively. Obesity was associated with a 71% increased risk of rectal cancer in men and more than a twofold increased risk in women.

"This is a huge cohort with a minimum follow up of 10 years, and all individuals had measured BMI, not just reported or recalled," said Prof. Levi. "This is the largest study ever, including both men and women, and it had the power to prove the importance of BMI at age 17 on events later in life."

The main limitation of the study is that the cohort was still young, with the median age at colorectal cancer diagnosis of 49.4 years. The study also lacked data on diet, physical activity, and smoking, which might affect risk estimates. Family history of colorectal cancer was also unknown.

Patients who still used statins after adverse reactions:lower rates of death and cardiovascular events

Statins are known to reduce the risk of death and cardiovascular events for people who are at high risk; however, as many as 75 percent of patients discontinue statin therapy within two years, often after reporting an adverse reaction, such as muscle aches and pains or gastrointestinal symptoms. A new study by researchers from Brigham and Women's Hospital explores outcomes for patients who continue receiving statins after experiencing an adverse reaction, finding that they had a lower risk of death and cardiovascular events. Among a subset of patients who continued taking a different statin, about 26 percent experienced a second adverse reaction, but the vast majority continued receiving the medication. The team reports its findings in a paper published July 25 in Annals of Internal Medicine.

"Statins represent an extremely effective therapy for managing risk of cardiovascular disease and have a much lower cost than new classes of drugs such as PCSK9 inhibitors. Our results indicate that they continue to be very effective at reducing risk, even after a patient has experienced an adverse reaction," said corresponding author Alex Turchin, MD, MS, an endocrinologist at BWH. "Whether a patient should continue taking statins after experiencing adverse symptoms is an important decision. We hope that our study's findings will help patients and their clinicians as they choose the best approach to fit a patient's circumstances."

In this retrospective cohort study, the researchers aggregated information from the electronic medical records of 28,266 study participants who had been seen at a primary care setting associated with Brigham and Women's Hospital or Massachusetts General Hospital. Adverse reactions were identified using natural language processing of narrative provider notes.

The researchers found that 70 percent of patients continued receiving statin prescriptions after the adverse reaction. The team then analyzed a composite primary outcome of heart attack, stroke or death from any cause. Patients who continued receiving statin prescriptions had a 12.2 percent incidence rate compared to those without a continued prescription who had an incidence rate of 13.9 percent.

In addition, the team performed a secondary analysis on 7,000 patients who had been switched to another statin medication following an adverse event. They found that about 26 percent reported a second adverse reaction after starting the second statin drug, but that more than 80 percent continued receiving their prescription, suggesting that the side effects, if any, were tolerable to the patients.

"Statins remain a first-line therapy for managing cardiovascular risk, but many patients do not reattempt statin therapy and remain without treatment for prolonged periods after an adverse reaction," said Turchin. "Alternative therapies such as ezetimibe are not as effective, and new classes of drugs are expensive. Improving our understanding of the benefits and risks of reattempting statin therapies before switching to a different class of drugs could help both patients and physicians make informed choices about care."

Because this is a retrospective study, the researchers could not determine cause and effect, but did see a clear association between continued statin prescription and lower incidence of death and cardiovascular events. The authors note some of the inherent limitations of their study, including that they could only determine which patients continued receiving a statin prescription - not necessarily whether the patients actually continued taking the drug. In addition, they were only able to analyze a subset of patients for risk of recurrent adverse reactions.

Some dangers of antidepressants and certain antibiotics during pregnancy

Children exposed to antidepressants during pregnancy seem to be at a slightly higher risk of autism than children of mothers with psychiatric disorders who were not treated with antidepressants during pregnancy, finds a study published in The BMJ, although the absolute risk of autism was small.

 A new study published in the British Journal of Clinical Pharmacology has found links between certain antibiotics during pregnancy and major congenital malformations in newborns. Clindamycin, doxycycline, quinolones, macrolides, and phenoxymethylpenicillin were linked to organ-specific malformations, although the absolute risks for birth defects were small. Amoxicillin, cephalosporins, and nitrofurantoin were not associated with birth defects.

Gaining a few pounds may increase long-term heart failure risk

Gaining even a little weight over time may alter the structure and function of heart muscle, affecting long-term risk of heart failure, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

Researchers followed 1,262 adults (average age 44, 57 percent women, 44 percent black, 36 percent obese) who were free from heart disease and other conditions that put them at high risk for heart disease for seven years. Participants had MRIs scans of their hearts and multiple body fat measurements at the start of the study and then seven years later.

Researchers found those who gained weight:

• even as little as 5 percent, were more likely to have thickening and enlargement of the left ventricle, well-established indicators of future heart failure;
• were more likely to exhibit subtle decreases in their hearts' pumping ability; and
• were more likely to exhibit changes in heart muscle appearance and function that persisted even after the researchers eliminated other factors that could affect heart muscle performance and appearance, including high blood pressure, diabetes, smoking and alcohol use.

Conversely, people who lost weight were more likely to exhibit decreases in heart muscle thickness.

Notably, how much a person weighed at the beginning of the study didn't impact the changes, suggesting that even those of normal weight could experience adverse heart effects if they gain weight over time, researchers said.

"Any weight gain may lead to detrimental changes in the heart above and beyond the effects of baseline weight so that prevention should focus on weight loss or if meaningful weight loss cannot be achieved - the focus should be on weight stability," said Ian Neeland, M.D., study senior author and a cardiologist and assistant professor of medicine at University of Texas Southwestern Medical Center in Dallas, Texas. "Counseling to maintain weight stability, even in the absence of weight loss, may be an important preventive strategy among high-risk individuals."

The researchers caution that their study was relatively small and their findings do not mean that every person with weight gain will necessarily develop heart failure. The results do suggest that changes in weight may affect heart muscle in ways that can change the organ's function.

Healthy eating and exercise in pregnancy limits weight gain and lowers odds of caesarean

Encouraging healthy eating and physical activity during pregnancy limits excess weight gain and lowers the odds of having a caesarean section, finds a study published by The BMJ today.

The benefits are consistent, regardless of a woman's age, ethnicity, body mass index (BMI) and underlying medical conditions, suggesting that all women should be given advice on diet and lifestyle as part of routine antenatal care.

Both maternal obesity and excessive weight gain in pregnancy (gestational weight gain) put mother and infant at risk, both in pregnancy and in later life, with considerable costs to the health service and society.

Interventions based on diet or physical activity, or both, in pregnancy minimise gestational weight gain, and therefore may have a role in preventing adverse pregnancy outcomes.

So researchers from the International Weight Management in Pregnancy (i-WIP) Collaborative Group set out to assess the effects of diet and physical activity based interventions in pregnancy on weight gain and outcomes such as caesarean section, stillbirth and admission to a newborn intensive care unit.

Interventions included access to a dietician, specific antenatal classes for advice on diet and lifestyle, or structured exercise of moderate intensity (eg, aerobic classes or stationary cycling).

The research team analysed individual participant data from 36 randomised trials involving over 12,500 women, grouped according to age, pregnancy history, ethnicity, body mass index (BMI), and underlying medical conditions. Overall, the trials had a low risk of bias.

Diet and physical activity based interventions consistently reduced gestational weight gain, regardless of age, pregnancy history, ethnicity, BMI, and existing medical conditions, and remained when studies at high risk of bias were excluded.

Interventions also lowered the odds of caesarean section, but had no effect on offspring outcomes, such as stillbirth or admission to an intensive care unit.

When they included additional study-level data, they found additional benefit for gestational diabetes.

The authors outline some study limitations, including the fact that participants were mostly white and of medium to high education status, a factor favouring compliance with interventions. Nevertheless, they say their analysis "confirms that diet and physical activity based interventions in pregnancy reduce gestational weight gain."

And they say discussions about diet and physical activity in pregnancy, which are delivered as part of antenatal care, "should incorporate specific estimates of benefit for caesarean section and gestational weight gain, and the likelihood of preventing gestational diabetes."

Importantly, such interventions in pregnancy "could be considered in global efforts to reduce caesarean section in relevant populations," they conclude.

A linked editorial says this study provides reassuring information for women and healthcare practitioners that lifestyle interventions are safe in pregnancy, and help control weight gain.

1 in 3 cases of dementia preventable, nonmedical therapies ideal for dementia

Managing lifestyle factors such as hearing loss, smoking, hypertension and depression could prevent one-third of the world's dementia cases, according to a report by the first Lancet Commission on Dementia Prevention and Care. Presented at the Alzheimer's Association International Conference (AAIC) 2017 and published in The Lancet, the report also highlights the beneficial effects of nonpharmacologic interventions such as social contact and exercise for people with dementia.

"There's been a great deal of focus on developing medicines to prevent dementia, including Alzheimer's disease," says commission member and AAIC presenter Lon Schneider, MD, professor of psychiatry and the behavioral sciences at the Keck School of Medicine of USC. "But we can't lose sight of the real major advances we've already made in treating dementia, including preventive approaches."

The commission brought together 24 international experts to systematically review existing research and provide evidence-based recommendations for treating and preventing dementia. About 47 million people have dementia worldwide and that number is expected to climb as high as 66 million by 2030 and 115 million by 2050.

Reducing dementia risk, beginning in childhood

The commission's report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia -- one in three cases -- is attributable to these risk factors, the report says.

By increasing education in early life and addressing hearing loss, hypertension and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined.

In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact and managing diabetes could reduce the incidence of dementia by another 15 percent.

"The potential magnitude of the effect on dementia of reducing these risk factors is larger than we could ever imagine the effect that current, experimental medications could have," Schneider says. "Mitigating risk factors provides us a powerful way to reduce the global burden of dementia."

A nonpharmacologic approach to treating dementia

The commission also examined the effect of nonpharmacologic interventions for people with dementia and concluded that they had an important role in treatment, especially when trying to address agitation and aggression.

"Antipsychotic drugs are commonly used to treat agitation and aggression, but there is substantial concern about these drugs because of an increased risk of death, cardiovascular adverse events and infections, not to mention excessive sedation," Schneider says.

The evidence showed that psychological, social and environmental interventions such as social contact and activities were superior to antipsychotic medications for treating dementia-related agitation and aggression.

The commission also found that nonpharmacologic interventions like group cognitive stimulation therapy and exercise conferred some benefit in cognition as well.

The commission's full report provides detailed recommendations in the areas of prevention, treating cognitive symptoms, individualizing dementia care, caring for caregivers, planning for the future following a dementia diagnosis, managing neuropsychiatric symptoms and considering the end of life.

Why sugary drinks and protein-rich meals don't go well together

Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Dr Shanon Casperson, lead author of the study from USDA-Agricultural Research Service Grand Forks Human Nutrition Research Center, USA said: "We found that about a third of the additional calories provided by the sugar-sweetened drinks were not expended, fat metabolism was reduced, and it took less energy to metabolize the meals. This decreased metabolic efficiency may 'prime' the body to store more fat."

The researchers found that the inclusion of a sugar-sweetened drink decreased fat oxidation, which kick-starts the breakdown of fat molecules, after a meal by 8%. If a sugar-sweetened drink was consumed with a 15% protein meal, fat oxidation decreased by 7.2g on average. If a sugar-sweetened drink was consumed with a 30% protein meal, fat oxidation decreased by 12.6g on average. While having a sugar-sweetened drink increased the amount of energy used to metabolise the meal, the increased expenditure did not even out the consumption of additional calories from the drink.

Dr. Casperson said: "We were surprised by the impact that the sugar-sweetened drinks had on metabolism when they were paired with higher-protein meals. This combination also increased study subjects' desire to eat savory and salty foods for four hours after eating."

The researchers recruited 27 healthy-weight adults (13 male, 14 female), who were on average 23 years old. Participants made two 24-hour study visits, receiving two 15% protein meals (breakfast and lunch) after an overnight fast on one visit and two 30% protein meals after an overnight fast on the other visit. The increase in protein was counterbalanced by a decrease in carbohydrates. All meals were composed of the same foods and they provided 17g of fat and 500 kcals. Participants consumed a sugar-sweetened drink with one of the meals and a non-sugar sweetened drink with the other meal.

The researchers used a room calorimeter, a 25m3 furnished chamber that measures movement, oxygen, carbon dioxide, temperature and pressure, to assess how dietary changes affected energy expenditure and the way nutrients were processed by the body. By having study participants stay in a room calorimeter, researchers can determine how many grams of carbohydrate, protein and fat they are using and how many calories they are burning every minute. Study participants stayed inside the room for the duration of each study visit.

Dr. Casperson said: "Our findings suggest that having a sugar-sweetened drink with a meal impacts both sides of the energy balance equation. On the intake side, the additional energy from the drink did not make people feel more sated. On the expenditure side, the additional calories were not expended and fat oxidation was reduced. The results provide further insight into the potential role of sugar-sweetened drinks - the largest single source of sugar in the American diet - in weight gain and obesity."

Dietary changes were measured only for a short time and caution must be used when extrapolating the study data to dietary changes over longer periods of time. As this study was in healthy-weight adults only, the authors also caution that overweight individuals may respond differently to dietary changes.

Breakfast the largest meal = losing weight; dinner the largest: gaining weight

A study by researchers from Loma Linda University School of Public Health and the Czech Republic has found that timing and frequency of meals play a role in predicting weight loss or gain.

Using information gleaned from more than 50,000 participants in the Adventist Health Study-2 (AHS-2), the researchers discovered four factors associated with a decrease in body mass index: eating only one or two meals per day; maintaining an overnight fast of up to 18 hours; eating breakfast instead of skipping it; and making breakfast or lunch the largest meal of the day. Making breakfast the largest meal yielded a more significant decrease in BMI than did lunch.

The two factors associated with higher BMI were eating more than three meals per day --snacks were counted as extra meals -- and making supper the largest meal of the day.

As a practical weight-management strategy, Hana Kahleova, MD, PhD, recommends eating breakfast and lunch, skipping supper, avoiding snacks, making breakfast the largest meal of the day and fasting overnight for up to 18 hours. A postdoctoral research fellow at LLUSPH when the study was conducted, Kahleova is now director of clinical research for the Physicians Committee for Responsible Medicine in Washington, DC, and is currently on sabbatical from the Institute for Clinical and Experimental Medicine in Prague, Czech Republic, as a postdoctoral research fellow and diabetes consultant physician.

Kahleova says the findings confirm an ancient nutritional maxim: "Eat breakfast like a king, lunch like a prince, and dinner like a pauper."

Titled "Meal frequency and timing are associated with Body Mass Index in the Adventist Health Study-2," the study was co-written by Gary Fraser, MBChB, PhD, a professor at LLU Schools of Medicine and Public Health, and director of AHS-2. It was published as an online advance on July 12 and will appear in the Sept. 2017 edition of the Journal of Nutrition.

Fraser said that irrespective of meal pattern, there was, on average, an increase in weight gain year by year until participants reached the age of 60. After age 60, most participants experienced a weight loss each year.

"Before age 60 years, those eating calories earlier in the day had less weight gain," Fraser said, adding that after age 60, the same behavior tended to produce a larger rate of weight loss than average. "Over decades, the total effect would be very important."

The team employed a technique called linear regression analysis and adjusted their findings to exclude demographic and lifestyle factors that might skew the results.

Perceiving oneself as less physically active than peers is linked to a shorter lifespan

Would you say that you are physically more active, less active, or about equally active as other people your age?

Your answer might be linked to your risk of premature death decades from now - no matter how physically active you actually are, according to research by Stanford scholars Octavia Zahrt and Alia Crum.

The research, appearing July 20 in Health Psychology, finds that people who think they are less active than others in a similar age bracket die younger than those who believe they are more active -- even if their actual activity levels are similar.

"Our findings fall in line with a growing body of research suggesting that our mindsets -- in this case, beliefs about how much exercise we are getting relative to others -- can play a crucial role in our health," Crum said.

Powerful effects of perception

Crum, an assistant professor of psychology, and Zahrt, a doctoral candidate at the Graduate School of Business, analyzed surveys from more than 60,000 U.S. adults from three national data sets. The surveys documented participants' levels of physical activity, health and personal background, among other measures. In one of the samples, participants wore an accelerometer to measure their activity over a week.

Zahrt and Crum were interested in one question in particular: "Would you say that you are physically more active, less active, or about as active as other persons your age?"

The researchers then viewed death records from 2011, which was 21 years after the first survey was conducted. Controlling for physical activity and using statistical models that accounted for age, body mass index, chronic illnesses and other factors, they found that individuals who believed that they were less active than others were up to 71 percent more likely to die in the follow-up period than individuals who believed that they were more active than their peers.

Fit on the Farm?

Much of the study's inspiration derived from Zahrt's experience when she arrived at Stanford. Zahrt, a native of Germany who previously studied in France and England, had stayed in shape by biking to school and making occasional trips to the gym.

But at Stanford, Zahrt said it seemed that "everyone was incredibly active" and perhaps she wasn't exercising as much as she should.

"Suddenly, I felt like I had done something wrong all these years," Zahrt said. "I felt unhealthy and I was stressed about fitting more exercise into my busy schedule. I really had a negative mindset."

While taking a health psychology class taught by Crum, Zahrt learned more about the effects of mindsets on health outcomes. For example, Crum's prior research shows that the health benefits people get out of everyday activities depend in part on their mindsets -- that is, whether or not they believe that they are getting good exercise. In her 2007 study, Crum made a group of hotel room attendants aware that the activity they got at work met recommended levels of physical activity. Through this shift in mindsets, the workers, many of whom had previously perceived themselves as inactive, experienced reductions in weight, body fat and blood pressure, among other positive outcomes. Zahrt wondered if many people, like her, had negative mindsets about their physical activity levels because of social comparison with more active peers, and if this might be harming their health. Her class paper on this topic sparked the collaboration leading to the published study.

How mindsets influence us

Zahrt and Crum offer possible explanations for mindsets and perceptions having such powerful effects on health. One is that perceptions can affect motivation, both positively and negatively. Those who are made aware of their healthy activity levels -- like the hotel room attendants in Crum's 2007 study -- can build on them and exercise more. Those who deem themselves unfit are more likely to remain inactive, fueling feelings of fear, stress or depression that negatively affect their health.

The researchers also cite the established influence of placebo effects, where patients who think they are getting a treatment experience physiological changes without receiving actual treatment. In the same way, people who believe they are getting good exercise may experience more physiological benefits from their exercise than those who believe they aren't getting enough exercise.

"Placebo effects are very robust in medicine. It is only logical to expect that they would play a role in shaping the benefits of behavioral health as well," Crum said.

The researchers emphasize that the study is correlational in nature and thus does not prove that perceptions of inactivity cause earlier death. However, other experimental research -- such as Crum's 2007 study - does suggest a causal nature to the link between perceived amounts of exercise and health outcomes.

Taking mindsets seriously

"So much effort, notably in public health campaigns, is geared toward motivating people to change their behavior: eat healthier, exercise more and stress less," Crum said. "But an important variable is being left out of the equation: people's mindsets about those healthy behaviors."

In fact, a growing volume of research from Crum and other labs shows that perceptions and mindsets predict health and longevity, for example, in the domains of stress, diet and obesity.

That our mindsets could have such potent effects on our physiology may seem provocative and unlikely at first glance, but Crum reminds us that we shouldn't be surprised by these results considering the "everyday experiences where our beliefs or a simple thought have very palpable and physiological effects."

"In the case of stress, a thought about something going wrong can make us sweat or [become] shaky or increase our heart rate," Crum continued. "With sexual arousal, a simple thought or idea can have immediate physical effects. We experience these things regularly, and yet we're not cataloguing them as something that matters. For whatever reason -- dualism or a prioritization of the material -- we tend to ignore the fact that our thoughts, mindsets and expectations are shaping our everyday physiology."

How can people use this finding? Many Americans think that vigorous exercise in a gym is the only way to attain a proper activity level, according to Zahrt and Crum. But being mindful of and feeling good about activities you do every day - like taking the stairs, walking or biking to work, or cleaning the house -- could be an easy first step for everyone to benefit their health.

"It's time that we start taking the role of mindsets in health more seriously," Crum said. "In the pursuit of health and longevity, it is important to adopt not only healthy behaviors, but also healthy thoughts."

Study finds day-to-day experiences affect awareness of aging, mood

A study of older adults finds an individual's awareness of aging is not as static as previously thought, and that day-to-day experiences and one's attitude toward aging can affect an individual's awareness of age-related change (AARC) - and how that awareness affects one's mood.

"People tend to have an overall attitude toward aging, good or bad, but we wanted to know whether their awareness of their own aging - or AARC - fluctuated over time in response to their everyday experiences," says Shevaun Neupert, an associate professor of psychology at North Carolina State University and lead author of a paper on the study.

For the study, researchers enrolled 116 participants between the ages of 60 and 90. Each participant took a survey to establish baseline attitudes toward aging. For the following eight days, participants kept a log of daily stressors (such as having an argument), completed a daily evaluation of age-related experiences (such as "I am becoming wiser" or "I am more slow in my thinking"), and reported on their affect, or mood.

"We found that people's AARC, as reflected in their daily evaluations, varied significantly from day to day," says Jennifer Bellingtier, a recent Ph.D. graduate from NC State and co-author of the paper. "We also found that people whose baseline attitudes toward aging were positive also tended to report more positive affect, or better moods."

"People with positive attitudes toward aging were also less likely to report 'losses,' or negative experiences, in their daily aging evaluations," Neupert says.

"However, when people with positive attitudes did report losses, it had a much more significant impact on their affect that day," Neupert says. "In other words, negative aging experiences had a bigger adverse impact on mood for people who normally had a positive attitude about aging."

The study expands on previous work that found having a positive attitude about aging makes older adults more resilient when faced with stressful situations.

The paper, "Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect," is published in the journal The Gerontologist.

A healthy lifestyle increases life expectancy by up to 7 years

People who do not smoke, are not obese, and consume alcohol moderately can expect to live seven years longer than the general population, and to spend most of these extra years in good health, according to a new study published today in Health Affairs.

A new study published today in Health Affairs shows that people who refrain from engaging in risky health behaviours not only have a very long life -- longer than the famously long-lived Japanese - but that most of these additional years of life are spent in good health.

The study, which analyzed data for more than 14,000 U.S. individuals, found that never-smokers who were not obese lived 4-5 years longer than the general population, and that these extra years were free of disability. The results of the analysis further indicated that individuals who also consumed alcohol moderately lived seven more disability-free years than the general population, and had a total life expectancy surpassing that of the population of Japan, a country that is often considered to be a vanguard of life expectancy. The study was conducted by Mikko Myrskylä, Director of the Max Planck Institute for Demographic Research, Germany; and Neil Mehta, Professor of Health Management and Policy at the University of Michigan, USA.

Several behaviours have a cumulative impact

"Improvements in medical technology are often thought to be the gatekeeper to healthier, longer life. We showed that a healthy lifestyle, which costs nothing, is enough to enable individuals to enjoy a very long and healthy life," said Mikko Myrskylä.

He added: "A moderately healthy lifestyle is enough to get the benefits. Avoiding becoming obese, not smoking, and consuming alcohol moderately is not an unrealistic goal."

This study was the first to analyze the cumulative impact of several key health behaviours on disability-free and total life expectancy. Previous studies have looked at single health behaviours. Mikko Myrskylä and his colleague instead examined several behaviors simultaneously, which allowed them to determine how long and healthy the lives of people who had avoided most of the well-known individual behavioral risk factors were.

Smoking and obesity affect health when aging

The researchers noted that each of the three unhealthy behaviours - obesity, smoking, and unhealthy consumption of alcohol - was linked to a reduction in life expectancy and to an earlier occurrence of disabilities.

But there were also differences: smoking was found to be associated with an early death but not with an increase in the number of years with disability, whereas obesity was shown to be associated with a long period of time with disability. Excessive alcohol consumption was found to be associated with both decreased lifespan and a reduced number of healthy years. However, the absence of all of these risky healthy behaviors was found to be associated with the greatest number of healthy years.

The most striking finding was the discovery of a large difference in average lifespan between the groups who were the most and the least at risk. Men who were not overweight, had never smoked, and drank moderately were found to live an average of 11 years longer than men who were overweight, had smoked, and drank excessively. For women, the gap between these two groups was found to be even greater, at 12 years.

"The most positive result is that the number of years that we have to live with physical limitations does not increase as we gain more years through healthy lifestyle. Instead, healthy lifestyle is associated with a strong increase in physically fit years. In other words, the years we gain through a healthy lifestyle are years in good health," said Mikko Myrskylä.

"Our results show how important it is to focus on prevention. Those who avoid risky health behaviours are achieving very long and healthy lives. Effective policy interventions targeting health behaviors could help larger fractions of the population to achieve the health benefits observed in this study," the researcher emphasized.

These results are important not only for individuals, but also for society. In an aging society, the health of the elderly determines the amount of money spent on the health system. In addition, healthy elderly people are better able to participate in the labor market and to perform social roles, such as caring for grandchildren.

The researchers used data from a long-term study conducted in the U.S., the Health and Retirement Study, which covered more than 14,000 individuals aged 50-89 over the 1998-2012 period. The participants were interviewed about their health and behaviors every two years. Those who reported having no limitations in the so-called activities of daily living (walking, dressing, bathing, getting out of bed, or eating) were classified as free of disability. The participants who had a body mass index of less than 30 were classified as not obese. Those who had smoked less than 100 cigarettes in their lifetime were considered never smokers. Men who had fewer than 14 drinks per week and women who had fewer than seven drinks per week were considered moderate drinkers.

The researchers analyzed the ages at which the individuals with these healthy behaviours first became disabled, how many years they lived with disability, and their total life expectancy. The researchers then compared these results with those of the general population, and with those of individuals with particularly risky behavioural profiles.

How physical exercise prevents dementia

Numerous studies have shown that physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age. Now researchers at Goethe University Frankfurt have explored in one of the first studies worldwide how exercise affects brain metabolism.

In order to further advance current state of knowledge on the positive influence of physical activity on the brain, gerontologists and sports physicians at Goethe University Frankfurt have examined the effects of regular exercise on brain metabolism and memory of 60 participants aged between 65 and 85 in a randomised controlled trial. Their conclusion: regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.

As the researchers report in the current issue of the medical journal Translational Psychiatry, they thoroughly examined all the participants in the SMART study (Sport and Metabolism in Older Persons, an MRT Study) by assessing movement-related parameters, cardiopulmonary fitness and cognitive performance. In addition, magnetic resonance tomography (MRT) and magnetic resonance spectroscopy (MRS) were used to measure brain metabolism and brain structure. Following this examination, the participants mounted an exercise bike three times a week over a period of 12 weeks. The 30-minute training sessions were individually adapted to each participant's performance level.

The participants were examined again after the end of the programme in order to document the effects of this physical activity on brain metabolism, cognitive performance and brain structure. The researchers also investigated to what extent exercise had led to an improvement in the participants' physical fitness. The study was conducted by the Gerontology Department of the Institute of General Medicine (headed by Professor Johannes Pantel) and the Department of Sports Medicine (led by Professor Winfried Banzer).

As expected, physical activity had influenced brain metabolism: it prevented an increase in choline. The concentration of this metabolite often rises as a result of the increased loss of nerve cells, which typically occurs in the case of Alzheimer's disease. Physical exercise led to stable cerebral choline concentrations in the training group, whereas choline levels increased in the control group. The participants' physical fitness also improved: they showed increased cardiac efficiency after the training period. Overall, these findings suggest that physical exercise not only improves physical fitness but also protects cells.

Grapefruit Juice and Some Drugs Don't Mix

Grapefruit juice and the actual grapefruit can be part of a healthy diet. Grapefruit has vitamin C and potassium—nutrients your body needs to work properly.

But it isn’t good for you when it affects the way your medicines work, especially if you have high blood pressure or arrhythmia (irregular or abnormal heart beat).

This food and drug interaction can be a concern, says Shiew Mei Huang, PhD, of the U.S. Food and Drug Administration. The FDA has required that some prescription and over-the-counter (OTC) drugs taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug, Huang says.

Here are examples of some types of drugs that grapefruit juice can cause problems with (interact):

• Some statin drugs to lower cholesterol, such as Zocor (simvastatin) and Lipitor (atorvastatin).
• Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine).
• Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine).
• Some anti-anxiety drugs, such as buspirone.
• Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide).
• Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone).
• Some antihistamines, such as Allegra (fexofenadine).

Grapefruit juice does not affect all the drugs in the categories above. The severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice you drink. Talk to your doctor, pharmacist or other health care provider and read any information provided with your prescription or OTC drug to find out:

• If your specific drug may be affected.
• How much, if any, grapefruit juice you can have.
• What other fruits or juices may also affect your drug in a similar way to grapefruit juice.

How Grapefruit Juice Can Interfere With Medications

With most drugs that interact with grapefruit juice, “the juice lets more of the drug enter the blood,” Huang says. “When there is too much drug in the blood, you may have more side effects.”
For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver and muscle damage that can lead to kidney failure.

Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.

The amount of the CYP3A4 enzyme in the intestine varies from person to person, says Huang. Some people have a lot of enzymes and others just a little. So grapefruit juice may affect people differently even when they take the same drug.

Although scientists have known for several decades that grapefruit juice can cause too much of certain drugs in the body, Huang says more recent studies have found that the juice has the opposite effect on a few other drugs.

“Grapefruit juice can cause less fexofenadine to enter the blood,” decreasing how well the drug works, Huang says. Fexofenadine (brand name Allegra) is available as both prescription and OTC to relieve symptoms of seasonal allergies. Fexofenadine may also not work as well if taken with orange or apple juice, so the drug label states “do not take with fruit juices.”

Why this opposite effect? Instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, which help move a drug into our cells for absorption. As a result, less of the drug enters the blood and the drug may not work as well, Huang says.

Poor sleep = poor physical and mental health

More than a third of Americans don't get enough sleep, and growing evidence suggests it's not only taking a toll on their physical health through heart disease, diabetes, stroke, and/or other conditions, but hurting their mental health as well.

According to a recent study led by Postdoctoral FellowIvan Vargas, PhD, in the journal Cognitive Therapy and Research, those who are sleep deprived lose some of their ability to be positive-minded people. That may not sound serious, but medical experts say an inability to think positively is a serious symptom of depression that could be dangerous if left unaddressed. An estimated 16.1 million adults experienced a major depressive episode in 2014.

"In general, we have a tendency to notice positive stimuli in our environment," said Vargas. "We tend to focus on positive things more than anything else, but now we're seeing that sleep deprivation may reverse that bias."

In their study, Vargas and his team took 40 healthy adults, and randomized them to either 28 consecutive hours awake, or a full eight hours of sleep. All participants participated in a computer test measuring their accuracy and response time at identifying happy, sad and neutral faces to assess how they pay attention to positive or negative information.

The team found that those who were acutely sleep deprived were less likely to focus on the happy faces. They didn't necessarily focus more on the negative, but were less likely to focus on the positive. The study may have implications for those experiencing depression and/or anxiety.
There are many symptoms of depression -- including feeling sad and no longer being able to enjoy things you typically would, but poor sleep is associated with a particularly serious sign of the condition.

"Depression is typically characterized as the tendency to think and feel more negatively or sad, but more than that, depression is associated with feeling less positive, less able to feel happy," Vargas says, "Similarly, if you don't get enough sleep, it reduces your ability to attend to positive things, which over time may confer risk for depression."

Interestingly enough, in the present study, those with a history of insomnia symptoms were less sensitive to the effects of the sleep loss. The authors believe this might be because those with a history of insomnia symptoms have more experience being in sleep-deprived conditions and have developed coping methods to modulate the effect of sleep loss.

Vargas and colleagues recently presented a related study at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC, on the association of insomnia and suicide, finding that people who suffer from insomnia are three times more likely to report thoughts of suicide and death during the past 30 days than those without the condition.

The study comes amid a growing body of knowledge associating sleep disorders and depression. For example, ongoing research presented this year at SLEEP 2017 from a multi-center NIH-sponsored "Treatment of Insomnia and Depression" study (abstract 0335 here) suggests that cognitive-behavioral therapy for insomnia (CBT-I) may help achieve depression remission in those suffering from both depression and insomnia who sleep at least 7 hours each night. (A clinical practice guideline published in 2016 in Annals of Internal Medicine recommends CBT-I (not sleep medications) as the initial treatment for chronic insomnia.

Additionally, a new study in the journal Child Development furthers our understanding of the connection between late night cell phone use, mental health, and disrupted sleep, finding that using a cell phone at night can increase depression in teenagers and lower their self-esteem.
 

 

 

Long working hours increases the risk of developing atrial fibrillation

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People who work long hours have an increased risk of developing an irregular heart rhythm known as atrial fibrillation, according to a study of nearly 85,500 men and women published in the European Heart Journal.

The study showed that, compared to people who worked a normal week of between 35-40 hours, those who worked 55 hours or more were approximately 40% more likely to develop atrial fibrillation during the following ten years. For every 1000 people in the study, an extra 5.2 cases of atrial fibrillation occurred among those working long hours during the ten-year follow-up.

Prof Kivimaki and colleagues from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium analysed data from 85,494 men and women from the UK, Denmark, Sweden and Finland who took part in one of eight studies in these countries. They assessed the participants' working hours when they joined the studies between 1991 and 2004. Working hours were classified as less than 35 hours a week, 35-40 hours, which was considered as the standard working hours of full-time workers, 41 to 48 hours, 49 to 54 hours, and 55 hours or more a week. None of the participants had atrial fibrillation at the start of the studies.

During the ten-year follow-up period, there were 1061 new cases of atrial fibrillation. This gave an incidence rate of 12.4 per 1000 people in the study, but among the 4,484 people working 55 hours or more, the incidence was 17.6 per 1000. "Those who worked long hours had a 1.4 times higher risk of developing atrial fibrillation, even after we had adjusted for factors that could affect the risk, such as age, sex, socioeconomic status, obesity, leisure time physical activity, smoking and risky alcohol use," said Prof Kivimaki.

"Nine out of ten of the atrial fibrillation cases occurred in people who were free of pre-existing or concurrent cardiovascular disease. This suggests the increased risk is likely to reflect the effect of long working hours rather than the effect of any pre-existing or concurrent cardiovascular disease, but further research is needed to understand the mechanisms involved.

"A 40% increased extra risk is an important hazard for people who already have a high overall risk of cardiovascular disease due to other risk factors such as older age, male sex, diabetes, high blood pressure, high cholesterol, overweight, smoking and physical inactivity, or living with an established cardiovascular disease. For a healthy, young person, with few if any of these risk factors, the absolute increased risk of atrial fibrillation associated with long working hours is small."

The study does have some limitations, including the fact that working hours were only assessed once at the beginning of the study and that the type of job (for instance, whether it involved working night shifts) was not recorded.

However, Prof Kivimaki said: "The great strength of our study was its size, with nearly 85,000 participants, which makes it large by the standard of any study in this field. Obviously, monitoring of working hours over several years would be more ideal than a one-off measurement at the start of the study. However, I do not think the results would have been dramatically different with repeat measurements of working hours because people tend to keep their working patterns. In the current absence of trials with atrial fibrillation as the primary outcome in the general population, findings from observational studies such as this are particularly important in offering insights into the lifestyle determinants of this condition."

In an accompanying editorial, Dr Bakhtawar Mahmoodi and Dr Lucas Boersma, of St Antonius Hospital, Nieuwegein, The Netherlands, write: "The authors should be congratulated for the impressive collaborative effort required to integrate patient level data from multiple studies to increase the power. However, despite the efforts of the authors to thoroughly assess the reported association between long working hours and atrial fibrillation, there are many inherent limitations of the data that preclude from definite conclusions on acknowledging long working hours as an independent risk factor for atrial fibrillation."

They highlight the long, ten-year follow-up time during which there was no updated information on working hours and other factors that Prof Kivimaki and colleagues took into account in their analyses and which could have changed over this time. The type of jobs (office versus construction work) and irregular working hours, including night shifts, were not explored in the analyses, and these could have an impact on the risk of atrial fibrillation too. However, they conclude that the study "addresses an important topic and expands the literature on the aetiology of atrial fibrillation."

Artificial sweeteners linked to risk of weight gain, heart disease and other health issues

Artificial sweeteners may be associated with long-term weight gain and increased risk of obesity, diabetes, high blood pressure and heart disease, according to a new study published in CMAJ (Canadian Medical Association Journal)

Consumption of artificial sweeteners, such as aspartame, sucralose and stevia, is widespread and increasing. Emerging data indicate that artificial, or nonnutritive, sweeteners may have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting.

To better understand whether consuming artificial sweeteners is associated with negative long-term effects on weight and heart disease, researchers from the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation conducted a systematic review of 37 studies that followed over 400 000 people for an average of 10 years. Only 7 of these studies were randomized controlled trials (the gold standard in clinical research), involving 1003 people followed for 6 months on average.

The trials did not show a consistent effect of artificial sweeteners on weight loss, and the longer observational studies showed a link between consumption of artificial sweeteners and relatively higher risks of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues.

"Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products," said author Dr. Ryan Zarychanski, Assistant Professor, Rady Faculty of Health Sciences, University of Manitoba. "We found that data from clinical trials do not clearly support the intended benefits of artificial sweeteners for weight management."

"Caution is warranted until the long-term health effects of artificial sweeteners are fully characterized," said lead author Dr. Meghan Azad, Assistant Professor, Rady Faculty of Health Sciences, University of Manitoba. Her team at the Children's Hospital Research Institute of Manitoba is undertaking a new study to understand how artificial sweetener consumption by pregnant women may influence weight gain, metabolism and gut bacteria in their infants.

"Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products," said Azad.

The study was conducted by researchers from the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation and the Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba.

Plant-based diets with high intake of sweets, refined grains may increase heart disease risk

Plant-based diets are recommended to reduce the risk of heart disease; however, some plant-based diets are associated with a higher risk of heart disease, according to a study published today in the Journal of the American College of Cardiology.

In prior studies of the impact of a plant-based diet, there were several limitations. Plant-based diets were defined as "vegetarian" which consist of a variety of dietary patterns that exclude some or all animal foods. These studies treat all plant foods equally, even though certain plant foods like refined grains and sugar sweetened beverages are associated with a higher risk of cardio-metabolic disease.

To overcome these limitations, the researchers created three versions of a plant-based diet: an overall plant-based diet which emphasized the consumption of all plant food and reduced (but did not eliminate) animal food intake; a healthful plant-based diet that emphasized the intake of healthy plant foods such as whole grains, fruits and vegetables; and an unhealthful plant-based diet which emphasized consumption of less healthy plant foods such as refined grains.

Researchers used a baseline sample of 73,710 women from the Nurses' Health Study, 92,320 women from the Nurses' Health Study 2 and 43,259 men from the Health Professionals Follow-Up Study. These participants responded to a follow-up questionnaire every two years for over two decades on lifestyle, health behaviors and medical history. Participants with coronary heart disease at baseline were excluded, as were participants with cancer, stroke and coronary artery surgery.

During follow-up, 8,631 participants developed coronary heart disease. Overall, adherence to a plant-based diet was associated with a lower risk of heart disease. A higher intake of a more healthful plant-based diet - one rich in whole grains, fruits, vegetables, etc. - was associated with a substantially lower risk of heart disease. However, a plant-based diet that emphasized less healthy plant foods like sweetened beverages, refined grains, potatoes and sweets had the opposite effect.

"When we examined the associations of the three food categories with heart disease risk, we found that healthy plant foods were associated with lower risk, whereas less healthy plant foods and animal foods were associated with higher risk," said Ambika Satija, ScD, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health in Boston and the study's lead author. "It's apparent that there is a wide variation in the nutritional quality of plant foods, making it crucial to take into consideration the quality of foods in a plant-based diet."

In an accompanying editorial, Kim Allan Williams, MD, MACC, chair of the division of cardiology at Rush University Medical Center in Chicago, said the study adds to the substantial evidence that a predominately plant-based diet reduces heart disease risk. Not all plant-based foods are equally healthy, but plant-based diets with whole grains, unsaturated fats and an abundance of fruits and vegetables "deserve more emphasis in dietary recommendations."

Williams said, the long-term follow up allowed authors to examine dietary patterns and analyze the effect of gradual adherence to a plant-based diet through reduced animal food intake and increased plant food intake on heart disease risk. They said "just as physical activity is a continuum, perhaps an emphasis on starting with smaller dietary tweaks rather than major changes would be more encouraging and sustainable."

Limitations of the study include its observational nature and the self-reported diet assessments. However, these diet assessments were validated against multiple week diet records and biomarkers.

Daily crosswords linked to sharper brain in later life

The more regularly people report doing word puzzles such as crosswords, the better their brain function in later life, a large-scale and robust online trial has found.

Experts at the University of Exeter Medical School and Kings College London analysed data from more than 17,000 healthy people aged 50 and over, submitted in an online trial. In research presented at the Alzheimer's Association International Conference (AAIC) 2017, the team asked participants how frequently they played word puzzles such as crosswords.

The study, one of the largest of its kind, used tests from the CogTrackTM and PROTECT online cognitive test systems to assess core aspects of brain function. They found that the more regularly participants engaged with word puzzles, the better they performed on tasks assessing attention, reasoning and memory.

From their results, researchers calculate that people who engage in word puzzles have brain function equivalent to ten years younger than their age, on tests of grammatical reasoning speed and short term memory accuracy.

Keith Wesnes, Professor of Cognitive Neuroscience at the University of Exeter Medical School, said: "We found direct relationships between the frequency of word puzzle use and the speed and accuracy of performance on nine cognitive tasks assessing a range of aspects of function including attention, reasoning and memory. Performance was consistently better in those who reported engaging in puzzles, and generally improved incrementally with the frequency of puzzle use. For example, on test measures of grammatical reasoning speed and short-term memory accuracy, performing word puzzles was associated with an age-related reduction of around 10 years. We now need to follow up this very exciting association in a clinical trial, to establish whether engaging in puzzles results in improvement in brain function."

The study used participants in the PROTECT online platform, run by the University of Exeter and Kings College London. Currently, more than 22,000 healthy people aged between 50 and 96 are registered in the study, which is planning further expansion. The online platform enables researchers to conduct and manage large-scale studies without the need for laboratory visits. PROTECT is a 10 year study with participants being followed up annually to enable a better understanding of cognitive trajectories in this age range. PROTECT is funded by the Alzheimer's Society and the National Institute for Health Research (NIHR) Bioresource, including through its NIHR Clinical Research Network (CRN).

Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, said: "We know that many of the factors involved in dementia are preventable. It is essential that we find out what lifestyle factors really make a difference to helping people maintain healthy brains to stop the soaring rise of the disease. We can't yet say that crosswords give you a sharper brain - the next step is to assess whether encouraging people to start playing word games regularly could actually improve their brain function."

Dr Doug Brown, Director of Research of Alzheimer's Society, said: "We know that keeping an active mind can help to reduce decline in thinking skills.

"This new research does reveal a link between word puzzles, like crosswords, and memory and thinking skills, but we can't say definitively that regular 'puzzling' improves these skills.

"To be able to say for sure, the crucial next step is to test if there are benefits in people who take up word puzzles.

"In the meantime our top tips to reduce the risk of developing dementia are keeping physically active, avoiding smoking and eating a healthy balanced diet."

Happiness can affect physical health

A new review indicates that subjective well-being--factors such as life satisfaction and enjoyment of life--can influence physical health. The review's investigators also examine why this is so and conditions where it is most likely to occur.

Subjective well-being may exert its effects on physical health through health behaviors, as well as through the immune and cardiovascular systems. Although scientists still are exploring and debating when happiness most affects health, there is no doubt that it can do so.

With more research, it may one day be informative for clinicians to monitor individuals' subjective well-being just as other factors are currently assessed. Individuals should also take responsibility for their health by developing happy mental habits.

"We now have to take very seriously the finding that happy people are healthier and live longer, and that chronic unhappiness can be a true health threat. People's feelings of well-being join other known factors for health, such as not smoking and getting exercise," said Prof. Ed Diener, co-author of the Applied Psychology: Health and Well-Being article. "Scores of studies show that our levels of happiness versus stress and depression can influence our cardiovascular health, our immune system strength to fight off diseases, and our ability to heal from injuries."

Fermented red clover extract stops menopausal hot flushes and symptoms

The vast majority of women in the menopause are familiar with the status of Red Clover as an herbal medicine that soothes hot flush symptoms and hormonal fluctuations. This holds true, new research shows, if the red clover is taken in a fermented form. Fermented Red Clover extract is demonstrated to decrease significantly both the number and severity of daily hot flushes.

The study also found that the extract prevents the normally accelerated menopausal bone loss affecting one in three women over the age of 50 (e.g. results showed treatment blunted bone loss in the spine completely). These findings are very promising as the benefits take place without any of the side effects of traditionally proscribed hormone therapies that increase the risk of cancers and cardiovascular diseases.

The above is the most important information from the scientific article "Combined Red Clover isoflavones and probiotics potently reduce memopausal vasomotor symptoms", that researchers at the Dept. of Endocrinology and Internal Medicine under the Dept. Clinical Medicine at Aarhus University/ Aarhus University Hospital have published in the journal PLOS one.

The study lead Professor Per Bendix Jeppesen has previously presented partial unpublished data to the media. These findings have rapidly been miss-reported to mean "Red Clover works", which as Per Bendix Jeppesen and his colleague Ph.D. Max Norman Tandrup Lambert explain, "is an oversimplification that is very close to being incorrect".

"It is the fermentation process of the Red Clover extract that makes the difference, as the lactic acid fermentation increases the bioavailability of the bioactive estrogen-like compounds (known as isoflavones or phytoestrogens) that Red Clover has in abundance," explains Max Norman Tandrup Lambert.

"The challenge with isoflavones is that they can be difficult to digest as they naturally occur in the plant bound to sugar molecules which prevent absorption. Hence, a large proportion of the isoflavones that are consumed (e.g. as a pill or capsule) can pass through the intestine without entering circulation. This problem is bypassed when the Red Clover extract undergoes a fermentation process. To be technical the process separates the sugar molecules from the isoflavones, thereby increasing bioavailability," explains Max Norman Tandup Lambert.

Max and Per Bendix Jeppesen are aware that the research findings inadvertently provide an invaluable seal of approval to an ecological farmer and business owner Michael Mohr Jensen, who has patented the production process of the fermented Red Clover extract. Michael Mohr Jensen sells the product from his private company "Herrens Mark" on Fyn. Presumably, the goal from the researchers perspective is to promote research that can help women in the menopause that also has a commercial side.

"That characterization does not apply to me," says Per Bendix Jeppesen. "For me, when I can see that research has a realistic use practically I get extra curious. The fact that the research we have contributed has direct practical application is a great positive, it doesn't happen enough even with all the universities talking about becoming more business orientated and the necessity of collaboration with businesses," says Per Bendix Jeppesen.

Interestingly, it was Michael Mohr Jensen who contacted Per Bendix Jeppesen to ask if he and other researchers from the Dept. of Endocrinology and Internal Medicine would investigate his hypothesis regarding fermented Red Clover extract as a healthier alternative to traditional estrogen therapy proscribed by doctors. In the ensuing collaboration it was Per Bendix Jeppesen and Max Norman Tandrup Lambert that advised the farmer in fine-tuning his Red Clover extract to improve the gastro-intestinal uptake of the active isoflavone compounds.

The fermentation development was a success and the results are now tested in Max Norman Tandrup Lambert's Ph.D. project - a study that recruited 130 women with menopause symptoms, of which 60 were selected based on criteria of at least five severe hot flushes per day and blood tests (including FSH, that indicates the "stage" of menopause).

"The women were separated into two groups of 30, so 30 drank 150ml Red Clover extract per day for 12 weeks, whilst the other 30 drank a masked placebo product. After 12 weeks we tested again and were speechless about the data. There was a much greater effect than we had hoped for." Says Max Norman Tandrup Lambert.

Per Bendix Jeppesen also emphasizes that the research project has avoided relying only on "self reports", which can be a considerable source of error in investigations into whether a treatment works. For example in this study the women's' hot flush symptoms were measured using a so called 'skin conductor', a device that is applied to the underside of the wrist that can determine the number hot flush events and their severity objectively based on sweat secretion. Similarly, the effect of the Red Clover extract on bone health has been tested via so-called DXA scans of the spine and hips.

All measurements are taken in the same way before and after 12 weeks of treatment; this enhances the credibility of the findings, as menopause symptoms are particularly difficult to measure.

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Facts: Its just a phase, but...

• 75 % of women experience menopause symptoms, for some it can be debilitating.
• The primary symptoms of menopause are hot flushes, sweating, disrupted sleep and vaginal dryness.
• Secondary symptoms are tiredness, poor memory, headache, joint pain, weight gain, decreased libido, anxiety and depression.
• The most frequent menopause associated disease is osteoporosis, which affects one in three women over 50, where loss of bone density of a magnitude of around 4-6% can take place. The lifetime risk of developing osteoporosis for women is one in three.
• Other menopause associated risk factors are cardiovascular disease and negative changes to fat metabolism and profile.