Turning My Black Thumb Against Diabetes

Year 2 in my quest to use my organic garden as a tool for better health
by Sean Kelley When my wife and I bought our farm eight years ago, it seemed out of place for us. Despite growing up in rural Alabama, I know more about Gianni Versace than John Deere. Patti owns horses, but having livestock (or 1,200-pound lawn ornaments) does not make you a farmer. Neither does owning a farm.

In fact, most of the growth on our farm in recent years is due more to neglect than intervention on our part. Nature is reclaiming our eight-acre plot.

If owning a farm is out of character, gardening is anathema. Not only do I associate digging in the earth with constant adolescent battles with my father (whose idea of a father-son activity was often limited to early morning turns with a spade and hoe), but I have inherited my mother's black thumb.

(She once killed an entire household of Christmas cacti by feeding them what she thought was plant food, but was—in fact—bleach; I swear I heard plants screaming.)

Against these natures, I tilled up soil on the property last year to plant an organic garden. I had two goals: Make the farm work for us for a change and get more fresh vegetables into our diet. It wasn't a complete disaster, but our harvest of heirloom tomatoes, cucumbers, lettuces, and herbs was modest.

Now I'm back at it with renewed purpose. I'm still trying to stick to organic farming principles, but my primary goal is exercise. At the same time, that exercise will (hopefully) produce healthy fare for our table that's in line with my diabetic diet. The strategy has lots of benefits:

• A garden requires constant attention, meaning more exercises. Gardening can burn 300 calories an hour;
• Eating fruits and vegetables lowers diabetes risks and helps you lose weight
• A 2007 study by Saint Louis University found children eat more fruits and veggies when they're home grown—something we proved with our daughter (pictured with me above) last summer when she began to actually eat things we grew that she wouldn't eat from a store.

Monday night I put in 20 tomato bushes, a variety of peppers, leeks, basil, and eggplant. Trailing clumps of soil back into the house, I thought about all the energy I expended fighting the tiller, breaking up clay, and clomping around the property. I still hate digging in the dirt, but the benefits I can harvest for my health have potential that may turn my black thumb green.

How I'm Battling Supermarket Sticker Shock

A health-conscious eater learns to trim the fat from her budget
by Julie Upton, RD

I don't believe in skimping on good food, but my supermarket bill yesterday has forced me to confront my inner cheapskate.

My weekly shopping bill is usually just over $130, with a few odds and ends picked up midweek and the occasional meal out. This week, however, the tab was almost $165—a 27% increase. I rechecked to see if we had bought something pricey like steak or wine. No and no. The escalation of food costs has made news virtually daily, and according to the Consumer Price Index, food costs have increased more in the first quarter of 2008 than they have since 1990—and there's no sign of them heading south anytime soon.

Some of my big-ticket items were cage-free eggs ($5), organic milk ($3.50), imported cheese ($4.50), artisan seven-grain bread ($5.50), and New Zealand apples ($6). And I don't want to give most of them up.

So I researched some ways of putting my grocery shopping on a diet without ruining my healthy diet. I refuse to either spend Sundays clipping coupons or head to big-box retailers, where you can easily save 30% or more on food items, so here is what I'm doing to trim some of the fat from my weekly shopping budget.

Make a List
According food marketing specialist Phil Lempert: "Surveys of supermarketguru.com readers show that list makers spend 40% less when grocery shopping." Now I hope I can stick to only what's on the list.

Brown Bag It
Unlike my mother, who loves to cook and prefers cooking to eating out, I am not much of a cook. However, the best way to s-t-r-e-t-c-h my food budget is to eat in more often. My takeout lunch is around $10, but I can make a sandwich or have soup and salad at home for around $2.

Shop Full
I'm usually pretty disciplined when I go food shopping, but when I'm hungry I wind up with a cart filled with foods that curb my carb cravings: snack bars, pretzels, and more crackers than I know what do to with. These convenience foods are among the most expensive in the supermarket and add little nutritional value to my diet. So next time I go shopping, I'll avoid temptation and go on a full stomach.

Eating Green to Save Green
I'm going to stick to my vegetarian ways even more so now, because the foods that cost the most per serving are high-quality proteins (aka beef, poultry, and seafood). Consider this: Salmon costs about $.62/ounce and beans cost .$04/ounce, making the salmon 15 times more expensive than the beans. And, when I do eat meat, I'll make it go further financially by adding in a lot more vegetables to the dish.

Head to the Farmer's Market
I'm going to try to kick my daily New Zealand apple and South American banana habit. Living in California means that I have great locally grown berries available right now, as well as plenty of veggies. Eating in season can save you $2/pound on many fruits and vegetables. Right now, I can get fresh California-grown strawberries for less than $1/pound, whereas imported blueberries from Chile were $20/pound at the supermarket! Since berries deliver similar nutritional benefits, I'll take the strawberries, thank you.

Compare Prices
Using the unit pricing system (shelf tags), I can do my own price checks on comparable items to see which offers the best deal. Unit pricing provides the price per standard unit, often one ounce. For example, I found Tropicana orange juice costs $.09/ounce but the exotic pomegranate-blueberry juice next to it was .25/ounce—more than twice the price. In the cereal aisle, most big brands were around $.30/ounce but store brands were about $.15/ounce, or half the price.

Let me know if you're feeling my pain in the pocketbook, too—and what you're doing to save some green when shopping.

Health Tip: Your Diet and Sleep

(HealthDay News) -- If you've noticed that you feel particularly sleepy or more energized after eating certain foods, that's because what you eat can have an impact on how well you sleep and how awake you are during the day.

Here are examples of foods that can affect your sleep, courtesy of the National Sleep Foundation:

• Carbohydrate-rich foods, such as pastas and breads, can make you more sleepy.


• Carbohydrates work well with proteins to induce sleepiness, which makes combinations such as peanut butter on toast, cereal with milk, or cheese and crackers good bedtime snacks.


• A large meal can make you more tired, especially one with a lot of carbohydrates.
  Caffeine in foods and beverages is a stimulant that blocks hormones in the brain that make you feel sleepy.


• While alcohol may help you relax and fall asleep in the short term, over the course of the night it inhibits the sleep process and can prevent you from getting deep, restful sleep.

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Most With High Blood Pressure Don't Follow Recommended Diet

(HealthDay News) -- Few people with high blood pressure follow recommended dietary guidelines that help control the disease, a new study says.

In fact, people with hypertension actually appear to be eating worse than before the government-approved guidelines were introduced, according to the report published in the Feb.
11 issue of the Archives of Internal Medicine. The study said young people, blacks and the obese fared the worst in their dietary habits.

A diet high in fruits, vegetables and low-fat dairy products has been shown to help significantly lower blood pressure, according to background information in the article. This Dietary Approaches to Stop Hypertension (DASH) method, first published in 1997, complements other lifestyle changes, such as reducing sodium and losing weight, and can also help lower cholesterol levels, previous studies have shown.

The DASH diet is recommended by the Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure for all patients with hypertension.

The study analyzed dietary, health and personal data of adults collected in surveys done by the U.S. Centers for Disease Control and Prevention from 1988 to 1994 and from 1999 to 2004.

Using the DASH guidelines, researchers identified goals for eight target nutrients and calculated scores ranging from zero to nine for individuals with and without hypertension from the surveys; those who scored a 4.5 or higher were considered to be following the diet.

Dr. Philip B. Mellen, of the Hattiesburg Clinic in Hattiesburg, Miss., and his colleagues found that among individuals surveyed from 1999 to 2004, 28 percent had been diagnosed with hypertension. These individuals had an average DASH score of 2.92 (compared with 3.12 among those without high blood pressure), and only 19.4 percent followed the diet. Compared with those surveyed in 1988 to 1994, 7.3 percent fewer individuals with hypertension followed the DASH diet, reflecting fewer patients who consumed target levels of total fat, fiber and magnesium.

The findings suggest that the diet of Americans with hypertension has not been greatly influenced by the recommendations emerging from the DASH trial and instead reflect secular trends in the dietary patterns of the overall population, the authors wrote. Moreover, the DASH score was lower in subgroups likely to receive the greatest benefit from the DASH diet -- blacks and obese individuals.

More information
The National Heart, Lung, and Blood Institute has more about high blood pressure and how to control it.

Chronic Coughs Need a Doctor's Attention

(HealthDay News) -- If you wake up due to coughing or have a cough that lasts for weeks, you may have a potentially serious problem that requires medical attention.

"Cough is the most common respiratory symptom for which patients seek medical attention," Dr. Alan B. Goldsobel, chairman of the American Academy of Allergy, Asthma & Immunology's cough committee, said in a prepared statement.

"Cough protects the body by removing mucus and irritating particles from the respiratory tract. Coughing is a useful function and does not always mean there is a problem ...," Goldsobel explained. "However, coughing at night, after going to sleep indicates the need for medical attention."

Common causes of coughing include: viral upper respiratory tract infections; asthma; nasal and sinus disease; stomach and esophageal problems; an inhaled foreign body; habit; and environmental irritants.

People should see an allergist/immunologist if they have:

• a cough that lasts three to eight weeks or more;
• a cough that coexists with asthma;
• coexisting chronic cough and nasal symptoms;
• a chronic cough and tobacco use or exposure.

More information
To learn more about cough and children, visit the American Academy of Allergy, Asthma & Immunology.

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'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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'Hospitalist' Physicians Help Shorten Patient Stays

(HealthDay News) -- A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

The 2002-2005 study of almost 77,000 hospital stays at 45 centers showed that treatment by a hospitalist, rather than a general internist, resulted in about a half-day reduction in overall hospital stays on average, along with an average $268 drop in costs.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hopsitalist refers to a physician who cares solely for hospitalized patients.

The term may be new to the general public, but, in the medical profession, "hospitalist has been a recognized and accepted term that has been around for about a decade," said study author Dr. Peter K. Lindenauer, an associate professor of medicine at Baystate Medical Center and Tufts University, in Boston.

In fact, "There is a Society of Hospital Medicine with 5,000 to 10,000 members, and it is estimated that there may be 20,000 hospitalists across the United States now," Lindenauer said.

"What you can't debate is the number of hospitalists around the country -- there is no going back," added Dr. Laurence McMahon, chief of the division of general medicine at the University of Michigan, in Ann Arbor.

"We need to think about how these new doctors get into the health-care system and how they care for patients who are hospitalized," said Mcmahon, who also authored an accompanying editorial on the issue.

Traditionally, a person's private physician has been responsible for care after hospitalization, he said. That began to change about 30 years ago, with the emerging role of emergency room physicians and critical care physicians, Lindenauer said. "They have been assuming the role of attending physician in those situations," he said. "In some respect, the growth of the hospitalist model of care represents the completion of a series of steps toward specialization that began 30 years ago."

According to Lindenauer, the advent of the hospitalist means another question should be asked when individuals choose a private physician: Will that doctor turn over care to a hospitalist, if and when someone needs hospital care?

"It is a discussion that a patient should have with a primary-care physician when he is thinking about enrolling with that physician," Lindenauer said.

The differences shown in the study -- a shortening of length-of-stay by 0.4 days, on average -- are not great, he acknowledged, but they do add up over time.

"Shortening the length of stay by 0.4 days is small, but when you multiply it out over time by thousands of physicians, the effects can be very large. With 5,000 cases a year, [that's] a savings of 2,000 bed-days," he said.

The study was not able to assess patient satisfaction with treatment by a hospitalist rather than a primary-care physician, Lindenauer said, "But we know that efficiency is important, as important to patients as to physicians." he said.

And while full official recognition of the hospitalist speciality is yet to come, the Society of Hospital Medicine is working closely with the of American Board of Medical Specialties toward such an end, Lindenauer said.

"The differences between hospitalists and other doctors who take care of patients in hospitals are pretty minor," McMahon said. "What really is quite revolutionary is the change in how we take care of patients in the hospital."

More information
There's more on hospitalists at the Society of Hospital Medicine.


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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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Gene Tweak Reverses Aging in Mouse Skin Cells

(HealthDay News) -- Scientists say they've been able to temporarily return old skin cells to their youthful state by blocking the activity of a single gene.

"This gene gets more and more active with age," said lead researcher Dr. Howard Chang, an assistant professor of dermatology at Stanford University. "It doesn't exist to make us old. It is active in a number of processes, including the immune system and inflammation."

Chang said tweaking the gene, which produces a protein called NF-kappa-B, will not serve as a "fountain of youth" for the foreseeable future. The protein has a number of functions, some involved with cancer, and as-yet-unknown side effects must be explored before its safety is known. But one possible use is to help heal wounds more quickly in older people, he noted.

What's exciting about the discovery is that a single gene can have an immediate effect on older cells, Chang said. "People have known that you can affect the aging process with drastic interventions, like calorie restriction. Now we are talking about a single gene that, if blocked in an individual who is already old, can return cells to a youthful status, at least temporarily."

The researchers came across NF-kappa-B by searching existing data on genes that become more or less active as people get older. They found that the activity of a number of those genes is regulated by the protein.

They then used a genetically engineered mouse model to test the effect of inhibiting NF-kappa-B activity in a patch of skin cells.

After two weeks, a patch of treated skin from a 2-year-old mouse not only had the same genetic activity as that of a newborn animal but also looked more youthful, with more dividing cells.
It's fascinating "to engineer a mouse so that the rest of the mouse is old, but that one patch is young, to see that even locally, in a targeted way, you can affect the aging process," Chang said.

The finding also adds support to the theory that aging is not simply a process of wear-and-tear but the result of specific genetic changes, he said. And it shows that at least locally and temporarily, those changes can be stopped, Chang added.

The gene treatment has to be used cautiously, because NF-kappa-B is involved in so many different processes in the body, he noted.

A question to be asked now is, "What is the long-term effect of blocking the aging process for a while?," Chang said. "Would the tissue age rapidly again after the treatment stopped, or would they take much longer to age? It's important to sort these things out."

Long-term blockage of the gene would raise serious issues in terms of side effects, Chang said, since the gene is involved in so many body processes. Short-term use -- for wound healing, for example -- might sidestep those problems.

More information
There's more on skin aging at the U.S. National Library of Medicine.

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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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Energy Drinks Could Pose Blood Pressure Risks

(HealthDay News) -- Energy drinks boost blood pressure and heart rate and could pose risks to people with hypertension and heart disease, say Wayne State University researchers.

They found that drinking two cans of a popular energy drink increased blood pressure and heart rate in 15 healthy adults, average age 26.

Within a few hours of having the energy drinks, the volunteers' systolic blood pressure (top number) increased by as much as 9.6 percent, and diastolic blood pressure increased by as much as 7.8 percent. Heart rate increased by as much as 11 percent.

"This occurred while participants were sitting in chairs watching movies," study leader James Kalus noted in a prepared statement. "The increase in heart rate and blood pressure weren't enough for something to happen acutely, but a person on hypertension medication or who has a cardiovascular disease may not respond as well."

"While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy with low blood pressure," Kalus added.

He and his colleagues noted that most energy drinks contain high levels of caffeine and an amino acid called taurine, both of which have been shown to have effects on heart function and blood pressure. The researchers emphasized that energy drinks are different from sports drinks, which don't contain ingredients designed to heighten alertness.

The study was expected to be presented Nov. 6 at the American Heart Association annual meeting, in Orlando, Fla.

More information
The Nemours Foundation has more about energy drinks and food bars.

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Diet, Lifestyle Changes Cut Some Infertility Risk

(HealthDay News) -- Women who followed at least five certain lifestyle and diet behaviors were about 80 percent less likely to have infertility from ovulatory disorders than women who followed none of the behaviors, a Harvard study concludes.

The analysis of 17,544 married women participating in the ongoing Nurses' Health Study II found those with the highest fertility scores: ate less trans fat and sugar from carbohydrates; consumed more protein from vegetables than from animals; ate more fiber and iron; took more multivitamins; had a lower body mass index (BMI); exercised for longer periods of time each day; and consumed more high-fat diary products and less low-fat diary products.

The relationship between these behaviors and reduced risk of infertility was similar for women regardless of age and whether they'd been pregnant in the past, said the Harvard School of Public Health authors of the study, which was published in the Nov. 1 issue of the journal Obstetrics & Gynecology.

"We analyzed what happens if you follow one, two, three, four, or more different factors. What we found was that, as women started following more of these recommendations, their risk of infertility dropped substantially for every one of the dietary and lifestyle strategies undertaken.

In fact, we found a sixfold difference in ovulatory infertility risk between women following five or more low-risk dietary and lifestyle habits and those following none," lead author Jorge Chavarro, a research fellow in the school's department of nutrition, said in a prepared statement.

"The key message of this paper is that making the right dietary choices and including the right amount of physical activity in your daily life may make a large difference in your probability of becoming fertile if you are experiencing problems with ovulation," senior author Walter Willett, chair of the department of nutrition, added.

According to the researchers, infertility affects one in six couples, in the U.S. and Europe and ovulatory problems have been identified in up to 30 percent of those cases.

More information
The U.S. National Women's Health Information Center has more about infertility.

New Drug No Substitute for Standard Blood-Clot Therapy

(HealthDay News) -- Three studies on the new anti-clotting medication idraparinux found the drug was effective at treating deep vein thrombosis (DVT) and for the long-term prevention of blood clots. But it was not as effective as the usual treatment for potentially life-threatening pulmonary embolisms.

And, with long-term use, idraparinux appears to have a higher rate of serious bleeding complications than standard therapy.

"This wish to find new anti-coagulants (anti-clotting medications) is urgent," said lead researcher Dr. Harry Buller, chairman of the department of vascular medicine at the Academic Medical Center in Amsterdam, the Netherlands. "Our conclusion in the DVT study was that it was a good alternative. For pulmonary embolism, idraparinux was not as good as standard therapy."

And, Buller said, in the study that compared idraparinux to standard therapy for preventing the formation of new blood clots, the new drug was effective, but "there is a bleeding risk that is too high."

"Clearly, this drug in its present form won't come to the market," said Buller, who added that the drug's manufacturer, Sanofi-Aventis, is working on the medication and adding a biomarker to the drug so it could be quickly removed from the system if a complication such as excessive bleeding occured.

Sanofi-Aventis provided support for all three studies.

Buller said that in western societies, about two to four people per every 1,000 develop either a deep vein thrombosis or pulmonary embolism each year. That means that hundreds of thousands of people in the United States experience these problems each year, he said.

The current treatment regimen includes intravenously delivered or injections of the blood-thinner heparin, followed by six to 12 months of warfarin, an oral anti-coagulant. The currently available treatments are effective but necessitate careful monitoring and require patients to modify their diets and watch what medications they take to prevent complications.

"We wanted to find a medication that was a little safer, more patient-friendly and that could improve the quality of life," Buller said.

Two of the studies, published in the Sept. 13 issue of the New England Journal of Medicine, compared the use of idraparinux to standard therapy (heparin, followed by warfarin) for both DVT and pulmonary embolisms.

The DVT study included 2,904 people, and the pulmonary embolism study had 2,215 participants. In each group, the study volunteers were randomly chosen to receive either once-weekly injections of idraparinux or heparin, followed by three to six months of warfarin therapy.

The incidence of recurrence in the DVT group was 2.9 percent for those on idraparinux compared to 3.0 percent for those on standard therapy. In the pulmonary embolism group, the rates of recurrence were 3.4 percent in the idraparinux group versus just 1.6 percent in the usual treatment group.

Buller said that the frequency of recurrence in the standard therapy group was extremely low -- much lower than would normally be expected -- in the pulmonary embolism study.

"We've never seen this low frequency in studies. It's always around 3 to 4 percent," said Buller, who believes that this is likely a chance finding.

The third study, also published in the Sept. 13 New England Journal of Medicine, compared the use of idraparinux to a placebo in people who had already completed six months of treatment with either warfarin or idraparinux.

Just under half of the 1,215 people recruited for this study were randomly selected to receive six months of idraparinux, and the rest received a placebo. Just 1 percent in the idraparinux group had a recurrent blood clot, compared to almost 4 percent for those on a placebo. However, those who received an additional six months of idraparinux had a higher incidence of bleeding complications -- 3.1 percent versus 0.9 percent for those on a placebo.

"The long duration of action for idraparinux is a benefit, but it's also a hazard, because there's no antidote," said Dr. Edward L. Amorosi, a hematologist at the New York University Medical Center.

"It appears to be a more effective anti-thrombotic for DVT, but it's not safe enough to make it standard treatment," he added.

Buller said that Sanofi-Aventis is conducting research on pulmonary embolism treatment with a newer version of idraparinux, and that results should be available within a year. The new trial should help answer the question of whether or not the findings in the current pulmonary embolism trial were a statistical anomaly or not, he said.

More information
To learn more about blood clots, visit the U.S. National Library of Medicine.

High Co-Pays Cause Seniors to Go Without Meds

(HealthDay News) -- Seniors enrolled in Medicare plans that charge higher co-pays for brand name or non-preferred medications fill almost 15 percent fewer prescriptions than their peers who have a flat co-pay for all prescription medications, a new study finds.

The data highlights a tough decision for older Americans: Spend more or skip some of their medicines, including those for chronic diseases such as diabetes and high blood pressure.

"Consumers are sensitive to price. When they have to pay more, they tend to consume less," senior researcher Boyd Gilman said in a prepared statement.

Gilman and colleagues at Cambridge, Mass.-based Mathematica Policy Research Inc, analyzed spending on prescription drugs among almost 353,000 Medicare beneficiaries with employer-sponsored retiree drug coverage.

They compared spending by those in single-tiered plans to those in three-tiered prescription drug plans. Three-tiered plans charged retirees higher co-pays for using drugs that were not generic or preferred name brands, or that were less obviously medically necessary, whereas single-tier plans charged a flat $5 or $10 co-pay for all prescribed medications.

Writing in the online September issue of Health Services Research, the researchers reported that people enrolled in three-tiered plans spent 14.3 percent less on prescriptions and filled 14.6 percent fewer prescriptions compared to their peers with single-tier plans. Those in three-tiered plans typically relied on generics when they purchased medications, reported Gilman.

The data also showed that people with three-tiered plans had 57.6 percent higher out-of-pocket costs and filled 11.5 percent fewer prescriptions for ongoing medical needs such as diabetes, arthritis and high blood pressure.

"The use of prescription medications is fairly predictable. People know what drugs they need, and they can find out whether their drugs are covered by a plan, and -- if they are covered -- whether they belong to a lower-cost tier or a higher-cost tier," Gilman said.

More information
To learn more about choosing a Medicare drug plan visit the U.S. Department of Health and Human Services.

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Diet Still Important to Patients on Cholesterol-Lowering Drugs

(HealthDay News) -- Patients taking cholesterol-busting statins usually eat healthy, too, a new study finds.

The finding contrasts with what many doctors believe: that patients view drugs such as Lipitor, Pravachol and Zocor as a license to eat whatever they like because they think the medication is enough to protect them from heart disease.

"We went into this study thinking that these medications are so good, and changing your diet is so hard, that we expected people to relax their dietary efforts, increasing their fat intake," said lead researcher Dr. Devin Mann, of the Mount Sinai School of Medicine in New York City.

But that wasn't as big a problem as many people assumed, Mann said. "In reality, we often have expectations of what behavior will be. But you actually have to look and check, because behavior is tricky -- it's hard to predict," he said.

In the study, which is published in the August issue of Mayo Clinic Proceedings, Mann's team collected data on 71 patients taking statins to prevent heart disease. The researchers interviewed them when they started on the drug, and again three and six months later.

The researchers found there was no significant change in how much saturated fat the patients included in their diets.

"As doctors, we have assumptions of what behaviors will be like, but we often don't get what the opinions of the patients really are," Mann said. "It was surprising how many people, even if they thought diet wasn't going to be effective, still wanted to do it," he said.

Given these findings, Mann believes doctors should continue to pursue lifestyle changes with their patients. "We shouldn't give up on lifestyle just because we are starting drug therapy -- these things should really work together," he said.

Patients already understand this, Mann said. Doctors should encourage patients to make lifestyle changes and not think it's a waste of time, he noted.

Mann also believes that patients need to tell their doctors what they think about the medications and lifestyle changes that are being recommended.

"Patients and doctors should work from common ground to make decisions, because if you make decisions without information, you make poorly informed decisions," Mann said.

One expert was encouraged by the findings.

"Achieving and maintaining healthy lipid levels is essential for prevention of cardiovascular events and premature death," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles. "Many patients require both dietary modification and lipid-lowering medications to get to recommended lipid levels."

Unfortunately, study after study shows that many adults in the United States are not being adequately treated for their cholesterol levels and thus having cardiovascular events that could have been prevented, Fonarow noted.

"While many patients do not adhere to their medical regimen, missing doses or stopping altogether, little was known about whether starting lipid-lowering medications would adversely influence adherence to dietary recommendations," Fonarow said. "The results of this study -- showing no significant change in reported dietary habits after initiation of statin treatment -- should be reassuring to physicians and other health-care providers."

More information
For more information on healthy living, visit the American Heart Association.

Most Asian Men Have Better Prostate Cancer Survival Rates

(HealthDay News) -- Your prognosis for surviving prostate cancer may depend on your racial and ethnic background, a new study suggests.

Asian men have better survival rates than white males, while South Asians have the worst survival rates, according to results of a study of men living in California.

"Nearly all Asians do far better when they get prostate cancer," said study lead author Dr. Anthony Robbins, of the California Cancer Registry in Sacramento. "But Indian men didn't do as well as other Asian men, and they did worse than all other men, including blacks and whites," he added.

The reasons for these racial and ethnic differences in prostate cancer survival aren't known, Robbins said, adding, "We just couldn't explain it."

Not only couldn't the researchers explain the finding, they were left with an apparent paradox. The Asian men were usually older and had more advanced disease at the time of diagnosis, Robbins said. "Based on their risk factors, you would think they were going to do worse," he said.

In the study, Robbins and his colleagues collected data on 116,916 men (108,076 whites and 8,840 Asians from the six largest represented Asian ethnicities -- Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese) diagnosed with prostate cancer. The researchers compared prognostic factors and survival rates among the men.

The researchers found that for Asians, risk profiles were worse compared with whites. For example, Asians were more likely to have more advanced disease and use non-curative therapies. But, for Asians -- except for South Asians -- survival rates were equal to or better than rates for whites.

Japanese-American men were 34 percent less likely to die from prostate cancer compared with whites. But South Asian men -- those from India, Pakistan, Bangladesh, Sri Lanka, Nepal, and Bhutan -- were 40 percent more likely to die from the disease, Robbins said.

The study was published online Monday in the journal Cancer.

Some of the factors that may influence the findings include diet, exercise and genetics, Robbins speculated.

"Doctors that are seeing patients for prostate cancer need to be aware that these differences can be used as factors in planning the patient's treatment and telling the patient what their survival might be," Robbins said.

Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, thinks this study demonstrates the need to better understand how different racial and ethnic groups respond to diseases.

"This study points out the potential misleading conclusions we can come to when we use these large groups to lump different subpopulations into," he said.

"If you lump in the South Asian subgroup with other Asians, as is traditionally done, you totally miss the fact that these folks have a strikingly higher chance of dying from prostate cancer," Brooks said.

Brooks said the study finding can provide a basis for research to try to understand why these differences exist between populations.

Prostate cancer is the most common type of cancer to strike American men, other than skin cancer, according to the American Cancer Society, which estimates there will be about 218,890 new cases of prostate cancer in the United States in 2007, and about 27,050 men will die of the disease. Prostate cancer is the second leading cause of cancer death in males. While one in six men will get prostate cancer during his lifetime, only one man in 34 will die of the disease. The death rate for prostate cancer is declining, due in large part to earlier diagnoses, the society said.

Another paper in the same issue of the journal also found racial differences among women who survive breast cancer; with black women having poorer survival regardless of the stage of the disease.

It is known that black women had larger tumors and are more likely to have invasive breast cancer. But the study, lead by Dr. Alfred Neugut from Columbia University Medical Center and Russell McBride from Mailman School of Public Health, found that mortality among black women was up to 56 percent higher than whites.

Neugut's team says that the disparities in survival were surprising and suggest that non-clinical factors, such as access to and quality of care, may play a part.

More information
For more on prostate cancer, visit the American Cancer Society.

Health Tip: Risk Factors for Prostate Cancer

(HealthDay News) -- Prostate cancer is one of the most common cancers that affect men. While most cases aren't fatal, it is important to understand the risk factors for the disease to help recognize symptoms and begin treatment early.

The U.S. National Cancer Institute lists these potential risk factors for prostate cancer:

Aging.
High levels of testosterone.
A high-fat diet, which may increase the risk. (A low-fat diet rich in fruits and vegetables may help the risk.)
Blacks are at much greater risk of prostate cancer, whites are at intermediate risk, and Japanese have the lowest average risk.

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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