Harassing Smokers, Part 2: This One Touched a Real Nerve

By Scott Mowbray

Last week, as we kicked off our new How to Quit Smoking section on Health.com, I asked this question: Is It OK to Harass the Smokers We Love? The response was overwhelming—from smokers, former smokers, nonsmokers, children of smokers, parents of smokers, educators, and hospital workers.

Now the word “harass” raised a lot of hackles (I intended it to). Sarcasm was a common response, as from reader MAS: “Sure, harass away! Next we’ll turn the kiddies loose on the oldies, fatties, drunks, and anyone else who might ultimately become burdensome to society.”

JF wrote: “The problem with allowing kids to harass the smokers they love is that it gives kids carte blanche to harass everyone who smokes—including strangers and parents’ acquaintances.”

Many smokers said that harassment simply makes them light up, out of annoyance or spite. As Jessica put it, “I was at a party and some random person put up a huge stink about me smoking (outside). She told me secondhand smoke kills and I told her I was counting on it.”

But some ex-smokers said campaigns by children or spouses had been decisive in their quitting.

Awareness of the effects of secondhand smoke (SHS) on children also leads some parents to quit. Good thing: A CDC summary released last week noted that although antismoking legislation covering public places has significantly reduced SHS exposure among adults, “a higher prevalence of SHS exposure was still evident in the groups aged 4-11 years and 12-19 years” from 1999 to 2004. Kids are among the most vulnerable, and many parents smoke where kids breathe.

Some users asked why smoking was singled out—why not obesity, drinking, and other well-known dangers? “So don’t throw stones, dwellers in glass houses,” said one. “Hello, Brave New World,” wrote MAS.

But some of the most thoughtful posts reflected a sense of love, concern, and propriety. Sue wrote of a smoking friend, age 50, whom she gently encourages: “Should we paper his computer with Post-it notes, stage an intervention, email him photos of diseased lungs, shame him into quitting? Our motives are pure, but those actions would surely damage our friendship. He is struggling with his addiction. He doesn’t need us to point out the obvious.”

And Stephen concluded: “I absolutely believe that as humans we have an obligation to the people around us. This includes telling them when they are harming themselves and others such as smoking and other destructive behaviors. I don’t know what works but I know that supportive talking is at least a start.”

Read my first smoking post, Is It OK to Harass the Smokers We Love?

Read 97 Reasons to Quit Smoking. (You can email it to a smoker.)

Read the latest science on quitting.

(PHOTO: GETTY IMAGES)

Getting More Exercise, One Step at a Time

By Sean Kelley

Back when I had athletic street cred—as a soccer and rugby player and 5K specialist—I used to scoff at walkers. Although walking might be somewhat better than total lethargy, I failed to see how anyone could devote enough time to plodding around to get the benefit that one does with more aerobic activities. Besides, the mall, where such “exercisers” tended to hang out, is only open for so many hours a day.

At the height of this athletic snobbery, I likened walking for exercise to golfing as a sport: You can break a sweat doing either activity, but they’re not sports.

Of course, I was wrong. Golf is a sport, especially if you walk the course. (I’m still recovering from my last round; with 40 pounds of equipment on your back, walking from the clubhouse to the first tee burns a lot of energy). And walking, I’ve recently discovered, is substantially better for you than I thought. Read More

Build Better Bones and Prevent Osteoporosis

How people in their 30s, 40s, and 50s can fend off osteoporosis
by Ross Weale

Strong bones are important for healthy aging. To avoid osteoporosis and up your bone density, eat leafy greens, quit smoking, and drink your milk! Watch Health magazine contributor Samantha Heller's appearance on the Today show on March 26 to learn more.



SAMANTHA HELLER
Samantha Heller, RD, is the nutrition coordinator at the Fairfield Connecticut YMCA. A certified dietitian/nutritionist and exercise physiologist, Heller earned her master's degree in nutrition and applied physiology from Teachers College at Columbia University. She served as the senior clinical nutritionist and exercise physiologist at NYU Medical center in New York City for almost a decade and created and ran the outpatient nutrition program for the NYU Cardiac Rehabilitation Program. She has also been a fitness instructor for 15 years. Heller specializes in nutrition, wellness, stress management, and fitness for people who are fighting heart disease, diabetes, cancer, and obesity.

A contributing editor to Health magazine, her writing has also appeared in numerous other magazines, including Men's Fitness, Men's Health, and Glamour, as well as sites such as Fitness.com.

Marijuana Use Among MS Patients Raises Risk for Cognitive, Mood Problems

(HealthDay News) -- Multiple sclerosis patients who smoke marijuana in search of symptom relief are more likely to suffer cognitive shortfalls and mood disorders, new Canadian research suggests.

A slowing down in the ability to process and remember information is one significant side effect, as is a rise in the rate of depression and anxiety.

"This is a small study, so our findings are preliminary, but the bottom line is that multiple sclerosis patients who smoke cannabis appear to be at an increased risk for cognitive issues, particularly with respect to the speed of their thinking," said study author Dr. Anthony Feinstein, a professor of psychiatry with the Sunnybrook Health Sciences Centre's department of psychiatry at the University of Toronto.

Feinstein's observations are published in the Feb. 13 online edition of Neurology and are focused exclusively on the impact of smoking marijuana illegally obtained by patients themselves. Medically prescribed marijuana was not studied.

The authors noted that a "significant minority" of multiple sclerosis patients smoke marijuana to combat the tingling, numbness, blindness and paralysis that can accompany the progressive and often disabling nervous system disease.

However, Feinstein's team stressed that scientists have yet to definitively prove that the psychoactive substance -- long linked to psychosis, anxiety and delirium among healthy users -- provides a measurable benefit to the more than 400,000 Americans and 2.5 million people worldwide who suffer from the disease.

The researchers therefore assessed the experience of 140 Toronto-based MS outpatients, 10 of whom had smoked the drug at least once in the previous month and were considered regular marijuana users.

All the patients -- three-quarters of them women -- underwent cognitive and mental health exams by a neurologist and a neuro-psychiatrist. Interviews were also conducted to assess disease severity and course, medications being used, and current disability.

Feinstein and his team observed that while pot smokers were younger, there were no differences between marijuana users and nonusers in terms of gender, education, or MS disease course or duration.

However, MS patients who used marijuana were found to perform 50 percent slower on tests tracking information-processing speed and were more likely than nonusers to have a mental disability of some kind.

Marijuana use was also associated with a greater risk for being depressed or experiencing anxiety. However, the authors were not able to determine whether the drug had triggered such conditions, or if patients had sought out marijuana to help deal with a preexisting emotional issue.

They nonetheless cautioned that smoking marijuana might further raise the risk for experiencing the kind of neuro-psychological impairment that typically occurs among 40 percent to 65 percent of all MS patients.

Feinstein said that he next hopes to gather a much larger pool of patients, while exploring possible differences in the health impact of street-purchased marijuana versus prescribed cannabis.

Meanwhile, Dr. Marshall Keilson, director of neurology at Maimonides Medical Center in Brooklyn, N.Y., said he thinks it best to proceed on a case-by-case basis.

"There are some MS patients who are emotionally disabled from their disease, and if we can use cannabis to help them feel better about the world or life, we should," he said. "We need to always err on the side of doing what's best for our patients. And I don't necessarily believe there is a permanent damage to the brain, based on occasional marijuana use. If they're smoking 10 times a day, yes, there will be damage done. But this goes for excessive alcohol use, too. So, I think we're going to end up somewhere in the middle with this."

More information
For more on multiple sclerosis, visit the National Multiple Sclerosis Society.

Quit-Smoking Drug May Raise Suicide Risk

(HealthDay News) -- There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.
"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.
Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Last month, Pfizer agreed, after consulting with the FDA, to update packages of Chantix sold in the United States to more prominently display a warning that users should be monitored for suicidal behavior, depressed mood, and other mental health symptoms.

The FDA approved Chantix in May 2006 as a smoking-cessation drug. It acts in areas of the brain affected by nicotine and may ease withdrawal symptoms and block the effects of nicotine if users resume smoking.

On Friday, FDA officials advised patients to tell their doctor about any history of psychiatric illness before starting Chantix. The drug can cause current psychiatric illness to get worse even if it is under control. Chantix may also cause the recurrence of an old psychiatric illness, the officials warned.

Patients should also report changes in mood and behavior to their doctor. Symptoms to look out for include anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide, the FDA officials said.

In most cases, these symptoms developed while taking Chantix, but they can also appear after stopping the drug, the officials noted.
"We are continuing with the review process over the next several months as we try to pin down to what extent these problems are being seen with Chantix," Rappaport said.

Vivid, unusual, or strange dreams may occur while taking the drug. Patients may also experience impaired ability to drive or operate heavy machinery, the officials said.

More information
For more on quitting smoking, visit Smokefree.gov.

Breast Is Best for Reducing Stress

(HealthDay News) -- Breast-feeding is considered a great way for a mother to form a close bond with her infant. And now there's evidence to suggest it may also help kids be more resilient to stress.

Researchers in Sweden and the United Kingdom examined data on almost 9,000 children born in Great Britain in 1970. Relevant information was collected at birth and again at ages 5 and 10 from parents, teachers, health-care workers and midwives.

Teachers were asked to rate the kids' anxiety levels on a zero-to-50 scale at age 10. And parents were asked about major life events -- including divorce or separation -- that occurred when their children were between 5 and 10 years old.

Not surprisingly, children whose parents had divorced or separated were more likely to have high anxiety. But what the researchers found striking was the difference in stress levels between breast-fed and bottle-fed kids. Breast-fed children were significantly less anxious than kids who hadn't nursed at their mother's breast.

Lead author Scott Montgomery, an associate professor at the Karolinska Institutet in Stockholm, said the research team was interested in examining whether there are any specific early-life exposures that make children better able to cope with stress later in life. The study attempted to replicate animal studies that showed close physical contact between a mother and her offspring may have a positive impact on the development of the offspring's stress response, he said.

"The best marker of maternal physical contact in the first month of life that we could find among the research information at our disposal was breast-feeding," Montgomery said.

The American Academy of Pediatrics recommends that healthy women exclusively breast-feed their infants for at least the first six months of life and continue breast-feeding "for at least the first year of life and beyond for as long as mutually desired by mother and child."

Breast-feeding offers many health and development benefits for baby, says the National Institute of Child Health & Human Development. Kids get the right balance of nutrients to support optimal growth, fatty acids to promote brain development and protection against many childhood illnesses. And there are important emotional and physical benefits for moms as well.

"There is no question that breast-feeding is better for the health of mothers and children," said Nicole Else-Quest, an assistant professor of psychology at Villanova University in Pennsylvania, "but it is less clear how breast-feeding affects the mother-child relationship." Breast-feeding may help to establish an early bond, she added, but "it is only one of many ways to do so."
As for why there might be differences in stress between breast-fed and bottle-fed kids, Else-Quest said it is difficult to speculate "given that many factors influence the decisions to breast-feed in the first place."

The research team considered factors that might affect a child's reaction to stress and ability to cope, such as maternal depression, parental education levels, social class, and smoking habits. Even after accounting for those factors, breast-fed children were less anxious than their peers. In addition, bottle-fed children whose parents divorced were more anxious than breast-fed kids.
Yet the study findings don't prove that breast-feeding itself reduces anxiety. It may be a mark of close, early physical contact, the researchers noted.

"A child without such regular contact may perceive greater danger reacting to stress -- indicating a potentially dangerous situation -- with a more reactive and less well-controlled stress response," Montgomery said.

It's also possible, he added, that mothers who breast-fed simply have a better relationship with their child.

"The parent-child relationship influences the child's health and development in many ways," Montgomery said. "A good relationship with parents is important, and this relationship begins in infancy, so good early contact with the child is important."

The study findings were published in the journal Archives of Disease in Childhood.

More information
The National Institute of Child Health & Human Development has the latest research on breast-feeding.

Blackberries, Broccoli Sprouts Battle Cancer

(HealthDay News) -- Your local farmer's market might hold the key to cancer prevention, since new research shows that black raspberries, broccoli sprouts and some raw vegetables reduce the risk of esophageal and bladder cancers.

Data from three studies on the subject was presented Thursday at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention, in Philadelphia.

Fruits and vegetables have long been known to help reduce the risk of certain cancers. Based on prior research, the American Cancer Society recommends eating five servings of fruits and vegetables daily.

In the first study, Ohio State University researchers found black raspberries may protect against esophageal cancer by reducing the oxidative stress that results from Barrett's esophagus, a precancerous condition usually caused by gastroesophageal reflux disease. The esophagus is a long tube that connects the throat to the stomach. Reflux disease causes stomach acid to continually splash back up into the esophagus.

"Specifically in the case of Barrett's patients, reflux of the stomach and bile acid contribute to ongoing oxidative damage. Thus, our hypothesis is that feeding a food that is high in potential protective constituents, such as antioxidants, vitamins, minerals and other phytochemicals, may help restore the oxidative balance," lead researcher Laura Kresty said.

People with Barrett's esophagus typically are 30 to 40 times more likely to develop esophageal cancer, which has a poor five-year survival rate of 15 percent.

The team gave 32 grams to 45 grams of black raspberries daily for six months to 20 patients with Barrett's esophagus. They analyzed changes in blood, urine and tissue before, during and after the treatment, and found lower levels of some of the chemical markers of oxidative stress in both urine and tissue samples.

Black raspberries previously have been shown to reduce the risk of oral, esophageal and colon cancer in animal models, according to the researchers, who called for further study in humans.

Dietitian Wendy Demark-Wahnefried, a professor of behavioral science at M.D. Anderson Cancer Center at the University of Texas in Houston, said she would feel comfortable advising people with Barrett's to eat black raspberries. "It couldn't hurt," she said, but added that further studies need to find out if the berries really do prevent cancer.

In other research presented at the meeting, broccoli sprouts and cruciferous vegetables both showed promise in the fight against bladder cancer, according to two separate teams from the Roswell Park Cancer Institute in Buffalo, N.Y.

Using a rat model, a team lead by Dr. Yuesheng Zhang, a professor of oncology, demonstrated that a broccoli sprout extract reduced bladder cancer in rats by 70 percent.

"Our present study shows that broccoli sprout extracts fed to rats in the diet inhibits bladder cancer development induced by a carcinogen. We don't yet know if the extracts inhibit the growth of a existing bladder cancer," said Zhang, who explained that broccoli sprouts are a rich source of a well-known cancer preventive agent known as sulforaphane.

"We next plan to find out if broccoli sprout extracts can fight bladder cancer in humans," Zhang noted.

A second team at the institute found that people who ate three or more servings of raw, cruciferous vegetables per month reduced their risk of bladder cancer by 40 percent.

Cruciferous vegetables include broccoli, cabbage and cauliflower.

The team analyzed the dietary habits of 275 people with early bladder cancer and 825 people who were cancer-free. The researchers specifically asked how many servings of raw or cooked cruciferous vegetables they ate before their diagnosis and whether they smoked.

Analysis of the data showed that the more raw, cruciferous vegetables people ate, the lower their risk of bladder cancer. In comparison to people who smoked and ate fewer than three servings of raw vegetables a day, nonsmokers eating at least three servings of cruciferous vegetables daily were 73 percent less likely to develop bladder cancer.

"In our study, we do find intake of raw cruciferous vegetables showed risk reduction of bladder cancer in smokers, and even the heavier smokers," said lead researcher Li Tang.

The researchers stressed that the benefits are derived from raw cruciferous vegetables, giving cole slaw the edge over cabbage soup when it comes to cancer prevention.

"This confirms that there are a variety of compounds within fruits and vegetables that contribute to reducing the risk of cancer. Research like these studies contribute to our knowledge about what the impact of specific nutrients may be on specific types of cancer," said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"Cooking leaches out some nutrients but makes others more absorbable. Until we know more in this regard, the bottom-line message for consumers is eat at least five servings of fruits and vegetables each day, raw and/or lightly cooked. Focus on those with the most color, since, in general, fruit and vegetables with the most color have the most cancer-fighting antioxidants and phytochemicals."

"Surveys we've done indicate many people don't think they have control over their cancer risk, but studies clearly indicate they do. For the majority of people who don't smoke, watching their weight, being more active and eating a healthy diet are the most important ways to reduce cancer risk," Doyle said.

More information
To learn how diet and physical activity can help prevent cancer, visit the American Cancer Society.

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'Tis the Season For Allergy, Asthma

(HealthDay News) -- It's easy for the holidays to become the season of sneezing, congestion and other woes for people with food or other allergies and asthma, say experts at the American Academy of Allergy, Asthma & Immunology (AAAAI).

But some preventive measures can cut symptoms to a minimum, they say.

"Whether it's feasting on holiday meals, setting up your Christmas tree, or visiting your pet-owning relatives, allergy triggers may be lurking inside of our warm, cozy homes this time of year," Alisa M. Smith, vice-chairwoman of the AAAAI's indoor allergen committee, said in a prepared statement. "Unfortunately, with busy schedules, travel time and the stress of the holidays, it is easy to forget to take the proper care when dealing with allergies and asthma.

However, avoiding potential triggers and taking the proper precautions is necessary to keep symptoms under control."

The AAAAI offers the following tips for people with asthma and different types of allergies:
When you're at parties or family gatherings, inform your hosts about your food allergy and ask about the ingredients used to prepare the meal.

Always carry an injectable dose of epinephrine. Homemade meals/snacks don't have ingredient lists and may be contaminated with trace of amounts of allergenic foods through contact with storage containers or kitchen utensils.

Remind family and friends that strict avoidance is the only way for you to manage food allergies and that even a tiny bit of allergenic foods can trigger a dangerous allergic reaction.
If you're visiting homes where there are pets, take your allergy medication beforehand.

Real Christmas trees often carry microscopic mold spores that can cause allergic symptoms such as sneezing, water eyes, and an itchy nose.

Decorations and artificial trees can gather mold and dust while in storage. Clean them before you start putting them up.

Artificial snow can irritate your lungs if you inhale it. Be sure to follow directions when spraying artificial snow on windows or other surfaces.

The stress of the holiday season can sometimes trigger an asthma attack. Monitor your stress levels. If you do feel stressed, deep breathing and relaxation may help.

If you're sleeping away from home, bring your own pillow with an allergen-proof cover. Ask for down-free pillows.

Avoid wood smoke, which can trigger an asthma attack.

More information
The American Academy of Family Physicians has more about controlling allergy symptoms.

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Depression Linked to Bone Loss in Younger Women

(HealthDay News) -- Premenopausal women struggling with depression have lower bone mass than do non-depressed women in the same age range, a new study found.

The bone loss was most pronounced in certain regions of the hip, which is troubling given that hip fractures are one of the most serious -- and potentially fatal -- consequences of osteoporosis.

The level of bone loss seen in the depressed women was the same or higher than that associated with other, established risk factors for osteoporosis, including smoking, low calcium intake and lack of physical exercise, the researchers said.

The findings, published in the Nov. 26 issue of the Archives of Internal Medicine, could have implications for the prevention of osteoporosis.

"Premenopausal women with depression should be screened for low bone mass," said Dr. Giovanni Cizza, senior author of the study who conducted the research while at the U.S. National Institute of Mental Health. "They should do a bone mineral density measurement, because osteoporosis is a silent condition. Until someone fractures, you don't know you have osteoporosis."

Cizza is now a staff clinician at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

A woman's bone mass peaks during youth then thins after menopause. Previous, preliminary studies had suggested that depression might be a risk factor for low bone mass in older women.

For this study, Cizza and his colleagues looked at 89 women with depression and 44 women without depression. The women ranged in age from 21 to 45. The depressed women were taking antidepressant medications.

Seventeen percent of the depressed women had thinner bone density in the femoral neck, a vulnerable part of the hip. Only 2 percent of non-depressed women, by contrast, had thinner bone in this area.

Twenty percent of depressed women also had low bone density in the lumbar spine, compared with 9 percent of the non-depressed women.

Blood and urine samples also revealed that the depressed women had lower levels of "good" proteins called cytokines. "The bad cytokines that may cause bone loss are higher," Cizza said.

It's not clear what role antidepressants might play, but by relieving the depression, the drugs may also help bone mineral density, the researchers said.

More information
To learn more about bone health, visit the National Osteoporosis Foundation.

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Advantages and Disadvantages of Alcohol Intake on Cardiovascular Health Reviewed

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD

The latest American Heart Association guidelines caution people not to start drinking alcohol if they do not already drink alcohol, according to a review of the advantages and disadvantages of alcohol intake on cardiovascular health published in the August 23 Online First issue of the Journal of the American College of Cardiology.

"Accumulating scientific evidence indicates that light to moderate drinking done on a daily basis may significantly reduce the risks of coronary heart disease (CHD) and all-cause mortality," write James H. O'Keefe, MD, FACC, and colleagues from the Mid America Heart Institute in Kansas City, Missouri. "In contrast, excessive alcohol intake and binge drinking are toxic to both the heart and overall health and are the third leading cause of premature death among Americans.

The purpose of the present review is to:
1) outline the specific benefits and risks of alcohol, and the threshold of intake at which drinking becomes a health danger rather than an advantage;
2) detail the mechanisms whereby alcohol confers cardioprotection; and
3) discuss the ideal quantities, drinking patterns, and beverages, and which individuals are most likely to benefit."

Research to date has shown J-shaped relationships between alcohol consumption and several adverse health outcomes, including all-cause mortality, CHD, diabetes, hypertension, congestive heart failure, stroke, dementia, and Raynaud's phenomenon.

Some cardioprotective benefits have been demonstrated for light to moderate alcohol consumption (up to 1 drink daily for women and 1 or 2 drinks daily for men). Most studies have shown that light to moderate drinking is associated with risk reductions for CHD of approximately 30% to 35%.

Alcohol consumed in moderation seems to have an antiatherosclerotic effect, with decreased incidence of peripheral arterial disease and decreased atherosclerotic burden shown by coronary angiography, computerized tomography-detected coronary calcium, and carotid ultrasound.
Like exercise, alcohol consumption seems to be most cardioprotective when done daily and in moderation. However, increasingly excessive consumption is associated with proportional worsening of outcomes.

Because of the beneficial effects on high-density lipoprotein (HDL) cholesterol, insulin action, and inflammation, light to moderate alcohol intake may be particularly helpful for patients with abnormal glucose metabolism and/or insulin resistance. Light to moderate alcohol intake may be associated with reductions in the prevalence and incidence of diabetes, and a large meta-analysis with 12-year follow-up showed a 30% reduction in new diabetes in those who consumed 1 to 2 drinks daily.

The cardiovascular benefits associated with alcohol consumption protection are thought to be mediated by improvements in insulin sensitivity and HDL cholesterol. The major protective component seems to be the ethanol itself, and not the other ingredients found in different types of alcoholic beverages.

In a meta-analysis incorporating data from more than 1 million participants, consumption of 1 drink daily by women and 1 or 2 drinks daily by men was associated with an 18% reduction in total mortality, but daily intakes of more than 2 drinks in women and 3 drinks in men were associated with dose-dependent increased mortality.

Although low-dose, daily alcohol consumption has been linked to better health than less frequent use, binge drinking increases cardiovascular events and mortality, even in otherwise light drinkers.

"Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking," the study authors note. "Alcohol (ethanol) consumption is analogous to the proverbial double-edged sword, and perhaps no other factor in cardiovascular (CV) health is capable of cutting so deeply in either direction depending on how it is used."

Guidelines from the United Kingdom suggest that middle-aged or elderly men and postmenopausal women who drink seldom or never might consider the possibility that light drinking would benefit their health. On occasion, the reviewers have made a similar recommendation to patients who do not smoke and who have no personal or family history of substance abuse and no history of depression or bipolar disorder. However, they argue that light to moderate drinking should not be universally recommended to the general public or even to patients with cardiovascular disease.

As an analogy, they point out that observational data and findings from randomized trials using surrogate endpoints suggested that hormone replacement therapy for women and antioxidant vitamins improved cardiovascular outcomes, whereas later randomized trials with larger samples led to the opposite conclusions. They note that no randomized trials of alcohol for improving clinical outcomes have yet been performed. In observational studies, residual unmeasured confounding factors could be contributing to apparent benefits that seem to be associated with light to moderate drinking.

The investigators further note that heavy drinking has caused significant individual and societal problems and morbidity. In the past 15 years, the rates of alcohol abuse and binge drinking have been increasing, according to the findings of some studies. Alcohol abuse causes 100,000 deaths each year in the United States, and it has been deemed the third largest preventable cause of death.

Excessive alcohol consumption has been associated with increased risks for all-cause mortality, motor vehicle crashes, stroke, cardiomyopathy, cardiac dysrhythmia, sudden cardiac arrest, suicide, cancer (particularly of the breast and gastrointestinal tract), cirrhosis, fetal alcohol syndrome and sleep apnea.

"Sobering statistics warn that moderate daily drinking is a slippery slope that many individuals cannot safely navigate," the study authors conclude. "The latest American Heart Association guidelines caution people not to start drinking if they do not already drink alcohol, because it is not possible to predict in which people alcohol abuse will become a problem. Until we have more randomized outcome data, and tools for predicting susceptibility to problem drinking, it would seem prudent to encourage physicians and patients to focus on more innocuous interventions to prevent CHD."

J Am Coll Cardiol. Published online August 23, 2007.
2007;50:1009-1014.

Trouble at Home Boosts Kids' Asthma

(HealthDay News) -- Poor family support and bad neighborhoods can aggravate asthma symptoms in kids, Canadian research suggests.

Edith Chen and colleagues at the University of British Columbia in Vancouver examined the degree of support that 78 children with asthma received from family and peers. They also looked at social problems, such as crime and violence, in the children's neighborhoods.

They then assessed the children's lung function, asthma symptoms, and certain behaviors that can affect asthma.

The results indicated a correlation between social environment and asthma symptoms and lung function. Children who reported less family support and lived in worse neighborhoods experienced greater asthma symptoms, the team said. Those who reported less family support had poorer lung function.

Further analysis revealed that low levels of family support were associated with greater lung inflammation which, in turn, was associated with poorer asthma outcomes. Family support did not appear to influence behaviors that can affect asthma.

The researchers also concluded that living in worse neighborhoods was associated with higher rates of child smoking and exposure to smoke, which is associated with poorer asthma outcomes.

"Poor family relations may foster psychological experiences with direct physiologic consequences, whereas problematic neighborhoods may operate by providing the role models for maladaptive behaviors," the study authors wrote.

Peer group support had no significant effect on asthma symptoms or lung function. The study was published in the first issue for October of the American Journal of Respiratory and Critical Care Medicine.

More information
The American Lung Association has more about childhood asthma.

Experts Publish New Lung Disease Guidelines

(HealthDay News) -- Experts have devised new standards for the diagnosis, management and prevention of a widespread, deadly lung ailment -- chronic obstructive pulmonary disease (COPD).

COPD affects 15 percent to 25 percent of adults over the age of 40 and is the fourth leading cause of death in the United States. It's expected to become the fifth leading cause of death worldwide by 2020.

Cigarette smoking and exposure to secondhand smoke are among the most common risk factors for COPD in the developed world. In developing countries, major risk factors include long-term exposure to smoke from indoor cooking and heating fires.

Now, a report released Sept. 14 by the Global Initiative for Chronic Obstructive Lung Disease is setting the standard for caring for COPD patients.

The new guidelines -- published in the American Journal of Respiratory and Critical Care Medicine -- emphasize the importance of proper diagnosis, assessment of disease severity, and the need for a better understanding of co-existing conditions in order to improve treatment of COPD.

"This is an absolutely up-to-date summary of all the available evidence on the diagnosis, management and prevention of COPD," report lead author Dr. Klaus Rabe, of the department of pulmonology at Leiden University Medical Center in the Netherlands, said in a prepared statement.

"One of the most important points is that we now say COPD is preventable and treatable," Rabe said. "There are steps we can take to prevent it, and it is no longer viewed with therapeutic nihilism."

More information
The American Academy of Family Physicians has more about COPD.

Smokers' Infants Have High Nicotine Levels

(HealthDay News) -- In homes where at least one parent smokes, infants have 5.5 times higher levels of a nicotine toxin called cotinine in their urine than infants of nonsmokers, a British study finds.

Cotinine is created as the body tries to get rid of the nicotine in inhaled smoke.

The study of 104 12-week-old infants (71 with at least one parent who smoked and 33 with nonsmoking parents) also found that having a mother who smoked quadrupled urine cotinine levels. Having a father who smoked doubled cotinine levels in an infant's urine, the researchers found.

Sleeping with parents and lower-temperature rooms were also associated with increased cotinine levels in infants, said the study by researchers at the University of Leicester Medical School and Warwick University.

"Babies affected by smoke tend to come from poorer homes, which may have smaller rooms and inadequate heating," the study authors wrote. "Higher cotinine levels in colder times of year may be a reflection of the other key factors which influence exposure to passive smoking, such as poorer ventilation or a greater tendency for parents to smoke indoors in winter."

The researchers also noted that sleeping with a parent is a known risk factor for sudden infant death syndrome (SIDS). They suggest that one reason for this could be an infant's proximity to parents' clothing or other objects contaminated with smoke particles.

The findings were published online Tuesday ahead of print in the journal Archives of Disease in Childhood.

More information
The American Academy of Otolaryngology -- Head and Neck Surgery has more about children and secondhand smoke.

Resolve to Exercise Your Brain

(HealthDay News) -- Getting in shape tops many New Year's resolution lists, but the Alliance for Aging Research is encouraging Americans to boost their brain health, too.

"There is a lot we can do to keep our brains healthy and potentially prevent or lessen the cognitive decline that often comes with aging," Daniel Perry, executive director of the nonprofit Alliance for Aging Research, said in a prepared statement. "We are encouraging people to take steps to improve brain health as part of their overall fitness regimen for the New Year."

The Alliance for Aging Research recommends these 10 steps for improving your brain health.

Eat a Brain-Healthy Diet. A diet rich in omega-3 fatty acids (commonly found in fish), protein, antioxidants, fruits and vegetables and vitamin B; low in trans fats; and with an appropriate level of carbohydrates will help keep your brain healthy.

Stay Mentally Active. Activities such as learning a new skill or language, working on crossword puzzles, taking classes, and learning how to dance can help challenge and maintain your mental functioning.

Exercise Regularly. Exercising often can increase circulation, improve coordination, and help prevent conditions that increase the risk of dementia such as heart disease, stroke and diabetes.
Stay Social. Spending time with friends, volunteering, and traveling can keep your mind active and healthy.

Get Plenty of Sleep. Not getting enough sleep can have a negative impact on brain health.

Manage Stress. Participating in yoga, spending time with friends, or doing other stress-relieving activities can help preserve your ability to remember and learn.

Prevent Brain Injury. Wearing protective head gear and seat belts can help you avoid head injury, which has been associated with an increased risk of dementia.

Control Other Health Conditions. Maintaining a healthy weight, exercising, eating a well-balanced and nutritious diet, and controlling stress can help reduce your risk of diseases that affect your brain, including diabetes, heart disease, high blood pressure and hypertension.

Avoid Unhealthy Habits. Smoking, heavy drinking and use of recreational drugs can increase the risk of dementia and cognitive decline.

Consider Your Genes. If your family history puts you at risk for developing dementia, work with your doctor to find ways to maintain your brain health to help avoid or slow the progression of cognitive decline.

More information
The National Institute on Aging has more about forgetfulness.

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Research Yields Family Clues to Rheumatoid Arthritis

(HealthDay News) -- Women whose brothers are affected with painful rheumatoid arthritis are more likely to develop a severe form of the disease, new research shows.
The finding adds to growing evidence that genes play a key role in the autoimmune disorder, one expert said.

"The importance of this study is that it is beginning to show us how multiple genetic factors can interact and regulate the development and course of rheumatoid arthritis (RA)," said Dr. John Hardin, chief science officer of the Arthritis Foundation and a rheumatologist at the Albert Einstein College of Medicine, New York.

He was not involved in the research, which is published in the October issue of Arthritis & Rheumatism.

According to the Arthritis Foundation, about two million people in the United States suffer from rheumatoid arthritis, an autoimmune, chronic inflammatory disease in which the joints can become extremely painful. In people with RA, the immune system has an abnormal response, mistaking the body's healthy tissue for a foreign invader and attacking it.

Dr. Lindsey A. Criswell, the new study's lead author and a professor of medicine at the University of California, San Francisco, explained that her team "compared the disease features among women who had no brothers with RA to the features of women with one or more brothers with RA."

The researchers focused on 1,004 affected members of 467 families in which two or more siblings have rheumatoid arthritis. "We compared features of the disease in all the men and all the women," Criswell said, trying to build on what is already known about sex differences in the disease.

They found that women whose brothers were affected with the painful form of arthritis in which the body "turns" on itself were more likely to have high levels of an antibody associated with the disease, she said. According to Criswell, this information could be useful to both physicians and patients to help predict the course of the disease.

It's already known that RA affects women three times as often as men, and that it strikes men later in life. While women develop RA anywhere from adolescence to menopause, it is rarely seen in men under age 45.

Criswell's team found that while the disease occurs later in men, male patients showed more signs of "erosive" disease. They were also more likely than women to test positive for rheumatoid factor and antibodies to "cyclic citrullinated peptides" or CCP, both hallmarks of the disease.

Men with RA were more likely to have a history of smoking and to have a gene called HLA-DRB1, a subtype of the genetic marker HLA-DR4, which is known to be associated with the disease. Women whose brothers had RA also had higher anti-CCP antibodies and were more likely to have this gene, compared to females whose brothers do not have RA, lending support to the idea that the disease runs in families.

According to the Arthritis Foundation, people with the genetic marker HLA-DR4 may be at increased risk of getting RA; the marker is found in white blood cells and helps the body differentiate between its own cells and foreign invading ones.

"It has been clear for a long time that RA runs in families," Criswell said. "But like many diseases, the genetic cause is complex. There is not a single gene that determines who will and won't get it but rather a number of genes. We have been facing a challenge of identifying multiple genes in addition to environmental factors."

Genetic information is helpful for a number of reasons. "[It] might influence how we treat them, and whether men or women are at greater risk," Criswell said. Family histories might also alert the doctor and the patient to expect the course of the disease to be more severe.

The study adds to our understanding of the disease, said Hardin. "We have [identified] two genes so far, but it's clear other genes are involved," he said.

The take-home message of the study is that patients should tell their doctor if they have a brother with the disease, Hardin said. Rheumatologists, too, should remember to ask patients if other family members have the disease.

More information
For more on rheumatoid arthritis, head to the Arthritis Foundation.

Nicotine May Help Spur Lung Cancer

FRIDAY, July 21 (HealthDay News) -- While the nicotine in tobacco and in nicotine-replacement patches and gums doesn't cause lung cancer, it may help it along, a new study finds.
"Nicotine can promote the growth of new blood vessels and new cells -- two things that are correlated with the progression of cancer -- and our study shows how this actually happens," said study co-author Srikumar P. Chellappan, an associate professor in the Drug Discovery Program with the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, in Tampa.

The finding raises questions about the use by lung cancer patients of nicotine-containing interventions aimed at helping smokers quit, such as popular patches and gums.
Chellappan's team identified a key binding process taking place between nicotine and receptors found on cells lining the lung's air passages, and in lung cancer cells themselves. The bond between nicotine and these receptors provokes further lung cancer cell proliferation, the researchers report in the August issue of the Journal of Clinical Investigation.
The Florida group conducted their lab work on cancer cells taken from patients afflicted with non-small cell lung cancer (NSCLS).

According to the American Cancer Society, lung cancer accounts for 13 percent of all new cancers and is the leading cancer killer of American men and women. Non-small cell cancers comprise 85 percent of the nearly 175,000 new cases of lung cancer diagnosed in the United States each year.

But while tobacco smoke is the direct cause of eight out of 10 lung malignancies, nicotine -- the addictive chemical in tobacco -- does not have cancer-causing properties. The role, if any, of nicotine in lung cancer has long been the subject of debate.

In previous work, Chellapan found that nicotine exposure among lung cancer patients did appear to undermine chemotherapy's effectiveness in killing off cancer cells. Because so many patients use nicotine patches or gums to help them quit, this raise the troubling notion that these interventions might actually help encourage the disease.

In this study, Chellappan's focused on NSCLS cells and adjacent cells from the lung's air passages also known as bronchial cells. They exposed both cell types to nicotine in the test tube. The amount of nicotine used was the equivalent to what would typically be present in the bloodstream of a patient who smokes one pack of cigarettes a day.

In addition to binding with what are known as nicotinic acetylcholine receptors, the nicotine appeared to help create signaling pathways that promoted the cancer cell growth cycle. This growth activated and recruited other cell machinery known to stimulate tumor growth.
The researchers concluded that, in the test-tube setting, nicotine appears to go beyond simply protecting cancer cells as had been previously observed. Instead, it appears to promote cancer-cell proliferation and tumor progression.

"We found that a normal amount of nicotine that is typically present in the blood of smokers can really induce a proliferation of cancer cells, and we have identified some proteins in the cell that facilitate this proliferation," said Chellappan.

"So, smokers should be staying away from all products that contain nicotine," he cautioned. "Not just cigarettes -- anything. I can not say that this is just about smoking. This is about exposure to any nicotine. Even a patch to help quit smoking may not be the best idea."
Nevertheless, one expert is still on the fence when it comes to the risks and benefits for lung cancer patients in using nicotine-replacement therapies.

"You can't necessarily say whether nicotine-replacement therapy is a good or bad idea," said Dr. Norman H. Edelman, chief medical officer with the American Lung Association.
"My guess is that it's a good idea to engage in smoking cessation," he said. "Smoking cessation is a much healthier way to go rather than avoiding the nicotine in smoking-cessation therapies based on the theoretical risk shown in test tubes that nicotine can promote tumors."
Edelman emphasized, however, that the current study is "an important biologic finding" that will need to be followed up with research in animals and ultimately humans.

Two other major groups agreed. The U.S. National Cancer Institute's Web site states that "any potential risks of short-term use of nicotine-replacement therapy to stop smoking are far outweighed by the significant and known benefits that accrue to patients who stop smoking."
And the American Cancer Society's Web site notes that "numerous studies have shown that these products are safe and effective in helping smokers quit." Society experts also point out that the use of nicotine-replacement products, alongside in-person and phone counseling, can double a smoker's chances of successfully quitting.

More information
For more on cancer and nicotine, head to the U.S. National Cancer Institute.
Last reviewed: 07/21/2006 Last updated: 07/21/2006

Hyperactive Girls Can Often Become Unhealthy Women

FRIDAY, July 21 (HealthDay News) -- Hyperactive girls are more likely than other children to develop heart problems later in life, but researchers aren't sure there's a direct cause-and-effect link.

The Finnish study, which tracked 708 children into adulthood, also found that children who were hyperactive, socially isolated and had other problems dealing with people were more likely than other children to develop heart-damaging behaviors such as smoking as they became adults.

The study participants' emotional states were assessed when they were ages 3 to 9 in the early 1980s. Then, in 2001 and 2002, ultrasound was used to examine the health of the participants' arteries as young adults. They were also asked about their health habits, including smoking.
Those who as youngsters were hyperactive, isolated from other children and were most likely to display negative mood, low self-control and aggressive outbursts were more likely to smoke as adults, the study said. Girls who had those problems were also more likely to have high blood pressure and to be overweight as adults.

The study also found that all girls -- not just those diagnosed with a psychological problem -- who were more active than other children were more likely to show signs of clogged arteries as adults. This held true even when other factors were taken into account.

Stress, not hyperactivity itself, may be a major factor in all this, said researchers at the University of Helsinki. They speculated that hyperactive children may become stressed by constantly being told to not be so restless, not to be so noisy, "don't do this and don't do that."
The study was expected to be published in an upcoming issue of the journal Psychosomatic Medicine.

More information
The U.S. National Library of Medicine has more about hyperactivity.

Coffee Could Protect Liver

Drinking coffee may be related to a reduced risk of developing the liver disease alcoholic cirrhosis, according to a report in a recent issue of Archives of Internal Medicine.

Cirrhosis progressively destroys healthy liver tissue and replaces it with scar tissue. Viruses such as hepatitis C can cause cirrhosis, but long-term, heavy alcohol use is the most common cause of the disease in developed countries, according to background information in the article.

Most alcohol drinkers, however, never develop cirrhosis; other factors that may play a role include genetics, diet and nutrition, smoking and the interaction of alcohol with other toxins that damage the liver.

Arthur L. Klatsky, MD, and colleagues at the Kaiser Permanente Medical Care Program, Oakland, Calif., analyzed data from 125,580 individuals (55,247 men and 70,333 women) who did not report liver disease when they had baseline examinations, between 1978 and 1985.

Participants filled out a questionnaire to provide information about how much alcohol, coffee and tea they drank per day during the past year. Some of the individuals also had their blood tested for levels of certain liver enzymes; the enzymes are released into the blood stream when the liver is diseased or damaged.

By the end of 2001, 330 participants had been diagnosed with cirrhosis, including 199 with alcoholic cirrhosis. For each cup of coffee they drank per day, participants were 22% less likely to develop alcoholic cirrhosis. Drinking coffee was also associated with a slight reduction in risk for other types of cirrhosis.

Among those who had their blood drawn, liver enzyme levels were higher among individuals who drank more alcohol, indicating liver disease or damage; however, those who drank both alcohol and coffee had lower levels than those who drank alcohol but did not drink coffee, with the strongest link among the heaviest drinkers.

Tea drinking was not related to reduced risk in the study, suggesting that it is not caffeine that is responsible for the relationship between coffee and reduced cirrhosis risk. "Previous reports are disparate with respect to whether the apparently protective coffee ingredient is caffeine; in our opinion this issue is quite unresolved," the authors write.

The findings do not suggest that physicians prescribe coffee to prevent alcoholic cirrhosis, the authors continue. "Even if coffee is protective, the primary approach to reduction of alcoholic cirrhosis is avoidance or cessation of heavy alcohol drinking," they conclude. "Assuming causality, the data do suggest that coffee intake may partly explain the variability of cirrhosis risk in alcohol consumers.

Basic research about hepatic coffee-ethanol interactions is warranted, but we should keep in mind that coffee might represent only one of a number of potential cirrhosis risk modulators." This article was prepared by Mental Health Weekly Digest editors from staff and other reports.

Copyright 2006, Mental Health Weekly Digest via NewsRx.com.
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©Copyright 2006, Mental Health Weekly Digest via NewsRx.com

I am taking raw garlic with my evening meal.

I am taking raw garlic with my evening meal. It seems garlic can lower blood pressure by 5 to 10%. As mentioned in my previous post, garlic can lower cholesterol 15% which is a plus factor (Using food to control cholesterol). Garlic can also thin blood.A previous post also mentioned kefir, which I take occasionally. Another weapon in the arsenal against high blood.

And cut or reduce smoking, which is not a problem as I don't smoke.And my report card - the last test I had done showed that my diastolic blood pressure was reduced from 90 to 85, which is a good sign. I will have to take the test again soon.



Blood pressure: 120 over 80
Blood sugar: 4.6 mmol/L
Looks like it is working.
Natural Treatments for High Blood Pressure

New Cholesterol Guidelines?

New Cholesterol Guidelines?

Provided by: DrWeil.com

Q: I understand that there has been a change in what's considered normal cholesterol. Can you explain the difference and the reason for the change? -- Richard

A: Government health officials have recommended that target levels of LDL ("bad") cholesterol should be reduced by 30 points for people considered at moderate to high risk for heart disease. Up to now, an LDL of 130 was considered acceptable for those with a high risk of heart disease.

According to the new recommendations, LDL levels for people at high risk should be below 100. You're considered at high risk if you already have heart disease, diabetes, non-coronary atherosclerosis, or some other condition that increases your risk of a heart attack to 20 percent or more over the next 10 years.

The same reduction was recommended for those considered at "moderately high" risk of heart disease -- anyone with such risk factors such as advancing age, high blood pressure, cigarette smoking, and other lifestyle-related risks such as obesity, physical inactivity, or metabolic syndrome (elevated triglycerides and low HDL).

If you fall into this category, you have a 10 to 20 percent chance of suffering a heart attack within 10 years. If you have no risk factors for heart disease, you're unaffected by the new recommendations.

Under the new guidelines, millions of Americans whose LDL levels range from 100 to 129 will be treated with cholesterol-lowering "statin" drugs with the goal of reducing LDL levels by 30 to 40 percent, no matter what they are at the outset.

The changes were set in motion after results from five recent clinical trials indicated that the old cholesterol goals weren't low enough and that heart attack prevention is more effective when LDL levels are pushed well below 100.

In fact, evidence suggests that high-risk patients do best when their LDL is below 70, a level that may be hard to reach even with high doses of statins. The new recommendations were published in the July 13, 2004, issue of Circulation and were endorsed by the National Heart, Lung and Blood Institute, the American Heart Association and the American College of Cardiology.

Andrew Weil, MD