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

The Feel-Good-Enough Drugs

Antidepressants are widely prescribed because they restore balance. But balance isn’t happiness
by Walter Armstrong

I’ve been taking antidepressants since 1994. That may seem like a long time, but since I expect to pop these pills every morning until I die, I’ve stopped keeping count. You could say I’m reconciled to the fact that I was born with bad brain chemistry and need a little extra push to reach that state familiar to everyone but the chronically depressed as well-being. I like it there and have no intention of leaving.

I remember vividly the moment when Prozac first kicked in, like switching from black-and-white to color. I was talking on the phone to a friend who was telling me about her problems, which included taking care of a husband who was dying of AIDS. I heard in the familiar tone of her sad voice how hopeless she felt, but for the first time it failed to find an echo inside me. I proceeded to deliver my first-ever pep talk to her, with all the annoying sincerity of a fresh convert to hope.

The novelty wore off soon enough.
Continue reading "The Feel-Good-Enough Drugs" »

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.

Health Tip: Don't Suddenly Stop Taking an Antidepressant

(HealthDay News) - If you want to stop taking an antidepressant, it's important to speak with your doctor first, the American Academy of Family Physicians says. The doctor may recommend weaning your body off the medication gradually.

People who stop an antidepressant too quickly may trigger a host of symptoms that doctors call antidepressant discontinuation syndrome. Symptoms may include:

• Anxiety.
• Feelings of depression or sadness.
• Moodiness and irritability.
• Tiredness.
• Headaches and dizziness.
• Nausea and vomiting.
• Diarrhea.

If an antidepressant is causing an unpleasant side effect, your doctor may opt to lower your dose or prescribe a different type of antidepressant altogether.

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.

Relatives of Parkinson's Patients at Higher Psychiatric Risk

(HealthDay News) -- The close relatives of people with Parkinson's disease are at increased risk for depression and anxiety disorders, new research suggests.

The risk is particularly high in the brothers, sisters, parents and children of people who develop Parkinson's before age 75, said a team from the Mayo Clinic in Rochester, Minn.

The study included 1,000 immediate relatives of 162 Parkinson's patients and 850 immediate relatives of 147 people without Parkinson's. It's the first large population-based study to identify this kind of association.

"Studies by our group and others have shown that relatives of patients with Parkinson's disease have an increased risk of Parkinson's disease. Recently, we showed they also have increased risk of essential tremor and of cognitive impairment or dementia. However, the risk of psychiatric disorders was unknown," senior author Dr. Walter Rocca, a neurologist and epidemiologist, said in a prepared statement.

"Because many patients with Parkinson's disease develop anxiety and depression after and even before the onset of the disease, we explored whether this tendency was present to a greater extent in family members of people with Parkinson's disease compared with people without the disease. We found that, indeed, relatives of patients with Parkinson's disease are at increased risk for anxiety and depressive disorders, which suggests a genetic or other relationship between those disorders and Parkinson's disease," Rocca said.

Further research is needed to determine the exact cause or causes that boost the risk, he said.

The study was published in the December issue of the journal Archives of General Psychiatry.

More information
There's more on Parkinson's disease at We Move.

'Easy Does It' Eases Holiday Stress

(HealthDay News) -- It's supposed to be the happiest time of the year, but don't tell that to the patients who mob the offices of San Diego cardiologist Dr. Mimi Guarneri between Thanksgiving and New Year's.

Some complain of what doctors call "holiday heart" -- skipped beats, high blood pressure and angina due to stress or overindulgence. Others feel physically and emotionally overwhelmed, distracted by thoughts of difficult relatives or missing loved ones.

Guarneri, medical director of the Scripps Center for Integrative Medicine, has different advice for her patients, depending on their situations. But she's always sure to emphasize one theme: relaxation.

"The one thing is do is to take time out, take a deep breath, connect your mind with your body by simple breathing," she said. "And remember to not sweat the small stuff."

Easier said than done, of course. But when it comes to crippling holiday stress, specialists say the simplest pieces of advice are also the best.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C., advises people to be reasonable with their expectations from the season, and to anticipate trouble -- ranging from long lines at stores and airports, to bouts of sadness when images of absent loved ones come to mind.

By readying yourself for these moments, "they won't come as a shock when you realize, 'I'm getting ready to honk my horn or get steamed over this person who just pulled in front of me.' If you can do that, you can probably head off some of it," Williams explained.

He said it's not clear how many people get the blues around the holidays, but it's probably not uncommon. "It's perfectly normal to get a little bit depressed or a little sad during the holidays at one point or another," Williams said.

However, it may not be as bad as some might assume. In recent years, American researchers have looked at local statistics and debunked the long-held assumption that suicide rates shoot up around the holidays.

Not every episode of Christmastime depression is minor, however. If you find yourself early in the new year having trouble with sleeping or eating -- doing either one too much or too little -- it's possible that you've fallen into a clinical depression.

If that might be the case, "You should seek some professional evaluation and possibly treatment," Williams said.

In other cases, a little self-help can be key. "In the grand scheme of life, we say, 'Don't sweat the small stuff,'" Guarneri said. "We have to realize that a lot of stress is what we put on ourselves, not what other people are putting on us."

If you're alone and feeling isolated, she said, "get out and do service work, which brings joy to people." And, if you have the opposite problem -- too much to do and too many people to worry about pleasing -- learn to do less. "None of this is worth dying for," she said.

More information
Learn more about holiday stress from the American Psychological Association.

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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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Sleep Problems Plague the Older Set

(HealthDay News) -- Older Americans often have difficulty getting a good night's rest. It's a huge quality-of-life problem, experts say, because contrary to popular belief, seniors require about the same amount of sleep as younger adults.

"Sleep problems and sleep disorders are not an inherent part of aging," said Dr. Harrison G. Bloom, a senior associate at the International Longevity Center-USA and associate clinical professor of geriatrics and medicine at the Mount Sinai School of Medicine in New York City.

"It's pretty much of a myth that older people need less sleep than younger people."

Yet, in a study published recently in The American Journal of Medicine, researchers found that more than half of older Americans have problems getting the shuteye they need.

Older people tend to have "sleep fragmentation," meaning they wake up more often during the night, said study author Dr. Julie Gammack, an assistant professor of medicine in the Division of Geriatric Medicine at St. Louis University.

They also seem to get less "REM" sleep, the type of sleep during which rapid eye movement occurs, Bloom added.

It's unclear what role these naturally occurring changes in sleep patterns have on a person's quality of life, Bloom said. "What is important, though, is that older people often have actual sleep disorders and problems with sleep," he said.

And, experts say, there is usually more than one cause.

"Sleep disturbance in older adults is typically associated with acute and chronic illnesses, including specific sleep disorders like sleep apnea and restless leg syndrome that appear with greater frequency in older populations," said Michael V. Vitiello, a professor of psychiatry and behavioral sciences and associate director of the University of Washington's Northwest Geriatric Education Center.

As people age, they typically develop more diseases and suffer from aches and pains. "These things can disrupt sleep, so what they may perceive as a sleep disorder may actually relate to the effects of some of their other medical problems," Gammack noted.

Taking multiple medications, as many older people do, can also lead to fatigue and "hypersomnia," or being tired all the time, Bloom added.

Another big problem, he noted, is depression and anxiety. "Those are very commonly associated with sleep problems."

Despite the prevalence of sleep difficulties in older adults, many patients aren't getting the help they need.

"The average physician receives very little training about sleep disorders and typically does not routinely screen patients for them," said Vitiello, who serves on the board of directors of the National Sleep Foundation. This may be due to a lack of time or training or the belief that there is little that can be done to improve sleep, he explained.

As a result, problems like insomnia, restless leg syndrome, sleep apnea and circadian rhythm disorders are underdiagnosed and undertreated, Bloom said.

To rectify the problem, a national coalition of aging, geriatric medicine and sleep organizations is currently developing guidelines to promote prevention, diagnosis and treatment of sleep problems in older adults. The National Coalition for Sleep Disorders in Older People expects to publish its recommendations by mid-2008.

"The reason we're concerned with these [problems], besides a major issue on quality of life and being tired the next day and not functioning properly, is that these sleep disorders are associated with hypertension, diabetes, pulmonary disease, heart disease, depression and anxiety," said Bloom, chairman of coalition's expert task force.

A cause-and-effect relationship has yet to be established between sleep disorders and these chronic health problems, but Bloom suspects they at least contribute to each other. And he believes a causal relationship may be found in years to come.

"This is very, very much a tip-of-the-iceberg problem," he said.

More information
For tips on better sleep, visit the National Sleep Foundation.

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Follow-Up Exams Uncover More Iraq Vets With Emotional Woes

(HealthDay News) -- The number of Iraq war veterans needing mental-health care has risen sharply since the U.S. Defense Department began screening them a second time for emotional problems, U.S. military researchers reported Tuesday.

Initial screenings of veterans uncovered 4.4 percent who needed treatment for problems such as depression or post-traumatic stress disorder (PTSD). But six months later, a second screening found 11.7 percent were in need of mental health care, indicating that it might take several months for emotional disorders to emerge, the study suggested.

"We know mental health problems are a problem for soldiers who have been to war," said lead researcher Dr. Charles S. Milliken, of the Walter Reed Army Institute of Research at the U.S. Army Medical Research and Materiel Command. "We are doing a good thing by having erected these screening programs. Between the two screenings, we are finding a large group of soldiers that are having problems."

The findings are published in the Nov. 14 issue of the Journal of the American Medical Association.

For the study, Milliken and his colleagues collected data on the mental health of 88,235 Iraq war veterans who completed an initial screening and a second screening about six months later. Both screenings included a questionnaire and a short interview with a clinician.

"In the second screening, you do find a larger group of soldiers the first screening completely missed," Milliken said. "It's about twice as big."

The researchers found that more soldiers had mental health problems -- such as PTSD, major depression or alcohol abuse -- during the later screening. In the first screening, 4.4 percent of the soldiers were referred for mental health care, but, after the second screening, 11.7 percent were referred.

Milliken thinks the two-step screening process helps remove the stigma attached to seeking help for emotional problems. "Soldiers are like other young males, they have a stigma about seeking mental health care," he said.

Among all the soldiers screened, 20.3 percent of active duty personnel were referred for mental health care, as were 42.4 percent of reserve soldiers, the study found.

Milliken said he didn't know why the difference exists between the active duty soldiers and the reservists. He speculated, however, that it might have to do with the VA's insurance structure that allows reservists access to free care for service-related health problems.

One expert thinks the new, two-tier system for identifying soldiers with emotional problems is working, but the shear numbers of affected veterans could overburden the VA's health-care system.

"I am not surprised by the rates of PTSD among Iraqi vets," said Dr. Randall Marshall, director of Trauma Studies at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

Marshall said the difference in PTSD rates among active duty and reserve personnel is expected. "Part of what training is meant to do is desensitize soldiers to all the potential experiences on the battlefield, and the reservists have less training and are therefore more vulnerable to war experiences," he said.

Marshall also said that many reservists have had several tours of duty, "which is something they had not signed up for."

Also, many of these part-time soldiers were split from their units, which means they didn't have as much of a support system as active duty personnel, he said.

Marshall sees another major problem developing for returning veterans. Most psychotherapists aren't trained in the best ways to treat PTSD, he said. "You can't assume because it's a VA hospital everyone there has had this kind of training," he said.

In addition, the number of soldiers needing mental health care is straining an already overburdened system.
"If 20 percent of the veterans realize they need help and start to seek treatment, the system will be overwhelmed. Signs are, it already is," Marshall said.

More information
To learn more, visit the U.S. Department of Veterans Affairs.

Health Tip: Understanding Compulsive Overeating

(HealthDay News) - Compulsive overeating occurs when a person uncontrollably binges on large amounts of food. The affected person usually is overcome with feelings of guilt and shame.
Brown University offers these common reasons for why people compulsively overeat:

• To satisfy an obsession or preoccupation with food, weight and eating.
• To cope with other issues that the person can't control.
• To deal with stress, anxiety or depression.
• To mask low self-esteem.

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.

Gene Mutation Linked to Parkinson's Disease

(HealthDay News) -- People who carry a certain gene mutation appear to have a greater risk for getting Parkinson's disease and for getting it at a relatively early age, new research suggests.

The study authors also found that because Ashkenazi Jews -- those with an Eastern European background-- are more likely to carry this gene mutation, this population may run an even higher risk for the disease. An estimated 90 percent of American Jews are of Ashkenazi lineage.

Study lead author Lorraine N. Clark, a researcher at Columbia University, described her team's findings as "unique and different."

"We specifically compared patients who had an early onset Parkinson's before age 50 with patients who had a later onset after age 50, and also with patients with and without Jewish ancestry," she said. "And we showed that mutations are twice as common among early onset Parkinson's and also that they're more frequent among patients with Jewish ancestry."

Clark serves as an assistant professor in the department of clinical pathology with the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, as well as the Center for Human Genetics, both at Columbia University.

The findings are published in the Sept. 18 issue of the journal Neurology.

Parkinson's disease is a brain disorder that affects 1.5 million Americans, according to National Parkinson Foundation estimates. Approximately 60,000 news cases occur each year, striking men and women equally, usually over the age of 65.

The disease is characterized by widespread damage to dopamine-producing nerve cells, impeding their ability to regulate body movement and muscle control. Key signs of the disease include tremors, stiffness, balance problems, and slowness of movement. Patients may also experience difficulty with speech and depression. There is no known cure.

To explore potential genetic underpinnings to the onset of Parkinson's, Clark and her colleagues decided to focus on the GBA gene. Mutations of this gene have already been identified as the cause of Gaucher disease, a rare fat-storage disorder that disrupts spleen and brain function.

Gaucher's and Parkinson's have some links, the study authors noted. In some cases, Gaucher's patients have a family history of Parkinson's, while others actually develop neurological features of Parkinson's. It is also one of the most prevalent genetic illnesses among Ashkenazi Jews.

For the new study, the researchers conducted a sequencing analysis of the GBA gene among 278 Parkinson's patients, 178 of who were of Jewish ancestry dating back to all four grandparents. A similar analysis was done among 179 men and women without Parkinson's.

Clark and her team found that 14 percent of the Parkinson's patients had GBA mutations, compared to just 5 percent of the healthy patients. And, while GBA mutations were found among 22 percent of Parkinson's patients who were diagnosed with their illness before the age of 50, only 10 percent of patients diagnosed after 50 had such abnormalities.

Teasing out information on Jewish patients, the researchers found that while nearly 17 percent of Jewish Parkinson's patients had GBA mutations, the figure was 8 percent among non-Jewish Parkinson's patients.

Clark called the study findings preliminary, and she cautioned that it remains unclear whether a single GBA mutation is a cause of Parkinson's or merely a part of a larger puzzle.

Still, she believes the findings could prove helpful in opening up new avenues of research into the disease.

"This is a gene we hadn't really thought about before," she said. "And it implicates new pathways that might be important in the pathogenesis of Parkinson's disease which could lead to the development of new treatment strategies. I do think, however, that further studies are needed in larger patient populations before we could use this work in diagnostic testing and counseling."

Robin Elliott, executive director of the Parkinson's Disease Foundation in New York City, called the new research "very interesting and very worthwhile, solid work in one of the most fruitful areas of Parkinson's research.

"Genetics and the study of genetics has been one of the most exciting areas of Parkinson's in the last 10 years," he said. "In 1996, we had not a single gene associated with the disease, and now it's up to 12 or 13. So, this is a very important study that pushes the science even further, and gives us the basis for more work."

More information
To learn more, visit the Parkinson's Disease Foundation.

Child Maltreatment Rises in Homes of Soldiers Sent to War

(HealthDay News) -- A U.S. Army-sponsored study finds that children of enlisted soldiers are more likely to be abused or neglected when a parent is deployed to a combat zone.

The findings point to the need for more support services at home, the study authors said.

"The practical implication is that child maltreatment incidents are much more likely to occur during soldier deployments than during other times, and this really underlines the necessity of formal and informal support for parents who are going through this," said Deborah A. Gibbs, lead author of the study and a senior analyst with the Children and Families Program at RTI International in Research Triangle Park, N.C. "Our findings really put a number on the extent of the problem and suggest the areas in which supports are most necessary."

The study is published in the Aug. 1 issue of the Journal of the American Medical Association, a theme issue on violence and human rights.

U.S. Army support of the study should give the issue of child abuse in general even more of a spotlight, experts said.

"The fact that the military is taking an interest is going to be helpful for the whole nation," said Dr. Rachel Bramson, associate professor of family and community medicine with the Texas A&M Health Science Center College of Medicine and the Scott & White Clinic in College Station, Texas. "A lot of times if you have an organization of complexity with the degree of resources and the appropriate interest in their employee and family health, then you can bring about greater social change," she added.

U.S. Army spokesman Lt. Col. Ben Clark is deputy director of family programs, Family Advocacy Program, Army Family and Morale, Welfare and Recreation Command. Responding to the study, he said, "What they [the researchers] see is pretty consistent with what we see.

We see an increase of neglect cases when we have large deployments. We're getting resources to help with that."

Deployment of a parent results in added stress, particularly to the parent left behind. Stress, in turn, is thought to play a role in child maltreatment, including neglect, physical abuse, emotional abuse and sexual abuse.

In 2004, there were more than 1.1 million American military families with children younger than 18.

Although there is not a long history of research in this field, previous studies have found that children of parents in the U.S. military serving in Iraq and elsewhere have higher blood pressure, heart rates and stress levels than other youngsters, and that children from military families are twice as likely to die from severe abuse as other children are.

Gibbs and her colleagues looked at confirmed incidents of child maltreatment by a parent in 1,771 families of enlisted U.S. Army soldiers who had been deployed to combat at least once between September 2001 and December 2004.

In total, 1,858 parents in these families had maltreated their children. The overall rate of child maltreatment was 42 percent higher during the times when the soldier-parents were deployed, compared to when they weren't deployed.

Moderate or severe maltreatment was 61 percent higher during deployment periods as compared to non-deployment periods.

While rates of child neglect were nearly double during deployment, the rate of physical abuse was less.

The rate of maltreatment by female civilian spouses was more than triple during times of deployment. Male civilians had a higher rate of maltreatment during these periods, but not significantly so, the study found.

The rate of child neglect by civilian female spouses was nearly four times the rate at other times.

"When people are stressed, there's a much higher likelihood of abuse. It's true of any situation," Bramson said. "Also, most abusers were themselves abused. The key is preventing abuse, so you don't raise kids who are going to go on to be abusers. Luckily, there's more interest in trying to create community interventions. One of the major things is awareness, and that's why I'm excited about this coming from the military. That's going to get some attention."

Among the themed issue's other reports:
Almost 40 percent of Nepalese sex-trafficked girls and women, many forced into prostitution, who were repatriated tested positive for HIV infection.

Group psychotherapy helped reduce depression among displaced adolescent girls who had survived war in northern Uganda. The interventions were less effective among adolescent boys.
Former Ugandan and Congolese child soldiers who have more symptoms of post-traumatic stress disorder (PTSD) are less likely to be open to reconciliation and are more likely to have feelings of revenge.

Adults displaced by war in northern Uganda have high rates of PTSD and depression. They are also more likely to favor violent means to end the conflict, compared to people without comparable symptoms.

More information
Visit Prevent Child Abuse America for more on this issue.

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Gene May Help Spur Premenstrual Depression

(HealthDay News) -- Scientists have discovered a gene variant linked to an increased risk of severe premenstrual depression.

Premenstrual dysphoric disorder, or PMDD, is a psychiatric condition that affects about 8 percent of women in their childbearing years. Women with PMDD experience bouts of major depression and/or anxiety and severe irritability during the second half of their menstrual cycle.

These symptoms subside with the onset of the menstrual period.

PMDD has been thought to be related to hormonal changes over the course of the menstrual cycle.

For a new study published online June 30 in Biological Psychiatry, researchers studied 91 women with a confirmed diagnosis of PMDD over at least three months. Another 56 women who had no history of mood disorders related to the menstrual cycle served as the comparison group.

The team found four specific gene variants in the estrogen receptor alpha gene, ESR1, that were more common in the women with PMDD than in the control group.

"While these are preliminary findings that require replication in larger studies, we would argue that this may explain part of the variance among women in the susceptibility to developing this mood disorder," the study's senior author David R. Rubinow, Meymandi distinguished professor and chair of psychiatry at the University of North Carolina School of Medicine, said in a prepared statement.

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

Antidepressants Help More Kids Than They Harm

(HealthDay News) -- Whether depressed or troubled kids should take antidepressants has been the question at the center of an intense public debate in recent years, and the latest evidence suggests the answer is "yes."

A study in the April 18 issue of the Journal of the American Medical Association found that the benefits of antidepressants outweighed the risks for children and adolescents under the age of 19.

Anecdotal reports released over the past few years suggest that antidepressants raise suicide risk in children and teens. But the drugs may also prevent deaths by curbing depression, experts say.

"Our study shows that, at least in the short-term, treatment benefits appear to outweigh the risks," confirmed study author Jeffrey A. Bridge, an investigator with Columbus Children's Research Institute, in Ohio.

The findings seem to tip the scale more in favor of antidepressants, which include widely used selective serotonin reuptake inhibitors (SSRIs) such as Celexa, Paxil, Prozac and Zoloft.

"They're saying that, yes, there is a slightly increased risk but it's not as big as we thought and the risk-benefit ratio is favorable. But that's a decision that every family has to make. It's not a generalized decision," said Dr. Jane Ripperger-Suhler, an assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a psychiatrist with Scott & White Mental Health Center in Temple.

"This leans us more toward the middle -- that we don't have to say these are terrible medicines, that this looks like a fairly good option. and let's not take them off the table," she said.
Antidepressants, particularly SSRIs, have been the subject of intense controversy in recent years.

In October 2003, the U.S. Food and Drug Administration issued a public health advisory, warning of an increased risk of suicide attempts or suicide-related behavior among children and teens taking SSRIs.

One year later, the FDA directed manufacturers of those drugs to revise their labeling to include a black-box warning. The warning alerts health-care providers to an increased risk of suicide and suicidal thoughts in children and teens.

On the other side of the argument, a major new study found that SSRIs have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

The negative press SSRIs received may have had a chilling effect on their use in the pediatric population, however. One recent study found that the number of U.S. children being prescribed the antidepressants has dropped since warnings about suicidal behavior associated with the drugs emerged. This trend could be worrisome if it means that young patients who might benefit from SSRIs aren't getting them, experts have said.

The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis.

In 2004, an FDA review of 24 placebo-controlled trials involving antidepressant medication in more than 4,400 children and adolescents found that the medications spurred a twofold (4 percent vs. 2 percent) increased risk for suicidal behavior or ideation (thoughts of suicide), although no completed suicides were reported.

The current paper was a large review of all of the published and unpublished randomized clinical trials involving the use of antidepressants by children and adolescents younger than 19. The youngsters were being treated for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and anxiety disorders other than OCD. In all, 27 trials were reviewed and 5,310 patients were followed.

For every 100 children and adolescents treated with antidepressants, about one child would have thoughts of suicide or would attempt suicide beyond the risk associated with the underlying condition, the researchers found.

This was a number that was lower than the FDA's review, which found two instances of suicidal ideation or attempted suicide per 100 patients.

The study also found that the only antidepressant effective in treating depression in children under 12 was Prozac. Several medications were effective in older children.
The effects of the drugs were most pronounced for non-OCD anxiety disorders, followed by OCD and then MDD.

But the new findings are unlikely to be the last word on the subject.
"There are a few studies that are ongoing right now and that will certainly inform our findings," Bridge said.

"It doesn't seem like they have resolved the issue completely," added Ripperger-Suhler. "I'm hoping that someone will do a prospective study."

More information about Depression

Constipation and Acne

Constipation and acne are two problems affecting hundreds of thousands of people on a daily basis.

One hits you on the inside and the other on the outside. Could it be that more is going on with this unlikely pairing than you would first imagine?

When most people become constipated, they assume it’s just a momentary thing and they’ll soon become “regular” again. Likewise, when someone discovers a pimple or rash on their body, they usually throw some kind of drugstore cream on it and hope it goes away.

Usually, after a few days, the skin clears up and life turns back to normal. But it could very well be that constipation is leading to your skin blemishes, and that includes acne!

Constipation and Acne May Indicate Trouble
The human body is comprised mainly of water, about 55 to 60% in most adults. We already know it’s best to drink at least eight 8-oz. glasses of water a day.

If your body isn’t getting enough water, one of the first signs is constipation and acne or other skin blemishes.

Waste hardens within your colon and there are no fluids to lubricate its easy passage out of the body. You may also notice your skin begins to feel dry and cracks in certain places.

The lips, elbows and fingers are some of the first locations to notice the change. Spread all the moisturizer you want, but it’s not going to solve the problem because you must first hydrate from within.

Effects of Constipation
Another reason constipation and acne go hand in hand is the toxic effect constipation has on the body. When you’re constipated, your body isn’t getting rid of all the poisonous toxins normally expelled with a bowel movement. The toxins have nowhere to go, and they begin to accumulate before being reabsorbed into the bloodstream.

Then the toxins course through the body it goes into a state of emergency. The body senses these nasty poisons and begins trying to fight them off, trying to discover a way to detoxify itself. As a failsafe option, the toxins are expelled through the skin; but the acidic nature of the toxins causes the skin to become inflamed and thus develop acne.

If these toxins were left in the body indefinitely, they could eventually intensify to detrimental levels. Some signs you may be poisoning your system include bad breath and excess gas, bloating, depression, headaches, and “brain fog” or feeling like you can’t think clearly, and the aforementioned constipation and acne difficulties.

If your body is functioning properly and you are having regular bowel movements and eating the right foods, there is a very good chance acne can be reduced if not eliminated. Of course, the first step to changing your lifestyle involves becoming better educated. So, what foods, products or advice should one take to begin the transformation to better skin?

Positive Lifestyle Changes
Changing the way you look at food can be difficult, but it can be the most beneficial lifestyle shift you can make. Some foods aid in digestion and some can seize up the process. A high fiber colon healthy diet, with plenty of water consumption for the fiber to absorb in the colon, is one of the keys to controlling constipation and acne.

Foods Good for the Digestive System:
Fiber-rich fruits like apples, prunes, peaches, and raspberries
Fiber-rich vegetables like raw broccoli, cauliflower, kidney and lima beans, carrots, spinach, and Brussels sprouts
Whole grain cereals and breads (not enriched or bleached)
Protein-rich foods like fish, chicken, tofu, nuts, yogurt, and beans
Foods to Avoid:
You can’t have a good list without a bad list, so here are a few things you should avoid:
Caffeinated drinks
Foods with white flour or refined sugar (such as ice cream, cheese, processed foods, pizza, potato chips, etc.)
Heavy meats such as beef or pork
Alcohol
Chocolate

Cleansing the Colon
In order to regain control of your body, you need to clean it out and start fresh. The best way to accomplish this is with a thorough colon cleanse. Cleaning the colon, while it’s not a topic of everyday conversation, is one of the most important things you can do to help maintain your health and allow your body’s immune system to rebuild its strength. With a clean colon, your body can rid itself of the poisonous toxins causing constipation and acne as well as other health problems and skin conditions.

Oxy-Powder® is one of the most widely used colon cleansers; it gently cleans the colon with a unique formula of oxygenated magnesium, citric acid, and germanium-132. It thoroughly cleanses out deep-seated fecal matter, mucous, and sludge, leaving you feeling like a weight has been removed from your body. After removing all the garbage with Oxy-Powder®’s all-natural formula, your body can begin to rebuild a healthy environment within your colon for allowing good bacteria to grow in your digestive system.

As powerful as Oxy-Powder® is, it works gently enough so you don’t have to practically live in the bathroom. Once you finish the initial 7-day cleanse, you can help maintain your colon’s optimal health by following a regular maintenance program.

Helping to keep your body clean from the inside out offers many health benefits—mainly, reducing conditions such as bloating, excess gas, persistent fatigue, blurry vision, feeling heavy or lethargic, being overweight due to the accumulation of waste in the colon, and even chronic constipation.

So follow a healthful diet, stay well hydrated, get plenty of exercise, and be alert for signs such as constipation and acne symptoms as possible indicators something is not right in your normal digestive process.

more info at: http://www.dreddyclinic.com/products/oxypowder.htm

PTSD Can Take Months to Strike Wounded Iraq and Afghanistan Vets

(HealthDay News) -- Soldiers wounded during combat in Iraq and Afghanistan often develop post-traumatic stress disorder and depression months after getting out of a hospital, instead of soon after suffering their injuries, a new study found.

And the severity of the injuries also helps predict the risk of developing post-traumatic stress disorder (PTSD) or depression.

It's not clear why it's taking more than half a year, in some cases, for symptoms of PTSD and depression to emerge. However, the study authors speculated that the concentrated treatments and therapies offered in a hospital may temporarily ward off psychological problems, leaving them to surface once a soldier has been released and comes to realize the extent of the injuries.
The report was published in the October issue of The American Journal of Psychiatry.

"The rates of PTSD and depression are much lower immediately following the injury than what we were expecting," said lead researcher Dr. Thomas A. Grieger, of the Uniformed Services University of the Health Sciences and Walter Reed Army Medical Center, in Washington, D.C. "We were expecting rates of around 20 percent."

Instead, Grieger and his colleagues found the initial rate of PTSD and depression was 4 percent. The researchers expected the rates of PTSD and depression to be controlled early, as is often the case with victims of automobile accidents. "In contrast, in this [military] population, the rates went up instead of down with time," he said.

For the study, the researchers screened 613 soldiers, who were severely wounded between March 2003 and September 2004. Of those, 243 completed health assessments at one, four, and seven months after their injuries. The rates of PTSD were 4 percent at one month, 12 percent at four months, and 12 percent at seven months. Rates of depression were 4.4 percent at one month, 9 percent at four months, and 9 percent at seven months.

Grieger noted that 78 percent of those soldiers with PTSD or depression at seven months showed no signs of either condition at one month. "There is a need for ongoing evaluation of the individuals that have had these sorts of exposures," he said.

The reasons for these findings aren't clear, Grieger said. He noted, however, that soldiers in a hospital are getting psychiatric care and medication, which may not be continued after the soldiers leave. "It may be that these symptoms come on after they leave the hospital because they are not continuing with their medications," he said. "It may also be that individuals don't report symptoms in the immediate aftermath of the injury."

Grieger further speculated that it's only when the soldiers return home and realize the full impact of their injuries on their lives that PTSD and depression strike.

One expert thinks this study could be helpful in designing programs to prevent and treat PTSD and depression in military personnel.

"Being wounded is a risk factor for PSTD," said Dr. Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder.
Friedman believes it's important to understand why some soldiers recover from PTSD and depression when they struggle with it early, and why others develop these problems later. "This would enable us to do a better job of developing preventive approaches and trying to improve the situation for people following hospital discharge," he said.

Another researcher noted the rates of PTSD and depression seen among wounded soldiers returning from Iraq and Afghanistan are about the same as those seen among non-wounded soldiers.

"One of the important findings is that wounded soldiers did not have higher rates of PTSD than healthy soldiers surveyed using the same instruments and criteria," said Dr. Charles Hoge, who's with the department of psychiatry and behavioral sciences at Walter Reed Army Institute of Research. "This suggests that the preventive psychiatry services that wounded service members receive at Walter Reed has been effective in mitigating PTSD symptoms."

"The increase from 4 to 12 percent from one to four months is exactly what we've been seeing among non-wounded soldiers," Hoge added, who co-authored the new study. "We know that soldiers may not report mental-health symptoms until several months after they return home, and this study shows that this is true also among the wounded."

More information
The U.S. National Institute of Mental Health can tell you more about PTSD.

Poor Sleep Contributes to Health Problems

(HealthDay News) -- New studies are discovering just how vital sleep is to overall health.

So, sleep habits should become a standard part of a complete check-up, researchers say.

"There is increasing evidence that there is a very strong relationship between sleep quality and physical and mental health," said Dr. Phyllis C. Zee, a professor of neurology at Northwestern University's Feinberg School of Medicine.

"If you have poor health, that is associated with poor sleep. Also, if you have poor sleep, there is an association between that and poor health," Zee said. "What we don't have yet is the research to categorically say that if you improve sleep, you will improve conditions, such as diabetes or hypertension, or other medical conditions."

Still, physicians should be asking their patients about the quality and quantity of their sleep, Zee said. "Sleep should be another vital sign," she said.

Zee wrote an editorial in the Sept. 18 issue of the Archives of Internal Medicine, a special, themed issue on sleep and its relationship to overall health.

In one study, led by Richard L. Nahin, a senior advisor for scientific coordination and outreach at the U.S. National Center for Complementary and Alternative Medicine, looked at why people had trouble sleeping and how many were using alternative drugs to help them sleep.

Insomnia and trouble sleeping are most often associated with high blood pressure, heart failure, anxiety and depression, according to a national survey of 31,044 adults. "That's unusual. It had been most often thought that insomnia was quite prevalent on its own, but only 4 percent of the people who said they had insomnia said they had it without any of those conditions," Nahin said.

The researchers also found that 1.6 million Americans are using alternative therapies, such as melatonin to treat their insomnia. "That's quite high when you consider that there is very little reliable data on the efficacy and safety of using the products people are using," Nahin said.

These findings have implications for treating sleep problems, Nahin said.

"Instead of treating the insomnia itself, a health-care provider might be better off treating one of these comorbidities," he said. "In addition, a physician seeing a patient for insomnia should ask if the patient is using any alternative and complementary treatments, because they might upset the treatments the health-care provider wants to apply."

Another study found that people who have sleep-related breathing disorder -- marked by frequent pauses in breathing, labored breathing, or reduced breathing during the night -- were two to 2.6 times more likely to develop depression. Moreover, the odds of depression increased as breathing disorders became more severe, according to researcher Paul E. Peppard and colleagues from the University of Wisconsin.

And a study by French researchers found that people with allergic rhinitis, caused by hay fever and other allergies, have more difficulty sleeping and more sleep disorders than people without allergies. "The results show a significant impact of allergic rhinitis on all dimensions of sleep quality and, consequently, a lower quality of life as reflected by more somnolence [sleepiness]; daytime fatigue and sleepiness; and impaired memory, mood and sexuality, with a significantly increased consumption of alcohol and sedatives in cases compared with the control group," the study authors wrote.

One expert agrees that sleep problems shouldn't be ignored.

"If you think insomnia is an annoyance and merely something you should tough out, that may be a mistake," said Michael L. Perlis, director of the Sleep Research Laboratory at the University of Rochester, in New York. "It may lead you down the path to other morbidities. It would also be a mistake because it's treatable."

Other studies in the same journal issue found that:
· Fewer hours of sleep may contribute to poor health in young adults.
· Those in rural areas who sleep fewer hours appear to weigh more.
· The immune system may play a role in narcolepsy, a disorder characterized by an uncontrollable urge to sleep.
· The immune system may be affected by a lack of sleep that contributes to inflammation and a variety of diseases.

More information
The National Sleep Foundation can tell you more about getting a good night's sleep.

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Is It Dangerous to Combine Supplements and Drugs?

Is It Dangerous to Combine Supplements and Drugs? Provided by: DrWeil.com

Q: I'm curious about interactions between herbs and drugs. Are there many that we should worry about? -- Nicole S.

A: For the most part, I think warnings about interactions between herbs and drugs are overstated. For example, a few years ago the American Society of Anesthesiologists warned that certain herbs and supplements could pose a hazard to patients undergoing surgery.

The group claimed that several herbs have anti-blood-clotting activity and conceivably could interfere with clotting during and after surgery. St. John's wort was also singled out in 2003 as an agent that could diminish the effectiveness of certain drugs because of its effect on enzyme systems involved in drug metabolism. (Many pharmaceutical drugs have the same effect.)

In general, I think you're pretty safe taking most supplements, but you certainly should tell your doctor about anything you're taking regularly, particularly if you're also taking either prescription or over-the-counter drugs. Here's a quick rundown of some commonly used supplements and drugs that could interact to your detriment:

St. John's wort: May affect metabolism of antidepressants; HIV protease inhibitors used to treat HIV/AIDS; digoxin, a heart medication; theophylline, used to treat asthma; cyclosporine, an immunosuppressant; chemotherapy; birth control pills (it may reduce their effectiveness); the blood pressure and heart disease medications nifedipine and diltiazem; Coumadin, a blood-thinner; and non-nucleoside reverse transcriptase inhibitors for HIV/AIDS treatment.

Co-enzyme Q10, dong quai, feverfew, garlic, ginger, ginkgo, ginseng, vitamin E and St. John's wort: May increase the risk of bleeding if you're taking prescription anticoagulants such as Coumadin.

Echinacea: May increase levels of HIV protease inhibitors used to treat HIV/AIDS, calcium channel blockers used to treat high blood pressure, and anti-anxiety drugs.

Capsicum (red pepper, cayenne pepper): May increase the absorption and effect of ACE inhibitors used to treat high blood pressure, heart failure and kidney disease; theophylline (for asthma); sedatives; and antidepressants.

Garlic: May decrease the effectiveness of immunosuppressant drugs and HIV protease inhibitors. It also may reduce the need for insulin among diabetics (by lowering blood sugar).
Ginkgo: May increase the amount of antidepressant drugs in your blood; may cause seizures when combined with anti-psychotic drugs.

Ginseng: Can cause headache, trembling and manic behavior when combined with the antidepressant Nardil; may interfere with the action of the heart medication digoxin; may reduce blood sugar levels in people with Type II diabetes, thus affecting the need for insulin or other medication for diabetes.
Andrew Weil, MD

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