Friday, August 28, 2009

Obesity Is Biggest Health Problem for Kids

U.S. adults continue to rate obesity as the biggest health problem for children, according to a 2009 poll conducted by C.S. Mott Children's Hospital.

Although childhood obesity ranked No. 1 last year also, this is the first year it ranked at the top for whites, Hispanics, and African-Americans. Last year, Hispanics rated smoking as the top child health concern and African-Americans ranked teenage pregnancy.

Stress, which came in at No. 8, made the top 10 list for the first time this year. It ranked especially high among lower-income participants, perhaps reflecting the stresses that children face as their parents struggle in the current economy.

The complete list of children's health concerns rated as a "big problem:"

1. Childhood obesity2. Drug abuse3. Smoking/tobacco use4. Bullying5. Internet safety6. Child abuse and neglect7. Alcohol abuse8. Stress9. Not enough opportunities for physical activity10. Teen pregnancy

The fact that stress -- and many other problems on the list -- are behavioral or psychological in nature means that families need more than just good health care; they also need “guidance from community health and educational programs that cultivate healthy, protective behaviors and offer support when health problemsarise,” poll director Matthew Davis, MD, says in a written statement. Davis is an associate professor of general pediatrics and internal medicine at the University of Michigan Medical School and an associate professor of public policy at the University of Michigan Gerald R. Ford School of Public Policy.

The nationally representative survey was conducted in May 2009 and included 2,017 randomly selected adults 18 or older. Participants were asked to rank 23 different health concerns facing children in their communities. The margin of error is plus or minus three to four percentage points.

Can Your Diet Help Relieve Rheumatoid Arthritis?

If you suffer from rheumatoid arthritis, you may have heard that a specific diet or certain foods can ease your pain, stiffness, and fatigue. Someday, food may be the medicine of choice for those with arthritis and related inflammatory diseases. For now, though, here's information that may help you separate the facts from the myths about diet and rheumatoid arthritis.

Can the arthritis diet help my rheumatoid arthritis?

Eating certain foods or avoiding certain foods may help your rheumatoid arthritis symptoms. However, according to the Arthritis Foundation, there is no scientifically substantiated "arthritis diet." On the other hand, if you find certain foods worsen your rheumatoid arthritis symptoms and others help your symptoms to improve, it makes sense to make some adjustments in your diet.

A recent study showed that 30% to 40% of people with rheumatoid arthritis may benefit from excluding "suspect" foods that are identified with an elimination diet. An elimination diet guides you in removing suspected "trigger" foods from your daily diet. Then, after a period of time, you slowly add the suspect foods back into your diet and watch for increased pain and stiffness. For some people, eliminating those foods that seem to trigger pain and stiffness may help decrease rheumatoid arthritis symptoms.

Can some fats increase the inflammatory response in people with rheumatoid arthritis?

Yes. Studies show that saturated fats may increase inflammation in the body. Foods high in saturated fats, such as animal products like bacon, steak, butter, and cream, may increase pro-inflammatory chemicals in the body called prostaglandins. Prostaglandins are chemicals that cause inflammation, pain, swelling, and joint destruction in rheumatoid arthritis.

In addition, some findings confirm that meat contains high amounts of arachidonic acid.

Arachidonic acid is a fatty acid that's converted to pro-inflammatory chemicals in the body.

Some people with rheumatoid arthritis find that a vegetarian diet helps relieve symptoms of pain and stiffness. Other people with rheumatoid arthritis, however, get no benefit from eating a diet that eliminates meat.

Is omega-6 fatty acid linked to increased inflammation associated with rheumatoid arthritis?

Omega-6 fatty acids are in vegetable oils that contain linoleic acid. That includes corn oil, soybean oil, sunflower oil, wheat germ oil, and sesame oil. Studies show that a typical western diet has more omega-6 fatty acids compared to omega-3 fatty acids. Omega-3 fatty acid is a polyunsaturated fat found in cold-water fish.

Consuming excessive amounts of omega-6 fatty acids may promote illnesses such as cancer and cardiovascular disease. It may also promote inflammatory and/or autoimmune disease such as rheumatoid arthritis. Ingesting fewer omega-6 fatty acids and more omega-3 fatty acids, on the other hand, may suppress inflammation and decrease the risk of illness.

Many studies show that lowering the ratio of omega-6 fatty acids to omega-3 fatty acids contained in the diet can reduce the risk of illness.

How can omega-3 fatty acids help rheumatoid arthritis?

Omega-3 fatty acids, the polyunsaturated fats found in cold-water fish, nuts, and other foods, may have an anti-inflammatory effect in the body. The marine omega-3 fatty acids contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These are substances that may decrease inflammation. Some studies show a positive anti-inflammatory effect of omega-3 fatty acids with rheumatoid arthritis. The same is true for cardiovascular disease. This is important because people with rheumatoid arthritis have a higher risk of cardiovascular disease.

Human studies with marine omega-3 fatty acids show a direct relationship between increased DHA consumption and diminished C-reactive protein levels. That means reduced inflammation.

Which foods have omega-3 fatty acids that might be good for rheumatoid arthritis?

For omega-3 fatty acids, select cold-water fish such as salmon, tuna, and trout. Some plant foods are also sources of omega-3 fatty acids. They include walnuts, tofu and soybean products, flaxseed and flaxseed oil, and canola oil.

Can fish oil supplements help rheumatoid arthritis?

According to the American College of Rheumatology, some patients with rheumatoid arthritis report an improvement in pain and joint tenderness when taking marine omega-3 fatty acid supplements. You may not notice any benefit at first from taking a fish oil supplement. It may take weeks or even months to see a decrease in symptoms. But studies do show that some people who have a high intake of omega-3 fatty acids benefit from decreased symptoms and less use of anti-inflammatory drugs.

The American College of Rheumatology reminds consumers that fish oil supplements may have high levels of vitamin A or mercury.

Can a Mediterranean-type diet help rheumatoid arthritis?

Many studies suggest that a diet high in fruits, vegetables, and vitamin C may be linked to a lower risk of rheumatoid arthritis. In fact, we know that rheumatoid arthritis is less severe in some Mediterranean countries such as Greece and Italy. In those countries, the main diet consists of large amounts of fruits, vegetables, olive oil, and fatty fish high in omega-3s. The
Mediterranean-type diet may even protect against severe rheumatoid arthritis symptoms.
Fruits, vegetables, grains, and legumes are high in phytonutrients. These are chemicals in plants that have disease-fighting properties and immune-boosting antioxidants such as vitamin C, vitamin E, selenium, and the carotenoids. A plant-based diet is also high in bioflavonoids. These are plant compounds that reportedly have anti-viral, anti-inflammatory, and anti-tumor activities.

Nutrition researchers who test the antioxidant activity of foods believe that certain foods may reduce the risk of some degenerative diseases associated with aging. These diseases include arthritis, heart disease, diabetes, and cancer. More recent findings show that the higher intake of omega-3 fatty acids with the Mediterranean diet may be linked to the improvement in rheumatoid arthritis symptoms.

What vitamins and minerals are important for people with rheumatoid arthritis?

Folic acid, or folate, is a B vitamin found in food. It can also be obtained by supplementation. It is important to you if you take methotrexate, a commonly prescribed medication for rheumatoid arthritis. Your body uses folic acid to manufacture red blood cells. Supplementing with folic acid may allow people with rheumatoid arthritis to stay on methotrexate longer. That way they can benefit from relief of pain and inflammation without suffering the medication's side effects.

Selenium helps to fight free radicals that cause damage to healthy tissue. There are some studies that indicate people with rheumatoid arthritis have reduced selenium levels in their blood.

Current findings are preliminary and so no recommendations have been made for selenium supplementation. One 3.5-ounce serving of tuna gives you a full day's requirement of selenium.

Supplementing your diet with bone-boosting calcium and vitamin D is important, especially if you take corticosteroids (like prednisone) that can cause bone loss. The risk of bone loss is higher in people with rheumatoid arthritis. So check with your doctor to see how much calcium and vitamin D you need to get daily through foods, supplements, and sunlight.

What about alcohol and rheumatoid arthritis?

A recent study published in the Annals of Rheumatic Diseases (2008) concluded that drinking alcohol may be linked to a significantly reduced chance of getting rheumatoid arthritis. While the researchers did not know how alcohol protects against rheumatoid arthritis, they believed the data should encourage further study on how arthritis may be prevented through diet and lifestyle measures. Talk to your doctor about drinking alcohol if you take any rheumatoid arthritis medication. Avoid alcohol if you take methotrexate because liver damage could be a serious side effect.

Can weight loss help my rheumatoid pain and stiffness?

Yes. Studies show that dropping extra pounds is important for your joints and overall health. Excess pounds put extra strain on knees, hips, and other weight-bearing joints, not to mention your heart. Being overweight or obese actually worsens the joints -- making them stiffer and more painful -- and can exacerbate rheumatoid arthritis flares.

Make Yourself Beautiful on a Budget

Throughout history, women have tried some bizarre DIY beauty treatments: Geishas applied nightingale droppings; English nobility used mercury and puppy urine; Cleopatra reportedly soaked in sour donkey milk.

Today, we still want to keep our complexions radiant, smooth, and firm. Fortunately, there’s no need to slap disgusting -- or potentially deadly -- ingredients onto our skin. You just need to make a trip to your local grocery store to whip up some of the most beneficial and budget-friendly facials you can find.

Here’s how some of the pros cook up skin care at home:

Let a Breakfast Staple Double as an Exfoliating Cleanser

For a simple DIY scrub, mix a teaspoon of white sugar, corn meal, baking soda, or cooled coffee grounds into your daily cleanser.

A packet of instant maple brown sugar oatmeal is one of the beauty secrets Cristina Bartolucci, founder of DuWop Cosmetics and celebrity makeup artist, uses to keep her skin soft. She combines a handful of the oatmeal with a few pumps of cleanser in her palm and packs it on her skin. In about 10 minutes, Bartolucci gently scrubs it off. The oats fight irritation while the brown sugar exfoliates. Plus, you can use the leftovers for breakfast!

Look to Your Spice Rack for an Irritation-Fighting Facial

New York City restaurateur Donatella Arpaia squeezes fresh apricots onto sunburned skin to relieve itching and burning. Another way to calm irritated skin: Soak a washcloth in cooled whole milk and apply it to your face.

Expert facialist and founder of Lather skin care, Emile Hoyt says turmeric is one of the best anti-inflammatory ingredients around. Mix a half teaspoon of the spice with 6 ounces of plain yogurt, 2 tablespoons of honey, and half a cup of oat flour and spread it on clean skin. Hoyt says that dry, irritated complexions will feel moisturized and refreshed after 15 minutes of this treatment.

Brew Up an Oil-Erasing Mask

Oily or acne-prone skin can benefit from brewer’s yeast. Whisk two egg whites with 2 teaspoons of the yeast and apply with a paint brush or large makeup brush. Leave on for 20 minutes and rinse.

Rather than pay for an expensive mud mask, a bottle of Milk of Magnesia can dry up oil just as well. Paula Begoun, author of The Complete Beauty Bible, advises blotting unflavored Milk of Magnesia on your skin and letting it dry. Rinse it away with a washcloth in about 15 minutes for a shine-free fix.

Take advantage of buttermilk’s astringent qualities and dip a cotton ball in it, dab on your skin, let it dry for a few minutes, and rinse away with a gentle cleanser to send excess oil down the drain.

Try Some All-Natural Anti-aging Agents

Nutritionist Keri Glassman, author of The Snack Factor Diet, suggests mashing a banana and grating five almonds for a mask that exfoliates, smoothes, and fights aging.

Normal complexions will soak up the age-fighting, antioxidant benefits from olive oil, says dermatologist Leslie Baumann. Dab the oil onto flaky areas, or mix a teaspoon of brown sugar with a quarter cup of olive oil for a nutritious cleanser.

Ole Henriksen, founder of the Ole Henriksen Spa in Los Angeles, says you can perk up your skin with a cleanser that combines a cup of plain yogurt and 2 teaspoons of dry red tea leaves. Sponge on the mixture and use it as a cleanser. Henriksen says the yogurt helps fade uneven pigmentation and the tea leaves are gentle enough to scrub any complexion.

Insider Tip: How to Make the Most of Your Homemade Beauty Treatments

Although all the good-for-your-skin ingredients are crucial for a facial to work, the method used to apply them is just as important. “The reason you look so great after a facial is because you have increased blood circulation to your skin due to the facial massage,” says Eva Scrivo, owner of Eva Scrivo Salons in New York City.

It just takes three minutes and you can do it whenever applying a homemade beauty treatment or even just cleansing. “This is the reason aestheticians have beautiful skin,” Scrivo says. Here’s how she advises getting your complexion into shape: Whenever you apply a treatment or cleanse, apply light pressure -- enough so you can feel the bones of your face -- with your finger tips. Start at the jaw line and move up to the forehead using upward strokes.

Sen. Ted Kennedy Dies of Brain Cancer

Massachusetts Sen. Edward Kennedy died late last night at his home in Hyannis Port, Mass., of brain cancer at age 77.

Kennedy had a malignant glioma, a type of brain cancer. A glioma is a brain tumor that begins in glial cells, which are cells that surround and support nerve cells.

In a statement posted on Kennedy's senate web site, the Kennedy family says, "We've lost the irreplaceable center of our family and joyous light in our lives, but the inspiration of his faith, optimism, and perseverance will live on in our hearts forever. We thank everyone who gave him care and support over this last year, and everyone who stood with him for so many years in his tireless march for progress toward justice, fairness, and opportunity for all. He loved this country and devoted his life to serving it. He always believed that our best days were still ahead, but it's hard to imagine any of them without him."

Kennedy Remembered

Condolences and remembrances have been posted by officials from both sides of the political aisle.

In a statement posted on the White House's web site, President Barack Obama says, "Michelle and I were heartbroken to learn this morning of the death of our dear friend, Senator Ted Kennedy."

"For five decades, virtually every piece of major legislation to advance the civil rights, health and economic well-being of the American people bore his name and resulted from his efforts," Obama says.

Sen. Orrin Hatch, a Republican Senator from Utah, issued a statement saying that America had "lost a great elder statesman ... and I lost a treasured friend." Hatch called Kennedy "larger than life" and said that "many had come before, and many will come after, but Ted Kennedy's name will always be remembered as someone who lived and breathed the United States Senate and the work completed in its chamber."

Nancy Reagan, widow of former President Ronald Reagan, issued a statement saying she was "terribly saddened" to hear of Kennedy's death. "Given our political differences, people are sometimes surprised by how close Ronnie and I have been to the Kennedy family. But Ronnie and Ted could always find common ground, and they had great respect for one another. In recent years, Ted and I found our common ground in stem cell research, and I considered him an ally and dear friend. I will miss him."

Gov. Arnold Schwarzenegger, the Republican Senator of California and husband of Kennedy's niece, Maria Shriver, is quoted by the Associated Press as saying that he had "personally benefited and grown from his experience and advice, and I know countless others have as well. Teddy taught us all that public service isn't a hobby or even an occupation, but a way of life and his legacy will live on."

Kennedy's Brain Cancer

Kennedy's doctors at Massachusetts General Hospital announced his brain cancer diagnosis on May 20, 2008.

Kennedy left Massachusetts General Hospital for his home on Cape Cod, Mass., on May 21, 2008.

In June 2008, Kennedy underwent successful brain surgery at Duke University Medical Center and returned home to Massachusetts, where he got chemotherapy and radiation therapy.

Last Cause: Health Care Reform

Kennedy, a U.S. senator since 1962, returned to the Senate on July 9, 2008, for a vote on Medicare. "I wanted to be here," Kennedy said in a statement. "I wasn't going to take the chance that my vote could make a difference."

In 2009, Kennedy pressed for health care reform while continuing his brain cancer treatment. In June 2009, Kennedy, who served as chairman of the Senate Committee on Health, Education, Labor, and Pensions, released the "Affordable Health Choices Act."

Kennedy was honored and gave a speech at the Democratic National Convention in Denver in August 2008. In that speech, he said "the torch will be passed to a new generation of Americans" in the 2008 presidential election. "The work begins anew. The hope rises again. And the dream lives on."

Relieve Back Pain With Core Strength Training

Pierce Dunn thought surgery had put an end to nearly 15 years of back pain. After a double discectomy about eight years ago, he says, “I could wake up in the morning without worrying that I wouldn’t be able to get out of bed. I became a human being again!”

Feeling revitalized, Dunn, now 57, a partner in a Baltimore investment advisory firm, decided to return to his former hobby: golf. “I played as frequently as I could,” says Dunn. “Since then I’ve been told that golf is about the worst thing you can do if you have a back problem. Soon I was having back spasms that left me incapacitated for a day or two at a time.”

Weak Muscles Lead to Back Pain

Dunn was referred to the sports medicine program at Life-Bridge Health and Fitness Center, part of a regional health network in Maryland overseen by medical director Michael Kelly, MHSc, a certified neuromuscular therapist. Kelly soon found that, although Dunn was very fit for a man his age, he’d neglected some areas of his body. “The muscle groups I was using were in good shape, but then I’d isolate other muscle groups, and I could barely lift the weight. I was like an infant,” Dunn says.

About 25% of Americans are affected by back pain in a given year, and they spend more time at the doctor’s office for back pain than for any other medical condition except high blood pressure and diabetes.

Instead of jumping for pills or surgery, says Kelly, people with chronic back pain should first seek out a thorough functional assessment from a qualified trainer with experience in sports medicine.

Exercising for Back Pain

“A lot of back pain is due to postural alignment problems,” Kelly says. “If you catch it soon enough and correct the problem with exercise and strengthening, you can avoid future pain.”

Today, Dunn has learned a number of ways to use exercise to relieve and prevent back pain. For example, he works hard on strengthening the muscles involved in the body’s core stabilization such as the glutes, a key element in a golfer’s swing.

“When your torso and hips are moving rapidly from back to front, your back can keep your torso rotating and put incredible strain on your spine,” he says. “When you engage your glutes at the end of the swing, it’s like a brake on the spine.”

Back pain can be relieved by many different types of exercises. For instance, a knees-to-chest exercise can be a big help if your pain is due to spinal stenosis, a narrowing of areas in the spine that can put pressure on the nerves. That’s because lying on your back and pulling the knees to the chest for about 60 seconds opens up the disc space in the back, which relieves pressure on the nerves, says Kelly.

Today, Dunn says, “I still have a tight back from time to time, but the pain has almost completely gone away.” Even better: “I haven’t had to give up golfing!”

Palliative Cancer Care Lifts Spirits

Palliative care may boost mood and quality of life for people with advanced cancer, but it may not help them live longer, a new study shows.

Palliative care is a kind of care for people who have a serious illness that usually isn't going to go away and gets worse over time. It aims to ease pain and suffering by helping patients and their families manage symptoms and the side effects of treatments. It also provides emotional support to patients and their families.

It's not the same as hospice care, which serves terminally ill patients who are no longer seeking treatment to cure their illness.

Researchers from the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center wanted to investigate the effectiveness of palliative care in patients with advanced cancer. Their study is published in the Aug. 19 issue of The Journal of the American Medical Association.

The researchers studied 322 patients newly diagnosed with advanced cancer from clinics in New Hampshire and a VA medical center in Vermont. Half of the patients were assigned to telephone-based palliative care intervention; the palliative care consisted of four weekly sessions followed by ongoing monthly calls conducted by specially trained advanced practice nurses. They also received traditional cancer treatment.

The palliative care sessions conducted in the study focused on encouraging active patient involvement in a number of areas, including:

Communication with family members and the medical treatment team

Symptom management

Coping and problem-solving skills

Advance care planning

Treatment decision-making

The other group received usual cancer care, which included use of all oncology and supportive services available at their institutions, including referral to a palliative care service.

All patients were reassessed on quality of life, symptom intensity, and mood after one month and then every three months until death or the conclusion of the study. The study was conducted from 2003-2008.

Those patients who received the palliative care intervention reported improvements in quality of life and depressed mood over patients undergoing usual care. There were no significant differences between the groups, however, in the intensity of symptoms, the number of trips to the emergency room, the number of days spent in the hospital or intensive care unit, or survival.

"Comprehensive, high-quality cancer care includes interdisciplinary attention to improving physical, psychological, social, spiritual, and existential concerns for the patient and his or her family," the researchers write. "While our study did not show that early intervention for patients with advanced cancer by a nurse-led program improved symptoms or reduced use of some resources, the study did show that it provides some patients with advanced cancer a higher quality of life and mood."

As for the next steps, the researchers say they would like to study a larger, more diverse group of people. They also recommend additional research examining the effects of in-person palliative care as opposed to telephone-based sessions.

Ideal Weight or Happy Weight?

Maybe you've been struggling -- without success -- to get down to the size you were in high school or on your wedding day. But do you really need to go that low? The truth, experts say, is that you can weigh more than your ideal weight and still be healthy (not to mention happy).

If you're overweight, losing just 10% of your body weight is associated with a myriad of health benefits, including lowering blood pressure, blood cholesterol, and blood sugar, and reducing your risk for heart disease. Not only that, experts say, but this kind of weight loss is easier to attain and maintain, setting you up for success in the long run.

Your Weight "Set Point"

Just as your body temperature is programmed to stay around 98.6 degrees, your body weight is naturally regulated to stay within a range of 10%-20%, says Thomas Wadden, PhD, director of the Center for Weight and Eating Disorders at University of Pennsylvania Medical School. This weight range is known as the "set point."

A complex set of hormones, chemicals, and hunger signals help your body naturally maintain your weight within this range, says American Dietetic Association spokeswoman Dawn Jackson Blatner, RD.

It is not just a matter of genetics, though. Your eating and exercise habits can also help to determine your set point.

"Overeating swamps the internal regulatory system, and, as a result, the set point increases -- which is much easier to do than it is to lower it," says Wadden. The body adjusts to the higher weight and "resets" the set point to defend the new weight.

It is difficult, but not impossible, to set your range lower. "With changes in healthy eating and exercise behavior, you can lower your set point," says Blatner.

The 10% Solution to Weight Loss

A recent book, Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off, by George Blackburn, MD, suggests that maintaining a 10% loss for six months to a year helps your body adjust to the lower weight and thus reset the set point.

Wadden explains that when you lose large amounts of weight at once, you set up an internal struggle and hormones like ghrelin spike to make you hungrier as your body tries to defend its comfortable range.

Instead, experts recommend that you try losing 10% the old-fashioned way -- by slowly changing eating and exercise behaviors -- then maintain this new weight for a few months before trying to lose more. Not only will your body get the signal to lower its "set point," but you'll give yourself a chance to get used to new food choices, smaller portions, and regular exercise.

“When patients lose 10% it may not be the pant size they want, but they start to realize how a little weight loss impacts their health in very positive ways," says Blatner. "They feel better, sleep better, have more energy or less joint pain, and some people are able to reduce medications."

How Much Should I Weigh?

Most people overestimate how much weight they can realistically lose, which leads to frustration, says Blatner. To find your happy or healthy weight, Blatner suggests looking back on your weight history as an adult and identify a weight you were able to maintain naturally and fairly easily.

And if you've gained more than a few pounds since your wedding day, forget trying to fit into that bridal gown. "As you gain weight, you experience an increase in fat cell size and number, which will probably prevent you from getting back to your married weight," says Wadden.

Instead of focusing on the numbers on the scale, Blatner suggests setting behavioral goals: "Eat breakfast every day, go for daily walks, eat more fruits and vegetables -- when you set behavior goals, they are easier to accomplish and they make you feel good." Stick with these behaviors for 3-6 months and they will become part of your life.

Based on your current weight, eat about 10 calories per pound of nutritious food (low in fat, rich in lean protein, high in fiber), get regular exercise, and assess your weight after a month or so.
"Your weight will settle out and typically you will lose 10%, then hit a plateau, which is a good time to maintain the weight loss," says Wadden.

As you get to a healthy weight, you can go up to 12 calories per pound.

Tips for Weight Loss Success

Here are some tips from Blatner for weight loss success:

Eat regular meals. People who eat regular meals consume fewer calories than those who eat irregular meals.

Use a plate, sit down, and enjoy your meals. Folks who do this eat 43% smaller portions than those who eat out of containers or on the run, according to Blatner.

Get at least 30 minutes of moderate activity each day.

How much and what you eat makes a big difference. Enjoy normal portions of foods that are high in fiber (fruits, veggies, whole grains) and rich in lean or low fat protein is the secret to feeling full.

Think positive: Focus on the benefits of a healthier lifestyle rather than the scale.

Skip Breakfast, Get Fat

Skipping breakfast is often a big no-no if you are trying to lose or maintain weight because it leads to high-calorie cravings later. Now researchers think they know why that happens.

Forgoing the first meal of the day actually tricks your brain into thinking you want higher-calorie foods -- foods that can make you fat, or at least increase your risk for weight gain.

A team from Imperial College London presented the news at the Endocrine Society's 91st annual meeting in Washington, D.C. The researchers used a scan called functional magnetic resonance imaging (fMRI) to look at how feeding behaviors affected the brain's "reward" center, which plays a role in pleasures and the body's response to them.

Functional MRI allows doctors to look at how blood flow increases in response to brain activity.
The study involved 20 healthy, non-obese people. They skipped breakfast before the fMRI exam. During the test, they looked at random photos of high- and low-calorie foods. The high-calorie foods included pizza, cake, and chocolate. The healthier options included vegetables, fish, and salad.

The brain's reward center lit up more vividly, or became more active, when the person saw a high-calorie food as opposed to a low-calorie choice. (The taste and smell of food can also activate the brain's reward center.)

However, when the participants ate breakfast and had the same test repeated 90 minutes after eating breakfast, the brain's reward center did not show any significantly greater activity when shown the high-calorie photos.

The study participants also rated how appealing they found each food picture. When skipping breakfast, high-calorie foods topped the list of favorites. After eating, however, the group did not show a strong preference for the calorie-laden foods. Their choices corresponded with the MRI findings.

Breakfast has long been touted as the most important meal of the day, and researchers say their findings add credence to that adage.

"Our results support the advice for eating a healthy breakfast as part of the dietary prevention and treatment of obesity," Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London, says in a statement. "When people skip meals, especially breakfast, changes in brain activity in response to food may hinder weight loss and even promote weight gain."

Researchers hope the findings could one day lead to the development of weight loss medications that target the brain's reward circuitry and disrupt the craving bias between high-calorie and low-calorie foods.

Can’t Sleep? Adjust the Temperature

Tony Roy is among the 30% of American adults with insomnia-related problems. “I can go to sleep, but I wake up three or four hours later,” says Roy, a 51-year-old philosophy professor at California State University, San Bernardino. When he sought help at the nearby Sleep Disorders Center at Loma Linda University Medical Center, he got advice that had never occurred to him:

Pay close attention to your bedroom temperature.

For years, Roy had followed his energy-conscious wife’s suggestion to lower the thermostat. “It was quite cold in our house,” he says. “We used to sleep with the thermostat set at about 60. I used lots of blankets.”

Not enough, it turned out. The very first night Roy followed his doctor’s suggestion to push the heat up to a more comfortable 68 degrees, he got a much better night’s sleep. “I was able to go back to sleep when I did wake up,” he says.

How Air Temperature Affects Your Sleep

Experts agree the temperature of your sleeping area and how comfortable you feel in it affect how well and how long you snooze. Why? “When you go to sleep, your set point for body temperature -- the temperature your brain is trying to achieve -- goes down,” says H. Craig Heller, PhD, professor of biology at Stanford University, who wrote a chapter on temperature and sleep for a medical textbook. “Think of it as the internal thermostat.” If it’s too cold, as in Roy’s case, or too hot, the body struggles to achieve this set point.

That mild drop in body temperature induces sleep. Generally, Heller says, “if you are in a cooler [rather than too-warm] room, it is easier for that to happen.” But if the room becomes uncomfortably hot or cold, you are more likely to wake up, says Ralph Downey III, PhD, chief of sleep medicine at Loma Linda University and one of the specialists treating Roy.

He explains that the comfort level of your bedroom temperature also especially affects the quality of REM (rapid eye movement) sleep, the stage in which you dream.

What’s the Best Temperature for Sleeping?

Recommending a specific range is difficult, Downey and Heller say, because what is comfortable for one person isn’t for another (explaining how Roy’s wife slept blissfully in the chilly 60-degree room). While a typical recommendation is to keep the room between 65 and 72 degrees Fahrenheit, Heller advises setting the temperature at a comfortable level, whatever that means to the sleeper.

Roy plans to keep a close eye on the thermostat, even if the heat bills are a bit higher.

There are other strategies for creating ideal sleeping conditions, too. Experts from the American Academy of Sleep Medicine, for instance, advise thinking of a bedroom as a cave: It should cool, quiet, and dark. (Bats follow this logic and are champion sleepers, getting in 16 hours a day.) Be wary of memory foam pillows, which feel good because they conform closely to your body shape -- but may make you too hot. And put socks on your feet, as cold feet, in particular, can be very disruptive to sleep.

Are Antidepressants Safe During Pregnancy?

Women who take antidepressants face a difficult choice when they become pregnant, and for many the risks vs. benefits of continuing treatment are not clear, a joint report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists finds.

The report confirms that there are far more questions than answers about the dangers antidepressants pose to the babies born to women who take them.

It also presents guidelines to help doctors and patients identify who should and should not consider stopping drug treatment.

Pregnant women who experience psychotic episodes, have bipolar disorder, or who are suicidal or have a history of suicide attempts should not be taken off antidepressants, the report concludes.

"We know that untreated depression poses real risks to babies. That is not conjecture," Yale University School of Medicine ob-gyn Charles Lockwood, MD, tells WebMD. "We know much less about the risks associated with antidepressant use. It is clear that more study is needed."
According to one study, the rate of antidepressant use during pregnancy more than doubled between 1999 and 2003. The study found that in 2003, one in eight women took an antidepressant at some point during her pregnancy.

Greater use of selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac, Paxil, and Zoloft were largely responsible for the increase.

These drugs were generally considered safe for pregnant women at the time, but safety concerns soon emerged, especially regarding Paxil.

Separate studies from Sweden and the U.S. suggested an increased risk for congenital heart defects in babies born to women who took Paxil during pregnancy.

The reports led the FDA to issue an advisory in December 2005 warning about the potential risk based on early results of two studies.

But the joint panel found the evidence linking Paxil use during pregnancy to heart problems in newborns to be inconclusive.

Lockwood tells WebMD that if the risk is real, it is probably not limited to Paxil alone.
"It is very likely to be a class effect and not just this one drug," he says.
Miscarriage, Low Birth Weight, and Preterm Birth

SSRI use during pregnancy has also been linked in some studies to an increased risk for miscarriage, low birth weight, and preterm delivery.

But once again, the report found no definitive link between the use of the antidepressants and these pregnancy outcomes.

"Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or behaviors that can adversely affect pregnancy," the joint panel writes.

The report was published in both the American Psychiatric Association journal General Hospital Psychiatry and the American College of Obstetricians and Gynecology journal Obstetrics and Gynecology.

The joint panel concludes that a gradual reducing of antidepressant dosages and stopping antidepressants altogether may be appropriate for women who hope to become pregnant if they have had mild or no symptoms for six months or longer.

The group also recommended that:

Women who are already pregnant should not attempt antidepressant withdrawal if they have severe depression.

Psychiatrically stable women who want to stay on antidepressants during pregnancy should consult with their psychiatrist and ob-gyn about the potential risks and benefits.

Women with recurrent depression or those who have symptoms despite drug treatment may benefit from psychotherapy when available.

Psychiatrist Ariela Frieder, MD, who specializes in treating pregnant women with depression at Montefiore Medical Center in New York City, tells WebMD that her patients tend to be very concerned about how antidepressants will affect their baby and much less aware of the dangers posed by untreated depression.

Frieder was a practicing ob-gyn in her native Argentina before moving to New York where she did her residency in psychiatry.

"Many women want to stop treatment abruptly and even stop on their own, but this can be very risky," she says.

Jennifer Wu, MD, an ob-gyn who practices at New York's Lenox Hill Hospital, agrees.

"The old conventional wisdom was that pregnancy was a honeymoon period for depression and that patients would be able to come off their medications and be OK," she tells WebMD. "But we have learned that this is not true. It has become more and more apparent that pregnancy is a vulnerable time for patients with a history of depression."

Saturday, August 22, 2009

Low Folate May Be Linked to Allergies

May 8, 2009 -- Early research suggests that low folate levels may be linked to an increased risk for allergy and asthma, but more study is needed to confirm the association.

Researchers from the Johns Hopkins Children's Center examined the blood folate levels of more than 8,000 people with and without asthma and allergies who were enrolled in a large, national health registry.

They found that those with the lowest serum folate levels were 31% more likely to have test-verified allergy and 40% more likely to have wheeze than people with the highest levels. They also found them 16% more likely to have diagnosed asthma, although the asthma finding wasn't statistically significant.

Pediatric allergist and study researcher Elizabeth C. Matsui, MD, MHS, tells WebMD that the relationship appeared to be dose-dependent, meaning that the people with the highest blood folate levels had the lowest incidence of wheeze and allergies and the people with the lowest folate levels had the highest incidence.

But she warns that it is too soon to recommend that people take folic acid -- the synthetic form of folate used in supplements -- in an effort to reduce their risk for allergy and asthma or to treat symptoms.

"That would be premature," she says. "Our findings are a clear indication that folic acid may indeed help regulate immune response to allergens, and may reduce allergy and asthma symptoms. But we still need to figure out the exact mechanism behind it, and to do so we need studies to follow people receiving treatment with folic acid."

Few Are Folate Deficient

Less than 5% of Americans have so little folate in their blood that they are considered deficient in the B vitamin, Matsui says.

That's because since 1996, the U.S. government has required folic acid to be added to cereals, flours, pastas, rice, and other grain products in an effort to ensure that pregnant women get enough of the vitamin to protect against certain birth defects.

Folate is also abundant in leafy green vegetables like spinach and turnip greens, citrus fruits, dried beans, liver, and many other foods.

The people in the study who had the least folate in their blood were not deficient in the vitamin. Instead, they had what would be considered low-normal plasma folate levels, Matsui says.

Nevertheless, even after adjusting for known risk factors for asthma and allergy, people with the lowest blood folate levels had the highest odds of test-verified allergy, wheeze, and allergy-related IgE antibodies.

The study appears in the latest online issue of the Journal of Allergy & Clinical Immunology.

Allergies, Asthma, and Folic Acid

Allergist Cascya Charlot, MD, tells WebMD that the findings are intriguing enough to justify interventional studies that could determine if folic acid supplementation really does protect against asthma and allergies.

Charlot is medical director of Allergy and Asthma Care of Brooklyn.

"There may be something there," she says. "Now we need to see if treating people with folic acid will reduce symptoms."

The study is among the first to suggest that folic acid may protect against allergy and asthma, but several other studies -- also preliminary -- suggest that supplementation may promote allergic disease in some populations.

Last October, Duke University researchers reported that mice exposed to high levels of folate prior to birth had an increased risk for allergic disease early in life.

The researchers suggested that the dramatic increase in asthma over the last two decades may be at least partly related to efforts to increase supplementation among pregnant women.

Charlot says the seemingly conflicting findings highlight the need for more research.

"It looks like there is something here, but it is clear that we don't really understand what is going on," she says.

Pregnant Women First to Get Swine Flu Vaccine

If swine flu vaccine is in short supply -- nationally or in local areas -- pregnant women and people caring for or living with infants will go to the front of the line, the main U.S. vaccine advisory committee today recommended.

Next would come health care workers and first responders who have direct contact with patients, children 6 months to 4 years old, and kids 4 to 19 years old with medical conditions that put them at risk of severe flu disease. There are about 42 million Americans in these groups.

Plenty of Swine Flu Vaccine?

By the end of October, officials expect to have 120 million doses of swine flu vaccine on hand. That's not enough for everybody -- especially if two doses are needed -- but that would be enough to add more people to the front of the line.

If projected vaccine supplies are on hand, otherwise healthy children 4 and older would be included in the first group to get the vaccine. People 25 to 64 with underlying medical conditions that put them at risk of severe flu disease would also be included, as would a larger group of health care workers and emergency medical technicians.

Once there's enough vaccine for these urgent groups, swine flu vaccine will be offered to healthy people 24 and older.

But not everyone agrees that the vaccine should be doled out one group at a time. The 120 million doses of swine flu vaccine that should arrive by the end of October is more doses of flu vaccine than Americans have ever used in a single year.

"The only sin is vaccine left in the refrigerator. And this happens every time you prioritize flu vaccine," William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases, told the committee.

Swine Flu Vaccine: Full Speed Ahead or Go Slow?

The recommendations came today in a special, urgently called meeting of the CDC's Advisory Committee on Immunization Practices, a group of vaccine and infectious disease experts from outside the CDC. The group's recommendations are almost always made official U.S. vaccine policy by the FDA and CDC.

The next wave of the H1N1 swine flu pandemic is expected to hit the U.S. this fall. Early vaccine supplies -- about 40 million doses -- could become available as early as September.

That will happen only if officials decide by mid-August to start packaging swine flu vaccine without waiting for initial safety and efficacy data from clinical trials. Those trials have just begun. The earliest information from those trials won't be available for six to eight weeks.

The new flu vaccine will be the second flu vaccination Americans will be urged to get. This year, even more than others, health officials will be urging us to get our annual flu vaccine to protect against seasonal flu. Soon after that, we'll be asked to line up to get our swine flu vaccination.

"This year our challenge has doubled," HHS Secretary Kathleen Sebelius said in a video feed to the meeting. "Like seasonal flu, the novel H1N1 flu is deadly. ... It has spread wide and disrupted communities across the U.S. While media attention has decreased over the summer, the threat from this virus has not."

We may very well be asked to get two shots of swine flu vaccine. CDC flu expert Anne Schuchat, MD, says the CDC expects immunization to require two shots, given three weeks apart. It's not yet clear whether the inhaled version of the swine flu vaccine will require two doses or just one.

A Novice Hiker's How-To Guide

Hiking can be a fun workout that lets you enjoy the outdoors with your friends. But if you are not prepared, all the fun can drain out of a hike. Here are some things to remember that will help ensure you have a great time on your next trek outdoors.

"You want to be able to enjoy the beautiful scenery and the company of friends that may be with you," says Richard Ray, EdD, an avid hiker, professor of kinesiology, and athletic trainer at Hope College in Holland, Mich. "You don't want to be so darn tired when you're out there or at the end of the trail that you're no good for anything."

When planning a hike, your first task is to pick a trail suited to your abilities. If this is one of your first hikes and you're not in the best shape, pick a relatively short and flat trail that's not at a high altitude. Unfortunately, you can't rely on trail labeling because it's not consistent. Read up on the trails you'd like to hike and consider getting a topographical map of the region to make sure it's not too rugged or steep.

Ray says you'll need to get three of your "critical body systems" ready for hiking:

Your feet;

Your legs;

Your cardiovascular system.

Protect your feet with good hiking boots. Be sure you have "broken them in" by walking around the house or neighborhood in them. Pick a good midweight, high-top, hiking boot with a good sole that's going to support your foot. Talk to people who sell high-quality hiking products to help you find boots that are right for you and to be sure that they fit you properly.

To strengthen your legs for a hike on flat terrain, walking or jogging every day for 6-8 weeks before the hike is a good preparation. Start with about 20 minutes a day and try to work up to about 40. If you're going to be hiking over hills and valleys, a stair machine can help you prepare. If you're going to be wearing a backpack on your hike, wear it while training, too.

Norris Tomlinson, ACE, ACSM, also recommends specific leg exercises like squats and lunges as well as weight training to keep the leg muscles in good condition. He is a personal trainer and group exercise specialist who is national director of Group Exercise in Chicago.

To build up your cardiovascular system, any aerobic exercise will do, including walking, jogging, or biking.

Ray says that it takes 6-8 weeks to make noticeable improvements in your cardiovascular system and leg strength. "But that doesn't mean you shouldn't start even if you only have a few weeks to go," he says. "If your hike is 3 weeks away, and you haven't done anything, get out there and get started. Anything is better than nothing."

And be sure you are properly outfitted. What you bring on your hike depends on where you're going and for how long, but some key items include a map, compass, knife, matches, rain gear, water, and a water purification system. Even on a short hike, you should bring some food, such as crackers, cheese, dried fruit, candy bars, or trail mix.

Also, make sure someone knows where you're going and when you plan to return. Steer clear of terrain that makes you uncomfortable. Stay hydrated and keep dry. Don't hike at a high altitude until your body has become accustomed to it. And remember that it's best to have others hike with you.

And finally, if the idea of an outdoor workout with your friends makes hiking attractive to you, remember that the slowest person in your group will set the pace. If fitness is your goal, make sure your hiking partners are well matched to you in terms of fitness level and goals.

Popcorn, Cereal Pack Antioxidant Punch

Aug. 18, 2009 -- Whole grains pack a powerful antioxidant punch along with their well-known fiber muscle, according to a new study.

For the first time, researchers have measured the total antioxidant content of many popular breakfast cereals and whole-grain snacks, and it turns out that the fiber powerhouses are also heavyweights in the cancer-fighting antioxidant division as well.

Raisin Bran and popcorn topped the list, but the study shows that many other popular whole-grain breakfast cereals and snacks may be an overlooked source of healthy antioxidants known as polyphenols.

Polyphenols are often associated with the seeds and skins of fruits and vegetables and are a major reason why wine, chocolate, and coffee have been become well known for their potential role in fighting cancer, heart disease, and other ailments.

"Early researchers thought the fiber was the active ingredient for these benefits in whole grains, the reason why they may reduce the risk of cancer and coronary heart disease," researcher Joe Vinson, PhD, of the University of Scranton in Pennsylvania, says in a news release. "But recently, polyphenols emerged as potentially more important. Breakfast cereals, pasta, crackers, and salty snacks constitute over 66% of whole grain intake in the U.S. diet."

Grains Have Antioxidants, Too

The study, presented this week at a meeting of the American Chemical Society, measured the total polyphenol content of nine whole-grain flours, 28 ready-to-eat breakfast cereals, four hot cereals, and 38 grain-based foods and snacks, including pasta, crackers, chips, and popcorn.
"We found that, in fact, whole-grain products have comparable antioxidants per gram to fruits and vegetables,” Vinson says.

Based on the typical serving size, researchers say that oat cereals had the most antioxidants, followed by corn, wheat, hot oat cereals, and rice cereals.

Of the breakfast cereals tested, Raisin Bran had the highest antioxidant count per serving at 524 milligrams. But researchers say this was primarily because of the addition of phenol-rich raisins.
The results showed a wide variation in the antioxidant content of each class of cold cereals. For example, cinnamon- and cocoa-flavored cereals were much higher in antioxidants than would be expected from their grain content alone.

Researchers say bran cereals made from wheat are not much higher in antioxidants than other wheat cereals, but they have more fiber. Whole-grain flours were also very high in antioxidants.
Among snack foods, the results showed that popcorn had the highest levels of antioxidant polyphenols.

Tips for Reaping the Benefits of Whole Grains

Eating more whole grains is an easy way to add a layer of "health insurance" to your life. Whole grains are packed with nutrients including protein, fiber, B vitamins, antioxidants, and trace minerals (iron, zinc, copper, and magnesium). A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity, and some forms of cancer. Whole-grain diets also improve bowel health by helping to maintain regular bowel movements and promote growth of healthy bacteria in the colon.

Yet only 10% of Americans consume the recommended three servings a day.

Why? For one thing, it's not always easy to tell just which foods are whole grain. Scan the bread, cereal or snack aisle, and virtually every package touts its whole-grain goodness. But not all of them actually are whole grain. Terms like "multigrain," "100% wheat," "cracked wheat," "organic," "pumpernickel," "bran," and "stone ground" may sound healthy, but none actually indicates the product is whole grain.

Further, many Americans have the perception that whole grains just don't taste good, or that it's difficult to work them into their daily diets.

To help you start reaping the benefits of a diet rich in whole grains, WebMD got the skinny on how to tell which foods are made of whole grains, along with suggestions on how to fit the recommended servings into your healthy eating plan.

Know Your Whole Grains

A whole grain contains all edible parts of the grain, including the bran, germ, and endosperm. The whole grain may be used intact or recombined, as long as all components are present in natural proportions. To recognize whole grains, keep this list handy when you go to the grocery store and choose any of the following grains:

Whole-grain corn

Whole oats/oatmeal

Popcorn

Brown rice

Whole rye

Whole-grain barley

Wild rice

Buckwheat

Triticale

Bulgur (cracked wheat)

Millet

Quinoa

Sorghum

100% whole wheat flour

But what about when you're buying processed products, such as a loaf of bread? You probably know to avoid products made of "refined" wheat. But did you know that some manufacturers strip the outer layer of bran off the whole kernel of wheat, use the refined wheat flour, add in molasses to color it brown, and call it "100% wheat" bread? That's true -- but it is not a whole grain.

That's why it's important to check the ingredient list for the word "whole" preceding the grain (such as "whole wheat flour"). Ideally, the whole grain will be the first ingredient in the list, indicating that the product contains more whole grain than any other ingredient.

One simple way to find whole grains is to look for the FDA-approved health claim that reads, "In a low fat diet, whole grain foods may reduce the risk of heart disease and some forms of cancers." This is found on whole-grain products that contain at least 51% whole-grain flour (by weight) and are also low in fat, saturated fat, and cholesterol.

Another easy way to find whole-grain products is to look for the Whole Grain Council's whole grain stamp, which shows how many grams of whole grains are in each serving. If all of the grain is whole grain, the stamp also displays a "100%" banner.

The amount of grains you need daily varies based on your age, sex, and physical activity level. Most adults need six servings of grains each day, and at least half are recommended to come from whole grains. You can determine how much you need by checking the U.S. government's My Pyramid Plan.

More Whole Grain Products

The good news is that whole grains are not necessarily brown, or multigrain, or only found in adult cereals. You can find them throughout the food supply, including many processed foods.

Since the 2005 U.S. Dietary Guidelines recommended that Americans eat more whole grains, there has been an explosion of whole-grain options. Even many restaurants now offer brown rice and other whole grains options.

For whole-grain nutrition without the "grainy" taste, there are newly reformulated products that use lighter whole wheats and new processing techniques to make them look and taste more like white flour.

These "white whole-grain" products are a great way to transition into eating more whole grains, particularly if your kids are turning their noses up at them.

Whole Grains and Fiber

Whole grains can be an excellent source of fiber. But not all whole grains are good sources of fiber. Whole wheat contains among the highest amount of fiber of the whole grains. Brown rice contains the least.

For most people, whole grains are their diet's best source of fiber.

Most whole-grain sources yield from 1-4 grams of fiber per serving, comparable to fruits and vegetables, and just the right amount when spread throughout the day.

Can't fiber supplements give you the same benefit? While you get plenty of fiber from these supplements, you'll miss out on all the other nutritional benefits of whole grains. However, if you know you're not getting at least 25 grams of fiber per day, fiber supplements are a great way to help you get there.

8 Easy Ways to Get More Whole Grains into Your Diet

Learning to enjoy whole grains is simply a matter of retraining your taste buds to become familiar with the fuller, nuttier flavor of the grain, experts say.

Whole grains taste and feel different to the mouth, and therefore it takes time to adjust to these new grains.

Here are eight easy ways to work more whole grains into your daily diet:

Choose whole-grain breads, cereals, English muffins, waffles, bagels, and crackers. Enjoy a sandwich at lunch with two slices of whole-grain bread, or a whole-grain pita or wrap, and you're two-thirds of the way toward meeting your goal.

Eat popcorn. What could be easier than eating air-popped popcorn as a snack? A study in the 2008 May issue of the Journal of the American Dietetic Association found that people who regularly ate popcorn averaged 2.5 servings of whole grains per day, while non-popcorn eaters got less than one serving.

Make your snacks whole grain. Snacks account for one-third of whole grain consumption - just make sure you choose the right ones. Check the label, because even though it is made with a whole grain, it could still be high in fat, calories, and sodium.

Start your day with a bowl of whole-grain cereal. Members of the National Weight Control Registry who have lost substantial amounts of weight -- and kept it off -- swear by the importance of eating a nutritious breakfast, such as cereal, each day. But keep in mind that even when a product is made from whole grain, it's not necessarily healthy. Read the label and select cereals based on the whole-grain content and amount of sugar it contains. The less sugar, the better.

Add whole grains to your baked goods. Magee likes to blend half whole-wheat flour with all-purpose flour to boost the whole-grain content of her baked goods. You can also use white wheat flour, available in your local grocery store. Another option is to replace one-third of the flour with whole-grain oats.

Choose brown rice and whole-wheat or blended pasta. Cook up a batch of brown rice and freeze or keep in the fridge 4-5 days and if time is an issue, there are great ready brown rice products. Try whole-grain pasta, or some of the blended pastas made with a mix of whole and refined grains. Don't be put off by the dark color of whole-grain pasta that becomes much lighter when it is cooked.

Experiment with different grains. Visit your local health food market and try your hand at some of the less-familiar whole grains available. Try risottos, pilafs, whole-grain salads, and other grain dishes made with barley, brown rice, millet, quinoa, or sorghum, Magee suggests. Add barley to canned soup, then boil to cook the barley. Add uncooked oats to meatloaf or stir oats into yogurt for crunch and added nutrition.

Start your kids off right. Starting off young kids with a diet of all whole grains. For older kids, try the white whole-wheat flour, and incorporate whole grains into foods that have other flavors: French toast; burgers on whole-grain buns; brown rice medley with veggies; in soups or dishes like shrimp Creole; whole-wheat pitas as crusts for make-your-own individual pizzas.

Antidepressant Use Nearly Doubles

Aug. 3, 2009 -- Antidepressant use has nearly doubled in the U.S, according to a new study.
Meanwhile, the use of psychotherapy by those prescribed the antidepressants has declined during the same period studied, from 1996 to 2005.

"I expected there to be an increase [in antidepressant use], but I didn't expect the increase to be as large as we actually found," says Mark Olfson, MD, MPH, professor of clinical psychiatry at New York State Psychiatric Institute of Columbia University, who co-authored the study with Steven C. Marcus, PhD, of the University of Pennsylvania, Philadelphia.

''Ten percent of the population is being treated with an antidepressant during the course of a year," he says. That compares to 5.8% in 1996, he found.

Although part of the uptick can be linked to the fact that mental health treatment is becoming more common and accepted, Olfson tells WebMD that he fears the medications may sometimes be prescribed "in a casual way."

The study appears in the Archives of General Psychiatry.

Depression Slideshow

What is depression? Find out different types and the treatments.

Antidepressant Use Trends: Study Details

Olfson and Marcus analyzed data from the Medical Expenditure Panel Surveys, sponsored by the Agency for Healthcare Research and Quality, which provides national estimates in the U.S. about health care use and costs.

For the 1996 survey, nearly 19,000 people aged 6 and older were included, and more than 28,000 in the 2005 survey. A designated adult in each household answered questions about prescribed medications, medical visits, and other information.

The rate of antidepressant treatment increased from 5.84% to 10.12 % -- or from 13 million people to about 27 million, the researchers found.

One exception to the trend involved African-Americans. "African-Americans really did stand out as one group that didn't experience a significant increase in antidepressant use," Olfson says. In 1996, 3.6% of African-Americans surveyed were on antidepressants and 4.5% in 2005.

Another important finding, Olfson says, is that fewer people on antidepressants surveyed in 2005 also took part in psychotherapy or "talk therapy." Although 31.5% of those surveyed in 1996 on antidepressants also did talk therapy, just 19.8% of those surveyed in 2005 both took antidepressants and participated in psychotherapy.

Often, the two are recommended together for depression.

Antidepressant Use Trends: Study Interpretations

The researchers say a number of factors explain the increasing use of antidepressants. "There has been broad and growing acceptance of antidepressant medicine in the U.S.," Olfson tells WebMD.

In an unrelated survey released last week, researchers found that American attitudes toward psychiatric medicines are becoming more positive. The researchers compared the responses of people in surveys done in 1998 and 2006.

Other factors explaining the increase, according to Olfson:

Major depression is more common. Two surveys found the prevalence of major depression in adults rose from 3.3% in 1991-1992 to 7.1% in 2001-2002.

Since 1996, several new antidepressants have come on the market.

Clinical guidelines support the use of antidepressants for conditions other than depression, such as anxiety disorders.

The lower increase in antidepressant use among African-Americans may be cultural, Olfson says, with a tendency to embrace psychotherapy over medication. "There is also some evidence that African-Americans as compared to whites have lower rates of depression," he says. That may be part of the story as well."

Antidepressant Use Trends: Second Opinion

Another expert says the research seems to have both encouraging and not-so-encouraging implications.

The encouraging implication is that "people are not so embarrassed, that they are more open to seeking help for depression," says Eric Caine, MD, the John Romano Professor and chair of the Department of Psychiatry, University of Rochester Medical Center, Rochester, N.Y., who reviewed the study for WebMD.

The fall in psychotherapy use found in the Olfson study, however, is a concern, Caine says. "In mild to moderate depression, psychotherapy is as good as or better than medications," Caine says. He emphasizes that the antidepressants are lifesavers for some and sometimes needed. But, he adds, ''in the population as a whole, most depression is mild or moderate."

Antidepressant Use: Take-Home Point

Deciding to take an antidepressant should be treated by the prescribing physician and the patient as an important one, Olfson says. "Know that it requires monitoring," he says, "and to have symptoms followed over time."

''There is a risk out there of 'casual' prescriptions," Olfson says. "The risk is that people will get these medications but not the surrounding attention and care that we know is needed to have the very best outcome."

Friday, August 21, 2009

Spinal Fracture: Cement No Better Than Sham

Aug. 5, 2009 -- A popular treatment for painful spinal compression fractures works no better than sham therapy in patients with osteoporosis, according to two new studies published today in the New England Journal of Medicine.

Researchers compared outcomes among patients who received injections of medical-grade cement to stabilize collapsed vertebra with those of patients who received a sham treatment.
Both treatments seemed to work, but patients injected with the cement showed no more improvement in pain and function than patients who received the sham treatment.

Cement injection, known medically as vertebroplasty, has become a leading treatment for osteoporosis-related spinal fractures. By one estimate, the number of vertebroplasties performed in the United States doubled between 2001 and 2007.

Same Outcome, Different Interpretations

The new studies are the most rigorously designed trials ever to examine the effectiveness of the cement treatment for the treatment of spinal compression fractures.

The two lead researchers differed in their interpretation of the implications for clinical practice.
“Our trial found no benefit for this treatment, so it should not be used in clinical practice,” says Rachelle Buchbinder, PhD, who led a team of researchers from Melbourne, Australia’s Monash University.

Interventional neuroradiologist David F. Kallmes, MD, of the Mayo Clinic, who led the second study, says more research is needed to determine if certain patients respond better to the cement injections than to other treatments.

“I think it’s fair to say that vertebroplasty does not work in the way that we thought it does, but it does work,” he tells WebMD. “It’s just that the (sham) treatment worked just as well and we can’t say why.”

The Australian study involved 78 patients with severe pain from osteoporosis-related vertebral fractures treated with either cement injections or a sham. Neither the patients nor the researchers knew which treatment was being given.

Both sets of patients received the same hospital care and local anesthetic before treatment. But those who did not get the cement treatment received cues such as pressure placed on the back and exposure to the smell of the bone cement.

The researchers measured pain, quality of life, and functional status one week after treatment and one, three, and six months later. They found that both groups had similar improvements in pain, function, and quality of life over time.

In the similarly designed Mayo Clinic trial, 131 patients from eight treatment centers in the U.S., U.K., and Australia were treated with either cement injection or sham.

One month later, both groups saw significant and similar improvements in pain, quality of life, and functional status.

Patients in the Mayo trial were able to “cross over” and get the other treatment after a month.
Even though they had no confirmation of which treatment that was, nearly four times as many patients who had the sham treatment switched, suggesting that more of them were less satisfied with their initial treatment.

“It is possible that there was a treatment effect (with the cement treatment) that we were just unable to measure,” Kallmes says. “I don’t think we should give up on this procedure. I think it needs to be studied in more detail.”

More Patients Needed for Trials

For this reason, Kallmes says he will not recommend the cement injections to patients in the future unless they agree to participate in clinical trials.

Interventional radiologist Avery Evans, MD, tells WebMD that there has been so much hype about the cement injections, patients have been reluctant to enroll in trials if it meant they might not get the treatment.

An associate professor of radiology and neurosurgery at the University of Virginia, Evans agrees that more research is needed to determine if vertebroplasty benefits specific subgroups of patients.

“Up until now no one was willing to randomize their patients because they were so convinced that vertebroplasty was the greatest thing in the world,” he says. “Now it’s time for us to admit that we aren’t as smart as we thought we were and ask the questions, ‘Are there patients who are helped by this treatment, and who are they?'"

In an editorial published with the studies, James N. Weinstein, DO, who directs the Dartmouth Institute for Health Policy and Clinical Practice, questioned whether the sham treatment really was a placebo treatment and whether either treatment was better than no treatment at all.

He pointed out that of the approximately 750,000 people who suffer from vertebral fractures each year, only about a third receive any kind of treatment.

“Although (the two trials) provide the best available scientific evidence for an informed choice, it remains to be seen whether there will be a paradigm shift in the treatment of vertebral compression fractures with vertebroplasty or similar procedures,” he writes.

Why Willpower Often Fails

Aug. 7, 2009 -- People who rely on sheer willpower to help them lose weight, stop smoking, or beat other addictions more often than not end up giving in to temptation, and now new research may help explain why.

The study found that people tend to overestimate their ability to resist strong urges, and that those who are most confident about their willpower are most likely to lose it.

Rather than rely on self-control in situations where temptations arise, the best way to stay in control is to avoid those situations altogether, says psychologist and lead researcher Loran Nordgren, PhD, of Northwestern University’s Kellogg School of Management.

“The key is simply to avoid any situation where vices and other weaknesses thrive and, most importantly, for individuals to keep a humble view of their willpower,” he says in a news statement.

Nordgren and colleagues conducted a series of experiments on college students examining their reactions when exposed to temptation.

In one experiment, smokers who most strongly believed they could resist the urge to smoke were twice as likely to light up a cigarette as were smokers who perceived themselves as having low self-control.

In another test, hungry students more accurately predicted their ability to resist a future tempting snack than those who were not hungry, suggesting that the absence of hunger pangs makes people overconfident about their power over food.

The findings, which appear in the upcoming issue of the journal Psychological Science, have implications for anyone trying to overcome addiction, be it to food, alcohol, drugs, sex, or any number of other behaviors, Nordgren notes.

“We expose ourselves to more temptation than is wise, and subsequently we have millions of people suffering with obesity, addictions, and other unhealthy lifestyles,” he says. “And while our study focused on personal behaviors like smoking and eating, it is easy to apply our findings to a broader context.”

Diabetes and Weight Loss: Finding the Right Path

There's no question about it: If you're overweight and have type 2 diabetes, dropping pounds lowers your blood sugar, improves your health, and helps you feel better

But before you start a diabetes weight loss plan, it's important to work closely with your doctor or diabetes educator - because while you're dieting, your blood sugar, insulin, and medications need special attention.

Make no mistake -- you're on the right path. "No matter how heavy you are, you will significantly lower your blood sugar if you lose some weight," says Cathy Nonas, MS, RD, a spokeswoman for the American Dietetic Association and a professor at Mount Sinai School of Medicine in New York City.

A National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. The study involved people who were overweight (average body mass index of 34) and who had high -- but not yet diabetic -- blood sugar levels.

"We know it's true -- that if someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar," Nonas tells WebMD.

"We see it all the time: people can get off their insulin and their medication," she says. "It's wonderful. It shows you how interwoven obesity and diabetes are."

Even losing 10 or 15 pounds has health benefits, says the American Diabetes Association. It can:

Lower blood sugar

Reduce blood pressure

Improve cholesterol levels

Lighten the stress on hips, knees, ankles, and feet

Plus, you'll probably have more energy, get around easier, and breathe easier.

On a Diabetes Weight Loss Plan, Watch for Changes in Blood Sugar

Cutting back on just one meal can affect the delicate balance of blood sugar, insulin, and medication in your body. So it's important to work with an expert when you diet.

Check with your doctor before starting a diabetes weight loss plan, then consult with a diabetes educator or nutritionist, advises Larry C. Deeb, MD, a diabetes specialist in Tallahassee, Fla. and president-elect of the American Diabetes Association.

"Don't try to lose weight on your own," says Deeb. "With a doctor and a good nutritionist, it's very safe to do. This is very important if you're taking insulin or medications."

Go for the Right Balance in a Diabetes Weight Loss Plan

Christine Gerbstadt, MD, a spokeswoman for the American Dietetic Association, warns: "You don't want to run the risk of high or low blood sugar while you're dieting," she tells WebMD. "You want tight glucose control while you lose weight."

Gerbstadt suggests cutting 500 calories a day, "which is safe for someone with diabetes," she says. "Cut calories across the board -- from protein, carbohydrates, and fat -- that's the best way." She recommends that people with diabetes maintain a healthy ratio of carbs, fat, and protein. The ideal:

50% to 55% carbs

30% fat

10% to 15% protein

Watch the Carbs in a Diabetes Weight Loss Plan

For people with diabetes, a refresher course on carbs may also be in order, Gerbstadt says.
That's because carbs have the biggest effect on blood sugar, since they are broken down into sugar early in digestion. Eating complex carbs (whole-grain bread and vegetables, for example) is good because they are absorbed more slowly into the bloodstream, cutting the risk of blood sugar spikes, Gerbstadt explains.

"Worst case scenario is sliced white bread," she says. "Whole-wheat bread is an improvement.

Adding a little peanut butter is even better."

Simply cutting lots of carbs -- a common dieting strategy -- can be dangerous, Gerbstadt says. When your body doesn't have carbs to burn for fuel, your metabolism changes into what's known as ketosis -- and fat is burned instead. You'll feel less hungry, and eat less than you usually do -- but long-term ketosis can cause health problems.

"Ketosis decreases oxygen delivery to the tissues, which puts stress on eyes, kidneys, heart, liver," Gerbstadt says. "That's why the low-carb, high-protein Atkins diet is not really safe for people with diabetes. Diabetics need to try to stick with a more balanced diet so your body can handle nutrients without going into ketosis."

Special Challenges when Following a Diabetes Weight Loss Plan

"For anyone, losing weight is challenging enough," Luigi Meneghini, MD, tells WebMD.

Meneghini is director of the Kosnow Diabetes Treatment Center at the University of Miami School of Medicine. "For people who inject insulin, it's even more difficult because they have to eat when they have low blood sugar. When you have to reduce calorie intake, prevent overmedication, and eat to correct your low blood sugar, it's very challenging."

Indeed, both low and high blood sugar levels are the two big concerns for people with diabetes.
Low Blood Sugar (hypoglycemia) occurs when the amount of insulin in the body is higher than your body needs. In its earliest stages, low blood sugar causes confusion, dizziness, and shakiness. In its later stages, it can be very dangerous -- possibly causing fainting, even coma.

Low blood sugar is common when people lose weight because cutting calories and weight loss itself affect blood sugar levels. If you don't reduce your insulin dosage or pills to match new blood sugar levels, you'll be risking high blood sugar.

High Blood Sugar (hyperglycemia) can develop when your body's insulin level is too low to control blood sugar. This happens when people on insulin or sugar-lowering medications don't take the correct dose or follow their diet.

The Effects of Exercise on Diabetes

One of the benefits of exercise is that it helps keep your blood sugar in balance, so you won't have to cut as many calories.

"Walk an extra 20 minutes a day, and you can eat a little bit more," Gerbstadt explains, and instead of cutting 500 calories, "you can cut back just 200 or 300 calories, and still get excellent results in weight loss. You'll also control your blood sugar. And the weight will be more likely to stay off if you lose it slowly, safely."

Keep in mind: Each type of exercise affects blood sugar differently.

Aerobic exercise -- running or a treadmill workout -- can lower your blood sugar immediately.
Weight lifting or prolonged strenuous exercise may affect your blood sugar level many hours later. This can be a problem, especially when you're driving a car. It is one of the many reasons that you should check your blood sugar before driving. It's also a good idea to carry snacks such as fruit, crackers, juice, and soda in the car.

"With physical activity, you burn blood sugar as well as sugar stored in muscle and in the liver," explains Meneghini. "People using insulin or medications to simulate release of insulin should closely monitor blood sugar levels when they begin exercising more. Over time, as you exercise regularly, you can reduce doses of medications and insulin."

Getting Started on Your Diabetes Weight Loss Plan

Losing weight is never easy. That's where a diabetes educator or a nutritionist can help, advises Deeb A diabetes educator or nutritionist can develop a program that fits you and your lifestyle -- a program with realistic goals, he says.

"You will need a meal plan, one that you can follow every day. You'll need to know how to alter your insulin and medication based on what you're eating and whether you're exercising more," Deeb tells WebMD. "That's the safest way to lose weight."

A consultation with a diabetes educator or dietitian/nutritionist can cost from $60-$70.

Typically, insurance covers the first two visits, but may not cover additional visits, says Meneghini.

Reasonably priced diabetes support groups and classes are available, frequently through hospitals. Ask your doctor or physician assistant for recommendations.

There are also diabetes web sites with in-depth exercise and weight loss information, including:
American Diabetes Association at http://www.diabetes.org