Weight training improves quality of life (QOL) in breast cancer survivors, according to the results of a randomized trial reported in the March 27 Early View issue of Cancer.

"Aerobic exercise training has been shown to have beneficial effects on QOL in breast cancer survivors," write Tetsuya Ohira, MD, from the University of Minnesota in Minneapolis, and colleagues from the Weight Training for Breast Cancer Survivors (WTBS) Study. "However, the effects of weight training on psychological benefits are unknown.... There is the potential that for breast cancer survivors, weight training might increase a sense of control over their lives during the 'watchful waiting' time frame between the end of active treatment and the 5-year mark post-diagnosis (e.g., psychological empowerment via physical strength increases)."

In the WTBS Study, 86 breast cancer survivors 4 to 36 months' posttreatment were randomized into a treatment group receiving twice-weekly weight training and a control group. The main endpoints were changes in QOL measured by the cancer rehabilitation evaluation system (CARES) short form, and change in depressive symptoms on the Center for Epidemiologic Studies–Depression Scale (CES-D) from baseline to month 6.

Compared with the control group, the treatment group had improvements for 6 months in the physical global QOL score (standardized difference, 0.62; P = .006) and in the psychosocial global score (standardized difference, 0.52; P = .02). There were no changes in CES-D scores. Increases in upper body strength were correlated with improvements in physical global score (r = 0.32; P <.01) and in psychosocial global score (r = 0.30; P < .01). Increases in lean mass had similar associations with improvements in physical global score (r = 0.23; P <.05) and in psychosocial global score (r = 0.24; P <.05).

"Twice-weekly weight training for recent breast cancer survivors may result in improved QOL, in part via changes in body composition and strength," the authors write. "The mechanism by which weight training may improve QOL in breast cancer survivors may be a sense of return to feeling in control of their bodies that may translate into feeling greater efficacy in other areas of life."

Naltrexone may augment the effects of the nicotine patch for smoking cessation, according to the results of a double-blind, dose-ranging study reported in the March 27 issue of the Archives of Internal Medicine. As an added benefit in some patients, low-dose naltrexone therapy may also lead to weight reduction.

"Many smokers remain refractory to current therapies, which only partially address weight gain after smoking cessation," write Stephanie S. O'Malley, PhD, from Yale University School of Medicine in New Haven, Conn, and colleagues. "This study evaluated whether naltrexone hydrochloride augmentation of nicotine patch therapy improves smoking abstinence and reduces postcessation weight gain more than nicotine patch therapy alone and at what dose."

At an outpatient research center, 400 individuals who smoked 20 or more cigarettes daily were randomized to treatment for 6 weeks with a 21-mg nicotine patch and oral naltrexone (0, 25, 50, or 100 mg/day) Follow-up was for 1 year after randomization. The a priori specified main outcomes were prolonged 4-week cigarette abstinence after a 2-week grace period in the intent-to-treat sample, and weight gain in these abstainers.

In the intent-to-treat analysis, there were no significant differences in prolonged 4-week abstinence (P = .49) or 6-week continuous abstinence after the quit date (P = .12) during treatment. In 295 participants who completed treatment, the 100-mg dose was associated with higher continuous abstinence rates (71.6%) than was placebo (48%; odds ratio, 2.73; 95% confidence interval, 1.39 - 5.39; P < .01).

In the group of continuous abstainers, those receiving 25 mg of naltrexone gained significantly less weight (mean, 0.7 ± 0.31 kg) than did the placebo group (1.9 ± 0.33 kg; P < .01). Participants with prolonged abstinence and treatment completers had similar naltrexone dose effects on weight.

"The 100-mg dose of naltrexone hydrochloride appears the most promising for augmenting the efficacy of the nicotine patch on smoking cessation outcomes but requires further study," the authors write. "The significant weight reduction with low-dose naltrexone therapy suggests that it may be useful as a second-line treatment for weight-concerned smokers."

Study limitations are that the results of the treatment completer analysis must be interpreted cautiously, given the lack of significant effects in the intent-to-treat sample; possible inflation of smoking abstinence rates due to undetected smoking lapses; limited generalizability because of recruitment via advertisements and press releases, and predominantly white sample; insufficient power to detect effects on posttreatment outcomes; short duration of treatment; and type I error.

"The results of this dose-ranging study provide support for further testing of the efficacy of the 100-mg dose for smoking cessation," the authors conclude. "In the meantime, the benefit of low-dose naltrexone therapy on reducing weight gain may have immediate clinical utility for the subset of weight-concerned smokers."

The National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcohol Dependence, National Institutes of Health, the Robert Wood Johnson Foundation, and the Department of Veterans Affairs, Newington, Conn, supported this study. GlaxoSmithKline Inc, donated nicotine patches. Three authors have disclosed they are coinventors on a patent held by Yale University for smoking cessation treatments using naltrexone and related compounds. Several authors have disclosed relevant financial relationships with Alkermes Inc, the maker of an investigational injectable naltrexone; DuPont, the maker of naltrexone; GlaxoSmithKline Inc; Forest Laboratories; Lipha Pharmaceuticals; Ortho-McNeil, Inc; Bristol-Myers Squibb; Pfizer Inc; Sanofi-Aventis; Mallinckrodt Pharmaceuticals; and Johnson & Johnson.

New research may help explain why eating fruits, vegetables, whole grains, and nuts helps protect the heart and prevent diabetes.

The key may be the mineral magnesium.

People in the study who ate magnesium-rich diets seemed to be protected against developing metabolic syndrome, a cluster of risk factors linked to cardiovascular disease and diabetes.

These risk factors include elevated blood pressure, low levels of HDL "good" cholesterol, elevated triglycerides (blood fats), elevated fasting-glucose (blood sugar) levels, and abdominal obesity as determined by waistline measurement.

Low-Magnesium Diets

Study participants who ate diets low in magnesium were more likely to develop the heart disease and diabetes risk factors.

Whole grains, nuts, and many fruits and vegetables are excellent dietary sources of magnesium.

"These foods have long been recognized as being healthy foods that may protect people from disease," researcher Ka He, MD, ScD, tells WebMD. "Magnesium could play an important role in this, but it is just one component of diet -- and diet is just one component of a healthy lifestyle."

The study group consisted of 4,637 young adults between the ages of 18 and 30 when enrolled in the mid-1980s. Fifteen years after entering the study, just over 600 had developed metabolic syndrome.

The researchers divided all the participants into four equal-sized groups based on their reported magnesium intake.

Daily Recommendations

The National Academy of Sciences recommends a daily magnesium intake of 400 milligrams and 310 milligrams, respectively, for adult males and nonpregnant females age 19 to 30. The recommended levels are 420 milligrams for adult males over 30 and 320 milligrams for adult nonpregnant females over 30.

He and colleagues concluded that people in the study who consumed the most magnesium had a 31% lower risk of developing metabolic syndrome, compared with people who ate the least.

Higher magnesium intake was associated with reduced risk of the individual risk factors that make up metabolic syndrome compared with those with the lowest intake.

The findings are reported in the April 4 issue of the American Heart Association journal Circulation.

Foods, Not Supplements

The researchers noted that the findings need to be confirmed in clinical studies. These studies are also necessary, He says, for determining the optimal daily dosage of the nutrient for people at risk for heart disease or diabetes.

He adds that foods, not dietary supplements, are the best sources of magnesium. Almonds, cashews, soybeans, spinach, avocados, whole grains, beans, and some fish are good food sources of the nutrient.

"Magnesium-rich foods are also rich in other nutrients, which may also be important for reducing risk," he says.

Cardiologist Nieca Goldberg, MD, worries that that message may be lost on many people who think they can take the easy way out with dietary supplements. Too much magnesium from supplement sources (outside of food) can cause problems ranging from weakness and nausea to toxic effects on the heart and nervous system.

"Certainly it is easier to go out and buy a bottle of pills than make the commitment to eating a healthier diet," she says. "But I can tell you from experience that when people make that commitment it really does pay off."

Goldberg is chief of the Women's Cardiac Care center at New York's Lenox Hill Hospital.

In addition to eating a diet rich in vegetables, fruits, whole grains and nuts, she recommends limiting simple carbohydrates, like those found in pasta and other white-flour based foods.

And both Goldberg and He agree that diet is just one factor in reducing heart disease and diabetes risk.

"People should eat healthy foods that are rich in magnesium to reduce their risk," He says. "But exercising regularly, not smoking, and maintaining a healthy body weight are also very important

Obesity, particularly visceral adiposity, and its related metabolic and cardiovascular disorders, is a worldwide pandemic. The biological properties of one of the most widespread illicit drugs of abuse, marijuana, have been recruited for obesity management. By uncovering the cellular interactions of the cannabinoid Δ⁹-tetrahydrocannabinol (Δ⁹-THC)—the major active component of marijuana—researchers have identified new molecular pathways for treating cardiometabolic disease. Studies have demonstrated that modulation of the endocannabinoid system holds great therapeutic promise for the treatment of obesity, dyslipidemia, insulin resistance and atherosclerosis.^[1,2]

The endocannabinoid system contributes to the regulation of food intake, energy balance, inflammation, and lipid and glucose metabolism, and might therefore play a fundamental role in the development of obesity and atherosclerosis.^[3] To date, two G-protein-coupled cannabinoid receptors that bind Δ⁹-THC with equal affinity have been identified: CB₁ and CB₂. The CB₁ receptor, believed to mediate the psychotropic effects of cannabis and to participate in the modulation of food intake and adipogenesis, is expressed at high levels by brain cells and by several peripheral tissues including the gastrointestinal tract, the adrenal gland, the heart and adipose tissue. CB₁ knockout mice exhibit a lean phenotype and appear to be resistant to diet-induced obesity and insulin resistance.^[4] By contrast, CB₂ receptors are located primarily on blood cells and immune tissues, and stimulation of these receptors with Δ⁹-THC results in an immunosuppressive phenotype via the modulation of immune-cell cytokine production.^[5] This molecular system might have a role in the development of obesity, the metabolic syndrome and atherosclerosis, and its modulation might form the basis of new therapeutic strategies for these pathophysiologically linked conditions.

Using apolipoprotein E knockout mice Steffens et al. demonstrated that Δ⁹-THC can protect against the development of atherosclerosis.^[1] CB₂ receptors were expressed in both human and mouse atherosclerotic lesions, but were absent in nondiseased arteries. Apolipoprotein E knockout mice fed a high cholesterol diet developed extensive atherosclerotic lesions in the aortic root; however, when 1 mg/kg Δ⁹-THC daily was added to the diet—a dose not associated with CB₁ activation and psychotropic effects—a significant reduction in the progression of atherosclerotic lesions was observed. Concomitant CB₂ receptor antagonist treatment abolished this observed anti-atherosclerotic effect. Even though Δ⁹-THC-fed mice continued to have elevated serum lipid levels, fewer inflammatory cells were recruited into atherosclerotic lesions, suggesting that Δ⁹-THC treatment had a beneficial effect on the inflammatory milieu. Indeed, Steffens and co-workers demonstrated that the immunosuppressive properties of Δ⁹-THC interfered with the adhesion, migration, proliferation and function of immune cells involved in atherosclerotic plaque formation.

These promising results do not imply that smoking marijuana is the key to a healthy heart.^[6] Too often there is failure to translate promising results observed in murine models to human patients. The effects of Δ⁹-THC on atherogenesis in man have not been studied, so whether this cannabinoid does more cardiovascular harm than good remains to be seen. The beneficial effects of Δ⁹-THC observed by Steffens et al. followed a U-shaped distribution with a very narrow therapeutic window, suggesting that the blood concentrations of Δ⁹-THC obtained from smoking marijuana would be too variable to provide sustained clinical benefit.^[1] Furthermore, it is unlikely that purified Δ⁹-THC extract or marijuana would be legalized for use as an adjunctive treatment of cardiovascular disease, since both compounds could serve as drugs of abuse. In addition, smoking marijuana increases carboxyhemoglobin levels, and Δ⁹-THC activation of CB₁ receptors induces a cardiovascular stress response; raising heart rate and blood pressure, decreasing the anginal threshold, and promoting acute coronary syndromes. Overall, smoking marijuana probably has a negative effect on the cardiovascular system. For these reasons, therapeutic strategies using the apparent anti-inflammatory properties of Δ⁹-THC will probably depend upon developing specific CB₂-receptor agonists, to prevent the onset of psychotropic effects. Once thoroughly tested in animal models, translation to human trials could see the positive effects reported by Steffens et al. clinically realized.

Activation of the endocannabinoid system through the CB₁ receptor plays an important role in central and peripheral regulation of energy balance, body weight and food intake. Blockade of the CB₁ receptor appears to offer great promise in cardiometabolic risk reduction, and 1-year results from the RIO program are very encouraging.^[2] In this trial, 1,507 patients with a BMI of at least 30 kg/m², or at least 27 kg/m² or more with treated or untreated dyslipidemia, hypertension or both, received double-blind treatment with 5 mg rimonabant—a selective CB₁ receptor blocker—daily, 20 mg rimonabant daily, or placebo, in addition to a hypocaloric diet. Treatment with 20 mg rimonabant for 1 year significantly decreased total body weight and waist circumference, and produced a significant weight-independent effect on lipid parameters and several other cardiovascular risk factors. The beneficial changes to the lipid profile remained significant after adjusting for weight loss. Furthermore, treatment resulted in a significant reduction in fasting plasma glucose, fasting plasma insulin, insulin resistance and the proportion of patients who fulfilled the criteria for the metabolic syndrome compared with placebo. To explain the observed weight-independent effect on both lipid and glycemic variables, Van Gaal et al. hypothesized that enhanced rimonabant-induced expression of adiponectin—a cytokine that has a role in the regulation of hyperglycemia, hyperinsulinemia and fatty acid oxidation and is reduced in obese individuals—could be responsible.^[2] Thus, by improving adipocyte function, rimonabant might contribute to beneficial changes in other adipokines, such as C-reactive protein, reinforcing the link between obesity and atherosclerosis.^[7] Further investigation of in vivo effects of rimonabant are required to fully elucidate this mechanism, especially given the concern that CB₁ antagonists might raise blood pressure.^[8] Furthermore, rimonabant appears to be a useful agent for smoking cessation, yet another cardiac risk factor.^[9] Thus, pharmacologic manipulation of cannabinoid-receptor signaling might combat the development of atherosclerosis through the treatment of obesity, the metabolic syndrome, vascular inflammation and smoking. The beneficial effects with rimonobant appear to be consistent in over 6,600 patients enrolled in the RIO program. Patients administered this drug enjoy sustained reductions in weight, BMI and visceral adiposity, and improvements in insulin sensitivity and dyslipidemia. More importantly, the beneficial effects to counter insulin resistance, improve dyslipidemia and increase adiponectin, are only partly explained by the reduction in weight, indicating a potential direct role for CB₁ in adipogenesis and lipid derangement.

The results of the RIO program and the study by Steffens et al. indicate that modulating the activity of the endocannabinoid system holds promise as an approach to treating obesity, dyslipidemia and atherogenesis.^[1,2] The CB₁ and CB₂ receptors might have opposing effects on atherogenesis: whereas central CB₁-receptor blockade offers hope for atherogenic risk reduction, peripheral CB₂-receptor stimulation in animals has powerful anti-atherosclerotic effects. It is possible that a strategy of CB₁-receptor antagonism and CB₂-receptor agonism might emerge as the most effective treatment across the spectrum of insulin resistance and vascular disease. It is paradoxical that studying the effects of cannabis, an illicit drug that provides society with numerous social problems, could serve as the basis for novel therapeutic strategies to reduce cardiometabolic risk.

The Beverage Guidance Panel has developed guidelines for beverage classification and consumption, according to a report in the March issue of the American Journal of Clinical Nutrition.

"Over the past several decades, levels of overweight and obesity have increased across all population groups in the United States," write Barry M. Popkin, from the University of North Carolina, Chapel Hill, and colleagues. "Concurrently, an increased daily intake of 150-300 kcal (for different age-sex groups) has occurred, with approximately 50% of the increased calories coming from the consumption of calorically sweetened beverages."

To provide guidance on the relative health and nutritional benefits and risks of various beverage categories, the Beverage Guidance Panel systematically reviewed the available literature on beverages and health. The panel also hoped to develop a deeper dialogue within the scientific community on overall beverage consumption patterns in the United States, and on the great potential to improve health by changing this pattern.

On the basis of caloric and nutrient contents and related health benefits and risks, the panel ranked beverages from the lowest to the highest value. To fulfill daily water needs, drinking water was ranked as the preferred beverage, followed in decreasing value by tea and coffee, low-fat (1.5% or 1.0%) and skim (nonfat) milk and soy beverages, noncalorically sweetened beverages, beverages with some nutritional benefits (fruit and vegetable juices, whole milk, alcohol, and sports drinks), and calorically sweetened, nutrient-poor beverages.

"The Panel recommends that the consumption of beverages with no or few calories should take precedence over the consumption of beverages with more calories," the authors write. "Potable water could be used to fulfill almost all the fluid needs of healthy individuals. However, to allow for variety and individual preferences, healthful diets may include several other types of beverages."

A healthy diet does not rely on fluids to provide energy or nutrient needs, according to the panel report. Because fluids are less satiating than are solid foods, their consumption is associated with a lack of dietary compensation. In other words, fluid calories are not readily "registered" for appetite regulation.

The Panel on Water and Electrolytes of the Institute of Medicine (IOM) has recognized that fluid requirements vary widely among individuals and populations. Therefore, they defined an adequate intake (AI) for water rather than an estimated average requirement (EAR). The AI was set at 125 fl oz (3.7 L)/day for men and 91 fl oz (2.7 L)/day for women. About 80% of the AI is contributed by beverages, including water, and the rest by solid foods. Conversely, except for milk and fruit juices, the contribution of fluids to meeting the recommended dietary allowance (RDA) for essential nutrients is minimal. In a healthy diet, the balance between energy and nutrient content is a critical factor defining the role of beverages.

The proposed guidance system ranks water at the bottom (level 1), to be consumed frequently, and calorically sweetened beverages at the top (level 6), to be consumed sparingly. These recommendations are aimed at the population older than 6 years.

"Below that age, there are many additional factors, such as development of taste preferences and early imprinting of food choices, that may affect beverage choice and intake," the authors write.

For individuals older than 6 years, the Panel recommends the following ranges of intake for beverages:

• Level 1 (water), 20 to 50 fl oz/day.
• Level 2: (unsweetened tea and coffee), 0 to 40 fl oz/day (may replace water, but caffeine is a limiting factor, up to 400 mg/day, or ~32 fl oz coffee/day).
• Level 3: (low-fat and skim milk and soy beverages), 0 to 16 fl oz/day.
• Level 4: (noncalorically sweetened beverages), 0 to 32 fl oz/day (may substitute for tea and coffee with the same limitations as for caffeine).
• Level 5: (caloric beverages with some nutrients), 0 to 8 fl oz of 100% fruit juices/day, 0 to 1 alcoholic drink/day for women and 0 to 2 alcoholic drinks/day for men (one drink is ~12 fl oz of beer, 5 fl oz of wine, or 1.5 fl oz of distilled spirits), and 0 fl oz of whole milk/day.
• Level 6: (calorically sweetened beverages), 0 to 8 fl oz/day.

"The obesity epidemic provides the rationale for developing the Beverage Guidance System," the authors write. "Because some beverages provide primarily energy and can contribute significantly to a positive energy balance, reducing their consumption is an important component of a broader strategy to reduce energy intake."

Research and development issues identified for the food industry include reducing the calorie content of sweetened beverages by 75% to 80% from current levels and developing low-calorie alternatives; reversing the trend among children and adolescents to replace milk in their diet with calorically sweetened beverages; and studying potentially negative effects of fortifying noncaloric beverages, such as flavored bottled water, with essential nutrients.

"The Panel also notes the need for further research regarding the health effects of dairy products and reduced or noncalorically sweetened beverages," the authors conclude. "In our view and in agreement with the IOM, it is important that >60%, if not 100%, of fluid needs are provided by calorie-free beverages. This is important because, as we recognize, fluid needs vary widely among people, and persons with higher-than-average needs should increase their fluid intake from calorie-free beverages, preferably water."

Dr. Popkin initiated the Beverage Guidance Panel. According to the study's disclosure statement, the Unilever Health Institute in the Netherlands assisted by providing funding for the group's meeting in Boston and for the publication of its deliberations. Unilever had no power to influence or veto panel decisions and did not attempt to make changes. The manuscript was initially drafted by Dr. Popkin with major additions for all sections coming from each coauthor until full agreement was reached. All authors participated in all sections of manuscript preparation and review. One of the authors is a member of a scientific advisory board of Unilever.

Alcohol use, tobacco use, and male gender are all risk factors for earlier onset of colorectal cancer and may one day be used to individualize screening recommendations, according to a new report.

"Most medical groups recommend colon cancer screening at age 50 because that's when the risk really goes up," senior author Dr. Hemant K. Roy, from Northwestern University in Evanston, Illinois, told Reuters Health. "Aside from considering a person's family history of colon cancer, screening really isn't individualized."

Our results support the notion that a "one-size-fits-all" approach is not the best way to screen for colorectal cancer, Dr. Roy said. In particular, "screening should possibly start earlier than 50 years of age in alcohol and tobacco users."

The new findings, which appear in the Archives of Internal Medicine for March 27, are based on analysis of data for 161,172 patients who were diagnosed with colorectal cancer between June 1, 1993 and December 31, 2003.

Current drinkers or smokers developed cancer, on average, 5.2 years earlier than their counterparts who did not drink or smoke. Current drinking and smoking hastened the onset of disease by 7.8 years. Current drinkers and smokers were also slightly more likely to have distal location for their malignancy.

Cancer onset in men was 1.9 years earlier than in women (p < 0.001). Distal disease sites were also more common in men.

The effect of smoking on disease onset was stronger in women than in men. Women smokers developed cancer 6.3 years earlier than their peers who did not drink or smoke compared with 3.7 years in men.

"Smoking and alcohol use are generally accepted risk factors for colorectal cancer, but I was somewhat surprised at the magnitude of the effect they had on disease onset," Dr. Roy said.

Although confirmation in other studies is needed, "our findings are very intriguing and may lead to tailored recommendations for colorectal cancer screening," Dr. Roy noted.

A peptic ulcer is an area of damage to the tissues lining the stomach, esophagus, or duodenum (the first part of the small intestine). Over 25 million Americans will have a peptic ulcer at some point in their lifetime. People of all ages can suffer from ulcers. Men and women are equally affected.

Peptic ulcers were formerly thought to be caused by lifestyle stress, coffee consumption, or spicy foods. Now it is clear that about 90% of peptic ulcers are caused by a bacterial infection that can usually be cured.

The bacterium Helicobacter pylori (H. pylori) was established as the leading cause of peptic ulcers in the early 1980s. It was also found to cause gastritis (inflammation of the stomach lining)

H. pylori is a spiral-shaped bacterium that can live and grow on the lining tissues of the stomach. Some people can be infected with H. pylori and never develop an ulcer or show any symptoms of the infection. In other people, the organism may persist for years before any symptoms develop.

It remains unclear why some people develop symptoms of the infection and others do not. It is also not clear exactly how H. pylori is transmitted from person to person. In the United States, H. pylori infection is more common among the elderly, African-Americans, Hispanics, and in those living under lower socioeconomic conditions.

Ulcers related to H. pylori infection are commonly treated now with a one- to two-week course of an antibiotic. The antibiotic is usually given along with a bismuth preparation (such as Pepto-Bismol) or one of the proton pump inhibitors that decrease acid output by the stomach. Omeprazole (Prilosec) and lansoprazole (Prevacid) are common proton pump inhibitors. If antibiotics are not administered, up to 80% of ulcers recur, in contrast to about 6% when the H. pylori infection is treated with an antibiotic.

Tests for H. pylori infection include upper endoscopy, in which a lighted optical scope is used to examine the esophagus, stomach, and duodenum. With endoscopy, the diagnosis of an ulcer can be confirmed and biopsy material removed and examined for the presence of H. pylori.

Noninvasive tests cannot determine if an ulcer is present but may be used to diagnose H. pylori infection. These include blood tests to identify antibodies to H. pylori and a the urea breath test (UTB). For the urea breath test, an oral preparation of urea containing radiolabeled carbon is given. H. pylori in the stomach metabolize the urea, and the resulting radioactive carbon is absorbed into the blood stream and ultimately exhaled. The exhaled breath is tested for radioactive carbon, indicating the H. pylori infection.

There are other causes of peptic ulcer that are unrelated to H. pylori infection, but these are less common. In particular, the chronic use of non steroidal antiinflammatory drugs (NSAIDs) and cigarette smoking can be causes of both ulcer formation and failure of treatment.

If you want to eat foods for living longer, consider a plant-based diet.

We all know about the kinds of foods that may contribute to shortened, less healthy lives. Pork rinds, charred meat and lard, these kinds of things. But are there foods for living longer?

There is no shortage of people who will be happy to sell you a specific supplement or food that they claim will help you live a longer and healthier life. The science behind many of these products, however, is not always convincing to some public health scientists, or epidemiologists.

"What we know is that diets rich in fruits and vegetables appear to be much healthier, leading to less chronic disease and lower healthcare costs, but it's less clear how any specific dietary items affect longevity," says Hubert Warner, PhD, associate director of the biology of aging program at the National Institute of Aging.

Warner also says that not eating much food at all, ever, may promote living longer, while also making life decidedly less enjoyable.

"Many animal studies show that calorie restriction, meaning a permanent, low-calorie diet, can lengthen life in the laboratory," says Eugenia Wang, PhD, professor of biochemistry at the University of Kentucky in Louisville, who studies the genetics of aging. Several monkey studies on calorie restriction are under way at the University of Wisconsin, according to Warner, but no human studies have been done.

So if you're looking for foods for living longer, a plant-based diet -- something very similar to what most of us would consider a vegetarian diet -- seems to be the ticket, these experts say.

"There are thousands of small, short-term studies of foods or supplements that may show a particular effect, but when you look at large, long-term studies of how diet affects longevity and healthcare costs in the real world, it is plant-based diets that actually appear to be healthier," says Neal Barnard, MD, president of the Physicians' Committee for Responsible Medicine and author of Eat Right, Live Longer: Using the Natural Power of Foods to Age-Proof Your Body and other books.

Barnard cites a study, "Ten Years of Life. Is It a Matter of Choice?" as an example of this evidence. In the study, researchers looked at 34,192 non-Hispanic, white Seventh Day Adventists over age 30.

"Researchers like to study the Adventists because they are nearly all nonsmokers, they avoid alcohol, and are mostly vegetarians," says Barnard. Roughly 30% of the study subjects were vegetarians; about 20% were semi-vegetarians, eating meat less than once per week. The research showed that vegetarian men and women had "an expected age of death at 83.3 and 85.7 years, respectively." Men lived 7.28 years longer than the average American man, and women lived 4.42 years longer than the average American woman. 

"This gives Adventists a higher life expectancy than any other formally described population," the study authors' wrote. 

Ten extra years, without resorting to calorie restriction. What's more, this plant-based diet may offer protection from disease, according to the landmark China Project study, the largest study of diet and disease ever.

"In the '80s, China was like a huge living lab," says Banoo Parpia, PhD, an associate researcher at Cornell University in Ithaca, N.Y., who is involved with the China Project. "People didn't travel, and they ate locally." The thousands of people studied were largely without refrigeration or processed foods. They ate essentially a pre-modern diet, often growing their own food.

In more than 65 rural Chinese counties, researchers took blood and urine samples, weighed food, gave questionnaires, and filled out subject histories on everything from smoking history to age of onset of puberty.

Chinese diets were low in total fat (about 6% to 24%) and much higher in dietary fiber (about 10 to 77 grams per day). These diets contained less than 20% animal-based foods. The average American diet contains about 60% or more animal-based foods.

"At that time, China had higher rates of communicable diseases so their average life span was shorter than in the U.S., but the rate of heart disease and diabetes was very low, and breast cancer was almost nonexistent," says Parpia.

When the researchers correlated this information with the reported incidence of cancer for the areas, they were able to attribute the low levels of chronic disease and some cancers to the Chinese plant-based diet.

"The China Project study and others like it allow us to actually assess how diet affects incidence of disease and longevity in the real world," says Barnard. "What we see over and over again is that vegetarian or near-vegetarian diets over a lifetime yield a five- to 10-year lengthening of life."

Awakening to the sound of a whirring blender and the sharp scent of fresh soybeans on Saturday mornings meant only one thing: a breakfast of Grandma's warm, sweet soy milk. I loved to sit and watch as she squeezed the milk out of ground soybeans wrapped in a cheesecloth.

Countless glasses later, I discovered that soy milk has a lot more to offer than fond childhood memories. Packed in every yellow bean are estrogen-like molecules, called isoflavones, which may help fight heart disease, osteoporosis, cancer, and other diseases. Based on just some of the latest findings, the Food and Drug Administration last year gave food makers permission to extol soy's cholesterol-lowering prowess on package labels.

That's great, if you happen to believe soy is a healthy choice for everyone. But with soy showing up in everything from breakfast cereal and pasta to energy bars and smoothies, some researchers now worry that too much of a good thing could be harmful.

"People ought to know that there ain't no free lunch," says Lon White, MD, MPH, senior neuroepidemiologist at the University of Hawaii. "At some point -- if these molecules are as potent as [we think] they are -- there will be potent [adverse] effects."

White, for one, worries that soy may speed the aging of brain cells. He recently found evidence that the brains of elderly people who ate tofu at least twice a week for 30 years were aging faster than normal. Tests designed to assess memory and analytical ability showed that their brains functioned as if they were four years older than their actual age, White says of his study published in the April 2000 issue of the Journal of the American College of Nutrition.

Another fear is that the estrogen-like substances in soy may dampen the function of the thyroid. Consuming 40 milligrams of isoflavones a day can slow the production of thyroid hormone, says Larrian Gillespie, MD, author of The Menopause Diet and The Goddess Diet. (One tablespoon of soy powder contains about 25 milligrams of isoflavones, while most isoflavone supplements come in 40-milligram pills.)

According to Gillespie, within a few weeks of regularly consuming 40 milligrams of isoflavones, some women feel fatigued, constipated, and achy all over. Some also gain weight and have heavier menstrual periods. Menopausal women are at particular risk, since they're already prone to hypothyroidism. "Women think it's because of hormones and don't realize they're symptoms of hypothyroidism," Gillespie says. "Once they stop the soy, they say, 'I'm feeling fine again.' "

Soy's Not All Bad

But if some studies point to dangers from soy, others suggest important benefits. For instance, isoflavones may prevent the growth of estrogen-dependent breast cancer cells, according to findings published in the March 2000 issue of the journal Cancer Research. That's because isoflavones appear to encourage the body to break down estrogen more quickly -- before it can stimulate cancer cells to grow. Instead of lingering in the blood, bits and pieces of estrogen molecules wind up in the urine.

Isoflavones can also slow prostate cancer cells from growing, according to a study published in the June 2000 issue of the International Journal of Oncology. Other studies hint that eating soy may help prevent heart disease, endometriosis, and even osteoporosis in women, Gillespie says. However, if you think you may have any of these conditions, see your doctor before making any substantive changes to your diet.

Soy's biggest impact is on cholesterol levels, according to a mound of studies. One published in the December 1998 issue of the American Journal of Clinical Nutrition found that men who ate a low-fat diet and relied on soy as their main protein source for five weeks saw their "bad" (LDL) cholesterol levels decrease by as much as 14% and their "good" (HDL) levels increase by as much as 8%. Men who ate a low-fat diet but instead relied on meat as protein also saw their cholesterol levels significantly improve, though not as much as the soy-eaters.

And eating soy helps to replace animal products, which are loaded with saturated fats and cholesterol, says nutritionist Mark Messina, PhD, author of The Simple Soybean and Your Health.

In the Kitchen

So what's the verdict on soy? Health experts say that although there's no need to give up your favorite frosty shake made with soft tofu, frozen strawberries, and a dab of honey, you may not want to eat soy for breakfast, lunch, and dinner. Yet there's nothing wrong with incorporating soy into a healthy diet of fruits, vegetables, and whole grains.

Messina, for instance, recommends a daily serving of soy: perhaps 1 cup of soy milk or 3 to 4 ounces of tofu. "If 20 years from now researchers don't find any benefits to soy, then you've lost nothing," Messina says. "If they do find some benefits, then you've got a great trade-off."

As for my grandma, she successfully fought off breast cancer at the age of 80, and she couldn't be healthier now at 93. She still memorizes Bible passages and spends afternoons sweating to the beat of an exercise video. Researchers can't tell her what role, if any, soy has played in her life and health. It doesn't, however, seem to have done her any harm.

March 24, 2006 -- Your eyes may be a window to your body's health, a new study shows.

The report, published in Nutrition, shows that diet and lifestyle might sway the odds -- for better or worse -- of developing age-related macular degeneration (AMD).

AMD is America's leading cause of vision loss. More than 13 million people in the U.S. show some signs of AMD, which is uncommon in people younger than 55. A new study shows that diet, smoking, and BMI (body mass index) may affect the chances of getting AMD.

Eating healthfully, not smoking, and not being overweight could help keep age-related macular degeneration at bay, according to the new study. The reverse also appears to be true, write the researchers. They included Johanna Seddon, MD, of Harvard Medical School and the Harvard School of Public Health.

Tracking AMD

Seddon and colleagues studied 934 people who were 67 to 71 years old, on average. Half of the participants were screened at a Boston eye and ear clinic. The others were screened at an eye clinic in Portland, Ore.

A total of 184 participants didn't have AMD. The rest had mild AMD (201 patients), moderate AMD (326 patients), or advanced AMD (223 patients).

Participants completed surveys about their diet and lifestyle. They also gave blood samples, which Seddon's team checked for levels of C-reactive protein (CRP) and homocysteine, which have been linked to increased risk of heart disease.

The researchers had previously reported that CRP and homocysteine are associated with age-related macular degeneration. This time, they checked how diet and lifestyle affected levels of CRP and homocysteine, as well as AMD risk.

None of the participants were asked to change their diets or lifestyles. The researchers just looked for patterns among the participants' habits, blood chemicals, and AMD diagnosis.

Eye-Opening Data

The researchers found that people who smoked, were overweight, and consumed fewer antioxidants (natural chemicals found in many fruits and vegetables) tended to have higher levels of CRP and homocysteine.

For instance, people who reported eating fish more than twice per week had lower CRP levels. This was also true for people who consumed higher levels of vitamin C, beta-carotene, and the antioxidants lutein and zeaxanthin.

CRP levels were higher for people who smoked or had higher BMI, the study also shows.

Lower homocysteine levels were seen in people with more vitamin E in their blood and those who consumed more antioxidants and vitamin B-6. But higher blood levels of vitamin E were also tied to higher CRP levels. That contradiction should be studied further, note Seddon and colleagues.

"Overall, these findings suggest that sick eyes may occur in sick bodies related to smoking, being overweight, and other unhealthy behaviors," they write.

"AMD is associated with immune, inflammatory, and other cardiovascular mechanisms, and these results emphasize the need to adhere to healthy lifestyles for your eyes and your body overall," Seddon says in a news release.

Study Shows Regular Exercise Improves Mental and Physical Health of Menopausal Women

 It's never too late for women to reap the benefits from starting a regular exercise program, according to a new study that shows exercise can relieve the symptoms of menopause and improve quality of life.

Researchers found menopausal women aged 55-72 who started a yearlong exercise program experienced significant improvement in both mental and physical health while those who didn't exercise got worse.

"The group that improved took part in three hours of fully supervised exercise a week for 12 months," says researcher Carmen Villaverde-Gutierrez, professor of nursing at the University of Granada in Spain, in a news release. "As well as monitoring severe symptoms, we also looked at the women's quality of life and found that the average scores for the exercise group improved while those for the control group decreased."

The results appear in the Journal of Advanced Nursing.

Exercise Relieves Symptoms

In the study, researchers examined the effects of an exercise program consisting of cardiovascular, stretching, muscle strengthening, and relaxation exercises in 48 menopausal women. Half of the women participated in the 12-month exercise program and the other half did not.

At the start of the study, 50% of the women in the exercise group and about 58% of nonexercisers had severe menopausal symptoms. By the end of the study, the percentage of women with severe menopausal symptoms dropped to 37% among the exercise group and rose to over 66% among the others.

The exercise group also improved on measures of physical and psychological functioning and positive state of mind, while the nonexercisers declined in these areas.

"Joining the regular exercise programme improved the women's health and also gave them the chance to join a sociable group activity and reduce feelings of loneliness," says Villaverde-Gutierrez in a news release. "Our findings suggest that regular exercise programmes can help to alleviate some of the physical symptoms associated with the menopause and improve women's health and quality of life."

"We would like to see exercise programmes offered as an integral part of primary healthcare for menopausal women. At the very least, women going through the menopause should be encouraged to join a local exercise group suitable for their age and health so that they can share the benefits experienced by the women in our study," says Villaverde-Gutierrez.

NEW YORK (Reuters Health) Mar 27 - When it comes to treating localized prostate cancer, treatment decisions frequently do not appear to reflect patient preferences, investigators report in an upcoming issue of Cancer.

There is no gold standard for optimal treatment of localized prostate cancer, choices of which include radical prostatectomy, external beam radiation therapy, brachytherapy, and watchful waiting, the authors of the study note. Despite a plethora of studies examining how men decide on a treatment plan when they are diagnosed with localized prostate cancer, there is no consensus on what issues actually guide their decisions.

Dr. Scott D. Ramsey, from Fred Hutchinson Cancer Center in Seattle, and his associates conducted a literature search and identified 69 peer-reviewed studies concerning the treatment decision-making process for localized prostate cancer. The findings will appear in Cancer on May 1.

Initially, cancer eradication is the primary concern of most patients. The investigators report that the advice men are given varies according to physician specialty, and usually does not include all pertinent information required to make an informed decision as to survival and quality of life, nor does it always take into account the seriousness of the patient's cancer.

Nevertheless, physician recommendation is a major influencing factor for more than half of patients interviewed. Study results suggest that physicians' advice varies, with blacks and men with lower income or education levels receiving less aggressive treatment.

Patients also are concerned to varying degrees about side effects, such as incontinence and impotence. However, fear of side effects only rarely affects treatment decisions, and the authors suggest that many patients don't understand side effect issues and they often do not receive accurate information.

Dr. Ramsey and his associates recommend "future prospective studies aimed at examining how patient values evolve throughout the period of time from their first being diagnosed with prostate cancer until the completion of treatment."

They suggest that researchers explore how patients' personal values affect their decisions, as well as the role of family members, patients' ethnicity and socioeconomic status, and the settings in which men receive treatment.

Doctors don't know why one man develops prostate cancer and another doesn't.

But there are certain risk factors that make it more likely in some people, the U.S. National Cancer Institute says.

These include:

• Age. Men under age 45 rarely get this disease, while most men who do are over age 65.
• Family history. Your risk of contracting prostate cancer is higher if your father or brother had it.
• Race. Black men have a higher incidence of prostate cancer than white men; Asian and Native American men appear to be at lower risk.
• A diet high in animal fat.
• Certain cell changes in the prostate.

It's important to note that most men diagnosed with prostate cancer don't have any risk factors, except growing older, the institute says.

A cross-sectional study published online March 23 in BMC Psychiatry suggests the importance of evaluating for postpartum anxiety in addition to postpartum depression.

"Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored," write Renée L. Miller, from the Swinburne University of Technology in Hawthorn, Victoria, Australia, and colleagues. "Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression."

As part of a larger cross-sectional study, 325 primiparous mothers were evaluated with the EPDS and the Depression, Anxiety and Stress Scales (DASS-21). Mothers ranging in age from 18 to 44 years (median, 32 years) whose babies were aged between 6 weeks and 6 months were recruited through mother's groups and health centers in Melbourne, Australia.

Based on a cut-off of more than 9 on the EPDS, 80 women (25%) were possibly depressed. The DASS-21 corroborated depression in 58% of these women. In the total sample, the DASS-21 identified depression in 61 women (19%). When broader criteria for distress were used, the DASS-21 identified an additional 33 women (10%) with symptoms of anxiety and stress without depression, and a total of 41 women (13%) with symptoms of anxiety either alone or combined with depression.

Based on the DASS-21, 7% of the sample was diagnosed with both anxiety and depression. Women in this subgroup had higher mean EPDS and DASS-21 depression scores than did women with depression but without anxiety.

"The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone," the authors write. "The DASS-21 appears to be a useful instrument for this purpose."

Study limitations include recruitment from mothers' groups and health centers by placing posters rather than by approaching individual women directly; high proportion of tertiary educated women; possible self-selection bias; and lack of formal diagnostic structured interview to provide a "gold standard" against which to validate the DASS-21.

"For as long as the focus of postnatal maladjustment is on depression, failure to identify and treat significant symptoms of anxiety and stress may leave women vulnerable to worsening symptomatology," the authors conclude. "Untreated maternal distress can have a substantial impact on the well-being of the mother, her relationships, and her infant. The DASS-21 is a brief, easy to administer inventory that may assist practitioners (along with clinical interviews) to more effectively assess and treat new mothers who may be depressed, anxious and/or stressed in the postpartum."

An Australian Postgraduate Award supported this study. The authors report no relevant financial relationships.

While budding trees and blooming flowers are among the delights of spring, the season also brings the threat of sneezing, itchy, watery eyes, and other allergy symptoms for more than 20 percent of Americans.

The American Academy of Allergy, Asthma and Immunology offers the following 10 tips on how people with allergies can ease their symptoms:

• Spring clean. Do a thorough cleaning inside your home. Through the winter, windows, bookshelves, and air conditioning vents can collect dust and mold that can trigger allergy symptoms.
• Avoid pollen. Close the windows in your home when pollen counts are high. Avoid using window fans that may draw pollen inside. When mowing the lawn or gardening, wear a filter mask. Minimize outdoor activity when pollen counts are high. Peak pollen times are usually between 10 a.m. and 4 p.m. You can get up-to-date pollen information for your area by going to the National Allergy Bureau's Web site at www.aaaai.org/nab.
• Be prepared.Take allergy medications at least 30 minutes before your go outside. Consult with an allergist/immunologist to ensure medications are helping you or when you suffer reactions to medications.
• Wash n' dry right. Wash bedding weekly in hot water. Dry laundry indoors -- sheets hanging on outside lines can collect pollen.
• De-pollinate. Shower and wash your hair before bed in order to wash off pollen that's collected on your skin and hair.
• Watch pets, too. Keep pets off furniture and out of the bedroom. Pollen can cling to dogs and cats who've been outside.
• Drive (and breathe) safe. During peak pollen season, keep your car windows closed. Use air conditioning and point the vents away from your face.

  Sick building syndrome (SBS) may have more to do with the psychosocial work environment than with the physical attributes of the building, according to the results of a cross-sectional study reported in the March issue of Occupational and Environmental Medicine.

"Although guidelines exist for the investigation and management of SBS, systematic research has failed to identify consistent associations between particular physical properties of buildings and SBS," write A. F. Marmot from the Linton House in London, United Kingdom, and colleagues from the Whitehall II study. "There is increasing evidence that the psychosocial work environment is related to health and that the physical responses to work stress may resemble symptoms that have been attributed to the physical work environment. Work overload, lack of support at work, and conflict at work may exacerbate the effects of the physical work environment."

The investigators used cross-sectional data on the physical environment of a selection of 44 buildings to individual data from the Whitehall II study, an ongoing health survey of office-based civil servants. Ten symptoms of SBS and psychosocial work stress were evaluated with a self-report questionnaire administered to 4052 participants aged 42 to 62 years.

After adjustment for age, sex, and employment grade, no significant relationship was found between most aspects of the physical work environment and symptom prevalence. There was a nonsignificant trend toward a positive relationship between airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. High job demands, low support, and other features of the psychosocial work environment had greater effects on symptom prevalence. Based on multivariate analysis, only psychosocial work characteristics and control over the physical environment were independently associated with symptoms.

"The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms," the authors write. " 'Sick building syndrome' may be wrongly named."

Study limitations may include high quality of Whitehall buildings above the threshold for affecting symptoms; the potential for misclassification of the environmental characteristics for each building; self-reported nature of the psychosocial work characteristics and symptoms; and questionnaire and fieldwork data collected at different times of the year.

"These findings should not be interpreted as justification for assuming that the quality of the physical environment of the workplace is unimportant," the authors conclude. "The results imply that if SBS is reported in a building, management should consider causes beyond the physical design and operation of the workplace and should widen their investigation to include the organisation of work roles and the autonomy of the workforce.... SBS symptoms are more about the jobs people do, their psychosocial environment, and their ability to control conditions in their office than about the physical environment of the building or workstation where the job is performed."

Financial support for the Whitehall II study came from the UK Medical Research Council; the British Heart Foundation; Health and Safety Executive; the UK Department of Health; the National Heart, Lung, and Blood Institute and the National Institute on Aging of the US National Institutes of Health; the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health.

NEW YORK (Reuters Health) Mar 28 - Infection with Epstein-Barr virus (EBV), manifesting as infectious mononucleosis, in adolescents and young adults, more than doubles the risk of developing multiple sclerosis (MS) later in life, results of a meta-analysis suggest.

"Multiple sclerosis is a complicated disease, probably caused by a combination of factors," lead author Evan L. Thacker from the Harvard School of Public Health, Boston, told Reuters Health. "It is likely that some viral infections, such as infectious mono, play a role in determining whether multiple sclerosis will occur."

Similarities in the epidemiology of infectious mononucleosis and MS have led researchers to consider EBV in the cause of MS, Mr. Thacker and two colleagues from Harvard point out in the Annals of Neurology for March.

"Both infectious mononucleosis and MS occur in young adults, both follow a latitude gradient, and both are rare in populations where infections occur at an early age, suggesting that late infection with EBV, evidenced by occurrence of infectious mononucleosis, is an important causal factor in MS," they explain.

However, studies that have evaluated the relation of infectious mononucleosis and MS risk have produced inconsistent results.

Against this backdrop, the Harvard group systematically identified and statistically combined 14 relevant studies conducted in the US, Europe, and Australia to come up with an overall picture of the connection between infectious mono and MS.

The combined relative risk of MS after infectious mononucleosis was 2.3, they report.

"The most important observation in our study was that people who got infectious mono while growing up were about twice as likely to get multiple sclerosis later, compared to people who never got infectious mono," Thacker told Reuters Health.

"The potential implication of our observation is that some cases of multiple sclerosis could probably be averted through the prevention of infectious mono," he said. "One way to accomplish this might be to develop a safe and effective vaccine against Epstein-Barr virus, the virus that causes infectious mono."

The benefits of omega-3s in fighting heart disease may be only so-so, according to a new review of research on the fatty acids found in fish and some plant and nut oils.

The study doesn't rule out an important effect of omega-3 fatty acids on health, but the results indicate that the evidence behind the fishy fats is less conclusive than previously thought.

Eating foods rich in omega-3 fatty acids, such as fatty fish and some plant and nut oils, such as olive and walnut, is thought to lower the risk of heart disease, and several public health organizations have recommended that people to eat more oily fish, such as salmon and tuna.

But in a review of 89 studies that measured the effect of omega-3 fatty acids on heart attack, death, cancer, and strokes, researchers didn't find any clear benefit of omega-3s in reducing the risk of these health hazards.

Omega-3's Health Benefits Questioned

In the review, which appears in the journal BMJ, researchers analyzed the results of studies that looked at the omega-3 fatty acids on reducing health risks in people who increased their intake of omega-3s through diet or supplementation with fish oil capsules for six months or more.

After taking differences in study quality into account, researchers found the pooled results of the studies showed no strong proof that omega-3 fatty acids had an effect on reducing the risk of death or heart-related events, like heart attack and stroke.

Researchers say other recent reviews of studies on omega-3s have shown that people taking supplements of the fatty acids had a lower risk of death, and they can't explain why this review came up with conflicting results.

Therefore, they recommend that further study is needed to fully understand the benefits and risks of omega-3 fatty acids.

In an editorial that accompanies the study, Eric Brunner of the department of epidemiology and public health at the Royal Free and University College London Medical School writes, "We are faced with a paradox.

"For the general public some omega-3 is good for health," writes Brunner. "Health recommendations advise increased consumption of oily fish and fish oils. However, industrial fishing has depleted the world's fish stocks by some 90% since 1950, and rising fish prices reduce affordability particularly for people with low incomes. Global production trends suggest that, although fish farming is expanding rapidly, we probably do not have a sustainable supply of long-chain omega-3 fats."

NEW YORK (Reuters Health) Mar 24 - Results of a study published in the March issue of the American Journal of Psychiatry suggest an association between schizophrenia and a large range of autoimmune diseases.

"Individuals with schizophrenia and their relatives tend to have either higher or lower than expected prevalences of autoimmune disorders, especially rheumatoid arthritis, celiac disease, autoimmune thyroid diseases, and type 1 diabetes," Dr. William W. Eaton, of the Johns Hopkins University, Baltimore, Maryland, and colleagues write.

In a large epidemiological study, the researchers examined the association between schizophrenia and a range of autoimmune diseases. They used data from the Danish Psychiatric Register, the National Patient Register, and a register containing socioeconomic information. Included were 7704 patients diagnosed with schizophrenia between 1981 and 1998 and their parents, as well as matched control subjects and their parents.

Subjects with one or more autoimmune diseases had a 45% increased risk of schizophrenia, and schizophrenia patients had a higher prevalence of nine autoimmune disorders compared with the controls. The parents of schizophrenic patients had a higher prevalence of 12 autoimmune diseases compared with the parents of the controls.

Thyrotoxicosis, celiac disease, acquired hemolytic anemia, interstitial cystitis, and Sjogren's syndrome occurred more often in schizophrenic patients and their parents compared with the controls and their parents, the researchers report.

"In future clinical studies it may be interesting to search for a family history of autoimmune diseases, and specific autoantibodies, in patients with schizophrenia," Dr. Eaton's team suggests. "Eventually, individual or family disease comorbidity may help to elucidate shared etiologic pathways."

NEW YORK (Reuters Health) Mar 24 - Infants with snoring-related respiratory arousal have lower scores on standardized mental development assessments, the results of a study published in the March issue of Pediatrics suggest. Exposure to secondhand cigarette smoke may contribute to the deleterious effects of infant snoring.

"The link between sleep-disordered breathing and neurocognitive functioning in preschool and school-aged children now has been established clearly," Drs. Hawley E. Montgomery-Downs, of West Virginia University, Morgantown, and David Gozal of the University of Louisville in Kentucky point out.

In their study, the researchers assessed the potential association between snoring and decrements in developmental performance among 35 healthy infants. The possible contribution of exposure to cigarette smoke was also examined. The infants (mean age 8.2 months) underwent full overnight polysomnography recordings, and were administered the Bayley Scales of Infant Development, including the Mental Developmental Index.

Respiratory arousal index was significantly negatively correlated with Mental Development Index and snoring-associated arousals accounted exclusively for this association. No significant correlation was found between Mental Development Index score and spontaneous arousals, arousals associated with episodes of central apnea or oxyhemoglobin desaturation. All infants had an apnea-hypopnea index of 0.

Thirty-three percent of the infants were from a home in which at least one parent smoked. Infants from smoking households were more likely to snore and significantly more likely to have respiratory-related arousals. However, no significant differences on Mental Development Index scores were seen between infants from smoking or non-smoking households.

"This study and others clearly support the need for identification and evaluation of the youngest children with recognizable risk factors for sleep disordered breathing," the authors conclude. "This may pose a formidable challenge when we consider that the symptoms of sleep disordered breathing, such as snoring, are less frequently the presenting complaint in such children when compared with associated comorbidities, such as recurrent upper respiratory tract infections and delays in growth and development."

NEW YORK (Reuters Health) Mar 24 - Clinical trials have suggested that aspirin prophylaxis is less effective in preventing MI in women than in men, although women do benefit from a similar reduction in risk of ischemic stroke. However, new study results show that the lower efficacy in women is not due to a failure of aspirin to suppress platelet aggregation, as has been proposed.

"Women are clearly benefiting from taking aspirin and should continue to take it to improve their cardiovascular health," Dr. Diane M. Becker states in a Johns Hopkins press release. "Aspirin has been proven by all previous studies to lower the risk of stroke and, as our latest findings show, it also reduces platelet aggregation that can lead to potentially fatal clots in blood vessels."

To explore why aspirin seems to exert different effects in men and women, Dr. Becker, from Johns Hopkins Medical Institutions in Baltimore, and her team studied the effects of 14 days of aspirin therapy on platelet reactivity in unaffected individuals from families with premature coronary disease. They report their findings in the Journal of the American Medical Association for March 22/29.

Included in the study were unaffected healthy siblings of 403 patients with coronary heart disease events before 60 years of age, along with their adult offspring (571 men, 711 women). Platelet function was assessed at baseline and after 14 days of aspirin 81 mg daily, upon exposure to several agonists.

At baseline, platelet aggregation in reaction to all agonists was higher in women than in men, though the differences were "modest," the authors note.

For example, whole blood exposed to arachidonic acid 0.5 mM (which directly measures the cyclooxygenase-1 pathway, considered to be the most protective against MI), aggregation was 94.9% in men and 98.0% in women. Corresponding values after exposure to collagen 1 g/mL were 20.9% and 22.0%.

After aspirin treatment, most men and women demonstrated zero aggregation after exposure to arachidonic acid.

In platelet aggregation assays indirectly related to COX-1 (exposure to collagen, adenosine diphosphate and epinephrine), women demonstrated more inhibition but still had modestly but significantly more residual aggregation.

Closure time was measured in whole blood loaded into cartridges containing collagen and epinephrine. It was similar between men and women at baseline, but after aspirin, 32.4% of men and 50.8% of women had platelet function analyzer closure times of less than 300 seconds.

Multivariable analyses showed that the greatest contribution to the total variance in aggregation outcomes after exposure to agonists was the baseline level of aggregation. In most analyses, sex was not a significant predictor after adjustment for baseline aggregation.

"Although women in our study still retained a modest residual platelet reactivity that exceeds that of men, regardless of age," Dr. Becker's team concludes, "there is virtually total suppression of the COX-1 direct platelet function pathways in most women."

Intake of dairy foods and calcium is inversely related to risk for colon cancer, according to the results of a large, prospective cohort study reported in the March issue of the American Journal of Clinical Nutrition.

"Recent epidemiologic studies have generally reported a modest inverse association between calcium intake and the risk of colorectal cancer," write Susanna C. Larsson, MD, from Karolinska Institutet in Stockholm, Sweden, and colleagues. "However, findings pertaining to specific subsites in the colorectum have been conflicting."

In the Cohort of Swedish Men, 45 306 men aged 45 to 79 years and without a history of cancer completed a food-frequency questionnaire in 1997 and were followed up through December 31, 2004.

During a mean follow-up of 6.7 years, 449 incident cases of colorectal cancer occurred. After adjustment for age and other risk factors, the multivariate rate ratio (RR) of colorectal cancer for men in the highest quartile of total calcium intake compared with those in the lowest quartile was 0.68 (95% confidence interval [CI], 0.51 - 0.91; P for trend = .01).

High dairy consumption was also associated with a lower risk for colorectal cancer. Colorectal cancer risk for 7 servings/day or more of total dairy foods was about half that for less than 2 servings/day (multivariate RR, 0.46; 85% CI, 0.30 - 0.71; P for trend = .01). Milk was the dairy food that was most strongly inversely associated with the risk for colorectal cancer.

For cancer subsites, RRs were 0.37 for proximal colon (95% CI, 0.16 - 0.88), 0.43 for distal colon (95% CI, 0.20 - 0.93), and 0.48 for rectum (95% CI, 0.23 - 0.99).

"Our findings provide support for inverse associations between intakes of calcium and dairy foods and the risk of colorectal cancer," the authors write. "The associations did not vary significantly by subsite in the colorectum."

Study limitations include possible misclassification of calcium intake, and the possibility of unmeasured confounders accounting for the observed associations.

"Future studies should examine the relation of other components of dairy foods, such as conjugated linoleic acid, sphingolipids, and milk proteins, with the risk of colorectal cancer," the authors conclude.

The Swedish Cancer Foundation, the Swedish Research Council-Longitudinal Studies, the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), Västmanland County Research Fund against Cancer, Örebro County Council Research Committee, and Örebro Medical Center Research Foundation supported this study. The authors have disclosed no relevant financial relationships.

In an accompanying editorial, James C. Fleet, from Purdue University in West Lafayette, Indiana, calls this a powerful study with a large population linked to well-maintained, complete health records.

"Although this study offers some new insight into the dietary modulation of colon cancer, one is still likely to feel that this story has a lot more to reveal and that [this article] only begins to address these gaps," Dr Fleet writes. "Given that the interaction between vitamin D status and calcium metabolism is well established and that vitamin D status appears to modulate the effect of calcium on colon cancer risk, future studies on calcium or dairy intakes and cancer risk should not ignore it."

NEW YORK (Reuters Health) Mar 24 - Oral contraceptives improved features of polycystic ovary syndrome (PCOS) in adolescent girls but have an unfavorable impact on insulin resistance, according to a report in the February issue of Fertility and Sterility.

Adolescent girls with PCOS often have reduced insulin sensitivity, hepatic insulin resistance, and compensatory hyperinsulinemia, the authors explain. Oral contraceptives may worsen these features.

Dr. George Mastorakos and colleagues from Athens University School of Medicine, investigated the effect on carbohydrate metabolism of two combined oral contraceptives containing cyproterone or desogestrel as progestogenic compounds in 36 adolescent girls with PCOS.

Although body mass index and waist-to-hip ratio remained unchanged during treatment, three patients developed impaired fasting glucose and another three patients developed impaired glucose tolerance after 12 months of treatment, the authors report.

The fasting glucose-to-insulin ratio declined after 12 months of treatment in both groups, the results indicate, although the decline was statistically significant only in the cyproterone group. Similarly, the insulin sensitivity index decreased significantly and insulin secretion increased significantly only in the cyproterone-treated group.

"Both combined oral contraceptive formulations are effective in ensuring normal menstrual cyclicity and in reducing hirsutism in adolescent patients with PCOS," the authors note. "Both treatments have an unfavorable impact on insulin resistance. However, as has been suggested in the past, this effect is not translated into a clinically relevant major impact."

"The positive correlation between insulin values and body mass index in women with PCOS suggests that obese teenage patients, along with psychological support, should also be encouraged to lose weight and exercise in an effort to improve the clinical and metabolic features of the syndrome," the researchers conclude.

More than 2 million women living in the U.S. have been treated for or are living with breast cancer, and more than 40,000 women are expected to die from the disease in 2006. Though breast cancer death rates are declining -- mostly due to earlier diagnosis -- the disease remains the second leading cause of cancer death in women (after lung cancer).

Depending on the characteristics of the tumor, treatment for early-stage breast cancer can include surgery or radiation and may also include the use of hormonal therapy, chemotherapy, or biological ("targeted") therapies. For metastatic breast cancer, or cancer that has spread to other parts of the body, therapies that affect the entire body (systemic therapies) are used, such as hormonal therapy, chemotherapy, or biological therapies. Researchers are focusing on the best way to use these treatments to gain the most favorable results with the least amount of side effects and they are making headway. Experts presented their findings at the 2005 San Antonio Breast Cancer Symposium.

Advances in Hormonal Therapy for Postmenopausal Women

Tamoxifen has been available for the treatment of early-stage breast cancer since the 1980s; but, more recently, a new class of drugs called aromatase inhibitors has been found to produce better results when compared directly with tamoxifen. Aromatase inhibitors, indicated for use in postmenopausal women, act by blocking the formation of estrogen, which fuels the growth of "hormone receptor-positive" breast cancers.

The three aromatase inhibitors approved in the U.S. include Femara, Aromasin, and Arimidex.

Several studies are under way to find out the best strategy for using these agents in patients who have already received tamoxifen. One study presented at the breast cancer symposium reported increased disease-free survival when patients received two to four years of Femara instead of a placebo (sugar pill) after receiving five years of tamoxifen. In particular, patients who had disease that had spread to their lymph nodes seemed to show the greatest benefit from continued Femara use.

Likewise, a study comparing Femara to placebo suggested that patients who took a placebo following five years of tamoxifen therapy and then chose to switch to Femara experienced significantly longer survival -- both disease-free and overall -- than did patients who continued taking placebo. In other words, these results suggest that there is still risk of recurrence after finishing a five-year course of tamoxifen, but that benefit may still be gained from taking Femara even when there is a delay between its initiation and ending tamoxifen.

Positive results have also been demonstrated with Arimidex, another aromatase inhibitor, in the treatment of early-stage breast cancer. One study found that switching to Arimidex after two to three years of tamoxifen was linked to better survival without disease recurrence after five years compared with staying on tamoxifen for five years.

Similar findings have been reported for Aromasin.

Together, these findings help to confirm that aromatase inhibitors provide significant benefit to patients with early-stage breast cancer.

"I think that the message that we should get from these and other recent studies is that tamoxifen has prevented thousands of recurrences and has saved thousands of lives," says Henning Mouridsen, MD, with the Copenhagen University Hospital in Denmark. "But the advent of the new aromatase inhibitors is going to further improve the prognosis of postmenopausal patients with estrogen receptor-positive tumors."

Targeted Cancer Treatments

Perhaps the most important breakthrough in cancer treatment over the past few years has been the introduction of so-called "targeted" therapies. Rather than the sledgehammer effect achieved by traditional therapies, the newer targeted therapies are designed to home in on cancer cells like a missile while leaving the healthy cells untouched. As a result, these agents lack many of the severe side effects associated with chemotherapy.

Herceptin, an effective targeted therapy for breast cancer, attaches to a protein on the surface of breast cancer cells called HER2 that transmits growth-stimulating signals to cells. By blocking the actions of HER2, Herceptin slows or stops the growth of tumor cells. Herceptin is effective in tumors that express large amounts of the HER2 protein (described as HER2-positive), which is the case in about 25% of patients.

Results from several trials of Herceptin in early-stage breast cancer have confirmed the striking effectiveness of this agent when used with or after chemotherapy. However, the results are preliminary, and further studies are needed to determine the best way to combine Herceptin with chemotherapy, how long to give it, and which patients might benefit the most.

At the breast cancer meeting, Dennis Slamon, MD, presented results from a large international trial that evaluated three treatment regimens, two of which contained Herceptin. Both of the Herceptin-containing treatments were more effective in reducing disease recurrence than the non-Herceptin-containing regimen. However, an increased risk of heart problems was seen in both Herceptin-containing groups. Adriamycin, a chemotherapy agent used in one of the Herceptin containing treatments, has also been linked to heart-related side effects -- making researchers particularly cautious about combining Adriamycin with Herceptin. Therefore, it was encouraging to see that both of the Herceptin-containing regimens -- one containing Adriamycin and the other not -- were effective.

This study also identified certain genetic changes in breast tumors that may indicate increased susceptibility of the tumor -- meaning a better response -- to Adriamycin treatment. In patients with these types of tumors (about 30% of the patients tested), researchers suggested that the added risk of heart problems from Herceptin and Adriamycin might be worthwhile given the superior treatment effect, although these data need further confirmation.

One question that remains unanswered with regard to Herceptin is how long patients should keep taking the drug. Given the high cost and the potential for rare but serious heart side effects, it is important to know if patients would also benefit from a shorter course of the therapy. An intriguing study presented at the meeting found that Herceptin given for only nine weeks alongside a chemotherapy regimen was also able to decrease breast cancer recurrence. The tentative conclusion of the study indicated that short-term use of Herceptin appears to be effective and may be better tolerated than a longer one-year regimen.

Advances in hormonal and biological therapies and optimized chemotherapy dosing for breast cancer will help doctors better treat early-stage breast cancer and breast cancer that has spread to other parts of the body.

More than 2 million women living in the U.S. have been treated for or are living with breast cancer, and more than 40,000 women are expected to die from the disease in 2006. Though breast cancer death rates are declining -- mostly due to earlier diagnosis -- the disease remains the second leading cause of cancer death in women (after lung cancer).

Depending on the characteristics of the tumor, treatment for early-stage breast cancer can include surgery or radiation and may also include the use of hormonal therapy, chemotherapy, or biological ("targeted") therapies. For metastatic breast cancer, or cancer that has spread to other parts of the body, therapies that affect the entire body (systemic therapies) are used, such as hormonal therapy, chemotherapy, or biological therapies. Researchers are focusing on the best way to use these treatments to gain the most favorable results with the least amount of side effects and they are making headway. Experts presented their findings at the 2005 San Antonio Breast Cancer Symposium.

Advances in Hormonal Therapy for Postmenopausal Women

Tamoxifen has been available for the treatment of early-stage breast cancer since the 1980s; but, more recently, a new class of drugs called aromatase inhibitors has been found to produce better results when compared directly with tamoxifen. Aromatase inhibitors, indicated for use in postmenopausal women, act by blocking the formation of estrogen, which fuels the growth of "hormone receptor-positive" breast cancers.

The three aromatase inhibitors approved in the U.S. include Femara, Aromasin, and Arimidex.

Several studies are under way to find out the best strategy for using these agents in patients who have already received tamoxifen. One study presented at the breast cancer symposium reported increased disease-free survival when patients received two to four years of Femara instead of a placebo (sugar pill) after receiving five years of tamoxifen. In particular, patients who had disease that had spread to their lymph nodes seemed to show the greatest benefit from continued Femara use.

Likewise, a study comparing Femara to placebo suggested that patients who took a placebo following five years of tamoxifen therapy and then chose to switch to Femara experienced significantly longer survival -- both disease-free and overall -- than did patients who continued taking placebo. In other words, these results suggest that there is still risk of recurrence after finishing a five-year course of tamoxifen, but that benefit may still be gained from taking Femara even when there is a delay between its initiation and ending tamoxifen.

Positive results have also been demonstrated with Arimidex, another aromatase inhibitor, in the treatment of early-stage breast cancer. One study found that switching to Arimidex after two to three years of tamoxifen was linked to better survival without disease recurrence after five years compared with staying on tamoxifen for five years.

Similar findings have been reported for Aromasin.

Together, these findings help to confirm that aromatase inhibitors provide significant benefit to patients with early-stage breast cancer.

"I think that the message that we should get from these and other recent studies is that tamoxifen has prevented thousands of recurrences and has saved thousands of lives," says Henning Mouridsen, MD, with the Copenhagen University Hospital in Denmark. "But the advent of the new aromatase inhibitors is going to further improve the prognosis of postmenopausal patients with estrogen receptor-positive tumors."

Oral Chemotherapy Agents

A recently approved drug for kidney and stomach cancer is emerging as a potential treatment for breast cancer. Sutent, like Avastin, also stops the development of the tumor's blood supply but is given orally. This agent has demonstrated its effectiveness when used alone, without additional chemotherapy or hormonal therapy, in patients with previously treated metastatic breast cancer. In one study of 64 patients treated, 16% responded favorably.

Findings about an experimental oral drug, lapatinib, were also presented at the meeting. Like Herceptin, lapatinib targets HER2, but it also targets a related protein called EGFR, meaning that it could have a broader range of effectiveness or could be especially effective when added to Herceptin. One small study evaluated the combination of lapatinib and Herceptin in patients with metastatic breast cancer. The researchers reported no additional or unexpected side effects with the combination. Moreover, a good percentage of this difficult-to-treat population responded to the treatment.

"We are very excited about the results of all of these studies with these new agents, and they clearly demonstrate a role for this type of therapy in the treatment of metastatic breast cancer," Miller says. "We also expect an even greater benefit for these therapies when used for earlier-stage disease as opposed to the metastatic setting."

Trying your hand at gardening may be a best-kept secret to getting and staying in shape.

Gardening can be a great workout and boost for body and soul -- if you do it right.

Sharon Lovejoy, author of Country Living Gardener: A Blessing of Toads, tells WebMD she started gardening as an infant. Her grandmother, not her mother, was the gardener in the family. "I think it often skips a generation," she says.

The key, Lovejoy says, is to see gardening not as a punishment but a joy. "You should feel lucky to be outside in the garden," she says.

And maybe healthier, too. And not just from eating veggies you grew yourself.

Aerobic Gardening

Gardening provides all three types of exercise: endurance, flexibility, and strength.

Jeff Restuccio, author of Fitness the Dynamic Gardening Way, is a first-degree black belt but found he was getting more exercise playing in the garden with his kids. "I like gardening because it's purposeful," he tells WebMD. "With food so cheap in the stores, you may not save money growing your own, but the chances are, if you grew it, your family will eat it."

He suggests making your gardening into a structured exercise routine, alternating light activities with heavier ones, then a light one, and so on. Rake for a while, then dig holes, then prune. "Exercise 30 to 60 minutes, then quit, whether everything is planted or not," he advises.

"Stretch first!" Lovejoy begs. "You'd stretch before going to the gym, wouldn't you?"

Restuccio also recommends concentrating on deep breathing while you work -- and increasing your range of motion, exaggerating the raking motion or the digging motion. "You can use up 500 calories an hour that way," he says (official counts put gardening activities at the 100- to 200-per-hour calorie-burning level).

He also recommends raking right-handed 15 times, then left-handed 15 times.

"If you think double digging (going down a foot, turning the soil over, then down another foot, bringing that soil to the top) isn't exercise," he says, "you haven't tried it."

Gardening is something parents and kids can do together. "Never make cutting the grass or helping a punishment," she urges.

"When I go into the schools, I see so many more obese kids than I did 20 years ago," Lovejoy says. "I think parents are afraid to let them out."

You never know where those seeds, if you will pardon the expression, will fall or when they will sprout. "Many of us probably had to weed the garden," Sandra Mason, an extension educator in horticulture and environment at the University of Illinois, tells WebMD. "A lot [of people] come back to gardening later -- maybe when [they] purchase a home."

Gardening as Therapy

The American Horticulture Therapy Association concentrates on the cleansing, calming benefits of being in the natural world.

• Lovejoy says studies have shown a link between ADHD and insufficient outdoors time.
• "Hospital patients also do better when looking at a plant rather than a cinderblock wall," she says. "Maybe that is how bringing flowers to the hospital got started."
• Older people, even those with memory problems, thrive in a community gardening situation, according to the AHTA.
• Special gardens have also sprung up for the blind, the wheelchair-bound (raised beds), and people with mental disabilities.(2)

  Just walking into a fragrant, warm greenhouse can change someone's whole mood, Lovejoy points out.

  Getting Started and Keeping It Up

  When you walk away from the garden, however, it doesn't sit there like an elliptical trainer waiting for you to come back. It starts changing. The keys to making gardening a hobby you can maintain include:

• Start small. A 4-foot by 6-foot bed can produce a lot of tomatoes or cut flowers. Or you can garden in containers, just be sure they are large enough that they don't dry out too quickly. Containers are great for city folk and those without a back 40, also.
• Be realistic. Peonies are not going to live in Phoenix. Forget it. You need to learn your growing region number (check any catalog, because these will soon be a part of your life, too). Stick with plants with a chance of survival. Constantly killing inappropriate species can rasp on your last nerve.
• Don't do one activity each time you go out there. "Switch every 30 minutes," Mason advises.
• Take regular breaks. "I sometimes put a rock or something to show where I am quitting the weeding," Mason says. You can also set a timer.
• Lift heavy bags carefully. Remember the old saw: Lift with your legs. "Use your biggest, strongest muscles for the heavy stuff," Mason notes. She also says to watch the twisting. "We tend to lift a shovel of dirt, then twist to the side to dump it. Move your feet instead."
• If you have allergies, talk to your doctor about it. Lovejoy doesn't stop gardening, she takes a Benadryl. Mason points out that you can sort of de-allergize your yard. "Plants pollinated by bees tend to have heavier pollen that doesn't fly around as much," Mason says. "Wind-pollinated trees and plants tend to cause more trouble."
• Don't throw poison everywhere. This seems so obvious, but when people see a bug, Lovejoy says, they grab a can. "Usually a squirt of water to get the bug off the plant does the trick," she says. This goes for water gardens, too. Algaecides can cause an imbalance. Instead, cover the surface with as many lilypads as you can.
• Don't flip for fertilizer, either. "Fertilizers are like vitamins," Mason says. "What you have naturally may be enough." Better to feed the soil with compost, she says.
• Check out all the new tools. Mason says there are new implements for people with arthritic hands or people with carpal tunnel syndrome (which she has). "Certain gloves can improve your grip," she says.
• If you are heaving off the couch to garden, take it slowly. Sedentary people who suddenly start exercising vigorously risk injury.
• Take a nice hot bath after gardening. You've earned it!

  Finally, "don't forget to enjoy your work," Mason says. "Garden benches are meant to be sat on."

  Mason adds: "Go out in your garden every morning. Greet your garden. It will make you feel so good to start the day."

Patients who become depressed after heart attack have been shown to have an increased risk of dying in subsequent months, but now researchers report that risk evens out on down the road.

Johns Hopkins researchers have found 20% of patients have mild to moderate depression after heart attack. An earlier study by Duke researchers showed that these depressed patients had a fourfold increased risk of dying, but the current study of 280 heart attack patients shows that risk of dying evens out over three, five, and eight years.

"The good news is that depression after a heart attack doesn't provide a lifelong sentence of being at higher risk for death," said Roger S. Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who commented on the study. "In the long run things come back to baseline."

The Maryland researchers examined the long-term association between depression and mortality in post-heart attack patients. The results were reported at the American College of Cardiology annual meeting.

One in five of the heart attack patients, or 56 of 280 patients, were found to have mild to moderate depression using the Beck Depression Inventory, a survey used to evaluate depression.

Patients who were depressed after experiencing a heart attack had longer hospitalizations, their hearts weren't pumping as strongly, and they reported lower social support than patients who weren't depressed.

Although there were 68 deaths after three years, 98 deaths at five years, and 136 deaths at eight years, depressed patients did not have an increased rate of death compared with other heart attack patients.

"Depression is a very important risk factor after heart attack," Kapil Parakh, MPH, of Johns Hopkins Bayview Medical Center tells WebMD. "We have shown in previous groups that depression after heart attack increases the risk of death in the next few months, but as the years go by depression is no longer associated with mortality."

While depression is an important risk factor for death after heart attack, depression appears to have the greatest impact in the immediate months after heart attack, Parakh says. "It's important to treat patients with depression."

Blumenthal says it is unknown whether those patients at high risk have died or whether the depression, like that after the death in the family, subsides in time.

"Either way that short-term risk doesn't appear to be maintained," he says. "Family members must remember that heart attack is a traumatic event that can cause depression. It can influence lifestyle habits and compliance in taking medications.

"Friends and family should alert the physician to depression in a heart attack patient," he notes.

Obesity surgery might help get high blood pressure under control.

The finding comes from John Fernstrom, PhD, and colleagues of the University of Pittsburgh's medical school.

They report that among very obese people, blood pressure often dipped after weight loss surgery, especially for people with previously untreated high blood pressure.

The results could help show which patients "are likely to experience substantial improvements in blood pressure" after gastric bypass surgery and possibly no longer need medicine to control blood pressure, Fernstrom says in a news release.

Fernstrom's study appears in the Archives of Surgery. It comes on the heels of a report by other researchers showing that weight loss surgery may help avoid heart disease and stroke.

Before and After Surgery

Fernstrom's team checked the medical records of 347 people who got weight loss surgery.

The patients were "very obese" before surgery, with an average BMI (body mass index) of 50-55, the researchers write. A BMI of 30 or more is considered obese. Being overweight or obese can boost blood pressure, the researchers write.

Before gastric bypass surgery, 192 patients had high blood pressure. Of those patients, 103 were taking prescription drugs to control their blood pressure. High blood pressure was defined as a reading of 140 or higher for systolic pressure (top number), 90 or higher of diastolic pressure (bottom number), or both.

Average BMI fell to 35 during the first 12-18 months after surgery. That's a big drop, but a BMI of 35 is still obese, Fernstrom and colleagues note.

After surgery, 92 patients still had high blood pressure, with 68 taking blood pressure medicines. Of the 103 patients taking blood pressure drugs before surgery, 35 stopped taking those drugs in the months after surgery, the study shows.

Biggest Improvements

The biggest blood pressure improvements were seen in patients who had had untreated high blood pressure before surgery, write Fernstrom and colleagues.

Patients with normal blood pressure and those already being treated for high blood pressure had less room for improvement. Diastolic blood pressure improved more than systolic blood pressure.

The researchers checked the patients' medical charts for nearly two years after surgery. It's not yet clear if the patients' BMI and blood pressure improvements lasted longer than that, the researchers note.

The patients' medical charts don't track changes in the patients' eating habits or physical activity, which may also affect blood pressure.

If you're one of the millions of Americans whose blood pressure is creeping above normal, take note: A new study suggests the blood-pressure-lowering drug Atacand may be able to delay the development of full-blown hypertension among people whose blood pressure is slightly high.

In a new study, taking the drug for two years appeared to prime the body to keep blood pressure in check, even when the person stopped the drug for another two years.

The strategy isn't ready for prime time yet. But if it pans out in future research, it promises a host of rewards, says researcher Stevo Julius, MD, ScD, an emeritus professor of cardiovascular medicine at the University of Michigan Medical Center in Ann Arbor.

That's because people with 'prehypertension' are on the verge of developing the real thing, with all its risks: heart attacks, strokes, hospitalization, even death. To avoid these consequences, doctors put people with hypertension on blood-pressure-lowering pills -- often for life.

"Having to take medication for hypertension is a life sentence and patients don't like it," Julius tells WebMD. "This [strategy] could at least give people a chance."

The study, which was presented here at the American College of Cardiology annual meeting, was simultaneously published online in The New England Journal of Medicine.

Atacand and Hypertension Risk

Prehypertension is defined as having systolic blood pressure (the top number in a blood pressure reading) of 120 mm Hg to 139 mm Hg or diastolic pressure (the bottom number) of 80 mm Hg to 89 mm Hg. A person's blood pressure is considered high if the systolic pressure is 140 or higher or the diastolic pressure is 90 or higher. Normal blood pressure is a systolic reading of less than 120 and a diastolic reading of less than 80.

For the study, the researchers studied 772 people who fell into the high end of prehypertension, with systolic blood pressure readings of 130-139 and a diastolic reading of 89 or lower or a systolic pressure of 139 or lower and a diastolic pressure of 85 to 89.

For two years, half the participants were given Atacand and the other half, a placebo. Then for the next two years, they all were given placebo. All the participants also got diet and exercise counseling throughout the four-year study.

During the first two years, people on Atacand were two-thirds less likely to develop high blood pressure.

During the second two-year period with all participants taking placebo, there was still a significant difference in high blood pressure rates between the two groups, although it wasn't as large. The participants who had originally been on Atacand were 16% less likely to develop high blood pressure than the original placebo group after four years.

The risk of side effects was low in both groups.

Postponing High Blood Pressure

"The bottom line," Julius says, "is that if you treat early, the drug is well-tolerated and you can postpone hypertension. Two years of treatment with Atacand gives you one year of extra protection."

That said, "the effect was moderate and we need to improve on it," he says.

James H. Stein, MD, co-chairman of the cardiology meeting and associate professor of medicine at the University of Wisconsin Medical School in Madison, agrees.

While Stein says he found the 16% difference in hypertension rates disappointing, "the hypothesis is still alive."

The problem may have been that treatment wasn't started early enough, he tells WebMD.

"It's wishful thinking that starting medication when a person already has a blood pressure reading in the 130s will allow them to later go off their medication without consequence," he says. "Maybe if we started a person on treatment when their reading was still in the 120s, hypertension could be better forestalled or prevented."

Julius agrees, and hopes he gets funding to perform such a study.

While only Atacand was tested in this trial, Julius says he suspects that other blood pressure drugs would also work.

The study, called the Trial of Preventing Hypertension or TROPHY study, was funded by AstraZeneca, which makes Atacand. AstraZeneca is a WebMD sponsor.

NEW YORK (Reuters Health) Mar 23 - British researchers who conducted a meta-analysis of trials found no strong evidence that consuming omega 3 fatty acids for at last 6 months has a clear effect on mortality, cardiovascular events, or cancer.

UK guidelines encourage consumption of more oily fish, especially after myocardial infarction, Dr. Lee Hooper and associates note in their report, published in BMJ Online First on March 23.

To see if such recommendations are justified, Dr. Lee, from the University of East Anglia in Norwich, and colleagues reviewed 48 randomized control trials (RCTs) that included nearly 37,000 participants, and 41 prospective cohort studies that included more than 570,000 subjects.

When including all RCTs, the relative risk (RR) of death was 0.87 among subjects assigned to omega 3; however, the authors note that the evidence was "weak" and that "inconsistency was moderate." When they evaluated the 25 RCTs rated as having a low risk of bias, the RR was 0.98. Results were similar for long chain versus short chain omega 3, and for dietary advice versus supplements.

In the cohort studies, omega 3 seemed to protect against death (RR 0.65), but the authors note that adjustment for confounders may not have been adequate.

The 18 RCTs that examined cardiovascular events yielded an RR of 0.95 with wide confidence intervals and high inconsistency.

Ten RCTs and seven cohort studies that evaluated cancer incidence showed no protective effect (RR 1.07 and 1.02, respectively).

Dr. Hooper's team advises that the general public should still be encouraged to eat more oily fish after MI, "but evidence should be reviewed regularly." They add, "It is probably not appropriate to recommend a high intake of omega 3 fats for people who have angina but have not had a myocardial infarction."

In a related editorial, Dr. Eric Brunner, from Royal Free and University College London Medical School, points out the added complication that the supply of oily fish is dwindling due to overfishing. Therefore, "we probably do not have a sustainable supply of long chain omega fats."

NEW YORK (Reuters Health) Mar 22 - While carotid sinus hypersensitivity (CSH) is the most commonly reported cause of syncope and falls in the elderly, it is also seen in about a third of those who have not experienced such events, UK researchers report in the March 13th issue of the Archives of Internal Medicine.

To determine the prevalence of CSH, Dr. Simon J. Kerr of Newcastle General Hospital and colleagues randomly sampled patients over 65 years of age from a single general practice. In all, 272 underwent supine and upright carotid sinus massage with continuous heart rate and phasic blood pressure monitoring -- the recommended diagnostic procedure.

CSH was defined as asystole for 3 seconds or longer and/or a drop in systolic blood pressure of 50 mm Hg or greater. CSH was present in 107 (39%) of the subjects, and 16% had symptoms including syncope.

Of 80 previously asymptomatic subjects, 28 (35%) had CSH.

Given that CSH is a common finding, the researchers conclude that its presence "should not necessarily preclude further investigation for other causes of syncope."

Dr. Neil L. Coplan of Lenox Hill Hospital, New York, author of an accompanying editorial told Reuters Health that "if carotid sinus hypersensitivity is associated with symptoms, it should be considered as a likely possibility to explain the cause for the presenting complaint and treatment should be instituted."

However, "if there are no symptoms associated with the exaggerated carotid artery reflex or if the carotid sinus hypersensitivity is demonstrated in a patient who does not have a complaint of transient neurological symptoms, the clinical significance of the carotid sinus massage results needs to be questioned," he advised.

Too Much or Too Little Sleep May Raise Risk of Developing Diabetes

Skimping on sleep or overindulging in sleep might make diabetes more likely.

A study in Diabetes Care shows men who got little sleep (up to five or six nightly hours) or a lot of sleep (more than eight hours per night) were more likely to develop diabetes than men with moderate amounts of nightly sleep.

The study included more than 1,100 middle-aged and elderly men living in and around Boston. The researchers included H. Klar Yaggi, MD, MPH, of Yale University's medical school.

Getting too much or too little sleep could be a risk factor for diabetes, Yaggi's team reports.

Sleep and Diabetes

When the study started in the late 1980s, none of the men had diabetes.

They provided blood samples and were interviewed about their health habits, including their average hours of nightly sleep. Follow-up interviews were done in the mid-1990s and in 2002-2004.

Ninety new cases of diabetes were diagnosed during the study.

"Generally, those at the extremes in sleep duration [up to five hours and more than eight hours of sleep per night] had a worse risk profile in terms of diabetes risk than those who reported seven hours of sleep per night," Yaggi and colleagues write.

They took into account other factors that boost diabetes risk. Even so, nightly hours of sleep mattered.

Seven Hours Ideal?

Seven hours of nightly sleep might be ideal for taming diabetes risk, the study suggests.

Compared to men who slept for seven hours per night, diabetes risk was twice as high for men reporting little nightly sleep (less than five or six hours) and three times as high for men reporting lots of sleep (more than eight hours per night).

Think of Goldilocks, the fictional character from fairy tales. She hunted for a bed that wasn't too hard or too soft, and for porridge that wasn't too hot or too cold. The "just right" level was Goldilocks' goal, and if Yaggi's study is right, seven hours of sleep might be "just right" for lowering diabetes risk.

However, Yaggi's study doesn't prove that sleep habits caused (or prevented) diabetes in any of the men. Men reporting seven hours of nightly sleep also tended to be younger, more educated, in better health, and had higher testosterone levels, the study shows.

They add that the effects of sleep on diabetes risk may be mediated by changes in testosterone. Other studies have shown that low testosterone has been associated with risk factors for diabetes including obesity, body fat distribution, and insulin resistance.

Risk of Death Tied to Post-Heart Attack Depression Lessens Over Years

Patients who become depressed after heart attack have been shown to have an increased risk of dying in subsequent months, but now researchers report that risk evens out on down the road.

Johns Hopkins researchers have found 20% of patients have mild to moderate depression after heart attack. An earlier study by Duke researchers showed that these depressed patients had a fourfold increased risk of dying, but the current study of 280 heart attack patients shows that risk of dying evens out over three, five, and eight years.

"The good news is that depression after a heart attack doesn't provide a lifelong sentence of being at higher risk for death," said Roger S. Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who commented on the study. "In the long run things come back to baseline."

The Maryland researchers examined the long-term association between depression and mortality in post-heart attack patients. The results were reported at the American College of Cardiology annual meeting.

One in five of the heart attack patients, or 56 of 280 patients, were found to have mild to moderate depression using the Beck Depression Inventory, a survey used to evaluate depression.

Patients who were depressed after experiencing a heart attack had longer hospitalizations, their hearts weren't pumping as strongly, and they reported lower social support than patients who weren't depressed.

Although there were 68 deaths after three years, 98 deaths at five years, and 136 deaths at eight years, depressed patients did not have an increased rate of death compared with other heart attack patients.

"Depression is a very important risk factor after heart attack," Kapil Parakh, MPH, of Johns Hopkins Bayview Medical Center tells WebMD. "We have shown in previous groups that depression after heart attack increases the risk of death in the next few months, but as the years go by depression is no longer associated with mortality."

While depression is an important risk factor for death after heart attack, depression appears to have the greatest impact in the immediate months after heart attack, Parakh says. "It's important to treat patients with depression."

Blumenthal says it is unknown whether those patients at high risk have died or whether the depression, like that after the death in the family, subsides in time.

"Either way that short-term risk doesn't appear to be maintained," he says. "Family members must remember that heart attack is a traumatic event that can cause depression. It can influence lifestyle habits and compliance in taking medications.

"Friends and family should alert the physician to depression in a heart attack patient," he notes.

Nail color and texture can reflect a wide range of medical conditions.

But can a doctor truly detect undiagnosed heart disease or kidney problems by looking at your nails? American College of Physicians spokeswoman Christine Laine, MD, MPH, says it's not likely. She doesn't dispute the connection between nails and disease, but she cautions, "Nail changes are rarely the first clue of serious illness. In most instances, patients will manifest other signs or symptoms of disease before nail changes become evident. For example, it would be unusual that nail clubbing was the first thing a patient with emphysema noticed. Breathing difficulty probably would have been present already."

In addition, Laine, who is the senior deputy editor of the Annals of Internal Medicine, notes that certain illnesses may cause nail changes in some patients but not in others. "For example, not all people with liver disease develop white nails," Laine tells WebMD. The reverse is true as well - not everyone with white nails has liver disease. "In the absence of other signs or symptoms of disease, I would be reluctant to launch a complex, expensive work-up for systemic disease solely because of nail findings."

Fox agrees there is no need to run to the nearest cardiologist if your nail beds turn red. "It could very well be from nail polish," he says. Before assuming the worst, it's important to look at more common explanations, such as bruises, bleeding beneath the nail, and fungal infections.

When to See a Dermatologist

Many common nail disorders stem from fungal infections, which can cause the nails to crack, peel, and change color and texture. These infections often prove difficult to treat and may require professional help, including prescription antifungal medications. Fox says it's best to see a dermatologist if symptoms persist, especially if the nails start to dislodge from the base or you experience pain and swelling.

Changes in texture, shape, or color that aren't due to a bruise or fungal infection, including irregular growth, pitting or holes in the nails, dark brown streaks beneath the nail and cuticle, or long-standing warts on the nail bed are particular concerns. According to Lior, they can indicate skin cancer. "Warts around the nails have a tendency to develop into squamous cell cancer," she tells WebMD. "If patients see a dark discoloration involving the cuticle, then we worry about melanoma," the deadliest form of skin cancer.

Fox advises reporting these types of changes to a specialist as soon as possible. "Dermatologists are well-trained in deciphering between innocuous and serious nail conditions, as well as determining when a change requires further testing."

Tips for Strong, Healthy Nails

To strengthen your nails, avoid infections, and improve their appearance, try the following tips:

• Keep your nails clean and dry.
• Avoid nail-biting or picking.
• Apply moisturizer to your nails and cuticles every day. Creams with urea, phospholipids, or lactic acid can help prevent cracking.
• File your nails in one direction and round the tip slightly, rather than filing to a point.
• Don't remove the cuticles or clean too deeply under your nails, which can lead to infection.
• Don't dig out ingrown toenails. See a dermatologist if they become bothersome.
• Avoid nail polish removers that contain acetone or formaldehyde.
• Bring your own instruments if you get frequent manicures.
• If you have artificial nails, check regularly for green discoloration (a sign of bacterial infection).
• Eat a balanced diet and take vitamins containing biotin.

Finally, ask your doctor to take a look at your nails during your next checkup. Fox says this is becoming more routine "because the nails offer such a unique window into the health of our bodies."

Children have less psychopathology if depression in their mothers is successfully treated, according to an assessment of children whose mothers were enrolled in a multicenter trial, as reported in the March 22/29 issue of JAMA.

"Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing," write Myrna M. Weissman, PhD, from Columbia University and the New York State Psychiatric Institute, and colleagues from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)–Child Team. "Only a few studies of children of depressed parents have suggested some benefit for children of reducing parental symptoms, but none of those published have directly treated parental depression in a definitive large sample."

Between December 16, 2001, and April 24, 2004, 151 children whose depressed mothers were being treated with medication in the multicenter STAR*D trial were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. The study, which is being conducted in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States, is ongoing, and cases are being followed up at 3-month intervals. Children were aged 7 to 17 years.

Primary outcomes include child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; and child functioning based on the Child Global Assessment Scale. Remission of depression in the mothers was defined as a score of 7 or lower on the Hamilton Rating Scale for Depression (HRSD).

Remission of maternal depression after 3 months of treatment was significantly associated with reductions in the children's diagnoses and symptoms. Children of mothers whose depression remitted had an overall 11% decrease in rates of diagnoses compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not remit. After controlling for the child's age, sex, and possible confounding factors, this rate difference remained significant (P = .01).

Of the children with a diagnosis at baseline, remission occurred in 33% of those whose mothers' depression remitted, and in 12% of those whose mothers' depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis of depression remained free of psychiatric diagnoses at 3 months. However, 17% of the children whose mothers remained depressed acquired a psychiatric diagnosis.

Findings were similar when child symptoms were used as an outcome. A greater level of maternal response was associated with fewer current diagnoses and symptoms in the children. To detect an improvement in the child, a maternal response of at least 50% was required.

"Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders," the authors write. "These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed."

Study limitations include lack of experimental design; inability to demonstrate causality or to rule out reverse causation in which children's improvement had a positive impact on mothers; low rate of women with children in the overall STAR*D study; use of a single antidepressant in an open trial design without a placebo control; lack of blinding of child assessors; inability to account for the impact of the fathers' psychiatric state; and maternal bias in reporting children's symptoms.

"From a clinical vantage point, our findings suggest that vigorous treatment of depressed mothers to achieve remission is associated with positive outcomes in their children as well, whereas failure to treat depressed mothers may increase the burden of illness in their children," the authors conclude. "At a time when there are many questions about the appropriate and safe treatment of psychiatric disorders in children, these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed."

The National Institute of Mental Health supported this study. Some of the authors have disclosed various relevant financial relationships with Eli Lilly, GlaxoSmithKline, Abbott Laboratories, Lichtwer Pharma GmbH, Lorex Pharmaceuticals, Bayer AG, Compellis, Janssen Pharmaceutica, Knoll Pharmaceutical Co, Lundbeck, Dov Pharmaceuticals, Biovail Pharmaceuticals Inc, BrainCells, Grunenthal GmBH, Sepracor, Somerset Pharmaceuticals, Aspect Medical Systems, AstraZeneca, Bristol-Myers Squibb, Cephalon, J&J Pharmaceuticals, Novartis, Organon Inc, Pharmavite, Pfizer Inc, Roche, Sanofi/Synthelabo, Solvay Pharmaceuticals, Wyeth-Ayerst, Healthcare Technology Systems Inc, Forest Pharmaceuticals, Johnson&Johnson, Cyberonics, National Institutes of Health, National Institute of Mental Health, Predix, Pfizer/Parexel, and Corcept Therapeutics Inc. Forest Laboratories provided citalopram at no cost.

By Will Boggs, MD

NEW YORK (Reuters Health) Mar 15 - Scientific presentations can influence treatment patterns before the research findings are subjected to peer review, according to a report in the March 15th issue of the Journal of the National Cancer Institute.

"I would hope for community physicians to understand the potential risk of early adoption of preliminary data," lead author Dr. Sharon H. Giordano from University of Texas M.D. Anderson Cancer Center, Houston, told Reuters Health. "As physicians, we all want to offer our patients the best therapy. However, it is equally important not to expose patients to unnecessary risks."

Dr. Giordano and colleagues investigated 3341 women with breast cancer who were diagnosed soon after a scientific presentation and widespread media coverage of the results from a trial of paclitaxel for early breast cancer, but before FDA approval for that indication.

The rate of taxane use increased from 5.2% before the May 1998 presentation at the annual meeting of the American Society of Clinical Oncology, to 23.6% after May 1998, the results indicate. The dramatic increase in taxane use was confined mostly to women with lymph node-positive breast cancer, the researchers note.

Multivariable models confirmed that women who started chemotherapy in May 1998 were nearly seven times more likely to receive a taxane than women who started chemotherapy before May 1998.

"This increase was seen well before the data were published in a peer-reviewed journal and even before FDA granted approval for the use of paclitaxel for early-stage breast cancer," the investigators write.

"Moving fast is a gamble," write Dr. Steven Woloshin and Dr. Lisa M. Schwartz from VA Outcomes Group, White River Junction, Vermont in a related editorial. "When preliminary findings turn out to be true, patients benefit. When the findings are not true, patients get hurt: They are exposed to ineffective or harmful treatments, or they forgo good alternatives."

"Physicians are confronted with preliminary research findings all the time," the editorialists conclude. "To decide whether the findings are good enough to change practice, they must be able to answer some fundamental questions. The most basic question, of course, is what is the rush?"

"Presenters at scientific meetings need to be aware of the potential impact of their presentations and take great care to provide balanced presentations on a topic," Dr. Giordano said. "Additionally, timely publication of findings that can stimulate practice change is very important."