Sea swimming associated with increased ailments

People who swim, bathe or take part in water sports in the sea are substantially more likely to experience stomach bugs, ear aches and other types of illness than those who do not.

The large-scale research analysis was led by the University of Exeter Medical School in collaboration with the Centre for Ecology and Hydrology. It is the first systematic review to examine the evidence on whether spending time in the sea is associated with increased risk of reporting a variety of ailments.

The results demonstrated that sea bathing doubled the odds of reporting general ear ailments, and the odds of reporting earache specifically rose by 77%. For gastrointestinal illnesses, the odds increased by 29%.

Dr Anne Leonard, of the University of Exeter Medical School, said:

 "In high-income countries like the UK, there is a perception that there is little risk to health of spending time in the sea. However, our paper shows that spending time in the sea does increase the probability of developing illnesses, such as ear ailments and problems involving the digestive system, such as stomach ache and diarrhoea. We think that this indicates that pollution is still an issue affecting swimmers in some of the world's richest countries."

Despite significant investment resulting in an improvement water quality in recent years, seawater is still polluted from sources including industrial waste, sewage and run-off from farmland.

The researchers whittled down more than 6,000 studies to 19 studies which met the strict criteria for inclusion in the meta-analysis, designed to establish robust research evidence. Many of the studies included recruited thousands of participants. The number of people analysed in total exceeded 120,000. All the studies were conducted in high-income countries since 1961. The studies looked at the links between sea bathing and the incidence of illness in countries including the US, UK, Australia, New Zealand, Denmark and Norway.

Dr Will Gaze, of the University of Exeter Medical School, supervised the research. He said:

"We don't want to deter people from going into the sea, which has many health benefits such as improving physical fitness, wellbeing and connecting with nature. However, it is important that people are aware of the risks so they can make informed decisions. Although most people will recover from infections with no medical treatment, they can prove more serious for vulnerable people, such as the very old or very young, or those with pre-existing health conditions. We have come a long way in terms of cleaning up our waters, but our evidence shows there is still work to be done. We hope this research will contribute to further efforts to clean up our coastal waters." 

Dr Ruth Garside, of the University of Exeter Medical School, is an expert on systematic reviews. She said "Systematic reviews use rigorous methods to identify and assess all the relevant research on a topic in an unbiased way. The study findings are then combined statistically - this allows us to have more confidence in the results."

Only 25 percent of women receive appropriate advice on pregnancy weight gain

A new study of the role of healthcare provider recommendations on weight gain during pregnancy showed that while provider advice did influence gestational weight gain, only about one in four women received appropriate advice and another 25% received no advice. The impact of provider recommendations for pregnancy weight gain that are consistent with current Institute of Medicine (IOM) guidelines is reported in an article published in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Women's Health website.

The article entitled "Achieving Appropriate Gestational Weight Gain: The Role of Healthcare Provider Advice" was coauthored by Nicholas Deputy, PhD, MPH, Andrea Sharma, PhD, MPH, Shin Kim, MPH, and Christine Olson, MD, MPH, Emory University, Centers for Disease Control and Prevention, and U.S. Public Health Service Commissioned Corps., Atlanta, GA. The researchers examined associations between healthcare provider advice -- whether it was received or not, and whether it was consistent with IOM recommendations, above, or below -- and likelihood of inadequate or excessive weight gain during pregnancy. The authors also considered the pre-pregnancy body mass index (BMI) of the study participants.

"This study by Deputy et al. highlights the importance of healthcare providers as a crucial source of guidance on appropriate weight gain during pregnancy, which is of utmost importance to maternal and fetal health," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health. "It is essential that provider advice be consistent with the most up-to-date recommendations and best practices. These findings can be extrapolated beyond weight gain to other aspects of a healthy lifestyle that can impact pregnancy."

Vegetarian and Mediterranean diet may be equally effective in preventing heart disease

A lacto-ovo-vegetarian diet, which includes eggs and dairy but excludes meat and fish, and a Mediterranean diet are likely equally effective in reducing the risk of heart disease and stroke, according to new research in the American Heart Association's journal Circulation.

Previous separate studies have shown that a Mediterranean diet reduces certain risk factors for cardiovascular disease, as does a vegetarian diet; however, this was the first study to compare effects of the two distinct eating patterns.

Current study authors said they wanted to evaluate whether switching to a lacto-ovo-vegetarian diet would also be heart-healthy in people who were used to eating both meat and fish. "To best evaluate this issue, we decided to compare a lacto-ovo-vegetarian diet with a Mediterranean diet in the same group of people," said Francesco Sofi, M.D., Ph.D, lead study author and professor of clinical nutrition at the University of Florence and Careggi University Hospital in Italy.

The study included 107 healthy but overweight participants, ages 18-75, who were randomly assigned to follow for three months either a low-calorie vegetarian diet, which included dairy and eggs, or a low-calorie Mediterranean diet for three months. The Mediterranean diet included poultry, fish and some red meat as well as fruits, vegetables, beans and whole grains. After three months, the participants switched diets. Most participants were able to stay on both diets.

Researchers found participants on either diet:

• lost about 3 pounds of body fat;
• lost about 4 pounds of weight overall; and
• experienced about the same change in body mass index, a measure of weight in relationship to height.

Authors said they did find two differences between the diets that may be noteworthy. The vegetarian diet was more effective at reducing LDL (the "bad") cholesterol, while the Mediterranean diet resulted greater reductions in triglycerides, high levels of which increase the risk for heart attack and stroke.

Still, "the take-home message of our study is that a low-calorie lacto-ovo-vegetarian diet can help patients reduce cardiovascular risk about the same as a low-calorie Mediterranean diet," Sofi said. "People have more than one choice for a heart-healthy diet."

In an editorial accompanying the study, Cheryl A. M. Anderson, Ph.D., M.P.H., M.S., an associate professor of preventive medicine at the University of California, San Diego, in California, wrote that there were similarities between the two diets that may explain the results. Both follow "a healthy dietary pattern rich in fruits and vegetables, legumes [beans], whole grains and nuts; focusing on diet variety, nutrient density and appropriate amount of food; and limiting energy intake from saturated fats."

Anderson, who was not involved in the study, added that promoting both diets by healthcare professionals "offer a possible solution to the ongoing challenges to prevent and manage obesity and cardiovascular diseases."


Study limitations include the fact that participants were at "relatively low" risk of cardiovascular disease. Anderson said future research should compare the diets in patients at higher risk for heart disease and should also explore "whether or not healthful versions of traditional diets around the world that emphasize fresh foods and limit sugars, saturated fats, and sodium can prevent and manage obesity and cardiovascular diseases."



Not new research, but also worth reading:

10 best foods for your heart

Researchers find low magnesium levels make vitamin D ineffective

Study in The Journal of the American Osteopathic Association suggests up to 50 percent of US population is magnesium deficient

There is a caveat to the push for increased Vitamin D: Don't forget magnesium. 
A review published in The Journal of the American Osteopathic Association found Vitamin D can't be metabolized without sufficient magnesium levels, meaning Vitamin D remains stored and inactive for as many as 50 percent of Americans.

"People are taking Vitamin D supplements but don't realize how it gets metabolized. Without magnesium, Vitamin D is not really useful or safe," says study co-author Mohammed S. Razzaque, MBBS, PhD, a professor of pathology at Lake Erie College of Osteopathic Medicine.

Razzaque explains that consumption of Vitamin D supplements can increase a person's calcium and phosphate levels even if they remain Vitamin D deficient. The problem is people may suffer from vascular calcification if their magnesium levels aren't high enough to prevent the complication.
Patients with optimum magnesium levels require less Vitamin D supplementation to achieve sufficient Vitamin D levels. Magnesium also reduces osteoporosis, helping to mitigate the risk of bone fracture that can be attributed to low levels of Vitamin D, Razzaque noted.

Deficiency in either of these nutrients is reported to be associated with various disorders, including skeletal deformities, cardiovascular diseases, and metabolic syndrome.

While the recommended daily allowance for magnesium is 420 mg for males and 320 mg for females, the standard diet in the United States contains only about 50 percent of that amount. As much as half of the total population is estimated to be consuming a magnesium-deficient diet.

Researchers say the magnesium consumption from natural foods has decreased in the past few decades, owing to industrialized agriculture and changes in dietary habits. Magnesium status is low in populations who consume processed foods that are high in refined grains, fat, phosphate, and sugar.
"By consuming an optimal amount of magnesium, one may be able to lower the risks of Vitamin D deficiency, and reduce the dependency on Vitamin D supplements," says Razzaque.

Magnesium is the fourth most abundant mineral in the human body after calcium, potassium, and sodium. Foods high in magnesium include almonds, bananas, beans, broccoli, brown rice, cashews, egg yolk, fish oil, flaxseed, green vegetables, milk, mushrooms, other nuts, oatmeal, pumpkin seeds, sesame seeds, soybeans, sunflower seeds, sweet corn, tofu, and whole grains.

DASH-Style diet associated with reduced risk of depression

Eating a diet that emphasizes vegetables, fruit and whole grains it may lead to a reduced risk of depression, according to a study by researchers at Rush University Medical Center.

Study author Dr. Laurel Cherian will present a preliminary study abstract with these conclusions during the American Academy of Neurology's 70th Annual Meeting in Los Angeles from April 21 to 27, 2018.

Study participants who closely adhered to a diet similar to the Dietary Approaches to Stop Hypertension (DASH) diet were less likely to develop depression than people who did not closely follow the diet. The DASH diet recommends fruits and vegetables and fat-free or low-fat dairy products and limits foods that are high in saturated fats and sugar.

"Depression is common in older adults and more frequent in people with memory problems, vascular risk factors such as high blood pressure or high cholesterol, or people who have had a stroke," said Cherian, a vascular neurologist and assistant professor in Rush's Department of Neurological Sciences. "There is evidence linking healthy lifestyle changes to lower rates of depression and this study sought to examine the role that diet plays in preventing depression."."

The National Institutes of Aging-funded study evaluated a total of 964 participants of the Rush Memory and Aging Project with an average age of 81 annually for approximately six-and-a-half years. Each participant was monitored for symptoms of depression and filled out questionnaires about how often they ate various foods. The researchers examined how closely the participants' reported diets adhered diets such as the DASH diet, Mediterranean diet and the traditional Western diet, which is high in saturated fats and red meats and low in fruits and vegetables.

The researchers categorized participants in three groups based on how closely they adhered to these diets. Those who were in the two groups that followed the DASH diet more closely were 11 percent less likely to develop depression than people in the group that did not follow the diet closely.
Conversely, the researchers found that the more closely people followed a Western diet, the more likely they were to develop depression.

Cherian noted that the study does not prove that the DASH diet leads to a reduced risk of depression; it only shows an association.

"Future studies are now needed to confirm these results and to determine the best nutritional components of the DASH diet to prevent depression later in life and to best help people keep their brains healthy," said Cherian.

Ice chips only? Study questions restrictions on oral intake for women in labor

At most US maternity units, women in labor are put on nil per os (NPO) status--they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

"The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor," write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink "ad lib" doesn't adversely affect maternal and neonatal outcomes.

No Increase in Complications with 'Ad lib' Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or "as they please"). Another four practice groups kept all patients NPO (nil per os, or "nothing by mouth").

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were "sufficiently equivalent" for comparison. The women's average age was 31 years. Before delivery, a "preexisting medical condition" complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes--including requiring a higher level of care after delivery and the newborns' condition as measured by Apgar score--were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. "Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women," Anne Shea-Lewis and colleagues write.

"Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor," the researchers add. They note some limitations of their study, especially the fact that the women weren't randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the "often long and grueling" process of labor and delivery. "Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress," Anne Shea-Lewis and colleagues conclude. "Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy."

###

Click here to read "Original Research An Investigation into the Safety of Oral Intake During Labor."

The 90+ Study finds link between moderate Alcohol Consumption and Longevity

University of California-Irvine faculty investigator, Dr. Claudia Kawas, presented findings from The 90+ Study at the American Association for the Advancement of Science’s annual conference this past weekend, highlighting the link between moderate alcohol consumption and longevity. In an observational study of participants age 90 and older, Dr. Kawas and her team found that consuming about two glasses of beer or wine daily was associated with 18% reduced risk of premature death. Findings also suggest regular exercise, social and cognitive engagement, and a few extra pounds in older age are associated with longevity.

The 90+ Study was initiated in 2003 to study the oldest-old, the fastest growing age group in the United States.  The 90+ Study is one of the largest studies of the oldest-old in the world. More than 1,600 people have enrolled.  Because little is known about people who achieve this milestone, the remarkable increase in the number of oldest-old presents a public health priority to promote the quality as well as the quantity of life.

The 90+ Study participants

Initial participants in The 90+ Study were once members of The Leisure World Cohort Study (LWCS), which was started in 1981.  The LWCS mailed surveys to every resident of Leisure World, a large retirement community in Orange County, California (now incorporated as the city of Laguna Woods).  Using the 14,000 subjects from the LWCS, researchers from The 90+ Study were able to ask, What allows people to live to age 90 and beyond?

Studying the oldest-old

Participants of The 90+ Study are visited every six months by researchers who perform neurological and neuropsychological tests. Our researchers at the Clinic for Aging Research and Education (CARE), located in Laguna Woods, obtain information about diet, activities, medical history, medications and numerous other factors. Additionally, participants are given a series of cognitive and physical tests to determine how well people in this age group are functioning.

Goals of the study

• Determine factors associated with longevity:  What makes people live to age 90 and beyond?  What types of food, activities or lifestyles are associated with living longer?
• Examine the epidemiology of dementia in the oldest-old: How many people aged 90 and older have dementia?  How many become demented each year?  What are ways to remain dementia-free into your 90s?
• Examine rates of cognitive and functional decline in the oldest-old: How do memory loss and disability affect those in their 90s?  How can people prevent memory loss and disability at this age?
• Examine clinical pathological correlations in the oldest-old:  Do the brains of people in their 90s show evidence of memory loss and dementia?  Do people with dementia have differences in their brains that can be detected and treated?  Determining Modifiable Risk Factors for Mortality and Dementia: What kinds of things can people change in their lives to live longer?  Can people change their risk of dementia through diet, exercise or supplements?

Major findings

Researchers from The 90+ Study have published many scientific papers in premier journals.  Some of the major findings are:

• People who drank moderate amounts of alcohol or coffee lived longer than those who abstained.
• People who were overweight in their 70s lived longer than normal or underweight people did.

Simple walking test may help make difficult diagnosis

There's a cause of dementia that can sometimes be reversed, but it's often not diagnosed because the symptoms are so similar to those of other disorders. Now researchers say a simple walking test may be able to accurately diagnose the disease, according to a study published the February 21, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The test involves seeing how fast a person can walk while doing something else at the same time, such as counting backwards or carrying a tray. The study found that the walking test may help differentiate whether someone has idiopathic normal pressure hydrocephalus or progressive supranuclear palsy.

Idiopathic normal pressure hydrocephalus (iNPH), caused by excess fluid in the brain, can often be reversed but it is usually not diagnosed because it shares symptoms like walking, balance and thinking problems with other neurologic conditions, primarily progressive supranuclear palsy (PSP), which is caused by damage to nerve cells in the brain. There is no cure for PSP, but treatment may help ease symptoms.

"It is important that people with idiopathic normal pressure hydrocephalus are accurately diagnosed so they can be treated, and their health can improve," said study author Charlotte Selge, MD, of the Ludwig Maximilian University of Munich in Germany. "A simple walking test may help determine if a person has iNPH or PSP relatively early in the course of the disease. Our study found that adding another task while someone walks, and evaluating how it affects their walking ability, improves accuracy of the diagnosis."

The study involved 27 people with iNPH, 38 people with PSP, and 38 healthy people of similar sex and age. Those with PSP and healthy controls had an average age of 69. Those with iNPH had an average age of 72. All participants received a complete neurologic exam, eye exam, MRI as well as thinking and memory tests. All were able to walk at least 30 feet without a walker or cane.

Researchers assessed participants' manner of walking, or gait, by having all participants walk on a pressure-sensitive carpet that was 22 feet long. People were first asked to walk at three different speeds: slow, their preferred speed and as fast as possible. They were then asked to walk and count backwards at the same time and after that, to walk while carrying a tray.

Researchers found that walking while counting backwards resulted in a greater reduction of walking speed in those with PSP than in those with iNPH. Walking speed was reduced by 34 percent in those with PSP and by 17 percent in those with iNPH. When walking while carrying a tray, gait worsened for those with PSP but actually improved for those with iNPH, which may mean the dual-task test wasn't challenging enough for those with iNPH, Selge said.

"People with PSP appear to be more sensitive to these dual-task walking tests than people with iNPH," said Selge.

By just assessing walking, researchers were able to accurately diagnose who had PSP and who had iNPH 82 percent of the time. But when adding both dual-task tests to the assessment, diagnostic accuracy increased to 97 percent.

"Our findings suggest that adding these dual-task tests would be an inexpensive and effective way to improve diagnosis of iNPH," said Selge. "Future studies may want to increase the complexity of tasks to see if they provide even more accuracy as well as insight into how the two diseases affect gait."

Exercise reduces risk of developing diabetes

Exercising more reduces the risk of diabetes and could see seven million fewer diabetic patients across mainland China, Hong Kong and Taiwan, according to new research.

Researchers have found that higher levels of Leisure-time Physical Activity (LTPA), such as walking, jogging or running, are linked to a lower risk of diabetes in high-risk individuals.

And they have observed health benefits from low-intensity physical activity too - making it possible for older people to take steps to improve their health and reduce the risk of diabetes.

The research team, led by experts from the University of Birmingham, recommends that swift action is taken by health chiefs to promote physical activity as a way of reducing diabetes and combating China's growing obesity epidemic.

Over an 18-year period, researchers studied the lifestyles of 44,828 Chinese adults, aged between 20 and 80, who had been recently diagnosed with impaired fasting glucose (IFG) - an early warning signal for type 2 diabetes affecting one in four Chinese adults.

Professor Neil Thomas, from the University of Birmingham's Institute of Applied Health Research, commented: "We found that higher levels of LTPA are associated with a lower risk of diabetes in a large population of Chinese adults with IFG.

"About one fifth of the observed diabetes cases which developed could have been avoided if inactive individuals had engaged in World Health Organisation (WHO) recommended levels of exercise.

"In the approximately 370 million Chinese adults with IFG, increasing LTPA by one category - for example, from low to moderate - would correspond to a potential reduction of at least seven million cases of diabetes. It may also offset the rapid increases in diabetes resulting from population ageing and China's ongoing obesity epidemic.

"However, more than three-quarters of Chinese adults do not perform sufficient physical activity to reap such health benefits. Our findings emphasise the urgent need to promote physical activity as a strategy for diabetes prevention."

The research team included experts from the Chinese University of Hong Kong, Academia Sinica, Taipei, Taiwan and MJ Health Research Foundation, Taipei, Taiwan. Their findings were published in the British Journal of Sports Medicine.

Researchers studied a Chinese-born IFG population in Taiwan, following their health from 1996 to 2014. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA was reduced by 12%, 20%, and 25% respectively after adjusting for physical labour at work and other factors.

The researchers found that 19.2% of diabetes cases could have been avoided if the inactive participants had engaged in WHO recommendation levels of LTPA.

Estimations suggest there are about 112 million diabetic patients across the Greater China area (Mainland China, Hong Kong and Taiwan) accounting for 40-60% of premature deaths before the age of 60 years and at least US$51 billion of economic burden.

Progressive deterioration in glucose metabolism occurs many years before the clinical diagnosis of type 2 diabetes, for which IFG is an early detectable pathological change.

Individuals with IFG constitute a significant proportion of the Chinese population, with 25% of Chinese adults meeting the American Diabetes Association (ADA) definition of IFG.

Every year 6-9% of individuals with IFG progress to diabetes and, compared to people with normal blood sugar levels, such patients have a higher risk of death from vascular and chronic kidney disease.

How a combination of exercise and music helps us feel less pain

Often, pain emerges as a consequence of disease, injury or intense physical demands. About seven per cent of adults in Germany experience chronic pain and feel constrained by it. There are several options to help manage this. A new alternative to painkillers or heat therapy could be Jymmin, a mixture of working out on gym machines and free musical improvisation, jamming, developed by scientists at the Max Planck Institute for Human Cognitive and Brain Sciences (MPI CBS) in Leipzig. They found out that this new fitness technology makes us less sensitive to pain.

In Jymmin, fitness machines are modified in a way that movement strength on the abdominal trainer, pull bar or stepper creates a wide range of sounds. Software for music composition developed at MPI CBS and a related sensor system enable users to produce a unique accompaniment from each fitness machine. The exerciser becomes the composer and the machines their instruments.

"We found that Jymmin increases the pain threshold. On average, participants were able to tolerate ten per cent more pain from just ten minutes of exercise on our Jymmin machines, some of them even up to fifty per cent", says Thomas Fritz, head of research group Music Evoked Brain Plasticity at MPI CBS. From previous studies the neuroscientist already knew that sports in general increases our pain threshold. "Jymmin showed these effects to be even stronger compared to normal workouts", Fritz states. After Jymmin, the participants were able to immerse their forearm into ice water of one degree Celsius for five seconds longer compared to a conventional exercise session.

Scientists working with Fritz think one of the main reasons for this might be the increased release of endorphins: the higher their level, the more tolerant we are to pain. The combination of physical exertion and making music seems to trigger the release of endorphins in a particularly efficient way.

Interestingly, the effect size was dependent on the individual experience of pain. The scientists had divided the twenty-two participants according to how they rated pain. Indeed, the participants with the highest pain threshold benefitted the most from this training method. This could be due to their already more effective release of endorphins in comparison to those who are more pain sensitive.

"There are several possible applications for Jymmin that can be derived from these findings", the neuroscientist says. It could help alleviate pain in sufferers of acute or chronic pain, for example. These machines could especially deliver valuable support in rehabilitation clinics by enabling more efficient training. "Patients simply reach their pain threshold later." A current study with chronic pain patients furthermore seems to imply that Jymmin can also reduce anxiety, a contributor to chronic pain.

On the other hand there are top athletes who strive to achieve highly demanding physical performances and want to increase their pain thresholds. Preliminary investigations on top swimmers in South Korea showed that athletes who warmed up using Jymmin machines were faster than those using conventional methods. In a pilot test, five of six athletes swam faster than in previous runs.

Several former studies have demonstrated that Jymmin has many positive effects on our well-being. They revealed that not only is less effort in sports and exercise required to reach the same result, but also that personal mood and motivation is improved. Even the music itself--produced by their Jymmin--was perceived as pleasant, even if not described as their personal music taste.

Sleep problems in menopause linked to hot flashes, depression -- and may not last

A new study of middle-aged women found that sleep problems vary across the stages of menopause, yet are consistently correlated with hot flashes and depression. The findings suggest that addressing those risk factors may also address sleep disruptions, as well as give women hope that their sleep symptoms may not last past the menopausal transition, said Rebecca Smith, a professor of pathobiology at the University of Illinois at Urbana-Champaign. Smith conducted the study with Jodi Flaws and Megan Mahoney, professors of comparative biosciences at Illinois.

"Poor sleep is one of the major issues that menopausal women seek treatment for from their doctors," Mahoney said. "It's a huge health care burden, and it's a huge burden on the women's quality of life. Investigating what's underlying this is very important."

The Illinois group used data from the Midlife Women's Health Study, which followed 776 women aged 45-54 in the greater Baltimore area for up to seven years. The women provided annual surveys and blood samples so that the researchers could track sleep disruptions, other menopausal symptoms and hormone levels as women transitioned from pre- to post-menopause.

To track poor sleep, the surveys asked questions about the frequency of insomnia, restless sleep and sleep disturbances.

"Self-reporting is not as precise as a clinical sleep trial, but we think it's more helpful for most women because it's more accurate to their experience," Smith said. "For a woman going through menopause, it might not matter if she's been diagnosed with clinical insomnia; it's whether she feels like she has insomnia that matters to her."

The study found no correlation between the likelihood of reporting poor sleep before menopause, during menopause and after menopause. This means that, for many women in the study, their reported sleep problems changed as they transitioned to different stages of menopause. For example, women who had insomnia during menopause were not more likely to have insomnia after menopause.

"That's a hopeful thing for women who feel like their sleep has gone downhill since they hit the menopause transition: It might not be bad forever," Smith said. "Your sleep does change, but the change may not be permanent."

In analyzing the surveys for any other symptoms or factors that might be associated with poor sleep, the researchers found that hot flashes and depression were strongly correlated with poor sleep across all stages of menopause.

Those two risk factors vary in reported frequency across menopausal stages, which might help explain why poor sleep also varies across the stages, the researchers said.

"It indicates that when dealing with sleep problems, physicians should be asking about other symptoms related to menopause, especially looking for signs of depression and asking about hot flashes," Smith said. "Sleep disturbances in menopause are part of a bigger picture that physicians should be looking at."

To further study factors affecting sleep in menopause, Mahoney is partnering with Carle Foundation Hospital in Urbana, Illinois, to recruit women for a study on how endocrine-disrupting chemicals in the environment might affect menopause symptoms. Such chemicals are found in a variety of plastics and household goods, and women are exposed to them every day, Mahoney said.

"We know that they can disrupt hormones in animal studies, and we know that humans are exposed to them, so we're asking the question, how much are menopausal women being exposed to these chemicals and are they related to their sleep problems?"

Low-fat or low-carb? It's a draw

New evidence from a study at the Stanford University School of Medicine might dismay those who have chosen sides in the low-fat versus low-carb diet debate.

Neither option is superior: Cutting either carbs or fats shaves off excess weight in about the same proportion, according to the study. What's more, the study inquired whether insulin levels or a specific genotype pattern could predict an individual's success on either diet. The answer, in both cases, was no.

"We've all heard stories of a friend who went on one diet -- it worked great -- and then another friend tried the same diet, and it didn't work at all," said Christopher Gardner, PhD, professor of medicine and the lead author of the study. "It's because we're all very different, and we're just starting to understand the reasons for this diversity. Maybe we shouldn't be asking what's the best diet, but what's the best diet for whom?"

Past research has shown that a range of factors, including genetics, insulin levels (which helps regulate glucose in the body) and the microbiome, might tip the scales when it comes to weight loss.

The new study, to be published Feb. 20 in JAMA, homed in on genetics and insulin, seeking to discover if these nuances of biology would encourage an individual's body to favor a low-carbohydrate diet or a low-fat diet. The senior authors of the study are Gardner; Abby King, PhD, professor of health research and policy and of medicine; Manisha Desai, PhD, professor of medicine and of biomedical data science; and John Ioannidis, MD, DSc, professor of medicine.

A tale of two diets
In his quest to find out if individual biological factors dictate weight loss, Gardner recruited 609 participants between the ages of 18 and 50. About half were men and half were women. All were randomized into one of two dietary groups: low-carbohydrate or low-fat. Each group was instructed to maintain their diet for one year. (By the end of that year, about 20 percent of participants had dropped out of the study, due to outside circumstances, Gardner noted.)

Individuals participated in two pre-study activities, the results of which were later tested as predictors of weight loss. Participants got part of their genome sequenced, allowing scientists to look for specific gene patterns associated with producing proteins that modify carbohydrate or fat metabolism. Then, participants took a baseline insulin test, in which they drank a shot of glucose (think corn syrup) on an empty stomach, and researchers measured their bodies' insulin outputs.

In the initial eight weeks of the study, participants were told to limit their daily carbohydrate or fat intake to just 20 grams, which is about what can be found in a 1.5 slices of whole wheat bread or in a generous handful of nuts, respectively. After the second month, Gardner's team instructed the groups to make incremental small adjustments as needed, adding back 5-15 grams of fat or carbs gradually, aiming to reach a balance they believed they could maintain for the rest of their lives.

At the end of the 12 months, those on a low-fat diet reported a daily average fat intake of 57 grams; those on low-carb ingested about 132 grams of carbohydrates per day. Those statistics pleased Gardner, given that average fat consumption for the participants before the study started was around 87 grams a day, and average carbohydrate intake was about 247 grams.

What's key, Gardner said, was emphasizing that these were healthy low-fat and low-carb diets: A soda might be low-fat, but it's certainly not healthy. Lard may be low-carb, but an avocado would be healthier.

 "We made sure to tell everybody, regardless of which diet they were on, to go to the farmer's market, and don't buy processed convenience food crap. Also, we advised them to diet in a way that didn't make them feel hungry or deprived -- otherwise it's hard to maintain the diet in the long run," said Gardner. "We wanted them to choose a low-fat or low-carb diet plan that they could potentially follow forever, rather than a diet that they'd drop when the study ended."

Continuing to mine the data
Over the 12-month period, researchers tracked the progress of participants, logging information about weight, body composition, baseline insulin levels and how many grams of fat or carbohydrate they consumed daily. By the end of the study, individuals in the two groups had lost, on average, 13 pounds. There was still, however, immense weight loss variability among them; some dropped upward of 60 pounds, while others gained close to 15 or 20. But, contrary to the study hypotheses, Gardner found no associations between the genotype pattern or baseline insulin levels and a propensity to succeed on either diet.

"This study closes the door on some questions -- but it opens the door to others. We have gobs of data that we can use in secondary, exploratory studies," he said. Gardner and his team are continuing to delve into their databanks, now asking if the microbiome, epigenetics or a different gene expression pattern can clue them in to why there's such drastic variability between dieting individuals.

Perhaps the biggest takeaway from this study, Gardner said, is that the fundamental strategy for losing weight with either a low-fat or a low-carb approach is similar. Eat less sugar, less refined flour and as many vegetables as possible. Go for whole foods, whether that is a wheatberry salad or grass-fed beef. "On both sides, we heard from people who had lost the most weight that we had helped them change their relationship to food, and that now they were more thoughtful about how they ate," said Gardner.

Moving forward, he and his team will continue to analyze the reams of data collected during the yearlong study, and they hope to partner with scientists across Stanford to uncover keys to individual weight loss.

"I'm hoping that we can come up with signatures of sorts," he said. "I feel like we owe it to Americans to be smarter than to just say 'eat less.' I still think there is an opportunity to discover some personalization to it -- now we just need to work on tying the pieces together."

Your Guide to the New, Smarter CPR

The good news is you don't need to know mouth-to-mouth resuscitation to save a life

Every year some 350,000 people suffer cardiac arrest—when the heart suddenly stops working—away from the relative safety of a hospital. Whether those people receive cardiopulmonary resuscitation right away can literally mean the difference between life and death.
Research has found that the willingness of bystanders to perform CPR can result in a twofold increase in a victim’s chance of survival.
But research also shows that many people are afraid to jump in and help. Less than a third of people who go into sudden cardiac arrest receive CPR from a bystander, according to recent studies.
“Often people hesitate to do CPR because they haven’t had training, are afraid of doing it wrong, or even fear they might get sued if they cause an unintentional injury,” says Orly Avitzur, M.D., medical director for Consumer Reports.
Thanks to good Samaritan laws enacted in every state, you can’t be sued if you act in good faith in an emergency. “And the risk of injuring someone is quite low—you can really only make them better, not worse,” says Jonathan L. Epstein, senior director of science and content development for the American Red Cross.
For this reason, experts say fear—and even a lack of formal training—shouldn’t stop you from intervening in an emergency. In fact, evidence has emerged in the past 10 years that a technique called “hands-only CPR,” where you do chest compressions without mouth-to-mouth resuscitation, can be just as effective as doing both.
A Cleveland Clinic survey released earlier this month found that while more than half of Americans said they know CPR, only 1 in 6 know that hands-only CPR is the recommended method. And only about one in 10 of the 1,000 people surveyed knew the correct beat pace for compressions.
Hands-only CPR is much less complicated, making it a good choice if you have limited (or even zero) training. Here’s what you should know the next time you have an opportunity to save someone’s life.

A Simpler Way to Do CPR

“We want to get the message out to the public that doing anything is far superior to doing nothing,” Epstein says. “If you’re more comfortable doing the hands-only technique, that can help buy the victim precious minutes until the ambulance arrives.”
A growing stack of evidence, including a 2017 review of the research from the Cochrane Collaboration, an independent panel of experts, supports this approach.
One 2010 study published in the New England Journal of Medicine looked at 1,941 patients who went into cardiac arrest outside of the hospital. Roughly half were given traditional CPR (chest compressions plus rescue breaths) by bystanders who were guided by the 911 dispatcher; the other half were given just chest compressions by bystanders who were guided by the 911 dispatcher.
“We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge,” the authors wrote.
Another benefit of the hands-only technique is accessibility.
“Getting full CPR training is a barrier for many people, and older people, as a group, are much less likely to be trained,” says Benjamin S. Abella, M.D., director of the Center for Resuscitation Science at the University of Pennsylvania and author of a recent study on age disparity in CPR training. While the mean age of sudden cardiac arrest victims is around 64, people 60 and older are about 50 percent less likely to be trained in CPR compared with those under younger than 49, Abella says. Teaching hands-only CPR could help increase knowledge and confidence in all age groups.
“The barriers are much lower for learning the hands-only technique,” Abella says. In fact, he says, when people who took a full CPR certification course and others who took an abbreviated 30-minute class on the hands-only technique were tested 30 days later, both had retained similar skills. 

CPR: Putting It Into Action

It’s important to note that hands-only CPR is to be used only on adults and teenagers. The recommended technique for younger children and babies still includes both chest compressions and rescue breaths. But don’t hesitate to use hands-only CPR on everyone else. Just keep these tips in mind:
Know the signs. “If someone collapses in front of you and they’re unresponsive when you yell at them or tap them on the shoulder, you should call 911 and immediately start chest compressions,” Epstein says.
Don’t go at it alone. Epstein recommends putting your phone on speaker and placing it right next to the victim, so you are able to speak to the 911 dispatcher and receive directions without stopping compressions.
Keep the beat. “You want to push down on the center of the chest, hard and fast, trying to compress at least 2 inches down,” Epstein says. The goal is to work at a pace that allows for 100 compressions per minute. You can get a metronome app on your phone that will keep the beat or try singing the Bee Gees “Stayin’ Alive” (a song with 100 beats per minute) and compressing in time to the song.
Refresh your knowledge. While you can perform hands-only CPR with nothing more than the help of a 911 dispatcher, if you want to have more confidence in your skills, a brief training course—or even a review of all the steps involved—might help. Check out the American Heart Association (cpr.heart.org) and the Red Cross (redcross.org/take-a-class) for a list of courses as well as videos and step-by-step directions for performing hands-only CPR technique.

Sunlight Protects Against Influenza

Recent medical literature suggests that vitamin D supplementation protects against acute respiratory tract infection. Humans exposed to sunlight produce vitamin D directly. This paper investigates how differences in sunlight, as measured over several years within states and during the same calendar month, affect influenza incidence. 

The researchers find that sunlight strongly protects against influenza. This relationship is driven by sunlight in late summer and early fall, when there are sufficient quantities of both sunlight and influenza activity. A 10% increase in relative sunlight decreases the influenza index in September by 3 points on a 10-point scale. This effect is far greater than the effect of vitamin D supplementation in randomized trials, a differential due to broad exposure to sunlight, hence group immunity.

Not being aware of memory problems predicts onset of Alzheimer's disease

---

Doctors who work with individuals at risk of developing dementia have long suspected that patients who do not realize they experience memory problems are at greater risk of seeing their condition worsen in a short time frame, a suspicion that now has been confirmed by a team of McGill University clinician scientists.

 

Some brain conditions can interfere with a patient's ability to understand they have a medical problem, a neurological disorder known as anosognosia often associated with Alzheimer's disease. In a study published today in Neurology, Dr. Pedro Rosa-Neto's team from McGill's Translational Neuroimaging Laboratory shows that individuals who experience this lack of awareness present a nearly threefold increase in likelihood of developing dementia within two years.

Joseph Therriault, a master's student in McGill's Integrated Program in Neuroscience and lead author of the paper drew on data available through the Alzheimer's Disease Neuroimaging Initiative (ADNI), a global research effort in which participating patients agree to complete a variety of imaging and clinical assessments.

Therriault analysed 450 patients who experienced mild memory deficits, but were still capable of taking care of themselves, who had been asked to rate their cognitive abilities. Close relatives of the patient also filled out the similar surveys. When a patient reported having no cognitive problems but the family member reported significant difficulties, he was considered to have poor awareness of illness.

Anosognosia is linked to Alzheimer's disease pathophysiology

Researchers then compared the poor awareness group to the ones showing no awareness problems and found that those suffering from anosognosia had impaired brain metabolic function and higher rates of amyloid deposition, a protein known to accumulate in the brains of Alzheimer's disease patients.

A follow up two years later showed that patients who were unaware of their memory problems were more likely to have developed dementia, even when taking into account other factors like genetic risk, age, gender and education. The increased progression to dementia was mirrored by increased brain metabolic dysfunction in regions vulnerable to Alzheimer's disease.

The finding provides crucial evidence about the importance of consulting with the patient's close family members during clinical visits.

"This has practical applications for clinicians: people with mild memory complaints should have an assessment that takes into account information gathered from reliable informants, such as family members or close friends," says Dr. Serge Gauthier, co-senior author of the paper and Professor of Neurology & Neurosurgery, Psychiatry and Medicine at McGill.

"This study could provide clinicians with insights regarding clinical progression to dementia," adds Dr. Rosa-Neto, co-senior author of the study and clinician scientist and director of the McGill Center for Studies in Aging, a research center affiliated with the Montreal West Island IUHSSC.

The scientists are now taking this research further by exploring how awareness of illness changes across the full spectrum of Alzheimer's disease, and how these changes are related to critical Alzheimer's biomarkers.

Women who clean at home or work face increased lung function decline

Women who work as cleaners or regularly use cleaning sprays or other cleaning products at home appear to experience a greater decline in lung function over time than women who do not clean, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction," researchers at the University of Bergen in Norway analyzed data from 6,235 participants in the European Community Respiratory Health Survey. The participants, whose average age was 34 when they enrolled, were followed for more than 20 years.

"While the short-term effects of cleaning chemicals on asthma are becoming increasingly well documented, we lack knowledge of the long-term impact," said senior study author Cecile Svanes, MD, PhD, a professor at the university's Centre for International Health. "We feared that such chemicals, by steadily causing a little damage to the airways day after day, year after year, might accelerate the rate of lung function decline that occurs with age."

The study found that compared to women not engaged in cleaning:

• Forced expiratory volume in one second (FEV1), or the amount of air a person can forcibly exhale in one second, declined 3.6 milliliters (ml)/year faster in women who cleaned at home and 3.9 ml/year faster in women who worked as cleaners.
• Forced vital capacity (FVC), or the total amount of air a person can forcibly exhale, declined 4.3 ml/year faster in women who cleaned at home and 7.1 ml/year faster in women who worked as cleaners.

The authors found that the accelerated lung function decline in the women working as cleaners was "comparable to smoking somewhat less than 20 pack- years."

That level of lung impairment was surprising at first, said lead study author Øistein Svanes, a doctoral student also at the Department for Clinical Science. "However, when you think of inhaling small particles from cleaning agents that are meant for cleaning the floor and not your lungs, maybe it is not so surprising after all."

The authors speculate that the decline in lung function is attributable to the irritation that most cleaning chemicals cause on the mucous membranes lining the airways, which over time results in persistent changes in the airways and airway remodeling.

The study did not find that the ratio of FEV1 to FVC declined more rapidly in women who cleaned than in those who did not. The metric is used when diagnosing and monitoring patients with chronic obstructive pulmonary disease, or COPD. The study did find that asthma was more prevalent in women who cleaned at home (12.3 percent) or at work (13.7 percent) compared to those who did not clean (9.6 percent).

The study also did not find that men who cleaned, either at home or at work, experienced greater decline in FEV1 or FVC than men who did not.

The researchers took into account factors that might have biased the results, including smoking history, body mass index and education.

Study limitations include the fact that the study population included very few women who did not clean at home or work. These women, the authors wrote, might "constitute a selected socioeconomic group." The number of men who worked as occupational cleaners was also small, and their exposure to cleaning agents was likely different from that of women working as cleaning professionals.

"The take home message of this study is that in the long run cleaning chemicals very likely cause rather substantial damage to your lungs," Øistein Svanes said. "These chemicals are usually unnecessary; microfiber cloths and water are more than enough for most purposes."

He added that public health officials should strictly regulate cleaning products and encourage producers to develop cleaning agents that cannot be inhaled.

Link between chronic pain and glutamate consumption

Chronic pain is among the most vexing health problems, including in the developing world, where most research suggests that the prevalence of pain is similar to the United States and other developed nations.

Preliminary research from a small pilot study carried out in Meru, in eastern Kenya, shows a link between chronic pain and consumption of glutamate, a common flavor enhancer found in Western and non-Western diets worldwide. Results demonstrated that when study participants cut monosodium glutamate from their diets, their symptoms improved. The findings are published in the journal Nutrition.

"This preliminary research in Kenya is consistent with what I am observing in my chronic pain research here in the United States," said Kathleen Holton, lead author of the study and assistant professor of health studies at American University. "We don't know what exposure is leading to this susceptibility to dietary glutamate, but this pilot study suggests the need for a large-scale clinical trial, since dietary change could be an effective low-cost treatment option for developing countries."

As researchers study glutamate, they're gaining insights into how the chemical works in the human brain and body. In the brain, glutamate is a common neurotransmitter. It also can act as an excitotoxin, over-stimulating and damaging or killing nerve cells. Some research has found that increased consumption of glutamate may enhance chronic pain symptoms, so there is biological cause for scientists to examine the chemical in relation to pain.

Glutamate is also a naturally occurring chemical in some foods, like soy sauce and parmesan cheese, but is more commonly found as a food additive. In the U.S., glutamate is added to many food products and found under many names including 'monosodium glutamate,' 'hydrolyzed protein,' 'protein isolate,' 'protein extract' and 'autolyzed yeast extract,' just to name a few. In Kenya, people's exposure to glutamate is only from a few foods which contain MSG, with the largest exposure being from a mixed seasoning spice called Mchuzi Mix, which is typically used in cooking daily.

In the Kenya study, the goal was to test whether a dietary intervention could perform as well as or better than over-the-counter medication in relieving pain. With a sample size of 30 participants, the researchers tested the effects of removing MSG, increasing water intake, or a combination of both, relative to acetaminophen (the main treatment option available in Meru). Study participants experienced chronic pain for at least three months or more and in at least three quadrants of the body.

Similar to what is seen with widespread chronic pain patients in the U.S., most also suffered from other neurological symptoms, including headaches or migraines, chronic fatigue, cognitive dysfunction, and sleep issues.

Holton's collaborators in the research were University of Michigan Professor Dr. Daniel J. Clauw, M.D., and Dr. Peter K. Ndege, M.D., of Meru University of Science and Technology in Kenya. This research came about after Clauw learned about Meru villagers' plight with chronic pain. When the team initially surveyed residents in the area, an estimated 60 percent reported chronic pain, twice the amount typically observed.

The participants were broken into four groups. Because dehydration is associated with headache pain, the researchers factored that into the study design. The groups consisted of the following: If subjects commonly consumed Mchuzi Mix, they were given a similar mixed seasoning substitute that contained no MSG. Those reporting low water intake and no MSG were given bottled water and instructed to increase water consumption to eight cups a day.

Those with low water consumption who also consumed MSG were given water and the substitute spices. The control group had neither exposure and was given acetaminophen. The group that removed MSG from its diet and consumed more water reported significant improvements in their symptoms, as did the group receiving acetaminophen.

In the future, Holton, Clauw and Ndege plan a larger, epidemiological survey to further understand the prevalence of widespread chronic pain in the region and to train Kenyan research staff how to conduct a large-scale clinical trial to test if dietary change could be an effective, low-cost treatment option for pain in countries like Kenya.
"This would be incredible if we could impact chronic pain simply by making slight modifications to diet," said Clauw, a leading expert on chronic pain.

Eating yogurt may reduce cardiovascular disease risk

A new study in the American Journal of Hypertension, published by Oxford University Press, suggests that higher yogurt intake is associated with lower cardiovascular disease risk among hypertensive men and women.

High blood pressure is a major cardiovascular disease risk factor. Clinical trials have previously demonstrated beneficial effects of dairy consumption on cardiovascular health. Yogurt may independently be related to cardiovascular disease risk.

High blood pressure affects about one billion people worldwide but may also be a major cause of cardiovascular health problems. Higher dairy consumption has been associated with beneficial effects on cardiovascular disease-related comorbidities such as hypertension, type 2 diabetes, and insulin resistance.

For the current analyses, participants included over 55,000 women (ages 30-55) with high blood pressure from the Nurses' Health Study and 18,000 men (ages 40-75) who participated in the Health Professionals Follow-Up Study.

In the Nurses' Health Study, participants were asked to complete a mailed 61-item questionnaire in 1980 to report usual dietary intake in the preceding year. Participants subsequently reported any interim physician-diagnosed events including myocardial infarction, stroke, and revascularization. Permission was requested to access medical records to confirm all reported new diagnoses.

Higher intakes of yogurt were associated with a 30 percent reduction in risk of myocardial infarction among the Nurses' Health Study women and a 19 percent reduction in the Health Professionals Follow-Up Study men.

There were 3,300 and 2,148 total cardiovascular disease cases (myocardial infarction, stroke, and revascularization) in the Nurses' Health Study and the Health Professionals Follow-Up Study, respectively. Higher yogurt intake in women was associated with a 16 percent lower risk of undergoing revascularization.

In both groups, participants consuming more than two servings a week of yogurt had an approximately 20 percent lower risks of major coronary heart disease or stroke during the follow-up period. When revascularization was added to the total cardiovascular disease outcome variable, the risk estimates were reduced for both men and women, but remained significant.

Higher yogurt intake in combination with an overall heart-healthy diet was associated with greater reductions in cardiovascular disease risk among hypertensive men and women.

"We hypothesized that long-term yogurt intake might reduce the risk of cardiovascular problems since some previous small studies had shown beneficial effects of fermented dairy products," said one of the paper's authors, Justin Buendia. "Here, we had a very large cohort of hypertensive men and women, who were followed for up to 30 years. Our results provide important new evidence that yogurt may benefit heart health alone or as a consistent part of a diet rich in fiber-rich fruits, vegetables, and whole grains."

Medical cannabis significantly safer for elderly with chronic pain than opioids

Medical cannabis therapy can significantly reduce chronic pain in patients age 65 and older without adverse effects, according to researchers at Ben-Gurion University of the Negev (BGU) and the Cannabis Clinical Research Institute at Soroka University Medical Center.

The new study, published in The European Journal of Internal Medicine, found cannabis therapy is safe and efficacious for elderly patients who are seeking to address cancer symptoms, Parkinson's disease, post-traumatic stress disorder, ulcerative colitis, Crohn's disease, multiple sclerosis, and other medical issues.

"While older patients represent a large and growing population of medical cannabis users, few studies have addressed how it affects this particular group, which also suffers from dementia, frequent falls, mobility problems, and hearing and visual impairments," says Prof. Victor Novack, M.D., a professor of medicine in the BGU Faculty of Health Sciences (FOHS), and head of the Soroka Cannabis Clinical Research Institute. Novack is also the BGU Gussie Krupp Chair in Internal Medicine.

"After monitoring patients 65 and older for six months, we found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported."

This older population represents a growing segment of medical cannabis users, ranging from approximately seven percent to more than 33 percent, depending on the country. Recent U.S. polls indicate Americans over 65 represent 14 percent of the total population and use more than 30 percent of all prescription drugs, including highly addictive painkillers.

BGU researchers surveyed 2,736 patients 65 years and older who received medical cannabis through "Tikun Olam," the largest Israeli medical cannabis supplier. More than 60 percent were prescribed medical cannabis due to the pain, particularly pain associated with cancer. After six months of treatment, more than 93 percent of 901 respondents reported their pain dropped from a median of eight to four on a 10-point scale. Close to 60 percent of patients who originally reported "bad" or "very bad" quality of life upgraded to "good" or "very good" after six months. More than 70 percent of patients surveyed reported moderate to significant improvement in their condition.

The most commonly reported adverse effects were dizziness (9.7 percent) and dry mouth (7.1 percent). After six months, more than 18 percent of patients surveyed had stopped using opioid analgesics or had reduced their dosage.

All patients received a prescription after consulting with a doctor who prescribed treatment. More than 33 percent of patients used cannabis-infused oil; approximately 24 percent inhaled therapy by smoking, and approximately six percent used vaporization.

One or more soda a day could decrease chances of getting pregnan

The amount of added sugar in the American diet has increased dramatically over the last 50 years. Much of that increase comes from higher intake of sugar-sweetened beverages, which constitute approximately one-third of the total added sugar consumption in the American diet. While consumption of these beverages has been linked to weight gain, type 2 diabetes, early menstruation, and poor semen quality, few studies have directly investigated the relationship between sugary drinks and fertility.

Now, a new study led by Boston University School of Public Health (BUSPH) researchers has found that the intake of one or more sugar-sweetened beverages per day--by either partner--is associated with a decreased chance of getting pregnant.

The study was published in Epidemiology.

"We found positive associations between intake of sugar-sweetened beverages and lower fertility, which were consistent after controlling for many other factors, including obesity, caffeine intake, alcohol, smoking, and overall diet quality," says lead author Elizabeth Hatch, professor of epidemiology. "Couples planning a pregnancy might consider limiting their consumption of these beverages, especially because they are also related to other adverse health effects."

About 15 percent of couples in North America experience infertility. Identifying modifiable risk factors for infertility, including diet, could help couples conceive more quickly and reduce the psychological stress and financial hardship related to fertility treatments, which are associated with more than $5 billion in annual US healthcare costs.

Through the Pregnancy Study Online (PRESTO), an ongoing web-based prospective cohort study of North American couples, the researchers surveyed 3,828 women aged 21 to 45 living in the United States or Canada and 1,045 of their male partners. Participants completed a comprehensive baseline survey on medical history, lifestyle factors, and diet, including their intake of sugar-sweetened beverages. Female participants then completed a follow-up questionnaire every two months for up to 12 months or until pregnancy occurred.

Both female and male intake of sugar-sweetened beverages was associated with 20 percent reduced fecundability, the average monthly probability of conception. Females who consumed at least one soda per day had 25 percent lower fecundability; male consumption was associated with 33 percent lower fecundability. Intake of energy drinks was related to even larger reductions in fertility, although the results were based on small numbers of consumers. Little association was found between intake of fruit juices or diet sodas and fertility.

"Given the high levels of sugar-sweetened beverages consumed by reproductive-aged couples in North America, these findings could have important public health implications," the authors concluded.

Climb stairs to lower blood pressure and strengthen leg muscles

 If you don't have the time or money for aerobic and resistance training, why not try climbing the stairs? A new study demonstrates that stair climbing not only lowers blood pressure but also builds leg strength, especially in postmenopausal women with estrogen deficiencies who are more susceptible to vascular and muscle problems. The study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Few people would argue that exercise is good for you. But for postmenopausal women, identifying the right form of exercise to achieve the desired benefits without creating additional health problems is more complicated. High-intensity resistance training, for example, is an effective intervention for reducing age-related loss of muscle strength in postmenopausal women. However, it also has the potential to increase blood pressure in middle-aged adults with prehypertension or hypertension.

These negative effects have been minimized by combining aerobic and resistance training, but there are barriers that prevent many women from taking advantage of the benefits. These real and perceived barriers include lack of time, money, nearby fitness facilities, poor weather, and a sense of embarrassment.

Stair climbing, in contrast, offers the benefits of aerobic and resistance exercise for improving cardiorespiratory fitness and leg muscle strength in postmenopausal women without their having to leave the house or pay a fee. It offers the additional benefits of fat loss, improved lipid profiles, and reduced risk of osteoporosis. Before this study, stair climbing had not been evaluated for its effects on blood pressure and arterial stiffness, which is a thickening and stiffening of the arterial wall.

In the article "The effects of stair climbing on arterial stiffness, blood pressure, and leg strength in postmenopausal women with stage 2 hypertension," results are provided from a study involving Korean postmenopausal women who trained four days a week, climbing 192 steps two to five times a day. The study concluded that stair climbing led to reductions in arterial stiffness and blood pressure and increases in leg strength in stage 2 hypertensive postmenopausal women.

"This study demonstrates how simple lifestyle interventions such as stair climbing can be effective in preventing or reducing the negative effects of menopause and age on the vascular system and leg muscles of postmenopausal women with hypertension," says Dr. JoAnn Pinkerton, NAMS executive director.

Everyday activities associated with more gray matter in brains of older adults

Higher levels of lifestyle physical activity - such as house cleaning, walking a dog and gardening, as well as exercise - are associated with more gray matter in the brains of older adults, according to a study by researchers at Rush University Medical Center. The Journal of Gerontology: Psychological Sciences will publish the study's findings on Feb. 14.

The gray matter in the brain includes regions responsible for controlling muscle movement, experiencing the senses, thinking and feeling, memory and speech and more. The volume of gray matter is a measure of brain health, but the amount of gray matter in the brain often begins to decrease in late adulthood, even before symptoms of cognitive dysfunction appear.

"More gray matter is associated with better cognitive function, while decreases in gray matter are associated with Alzheimer's disease and other related dementias," said Shannon Halloway, PhD, the lead author of the Journal of Gerontology paper and the Kellogg/Golden Lamp Society Postdoctoral Fellow in the Rush University College of Nursing. "A healthy lifestyle, such as participating in lifestyle physical activity, is beneficial for brain health, and may help lessen gray matter atrophy (decreases)."

Study used accelerometer to measure activity of 262 older adults

The study measured the levels of lifestyle physical activity by 262 older adults in Rush's Memory and Aging Project, an ongoing epidemiological cohort study. Participants are recruited from retirement communities and subsidized housing facilities in and around Chicago to participate in annual clinical evaluations and magnetic resonance imaging (MRI) scans, and to donate their brains and other parts of their bodies for research after their deaths.

Participants in the lifestyle study wore a non-invasive device called an accelerometer continuously for seven to ten days. The goal was to accurately measure the frequency, duration and intensity of a participant's activities over that time.

Lifestyle physical activity is "more realistic for older adults" than a structured exercise program that might require them to go to a gym, according to Halloway.

"Accessibility becomes an issue as one ages," Halloway said. "Transportation can be a problem. Gym settings can be intimidating for any individual, but especially so for older adults."

Accelerometers provide more precise measures of activity

The use of accelerometers was only one of the ways in which this analysis differed from some other investigations of the health of older people. Most research that explores the effects of exercise relies on questionnaires, which ask participants to "self-report" their levels of activity, Halloway said. She added that questionnaires tend to ask in a fairly non-specific fashion about types and intensity of exercise.

The real problem with questionnaires, though, is that "sometimes, we get really inaccurate reports of activity," Halloway acknowledged. "People commonly over-estimate, and on the flip side, some underestimate the lifestyle activity they're getting from things they don't consider exercise, like household chores, for example."

As to the accelerometer, she says, "it's not as commonly used (in studies of exercise) as we would like," even though accelerometers provide more precise results than self-reporting.

Study provided insights into activity levels of people past 80

Another departure in Halloway's study from some other investigations was the opportunity she had to assess the effects of exercise on individuals older than 80. In fact, the mean age in this study was 81 years, compared with 70 years for other studies Halloway used as a reference.

"One great strength of the Rush Alzheimer's Disease Center is its amazing ability to follow up with participants, and its high retention rates of participants," Halloway says. As a result, the Memory and Aging Project captures a number of participants in that older age group.

However, no one was included in Halloway's analysis who had a diagnosis or symptoms of dementia, or even mild cognitive impairment; a history of brain surgery; or brain abnormalities such as tumors, as seen on MRIs.

The study compared gray matter volumes as seen in participants' MRIs with readings from the accelerometers and other data, which all were obtained during the same year. Halloway's analysis found the association between participants' actual physical activity and gray matter volumes remained after further controlling for age, gender, education levels, body mass index and symptoms of depression, all of which are associated with lower levels of gray matter in the brain.

"Our daily lifestyle physical activities are supportive of brain health, and adults of all ages should continue to try and increase lifestyle physical activity to gain these benefits," Halloway said. "Moving forward, our goal is to develop and test behavioral interventions that focus on lifestyle physical activity for older adults at increased risk for cognitive decline due to cardiovascular disease,"

Poor fitness linked to weaker brain fiber, higher dementia risk

Scientists have more evidence that exercise improves brain health and could be a lifesaving ingredient that prevents Alzheimer's disease.

In particular, a new study from UT Southwestern's O'Donnell Brain Institute suggests that the lower the fitness level, the faster the deterioration of vital nerve fibers in the brain. This deterioration results in cognitive decline, including memory issues characteristic of dementia patients.

"This research supports the hypothesis that improving people's fitness may improve their brain health and slow down the aging process," said Dr. Kan Ding, a neurologist from the Peter O'Donnell Jr. Brain Institute who authored the study.

White matter
The study published in the Journal of Alzheimer's Disease focused on a type of brain tissue called white matter, which is comprised of millions of bundles of nerve fibers used by neurons to communicate across the brain.

Dr. Ding's team enrolled older patients at high risk to develop Alzheimer's disease who have early signs of memory loss, or mild cognitive impairment (MCI). The researchers determined that lower fitness levels were associated with weaker white matter, which in turn correlated with lower brain function.

Distinctive tactics
Unlike previous studies that relied on study participants to assess their own fitness, the new research objectively measured cardiorespiratory fitness with a scientific formula called maximal oxygen uptake. Scientists also used brain imaging to measure the functionality of each patient's white matter.
Patients were then given memory and other cognitive tests to measure brain function, allowing scientists to establish strong correlations between exercise, brain health, and cognition.

Lingering mysteries
The study adds to a growing body of evidence pointing to a simple yet crucial mandate for human health: Exercise regularly.

However, the study leaves plenty of unanswered questions about how fitness and Alzheimer's disease are intertwined. For instance, what fitness level is needed to notably reduce the risk of dementia? Is it too late to intervene when patients begin showing symptoms?

Some of these topics are already being researched through a five-year national clinical trial led by the O'Donnell Brain Institute.

The trial, which includes six medical centers across the country, aims to determine whether regular aerobic exercise and taking specific medications to reduce high blood pressure and cholesterol levels can help preserve brain function. It involves more than 600 older adults at high risk to develop Alzheimer's disease.

"Evidence suggests that what is bad for your heart is bad for your brain. We need studies like this to find out how the two are intertwined and hopefully find the right formula to help prevent Alzheimer's disease," said Dr. Rong Zhang of UT Southwestern, who oversees the clinical trial and is Director of the Cerebrovascular Laboratory in the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, where the Dallas arm of the study is being carried out.

Prior findings
The research builds upon prior investigations linking healthy lifestyles to better brain function, including a 2013 study from Dr. Zhang's team that found neuronal messages are more efficiently relayed in the brains of older adults who exercise.

In addition, other teams at the O'Donnell Brain Institute are designing tests for the early detection of patients who will develop dementia, and seeking methods to slow or stop the spread of toxic proteins associated with the disease such as beta-amyloid and tau, which are blamed for destroying certain groups of neurons in the brain.

"A lot of work remains to better understand and treat dementia," said Dr. Ding, Assistant Professor of Neurology & Neurotherapeutics. "But, eventually, the hope is that our studies will convince people to exercise more."

Avoiding risky sedatives in older adults

They help many people sleep, or feel calmer or less anxious. But in older people, they also double the risk of car crashes, falls and broken hips.

That's why the medications known as benzodiazepines show up on international guidelines as drugs that very few people over the age of 65 should take.

Yet a sizable percentage of adults in that age group still have an active prescription for one, according to new research from three countries that have made a special effort to reduce their use.

Currently, about seven percent of older veterans in the United States have a benzodiazepine prescription, and the numbers are even higher in Canada and Australia, according to the study published in the Journal of the American Geriatrics Society.

There's been a steady decline in all such prescriptions since new guidelines came out, the research shows. And the number of older adults starting on the drugs for the first time has dropped even faster.
But despite these reductions, the researchers say that the continued use of the drugs show much more needs to be done to alert providers, and patients and families, to their hazards and the need to find alternative treatments.

"This downward trend is definitely encouraging, in particular the trend in the new starts for these medications, because the easiest solution is to not start people on them at all," says Donovan Maust, M.D., M.S., an assistant professor of geriatric psychiatry at the University of Michigan Medical School who worked on the study and has studied the risks of psychoactive drugs on older adults.

He notes that research shows that newer antidepressant medications, and non-drug psychotherapy approaches, have been shown to help ease many of the symptoms that often prompt doctors to prescribe benzodiazepines - without the risks. Also, research has shown that patients who take a benzodiazepine to calm the effects of acute stress are actually more likely to develop post-traumatic stress disorder.

More about the study
An international group of authors including Maust and his colleagues looked at data from older adults treated in three different healthcare systems between 2010 and 2016: the U.S. Veterans Affairs healthcare system; Canada's most populous province, Ontario; and Australia.

In all, the percentage of U.S. veterans over age 65 prescribed a benzodiazepine dropped from 9.2 percent in 2010 to 7.3 percent in 2016, and the percentage newly started on the drugs for the first time dropped from 2.6 percent to 1.7 percent over the same time period.

Maust notes that the veteran population likely has even lower benzodiazepine use than the general U.S. population because of ongoing VA efforts to discourage their use.

Ontario started with much higher prevalence: 18.2 percent of all older adults had a current prescription in 2010, declining to 13.4 percent by 2016. The province also made strides in reducing the percentage who started a prescription each year, from 6 percent to 4.4 percent.

Australia started off with the largest proportion of its over-65 population having a benzodiazepine prescription, at 20.2 percent in 2010. By 2016, that had declined to 16.8 percent. But the number of first-time prescriptions didn't go down much - from 7 percent to 6.7 percent.

Choosing wisely together
All three countries participate in Choosing Wisely International, an effort supported by the Commonwealth Fund to help countries emulate the Choosing Wisely initiative launched by the American Board of Internal Medicine that now offers American doctors and patients dozens of evidence-based recommendations. Australia and Canada each have their own national initiatives.

In fact, benzodiazepine use by people over age 65 landed in the top 10 of all issues that the Choosing Wisely International group chose to focus attention on.

Jonathan Brett, MBBS, from the University of New South Wales and the study's lead author, notes "this analysis is the first publication of an international collaborative explicitly focused on the measurement of harmful or wasteful care."

Studying the use of the drugs in different countries was tricky because of the nature of data available from each national system, notes Maust, who is a member of the U-M Institute for Healthcare Policy and Innovation.

In the U.S. VA system, which shares one medical record system, the effort to educate providers about the risks of benzodiazepines in older patients, and to scrutinize prescriptions for them, appears to have borne fruit.

In Ontario and Australia, the oldest patients had the highest rates of existing or new prescriptions, which is how prescribing looks for non-Veteran older adults in the U.S.

Surprisingly, in the VA system, the youngest group of older patients - those ages 65 to 74 - had higher benzodiazepine prescription numbers than the oldest veterans.

Since 2012, all benzodiazepines have been listed on the American Geriatrics Society's Beers Criteria list of medications that carry outsize risks for older adults. The U.S. Choosing Wisely recommendations against them came out in 2013. But concerns about their use among older adults have been raised for over 20 years.

"When you consider that, it's disappointing that new use isn't dropping more," says Maust. "We need to bend the curve further, with special focus on those who have never been prescribed these medications before because the greatest risk of fall is in the first few weeks after starting on one of

Crash diets can cause transient deterioration in heart function

---

Crash diets can cause a transient deterioration in heart function, according to research presented today at CMR 2018.1 Patients with heart disease should seek medical advice before adopting a very low calorie diet.

"Crash diets, also called meal replacement programmes, have become increasingly fashionable in the past few years," said lead author Dr Jennifer Rayner, clinical research fellow, Oxford Centre for Magnetic Resonance, University of Oxford, Oxford, UK.

"These diets have a very low calorie content of 600 to 800 kcal per day and can be effective for losing weight, reducing blood pressure, and reversing diabetes," she added.2 "But the effects on the heart have not been studied until now."

This study used magnetic resonance imaging (MRI) to investigate the impact of a very low calorie diet on heart function and the distribution of fat in the abdomen, liver, and heart muscle.

The study included 21 obese volunteers. The average age was 52 years, average body mass index (BMI) was 37 kg/m2, and six were men. Participants consumed a very low calorie diet of 600 to 800 kcal per day for eight weeks. MRI was performed at the start of the study and after one and eight weeks.

After one week, total body fat, visceral fat and liver fat had all significantly fallen by an average of 6%, 11%, and 42%, respectively. This was accompanied by significant improvements in insulin resistance, fasting total cholesterol, triglycerides, glucose and blood pressure.

However, after one week, heart fat content had risen by 44%. This was associated with a deterioration in heart function, 3 including the heart's ability to pump blood.

By eight weeks, heart fat content and function had improved beyond what they had been before the diet began and all other measurements including body fat and cholesterol were continuing to improve.

Dr Rayner said: "The metabolic improvements with a very low calorie diet, such as a reduction in liver fat and reversal of diabetes, would be expected to improve heart function. Instead, heart function got worse in the first week before starting to improve."

"The sudden drop in calories causes fat to be released from different parts of the body into the blood and be taken up by the heart muscle," she continued. "The heart muscle prefers to choose between fat or sugar as fuel and being swamped by fat worsens its function. After the acute period in which the body is adjusting to dramatic calorie restriction, the fat content and function of the heart improved."

More research is needed to discover the impact of the acute reduction in heart function. In people with existing heart problems it might exacerbate their condition -- for example aggravating heart failure symptoms like shortness of breath or increasing the risk of arrhythmias.

Dr Rayner said: "If you have heart problems, you need to check with your doctor before embarking on a very low calorie diet or fasting. People with a cardiac problem could well experience more symptoms at this early time point, so the diet should be supervised."

She added that very low calorie diets do have benefits and do not need to be avoided. "Otherwise healthy people may not notice the change in heart function in the early stages," she said. "But caution is needed in people with heart disease."