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How to Stay Healthy
News on blood pressure drugsBehind the scenes at your doctor’s office debate continues about which drug should be the first line of treatment for high blood pressure. Diuretics (also known as water pills) have been around for decades, but the makers of newer, more specialized — and more costly — drugs have been wooing physicians and their patients. The question isn’t whether these drugs work effectively to lower blood pressure; they do. But evidence indicating which is best at reducing heart disease and other cardiovascular events has been missing — until now. The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) study was designed to compare a diuretic to three other commonly prescribed classes of antihypertensive drugs — calcium channel blockers (CCBs), alpha-adrenergic blockers, and angiotensin-converting enzyme (ACE) inhibitors. The study involved 42,000 patients over the age of 55 with hypertension and one other risk factor for heart disease, such as previous heart attack or stroke. Each of the patients was randomly assigned to receive one of the study drugs for four to eight years. Researchers monitored the patients’ blood pressures and recorded evidence of heart disease and cardiovascular events. Part of the study was halted early when evidence showed patients taking the alpha-adrenergic blocker had higher rates of cardiovascular disease and heart failure than patients taking the diuretic. The primary results of the comparison of the ACE inhibitor lisinopril and the CCB amlodipine to the diuretic chlorthalidone were striking. The occurrence of death from heart disease was the same across each of the groups, and the rate of nonfatal heart attack was also similar. However, a slightly higher percentage of patients taking the diuretic chlorthalidone achieved better blood pressure control. Chlorthalidone was also better at preventing heart failure than amlodipine, the CCB. Patients taking the ACE inhibitor lisinopril had a higher risk of stroke, angina, and heart failure. In particular, black participants who took lisinopril had a 40% higher risk of stroke than black participants who took the diuretic. The findings of the ALLHAT study indicate that when it comes to drugs for high blood pressure, newer and more costly does not mean better. In fact, diuretics should be the first line of treatment for many people with high blood pressure. Not only are they better at controlling high blood pressure while preventing major cardiovascular events, diuretics also cost less than the other drugs. A one-year supply of Chlorthalidone costs about $96, while the CCB amlodipine would set you back $480. Lisinopril costs $384 a year for the brand name drug (either Zestril or Prinovil), and $240 for the generic. What should you do with these study results? If you’re just starting drug treatment for high blood pressure, you might want to try a diuretic first. If you, like most people, need a combination of drugs to keep your blood pressure in check, one should probably be a diuretic. If you’re already taking a different kind of medicine and it is working well for you, there’s no need to switch. However, if you want to cut down your drug bills, you might want to talk to your doctor about a diuretic. (Journal of the American Medical Association, December 18, 2002) February 2003 Update Killer snowEvery winter, about 1,200 Americans die from a heart attack or some other cardiac event during or after a big snowstorm, and shoveling is often the precipitating event. Why is shoveling so hazardous?
If you have a heart condition, you shouldn’t shovel under any circumstances. People older than 50 should also try to avoid it. Contact your local council on aging to see if they provide a list of teens in your neighborhood who you can hire to do the job for you. Or buy a snow blower. If you must shovel, take it easy. Rest often. Dress warmly and stay well hydrated. Wherever possible, push the snow rather than lift it. Clear only the snow that blocks your path into the house, the rest will melt on its own. And of course, listen to your body. Head home if you experience potential signs of heart trouble, including chest pain, palpitations, undue shortness of breath, fatigue, lightheadedness, or nausea. Also stop if your fingers or toes get numb or hurt — you could have frostbite. January 2003 Update Medications for postmenopausal osteoporosis preventionRisk of osteoporosis increases after menopause, when levels of estrogen — which helps preserve bone density — drop. Until recently, most doctors recommended long-term hormone replacement therapy (HRT) to treat postmenopausal women who need medication to prevent bone loss. But things changed after results from a large trial on a common HRT drug showed that estrogen plus progestin (as the medication Prempro) did more harm than good. An increased risk for breast cancer and cardiovascular events outweighed the benefits of less colorectal cancer and fewer fractures. (See the Update from July 2002 for more information on the trial.) Health experts now encourage most women who have been taking long-term HRT for osteoporosis prevention to consider an alternative. Fortunately there are several options. Each of the FDA-approved treatments (see chart) has potential benefits and risks that women and their doctors should weigh before making a decision. Even with HRT’s proven risks, it may still be a good choice for certain women — especially in lower doses, which recent data have shown to have bone benefits comparable to higher, standard doses.
December 2002 Update Living independently — and safely — in your later yearsThe majority of older people remain independent well into later life. Most seniors want to remain in their own homes, a goal that’s easier to accomplish if they adapt their lives and homes to accommodate their aging bodies. Some tips for independent living include: Redecorate. The average home is riddled with obstacles that older eyes and feet might not be able to maneuver around. Removing slippery throw rugs, using night lights, putting nonskid mats in the bathroom and kitchen, not using high-gloss floor polishes, and installing handrails that extend beyond the bottom stair can all help. You can often fit your bathrooms with items like walk-in showers, grab bars, and higher toilet seats. Ramps, elevators, and other devices can help you handle stairs. Keep often-needed items in the handiest cabinets and use a grasping tool to get things that are out of reach instead of climbing on a chair or ladder. Lifestyle changes. Wearing rubber-soled shoes and getting regular exercise can help keep you upright. Activities like tai chi or yoga especially help since they work on balance and strength, and are not jarring on muscles or bones. Limit your alcohol intake and learn whether any of your medications might cause dizziness or affect your balance. Seek helping hands. Shopping for groceries and other essentials can be accomplished over the phone and via the Internet these days. Meal preparation, transportation, home repair, housecleaning, and help with financial or personal tasks such as paying bills and bathing might be hired out if you can afford it, shared among friends and family, or included in the repertoire of elder services offered in your community or through insurance. Plan for emergencies. Who can check in on you regularly? Whom can you call in an emergency? What would happen if you fell and couldn’t reach the phone? Keep emergency numbers near each phone or, better still, on speed dial. Carry a cell phone or consider investing in a personal alarm system, if necessary. Look into companionship services or simple visits and phone checks from a local agency on aging or religious group. To find agencies near you, call the Eldercare Locator at 1-800-677-1116 or visit their web site at www.aoa.dhhs.gov/elderpage/locator.html. October 2002 Update Physical activity benefits all agesThe frail health often associated with aging is in large part due to physical inactivity, according to a report released by the U.S. Department of Health and Human Services (HHS). It also advises that it’s never too late to benefit from becoming physically active. The report cites that even moderate levels of activity — such as washing a car or raking leaves — can produce considerable benefits that can be even more noticeable in older adults. Regular exercise improves cholesterol levels, reduces blood pressure, cuts body fat, and lowers blood sugar. Physical activity also improves bone and muscle strength. All in all, people who exercise live longer — and they also live better. Current guidelines recommend at least 30 minutes of moderate physical activity a day. However, few older Americans reach this level. Lack of physical activity and poor diets are the major causes of obesity, an epidemic that is affecting people of all ages. In the '70s and '80s, doctors were telling Americans to run; now, they are asking people to walk. Walking can be a moderately intense aerobic activity. But even at a more relaxed pace, walking has huge benefits. The distance actually seems more important than the pace — and it doesn't take heroic distances to get real benefit. In 1993, the Harvard Alumni study found that men who walked just 1.3 miles a day had a 22% lower death rate than those who walked less than 0.3 mile a day. Strong muscles also improve your health. So set aside 15 minutes two or three times a week for resistance or strength training as well as 10–15 minutes at least three times a week for stretching exercises. The HHS report provides strategies that individuals, doctors, and even communities can follow to promote physical activity. Individuals are encouraged to take part in activities that they enjoy and to make them a daily part of life. Doctors should help patients start and continue these regimens and overcome any difficulties they encounter. Communities can establish programs tailored to seniors’ physical activity needs and improve walking or bike trails. The complete report is available at www.ahrq.gov/ppip/activity.htm August 2002 Update How to apply sunscreen for maximum protectionMost families follow common medical advice and take along a bottle of sunscreen when they're spending a day in the sun. But how do you know if you're applying enough? Most people don't, but a letter published in the June 22, 2002, issue of the British Medical Journal may help clarify the amount of sunscreen you should use and how often you should apply it. The letter, written by Drs. Steve Taylor and Brian Diffey, suggests people follow the "rule of nines" to get the sun protection factor (SPF) that's listed on the bottle. According to the rule, you should divide your body into 11 different sections, each making up about 9% of your total surface area:
For sufficient protection, use a two-finger approach: cover each of the 11 sections with enough sunscreen to span the length of your pointer and middle fingers. The authors admit that this is more sunscreen than most people feel comfortable wearing, so they suggest that people put on half that amount at one time, and then apply another dose a half hour later. Studies have shown that sunscreen users do not apply enough sunscreen to protect the whole body. As a result, the actual SPF is close to half that on the product label. It's also worth noting that according to the American Academy of Dermatologists, staying out of the sun is the best way to prevent skin cancer. Because harmful sun rays like UVA and infrared get through sunscreen, you shouldn't think of it as a shield against the sun or use it as an excuse to stay out longer. Although sunscreen is an important part of sun protection, it is second to wearing a shirt and hat and avoiding sun exposure altogether (especially between the hours of 10 a.m. and 4 p.m.). August 2002 Update No link found between prostate cancer and vasectomyGood news for the millions of men worldwide who've had vasectomies: a new study disputes a link between this birth-control operation and prostate cancer. Two 1990 studies that connected prostate cancer and vasectomies caused men to question the procedure, even though no medical explanation for the connection could be found. Other research has both confirmed and denied the association in the past 10 years. But the new study, published in the June 19, 2002, Journal of the American Medical Association, should ease men's minds. It involved over 2,000 men of European descent living in New Zealand, the country with the highest rate of vasectomies. Researchers asked 953 men with prostate cancer and 1,260 who were cancer free about their medical histories — including whether they had had a vasectomy. It turned out that slightly fewer men with prostate cancer had undergone the surgery, which supports claims that going under the knife doesn't cause cancer. The same held true for the 38% of men studied who had had the procedure more than 25 years ago, which suggests that there are no long-term effects. One reason why the link may have been found in earlier studies is that men who have vasectomies generally see their urologists more often, which may lead to more tumors being found in these men as compared to others, the researchers said. The study also found no link between prostate cancer and history of sexually transmitted disease, smoking, drinking alcohol, and number of children. Prostate cancer will be diagnosed in 198,000 Americans this year, and it will take 31,500 lives. Although prostate cancer lags behind heart attacks, strokes, and lung cancer as the leading cause of death in American men, it's the disease many men fear most. August 2002 Update New Developments in Hormone Replacement TherapyIn July 2002, the government halted a major study of hormone therapy three years early because of a slight but significant increase in the risk of invasive breast cancer. Researchers concluded that the long-term risks of taking hormones outweigh the benefits for a woman who still has her uterus. More than 16,000 women took part in the study, known as the Women's Health Initiative, the largest to compare postmenopausal hormones with a placebo. The therapy was a combination of estrogen and progestin (Prempro), a treatment used by an estimated six million women to replace the declining levels of hormones at menopause. The study sought to determine whether this combination hormone therapy could prevent such ailments as osteoporosis and heart disease. But while there were small decreases in hip fractures and colorectal cancer, the increases in breast cancer, heart attacks, strokes, and blood clots were too unsettling. The data suggested that for every 10,000 women on the estrogen-progestin combination, an additional 8 will develop invasive breast cancer, when compared with women not taking the therapy. An additional 7 will have cardiovascular disease, 8 will have a stroke, and 8 will have blood clots in the lungs (pulmonary embolism). In the aftermath of the trial, it seems that many doctors will be reconsidering prescribing estrogen and progestin. Some women may want to lower their doses or limit the duration of the use of these combinations, while others will elect to try other treatments to combat their hot flashes, vaginal dryness, and other menopausal symptoms. However, it is important for women already on hormone replacement therapy (HRT) to know that there is no urgency to stop, and waiting until an annual exam to discuss it with a doctor is fine. There is also no harm in stopping immediately, if a woman is more comfortable doing so. It's important to remember that only combination therapy appears to have these effects. Estrogen alone taken by women who have had a hysterectomy has not displayed such risks. A separate trial, with 10,000 women who have had a hysterectomy randomly assigned to either estrogen or a placebo, has not indicated an increased breast cancer risk. The trial is scheduled to go until 2005. The full report on the Women's Health Initiative appeared in the Journal of the American Medical Association on July 17, 2002. July 2002 Update Drinking Tea Benefits Heart and BonesThe health benefits of drinking tea have been well publicized lately, and recent studies point to two newly discovered advantages to consuming this beverage. One shows that drinking tea can help prevent death after a heart attack. The other reports that tea may increase bone mineral density, which helps prevent fractures and osteoporosis. In the first study, published in Circulation, researchers questioned 1,900 patients hospitalized for heart attacks about the amount of caffeinated tea they drank in the past year. After adjusting for age, gender, and other variables, researchers found that those who drank 14 or more cups of tea per week were 39% less likely to die of cardiovascular disease in the 3.8 years following their heart attack than non-tea drinkers. Patients who consumed 1–14 cups of tea per week were 31% less likely to die from cardiovascular causes during that period than non-tea drinkers. When researchers further looked into subjects' caffeine intake, they found that caffeine from sources other than tea did not affect death rates. In the second study, published in the Archives of Internal Medicine, researchers surveyed 1,037 men and women age 30 and older about their tea consumption. Subjects who drank tea at least once a week for the preceding six months were labeled "habitual tea drinkers." This group was asked about their tea-drinking history, the kind of tea they drank, how often they drank it, and how much they drank in each sitting. Researchers then measured the bone mineral density (BMD) of the lumbar spine, hip, neck, and total body of both the habitual tea drinkers and the non-drinkers. The researchers found that people who consumed tea regularly for more than 10 years had the highest BMD scores compared to the other groups, after they adjusted for sex, age, weight, and lifestyle variables that may affect BMD. Those who drank tea regularly for the past 6–10 years also had significantly higher lumbar spine BMDs than the nonhabitual tea drinkers. People who consistently drank tea for the past 1–5 years did not have any significant differences in BMD score compared to the nonhabitual drinkers. It didn't seem to matter what type of tea the person drank, and neither did the amount of tea consumed each time. Only duration of habitual tea consumption was an independent predictor of BMD score. Tea contains several components, including fluoride and flavonoids, which may work separately or in concert to maintain or restore bone density. Although BMD score is often a good gauge of the risk of fracture from osteoporosis, this study did not actually test the link between tea consumption and bone fracture. July 2002 Update Aspirin and heart diseaseShould you take aspirin to prevent a heart attack? According to a new study, aspirin helps lower cardiovascular risk, but whether or not you should take it depends on a bevy of factors. The study, published in the May 9, 2002, issue of the New England Journal of Medicine, analyzes the major trials on the subject. Four out of five of the randomized trials show a reduction in cardiovascular events (especially heart attacks) with aspirin use. (In randomized trials, researchers randomly assign patients to one of the treatments being tested.) But the studies' statistics vary wildly. For example, risk reduction ranged from 4%–44%, depending on the study. All but one trial showed that aspirin use increased the risk of bleeding, most commonly in the stomach. Two large observational studies also showed that aspirin use decreased coronary events in both people with and without heart disease. (In observational studies, researchers simply monitor subjects' behaviors and health, they do not test a specific treatment on them.) Subjects' ages had an impact in both studies, with aspirin's benefit on the heart kicking in when subjects hit 50 years old in one, 60 years old in the other. Other trials have found that aspirin has the greatest effect on patients with high risk for heart disease. So what should you do? That depends a lot on your heart disease risk. To calculate your risk go to this downloadable scoring system on the National Institutes of Health Web site. Then, if you answer yes to any of these questions, talk to your doctor about starting aspirin therapy:
But if your risk is 0.6% or lower per year, you're probably not a good candidate for aspirin therapy. You should also avoid the therapy if you're allergic to aspirin, prone to bleeding, or suffer from platelet disorders or ulcers. Your own preference is another important factor in making this decision. Keep in mind that if you have high blood pressure, you'll need to take extra care to control it in order to get the most benefits from aspirin. Also, besides stomach bleeding, aspirin use may cause hemorrhagic stroke. July 2002 Update Healthy Diet Eradicates Need for Trendy Supplements in ElderlyMagazine ads and television commercials tout dietary supplements that claim to be a veritable fountain of youth for seniors. Images of grandparents able to keep up with their grandkids convince older adults that shakes, energy bars, and special vitamins will help boost energy and decrease signs of aging. Health experts, however, stress that a well-balanced diet rich in fruit and vegetables is just as effective and probably safer. But many older adults skip meals and eat small amounts of fruits and vegetables, citing reasons ranging from rotten teeth to unhappiness with eating alone. While doctors acknowledge that nutritional shakes and energy bars are helpful for seniors who need to gain weight or have trouble chewing or swallowing, those who eat a balanced diet or stay active do not need them. In spite of what the experts have said, the savvy advertisements are convincing millions of seniors that they need these expensive supplements, some of which have not even been proven safe. Herbs are also a source of concern. Saw palmetto, an extracts made from the fruit of the saw palmetto plant, is promoted as a treatment for an enlarged prostate. Many people believe that herbs are natural and therefore safe but this is not the case. In fact, as with most nonprescription herbal products, the composition of the extract and the dosage have not been standardized and the supplement is not regulated by the FDA. If you decide to use saw palmetto, tell your doctor in order to alert him or her to possible interactions between it and other medications you may be taking. People who are on strict diets — like those prescribed for kidney disease, heart disease, or diabetes — must be especially wary of adding any special supplements to their diet. Regardless of whether health problems are present, you should always consult a physician before starting any dietary regimen. May 2002 Update Fish for Good HealthIn April, three studies delivered powerful evidence that fish is good for you — and could even save your life. The key is omega-3 (or n-3) fatty acids, beneficial polyunsaturated fats provided by many kinds of fish and certain plant foods. Researchers in the Nurses' Health Study examined 16 years of data involving almost 85,000 women and found an association between fish intake and a lower risk for heart disease and death. Women who ate fish just once a week had a heart attack risk 29% lower than those who ate it less than once a month. Women who ate fish five times a week had nearly half the risk of death from a heart attack. The Harvard's Physicians' Health Study, which involves more than 22,000 male doctors who initially had no heart disease, analyzed blood levels of omega-3 fatty acids and risk for sudden cardiac death. Researchers found that such deaths were 81% less likely in men with the highest levels of omega-3s. Over half of such deaths occur in people without prior symptoms of heart disease — a compelling reason for adding more fish to your diet. Finally, Italian researchers reported that heart attack survivors who took fish-oil supplements had a lower risk of sudden death. This trial studied omega-3 fatty acids and vitamin E in 11,000 men and women who had recently suffered heart attacks. Researchers found that 1 gram of omega-3 fatty acids daily reduced the risk for sudden coronary death by up to 42%. This benefit apparently reflects their calming effect on arrhythmias, potentially fatal heartbeat irregularities. Omega-3 fatty acids may also inhibit clotting and improve blood vessel function. The American Heart Association recommends four servings of fish per week but doesn't endorse supplements because of too few data on the subject. May 2002 Update Asthma Education Leads to Improvement in ChildrenManaging your child's asthma should include meeting with an asthma educator a few times, according to a follow-up study. Presented at the meeting of the American Academy of Allergy, Asthma, and Immunology, the study reports that after attending an interactive training program three times patients felt less worried about their asthma and had fewer asthma-induced awakenings during the night. Both patients and their caregivers, who also took part in the program, made better decisions about asthma care. The 30 subjects, asthmatic children ages 6–12, underwent ACE IT! (Asthma Care Education: Intensive Training), an interactive, small-group education program. The sessions included a motivational talk by a teenage athlete with asthma and a pharmacist's discussion of medications. A nurse and asthma specialist also taught the participants about the clinical nature of asthma, environmental controls, relaxation techniques, and asthma action plans. Researchers evaluated the children at the beginning and end of the training,
after six months, and again a year later. After the courses, the number
of patients reporting two or more nocturnal awakenings per month dropped
from 9 to 5, and the number of symptom-free days also improved, from
an average of 20 days per month to over 25 days per month. The researchers plan to continue tracking these 30 children to study the long-term effects on quality of life, morbidity, and cost of treatment. A previous study published in the Journal of Allergy and Clinical Immunology in 2000, found that the training program was much more effective than simply handing out educational materials. May 2002 Update Hepatitis A Vaccine is Safe and Effective for ChildrenHepatits A is a virus transmitted by contaminated food and is a common cause of inflammation of the liver (hepatitis). This illness may be associated with fever, yellowing of the skin and eyes (jaundice), loss of appetite, nausea, vomiting, and tiredness. In many parts of the world, hepatitis A is so common that almost every adult has been infected at some point in his or her life. A vaccine to protect against hepatitis A infection was licensed in the United States by the Food and Drug Administration in 1995 for individuals 2–12 years of age. A recent study published in the Journal of the American Medical Association showed that the hepatitis A vaccine was highly effective in preventing hepatitis A outbreaks among a large group of children who received it. The study also found the vaccine to be quite safe. Out of the nearly 30,000 children who received the vaccine, no serious side effects were reported. Mild adverse reactions were reported in a small percentage of cases, including injection site reactions, fever, and rash. Should your child be immunized? In the United States, there actually are certain areas of the country with higher than average rates of hepatitis A. Speak with your child's pediatrician because the hepatitis A vaccine is currently recommended for:
April 2002 Update Home visitation program improve seniors' livesThough many countries have nationalized home visitation programs for the elderly, controversy exists over whether they actually help improve the quality of participants' lives. A group of researchers recently analyzed much of the published data to try to put the subject to rest, and the news is favorable. The meta-analysis, published in the Feb. 27, 2002, issue of the Journal of American Medical Association (JAMA), focused on 18 trials that included over 13,000 participants. As part of each program studied, elderly people received visits from health care workers who tried to help them prevent functional impairment and admission into nursing homes. The workers asked about health care issues like immunization and exercise, looked for untreated health problems, and reviewed the proper use of any medications the patient was taking. Programs that evaluated many aspects of the senior's life (medical, functional, psychological, social situation, safety of the home) and included follow-up visits seem to be the most beneficial, according to the analysis. Participants in this type of program kept their independence the longest, remaining able to perform acts like dressing themselves and going to the bathroom without assistance. All types of programs appear to reduce mortality, but the older the patient, the less impact any program has on death rates. Short-term visitation programs had no significant effects on nursing home admissions. However, the rate of admission was significantly lower in people whose program included nine or more visits over a two- to three-year period. Though the authors of the JAMA study admit that it has its limits because
the comparisons made in any meta-analysis must be confirmed by other
studies, they do believe it has important policy implications. They recommend
that countries with home visit programs in place analyze them to see
if they include the components the researchers found to be effective.
They also suggest that countries that do not have such programs, like
the United States, consider implementing them. Immunizations for 2002Vaccinations against childhood illnesses are arguably one of the most significant medical achievements of the twentieth century. One hundred years ago, approximately half of all children born in the United States died before the age of 5, many of them from diseases that today can be prevented by vaccines. With proper immunization, the number of cases of these diseases has been reduced dramatically. Although no new vaccines have been added to the 2002 recommended childhood immunization schedule, this year's schedule highlights vaccines for pre-adolescents and "catch-up" vaccines for children who have fallen behind the currently recommended schedule. In addition, due to unusual national shortages of the pneumococcal and diphtheria/tetanus/pertussis vaccines, the 2002 immunization schedule also includes a link to information from the Centers for Disease Control (CDC), which explains the necessary modifications to the recommended schedule for these vaccines. These vaccine shortages will hopefully only be temporary. Please discuss your child's immunization history with the doctor to
insure that his or her immunizations are up to date in accordance with
the current 2002 Recommended Childhood Immunization Schedule, approved
annually by the CDC, the American Academy of Pediatrics, and the American
Academy of Family Physicians. For additional reliable and up-to-date
information about vaccines and their importance, visit the National Immunization
Program website at http://www.cdc.gov/nip or
the American Academy of Pediatrics website at http://www.aap.org/. New Cancer Prevention GuidelinesWhile some risk factors for developing cancer, such as family history, can not be changed, there are ways for people to reduce their chances. The American Cancer Society (ACS) recently released new dietary and physical activity guidelines for cancer prevention. One of the most basic tenets of a healthy diet is eating plenty of fruits and vegetables. The ACS recommends eating no less than 5 servings of a variety of fruits and vegetables every day. Many people have heard of antioxidants but aren't sure exactly what they are or what they do. Antioxidant nutrients (such as vitamin C, vitamin E, and carotenoids) protect the body against the tissue damage that occurs as a result of normal metabolism. Because such damage is associated with increased cancer risk, the antioxidant nutrients are thought to protect against cancer. Studies suggest that people who eat more vegetables and fruits, which are rich sources of these antioxidants, have a lower risk for some types of cancer, but studies of antioxidant supplements have not yet shown a reduction in cancer risk. Choosing whole grains over processed (refined) grains and sugars will also help, so stick to whole grain rice, bread, pasta, and cereals. Also, limit your red meat intake. When you do eat it, choose the way you cook it carefully. While adequate cooking is necessary to kill harmful microorganisms in meat, some research suggests that frying, broiling, or grilling it at very high temperatures creates chemicals that might increase cancer risk. Braising, steaming, and poaching meats cuts down on the production of these chemicals. Drinking too much alcohol is an established cause of cancers of the mouth, throat, liver, and breast. Therefore, the ACS recommends limiting alcoholic consumption to 2 drinks per day for men and 1 drink per day for women. The ACS also reminds people to remember that "low fat" or "fat free" snacks like cakes and cookies are often high in calories. High sugar intake can lead to obesity and elevated insulin levels, conditions that increase cancer risk. Physical activity is also an important component in the prevention of cancer. Adults should engage in moderate-to-vigorous activity (walking, leisurely bicycling, running, swimming) for 30 minutes or more at least 5 days a week. Simple additions to your daily routine such as taking the stairs instead of the elevator, taking 10-minute exercise breaks at work, and walking to visit co-workers instead of emailing them are simple ways to increase your activity level. An unhealthy diet and lack of exercise can lead to weight gain and obesity, conditions that are associated with developing cancers of the breast, colon, endometrium, esophagus, gallbladder, pancreas, and kidney. In addition to the general guidelines set forth by the ACS, there are also answers to frequently asked questions about the rumored or theoretical relationships between cancer and such substances as aspartame, beta-carotene, calcium, coffee, fish oils, fluorides, folic acid, saccharin, and tea. The ACS suggests that public, private, and community organizations create environments that support the adoption and maintenance of these healthful eating and physical activity behaviors. People should have access to healthful foods in schools, at work sites, and when on daily outings in their town or city. For a copy of the complete set of guidelines, call the American Cancer
Society at 1-800-ACS-2345. Periodontitis and Heart DiseaseThe question of whether gum disease is associated with heart disease
is controversial. The first research to suggest a connection, published
in 1989, found that even after controlling for such cardiovascular disease
risk factors as smoking and diabetes, heart-attack patients had significantly
worse dental health than control subjects. Since then, several studies
have also suggested a link, but the nature of the relationship — is
it causative or coincidental? — remains in question. Obesity in Children is on the RiseA recent study published in the Journal of the American Medical Association showed
that American children are heavier now than ever before. In 1998, 12%,
21%, and 22% of Caucasion, African American, and Hispanic children, respectively,
were classified as overweight. In fact, between 1986 and 1998, the prevalence
of overweight children rose steadily among these groups. Birth Control PatchThe first skin patch approved for birth control by the U.S. Food and
Drug Administration will be available by prescription in 2002. Ortho
Evra works by slowly releasing progestin and estrogen, the same hormones
used in birth control pills, into the bloodstream. Its efficacy lies
in the prevention of ovulation and the thickening of the cervical mucus,
which makes it harder for sperm to enter the uterus. Bicycle Helmets Save LivesAlthough bicycling is one of the most popular sports, injuries associated
with bicycling are the leading cause of emergency room visits for children
and adolescents. Unfortunately, many of these injuries include head trauma.
February 2002 Update Advanced Macular Degeneration and Nutritional SupplementsNutritional supplements may help slow the progression of advanced macular
degeneration (AMD), the most common cause of vision loss in people over
age 55, a new study suggests. White-Coat HypertensionMost people feel a bit anxious during a doctor's visit. But for some
people, their anxiety causes temporary high blood pressure, detectable
during the time of the visit. Physicians have been debating whether or
not they should treat this phenomenon, referred to as "white-coat" hypertension.
Some believe the short-lived blood pressure elevation is harmless, while
others believe it should be treated like persistent high blood pressure. Long or Irregular Menstrual Period and Diabetes RiskWomen with long or highly irregular menstrual periods face twice the
risk of developing adult-onset diabetes compared with women with regular
periods, a new study suggests. Sugar and Tooth Decay"If you eat too much candy your teeth will rot!" We've known
about the link between sugar consumption and tooth decay for centuries.
The bacteria in dental plaque feeds on sugar, and the acid produced by
the bacteria attacks the protective enamel surface of the teeth, allowing
for tooth decay to proceed. But since the advent of fluoride in water,
toothpaste, dental treatments, and even processed foods, do we still
need to restrict how much sugar we eat? Vaccine safety: no link between thimerosal and neurodevelopmental disordersParents should feel confident and safe when having their children immunized.
No evidence exists that proves a link between thimerosal-containing vaccines
and neurodevelopemental disorders, such as autism, attention deficit-hyperactivity
disorder, or speech and language delay. The Institute of Medicine recently
reported these findings, consistent with the recommendations of the American
Academy of Pediatrics. Lyme Disease UpdateCan antibiotics catch Lyme disease before it develops? Do antibiotics
alleviate the lingering symptoms after the infection is cured? Two recent
studies published in The New England Journal of Medicine shed
light on these two controversial questions. In the second study, researchers investigated whether prolonged treatment
with antibiotics reduces the fatigue, muscle and joint pain, and mood
or memory disturbances that some people experience even after the infection
has cleared. But the study was discontinued early when preliminary results
showed prolonged antibiotic treatment was no more effective than a placebo
at improving the persistent symptoms. Flu Vaccine and Recurrent Heart Attack RiskLate each fall, the call goes out to remind people to get their flu
vaccinations. Most healthy people equate the flu with a week of being
miserable. However for the elderly or people with chronic illnesses,
the complications of influenza, such as pneumonia, can be life threatening.
Good enough reason to get the shot, but now research suggests the vaccination
may also lower heart attack risk. Take Low-Dose Aspirin and Skip Vitamin E to Prevent Cardiovascular DiseaseFor more than 100 years aspirin has helped relieve headaches and other
pain, and now new evidence from the Primary Prevention Project backs
the claim it also helps prevent heart attacks and other cardiovascular
events. The same study also found the antioxidant vitamin E didn't help. Early Childcare and Communicable IllnessesAll kids get sick, but young children in day care are at increased risk
for infection. Walk, Don't Run for Weight LossPeople often disrupt their sedentary lifestyles with bouts of high-intensity
exercise, like running or aerobics, to avoid gaining weight or developing
heart disease. But a new study shows spending some of your day engaged
in moderate activity, like biking, walking, or even taking the stairs
at work, may be more a successful method for boosting daily calorie expenditure
and losing weight. National Cholesterol Education Program Releases New Guidelines for Treating and Preventing High CholesterolOn May 15, 2001, the National Cholesterol Education Program (NCEP) — coordinated
by the National Heart, Lung, and Blood Institute (NHLBI) — released
the first major revision of its recommendations for detecting and lowering
high cholesterol in adults since 1993.
Another key change in the guidelines is intensified lifestyle recommendations
regarding nutrition, exercise, and weight control to treat high cholesterol.
The updated diet advises that less than 7% of daily calories come from
saturated fat and limits dietary cholesterol to less than 200 mg per
day. It also allows up to 35% of daily calories from total fat, provided
most come from unsaturated or monounsaturated fat, which doesn't raise
cholesterol levels. Additionally, the guidelines strongly underscore
the need for weight control and physical activity, both of which improve
various heart disease risk factors.
May 2001 Update Study Shows Fish Consumption Protects Against Stroke, But FDA Suggests Pregnant Women Should Take CautionA large study in the Journal of the American Medical Association (JAMA)
recently showed that regularly eating fish might protect against ischemic
stroke, which is the most common type of stroke. Numerous studies have
already shown an association between fish consumption and a reduced risk
of heart disease. But there is a caveat. The Food and Drug Administration
(FDA) recently warned that pregnant women and women who are of childbearing
age who may become pregnant, should avoid certain types of fish that
contain high levels of mercury, which may be harmful to their unborn
children. Reducing Your Risk of Deep Vein Thrombosis During Airline TravelDeep vein thrombosis (DVT), recently featured in the news as "economy
class syndrome," is the formation of a blood clot in the deep veins
of the legs while sitting — particularly in the cramped seats of
an airplane (be it economy class or first class), car, bus, or train — for
long periods. You move less in tight quarters, causing circulation to
decrease and allowing blood to collect and form a clot. The blood clot
may cause pain and swelling in the legs. Serious, even fatal complications
can occur if the blood clot breaks loose in the blood stream and travels
to the heart or lungs. Older people, and those who are obese or have
a family history of DVT tend to be at the highest risk.
Studies do not agree on how long a flight needs to be to pose a risk
of blood clotting. A few studies even suggest that there is no association
between blood clots and air travel. Clearly, more research is necessary.
However, while we wait for a definitive answer to these questions, heeding
these simple instructions may help prevent problems. Pet Reptiles and SalmonellaBetween 1996 and 1998, approximately 16 state health departments reported salmonella infections in persons who had direct or indirect contact with reptiles (i.e., lizards, snakes, or turtles) to the Centers for Disease Control and Prevention. Salmonella infection can result in severe illness and even death, particularly in infants, young children, and anyone with a compromised immune system. The CDC issued the following recommendations to reduce the chances of anyone in your family contracting this potentially deadly infection from these increasingly popular exotic pets:
Starve a Cold, Feed a Fever, Take a Pill for the Flu?The height of the flu season is starting to wane, but we seem to be at the peak of print and television ads promoting new treatments. Late in 1999, the U.S. Food and Drug Administration approved two new anti-influenzal drugs zanamivir (Relenza) and oseltamivir (Tamiflu). Both work by interfering with an enzyme needed for the flu virus to reproduce. Both offer an option for treating uncomplicated cases of the flu. In clinical trials, when taken within two days of the onset of flu symptoms,
Relenza was shown to make people feel better a little (about 36 hours)
sooner. This drug is administered in an inhaler twice daily for five
days. Relenza has not been proved effective for people who have severe
asthma or chronic breathing problems, and in fact may cause bronchial
spasms in these individuals. Tamiflu comes in pill form (taken twice
a day for five days) and can reduce the length and severity of flu symptoms
if it is taken within two days of the onset of symptoms, but not by much. |
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©2000–2006 President & Fellows of Harvard College |
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