Pharma Knowledge Base

Obesity Is Biggest Health Problem for Kids

2009-08-28T06:11:00.000-07:00

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?

2009-08-28T06:06:00.000-07:00

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

2009-08-28T06:03:00.001-07:00

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

2009-08-28T06:00:00.000-07:00

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

2009-08-28T02:53:00.001-07:00

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

2009-08-28T02:51:00.001-07:00

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?

2009-08-28T02:48:00.000-07:00

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

2009-08-28T02:29:00.000-07:00

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

2009-08-28T02:26:00.001-07:00

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?

2009-08-28T02:17:00.000-07:00

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."

Low Folate May Be Linked to Allergies

2009-08-22T03:53:00.001-07:00

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

2009-08-22T03:49:00.000-07:00

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

2009-08-22T03:47:00.001-07:00

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

2009-08-22T03:44:00.000-07:00

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

2009-08-22T03:40:00.000-07:00

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

2009-08-22T03:35:00.000-07:00

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."

Spinal Fracture: Cement No Better Than Sham

2009-08-21T06:13:00.000-07:00

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

2009-08-21T06:10:00.000-07:00

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

2009-08-21T06:04:00.000-07:00

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

Cholesterol and Alcohol

2009-08-21T06:02:00.001-07:00

A major focus in the battle against heart disease is lowering cholesterol levels.

Not all cholesterol is unhealthy. There are two types of cholesterol. Low-density lipoprotein ( LDL) cholesterol is the "bad" type that tends to clog your arteries; high-density lipoprotein (HDL) cholesterol is the "good" kind that helps sweep cholesterol deposits out of your arteries and protects against a heart attack.

Doctors recommend keeping your LDL cholesterol levels low (optimally less than 100 mg/dL), while boosting your HDL levels (60 mg/dL or higher). You may have heard that drinking a glass or two of red wine each day can help raise HDL levels and help reduce your risk of heart disease. It's true that alcohol has some heart-healthy benefits, but it's important to be cautious when drinking alcohol because it also has many health risks.

Alcohol Boosts HDL Cholesterol

A few studies have found that people who drink alcohol in moderation have lower rates of heart disease, and might even live longer than those who abstain.

In particular, red wine might offer the greatest benefit for lowering heart disease risk and mortality because it contains higher levels of natural plant chemicals -- such as resveratrol -- which have antioxidant properties and might protect artery walls.

Many believe that the main cardiovascular benefit of alcohol is through its ability to raise HDL cholesterol levels. Alcohol has also been tied to a lower risk of blood clots and decreased levels of inflammation markers.

Risks of Drinking Alcohol

Before you order a round of wine or beer and toast to your heart, know that the news about alcohol isn't entirely positive. Consuming too much alcohol can actually increase your risk for heart disease and stroke, raise blood pressure, contribute to obesity, and increase the levels of fats called triglycerides in the blood.

Excessive drinking also can lead to heart muscle disease (cardiomyopathy), irregular heartbeat ( arrhythmia), and stroke. Eventually, heavy alcohol use can leave the heart too weak to pump efficiently, a condition called congestive heart failure.

Drinking alcohol also has other downsides, including increased risk of some cancers, cirrhosis of the liver, and an increased risk of accidents. That's why the American Heart Association does not recommend that you start drinking wine or any other alcoholic beverages specifically to lower your cholesterol or improve your heart health. Instead, the organization advises watching your weight, eating a healthy diet, and exercising regularly to keep your cholesterol levels in check.

If you do plan to drink, check with your doctor first. Drink alcohol only in moderation -- meaning a glass of wine or beer a day for women, and a glass or two a day for men. Some people -- especially pregnant women and those who take certain medicines regularly -- should avoid alcohol entirely.

Rheumatoid Arthritis and Sex

2009-08-21T05:58:00.000-07:00

Your sex life (or the lack of one) is probably not high on the list of topics when you're discussing your rheumatoid arthritis (RA) with your doctor. Even if you didn't have a ton of other topics to talk about, such as side effects of your medicines, morning stiffness and pain, and that promising new drug you just read about, talking about sex can be just plain embarrassing.

But the fact is one out of every three people with RA says that rheumatoid arthritis has had a considerable impact on their sexuality. And one out of every 10 people with RA says that sex is out of the question.

But the reason that people with RA often avoid sex has less to do with pain from achy joints associated with this autoimmune disease than the overwhelming fatigue and difficulty moving that are also hallmarks of the disease. That observation comes from research presented in 2006 at the 7th Annual European Congress of Rheumatology in Amsterdam, Netherlands.

But experts tell WebMD that improving your sex life -- and your intimate relationship -- is not only possible, but can also improve your arthritis symptoms.

"The good news," says Ava Cadell, PhD, "is that being intimate will take your mind off of everything else -- including your arthritis." Cadell is a clinical sexologist based in Los Angeles. "There is scientific evidence," she says, "that when you have an orgasm, you release morphine-like, feel-good chemicals that override the pain. Sex is the best prescription for good health."
Martin J. Bergman, MD, is chief of the division of rheumatology at Taylor Hospital in Ridley Park, Pa. He agrees with Cadell and adds, "Sexuality is part of the human experience -- a very important part."

Sex, Intimacy, and RA: Look at the Bigger Picture

"When we think of sex and sexuality," says Paul Dobransky, MD, "we often think of the physical." Dobransky is a Chicago-based psychiatrist and sex therapist and the author of several books including The Secret Psychology of How We Fall in Love. He tells WebMD that the one key for improving your sex life is to consider the emotional and cognitive parts of your relationship. Instead of only focusing on the physicality of sex, you should think about "the quality of friendship you have with your partner."

According to Dobransky, when you have a chronic illness such as RA, improving how you think and feel about your relationship can have a big impact on how sexual you feel. That, in turn, can enhance your sexual performance. It pays, he says, to work on the emotional part of your relationship.

Sex, Intimacy, and RA: Self-Esteem and Depression Affect Intimacy

There's more to RA than pain and fatigue. "It is very common," Dobransky tells WebMD, "to develop anxiety and depression that is secondary to RA." When that happens, the antidepressants used to treat depression can have sexual side effects. That adds another dimension to the equation, Dobransky says.

In addition, people with arthritis can have a poor self-image stemming from their joint deformities or medication side effects. For example, steroids can cause weight gain and facial swelling. And methotrexate can cause hair loss.

Making emotional connections, Dobransky says, can help you feel better about yourself. That, in turn, can help you feel more desirable.

Sex, Intimacy, and RA: Love in the Afternoon?

With RA, people often feel the most stiffness in the morning. As a result, sex may be more pleasurable later in the day. But some people may find that pain worsens at the end of the day.

That can make sex unappealing at bedtime.

"You need to develop teamwork and coordination with your partner," Dobransky says. "Some people with arthritis may be more open to a 'quickie' or daytime sex vs. evening sex." And once again, he points to the importance of the emotional connection. A good emotional connection, he says, "will promote better communication, more compromise, and more teamwork."

One approach he suggests is to say to your partner, "I seem not to have as much pain in the afternoon. I know you like having sex at night, but can we mix it up and try having sex in the afternoon from time to time?'"

If you are not sure when your pain flares or diminishes, Dobransky says you should track it and notice when it is at its lowest level and its highest. "Once you have established a pattern for your arthritis pain," he says, "you can team up with your partner to take advantage of this together."

Sex, Intimacy, and RA: More Than Just Sex

"Remember," Cadell says, "being intimate doesn't have to mean sexual intercourse." Synchronized breathing, eye gazing, hugging, and kissing are also on the intimacy menu.
"The sense of touch is the most healing," she says. "A lot of people with arthritis don't get massages because they feel discomfort. But being touched by their partner, whom they love and adore, can be healing."

Cadell suggests that you start by saying, "I miss you." Then you can ask for little things like a hug. Bringing intimacy up, she tells WebMD, can re-create that bond that's sometimes severed by an illness. "When one person is ill and the other isn't," says Cadell, "the other person feels helpless." As a result, your partner may be afraid to initiate intimacy because your partner doesn't want to hurt you or be rejected.

Talking about your feelings toward your partner helps your partner feel wanted. It can also let him or her know that advances will not be made in vain.

Sex, Intimacy, and RA: The Value of Experimentation

When you have RA, using sexual aids such as the Liberator line of pillows designed to support you where you can't support yourself can help. "These are wonderful props that can take the pressure off where it hurts," Cadell tells WebMD.

Experimenting with positions is another way to improve the quality of your sexual relationship.

Cadell says there are many different sexual positions to try depending on which joints are affected by RA.

Bergman says it comes down to trial and error. "There are certain positions that may be uncomfortable," he says, "but others may be very satisfactory."

Sex, Intimacy, and RA: Managing Your RA Makes a Difference

Bergman tells WebMD that much of the same advice that applies to other aspects of life with RA applies to sexuality. For starters, he says, it's important to take your RA medication regularly. "Skipping medication doses will only increase your pain," he says.

Treating RA early and aggressively can move almost half of all people with this disease into remission, Bergman says. "This approach to treatment means that questions about sex may never come up."

Chinese Herb May Ease Rheumatoid Arthritis

2009-08-21T05:55:00.000-07:00

Aug. 17, 2009 -- A Chinese herbal remedy may help ease symptoms in people with rheumatoid arthritis.

A new study shows that the Chinese herbal remedy Tripterygium wilfordii Hook F (TwHF), also known as “lei gong teng” or "thunder god vine," helped decrease joint tenderness and pain in a small group of people treated with the medicinal plant.

Those who took an extract of the herb's roots experienced greater improvement in rheumatoid arthritis symptoms than those who took the anti-inflammatory drug sulfasalazine.

Rheumatoid arthritis is a chronic inflammatory disease that causes pain and swelling of the joints. Rheumatoid arthritis also leads to joint damage and destruction. There is no cure for the condition, and currently available treatments are designed to ease the symptoms and disability caused by the disease.

Although recent advancements in rheumatoid arthritis treatment have led to a greater number of available therapies, many of those therapies come with side effects that prompt some users to discontinue treatment or seek complementary and alternative treatments.

Thunder God Vine for RA

Researchers say thunder god vine has been used in China for centuries to treat a variety of inflammatory diseases, and some small clinical trials have suggested that the Chinese herbal remedy may benefit people with rheumatoid arthritis.

This study, published in the Annals of Internal Medicine, compared the benefits and side effects of treatment with thunder god vine and a conventional anti-inflammatory drug used in rheumatoid arthritis. Researchers randomly assigned 121 people with rheumatoid arthritis to take the 60 milligrams of the Chinese herbal extract three times a day or 1 gram of the anti-inflammatory drug sulfasalazine twice a day for 24 weeks.

Nearly half of the participants dropped out before the study was complete. But after 24 weeks of treatment, researchers found that a greater proportion of people in the Chinese herbal remedy group experienced at least 20% improvement on a standard measure of rheumatoid arthritis symptoms than the other group.

Researcher Raphaela Goldbach-Mansky, MD, MHS, of the National Institutes of Health, and colleagues say the study was too short to show if thunder god vine also helped to slow the progression of joint destruction from rheumatoid arthritis. But if further studies confirm these results in larger numbers of people, thunder god vine may provide an affordable natural treatment option for rheumatoid arthritis.

DASH Diet May Prevent Kidney Stones

2009-08-21T05:53:00.000-07:00

Aug. 14, 2009 -- Following the DASH diet may cut down on kidney stones as well as improve high blood pressure.

That news comes from a study published online in the Journal of the American Society of Nephrology.

Data came from more than 241,700 U.S. health care workers who completed surveys about their diets every four years for up to 18 years.

Based on those dietary surveys, the researchers calculated a "DASH" score for each participant.

The highest scores went to participants whose diets most closely matched the Dietary

Approaches to Stop Hypertension (DASH) diet, which is widely used to lower hypertension (high blood pressure).

The following eating habits boosted DASH scores:

Eating a diet rich in fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains.

Eating a diet low in sodium, sweetened drinks, red meat, and processed meats.

People with the highest DASH scores were the least likely to develop kidney stones, regardless of age, sex, BMI (body mass index), hypertension, diabetes, use of medicines called thiazides, and intake of calories, fluid, caffeine, and alcohol.

"Consumption of a DASH-style diet is associated with a marked decrease in kidney stone risk," write the researchers, who included Eric Taylor, MD, of Brigham and Women's Hospital in Boston.

Behavioral Therapy for Pain and Insomnia

2009-08-21T05:50:00.000-07:00

Aug. 15, 2009 -- Cognitive behavioral therapy for insomnia may help older people who suffer pain from osteoarthritis, a new study shows.

The researchers conclude that cognitive behavioral therapy to help with sleep should be considered to help manage chronic pain conditions such as osteoarthritis.

"The particular strength of [cognitive behavioral therapy aimed at insomnia] is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more," Michael V. Vitiello, PhD, of the University of Washington in Seattle, says in a news release.

Better sleep can lead to improvement in coexisting medical or psychiatric illnesses, Vitiello says.
His research team assigned 23 older patients with osteoarthritis to cognitive behavioral therapy that was aimed at helping them learn how to sleep better. Twenty-eight other patients were assigned to a stress management and wellness program.

Those receiving the cognitive behavioral therapy reported improvements in sleep quality and pain relief measures before and after treatment, and a year later. Participants in the group that didn't get the cognitive behavioral therapy showed no significant improvements in sleep quality or pain.

"Sleep quality is a major concern of people with osteoarthritis, with 60 percent of people with the disease reporting pain during the night. ... Whether sleep disturbance preceded or follows pain onset is unclear, but reciprocal effects are likely," write the researchers.

Chronic pain initiates and exacerbates sleep disturbances, but the researchers say pain perception may decrease when people sleep better.

Breastfeeding May Cut Breast Cancer Risk

2009-08-19T02:40:00.001-07:00

Aug. 10, 2009 -- Women with a family history of breast cancer who have ever breastfed reduce their risk of getting premenopausal breast cancer by nearly 60%, according to a new study.

''For women with a family history of breast cancer, this suggests an extra benefit [of breastfeeding] is, it may reduce the risk of breast cancer," says Alison Stuebe, MD, an assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill, the lead author of the study. It is published in the Archives of Internal Medicine.

While previous studies have also suggested a link between breastfeeding and reduced breast cancer risk, results have been mixed, Stuebe writes. Studies in which women who already have breast cancer are asked about their breastfeeding history can be flawed by "recall bias," she says.

''Our goal was to collect information before the diagnosis and follow women," Stuebe tells WebMD.

Stuebe and her colleagues drew information from 60,075 women who were participants in the Nurses' Health Study II from 1997 to 2005 and had given birth.

The women answered questions about demographics, body measurements, and lifestyle factors every two years, and described their breastfeeding practices. They were asked about family history of breast cancer and if they had been diagnosed with invasive breast cancer.

By the end of the follow-up in June 2005, Stuebe's team found 608 cases of premenopausal invasive breast cancer, with 99% of the cases verified by medical records. The woman's average age at diagnosis was 46.

''Overall, in the whole group of women we studied, women who had breastfed were 25% less likely to develop premenopausal breast cancer than women who had never breastfed," says Stuebe, who conducted the research while at Brigham and Women's Hospital and Harvard
Medical School in Boston.

Family History of Breast Cancer

When the researchers looked separately at the women without a family history and those with a family history of breast cancer (mother, sister, or grandmother), they found ''almost the entire effect could be accounted for by women with a family history," she tells WebMD.
Among those with a family history, those who had breastfed had a 59% reduced risk for premenopausal breast cancer compared to those who never breastfed. The breastfeeding did not have to be exclusive breastfeeding, without formula use.

To understand better the difference between the overall risk reduction and the reduction in those with a family history, Stuebe offers this analogy: Suppose the Los Angeles Lakers and a group of 5-year-olds had a free-throw contest. Overall, the group may have made, say, 60% of the free throws. But when you look separately at the successful free throws made by the basketball stars vs. those made by the kids, the results will undoubtedly be driven entirely by the Lakers.

The risk reduction for women with a family history of breast cancer who breastfeed, Stuebe says, is comparable to that found in high-risk women who take hormonal treatments such as tamoxifen.

''For women without a family history," she tells WebMD, ''it may be that their rates of breast cancer are so low we don't detect a difference or there may not be a protective association."
The protective effect began with three months of breastfeeding, she tells WebMD. That's three months total, she says, not just for a single child. So a mother may have breastfed two children for a month and a half each and gotten the benefit, for instance.

Second Opinion

''It is a huge reduction in risk," says Amanda Phipps, a pre-doctoral research associate at the Fred Hutchinson Cancer Research Center in Seattle, of the nearly 60% decreased risk in women who breastfeed and have a family history of breast cancer.

''I find it very interesting," says Phipps, who has researched the link, too. "But I think because it is a rather novel finding it would need to be replicated in the literature."

In a study published in Cancer last year, Phipps and her colleagues found that certain breast cancer types may be rarer among women who breastfeed their babies for at least six months.
The biology to explain the link is not yet clear, Phipps says.

Even so, she calls the association "exciting" because breastfeeding is an action women can take to reduce their breast cancer risk, while many other risk factors -- such as having a family history -- are not modifiable.

Secrets of Super-Healthy People

2009-08-19T02:35:00.000-07:00

Are you secretly envious of your co-workers and friends who, like superheroes, never seem to get sick? You know, the ones glowing with good health while everyone around them is sneezing, sniffling, and coughing like villains.

Don't hate the healthy people. Instead, steal the secrets of people who manage to stay above the sickroom fray and take steps to boost your body's immunity.

Training for the Body

Jennifer Cassetta, a martial arts instructor in New York City, claims she never gets sick, and neither do her father and grandmother, who also teach martial arts. "I believe it is the holistic approach to exercise that calms the mind and relieves stress," she says. "And the cardio, strengthening, and conditioning help boost the immune system."

Cassetta says her health has changed dramatically after she picked up martial arts eight years ago. Before then, she was a smoking, take-out-every-night, espresso-drinking girl in her 20s.
"As I started to train, I started to change my habits drastically," she says. "I cleaned up my diet, trained more, and quit smoking. Now in my 30s, I have more energy, I look better, and am stronger than I ever have been."

One bout of vigorous exercise can increase circulation, says Christiane Northrup, MD, author of Women's Bodies, Women's Wisdom. "Whenever circulation is increased, you get far more white blood cells," she says, "so they check for foreign germs and are far more apt to be able to gobble them up."

Pay Attention to Your Mouth

Chicago public relations consultant Joanna Broussard says gargling regularly with an antiseptic mouthwash has helped improve her dental health and may have helped fend off other illnesses.
Twelve years ago, Broussard's dental hygienist convinced her to gargle consistently after brushing her teeth. "So I made the effort and got into the habit every morning," she says, "Since then I have not had colds. When people all around me have colds or the flu, I seem to be immune."

Another reason to bone up on your brushing and gargling is that poor oral hygiene and gum disease have been linked to more serious illnesses, including diabetes.

An Apple a Day Really Works

Your mom may have been right when she said, "An apple a day keeps the doctor away." A natural antioxidant called quercetin, found in red apples as well as broccoli and green tea, may give an immunity boost to individuals under stress.

In a study conducted by David Nieman, PhD, professor at Appalachian State University, results showed that only 5% of cyclists who took 1,000 milligrams of quercetin every day for five weeks reported upper respiratory illness during a two-week period following extreme exercise, whereas 45% of the cyclists who took a placebo reported illness following extreme exercise. However, there were no significant differences in measures of immune system function in the two groups.

Additionally, researchers found that athletes taking the quercetin supplement maintained better mental alertness and reaction time over the placebo group. So go ahead, stock up on those red apples and you may be thanking Mom later.

Don't Worry, Conquer Stress

Stop worrying about getting sick. The fear and expectation of having something adverse happen actually lowers immunity, says Northrup. "When people are worried about it all the time," she says, "they literally scare themselves to death."

Constant worrying causes cortisol and epinephrine levels to rise - and these stress hormones can weaken the body's overall immunity. "The immune system plummets when cortisol levels are chronically high," she says. "Your own body produces high levels of steroids when you're under constant stress."

Up Your Vitamin Intake

We have a worldwide epidemic of vitamin D deficiency, says Northrup. Everybody needs vitamin D, which can be found in foods like sockeye salmon, eggs, and milk.

Hyla Cass, MD, an integrative medical practitioner and author of 8 Weeks to Vibrant Health, adds that certain prescription drugs like acid blockers can deprive the body of nutrients like vitamin D.

Surveys show that Americans don't get enough vitamin C, says Elisabetta Politi, RD, MPH, CDE, nutrition director at the Duke Diet & Fitness Center.

Citrus fruits are a good source of vitamin C. "It's a myth that vitamin C prevents the cold," she says. "But having an appropriate amount of vitamin C from fruits and vegetables can boost immunity."

Mind Over Body

Atlanta interior designer Melissa Galt believes in a "mind over medicine" attitude. "I don't have time for sickness in my life," says Galt, who travels frequently and doesn't take anything to fight germs. "I don't believe in it and don't acknowledge it."

Every thought is accompanied by a chain of biochemical reactions in your body, says Northrup. So a positive attitude can increase levels of nitric oxide, which help to balance neurotransmitters, improve immunity, and increase circulation, she says.

"Whenever nitric oxide levels are high -- from anything ranging from positive thought to exercise -- you're actually improving your resistance to disease," she says.
Just Say Om

Santa Monica, Calif., yoga therapist Felice Rhiannon credits her meditation and breathing practices for improving her physical and emotional health. "Meditation practice helps to calm my nervous system and allows the immune system to function with less interference," she says. For Rhiannon, "A calmer mind means a calmer body."

"The greatest change is in my peace of mind and sense of ease," she says. "I don't get colds as often as I did when I was younger. My sleep is better and my ability to cope with life's inevitable stresses has improved."

In a study published in the journal Psychosomatic Medicine in 2003, researchers at the University of Wisconsin and Harvard University found that volunteers who participated in eight weeks of mediation training produced significantly more flu-fighting antibodies than those who didn't meditate.

Increase Your Social Ties

There are personality factors associated with individuals who are resistant to getting colds when they're exposed to a virus, says Sheldon Cohen, PhD, professor of psychology at Carnegie Mellon University whose research examines the effects of stress and social support on immunity and health.

For example, extroverts are less likely than introverts to get colds when exposed to a virus. "We actually control for their immunity," he says. "The explanation isn't that extroverts interact with more people, and therefore have immunity to that virus. There's something about being extroverted that seems to protect people."

Having a diverse social network is equally important, says Cohen. Individuals who belong to multiple social groups are less likely to develop colds when exposed to a virus. There's convincing literature in epidemiology that people who have more diverse social networks are also less likely to get heart disease and live longer, he adds.

Accentuate the Positive

Cohen's research suggests that people who have a positive emotional style -- described as happy, enthusiastic, and calm -- are less likely to catch colds.

Cohen and researchers at Carnegie Mellon University interviewed 193 healthy adults daily for two weeks and recorded the positive and negative emotions they experienced each day, and then exposed the volunteers to a cold or flu virus. Those with positive outlooks reported fewer cold symptoms and were more resistant to developing an upper respiratory illness.

"It's a stable characteristic of individuals," he says. "It's not driven by how happy they are on the day they get exposed to the virus."

Wash Your Hands - Over and Over

Hand washing may sound like obvious advice for combating germs, but surveys suggest that most of us are not vigilant about washing our hands after using the restroom.

"In order to prevent illness, it's important to wash your hands frequently," Cass says. "During cold and flu season, wash your hands with soap many times during the day because you're in contact with all kinds of pathogens -- door knobs, stair railings, other people. You really want to have clean hands."

According to the CDC, proper hand washing for 20 seconds is the most effective way to avoid the 1 billion colds that Americans catch each year, not to mention other infectious diseases.

Get Your ZZZs

Sleep is one of the best ways to stay healthy, Northrup says. "People who get a solid eight hours per night absolutely do better."

Sleep efficiency is the key, Cohen says. People who get into bed and fall asleep right away and stay asleep are more protected against colds than those who wake up repeatedly through the night.

A good night's sleep will restore the immune system, Northrup says, because when you get a good night's sleep, melatonin levels rise and that improves immunity.

And best of all, there are no side effects.

Cancer Death Rate Is Going Down in U.S.

2009-08-19T02:33:00.000-07:00

Aug. 13, 2009 -- Death rates from cancer have been decreasing in all age groups in recent years, but the steepest declines have been among younger people, a new study shows.

The findings suggest that measures for prevention, screening, and treatment are leading to lower death rates, researchers report in Cancer Research, a journal of the American Association for Cancer Research.

"Our efforts against cancer, including prevention, early detection and better treatment, have resulted in profound gains, but these gains are often unappreciated by the public due to the way the data are usually reported," says Eric Kort, MD, who finished the study while working at the Van Andel Research Institute in Grand Rapids, Mich.

Kort and colleagues analyzed mortality data from 1955 to 2004 reported by the National Center for Health Statistics and yearly U.S. population estimates.

The researchers write that previous reports of cancer mortality rates emphasized what's happening among older people, hiding shifts in deaths caused by the disease in younger groups.
"Age specific cancer mortality rates have been steadily declining in the United States since the early 1950s, beginning with children and young adults and now including all age groups," the researchers write.

In the second half of the 20th century, each successive decade of births from 1925 to 1995 had a lower risk of cancer death than its predecessor, suggesting that earlier detection, prevention, and treatment programs have been effective.

The youngest age groups experienced the steepest average rate of decline at 25.9% per decade, the researchers say. But even the oldest groups recorded a 6.8% decline per decade.

Sleep Less, Get Diabetes?

2009-08-19T02:30:00.000-07:00

Aug. 12, 2009 - If you're getting too little sleep, you may also be getting diabetes.

People at risk of diabetes tend to get too little sleep. They also tend to exercise too little and eat unhealthy Western diets. Is poor sleep really a diabetes risk factor?

Yes, suggests a study by University of Chicago researchers led by Plamen Penev, MD, PhD.

"If confirmed by future larger studies, these results would indicate that a healthy lifestyle should include not only healthy eating habits and adequate amounts of physical activity, but also obtaining a sufficient amount of sleep," Penev says in a news release.

Five men and six women volunteered for the study. Their average age was about 40. They were a little overweight and didn't exercise much, but were otherwise healthy. They tended to sleep just under eight hours a day.

During two 14-day periods, they stayed in a lab where their sleep, activity, diet, and blood chemistry were carefully monitored. They weren't allowed to exercise, and junk food was always at hand.

For one of the 14-day periods, they were allowed to sleep for 8.5 hours a day. During the other period, they were allowed no more than 5.5 hours sleep each day. Sleep researchers say it's rare for a person to need less than six hours of sleep daily.

As their sleep times shortened, the volunteers went to bed later (at half past midnight rather than at 11:15 p.m.) and got up earlier (at 6 a.m. rather than 7:45 a.m.).

With all the junk food lying around and with so little physical activity, they gained more than 4 pounds of weight regardless of how much they slept.

What was different was their ability to control their blood sugar. When sleeping too little, the volunteers' blood sugar was higher on a glucose-tolerance test. They also became less sensitive to the blood sugar-lowering hormone insulin.

"When the unhealthy aspects of the Westernized lifestyle are combined with reduced sleep duration, this might contribute to the increased risk of many overweight and sedentary individuals developing diabetes," Penev says.

Breast Cancer: Breast Cancer in Young Women

2009-08-19T02:28:00.001-07:00

Younger women generally do not consider themselves to be at risk for breast cancer. Only 5% of all breast cancer cases occur in women under 40 years old. However, breast cancer can strike at any age, and women of every age should be aware of their personal risk factors for breast cancer. (A risk factor is a condition or behavior that puts a person at an increased chance for developing a disease.)

There are several factors that put a woman at high risk for developing breast cancer, including:
Risk factors include:

A personal history of breast cancer or some non-cancerous breast diseases.

A family history of breast cancer, particularly in a mother, daughter or sister.

History of radiation therapy Evidence of a specific genetic defect (BRCA1/BRCA2 mutation). Women who carry defects on either of these genes are at greater risk for developing breast cancer.

A Gail Index score of at least 1.7% (The Gail Index uses risk factors such as age, family history of breast cancer, age of first menstrual period and first pregnancy, and number of breast biopsies to calculate a woman's risk of developing breast cancer within the next five years.)

Some studies have suggested that extended use of oral contraceptives (the Pill) results in a very slight increased risk for developing breast cancer over those who have never taken them. Women who have stopped using birth control pills for more than 10 years do not seem to be at any greater risk. Other studies, however, show no such effect. Researchers continue to study the conflicting results in these trials to determine if birth control pills play a role in breast cancer.

What Is Different About Breast Cancer In Younger Women?

Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally denser than the breast tissue in older women. By the time a lump in a younger woman's breast can be felt, the cancer often is advanced.

In addition, breast cancer in younger women may be aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are more likely to have a mutated (altered) BRCA1 or BRCA2 gene.

Delays in diagnosing breast cancer also are a problem. Many younger women who have breast cancer ignore the warning signs -- such as a breast lump or unusual discharge -- because they believe they are too young to get breast cancer.

Many women assume they are too young to get breast cancer and tend to assume a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women as cysts and adopt a "wait and see" approach.

Can Breast Cancer In Younger Women Be Prevented?

Although breast cancer may not be prevented, early detection and prompt treatment can significantly improve a woman's chances of surviving breast cancer. More than 90% of women whose breast cancer is found in an early stage will survive.

When women learn at a young age about the risks and benefits of detecting breast cancer early, they are more likely to follow the recommendations regarding clinical exams and mammograms. Young women also need to understand their risk factors and be able to discuss breast health with their health care providers.

Should Women Under Age 40 Get Mammograms?

In general, regular mammograms are not recommended for women under 40 years old, in part, because breast tissue tends to be more dense in young women, making mammograms less effective as a screening tool. In addition, most experts believe the low risk of developing breast cancer at a young age does not justify the radiation exposure or the cost of mammography.

However, screening mammograms may be recommended for younger women with a family history of breast cancer and other risk factors.

What's the Best Way for Younger Women to Screen for Breast Cancer?

The American Cancer Society (ACS) recommends that all women 20 years of age or older should perform monthly breast self-examinations. The best time to perform BSE is the day after your monthly period ends. Becoming familiar with the look and feel of their breasts offers the best chance for a young woman to notice any changes.

In addition to monthly BSE, regular clinical breast exams performed at least every 3 years by your doctor are recommended for all women beginning at age 20. Annual screening mammograms also are recommended at age 40. Women younger than 40 who have a family history or other risk factors for breast cancer should discuss their risk and an appropriate screening schedule with their health care providers.

How Is Breast Cancer Treated In Younger Women?

The course of treatment for breast cancer at any age is based on the extent of the person's disease (whether or not it has spread beyond the breast), as well as the woman's general health and personal circumstances.

Treatment options include surgery: either a lumpectomy, which involves removing the lump and some surrounding tissue, or a mastectomy, which is the removal of a breast.

Radiation therapy is generally used following a lumpectomy, and chemotherapy and/or hormone therapy often are recommended after surgery to help destroy any remaining cancer cells and prevent recurrence.

Breast cancer poses other challenges for younger women, as well, such as sexuality, fertility and pregnancy after breast cancer treatment.

Weight Lifting May Be OK After Breast Cancer

2009-08-19T02:25:00.000-07:00

Aug. 12, 2009 -- Weight lifting may be gaining strength as an option for breast cancer survivors with swelling in their arms.

A new study challenges the belief that breast cancer patients with lymphedema in their arms should avoid weight lifting.

Lymphedema is fluid buildup that causes swelling. In breast cancer patients, it can be a lasting side effect of removing lymph nodes during breast cancer surgery.

To avoid making lymphedema worse, heavy lifting of any kind is typically discouraged for breast cancer survivors with lymphedema.

But the new study, published in the Aug. 13 edition of The New England Journal of Medicine, shows that weight lifting may actually help breast cancer survivors with lymphedema.
The study included 141 U.S. women who had completed breast cancer treatment.

Half of the women got a free membership to a local health club and got trained in weight lifting by trainers who were knowledgeable about lymphedema.

For comparison, the other women weren't asked to start weight training, and they got a one-year pass to a health club only when the study ended.

The women in the weight lifting group worked out twice a week at their health clubs. They did weight lifting exercises that target the upper and lower body, as well as stretching, a cardio warm-up, and exercises for their abdominal and back muscles.

The women wore custom-fitted compression garments on their affected arm. Their trainers made sure the weight lifting exercises were challenging but not too hard.

Arm measurements taken throughout the study showed that women in the weight lifting group weren't more likely than women in the comparison group to have their affected arm swell by 5% or more.

In fact, the women in the weight lifting group reported greater improvement in their lymphedema symptoms -- and of course, they got stronger, too.

"These findings support the potential benefits of a slowly progressive weight-lifting program in women with breast cancer-related lymphedema, in conjunction with appropriate use of compression garments and close monitoring for arm and hand swelling," write the researchers, who included Kathryn Schmitz, PhD, MPH, of the University of Pennsylvania's Abramson Cancer Center.

The study "provides strong reassurance regarding the safety of appropriately supervised weight training in women with a history of breast cancer and lymphedema," states an editorial also published in the New England Journal of Medicine.

The editorial calls for more research, including a cost-savings analysis and ways to get the word out about safe weight lifting programs for breast cancer patients with lymphedema.

Men and Heart Disease

2009-08-19T02:22:00.000-07:00

When you think of heart disease in men, usually people think of coronary artery disease (narrowing of the arteries leading to the heart), but coronary artery disease is just one type of heart disease.

Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include:

Coronary artery disease (including heart attack)
Abnormal heart rhythms or arrythmias
Heart failure
Heart valve disease
Congenital heart disease
Heart muscle disease (cardiomyopathy)
Pericardial disease
Aorta disease and Marfan syndrome
Vascular disease (blood vessel disease)

Cardiovascular disease is the leading cause of death for both men and women in the U.S. It is important to learn about your heart to help prevent heart disease. And, if you have heart disease, you can live a healthier, more active life by learning about your disease and treatments and by becoming an active participant in your care.

Coronary Artery Disease

Coronary artery disease (CAD) is atherosclerosis, or hardening, of the arteries that provide vital oxygen and nutrients to the heart.

Abnormal Heart Rhythms

The heart is an amazing organ. It beats in a steady, even rhythm, about 60 to 100 times each minute (that's about 100,000 times each day!). But, sometimes your heart gets out of rhythm. An irregular or abnormal heartbeat is called an arrhythmia. An arrhythmia (also called a dysrhythmia) can involve a change in the rhythm, producing an uneven heartbeat, or a change in the rate, causing a very slow or very fast heartbeat.

Heart Failure

The term " heart failure" can be frightening. It does not mean the heart has "failed" or stopped working. It means the heart does not pump as well as it should.

Heart failure is a major health problem in the U.S., affecting nearly 5 million Americans. About 550,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than 65.

Heart Valve Disease

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood-flow through your heart.

Examples of heart valve disease include mitral valve prolapse, aortic stenosis, and mitral valve insufficiency.

Congenital Heart Disease

Congenital heart disease is a type of defect in one or more structures of the heart or blood vessels that occur before birth.

It affects about 8 out of every 1,000 children. Congenital heart defects may produce symptoms at birth, during childhood, and sometimes not until adulthood.

In most cases scientists don't know why they occur. Heredity may play a role as well as exposure to the fetus during pregnancy to certain viral infections, alcohol, or drugs.
Cardiomyopathy or Enlarged Heart

Cardiomyopathies, also called an enlarged heart, are diseases of the heart muscle itself. People with cardiomyopathies have hearts that are abnormally enlarged, thickened, and/or stiffened. As a result, the heart's ability to pump blood is weakened. Without treatment, cardiomyopathies worsen over time and often lead to heart failure and abnormal heart rhythms.

Pericarditis

Pericarditis is inflammation of the lining that surrounds the heart. It is a rare condition often caused by an infection.

Aorta Disease and Marfan syndrome

The aorta is the large artery that leaves the heart and provides oxygen-rich blood throughout the body. These diseases and conditions can cause the aorta to dilate (widen) or dissect (tear), increasing the risk for future life-threatening events:

Atherosclerosis (hardening of the arteries).
Hypertension (high blood pressure).

Genetic conditions, such as Marfan Syndrome, which causes the aorta to be weakened as it leaves the heart. This can lead to an aneurysm or ripping (dissection) of the aorta. Both can be repaired with surgery if caught early.

Connective tissue disorders (that affect the strength of the blood vessel walls) such as, scleroderma, osteogenesis imperfecta, polycystic kidney disease, and Turner's syndrome.
Injury.

People with aortic disease should be treated by an experienced team of heart specialists and surgeons.

Other Vascular Diseases

Your circulatory system is the system of blood vessels that carry blood to every part of your body.

Vascular disease includes any condition that affects your circulatory system. These include diseases of the arteries and blood flow to the brain.

Psoriatic Arthritis: 10 Tips to Fight Fatigue

2009-08-17T21:29:00.000-07:00

If you have psoriatic arthritis, chances are you've experienced a common symptom -- fatigue. Fatigue can be caused by a number of factors, making it hard to treat. But don't be discouraged -- there are many ways you can fight psoriatic arthritis and fatigue.

Psoriatic Arthritis and Fatigue: What Are the Causes?

Because everyone feels tired sometimes, it can be hard to define fatigue or pinpoint exactly when it started. But if excessive tiredness is having an impact on your daily life, it's likely that you're suffering from fatigue related to psoriatic arthritis.

"Fatigue is a difficult topic and understanding what causes it is hard," says John Hardin, MD, chief scientific officer of the Arthritis Foundation.

If you have psoriatic arthritis and fatigue, it could be because of the following:

Inflammation. When you have psoriatic arthritis or other kinds of inflammatory arthritis, your body releases chemicals called cytokines that cause inflammation and fatigue. If your fatigue is caused by inflammation from psoriatic arthritis, anti-inflammatory pain reliever medications may help.

Anemia. People with psoriatic arthritis can have anemia. When you have anemia, your body doesn't have enough red blood cells to carry as much oxygen as you need. You keep feeling tired because your body isn't getting enough oxygen.

Depression. People who have chronic diseases like psoriatic arthritis often experience depression, which can present itself as fatigue or make fatigue worse.

Inactivity. If psoriatic arthritis has made your joints stiff and swollen, you may think you should limit activity to preserve your energy and reduce pain. But this strategy backfires -- moving less actually makes you more tired.

Medication. Many of the medications used to treat psoriatic arthritis can cause fatigue as a side effect. The same is true for some medications used to treat depression.
Poor nutrition. When your joints are aching, it can be hard to find the energy and resolve to eat right. But poor nutrition is a leading cause of lack of energy and being overweight or obese can also zap your energy levels.

Inadequate sleep. It can be hard for people with psoriatic arthritis to find a comfortable sleeping position, and depression brought on by the disease often causes insomnia. Not getting enough sleep at night can make you more tired during the day.

10 Tips for Fighting Psoriatic Arthritis and Fatigue
Since the tiredness that comes with psoriatic arthritis can be due to a number of factors, it's essential to launch a multifront attack on your fatigue. Try any or all of the following tips to help restore your energy levels.

Psoriatic Arthritis Fatigue Fighter No. 1: Change your schedule. When you're diagnosed with a chronic condition like psoriatic arthritis, it's important to accept that you may need to make changes in your life. On days when you're really tired, give yourself permission to take a short nap. Or, if you find that your flexibility gets better as the day goes on, you may want to lay out your clothes and pack your lunch for the next day on the night before. That way, you'll avoid problems from morning stiffness.

Psoriatic Arthritis Fatigue Fighter No. 2: Get enough sleep. Because your body is already stressed by psoriatic arthritis, it's even more important to get a good night's rest. If you're having sleeping problems, ask your doctor whether changing your medications might help. Also, make sure you avoid heavy meals, alcohol, and caffeine before bed and practice good sleep hygiene. Make your bedroom a peaceful place for sleep and sex only, and try to go to sleep and get up at the same time every day.

Psoriatic Arthritis Fatigue Fighter No. 3: Exercise. It's true -- exercising and moving around actually gives you more energy. You don't need to overdo it -- getting 30 minutes of moderate exercise on most days of the week is plenty. Try to include a combination of aerobic exercises and strength-building activities, which will keep your heart healthy and your bones and muscles strong. Another benefit? If your fatigue is caused by being overweight, regular exercise will help you shed the extra pounds.

Psoriatic Arthritis Fatigue Fighter No. 4: Prioritize. When you have limited energy, it's important to realize you can't do it all. Reserve time and energy for the things that matter to you, like spending time with your spouse or playing with your children.

Psoriatic Arthritis Fatigue Fighter No. 5: Seek support. No one can better understand the fatigue you're feeling than someone else in the same situation. Online communities hosted by the National Psoriasis Foundation and the Arthritis Foundation let you connect with others with psoriatic arthritis and share tips on fighting fatigue.

Psoriatic Arthritis Fatigue Fighter No. 6: Treat depression. When you're depressed, it can be hard to believe that you'll ever feel energetic again. But treating depression, either with therapy, medication or a combination of the two, can help you feel like your old self again. If you think you might be depressed, ask your doctor for a referral to a licensed therapist or psychiatrist.

Psoriatic Arthritis Fatigue Fighter No. 7: Eat right. The National Psoriasis Foundation includes healthy eating as a key part of its Psoriatic Arthritis Total Approach to Health (PATH). Don't skip meals, and eat whole foods with a good mix of unsaturated fats, protein, and complex carbohydrates to give your body energy throughout the day.

Psoriatic Arthritis Fatigue Fighter No. 8: Support your joints. If your joints are swollen and tender, wearing supporting footwear and braces may help reduce pain. And when you reduce pain, you increase your desire and ability to be out and about.

Psoriatic Arthritis Fatigue Fighter No. 9: Do something you enjoy. All work and no play makes Jack a dull (and lethargic) boy. Make sure you carve out time to do what you love, whether it's seeing a movie with a friend or planting tomatoes in your garden.

Psoriatic Arthritis Fatigue Fighter No. 10: Practice stress-reduction techniques. High levels of stress can zap anyone's energy and may make psoriatic arthritis symptoms even worse. Practicing meditation or yoga, or even just curling up with a good book or sipping a cup of herbal tea, can reduce stress and increase energy.

Understanding Fibromyalgia - the Basics

2009-08-17T21:26:00.000-07:00

What Is Fibromyalgia?

Fibromyalgia is a non-life-threatening, chronic disorder of the muscles and surrounding soft tissue, including ligaments and tendons. Its main symptoms are muscle pain, fatigue, sleep disturbances, and tender points at certain parts of the body. Many people describe fibromyalgia as feeling like a persistent flu.

Some health care providers may use these terms to refer to fibromyalgia: fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, or tension myalgia. However, "fibromyalgia," which means "pain of the muscles and other fibrous tissue," is the accepted term and has replaced some of the others. Terms ending in "-itis," which means "inflammation," are now considered incorrect because inflammation does not play a significant role in fibromyalgia.

Key Characteristics of Fibromyalgia

Muscle pain, either throughout the body or only at certain points, is the primary symptom of fibromyalgia. It may range from mild discomfort to pain severe enough to limit work, social activities, and everyday tasks. Pain commonly occurs in the neck, upper back, shoulders, chest, rib cage, lower back, and thighs and may feel like a burning, gnawing, throbbing, stabbing, or aching sensation and may develop gradually. It usually seems worse when a person is trying to relax and is less noticeable during activity.

A related, key aspect of fibromyalgia is the presence of "tender points," muscles and tendons that are tender when pressed. Typically, tender points are located in the neck, back, knee, shoulder, elbow, and hip.

People with fibromyalgia, which is also linked to depression, also feel moderately to severely fatigued and have sleep problems, including insomnia. This may result from restless legs and arms, which may disrupt their sleep, or they may suffer from sleep apnea or grind their teeth while they sleep.

Tender Points and Fibromyalgia

According to the American Academy of Rheumatology, for a diagnosis of fibromyalgia, you must have unusual tenderness at a minimum of 11 of 18 specific "tender points" associated with the condition. Some health care providers diagnose fibromyalgia in patients who have fewer tender points but who otherwise have severe, widespread (meaning upper and lower body occurring on both right and left sides) pain symptoms that are present for at least three months.

The standard tender points are located in the muscles or other soft tissue on both sides and the front and back of the body. Those who have fibromyalgia may have unusual tenderness at any of several other points on the body as well.

Who Is Affected by Fibromyalgia?

Experts estimate that 3 million to 6 million Americans have fibromyalgia. Of these, 80% are women. One of the main risk factors is being a woman between the age of 20 and 50. Another risk factor is having a rheumatic disease, such as rheumatoid arthritis, lupus, or Sjogren's syndrome. Fibromyalgia also seems to run in families, so a gene may be at least partly responsible for the condition. Most people with fibromyalgia begin to notice symptoms between the ages of 20 and 40, but children and older adults may also develop the condition. Women with fibromyalgia typically feel pain throughout their body, while men are more likely to have facial pain or pain and stiffness in a certain part of the body as a result of a work- or recreation-related muscle strain.

What Causes Fibromyalgia?

Experts do not know what causes fibromyalgia. There are several theories about possible causes or triggers. Inadequate sleep is a possible trigger. Another is suffering an injury such as physical or emotional trauma. Some experts believe that a viral or bacterial infection plays a part.
Abnormal production of pain-related chemicals in the brain and nerves also contributes to the symptoms of fibromyalgia. It's thought that any one of these factors may bring on the symptoms of fibromyalgia in someone who is already genetically predisposed to the condition.

Autoimmune Disease and RA

2009-08-17T21:01:00.000-07:00

What do rheumatoid arthritis (RA), type 1 diabetes, Graves' disease, and multiple sclerosis have in common? One affects joints, another blood sugar. One puts the thyroid into “overdrive.” And the last condition affects the brain and spinal cord. Although the diseases seem pretty different, there is one common denominator. They are all believed to be autoimmune diseases.

RA is one of about 80 different types of autoimmune diseases. After cancer and heart disease, autoimmune diseases are the most common type of disease in the U.S., affecting 50 million Americans. Women make up nearly eight out of every 10 people with an autoimmune disease.
What is the common link between autoimmune diseases? And how does autoimmunity lead to rheumatoid arthritis? Here’s what you need to know.

What Is the Immune System?
To understand autoimmune diseases such as RA, it helps to know how the immune system normally works. Its most important job is protecting your body against foreign “invaders,” such as bacteria and viruses. White blood cells are the agents of the immune system. The immune system works in two main ways. It either directly attacks foreign invaders or it produces proteins called antibodies that attack the intruders.

“Normally, the choreography of this interaction between the white blood cells works very well,” says John A. Peyman, PhD, program officer in the clinical immunology branch of the National Institute of Allergy and Infectious Diseases (NIAID).

He tells WebMD that the body can tell what is a threat and what isn’t. When you have a cut on your finger, for example, you may end up with a small infection caused by germs that enter the wound. This prompts a type of immune response known as inflammation -- often marked by redness, swelling, heat, and pain. Then the immune system’s white blood cells heal the wound and remove the infection.

What Are Autoimmune Diseases?
With an autoimmune disease like RA, however, something goes awry. The white blood cells overreact to stimuli inside the body. Instead of protecting the body from infection or disease as it normally does, the immune system attacks and destroys the body’s healthy tissue. It does this by producing antibodies against the body’s tissue. This is called autoimmunity.

When the disease affects many organs, as in lupus, it’s called a systemic autoimmune disease. If it affects a single organ or type of tissue, such as in type 1 diabetes, it’s known as a localized autoimmune disease. Different autoimmune diseases often cluster in families and may affect almost any organ in the body. When they do, they may cause abnormal growth or changes in function.

There are some similarities to allergies in the way the body reacts negatively with an autoimmune disease. The difference is that with allergies, the body’s overreaction and response is to external factors such as dust or dander. With an autoimmune disease, the body is responding to itself.

Virginia T. Ladd, RT, is president and executive director of the American Autoimmune Related Diseases Association Inc. (AARDA). She tells WebMD it helps to think of autoimmune diseases the way we think of cancer. In other words, it helps to think of them as a disease category.
“There are more than 100 different forms of cancer,” Ladd says, “but they’re all formed by a mutant cell that the immune system allows to proliferate.” She says that autoimmune diseases also share a common disease pathway. “They’re all caused by the immune system attacking its own tissue.” For this reason, she says, we need a shift in our thinking about autoimmune diseases. In the past, these diseases have been looked at as individual “cars on a train” with too little focus on the “engine” that’s driving the train. In her view, research into autoimmunity has been stymied by specialization of medicine, which is organized by the organ - not the origin - of disease.

This is especially important because autoimmune diseases often run in families. And members of these families often develop different types of autoimmune diseases. “If you were going in to see a doctor for joint problems, would you think it mattered to mention that your brother had Crohn’s?” Ladd asks. Probably not. Most people wouldn’t put two and two together. Understanding this connection is very important, though, because early diagnosis and treatment of an autoimmune disease like RA can often make a big difference.

What Causes Autoimmune Diseases?
The causes of autoimmune diseases remain unknown. Much more research is needed to fully understand them. However, evidence is pointing to infectious agents, such as viruses and bacteria. They may be important triggers in people who have a certain genetic makeup. Smoking or drugs also may trigger these chronic diseases.
“The initiating cause can occur up to four years before any clinical symptoms appear,” Peyman says.

“Everyone should be aware that they can reduce their risk of developing these diseases,” Peyman says. “As with cardiovascular disease and many cancers, inflammation is a major factor in the dysfunction of the immune system with autoimmune diseases. A diet rich in antioxidants and smoking cessation are good places to begin in reducing inflammation, he says.

What Is Rheumatoid Arthritis?
Joint destruction is the hallmark of RA. The immune system attacks joint tissues for unknown reasons. White blood cells travel to the joint lining, or synovium, and cause inflammation known as synovitis. This leads to symptoms of warmth, redness, swelling, and pain. The chronic inflammation of RA causes the normally thin synovium to become thick and joints to become swollen and puffy.

With time, the inflamed synovium invades and destroys the cartilage and bone within the joint. Researchers studying rheumatoid arthritis now believe that it begins to damage bones during the first year or two that a person has the disease. That’s one reason why early diagnosis and treatment are so important.

About 1.3 million adults have RA. That’s down from a 1990 estimate of 2.1 million. The decrease partly reflects a more narrow definition of RA. However, the prevalence of RA does appear to be declining around the world. Women with rheumatoid arthritis still outnumber men two to one.

What Causes Rheumatoid Arthritis?
Recent research is uncovering a complex interplay between the hormonal, nervous, and immune systems in rheumatoid arthritis. Researchers are also trying to learn why rheumatoid arthritis often improves during pregnancy. One study suggests that certain proteins passed between the mother and unborn child may be responsible for the improvement. These are proteins that help the immune system tell the difference between the body’s own cells and foreign ones. This exchange of proteins may change the mother’s immune system during pregnancy in some way.
Both genetics and environmental factors combined appear to be the main triggers of RA.
Genetics. Those at risk for autoimmune diseases such as rheumatoid arthritis inherit certain types of human leukocyte antigens (HLAs). These are white blood cell proteins that cause the white blood cells to overreact. This genetic difference puts related family members at an increased risk for one or more autoimmune diseases.

Researchers are collecting information from families to gain even greater insights into genetic links. They have identified several genetic regions that increase the susceptibility for rheumatoid arthritis in animal models. Recent studies have found several novel genes associated with the disease.

Environmental factors. An original insult from an infection or other factor in the environment can lead to chronic arthritis years later. This makes it more difficult to identify the culprit. However, researchers are homing in on some possible targets, Peyman tells WebMD. They include:
Smoking

Parvovirus B19, also known as fifth disease
Epstein-Barr virus, a prominent infectious agent
Bacterial gum disease (periodontitis)

“Recent studies show that smoking tobacco modifies proteins in the lungs,” says Peyman. “These modified proteins are similar to those showing up in inflamed joints.” Cells travel from the lungs to an injured joint, where the immune system reacts strongly, causing ongoing inflammation.”
A similar process can happen with an infection. In people with genetic susceptibility, a minor localized infection in the mouth, for example, can trick the immune system into looking other places for modified proteins. This can lead to a “smoldering additional inflammation” in the body, which chronically attacks the joints, Peyman says.

“This molecular mimicry is the basis of much of the research into the immunology of autoimmune disease,” Peyman says. “Researchers are trying to find which components of a microbe or environmental insult are similar to the known targets of the immune system in autoimmune diseases. With rheumatoid arthritis, this has been a decades-long quest.”

4 Healthy Habits That Cut Disease Risk

2009-08-17T21:00:00.000-07:00

Aug. 10, 2009 -- Don't smoke. Get off the sofa and take a walk. Stay away from the junk food. Watch your waistline.

You may have heard the advice before. But did you know that if you follow all four of these healthy habits together, you could decrease your chances of developing some of the most common and deadly chronic diseases by nearly 80%?

Researchers reporting in this month's Archives of Internal Medicine analyzed the health, lifestyles, and diet of 23,513 German adults 35 to 65 years old, starting in the mid-1990s. The study showed that those who had more healthy habits were much less likely to get diseases such as cancer, diabetes, and heart disease.

The analysis included a detailed look at each person's body weight and height, disease background, food frequency, and how well they followed these four healthy lifestyle habits over the eight-year study period:
Never smoked
Exercised at least 3.5 hours per week
Maintained a body mass index (BMI) under 30

Followed a diet high in fruits, vegetables, and whole-grain breads, and limited in meats
Most of the people in the study had at least one healthy habit; only 9% said they followed all four.

After adjusting for risk factors that might influence the development of disease, the researchers learned that those who followed all four healthy habits had a 78% lower risk of developing a chronic condition such as diabetes, cardiovascular disease, or cancer compared to those who reported none of the healthy habits.

Specifically, in the study, all four of the healthy habits combined were linked to a:
93% lower risk of type 2 diabetes
81% lower risk of heart attack
50% lower risk of stroke
36% lower risk of cancer

Researchers say it's important to adopt and teach healthy habits early in life. Their findings "reinforce current public health recommendations to avoid smoking, to maintain a healthy weight, to engage in physical activity appropriately and to eat adequate amounts of fruits and vegetables and foods containing whole grains and to partake of red meat prudently," study author Earl S. Ford, MD, MPH, of the CDC, and colleagues write.

The following habits may help you lower your risk of developing chronic diseases. They are listed in order of largest to smallest impact on disease risk, as determined by the recent study.

Maintain a healthy weight. Your body mass index should be lower than 30.
Never smoke. (But if you already do, you should quit.)
Get at least 3.5 hours of exercise every week.
Follow a healthy diet. Ask your doctor for recommendations.

Pessimism, Cynicism Can Hurt Your Heart

2009-08-17T20:57:00.000-07:00

Aug. 10, 2009 -- Whether you believe the metaphorical glass is half full or half empty may not only affect how you see the world, it may also affect your heart.

New research suggests that having a positive attitude just might protect against heart disease and keep you alive.

The study of postmenopausal women is one of the largest ever to examine the impact of personality and temperament on the heart.

Just as optimism appeared to protect against heart disease and death, pessimism seemed to increase the risk for both.

And women with the highest degree of hostility and cynicism were also more likely to die than those with the sunniest dispositions.

“We don’t know exactly why, but attitude does appear to matter when it comes to heart disease and health,” University of Pittsburgh Medical Center internist Hilary A. Tindle, MD, MPH tells WebMD.

Pessimism, Hostility Bad for the Heart
The study participants were enrolled in the Women’s Health Initiative, a 15-year study that included about 162,000 postmenopausal women. None of the women had heart disease when they entered the study.

About 97,000 were included in the analysis by Tindle and colleagues.
The women completed surveys at study entry designed to assess their degree of optimism and their general level of hostility and cynicism.

For the optimism survey, the women were asked to answer "yes" or "no" to questions like, "In unclear times, I usually expect the best,” and “If something can go wrong for me, it will.”
The cynicism/hostility "yes" or "no" survey included questions like, “I have often had to take orders from someone who did not know as much as I did,” and “It is safer to trust nobody.”

Over eight years of follow-up:
Women who scored highest for optimism had a 9% lower risk for developing heart disease and a 14% lower risk of dying from all causes than women who scored lowest for optimism.
Women with a high degree of hostility and cynicism were 16% more likely to die than women who scored lowest for hostility and cynicism. The heart disease rate was similar for both groups.
Optimistic African-American women had a 33% lower risk for death than African-American women who were pessimists. Among white women, the survival advantage for optimists was 13%. African-American women who scored highest for hostility and cynicism were 62% more likely to die than African-American women who scored lowest.

Can a Pessimist Become an Optimist?
Compared to pessimists, optimists were more likely to be younger, live in the western U.S., have higher education and income levels, have a job, have health insurance, and attend church.
Pessimists were more likely than optimists to have diabetes, high blood pressure, high cholesterol, and suffer from depression. They were also more likely to be overweight, smoke, and avoid exercise.

But these factors did not fully explain the difference in heart disease and death risk between the two groups, Tindle says.

The study will appear in the Aug. 25 issue of the American Heart Association journal Circulation.
Psychologist and American Heart Association spokesman Barry J. Jacobs, PsyD, tells WebMD that the study adds to a growing body of research linking an optimistic attitude with better health.

“There is a lot of conjecture about why this is, but we don’t really know why optimism seems to be so beneficial for health,” he says.

Like Tindle and colleagues, many other researchers have found that negative thinkers make poorer lifestyle choices than positive thinkers. They also tend to suffer more from depression.
“Someone who believes that life is not worth living probably isn’t the type of person who goes to the gym three times a week,” Jacobs says.

But can someone who is pessimistic by nature change their tune to improve their health?
Psychiatrist Redford Williams, MD, who directs Duke University Medical Center’s Behavioral Medicine Research Center, believes they can.

Williams has devoted his career to teaching people how to overcome anger and hostility, and he is the author of the book Anger Kills: 17 Strategies for Controlling the Hostility That Can Harm Your Health.

In an interview with WebMD, Williams cited a 2005 Duke study showing that heart patients who attended a two-week, 12-hour workshop designed to teach such coping skills had less depression and better blood pressure control than heart patients who got a one-hour lecture on stress.
“People can learn these skills, and more and more research is showing that it can not only improve your life but save it,” he says.

11 "Don't-Tell-the-Wife" Secrets All Men Keep

2009-08-17T20:54:00.000-07:00

I was in the ninth grade when I learned a vital lesson about love. My girlfriend at the time, Amy, was stunningly cute, frighteningly smart and armed with a seemingly endless supply of form-fitting angora sweaters. And me? Let's just say I was an adolescent Chris Robinson to her budding Kate Hudson -- and well aware of my good fortune.

Then one day, as we stood in line for a movie at the mall, Simone Shaw, junior high prom queen, sauntered by. Suddenly Amy turned to me. "Were you looking at her?" she asked. "Do you think she's pretty?"

My mind reeled. Of course I was looking at her! Of course she was pretty! My God, she was Simone Shaw! I paused for a second, then decided to play it straight.
"Well, yeah," I chortled.

Five days later our breakup hit the tabloids (a.k.a. the lunchroom).
There comes a time in every man's life when he discovers the value of hiding the grosser parts of his nature. He starts reciting the sweet nothings you long to hear: "No, honey, I play golf for the exercise." "No, honey, I think you're a great driver." "No, honey, I wasn't looking at that coed washing the car in the rain."

We're not lying, exactly. We're just making things...easier. But Glenn Good, Ph.D., a relationship counselor, disagrees, and maybe he has a point. "These white lies are pretty innocent, but they can turn confusing," he says. "Many women think, If he's lying about himself, is he also lying about something else? Is he having an affair? To establish trust you have to tell the truth about the innocuous stuff."

And so, in the interest of uniting the sexes, we've scoured the country for guys willing to share the private truths they wouldn't normally confess. Some are a bit crass. Some you've always suspected. Some are surprisingly sweet. (Guys don't like to reveal the mushy stuff, either.) But read on, and you may discover that the truth about men isn't all that ugly.

Secret #1: Yes, we fall in lust 10 times a day -- but it doesn't mean we want to leave you
If the oldest question in history is "What's for dinner?" the second oldest is "Were you looking at her?" The answer: Yes -- yes, we were. If you're sure your man doesn't look, it only means he possesses acute peripheral vision.

"When a woman walks by, even if I'm with my girlfriend, my vision picks it up," says Doug LaFlamme, 28, of Laguna Hills, California. "I fight the urge to look, but I just have to. I'm really in trouble if the woman walking by has a low-cut top on."

Granted, we men are well aware that our sizing up the produce doesn't sit well with you, given that we've already gone through the checkout line together. But our passing glances pose no threat.

"It's not that I want to make a move on her," says LaFlamme. "Looking at other women is like a radar that just won't turn off."

Secret #2: We actually do play golf to get away from you
More than 21 million American men play at least one round of golf a year; of those, an astounding 75 percent regularly shoot worse than 90 strokes a round. In other words, they stink. The point is this: "Going golfing" is not really about golf. It's about you, the house, the kids -- and the absence thereof.

"I certainly don't play because I find it relaxing and enjoyable," admits Roland Buckingham, 32, of Lewes, Delaware, whose usual golf score of 105 is a far-from-soothing figure. "As a matter of fact, sometimes by the fourth hole I wish I were back at the house with the kids screaming. But any time I leave the house and don't invite my wife or kids -- whether it's for golf or bowling or picking up roadkill -- I'm just getting away."

Secret #3: We're unnerved by the notion of commitment, even after we've made one to you
This is a dicey one, so first things first: We love you to death. We think you're fantastic. Most of the time we're absolutely thrilled that we've made a lifelong vow of fidelity to you in front of our families, our friends and an expensive videographer.

But most of us didn't spend our formative years thinking, "Gosh, I just can't wait to settle down with a nice girl so we can grow old together." Instead we were obsessed with how many women who resembled Britney Spears we could have sex with before we turned 30. Generally it takes us a few years (or decades) to fully perish that thought.

Secret #4: Earning money makes us feel important
In more than 7.4 million U.S. marriages, the wife earns more than the husband -- almost double the number in 1981. This of course is a terrific development for women in the workplace and warmly embraced by all American men, right? Right?

Yeah, well, that's what we tell you. But we're shallow, competitive egomaniacs. You don't think it gets under our skin if our woman's bringing home more bacon than we are -- and frying it up in a pan?

"My wife and I are both reporters at the same newspaper," says Jeffrey Newton, 33, of Fayetteville, South Carolina. "Five years into our marriage I still check her pay stub to see how much more an hour I make than she does. And because she works harder, she keeps closing the gap."

Secret #5: Though we often protest, we actually enjoy fixing things around the house
I risk being shunned at the local bar if this magazine finds its way there, because few charades are as beloved by guys as this one. To hear us talk, the Bataan Death March beats grouting that bathroom shower. And, as 30-year-old Ed Powers of Chicago admits, it's a shameless lie. "In truth, it's rewarding to tinker with and fix something that, without us, would remain broken forever," he says. Plus we get to use tools.

"The reason we don't share this information," Powers adds, "is that most women don't differentiate between taking out the trash and fixing that broken hinge; to them, both are tasks we need to get done over the weekend, preferably during the Bears game. But we want the use-your-hands, think-about-the-steps-in-the-process, home-repair opportunity, not the repetitive, no-possibility-of-a-compliment, mind-dulling, purely physical task." There. Secret's out.
Secret #6: We like it when you mother us, but we're terrified that you'll become your mother
With apologies to Sigmund Freud, Gloria Steinem -- and my mother-in-law.
Secret #7: Every year we love you more

Sure, we look like adults. We own a few suits. We can probably order wine without giggling. But although we resemble our father when he was our age, we still feel like that 4-year-old clutching his pant leg.

With that much room left on our emotional-growth charts, we sense we've only begun to admire you in the ways we will when we're 40, 50 and -- God forbid -- 60. We can't explain this to you, because it would probably come out sounding like we don't love you now.

"It took at least a year before I really started to appreciate my wife for something other than just great sex; and I didn't discover her mind fully until the third year we were married," says Newton. "But the older and wiser I get, the more I love my wife." Adds J.P. Neal, 32, of Potomac, Maryland: "The for-richer-or-poorer, for-better-or-worse aspects of marriage don't hit you right away. It's only during those rare times when we take stock of our life that it starts to sink in."

Secret #8: We don't really understand what you're talking about
You know how, during the day, you sometimes think about certain deep, complex "issues" in your relationship? Then when you get home, you want to "discuss" these issues? And during these "discussions," your man sits there nodding and saying things like "Sure, I understand," "That makes perfect sense" and "I'll do better next time"?

Well, we don't understand. It doesn't make any sense to us at all. And although we'd like to do better next time, we could only do so if, in fact, we had an idea of what you're talking about.
We do care. Just be aware that the part of our brain that processes this stuff is where we store sports trivia.

Secret #9: We are terrified when you drive
Want to know how to reduce your big, tough guy to a quivering mass of fear? Ask him for the car keys.

"I am scared to death when she drives," says LaFlamme.
"Every time I ride with her, I fully accept that I may die at any moment," says Buckingham.
"My wife has about one 'car panic' story a week -- and it's never her fault. All these horrible things just keep happening -- it must be her bad luck," says Andy Beshuk, 31, of Jefferson City, Missouri.

Even if your man is too diplomatic to tell you, he is terrified that you will turn him into a crash-test dummy.

Secret #10: We'll always wish we were 25 again
Granted, when I was 25 I was working 16-hour days and eating shrimp-flavored Ramen noodles six times a week. But as much as we love being with you now, we will always look back fondly on the malnourished freedom of our misguided youth. "Springsteen concerts, the '91 Mets, the Clinton presidency -- most guys reminisce about the days when life was good, easy and free of responsibility," says Rob Aronson, 41, of Livingston, New Jersey, who's been married for 11 years. "At 25 you can get away with things you just can't get away with at 40."

While it doesn't mean we're leaving you to join a rock band, it does explain why we occasionally come home from Pep Boys with a leather steering-wheel cover and a Born to Run CD.
Secret #11: Give us an inch and we'll give you a lifetime

I was on a trip to Mexico, standing on a beach, waxing my surfboard and admiring the glistening 10-foot waves, when I decided to marry the woman who is now my wife. Sure, this was three years before I got around to popping the question. But that was when I knew.

Why? Because she'd let me go on vacation alone. Hell, she made me go. This is the most important thing a man never told you: If you let us be dumb guys, if you embrace our stupid poker night, if you encourage us to go surfing -- by ourselves -- our silly little hearts, with their manly warts and all, will embrace you forever for it.

And that's the truth.

5 Things You Didn't Know About Masturbation

2009-08-17T20:53:00.000-07:00

Although men may joke and tease each other about their solo sexual activity, women are typically less forthcoming about their own self-pleasuring. With a very close friend, some may compare notes discretely about the best vibrators or the stress relief going solo can provide.
But women's masturbation is not generally a common topic of conversation among girlfriends. Maybe it should be, say sex therapists. They point out that women's masturbation can have benefits both for health and relationships. Here are five things about masturbation women may not know:

1. "Normal" masturbation in women takes many forms.
Most women, like men, have masturbated at least once in their lives, research suggests. Frequency varies, and there's no "normal" for that. There's no ''normal" cutoff age, either, with the practice continuing into the 80s and beyond.

Women may feel guilty about it, especially if they are in a committed relationship, but there’s no need for guilt, sex therapists say. Sometimes a partner is tired, out of town, or otherwise unavailable. And it doesn't mean a woman needs to go without.

There is no one "method" of masturbation in women that's normal. "A range of ways is 'normal,''' says Paul Joannides, PsyD, a psychoanalyst in Waldport, Ore.

Fingers and vibrators are two common methods of women's masturbation. More than half of 2,056 women, aged 18 to 60, used a vibrator either during masturbation or intercourse, says Debby Herbenick, PhD, MPH, associate director of the Center for Sexual Health Promotion at Indiana University, Bloomington, who led the survey.

Other women who masturbate report they use the back of a vibrating toothbrush head, the handle of a hairbrush, or water jets in the bathtub, Joannides says.
Although some experts worry about side effects from vibrator use, such as genital numbness or pain, less than 30% of the women in Herbenick's vibrator survey said they had experienced them.

But another expert, Frank Sommers, MD, a Toronto psychiatrist, worries that excessive vibrator use during masturbation could desensitize women to orgasms with a partner. “I tell my patients, ‘Look on a vibrator as whipped cream -- you wouldn’t want to eat it every day.’’’
He believes too much vibrator use ‘’habituates your autonomic nervous system to such stimulation that a human could not duplicate it.”

2. Masturbation can improve your mood -- without the ''obligations'' of partnered sex.
However a woman chooses to masturbate, it can improve her spirits. "It can improve a depressed mood," says Kathleen Segraves, PhD, a sex therapist and associate professor of psychiatry at Case Western Reserve University and a therapist at Metrohealth Medical Center in Cleveland, Ohio. "Not clinical depression, but the 'blue funk' days."

"With solo sex, there is no distraction, and you can focus on your own experience without making sure someone else is having a good time," she says.

It doesn't mean you don't love your partner, maybe just that you need to think only about yourself sometimes, experts say. "The woman doesn't have to be outside her head, wondering, 'Am I taking too long?'" Segraves says.

3. Masturbation can improve your sex life with your partner.
Women who masturbate on a regular basis learn what feels good for them, Segraves says. "It helps build sexual confidence," she says. "It helps you guide the partner when you have a partner.”

You can say, for instance: "Please put your hand here," and not be embarrassed, she says.
Women who use a vibrator during masturbation tend to have better sexual functioning with a partner, Herbenick says.

Sex therapists typically recommend masturbation for women who have a difficult time reaching orgasm. It can help them learn about their body and feel less self-conscious.

"We know that women compared to men have a harder time learning to orgasm," Herbenick says. Masturbating can help, and masturbating with a vibrator may help even more, she says. "Using a vibrator, for reasons we don't understand, helps women orgasm." The survey is published in the Journal of Sexual Medicine.

Those who used a vibrator, she found, even if it had been a year since the use, "had better sexual functioning in terms of vaginal lubrication, desire, arousal and ease of orgasm, and they tended to have less pain or discomfort during intercourse."

But "it may be that those who don't find sex painful tend to use a vibrator,” she says.

4. Masturbation can help you relax.
Women are more apt than men to over-analyze a bad day and think: "How could I have done this better?" They are more likely than men, some researchers have found, to replay an argument or bad interaction with people in their head. It all adds up to excess stress.
Researchers call this rumination, and it has been linked in numerous studies to depression.
"If you can start pleasuring yourself, that will often interfere with ruminations," Segraves says. "Not all the time," she says. But it may help.

5. Masturbation can provide pain relief.
Women who masturbate often report that it helps relieve menstrual cramps and to improve the symptoms of premenstrual syndrome (PMS), such as irritability and crankiness.

Masturbating to orgasm may help migraine, too. Although orgasm has sometimes been found to trigger a migraine headache, it may also relieve it, according to some research. Scientists speculate that some factor associated with orgasm (by yourself or with a partner) may suppress pain or actually suppress the migraine process.

Physical Causes of Erectile Dysfunction

2009-08-17T20:52:00.000-07:00

The process of achieving an erection is complex and problems may occur for a variety of reasons. These problems can be psychological, physical, or a combination of the two.

Physical causes of ED are related to a breakdown or damage to the sequence of events that lead to an erection. This sequence involves nerve impulses in the brain, spine, and penis as well as the subsequent response in the muscles, fibrous tissues, veins and arteries in and near the corpora cavernosa.

Often times the breakdown or damage in the sequence affects the arteries, muscles, and surrounding tissues of the penis, and this breakdown is most commonly the result of a disease. Diseases that commonly cause ED include:

Diabetes : Diabetes can cause nerve and artery damage that can make achieving an erection difficult. Between 35% and 50% of men with diabetes experience ED, according the National Institutes of Health. Some estimates are higher, stating that up to 75% of men with diabetes will experience at least some degree of ED during their lifetime and the risk increases with age.
Kidney disease: Kidney disease can cause chemical changes to occur in your body that affect hormones, circulation, nerve function, and energy level. Often times these changes will lower a person's libido (sex drive) or sexual ability. Drugs used to treat kidney disease may also cause ED.

Neurological (nerve and brain) diseases: The nervous system (the body's system of nerves) plays a vital part in achieving and maintaining an erection and it is common for men with diseases such as stroke, multiple sclerosis (MS), Alzheimer's disease, Parkinson's disease and spinal cord injuries to experience ED. This is due to an interruption in the transmission of nerve impulses between the brain and the penis.

Vascular disease: Vascular diseases are those that affect the blood vessels. These diseases include atherosclerosis (hardening of the arteries), hypertension, and high cholesterol. These diseases, which account for 70% of physically-related causes of ED, all restrict blood flow to the heart, the brain and, in the case of ED, the penis.

Prostate cancer : Prostate cancer doesn't cause ED on its own, but treatment (radiation, hormonal manipulation, or surgery to remove the cancer) can lead to erectile problems.
The physical causes of ED are not only disease-related. There are many other potential causes, including:

Surgery: Surgery performed to treat diseases such as prostate cancer and bladder cancer often require the removal of nerves and tissues around the affected area which can lead to ED. Some of these surgeries result in only temporary problems (lasting 6-18 months) while others result in permanent damage to the nerves and tissue around the penis and require treatment in order for an erection to be achieved.

Injury: Injuries to the pelvis, bladder, spinal cord, and penis that require surgery also commonly cause ED.

Hormonal imbalances: Imbalances of hormones, such as thyroid hormones, prolactin, and testosterone, can affect a man's response to sexual stimulation. These imbalances can be the result of a tumor of the pituitary gland, kidney disease, liver disease, or hormonal treatment of prostate cancer.

Venous leak: If the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This is known as a venous leak, and can be a result of injury or disease.

Tobacco, alcohol or drug use: All three of these substances can damage a person's blood vessels and/or restrict blood flow to the penis, causing ED. Smoking in particular plays a large role in causing ED in people with arteriosclerosis.

Prescription drugs : There are over 200 types of prescription drugs that may cause ED.
Prostate enlargement: Bladder neck obstruction due to prostate enlargement has recently been implicated in being associated with varying degrees of ED.

Life Cycle of a Penis

2009-08-17T20:50:00.000-07:00

It's no secret that a man's sexual function declines with age. As his testosterone level falls, it takes more to arouse him. Once aroused, he takes longer to get an erection and to achieve orgasm and, following orgasm, to become aroused again. Age brings marked declines in semen volume and sperm quality. Erectile dysfunction (ED), or impotence, is clearly linked to advancing years; between the ages of 40 and 70, the percentage of potent men falls from 60% to roughly 30%, studies show.

Men also experience a gradual decline in urinary function. Studies show that a man's urine stream weakens over time, the consequence of weakened bladder muscles and, in many cases, prostate enlargement.

And that's not all. Recent research confirms what men have long suspected and, in some cases, feared: that the penis itself undergoes significant changes as a man moves from his sexual prime -- around age 30 for most guys -- into middle age and on to his dotage. These changes include:
Appearance. There are two major changes. The head of the penis (glans) gradually loses its purplish color, the result of reduced blood flow. And there is a slow loss of pubic hair. "As testosterone wanes, the penis gradually reverts to its prepubertal, mostly hairless, state," says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego and editor-in-chief of The Journal of Sexual Medicine.

Penis Size. Weight gain is common as men grow older. As fat accumulates on the lower abdomen, the apparent size of the penis changes. "A large prepubic fat pad makes the penile shaft look shorter," says Ira Sharlip, MD, clinical professor of urology at the University of California, San Francisco.

"In some cases, abdominal fat all but buries the penis," says Ronald Tamler, MD, PhD, co-director of the Men's Health Program at Mount Sinai Hospital in New York City. "One way I motivate my overweight patients is by telling them that they can appear to gain up to an inch in size simply by losing weight."

In addition to this apparent shrinkage (which is reversible) the penis tends to undergo an actual (and irreversible) reduction in size. The reduction -- in both length and thickness -- typically isn't dramatic but may be noticeable. "If a man's erect penis is 6 inches long when he is in his 30s, it might be 5 or 5-and-a-half inches when he reaches his 60s or 70s," says Goldstein.
What causes the penis to shrink? At least two mechanisms are involved, experts say. One is the slow deposition of fatty substances (plaques) inside tiny arteries in the penis, which impairs blood flow to the organ. This process, known as atherosclerosis, is the same one that contributes to blockages inside the coronary arteries -- a leading cause of heart attack.

Goldstein explains that another mechanism involves the gradual buildup of relatively inelastic collagen (scar tissue) within the stretchy fibrous sheath that surrounds the erection chambers. Erections occur when these chambers fill with blood. Blockages within the penile arteries -- and increasingly inelastic chambers -- mean smaller erections.

As penis size changes, so do the testicles. "Starting around age 40, the testicles definitely begin to shrink," says Goldstein. The testicles of a 30-year-old man might measure 3 centimeters in diameter, he says; those of a 60-year-old, perhaps only 2 centimeters.

Curvature. If penile scar tissue accumulates unevenly, the penis can become curved. This condition, known as Peyronie's disease, occurs most commonly in middle age. It can cause painful erections and make intercourse difficult. The condition may require surgery.

Sensitivity. Numerous studies have shown that the penis becomes less sensitive over time. This can make it hard to achieve an erection and to have an orgasm. Whether it renders orgasm less pleasurable remains an open question.

If there's a silver lining to these presumably unwelcome changes, it's this: Experts say these changes need not ruin your erotic life. One recent study involving 2,213 men in Olmstead County, Minn., showed significant declines in erectile function, libido, and ejaculatory function -- but only moderate decreases in sexual satisfaction. "Older men may be less likely to perceive these declines as a problem and be dissatisfied," concluded the study's authors.

As Goldstein puts it, "The most important ingredient for a satisfying sex life is the ability to satisfy your partner, and that doesn't require peak sexual performance or a big penis. As long as a man's partner enjoys sexual intercourse, he feels like a god."

Biologic Drug for Early RA?

2009-08-17T20:48:00.000-07:00

Aug. 6, 2009 -- In a new study, rheumatoid arthritis researchers say they've found a good plan for treating rheumatoid arthritis in its early stages.

The study, published in The Lancet, included 487 adults in Sweden who had had rheumatoid arthritis (RA) for less than one year.

First, all of the patients took the drug methotrexate for three to four months. That was all that 145 patients -- about 30% -- needed to bring their rheumatoid arthritis symptoms to a low level.
The remaining patients continued taking methotrexate. Half of them also started taking two more pills -- sulfasalazine and hydroxychloroquine -- to treat their RA.

The other half added a biologic drug called Remicade, which is given intravenously. Remicade belongs to a class of drugs called tumor necrosis factor (TNF) inhibitors.

One year later, 39% of the patients taking methotrexate plus Remicade had only low levels of RA symptoms, compared to 25% of patients taking methotrexate plus sulfasalazine and hydroxychloroquine.

The difference between the two groups didn't happen right away; the Remicade-plus-methotrexate group took the lead after six months of treatment, note the researchers, who included R.F. van Vollenhoven, MD, of the rheumatology clinic at Sweden's Karolinska University Hospital.

Adverse events were "balanced fairly well between the two groups" and were in line with the drugs' known side effects, van Vollenhoven and colleagues note.

The researchers aren't recommending anti-TNF drugs for everyone with RA, because anti-TNF drugs are more expensive than conventional drugs and aren't always needed or appropriate.
The researchers are following the patients for a second year; those results haven't been published yet.

"The results provide further evidence of the value of biological agents," states an editorial published with the study. Aggressive treatment, with a goal of remission, is also important, note the editorialists, who included Tuulikki Sokka, MD, PhD, of Finland's Jyvaskyla Central Hospital.
The study didn't compare Remicade to other anti-TNF drugs. It was funded in part by Schering-Plough, the drug company that markets Remicade outside the U.S.

Teens Taking Opioids to Relax, Get High - 12% of High School Seniors Report Taking Opioids Without a Doctor's Orders, Study Shows

2009-08-17T05:46:00.001-07:00

Aug. 6, 2009 -- American teens are using prescription opioids -- such as Vicodin, OxyContin, Percocet, and codeine -- without a doctor's orders at an alarmingly high rate. And they are more likely to use the drugs to relieve stress or get high rather than for pain relief.

Those findings come from a new study, published in the Archives of Pediatrics & Adolescent Medicine, that is based on questionnaires filled out by high school students in the spring of their senior year. A total of 12,441 students from more than 100 private and public high schools participated between 2002 and 2006.

More than one in 10 high school seniors (12.3%) reported ever having taken prescription opioids for a nonmedical reason. That included 8% who reported having done so within the past year.
Why Teens Use Opioids

Here are the top reasons the students gave for taking opioids:
56.4% to relax or relieve tension
53.5% to feel good or get high
52.4% to experiment
44.8% to relieve physical pain
29.5% to have a good time with friends.

The students who took the drugs for reasons other than pain relief were more likely to also use other drugs and to drink alcohol heavily.

“The prevalence of nonmedical use of prescription opioids among adolescents and young adults is now at its highest level in 15 years and represents a public health concern,” the authors write in the study.

They call for screenings into the reasons teens are taking such drugs without a doctor's orders, because cases of teens taking opioids for pain relief may need to be handled differently than cases of teens taking them for fun and relaxation.

Rheumatoid Arthritis: 8 Top Myths

2009-08-17T05:38:00.000-07:00

Rheumatoid arthritis affects about 1% of the population worldwide, but still misunderstanding swirls around this common and severe joint condition.

"There are so many misconceptions out there about rheumatoid arthritis," says Paul Kremer, MD, a rheumatologist and professor of medicine at Albany Medical College in New York.
"Arthritis is common, and rheumatoid arthritis often gets confused with the other kinds of arthritis in people's minds,” he says.

Plus, rheumatoid arthritis is still mysterious in many ways. Research and new treatments are constantly changing the understanding of the disease.

Even the experts still have a lot to learn about rheumatoid arthritis. WebMD teamed up with Kremer to explode a few common myths about this "commonly unusual" disease.

Myth No. 1: Rheumatoid arthritis is just like ‘regular arthritis.’

Fact: Rheumatoid arthritis is not "regular arthritis." What we think of as “regular arthritis” is osteoarthritis, caused by injury or normal wear-and-tear on aging joints. Osteoarthritis is the most common joint disease in middle age to older people.

By contrast, rheumatoid arthritis is a chronic, progressive autoimmune disorder. In response to an unknown trigger, the body makes antibodies that attack its own tissues. The self-attacks mostly affect the joints, although they can also affect other body parts. Disease attacks, called flare-ups, occur periodically, or can be continuous in some people.

"This is the most common confusion -- between osteoarthritis and rheumatoid arthritis. It gets even more confusing, because people with RA often also have osteoarthritis," adds Kremer.

Myth No. 2: Only old people get rheumatoid arthritis.

Fact: In most people who develop RA, the disease starts between the ages of 30 and 55.
"This is the peak age group," says Kremer, "but anyone can get rheumatoid arthritis, even teenagers." At the same time, "older folks may have more severe RA, because it's progressive and they've been living with it longer."

Myth No. 3: Rheumatoid arthritis isn't all that serious.

Fact: Rheumatoid arthritis can threaten your health and independence, especially if it's inadequately treated.

"A lot of people downplay RA as just 'Grandma's rheumatism,' and they miss the boat completely," says Kremer. "They delay seeing a physician, often for months or years, and a lot of joint damage can happen during that time."

Rheumatoid arthritis needs prompt diagnosis and regular treatment to protect joints from harm. In turn, this can protect your independence and long-term function.

Having rheumatoid arthritis also increases the risk for certain other conditions, says Kremer. “Cardiovascular diseases, infections, and lung disease are all more common in people with RA."

Myth No. 4: Most people with rheumatoid arthritis end up in a wheelchair or nursing home because of the disease.

Fact: Rheumatoid arthritis takes a different course in different people, but most people go on living independently.

Because of its progressive nature, rheumatoid arthritis has caused disability in many people. Much of the available information, though, comes from 20- or 30-year-old studies.

"These were done in another era -- before we started treating early with methotrexate, before we had the new biologic agents," says Kremer. "We have made extraordinary strides in the treatment of this disease. Today, the overwhelming majority of people under treatment for rheumatoid arthritis will do very well" in retaining independence and mobility, he says.

A recent study suggests Kremer is right: 94% of people with rheumatoid arthritis continued to perform all their normal activities independently after 10 years with the disease.

Myth No. 5: Most people with rheumatoid arthritis can't work.

Fact: Work tasks or habits may need to change with rheumatoid arthritis. But the diagnosis doesn't equal a lifetime of disability.

"Again, this myth may have been true in an earlier era, prior to the current treatments," says Kremer. "Certainly many people will need allowances at work, or will have to limit some activities during disease flares. But a large proportion of people with RA go right on working."
In fact, in one large study of people who had had rheumatoid arthritis for more than 10 years, their employment rates were no different than those of similar-age people without RA.

Myth No. 6: Because treatments for rheumatoid arthritis can be toxic, it's best to wait until the disease progresses before beginning treatment.

"This may be the most dangerous myth," warns Kremer.

There is now abundant proof that treating rheumatoid arthritis early prevents joint damage and disability. "Ideally, treatment should start as soon as possible after diagnosis," he adds. "Delaying treatment can mean worse outcomes down the road."

Numerous studies suggest that early treatment could delay full-blown rheumatoid arthritis from developing in some people.

It's true, medications used to treat RA can have side effects. Rarely are the side effects worse than untreated rheumatoid arthritis, though. Simple blood tests and doctor's visits can detect many of the serious side effects of rheumatoid arthritis medications.

Myth No. 7: Most people with rheumatoid arthritis get cancer, too.

Fact: People with rheumatoid arthritis are at slightly higher risk for developing lymphoma (blood cancer), but the risk is low overall.

"For lymphoma, the lifetime risk is about twice as high in people with RA. It's not clear why," says Kremer.

However, let’s keep that in perspective. Even with the increased risk, only a small minority of people with RA get lymphoma.

For example, in one study, after following over two thousand people with rheumatoid arthritis for about eight years, 11 of them developed lymphoma. According to population estimates, between three and eight people without rheumatoid arthritis would be expected to develop lymphoma over that same time period.

"Some of this increased incidence may be due to the increased inflammation in rheumatoid arthritis, and some may actually be due to the medications," says Kremer. "Nevertheless, most people with rheumatoid arthritis do not get cancer."

Methotrexate, the new biologics, or both may partially contribute to this increased risk. Nevertheless, rheumatologists stand behind the medicines. "You have to weigh the risks and the benefits," suggests Kremer. Untreated rheumatoid arthritis is frequently devastating, while lymphoma is uncommon, often slowly progressing, and treatable, he adds.

On the bright side: the risk of colorectal cancer is actually reduced by up to 40% in people with rheumatoid arthritis. One theory argues that the frequent use of anti-inflammatory medicines called NSAIDs (including aspirin, motrin, and ibuprofen) by rheumatoid arthritis patients helps to prevent cancer in the colon.

Myth No. 8: Painful, stiff joints from rheumatoid arthritis need to rest most of the day.

Fact: On the contrary; joints affected by RA need stretching and exercise.

"We want to keep these people mobile with medications and with encouraging exercise and physical activity," advises Kremer. Sometimes rest is necessary, but "most people with rheumatoid arthritis should be moving and exercising more, not less."

Immobility can be counterproductive for someone with rheumatoid arthritis. When joints are painful and stiff, it's natural to want to avoid movement. However, immobility sets up a vicious cycle. The muscles around a joint contribute a large part of the joint's strength and stability. All muscles need regular activity to stay healthy -- use it or lose it.

Everyone with rheumatoid arthritis can perform some kind of exercise.
Stretching exercises require minimal exertion and help keep joints flexible.
Low-impact aerobic exercise improves joint health, as well as overall mental and physical health. High-impact exercise, in general, should be avoided.

Child, Teen Cancers Linked to TNF Blockers - FDA Puts New Warning on Remicade, Enbrel, Humira, Cimzia, Simponi

2009-08-17T05:37:00.000-07:00

Aug. 4, 2009 - The FDA warns that TNF blockers -- the immune-disease drugs Remicade, Enbrel, Humira, Cimzia, and Simponi -- may cause lymphoma and other cancers in children and teens.

The drugs already carry a black-box warning that they may cause cancer. But the FDA now says the warning labels must highlight the drugs' possible risk of lymphoma and other cancers in children and teens.

TNF blockers neutralize a protein, tumor necrosis factor alpha, that is overproduced in inflammatory diseases. The drugs are used to treat juvenile rheumatoid arthritis, juvenile idiopathic arthritis (JIA), psoriatic arthritis, psoriasis, Crohn's disease, ankylosing spondylitis, and other autoimmune diseases.

TNF, however, has a normal function in the body: fighting cancer.

In a June 2008 alert, the FDA announced that it was investigating the link between TNF blockers and cancer in children and teens. That investigation, now complete, identified 48 cases of malignant cancers in children and teens and 147 cases of leukemia in all patients (including adults) taking TNF blockers.

Eleven children and teens died of lymphoma or complications of treatment; 26 of the 30 deaths among leukemia patients were linked to TNF blockers.

Because immune diseases themselves raise cancer risk, and because most patients take other immune-suppressing drugs along with TNF blockers, the FDA cannot say for sure that the TNF blockers definitively caused the cancers.

But the agency warns doctors and patients to be aware of the risk and to be on the lookout for any early signs of cancer.

The FDA investigation also links the TNF blockers to new-onset psoriasis that sent some patients to the hospital. Most patients improved after they stopped taking the drugs.

Are There Any Alternative Treatments for Epilepsy?

2009-06-28T08:19:00.000-07:00

There have been some studies of alternative treatments for epilepsy -- including biofeedback, melatonin, or large doses of vitamins. Here is what they found:

Biofeedback
Biofeedback is a method of using relaxation or imagery to change body functions such as breathing, heart rate and blood pressure. A biofeedback practitioner measures these functions with electrodes and a monitor. The practitioner describes a stressful situation and then teaches the patient various relaxation techniques.
The patient can see on the monitor the differences between stressed and relaxed situations. He or she can then use the relaxation techniques to feel more relaxed and control these body functions.
Biofeedback has been shown to help people with high blood pressure, migraine headaches and pain. Researchers have investigated whether biofeedback can help control seizures, but the results have not been encouraging. However, patients who have seizures triggered by anxiety or stressful situations may benefit from this therapy, in addition to their seizure medications.
Melatonin
Melatonin is a hormone that is manufactured by the pineal gland in the brain. Melatonin has been touted as an anti-aging substance, as a sleep aid, and as an antioxidant (a substance that protects against free radicals -- molecules that can damage the body). Studies into these claims have not been conclusive.
As for epilepsy, one study showed that melatonin may reduce the incidence of seizures in children, while another study found that melatonin increased the risk of seizures. At this time, it is believed that melatonin does not significantly help prevent seizures.
Vitamins
Although vitamins are necessary for good health, large doses of vitamins do not improve the symptoms of epilepsy and may even be harmful. You should get most of your vitamins from food by eating abalanced diet. If necessary, vitamin supplements such as folic acidcan help deal with vitamin loss caused by medication. People with epilepsy taking seizure medications do appear to have an increased need for calcium and vitamin D to help keep their bones healthy.Pregnant women also need sufficient folic acid to help prevent birth defects.

Reviewed by The Cleveland Clinic Neuroscience Center.

Electroencephalogram (EEG)

2009-06-28T08:16:00.000-07:00

An electroencephalogram (EEG) is a test that measures and records the electrical activity of your brain. Special sensors (electrodes ) are attached to your head and hooked by wires to a computer. The computer records your brain's electrical activity on the screen or on paper as wavy lines. Certain conditions, such as seizures, can be seen by the changes in the normal pattern of the brain's electrical activity.

Why It Is Done

An electroencephalogram (EEG) may be done to:

Diagnose epilepsy and see what type of seizures are occurring. EEG is the most useful and important test in confirming a diagnosis of epilepsy.
Check for problems with loss of consciousness or dementia.
Help find out a person's chance of recovery after a change in consciousness.
Find out if a person who is in a coma is brain-dead.
Study sleep disorders, such as narcolepsy.
Watch brain activity while a person is receiving general anesthesia during brain surgery.
Help find out if a person has a physical problem (problems in the brain, spinal cord, or nervous system) or a mental health problem.

How To Prepare

Before the day of the electroencephalogram (EEG) test, tell your doctor if you are taking any medicines. Your doctor may ask you to stop taking certain medicines (such as sedatives and tranquilizers, muscle relaxants, sleeping aids, or medicines used to treat seizures) before the test. These medicines can affect your brain's usual electrical activity and cause abnormal test results.

Do not eat or drink foods that have caffeine (such as coffee, tea, cola, and chocolate) for 8 hours before the test.

Since the electrodes are attached to your scalp, it is important that your hair be clean and free of sprays, oils, creams, and lotions. Shampoo your hair and rinse with clear water the evening before or the morning of the test. Do not put any hair conditioner or oil on after shampooing.

To find certain types of abnormal electrical activity in the brain, you may have to be asleep during the recording. You may be asked not to sleep at all the night before the test or to sleep less (about 4 or 5 hours) by going to bed later and getting up earlier than usual. If your child is going to be tested, try to keep him or her from taking naps just before the test. If you know that you are going to have a sleep-deprived EEG, plan to have someone drive you to and from the test.

How It Is Done

An electroencephalogram (EEG) may be done in a hospital or in a doctor's office by an EEG technologist. The EEG record is read by a doctor who is specially trained to diagnose and treat disorders affecting the nervous system (neurologist).

You will be asked to lie on your back on a bed or table or relax in a chair with your eyes closed. The EEG technologist will attach 16 to 25 flat metal discs (electrodes) to different places on your head, using a sticky paste to hold the electrodes in place. A cap with fixed electrodes may be placed on your head instead of individual electrodes. In rare cases, these electrodes may be attached to the scalp with tiny needles.

The electrodes are hooked by wires to a computer that records the electrical activity inside the brain. A machine can show the activity as a series of wavy lines drawn by a row of pens on a moving piece of paper or as an image on the computer screen.

Lie still with your eyes closed during the recording, and do not talk to the technologist unless you need to. The technologist will watch you directly or through a window during the test. The recording may be stopped from time to time to allow you to stretch and reposition yourself.

The technologist may ask you to do different things during the test to record what activity your brain does at that time.

You may be asked to breathe deeply and rapidly (hyperventilate). Usually you will take 20 breaths a minute for 3 minutes.
You may be asked to look at a bright, flashing light called a strobe. This is called photic or stroboscopic stimulation.
You may be asked to go to sleep. If you cannot fall asleep, you may be given a sedative to help you fall asleep. If an EEG is being done to check a sleep problem, an all-night recording of your brain's electrical activity may be done.

An EEG takes 1 to 2 hours. After the test, you may do your normal activities. But if you were sleep-deprived or given a sleep medicine, have someone drive you home after the test.

How It Feels

There is no pain with an electroencephalogram (EEG).

If paste is used to hold the electrodes, some paste may stay in your hair after the test, so you will have to wash your hair to remove it. If needle electrodes are used (which is rare), you will feel a brief, sharp prick (about like having a hair pulled out) when each electrode is inserted. If electrodes are placed in your nose, they may cause a tickling feeling and, rarely, some soreness or a small amount of bleeding for 1 to 2 days after the test.

If you are asked to breathe rapidly, you may feel lightheaded or have some numbness in your fingers. This reaction is normal. It will go away a few minutes after you start breathing normally again.

Risks

An electroencephalogram (EEG) is a very safe test. The electrical activity of your brain is recorded, but at no time is any electrical current put into your body. An EEG should not be confused with electroshock (electroconvulsive) therapy.

If you have a seizure disorder such as epilepsy, a seizure may be triggered by the flashing lights or by hyperventilation. If this occurs, the technologist is trained to take care of you during the seizure.

Results

There are several types of brain waves:

Alpha waves have a frequency of 8 to 12 cycles per second. Alpha waves are present only in the waking state when your eyes are closed but you are mentally alert. Alpha waves go away when your eyes are open or you are concentrating.
Beta waves have a frequency of 13 to 30 cycles per second. These waves are normally found when you are alert or have taken high doses of certain medicines, such as benzodiazepines.
Delta waves have a frequency of less than 3 cycles per second. These waves are normally found only when you are asleep or in young children.
Theta waves have a frequency of 4 to 7 cycles per second. These waves are normally found only when you are asleep or in young children.

**Electroencephalogram (EEG)**
Normal:	In adults who are awake, the EEG shows mostly alpha waves and beta waves.
	The two sides of the brain show similar patterns of electrical activity.
	There are no abnormal bursts of electrical activity and no slow brain waves on the EEG tracing.
	If flashing lights (photic stimulation) are used during the test, one area of the brain (the occipital region) may have a brief response after each flash of light, but the brain waves are normal.
Abnormal:	The two sides of the brain show different patterns of electrical activity. This may mean a problem in one area or side of the brain is present.
	The EEG shows sudden bursts of electrical activity (spikes) or sudden slowing of brain waves in the brain. These changes may be caused by a brain tumor, infection, injury, stroke, or epilepsy. When a person has epilepsy, the location and exact pattern of the abnormal brain waves may help show what type of epilepsy or seizures the person has. Keep in mind that in many people with epilepsy, the EEG may appear completely normal between seizures. An EEG by itself may not diagnose or rule out epilepsy or a seizure problem.
	The EEG records changes in the brain waves that may not be in just one area of the brain. A problem affecting the entire brain-such as drug intoxication, infections (encephalitis), or metabolic disorders (such as diabetic ketoacidosis) that change the chemical balance in the body, including the brain-may cause these kinds of changes.
	The EEG shows delta waves or too many theta waves in adults who are awake. These results may mean brain injury or a brain illness is present. Some medicines can also cause this.
	The EEG shows no electrical activity in the brain (a "flat" or "straight-line" EEG). This means that brain function has stopped, which is usually caused by lack of oxygen or blood flow inside the brain. This may happen when a person has been in a coma. In some cases, severe drug-induced sedation can cause a flat EEG.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

Moving too much.
Taking some medicines, such as those used to treat seizures (antiepileptic medicines) or sedatives, tranquilizers, and barbiturates.
Being unconscious from severe drug poisoning or a very low body temperature (hypothermia).
Having hair that is dirty, oily, or covered with hairspray or other hair preparations. This can cause a problem with the placement of the electrodes.

What To Think About

If the doctor thinks that a person has epilepsy but the EEG is normal, the technologist running the EEG test may have the person look at a flashing light (photic stimulation), breathe fast and deeply (hyperventilation), or sleep during the test. These techniques sometimes show epileptic EEG patterns that did not show up at first. If epilepsy is suspected after an initial EEG, the doctor may repeat the EEG more than once.
An EEG done during a seizure will almost always show abnormal electrical patterns. This makes an EEG useful when a doctor thinks that a person is having psychogenic seizures (pseudoseizures), which have no physical cause but can be caused by stress, emotional trauma, or mental illness. Psychogenic seizures do not cause abnormal electrical activity in the brain and will not show abnormal EEG results.
Other tests that may also be done include:
- Video EEG. Video EEG records seizures on videotape and on computer so that the doctor can see what happens just before, during, and right after a seizure. This test can be very helpful in finding the specific area of the brain that the seizures may be coming from. It is also helpful in diagnosing psychogenic seizures, which may look like real seizures but do not affect the electrical activity in the brain. Video EEG may be used short-term or long-term:
  - Short-term monitoring is done on an outpatient basis and may last up to 6 hours.
  - Long-term monitoring is done in the hospital and may last 3 to 7 days.
- Brain mapping. Brain mapping is a fairly new method that is very similar to EEG. With electrodes placed on the person's scalp to transmit the brain's electrical activity, a computer makes a color-coded map of signals from the brain. It is sometimes done to find a specific problem area in the brain that has already shown up on a regular EEG. Doctors are still not certain how brain mapping could be best used.
- Ambulatory EEG monitoring. In ambulatory EEG monitoring, the person is able to move around, and the test allows for long periods of time in recording of electrical activity in the brain. Fewer electrodes are attached to the person, and the person carries a small, portable recording unit. The recording may last for a full day or more, and the person is allowed to leave the hospital. Ambulatory EEG monitoring is not as accurate as a regular EEG.
Other Works Consulted
- Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.
- Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

Epilepsy Guide -Seizure Types and Symptoms

2009-06-28T07:59:00.000-07:00

Based on the type of behavior and brain activity, seizures are divided into two broad categories: generalized and partial (also called local or focal). Classifying the type of seizure helps physicians diagnose whether or not a patient has epilepsy.

Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by electrical impulses in a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. The most common types of seizures are listed below:

Generalized Seizures (Produced by the entire brain)	Symptoms
1. "Grand Mal" or Generalized tonic-clonic	Unconsciousness, convulsions, muscle rigidity
2. Absence	Brief loss of consciousness
3. Myoclonic	Sporadic (isolated), jerking movements
4. Clonic	Repetitive, jerking movements
5. Tonic	Muscle stiffness, rigidity
6. Atonic	Loss of muscle tone

Generalized Seizures

There are six types of generalized seizures. The most common and dramatic, and therefore the most well known, is the generalized convulsion, also called thegrand-mal seizure. In this type of seizure, the patient loses consciousness and usually collapses. The loss of consciousness is followed by generalized body stiffening (called the "tonic" phase of the seizure) for 30 to 60 seconds, then by violent jerking (the "clonic" phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the "postictal" or after-seizure phase). During grand-mal seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence.

Absence seizures cause a short loss of consciousness (just a few seconds) with few or no symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of "losing time."

Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects.

Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time.

Tonic seizures are characterized by stiffening of the muscles.

Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often results in a fall.

Partial Seizures (Produced by a small area of the brain)	Symptoms
1. Simple(awareness is retained) a. Simple Motor b. Simple Sensory c. Simple Psychological	a. Jerking, muscle rigidity, spasms, head-turning b. Unusual sensations affecting either the vision, hearing, smell taste or touch c. Memory or emotional disturbances
2. Complex (Impairment of awareness)	Automatisms such as lip smacking, chewing, fidgeting, walking and other repetitive, involuntary but coordinated movements
3. Partial seizure with secondary generalization	Symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions.

Partial Seizures

Partial seizures are divided into simple, complex and those that evolve into secondary generalized seizures. The difference between simple and complex seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness.

Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, autonomic, sensory or psychological. Motor symptoms include movements such as jerking and stiffening. Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). When simple partial seizures cause sensory symptoms only (and not motor symptoms), they are called "auras."

Autonomic symptoms affect the autonomic nervous system, which is the group of nerves that control the functions of our organs, like the heart, stomach, bladder, intestines. Therefore autonomic symptoms are things like racing heart beat, stomach upset, diarrhea, loss of bladder control. The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by some patients with a type of epilepsy called temporal lobe epilepsy. Simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena.

Complex partial seizures, by definition, include impairment of awareness. Patients seem to be "out of touch," "out of it" or "staring into space" during these seizures. There may also be some "complex" symptoms called automatisms. Automatisms consist of involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking.

The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive ("grand-mal") seizure. Most patients with partial seizures have simple partial, complex partial and secondarily generalized seizures. In about two-thirds of patients with partial epilepsy, seizures can be controlled with medications. Partial seizures that cannot be treated with medications can often be treated surgically.

Epilepsy and Your Changing Hormones

2009-06-28T07:56:00.000-07:00

Women with epilepsy face different issues than do men with epilepsy. For some women, the pattern of epileptic seizures is directly affected by the normal hormonal cycles they experience throughout their lives.

Two primary sex hormones flow through women's bodies. One is estrogen and the other is progesterone. Most of the time, your body has about the same amount of each.

What does that have to do with epilepsy? Doctors have learned that both of these hormones interact with brain cells. Estrogen is an "excitatory" hormone, which means that it makes brain cells give off more of an electrical discharge. Progesterone, on the other hand, is an "inhibitory" hormone, which means that it calms those cells down.

When the body is making more estrogen than progesterone, it can make the nervous system "excitable." In other words, you could be at greater risk for seizures. The hormones aren't actually causing the seizures, but they can influence when they happen.

Some women with epilepsy have more seizures at times when their hormones are changing. For example, some young women have their first seizures at puberty. Other women have more seizures around the time of their menstrual periods. This doesn't happen to all women, so doctors are still learning about how hormones and epilepsy interact.

Epilepsy and Your Menstrual Period

Some women have a form of epilepsy called catamenial epilepsy. This refers to seizures that are affected by a woman's menstrual cycle. Doctors aren't completely sure how many women with epilepsy have this, but they think it's about 10% to 12%.

The exact cause of these seizures is unknown. However, some women have most of their seizures when there is a lot of estrogen in their body, such as during ovulation. Other women have seizures when progesterone levels tend to drop, such as right before or during their period.

If you have seizures that start around the last half of your menstrual cycle and continue through the whole second half of your cycle, then you might have another type of catamenial epilepsy. This is when a woman has menstrual cycles that do not release an egg. These are called "anovulatory" cycles.

Women with epilepsy have more anovulatory cycles than other women do. Some doctors think that as many as 40% of menstrual cycles in women with epilepsy do not release an egg. It depends on the woman, and it is not always the same every month. Some months a woman will release an egg, and some months she will not. In general, though, women with epilepsy do not ovulate as regularly as women without epilepsy.

Why is that? Doctors do not know for certain. But, some seizures start in the temporal lobes of the brain. This is an area that is very closely connected to the areas regulating hormones. Women who have seizures that start in the temporal lobes may have their hormone production affected by their seizures.

If you can identify the role hormones play in your seizure patterns, it can help with your treatment. Try keeping a calendar of your menstrual cycle, and the days that you have seizures. Include notes about other factors that might be important, such as missed medication, sleep loss, stress, or illness. By sharing these records with your doctor, you can work together to manage your epilepsy more effectively.

Epilepsy and Life Changes

As you've already learned, many people develop their first seizures when they enter puberty. This happens to both men and women. Doctors think this is because before puberty we don't have many sex hormones circulating in our body. After puberty there are many more hormones in the body. And as you've seen, hormones do have a direct effect on the cells of the brain.

Does that mean that a woman's seizures might go away when she reaches menopause? Sometimes, but not always. In some women, seizures do seem to just disappear. This usually happens in women who have catamenial epilepsy. For other women, menopause doesn't seem to make a difference in their seizures. And still other women have worse seizures during menopause.

Most of the time, though, doctors say that seizures become easier to control as you get older. They are not sure if that's because the seizures themselves are decreasing, or because newer medications are now available that control epilepsy better than in the past.

Keep in mind that some types of antiseizure medications can cause bone loss when taken over a long period of time. Since osteoporosis is a particular problem for women who have reached menopause, this would be a good time to talk with your doctor about your medication and what you can do to help prevent osteoporosis. On the whole, it's best to build strong bones early in life - in your 20s and 30s - and not wait till you're close to menopause when some of your bone strength may have already been lost

ADHD Medications Help Kids in School

2009-06-28T07:55:00.000-07:00

April 27, 2009 -- Kids with ADHD usually struggle in the classroom, but new research offers support that medication can help them achieve in school.

In the study, grade school-aged children with attention deficit hyperactivity disorder (ADHD) who took medication performed better on standardized math and reading tests than children with ADHD who did not take medication.

More than 4 million children in the United States have a diagnosis of ADHD, and it is believed that about 60% take prescription medications, mostly stimulant drugs like Ritalin, Concerta, and Adderall, for the disorder.

“Our study shows that there is a true, long-term learning effect that can be measured objectively,” lead researcher Richard Scheffler, PhD, of the University of California, Berkeley School of Public Health, tells WebMD.

ADHD Treatment and Learning

The study included nearly 600 children with ADHD from across the U.S. followed from kindergarten through fifth grade.

Researchers were able to track the children’s academic progress by examining standardized math and reading scores. They also had information about each child’s family and medical background.

Medicated children were about one-fifth of a school year ahead of their non-medicated peers in math and about one-third of a school year ahead in reading, but both groups still lagged behind their classmates who did not have ADHD.

Although earlier studies have shown that medication helps with short-term memory in the classroom, the study is one of the first to show that treatment is associated with long-term improvements in academic performance, Scheffler says.

The research, funded by the National Institute of Mental Health, appears in the May issue of the journal Pediatrics.

“We are not saying that all children with ADHD need to be on medication,” Scheffler says. “Drugs are not the answer by themselves. But it is clear that many minority and low-income children have less access to drug treatments.”

Improving this access, Scheffler says, could lead to better academic performance for the most vulnerable children with ADHD.

Many Kids With ADHD Have Other Issues

As the mother of two children with ADHD, Trish White has seen firsthand the difference medication can make in the classroom.

But she stresses that drug treatment is just one of many interventions that can make a difference in the academic performance of kids with ADHD.

White’s son, who is now 12, was diagnosed with ADHD in the second grade; her daughter, now 8, was diagnosed in first grade.

Both children take medication for the disorder, and both have shown improvements in the classroom.

“The drugs help, but they are not a cure-all,” she says. “Drugs are just one part of it.”

School-based interventions like seating children with ADHD closer to the teacher to keep their attention focused and giving them more time to complete assignments are also important, she says.

ADHD researcher Lily Hechtman, MD, of McGill University, says that although ADHD drugs can help children, many children with ADHD have learning issues that the drugs do not address.

“About 20% of children with attention deficit disorders also have very specific learning disabilities,” she says. “These children clearly need other interventions.”

Even children without specific learning disabilities who have fallen behind academically will need more than medication to catch up if they are diagnosed after years of struggle in the classroom, she says.

Diagnosing ADHD in Children

2009-06-28T07:52:00.000-07:00

When you take your child to the pediatrician for a sore throat, a quick test can tell if it’s strep throat and put your child on the way to a course of antibiotics and generally a quick recovery. But when it comes to diagnosing attention deficit hyperactivity disorder (ADHD) – a condition in which children display symptoms of hyperactivity and impulsiveness, or inattention, or a combination of these -- the diagnostic process is rarely quick or easy. In fact, in many cases, the pediatrician is not the one to make the diagnosis.

Although some pediatricians with special training in the disorder will diagnose ADHD in children, most will refer you and your child to a mental health professional such as a psychologist, psychiatrist, counselor, or social worker trained in diagnosing and treating the disorder through behavioral management. You can also find a professional who specializes in ADHD diagnosis through your health plan, your child’s teacher or school counselor, other parents of children with ADHD, or nonprofit organizations such as Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

Criteria for ADHD Diagnosis

The person who evaluates your child for ADHD will be looking for the presence and severity of specific behaviors. The behaviors vary, depending on which of the three types of ADHD a child appears to have: hyperactivity-impulsivity, inattention, or combination. Different types of ADHD include these different symptoms in children:

Hyperactivity

Often fidgets with hands or feet, or squirms in seat
Often gets up from seat
Often has trouble enjoying quiet activities
Often runs or climbs where not appropriate
Often talks excessively

Impulsivity

Often blurts out answer before questions have been finished
Often has trouble waiting his or her turn
Often interrupts others

Inattention

Often makes careless mistakes in schoolwork or other activities
Often has trouble focusing on tasks or activities
Often does not seem to listen when spoken to directly
Often has trouble organizing activities
Often does not follow instructions
Often loses things needed for tasks or activities

Although many children display some of the behaviors for ADHD, they do not necessarily have the disorder. An ADHD diagnosis requires that these behaviors have been persistent for at least six months, that some symptoms began before age seven, that symptoms are present in two or more settings (such as school and home), and that they cause significant impairment in social or school functioning.

ADHD in Children: How a Diagnosis Is Made

The first step toward diagnosing ADHD should be a full physical exam. Then the psychologist or other mental health professional who evaluates your child for ADHD will probably set up an interview with you and two or more sessions with your child before making a diagnosis.

The evaluator will rule out other causes of your child’s behavior such as:

A sudden life change (such as divorce, a death in the family, or moving)
Undetected seizures
Thyroid problems
Lead toxicity
Sleep problems
Hearing problems
Learning disability
Anxiety
Depression

To do this, he will check your child’s medical and school records, and perhaps question both of you about what else is going on in your child's life. He may also administer tests to determine if your child has a learning disorder or some other problem that may be causing the behaviors.

If possible, the person making the diagnosis will want to observe your child’s behavior in the classroom and interview you and her teachers – and perhaps other adults who interact with your child on a regular basis – about your child's behaviors. The evaluator may also ask each of you to complete standardized forms, known as “behavior rating scales,” to rate different aspects of your child’s behavior.

Diagnosing ADHD in Adults

For an estimated 60% of children with ADHD, symptoms persist into adulthood. And, some adults with symptoms of ADHD were never diagnosed with the condition as children.

Sometimes an adult will recognize the symptoms in himself when his son or daughter is diagnosed. Other times, an adult who has sought help from a psychologist or counselor for depression, anxiety, or other problems discovers that they are related to ADHD.

Symptoms of ADHD in adults can include:

Chronic lateness and forgetfulness
Anxiety
Lack of organizational skills
Low self-esteem
Employment problems
Difficulty controlling anger
Impulsiveness

Symptoms of ADHD must have been present in childhood. For adults, these behaviors can cause problems at home, work, or school if not managed appropriately. If you suspect that you may have ADHD, talk to your doctor or therapist about how to proceed with an evaluation.

Vitamins and Supplements for ADHD

2009-06-28T07:51:00.000-07:00

Have you ever wondered whether vitamins and supplements can help treat the symptoms of ADHD?

Over the past few decades, alternative and complementary medicine has gained in popularity. As a result, there is now a wide range of nontraditional approaches to personal health and healing. These various remedies are sometimes used in the place of standard medical approaches. Oftentimes, though, they are used in addition to standard medical therapy. Some alternative remedies are safe, relatively affordable, and easily accessible. And some may actually create an opportunity for you to participate actively in key decisions about your health.

On the other hand, there are other natural or alternative remedies that are unsafe. That's why it's important to know what works -- and what doesn't -- when it comes to nonstandard treatments for conditions like ADHD. The fact that claims are made that a vitamin or supplement is natural is not a guarantee that it's safe. It's important to always discuss any therapy with your doctor before taking it.

Read on to discover whether there are vitamins and natural supplements that are safe and effective for treating symptoms of ADHD.

Zinc for ADHD symptoms

Some studies suggest that children with ADHD may have lower levels of zinc in their body. And some scientists have reported improved symptoms in children with ADHD who took zinc supplements along with traditional ADHD treatment.

Several studies have shown a reduction in hyperactivity and impulsivity with zinc supplementation. The same studies, though, report no change in inattentiveness, which is another key symptom of ADHD. A 2005 study in the Journal of Child and Adolescent Psychopharmacology, though,did show a correlation between zinc levels and teacher- and parent-rated inattention in children.

Foods high in zinc include oysters and other seafood, red meat, poultry, dairy products, beans, nuts, whole grains, and fortified cereals.

Fish oil for ADHD symptoms

There is some evidence that fish oil can help improve ADHD symptoms. Fish oil contains omega-3 fatty acids. There are some findings that suggest that, in children with ADHD who are 8 to 12 years old, fish oil supplementation may improve mental skills. For instance, it may help improve a child's ability to organize activities.

In one study, a specific supplement of fish oil and evening primrose oil was used. Results showed that it improved hyperactivity, inattentiveness, an inability to think clearly, and overall behavior in children with ADHD who were 7 to 12 years old.

Fish high in omega 3 fatty acids include salmon, albacore tuna, herring, mackerel, trout, and sardines.

St. John's wort: No help for ADHD

St. John's wort is a common herbal supplement. It's used for treating depression,anxiety, and sleep disorders. This herbal treatment affects brain chemicals, including serotonin, dopamine, and norepinephrine.

Recent scientific studies do not support the use of St. John's wort to treat ADHD. In fact, recent findings conclude that St. John's wort has no effect on the symptoms of ADHD.

One study involved a group of children and adolescents with ADHD ranging in age from 6 to17. Each child and adolescent was given either a placebo or St. John's wort supplement three times a day for 8 weeks. They were then evaluated for changes in their hyperactivity and inattentiveness. The results showed no difference between the two groups.

Other natural supplements for ADHD

There is some preliminary evidence that some natural supplements may benefit people with ADHD. For example, in one study, a combination of American ginseng and Ginkgo leaf improved ADHD symptoms in children ages 3 to 17. But researchers conclude that more scientific studies are needed to confirm this finding.

Some research also shows that the natural hormone melatonin may offer some benefit for children with ADHD who take stimulant medications. Researchers noted that it improved sleep problems in these children. Melatonin, though, has not been found effective in decreasing ADHD symptoms.

Natural supplements such as GABA and inositol are sometimes used to treat ADHD and ease mood symptoms. Neither one of these natural products is proven to be effective, though. Also, there is still insufficient evidence about the safety of either product.

Can nutritional supplements help with ADHD by filling dietary gaps?

Some proponents of nutritional supplements believe that ADHD symptoms occur because of a lack in the diet. They also believe that supplements are needed to fill that dietary gap.

For instance, there are some studies on using iron supplements to treat ADHD. Findings from these studies suggest that children with ADHD may have iron deficiencies. The hypothesis is that supplementing with iron may improve ADHD symptoms.

It's important, though, to use caution when giving your child any supplement. Taking too much iron, for instance, can be toxic -- even deadly. It's important to check with your child's doctor if you believe your child may be iron deficient.

In addition, always talk to your doctor before using any natural supplements. That includes megadoses of vitamins or minerals. That's because there's always a chance of toxicity or of interaction with medication.

ADHD Drugs: Sudden Death Risk Higher?

2009-06-28T07:49:00.002-07:00

June 15, 2009 -- A new study suggests that children and teens who take stimulants like Ritalin for ADHD have an increased risk for sudden cardiac death, but the FDA says the study has major limitations and should not change the way the drugs are used.

There have long been concerns that the stimulants used to treat ADHD may increase the risk for sudden death in children with undiagnosed heart conditions.

The new research finds corroborating evidence for concern, although all agree that the risk of sudden cardiac death is very small.

ADHD Stimulants and Sudden Cardiac Death

Researchers collected data on stimulant use among 564 children and teenagers who died unexpectedly of unknown causes and an equal number who died as passengers in auto accidents. Many of the unexplained deaths were later attributed to previously undiagnosed cardiac arrhythmias.

They concluded that the odds of using stimulant medication were six to seven times greater among the children who died suddenly of unexplained causes than among those who died in car crashes.

Ten children who died of unknown causes (just under 2%) took stimulants, compared to two children (0.4%) who died in auto accidents.

The study does not prove that ADHD drugs cause cardiac deaths. But lead researcher Madelyn S. Gould, PhD, tells WebMD that the results highlight the importance of carefully screening children and teens for heart conditions when the medications are prescribed.

The research was published today online and will appear in The American Journal of Psychiatry.

“These are very rare events, and parents should not be overly concerned,” she says. “This shouldn’t stop anyone from using medications that can help children. But the clinicians who prescribe these drugs must be vigilant about screening and monitoring their patients.”

FDA: Study Doesn’t Prove Link

The FDA and the National Institute of Mental Health funded the study, but FDA officials expressed reservations about the findings in a written statement and news briefing held today.

“Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk-and-benefit profile of stimulant medications used to treat ADHD in children.”

The biggest limitation, FDA officials said, is that information on stimulant use was collected years and in some cases a decade or more after the children died.

They expressed concern that recalling their children's stimulant use many years later might be greater for parents and physicians of children who died suddenly of unexplained causes.

Robert Temple, MD, of the FDA, said an ongoing study of cardiac outcomes among children taking stimulants for ADHD should provide additional information about risk.

Results from this study, also funded by the FDA and the Agency for Healthcare Research and Quality (AHRQ), should be published in a few months, he said.

ADHD Drugs Have Warnings

It is estimated that more than 2.5 million children and teens in the United States take stimulants to control their ADHD.

Drugs like Ritalin, Adderall, Dexedrine, and Concerta are known to increase heart rates and raise blood pressure, but the risk has not been considered significant in otherwise healthy children.

The FDA requires that these drugs include labeling warning of the risk of sudden cardiac death in patients with heart problems, but the incidence of cardiac events among children and teens taking the drugs for ADHD is not known.

In March of 2006, an FDA panel reported that between 1992 and 2005, 11 sudden cardiac deaths occurred in children taking Ritalin and Concerta, which both contain the stimulant methylphenidate, and 13 sudden cardiac deaths occurred among children taking the amphetamine-containing stimulants Adderall and Dexedrine. Three sudden cardiac deaths were also reported among children taking the ADHD drug Strattera, which is not a stimulant.

Late last year, a special panel of the American Heart Association recommended screening all children and teens taking ADHD drugs for hidden heart problems. The panel also called for electrocardiogram (ECG) screening of all patients being placed on the stimulants for the first time.

Editorial: ‘Drugs Aren’t Innocuous’

In an editorial published with the study, Benedetto Vitiello, MD, and Kenneth Towbin, MD, of the National Institute of Mental Health, write that this report “should underscore that stimulants are not innocuous and that their therapeutic use requires careful diagnostic assessment, diligent safety screening, and ongoing monitoring.”

Ritalin, Concerta, and other ADHD drugs are increasingly being used recreationally, usually in an effort to boost academic or job performance.

Vitiello tells WebMD that recreational users mistakenly think of these drugs as safe.

“These drugs are being widely misused, and people need to know that they are not benign,” he says.

A spokeswoman for McNeil Pediatrics, which makes Concerta, told WebMD that the company “welcomes any data that adds to the body of knowledge in this therapeutic area.”

Calls to Shire Pharmaceuticals, which manufactures Adderall, and Novartis Pharmaceuticals, which markets Ritalin LA, were not returned in time for publication.

Poorer Teens May Get More Migraines

2009-06-28T07:49:00.001-07:00

July 2, 2007 -- Poorer teenagers may be more likely to suffer from migraine headaches than richer teens.

Genetics play a big part in determining the risk of developing painful migraine headaches, but a new study suggests that family income may also play a role in migraine risk.

"Possible factors associated with low socioeconomic status, such as stress, poordiet or limited access to medical care may be responsible for this increase," says researcher Marcelo E. Bigal, MD, PhD, of Albert Einstein College of Medicine in Bronx, N.Y., in a news release.

Migraines in Teens

Researchers looked at the prevalence of migraines in a group of more than 18,000 teens and their parents. Overall, 6.3% of the teens reported experiencing one or more migraines in the previous year.

As in adults, the prevalence of migraines in teens was higher among girls than boys and among whites vs. African-Americans.

Among teenagers who had a parent with migraines, about 8% of both high- and low-income teens had migraines.

But when researchers looked at teens who weren't genetically predisposed to migraines, they found family income played a major role, with 4.4% of low-income teens vs. 2.9% of high-income teens reporting migraines.

"It would seem that for those teens who have a genetic predisposition for migraine, the stressful life events related to income don't matter," says Bigal. "They're more likely than other teens to get migraine regardless of their socioeconomic status, since they are predisposed."

Researchers say psychiatric factors -- such as depression, anxiety, and substance abuse -- were not examined in this study and may help explain the results, which appear in Neurology.

"Our study also suggests that we should explore environmental risk factors, such as stressful events and nutrition, as they relate to low income and migraine to understand how we might reduce the occurrence of migraine among these individuals," says Bigal.

Harry Potter Has Migraine Headaches?

2009-06-28T07:48:00.000-07:00

June 29, 2007 -- Harry Potter, the fictional character known worldwide from author J.K. Rowling's books and the Harry Potter movies, likely has migraine headaches.

That diagnosis comes from Fred Sheftell, MD, and colleagues. Sheftell works in Stamford, Conn., at the New England Center for Headache.

Sheftell's team scrutinized all of J.K. Rowling's published Harry Potter books, looking for references to Potter's headaches.

Harry Potter's migraine headaches happen when the evil Lord Voldemort is nearby, and they strike in the area of Potter's head where he has a scar in the shape of a lightning bolt, note Sheftell and colleagues.

After considering several headache diagnoses, Sheftell's team settled on the diagnosis of "probable migraine." Why "probable"? Because Potter's headaches disappear faster than typical migraines, note the researchers.

Harry Potter's Headaches

Sheftell and colleagues aren't trying to make light of migraine headaches. Instead, they're using Potter's case to build awareness of migraines and other headaches.

"That even a young male Wizard has recurrent disabling headache is a reflection of the wider problem of headache in children and adolescents," the researchers write.

Is their diagnosis correct? The researchers note that migraines may be passed down genetically, but little is known about Potter's birth parents.

Headaches can also be connected to other illnesses, but so far as Sheftell's team knows, Potter is otherwise healthy.

Of course, all that may change when the final Harry Potter book is published later this month. Meanwhile, the details of Potter's diagnosis appear in Headache, the journal of the American Headache Society.

Stroke Risk Linked to Some Migraines

2009-06-28T07:46:00.000-07:00

Aug. 9, 2007 -- Some migraines may increase young women's odds of having astroke, according to a new study.

The study -- published online today in the journal Stroke -- comes from experts including Leah MacClellan, MSPH, and Steven Kittner, MD, of the University of Maryland School of Medicine in Baltimore.

MacClellan, Kittner, and colleagues studied 1,000 African-American and white women age 15-49 living in and around the Baltimore-Washington, D.C. area.

The women were in their mid- to late-30s, on average (age range: 15-49). Stroke, which is America's third leading cause of death and a major cause of disability, usually strikes decades later.

The researchers asked the women about their history of headaches, including migraines.

Compared to the women who hadn't had a stroke, the stroke survivors were 50% more likely to report having a history of migraines with visual aura in the year or years before their stroke.

Symptoms of migraine with visual aura included ever seeing spots, lines, or flashing lights during a migraine.

Migraines without visual aura weren't linked to increased stroke risk.

Reducing Stroke Risk

Among the women who reported a history of migraine with visual aura, those who smoked and took oral contraceptives were seven times more likely to have had a stroke.

"Young women with probable migraine with visual symptoms can reduce their risk of stroke by stopping smoking and finding alternatives to the use of estrogen-containing contraceptives," Kittner states in an American Heart Association news release.

He uses the term "probable migraine" because the women's migraines weren't necessarily diagnosed by a doctor.

The researchers took many stroke risk factors into consideration. But they didn't have data on factors including the women's cholesterol levels, alcohol use,physical activity, and medications.

Migraines, Brain Lesions: New Links Seen

2009-06-28T07:17:00.000-07:00

June 23, 2009 -- Women who experience migraine headaches with aura may be more likely to develop brain lesions when they are older, according to a new study.

Researchers say the results add to a growing number of studies that suggest migraines may be more than a transient condition and may cause long-term damage in the form of cell death and lesions in the brain over time.

Migraine headaches are a common problem, affecting about 11% of adults and three to four times as many women than men. About one-third of those who suffer the painful headaches experience aura -- visual or sensory disturbances just prior to the migraine.

The study, published in TheJournal of the American Medical Association, looked at the association between midlife migraines and brain lesions later in life among 4,689 men and women in Iceland who have been followed since 1967. The participants were interviewed about migraine symptoms in midlife and received brain scans 26 years later.

Brain lesions were found in 39% of men and 25% of women. After adjusting for other risk factors, such as age, heart disease, and stroke risk, researchers found that women who had migraines with aura during midlife were more likely to have brain lesions in the cerebellum part of the brain. Twenty-three percent of women with migraine with aura had these types of brain lesions, compared with 15% of women without headaches.

There was no such association between migraine with aura and brain lesions in men.

Researcher Ann I. Scher, PhD, of Uniformed Services University in Bethesda, Md. and colleagues say further long-term studies are needed to better establish this relationship between migraine with aura and brain lesions and determine the mechanism behind the link.

An editorial that accompanies the study also urges caution in interpreting these results.

"It is premature to conclude that migraine has hazardous effects on the brain," write Tobias Kurth, MD, ScD, of the University Pierre et Marie Curie in Paris and Christophe Tzourio, MD, PhD, of the University Pierre et Marie Curie and Harvard School of Public Health, Boston in the editorial.

"However," the editorial notes, "the study raises important questions. New studies examining the association of migraine with structural brain changes and brain function should improve understanding of the associations and perhaps further unveil migraine-specific mechanisms."