Personal Health
Joel P. Rutkowski, Ph.D., Editor
July 3, 2003
GNC Says It Will Stop Selling Ephedra The Associated Press PITTSBURGH - Nutritional supplement retailer General Nutrition Centers on Friday announced that the company will stop selling products containing the weight-loss supplement ephedra at the end of June. GNC president Michael Meyers said the Pittsburgh-based company believes the products are safe when used as directed, but the company has found that more customers are using ephedra-free products. The Food and Drug Administration (news - web sites) has said there is evidence that products containing the herb can cause serious health problems, such as heart attacks and strokes. GNC has more than 5,300 retail stores in the United States and 26 foreign markets, including Canada and Mexico. The company is owned by Royal Numico, of the Netherlands, a baby-food maker and supplier of nutritional supplements. On the Net: GNC: http://www.gnc.com FDA dietary supplement site: http://www.cfsan.fda.gov/(tilde)dms/supplmnt.html 'White-Coat' Hypertension Not Often a Major Concern By Martha Kerr NEW YORK (Reuters Health) - "White-coat hypertension" -- a spike in blood pressure that occurs only in a doctor's office -- is rarely a cause for concern, researchers reported this week at a meeting of the Inter-American Society of Hypertension in San Antonio, Texas. In a study of people referred to a hypertension clinic, most people who had blood pressure readings of 200 millimeters per liter of mercury (mmHg) or higher during an office visit actually had much lower blood pressure, reported Dr. Mihaly Tapolyai of the Cleveland Clinic Florida in Weston. For people who get an extremely high blood pressure reading in a doctor's office, it would be a good idea to monitor their blood pressure throughout a 24-hour period before beginning treatment to be certain that the high reading isn't white-coat hypertension, according to Tapolyai. Tapolyai and associates followed 57 people whose average systolic blood pressure (the top number in a blood-pressure reading) was at least 200 mmHg at office visits. But when blood pressure was monitored throughout the day using a device worn on the body, the average systolic pressure was about 151 mmHg -- still high, but much lower than in a doctor's office. In comparison, a group of 80 patients with confirmed high blood pressure had an average systolic blood pressure of 146.1 mmHg during office visits and 137.9 on 24-hour monitoring. Blood pressures below 120/80 mm Hg are considered within a normal, healthy range Tapolyai reported that only 5.3% of the patients with severe office hypertension were determined to have so-called grade IV systolic hypertension, with systolic blood pressures of 200 mmHg or greater more than 20% of the time. Meanwhile, 7% of those with severe office hypertension proved to have normal blood pressure on 24-hour monitoring. Tapolyai pointed out in an interview with Reuters Health that the consequences of hypertension, such as congestive heart failure, stroke and death are associated with sustained high blood pressure -- not office hypertension. He warned that treating white-coat hypertension without confirming that a person truly has high blood pressure may cause a person's blood pressure to drop below normal. "The time has come to measure blood pressure with an ambulatory blood pressure monitor," especially in certain circumstances such as newly diagnosed cases of high blood pressure, high blood pressure that does not respond to treatment, episodic hypertension that affects people having an anxiety attack, white-coat hypertension or unusual circumstances like high blood pressure in the young, Tapolyai said. Standard measurement of blood pressure is acceptable for screening and for follow-up once high blood pressure has been established with 24-hour monitoring, he added. Back to the Top
By Dennis Thompson Jr. FRIDAY, May 2 (HealthScoutNews) -- You begin to take a breath, and find your chest has inexplicably tightened. Wheezing and coughing, you struggle to take in air. Your airways have become blocked or narrowed. The small tubes that carry air through your lungs, the bronchi and bronchioles, have suddenly become inflamed. They are suffering a double assault -- constricted by tightened muscles outside and flooded by mucus inside. You're suffering an attack of asthma, a disease that now affects some 15 million Americans. Asthma cases have doubled over the past 15 years, with more and more people worrying whether their next breath will come easy. May is Asthma Awareness Month, a time when doctors and activists hope to spread more information about the disease. Asthma attacks can be triggered by allergens, tobacco smoke or exercise -- particularly when exercising in cold air. If an attack is serious enough and left untreated, it can be fatal. The U.S. Department of Heath and Human Services says low-income and minority groups are more likely to die during an asthma attack, probably due to lack of access to proper medication. There was an average of 38.5 asthma-related deaths per 1 million blacks from 1993 to 1995, compared with 15.1 deaths per 1 million whites during that same period. Two factors play a part in whether you're likely to suffer from asthma: a cleaner living environment and genetics. Many doctors believe the increase in Americans' susceptibility to allergies and asthma may be linked to the fact that children are leading healthier lives in cleaner living spaces. The body typically grows resistant to allergies while fighting off childhood infections and diseases, says Dr. Henry Li, an allergist with the Institute for Asthma and Allergy. But children are facing fewer and fewer infections as they grow up, which could leave them more susceptible to asthma, Li adds. "When a society has developed and we have a cleaner and cleaner environment, there is less chance of getting childhood infections," Li says. Heredity also plays a large part, says Stacey Schubert, an asthma sufferer who also works as an epidemiologist with the asthma program at the Oregon Department of Human Services. Schubert's mother has asthma and her father suffers from allergies. Her brother also struggles with asthma. "There's definitely a genetic component to asthma," she says. Schubert has had asthma since she was a child, and has seen great improvements in the treatment of the disease. When she was young, she had to take fistfuls of medicines that weren't always effective. She found herself often dropping out of physical activities after growing short of breath, and eventually became overweight. Now she's 36, and the newer medicines have improved to the point where she can lead a very active lifestyle with few asthma attacks. Schubert enjoys step aerobics, kickboxing, weight lifting and biking, and she enjoys them without the ever-present fear of losing her breath. "Generally speaking, I don't have flare-ups or exacerbations," she says. "Controlling my asthma is very easy. I take my medications." More information To learn more about asthma, visit the Asthma and Allergy Foundation of America or the American Lung Association. Better Working Conditions May Improve Patient Care Reuters Health NEW YORK (Reuters Health) - Boosting nurse staffing levels in hospitals and nursing homes and improving communication between hospitals and other healthcare providers could lead to better patient care, the federal Agency for Healthcare Research said on Friday. Such measures are among a handful of effective strategies for improving patient safety gleaned from a review of 115 existing studies on healthcare working conditions in healthcare and non-healthcare settings, AHRQ said. A new report developed for AHRQ by the Evidence-based Practice Center at Oregon Health & Science University in Portland, Ore., helps shed light on what healthcare providers can do to improve the quality of healthcare. In addition to the recommendations on staffing and communication, the report concludes that preventable complications are less likely when complex, technical procedures are handled by physicians who do them frequently. It also finds that fewer staff interruptions and distractions will likely reduce medical errors and that, for some types of clinical care, more experience means better patient outcomes. A summary of the report is available on AHRQ's Web site (www.ahcpr.gov). The full report will be available later this spring. Erectile Dysfunction Linked to Heart Disease HealthScoutNews FRIDAY, May 2 (HealthScoutNews) -- Men who have erectile dysfunction are more likely to suffer cardiovascular disease, according to preliminary findings from researchers at McGill University Health Center in Montreal. The study evaluated more than 4,000 men, comparing the risk of erectile dysfunction in men with and without cardiovascular disease. They found the presence of cardiovascular disease was strongly associated with erectile dysfunction. "Among men without diagnosed cardiovascular disease, cardiovascular risk factors such as diabetes, smoking, high blood pressure and low HDL cholesterol were more common among those who had erectile dysfunction," lead investigator Dr. Steven Grover says in a news release. "This suggests that the men who have erectile dysfunction and have not had other symptoms of cardiovascular disease may be at increased risk for symptoms of cardiovascular disease. Accordingly, a complete diagnostic evaluation of erectile dysfunction should include screening for cardiovascular risk factors," Grover says. The findings were presented recently at the annual meeting of the American Urological Association in Chicago. More information Here's where you can learn more about erectile dysfunction. Study: New Way to Help Predict Pregnancy Problems Reuters Health NEW YORK (Reuters Health) - Several weeks before pregnant women show signs of a dangerous high blood pressure disorder, they have impaired blood flow in their arteries and elevated blood levels of a hypertension-promoting substance, new study findings indicate. "The results of this study may help the development of more accurate tests for the prediction and more effective treatment of preeclampsia," study author Kypros H. Nicolaides of King's College Hospital in London, said in a statement. Preeclampsia is a poorly understood pregnancy-induced condition marked by high blood pressure and elevated levels of protein in the urine. It affects about 7% of pregnant women in their third trimester of pregnancy, and poses a risk to both the mother and fetus. In severe cases, preeclampsia can lead to maternal seizures and even death. The condition resolves when the baby is born. Doctors have known that blood vessels become constricted in preeclampsia, resulting in high blood pressure. But it has been unclear whether the blood vessel problems are a cause or consequence of the disorder, Nicolaides and colleagues note in the May 3rd issue of The Lancet. Their study included 86 pregnant women who underwent ultrasound testing during their second trimester to see if they had normal uterine blood flow. Half did, while the others did not, suggesting they were at risk for preeclampsia or other complications. None of the 43 women who had normal uterine blood flow developed preeclampsia during their third trimesters, results showed. But among the 43 women with abnormal uterine blood flow, 10 went on to develop preeclampsia, 14 delivered underweight babies due to growth restriction in the womb and 19 had normal pregnancies. Second-trimester testing also showed that the half of the women with abnormal uterine blood flow had elevated blood levels of asymmetric dimethylarginine, or ADMA, which impairs the ability of blood vessels to widen. This happens because ADMA inhibits the effects of nitric oxide, which helps keep blood vessels relaxed and blood pressure in check. Additional ultrasound testing in the second trimester showed that, compared with women who did not develop preeclampsia, those who did had more restricted blood flow in their arms. This suggests the presence of blood vessel dysfunction that occurred before preeclampsia was diagnosed. And the more restricted the blood flow, the higher the blood levels of ADMA, the researchers reported. The findings suggest that doctors might be able to better predict preeclampsia by checking blood flow in the arms in addition to the uterus, according to the researchers. And since an amino acid known as L-arginine can help counter the effects of ADMA, it may be worth exploring whether L-arginine can help stave off preeclampsia in high-risk women, they conclude. Source: The Lancet 2003;361:1511-1517. Back to the Top
By Colette Bouchez FRIDAY, May 2 (HealthScoutNews) -- Among the most serious of pregnancy complications is a condition known as preeclampsia, a blood pressure-related problem that can develop in the last trimester and threaten the life of both mother and baby. Now a group of British doctors say they might have a way of predicting who is at risk for preeclampsia, long before symptoms occur. In a new study appearing in the May 3 issue of The Lancet, doctors from Harris Birthright Centre, Kings College Hospital, London, say problems appear linked to a dysfunction in the cells that line blood vessels -- called endothelial cells -- and a natural chemical known as asymmetric dimethylarginine (ADMA). "Maternal endothelial function is impaired in women who eventually develop preeclampsia, and it occurs before the development of the clinical syndrome," writes study author Kypros Nicolaides. Women who are at risk for preeclampsia, he says, appear to have high concentrations of ADMA. That chemical seems to contribute to the dysfunction of the cells within blood vessel walls. "The results of this study may help the development of more accurate tests for the prediction and more effective treatment of preeclampsia," says Nicolaides. While experts say the study is well done and holds promise, according to obstetrician Dr. Steve Farber it is only one of many promising theories about the cause of preeclampsia. "With each new study we find another piece of the puzzle, and we have a little better understanding of this complex problem and why it occurs," says Farber, president of the medical staff at Maimonides Medical Center in New York City. And while he says researchers have focused on the endothelial cells before, it remains to be seen whether ADMA is the missing piece of the puzzle everyone has been hoping to find. "It would be great if it was, but right now, we just don't know that," Farber says. Preeclampsia is characterized by a swelling that can occur throughout the body, usually accompanied by a rapid rise in blood pressure. It normally begins late in the third trimester and affects up to 8 percent of all pregnant women, particularly older mothers or those carrying twins or triplets. In some instances, preeclampsia can develop into the more severe condition known as eclampsia, causing a potentially fatal swelling in the brain. In underdeveloped nations, eclampsia accounts for up to 50,000 maternal deaths a year. Currently, the only known treatment for preeclampsia is delivery of the baby, which lets blood pressure return to normal and swelling to rapidly decrease. As such, says Farber, doctors and mothers are often forced to play a treacherous waiting game, hoping to give the baby enough time to fully develop within the womb, but still delivering early enough to avoid eclampsia. The new study involved two groups of 43 pregnant women who had a Doppler ultrasound examination of the uterus (a test that documents blood flow) in their second trimester, while blood tests checked levels of ADMA. In the first group of 43, the women were shown to have normal uterine arteries and no elevations in ADMA. Subsequently, they all delivered normally with no complications. In the second group of 43, the Doppler exam revealed impaired blood flow between the uterus and the developing baby. Of this group, 44 percent went on to have normal pregnancies and healthy births. In 33 percent of these women, however, babies developed intrauterine growth restriction, putting them at risk for low birth weight. The remaining 23 percent developed preeclampsia. Because the Doppler exams revealed abnormal blood flow within the uterine arteries, as well as abnormal blood vessel dilation, researchers suggest arterial dysfunction as a factor in the development of preeclampsia. More importantly, the women at risk for either preeclampsia or intrauterine growth restriction also had what doctors call a "striking elevation" in the concentration of ADMA in their blood -- which the researchers say may one day serve as a marker for women at risk. Although Farber says knowing can be important, he adds that right now it does little to change the clinical picture of preeclampsia since delivery still remains the only treatment option. More information To learn more about the symptoms of preeclampsia, visit the March of Dimes. To learn more about Doppler ultrasound, check out the American College of Radiology. Study Shows Women 50-64 at High Fracture Risk, Too By Alison McCook NEW ORLEANS (Reuters Health) - Although the risk of bone fractures increases with age, a new study released this week suggests that many women develop dangerously low bone mass and fractures even during the first years after menopause. Examinations of almost 90,000 women between the ages of 50 and 64 revealed that almost one-third had bone mass low enough to put them at a higher risk of fracture. Moreover, within a sample of almost 200,000 postmenopausal women, one-third of those who developed fractures were younger than 65. Although the natural decline in estrogen that accompanies menopause puts women at risk of fractures, most of the studies of bone mass and fracture risk focus on women who are at least 65, study author Dr. Susan K. Brenneman of drugmaker Merck & Co. -- which markets the osteoporosis drug Fosamax and funded the current study -- told Reuters Health. And within the medical community, Brenneman said that she suspected that doctors are not "as serious" about treating and screening for fracture risk in women under 65. "It's always thought that fracture and osteoporosis is really a disease of the older woman," she noted. These findings, presented here during the 51st annual clinical meeting of the American College of Obstetricians and Gynecologists, suggest that doctors need to focus on the problem of low bone mass and fracture in their younger, postmenopausal patients, too, she noted. "Some (younger women) do have low bone mass," she said. "And if they have low bone mass, they fracture as much as older women." The women aged 50 to 64 were participants in a national study involving more than 200,000 women over 50 designed to determine the risks of the bone-weakening disease osteoporosis. Researchers measured bone mass in all participants, then followed them for a year to determine how many developed fractures. Among the 163,935 women who completed the one-year survey, 2,440 reported bone fractures as a result of osteoporosis, 440 of which were hip fractures, a particularly debilitating type of fracture. Twenty percent of hip fractures occurred in women between the ages of 50 and 64, and this younger age group represented 37 percent of all one-year fractures reported by study participants. Moreover, nearly one-third of women between 50 and 64 had bone mass that was low enough to raise their risk of fracture by as much as almost three-fold, the researchers report. Young women appeared to have a higher risk of fracture if they had low bone mass, had experienced a previous fracture after age 45, had generally poor health and if their mothers had also experienced bone fractures in old age. Back to the Top
By Janice Billingsley FRIDAY, May 2 (HealthScoutNews) -- When choosing a sunscreen, there's more than sunburn prevention to keep in mind, a New York City dermatologist warns. The burning rays of the sun, called ultraviolet B (UVB) rays, are the primary cause of skin cancer, says Dr. Vincent DeLeo, associate professor of clinical dermatology at Columbia University. But new research shows that ultraviolet A (UVA) rays could also increase your risk for skin cancer, he says. "This is an area of great controversy, but new studies say that some skin cancers could be UVA-related," DeLeo says. The reason: These rays penetrate deeper into the dermis, which is the base layer of the skin, and weaken the body's immune system, a process called immunosuppression. This could explain why some skin cancers can appear anywhere on the body, not just where the skin has been directly exposed to the sun, DeLeo says. DeLeo made his remarks this week at the American Academy of Dermatology's Melanoma/Skin Cancer Detection press conference in New York City, and in a subsequent interview. This means people should seek out sunscreens that protect against UVA as well as UVB rays, something not always easy to do. A sunscreen's sun protection factor (SPF) only measures protection from UVB rays, not UVA rays, so it's hard to know what you're getting, DeLeo says. He cites a study that appeared last January in The Journal of Investigative Dermatology, an English Journal, in which 119 healthy, white-skinned men and women were asked to put sunscreen with an SPF of 15 on their buttocks, which had never been exposed to the sun. They were then radiated with both UVA and UVB rays. Tests showed the protection against the UVA rays was less than half that of the UVB rays. "The sunscreen protected against redness, but not against immunosuppression," DeLeo says. DeLeo says trials are under way in the United States to test sunscreens that protect against UVA rays, including products that contain mexoryl and tinosorb. In the meantime, consumers must be diligent about using other methods of avoiding sun damage. In addition to applying a sunscreen with a minimum SPF of 15, people should stay out of the summer sun between 10 a.m. and 4 p.m., wear protective clothing, and a broad brimmed hat. "If you don't get a sunburn, it doesn't mean you're protected from an immunosuppression response," DeLeo says. More information The American Cancer Society has helpful information about the sun and skin cancer. The American Academy of Dermatology offers some compelling data on the dangers of tanning salons. Supplemented Formula Helps Blood Pressure By Ed Edelson THURSDAY, May 1 (HealthScoutNews) -- Children fed formula supplemented with long chain polyunsaturated fatty acids have significantly lower blood pressure than those given unsupplemented formula. In fact, it's about as low as that of children who were fed mother's milk, European researchers report. It is the latest claim to be made for such supplementation, which has been said to improve either vision or intelligence or both. And the new claim is made on the basis of a carefully controlled study backed by a scientific theory. Nevertheless, it is drawing a wary response from at least one pediatrician. The study was done at four European centers. A report in the May 3 issue of the British Medical Journal says that at 6 years of age, the 71 children given the supplemented formula had blood pressure readings 3 millimeters lower than those of the 76 children in the unsupplemented group. And the supplemented group's readings were about the same as that of 88 children who were breast-fed. The result is important because "blood pressure does appear to track from childhood into adulthood," says study author Dr. J. Stewart Forsyth, a consultant pediatrician at the Tayside Institute of Child Health in Dundee, Scotland. Adult high blood pressure is one the strongest risk factors for heart disease and stroke. The theory is that the long chain polyunsaturated acids are absorbed in the cells of the endothelium, the delicate tissue that lines the blood vessels, Forsyth says, making them less vulnerable to the fatty deposits that eventually can block a blood vessel. Until recently, it was assumed that "infants were able to make these long chain fatty acids from short-chain fatty acids in formula," Forsyth says. Newer research shows that is not so, he says. But the study results may not be as convincing as they seem, says Dr. Michael Wasserman, a pediatrician at Ochsner for Children, a New Orleans branch of the Ochsner Clinic. There was a high dropout rate in the study, with only about 40 percent of the children who enrolled at the start completing it, he says, and there were differences between the groups that might cloud the results. But the main reason for skepticism is that high blood pressure is "a multidimensional condition influenced by many factors," Wasserman says. "You can't look at development of high blood pressure so simplistically. It is multidimensional in ways we don't understand." Diet is one dimension, Wasserman says, but "you are looking at a big pie. We don't know how big a slice of the pie this is." The question of using a supplemented formula comes up constantly in his pediatric practice, Wasserman says, because some formula makers advertise the benefits of the supplements. When he is asked, he says, "it probably does no harm and probably does some good." The gold standard of nutrition early in life is breast-feeding, says the American Academy of Pediatrics, and Forsyth and Wasserman agree. "I am a great supporter of breast-feeding," Forsyth says. "It is especially important in the first months of life." More information Advice on feeding your baby is offered by the American Academy of Pediatrics. The academy also offers A Woman's Guide to Breastfeeding. Studies Revive Colon Cancer Diet Theory By Emma Ross LONDON - New research has revived the notion that a high-fiber diet may protect against colon cancer. Long-standing recommendations for high-fiber diets have taken a hit over the last few years after a handful of carefully conducted studies failed to find a benefit. But experts say two major studies published this week in The Lancet medical journal — one on Americans and the other on Europeans — indicate previous research may not have examined a broad enough range of fiber consumption or a wide enough variety of fiber sources to show an effect. "These two new findings show that the fiber hypothesis is still alive," said the leader of the American study, Ulrike Peters of the U.S. National Cancer Institute (news - web sites). Figuring out the relationship between nutrition and disease has always proved difficult, but experts say fiber is particularly complicated because there are various types and they all could act differently. Fiber is found in fruits, vegetables and whole grains. Americans eat about 16 grams a day, while Europeans eat about 22 grams. The new studies indicate fiber intake needs to be about 30 grams a day to protect against colon cancer. There are 2 grams of fiber in a slice of whole meal bread. A banana has 3 grams and an apple has 3.5 grams, the same as a cup of brown rice. Some super-high fiber breakfast cereals have as much as 14 grams per half cup. In the American study, investigators compared the daily fiber intake of 3,600 people who had precancerous growths in the colon with that of around 34,000 people who did not. They were divided into five groups, according to how much fiber they ate. The average roughage intake in the lowest group was 12 grams a day, while in the highest group it was 36 grams a day. People who ate the most fiber had a 27 percent lower risk of precancerous growths than those who ate the least. In the European study, the largest one ever conducted on nutrition and cancer, scientists examined the link in more than 500,000 people in 10 countries. As in the American study, questionnaires separated the people into five groups, according to fiber intake. Following them for an average of four years, 1,065 of them had developed colorectal cancer. Those who ate the most fiber, about 35 grams a day, had about a 40 percent lower risk of colorectal cancer compared with those who ate the least, about 15 grams a day, the study found. "In the top quintile (group) they were eating 15 grams of cereal fiber, which is equivalent to five or six slices of whole meal bread, plus they were eating seven portions of fruit and vegetables a day, which is basically the Mediterranean levels," said the study's leader, Sheila Bingham, head of the diet and cancer group at Cambridge University's human nutrition unit. Discussions about the link between fiber and bowel health — or, at least the relative merits of white and brown bread — date back to antiquity. In a twist on modern thought, Hippocrates, who lived in the 5th century B.C., believed white bread was more nutritious because it creates less feces than brown bread. Scientists now believe the extra feces is a benefit. The contemporary theory that fiber wards off colon cancer began in the 1970s, when a British doctor, Denis Burkitt, noted that poor people in Africa produce more feces than Westerners and get much less colon cancer. One obvious difference between the two groups was that Africans consumed more fiber. Scientists believe that fiber dilutes and absorbs cancer-causing agents and makes them flow more quickly through the body. Researchers have also theorized that a high-fiber diet makes protective changes to cells or curtails bile acids that irritate the intestinal lining and promote growths. The first big dent in the theory came in 1999 from a study that tracked the eating habits of 88,757 American nurses for 16 years. The risk of colon cancer was the same, regardless of how much fiber the women were eating. Then in 2000, two studies which used a different method also came up negative. They put people on different diets and counted precancerous growths in their colons for up to four years. There was no apparent effect from high-fiber diets or supplements. One major difference between the former and current studies is that the new ones examine more diverse populations who eat different types of fiber and in hugely varying amounts. However, Andy Ness, a lecturer in epidemiology at Bristol University in England, who was not connected with either study, said the latest research is not the last word. "Across Europe, there is an amazing variation in risks of cancer. There is also a huge variation in diet, so across these cultures you can get this breadth of intake. However, what you might be picking up across this range of diet is a range of cultures. It's possible it's something else that goes with that pattern of diet," he said. On the Net: The Lancet, http://www.thelancet.com Thalidomide May Carry Dementia Risks: Case Report Reuters Health NEW YORK (Reuters Health) - The case of one patient treated for blood cancer with the drug thalidomide suggests that reversible mental decline could be one effect of the treatment, Virginia doctors reported Wednesday. The patient, a 66-year-old man with the blood cancer multiple myeloma, began to show signs of dementia in the months after he started thalidomide treatment, according to the report in The New England Journal of Medicine (news - web sites). The good news is that the patient's failing memory and other dips in mental function were reversed soon after going off the drug, according to his doctors at Virginia Commonwealth University Medical Center in Richmond. This case, they write, suggests that "physicians should consider the possibility that thalidomide may induce reversible dementia in patients with multiple myeloma." Thalidomide was once a notorious drug, banned in the 1960s for causing severe birth defects after it was used to treat morning sickness in some pregnant women. Recently, though, it has been shown to slow the progression of multiple myeloma. Typically, multiple myeloma patients who take thalidomide can experience side effects such as sedation and nerve pain in the extremities. In this patient's case, though, Dr. Alexander E. Morgan and colleagues found that the man became "forgetful and manic" two to three months after going on a chemotherapy regimen that included thalidomide and the drug dexamethasone. The man's mania ceased after the dexamethasone was discontinued, but his memory loss worsened, according to Morgan's team. Soon, the man's wife reported that he could no longer remember how to brush his teeth or take a shower. Nor could he remember her name or their children's. An extensive evaluation revealed no cause of the man's mental difficulties, but the answer came when he went on to develop a tremor -- a documented side effect of thalidomide. "Discontinuation of thalidomide therapy because of tremor, a known side effect, was followed by rapid recovery of memory and other cognitive functions," Morgan and colleagues write. They advise doctors to be aware of the potential for similar "reversible dementia" in multiple myeloma patients on the drug. Multiple myeloma accounts for approximately 10 percent of all blood cancers. Among patients with early forms of the disease, many progress to full-blown multiple myeloma within a few years. Source: The New England Journal of Medicine 2003;348:1821-1822. Back to the Top
By Paul Recer WASHINGTON - Aging brains may be sharpened and, in effect, made young again briefly by increasing the levels of a neurochemical called GABA, a study suggests. Researchers at the University of Utah found that GABA appears to help extremely old Rhesus monkeys focus their vision and thinking processes by silencing the interfering static from other neurons. GABA screens out the stray brain signals that may make thinking and seeing difficult in older brains, said Audie G. Leventhal, a professor at the University of Utah School of Medicine. "It eliminates the garbage signals," said Leventhal, first author of the study appearing Friday in the journal Science. Leventhal said that in old primates, both human and monkey, there is a decline in the levels of GABA, a chemical that inhibits neuron signals in the brain. Without enough of that control, he said, the brain is distracted and overwhelmed by stray signals, in the same way the ear is overwhelmed when trying to hear a whisper at a rock concert. "There, you wouldn't really hear anything," he said. "But if there is screaming in an empty room, then it is very easy to hear. That is sort of what GABA does." Without sufficient levels of GABA to drown out all of the background signals, said Leventhal, "then all of your higher brain functions go bad." Dr. Bernard W. Agranoff, a neurochemist and professor of psychiatry at the University of Michigan, said the study showing the effect of GABA in aging brains is an important finding that should be researched further in humans. "It doesn't automatically point toward a treatment, but it is an observation that needs to be followed up," said Agranoff, who was not involved in the research. "It is a quite interesting finding and the data looks very good." In the study, Leventhal and his co-authors measured the electrical activity of neurons in specific parts of the brains of both young and old Rhesus monkeys as the animals were exposed to light patterns flashed on a computer screen. Earlier work had shown that in young monkeys some neurons fired only for horizontal patterns, while others responded only to vertical or to diagonal patterns. In older monkeys, however, the neurons fired almost randomly, suggesting the brain cells had a diminished ability to distinguish shapes and motions. When minute quantities of GABA were injected directly into neurons, the brains of the older monkeys responded just like those of the young animals, Leventhal said. Signals were sharp and clean as neurons fired appropriately for each of the patterns on the screen, he said. The effect lasted only as long as GABA levels were maintained. When the chemical was removed, the brains of the old monkeys reverted to their aged confusion within a few minutes, Leventhal said. Added GABA appeared to have no effect on the young. The tests were conducted on six young monkeys, age 7 to 9, and on seven old monkeys, age 21 to 32. "These monkeys age about three times faster than humans," Leventhal said. "A 30-year-old Rhesus is equal to about a 90-year-old person." Some tranquilizers, such as Valium, Xanax and Librium, increase the levels of GABA in the brain of human patients. This suggests that these drugs might sharpen aged minds, but that is an idea that first must be carefully tested, Leventhal said. "The idea is counterintuitive," he said. "The idea that to get grandpa to move faster you have to tranquilize him isn't something that makes a lot of sense without these results." On the Net: Science: www.sciencemag.org Pesticides Linked with Prostate Cancer in Farmers Reuters WASHINGTON (Reuters) - Farmers who use certain pesticides seem to have a higher-than-average risk of prostate cancer (news - web sites), U.S. government researchers said on Thursday. The researchers, who published their study in the American Journal of Epidemiology, confirmed other findings that show farmers have an unusually high risk of prostate cancer. "Associations between pesticide use and prostate cancer risk among the farm population have been seen in previous studies; farming is the most consistent occupational risk factor for prostate cancer," Michael Alavanja of the National Cancer Institute (news - web sites) (NCI), who helped lead the study, said in a statement. Researchers at NCI and at the National Institute of Environmental Health Sciences and the Environmental Protection Agency (news - web sites) studied 55,332 farmers and nursery workers who worked with pesticides. Between 1993 and 1999, 566 new prostate cancers developed among the men, compared to 495 that would normally be expected in Iowa and North Carolina, the two states studied. The risk of developing prostate cancer was 14 percent greater for the pesticide applicators compared to the general population. One pesticide, methyl bromide, increased the risk of prostate cancer in all men. Six others raised the risk in men with a family history of prostate cancer. They are chlorpyrifos, coumaphos, fonofos, phorate, permethrin and butylate. More than 220,000 U.S. men will be diagnosed with prostate cancer this year, according to the American Cancer Society (news - web sites), and 30,000 will die of it. The biggest risk factors for prostate cancer are age and family history. African-American men have higher rates of prostate cancer, and some evidence suggests that men who eat lots of red meat and animal fat have a higher risk. Back to the TopHealthScoutNews THURSDAY, May 1 (HealthScoutNews) -- Estrogen plays an important role in wound healing and age-related estrogen loss in both women and men results in an impaired ability to heal as we grow older. So says a University of Manchester study in the May 1 issue of the Journal of Clinical Investigation. The study found estrogen influences wound healing by inhibiting the local inflammatory response. It does this by "downregulation" of macrophage inhibitory factor (MIF). The finding provides information about a specific target for treatment in people with delayed wound healing. Wound healing in the skin is associated with an initial inflammatory response, which is followed by reformation of the outermost layer of skin. During that initial response, the recruitment of inflammatory cells to the wound site causes increased local expression of MIF. That, in turn, attracts more inflammatory cells to the wound site. In their study, the University of Manchester researchers made small incisions in estrogen-deficient mice. After receiving the incision, the mice had an unchecked increase of MIF expression in the area of the wound, leading to excessive inflammation and delayed wound healing. The researchers also found the healing rates in MIF-deficient mice that also lacked estrogen were not significantly different than healing rates in normal mice. The study results indicate that MIF is a crucial component in uncontrolled inflammation and slow wound healing. That suggests that wound healing might be assisted by drugs that inhibit MIF. More information Here's where you can learn more about wounds. Soy Compound Shows Promise for Menopause Symptoms By Colette Bouchez WEDNESDAY, April 30 (HealthScoutNews) -- A new soy-based compound promises to rival estrogen by relieving hot flashes and building bone mass in menopausal women without many of the troubling side effects associated with traditional hormone therapy. That's the news being reported April 30 at the 51st annual meeting of the American College of Obstetricians and Gynecologists (ACOG) in New Orleans. A group of Israeli researchers presented the findings, which were based on a 12-month study that involved patients, laboratory cell lines and animals. "The conflicting data on hormone replacement therapy (HRT) has led to an intensive search for alternative treatments," reports Dr. Benjamin Chayen, on behalf of his colleagues at the Sheba Medical Center in Tel-Hashomer, Israel, where the research was conducted. That led the scientists to the soy compound known as Tofupill (DT56a). Among the 37 women who used the soy supplement, 75 percent reported relief from hot flashes. Tests showed they also experienced a measurable increase in bone density -- up to 4 percent in the spine and 2.9 percent in the neck. In laboratory tests, the researchers found the soy compound had no negative effects on breast cancer (news - web sites) cell lines, indicating it may not share estrogen's ability to stimulate tumor growth. And in rat studies, the soy appeared to stimulate growth of skeletal tissue without stimulating cell growth in the uterus, as estrogen therapy can do. While experts say the results are promising, New York University nutritionist Samantha Heller believes the research makes too many "leaps of faith" about issues that remain unproven. "It is not appropriate to extrapolate data gathered on rats and in vitro directly to humans and suggest that there is little concern regarding short- and long-term effects of supplementation," Heller says. She also points to conflicting evidence regarding the safety and efficacy of soy supplementation in women. "I would exercise caution with soy supplementation until more research is done," she says. "But including soy products in your diet may still confer many health benefits." Earlier in the week, doctors presented the following additional new findings at the conference:
The research involved 20 healthy menopausal women randomly assigned to daily use of either oral estrogen and progesterone, or oral estrogen and progesterone cream, for six months. The women then switched preparations for an additional six months of study. To keep track of uterine health, each woman received an endometrial biopsy at the start of the study and again after each six-month phase -- important since in the past topical progesterone cream was thought to be less effective in maintaining a healthy uterine lining than the oral form. The final result: Topical progesterone was as effective as the oral version in both the treatment of menopause symptoms and the protection of the uterine lining. The finding is significant, the researchers say, because earlier studies have shown that progesterone cream may be better tolerated by some women than the oral form of the hormone.
What they found: Although blood levels of selenium were similar in both groups, there was a significant reduction in the level found in hair samples of the women with a history of miscarriage. Both groups had comparable diets, lived in similar geographic areas and used similar hair products. Because the differences were only noted in hair samples, doctors concluded the selenium deficiency may be chronic rather than related to recent selenium intake. They suggest more research to determine if correcting that deficiency could affect pregnancy outcome.
In studies conducted on 143 women, researchers revealed that an easy, self-performed swab test that measures the acid level in the vagina (called a vaginal pH test) could accurately diagnose a yeast infection almost as often as a physician-generated test. The researchers say vaginal pH testing by women may be a convenient way to determine the true cause of intimate infections before buying an over-the-counter yeast treatment. This, they say, could reduce the rate of inaccurate self-diagnosis and subsequent incorrect use of antifungal medications -- a problem that can sometimes lead to serious complications. Currently, pH test strips are available at most local pharmacies. More information To learn the latest news on women's health issues, visit ObGyn Net, or The Women's National Health Information Center. Bright Light May Boost Testosterone in Men By Linda Carroll NEW YORK (Reuters Health) - An extra hour of bright light can lift the levels of a pituitary hormone that enhances testosterone in men, a new study shows. Researchers found that men who were exposed to an hour of bright light before sunrise experienced an increase in luteinizing hormone (LH), a hormone produced in the brain's pituitary gland. LH influences reproductive hormones in both men and women. Increases in LH in men drive up testosterone levels, while the hormone triggers ovulation in women. The new findings, published in the journal Neuroscience Letters, show that testosterone could be enhanced simply by extra hours of bright light, said study author Dr. Daniel F. Kripke, a professor of psychiatry at the University of California at San Diego. "There are many possible beneficial effects of increased testosterone," Kripke told Reuters Health. "Studies have shown that it may help with depression. It can improve libido. And there may be a muscle-building and strengthening effect." Light also impacts women's reproductive cycles, Kripke said. In an earlier study, his group showed that when women with long and irregular menstrual cycles were exposed to bright light, the cycles regularized. "We had some indication then that it was working through luteinizing hormone," the researcher said. For the new study, Kripke and his colleagues studied 11 healthy young men who were between the ages of 19 and 30, dividing participants into two groups. In the first part of the study, both groups were awakened at 5:00 am and exposed to either a bright light of approximately 150 watts or a low-wattage red light. During the second part, the groups were switched, so that the men who were exposed to bright light in the first part were then exposed to low light, and vice versa. The men's LH levels were tested before and after exposure to the lights. The researchers found that the men showed a 69-percent increase in LH levels after exposure to bright light. In the report, they note that sexual problems such as low libido are known to be part of depression, as well as a side effect of antidepressant medications. "It is theoretically possible," they write, "that light exposure, which increases LH secretion, will alleviate sexual dysfunctions in depressed patients." They suggest that studies like the current one be repeated in people with depression. Source: Neuroscience Letters 2003;341:25-28. Back to the TopSoy Extract Helps Some Prostate Cancer Patients
WEDNESDAY, April 30 (HealthScoutNews) -- A dietary supplement that contains the soy extract genistein reduced prostate-specific antigen (PSA) levels by as much as 61 percent in men with untreated prostate cancer (news - web sites). But the dietary supplement didn't have the same effect in men who had undergone surgery, radiation or hormone therapy for prostate cancer, say researchers from the University of California, Davis Cancer Center. PSA is a blood marker for prostate cancer. An increase is PSA is a warning sign of first-time prostate cancer or a sign of recurrence or progression of the disease in men who have been treated for prostate cancer. The study included 62 men with prostate cancer and elevated PSA levels. They were given 5 grams a day of genistein concentrated polysaccharide for six months. Sixteen of the men were on watchful waiting for the disease and 46 had undergone surgery, radiation or hormone therapy. Watchful waiting is recommended for some men with prostate cancer whose cancer causes no symptoms, is expected to grow slowly, and is small and contained within one area of the prostate. Among the 16 men on watchful waiting, three had to drop out of the study due to diarrhea. Of the 13 who completed the study, eight had a drop in their PSA levels. Those reductions ranged from 3 percent to 61 percent. The other five in that group had increased PSA levels by the end of the study. In the group of 46 men who had received treatment, one man had no change in his PSA level and all the rest had increases in PSA. The study was presented April 30 at the American Urological Association meeting in Chicago. More information Here's where you can learn more about prostate cancer. Investigators Question Ephedra Complaints By Lauran Neergaard WASHINGTON - Some 16,000 customer complaints about the popular Metabolife brand of ephedra are not enough to prove whether the herb caused dozens of heart attacks and strokes, some fatal, congressional investigators say. The report released Wednesday doesn't mean ephedra is safe, the Food and Drug Administration (news - web sites) stressed: There is evidence from other sources that the pills can cause serious health problems. Armed with reports of more than 100 deaths and thousands of side effects linked to ephedra use, the FDA two months ago pledged to put warning labels on every bottle that say the amphetamine-like stimulant can cause heart attacks, strokes or even kill. The General Accounting Office (news - web sites), Congress' investigative arm, examined 16,000 records of phone calls from ephedra customers with health complaints turned over to the Justice Department (news - web sites) last year by Metabolife International. The GAO counted 92 reports of serious side effects — including 18 heart attacks, 26 strokes, 43 seizures and five deaths — made by Metabolife customers to a company hot line. The GAO concluded that there was far too little information to definitively link any of the reports to the pills because patients, not doctors, reported the problems, and Metabolife employees sometimes recorded just a single word from each phone call. The FDA noted that the Rand Corp. also reviewed Metabolife's records, and called some of the cases "sentinel events" that warrant further investigation. Also, most of the agency's evidence is from other sources compiled before Metabolife revealed its records. "Today's report does nothing to change FDA's heightened concern that dietary supplements containing ephedra may present a significant and unreasonable risk of illness and injury," the agency said. Metabolife insisted the GAO report supports its position "that ephedrine-containing products such as Metabolife 356 are safe and effective when used as directed." Rep. Dan Burton, R-Ind., who requested the report, said the GAO's findings show the government needs to establish a federal tracking system for consumer complaints about any dietary supplement. The FDA decision came just weeks after Baltimore Orioles pitcher Steve Bechler died after using ephedra. Health and Human Services (news - web sites) Secretary Tommy Thompson has advised Americans, especially those who exercise, not to take the herb. The American Heart Association (news - web sites) and other health groups have urged a full ban on ephedra sales, calls the FDA currently is evaluating. Annoying Viruses Turn Deadly in Cancer Patients By Serena Gordon WEDNESDAY, April 30 (HealthScoutNews) -- An ounce of prevention really is worth a pound of cure when it comes to people undergoing cancer treatment and those with immune-suppressing disorders. A new study, set to appear in the May 15 issue of Cancer, found that people being treated for cancer were more likely to be seriously affected by common respiratory viruses. In fact, the researchers found death rates in cancer patients contracting such common illnesses as flu and respiratory syncytial virus (RSV) were as high as 75 percent. "Whatever we see in the general population will be magnified a hundredfold in people with disease," says study author Krystal Hicks, a clinical practice specialist in the department of blood and marrow transplantation at the University of Texas M.D. Anderson Cancer Center in Houston. For cancer, transplant and other immune-compromised patients, Hicks explains, "symptoms that start out innocently can progress very quickly into something life-threatening." She says that for most people, a cold stays in their upper respiratory airways, but in people whose immune systems are compromised simple colds can quickly settle in the lower respiratory tract. "Within 24 to 48 hours, you can have someone with a life-threatening pneumonia," she adds. Other groups at high risk from these viruses include people with AIDS (news - web sites), people who have had an organ transplant, people in nursing homes and older people with two or more risk factors, such as emphysema or heart disease. Hicks and her colleagues gathered information on the incidence of three common respiratory infections at three large bone marrow transplant centers in the United States and in Europe. The viruses studied were influenza (flu) and two common childhood viruses, parainfluenza and RSV. Flu still claims 20,000 lives in the United States every year. RSV causes 4,500 deaths and 90,000 hospitalizations annually, mainly in children, and parainfluenza is responsible for 70,000 hospitalizations every year, according to the study. The viruses are transmitted through direct contact with body secretions, such as saliva, or by inhaling contaminated droplets in the air. In most healthy adults, these viruses are rarely serious, but in those with compromised immune systems they can be deadly. This study found that between 30 percent and 50 percent of those undergoing treatment at these centers had one of these respiratory infections, and the mortality rate was between 28 percent and 75 percent. There are treatments for these infections, but Hicks says they're often ineffective, expensive and difficult to administer. That's why the authors emphasize prevention. Prevention is also important because of new, emerging viruses, such as SARS (news - web sites) and West Nile, Hicks says. First, she says, get a flu vaccine. Next, she recommends thorough and frequent hand washing. During months when these viruses are particularly active, she says it's best for people with cancer to avoid places with large crowds, such as movie theaters and malls. She adds you should also let family members know that, if they have a cold, they need to stay away until they're better. And at the first sign of illness, let your provider know because these illnesses can quickly progress. Dr. Jay Brooks, chair of hematology and oncology at the Ochsner Clinic Foundation in New Orleans, says people definitely underestimate the risk of infection when they're undergoing cancer treatment. "The flu vaccine is very important and is grossly underused," Brooks adds. The study says that only 20 percent of those at high risk get vaccinated for influenza every year. Brooks also says that if possible, immune-compromised patients should get the pneumoccocal vaccine as well. More information To learn more about cancer and common infections, visit the American Cancer Society. For more information on RSV, go to the U.S. Centers for Disease Control and Prevention. Low-Fat-Diet Guru Swims Against Swelling Tide By Adam Tanner SAUSALITO (Reuters) - Dean Ornish, America's best-known advocate of a low-fat diet, takes a few bites of his granola cereal with soy milk and pushes it across the table in rejection. "This is not the granola that they used to serve here, so I can't eat this; it's too fatty," he says at a cafe opposite his office in Sausalito, an area of natural beauty with hundreds of boats bobbing along the panoramic waterfront. He then orders an egg-white omelet with spinach and peppers, asking the chef to use as little oil as possible in the cooking. A slice of melon smiles from the plate's side. Ornish, with wiry orange-brown hair and a slender frame, lives the message he preaches: Eat a low-fat diet and feel better and healthier. He laughs when pushing away his granola, but bristles at any notion he is a priggish diet freak. "I am not trying to be the school marm, saying what you are doing is bad. I am not the food police," says the director of the Preventive Medicine Research Institute. "I don't care what people do as long as they know what the effects of those choices are. And if most people knew if they were willing to make these changes how much better they could feel, then many people might want to try that." Fat Nation In recent years, many have heard about Ornish's recommended diet of lots of fruits and vegetables, whole grains and beans, and no fatty dairy products or meats. His books, such as "Eat More, Weigh Less," are best-sellers, and he even advised then U.S. President Bill Clinton (news - web sites) and the White House chefs. The problem is, many Americans are ignoring the message. "There is clearly an obesity epidemic," Ornish says later at his office, booting up a laptop computer at his four-story, wood-framed institute overlooking the waterfront. "Americans are eating more fat and more simple carbohydrates than ever." He shows a series of computer maps of the United States that illustrate obesity state-by-state since 1985 to show a stunning increase in excess pounds from sea to shining sea. Today, more than 60 percent of Americans are overweight, half of whom are obese, putting their health at risk. Yet the fat trend is ever expanding. "There has been a bit of a backlash against not only just low-fat eating, but healthy living in general," says Ornish, who is also a professor of medicine at the University of California, San Francisco. "You used to find a lot more people interested in jogging and exercise and lifting weights and going to the gym, and there is less of that now." The High-Fat Backlash One reason is a recent wave of publicity around the late diet doctor Robert Atkins, advocate of a popular but controversial high-protein, low-carbohydrate diet. The Atkins approach embraces steak, chee |