Thursday, January 31, 2008

Hawthorn Extract Shown to Improve Heart Failure

Hawthorn extract has been touted for it's use in treating heart failure. A recent review from Cochrane indicates these benefits are real. The extract is made from the leaves and berries of the Hawthorne plant, and when taken with conventional treatment, Hawthorn extract can improve symptoms of congestive heart failure.

Fourteen trials, involving 855 patients were examined by two Cochrane reviewers. The evidence revealed significant benefits for heart failure treatment when compared with patients who were given placebo during the trials.

Those who took Hawthorn extract displayed increased exercise tolerance, improved exercise workload, less shortness of breath and fatigue, and less oxygen consumption during exercise. These benefits allow for increased activity and improved quality of life for patients diagnosed with Class I to III chronic heart failure.

Hawthorn extract is a popular herbal medicine. Experiments show that Hawthorne extract increases contractility of the heart, making it pump more forcefully. By increasing the force of contractions, blood flow to the lungs and organs improves, providing relief of common symptoms such as fatigue and decreased exercise tolerance. Digitalis provides the same benefit, and has been used for decades. Digitalis is derived from the Foxglove, or digitalis plant.

There were minimal side effects reported with Hawthorn use. Side effects included G.I upset such as nausea, dizziness, and "heart complaints" that were undefined in the review data. Side effects were infrequent.

If you have been diagnosed with congestive heart failure, you should speak with your doctor before adding any herbal medications to your treatment plan. This analysis provides good evidence that Hawthorne extract can provide symptomatic relief for chronic heart failure.

Will Hawthorn extract find it's way into the pharmaceutical industry?

Ref: Cochrane Database of Systematic Reviews 2008 Issue 1 ◦

Monday, January 28, 2008

Use of Oral Contraceptives for Prevention of Ovarian Cancer Draws Controversy

According to an analysis published in the January 25 issue of the Lancet, the use of oral contraceptives is shown to reduce the risk of ovarian cancer significantly. The evidence is so strong that there is advocacy for over the counter purchase of oral contraceptives.

Ovarian cancer is aggressive and deadly, making it a recent research focus. The dilemma involving this current analysis involves concerns over past studies that show an increase in breast and cervical cancer with hormone use. Obviously, the risk benefit ratio of taking oral contraceptives for ovarian cancer prevention must be weighed.

The current study encourages rapid dissemination of this information in an effort to combat the negativity associated with oral contraceptive use, and though over the counter purchase is advocated, accompanying commentaries urge caution. Experts believe that safe use of oral contraceptives requires close monitoring and counseling, though agreement exists that the pill should be made more readily available to women worldwide.

The editorial is already drawing controversy. Dr. José-María Simón Castellví, president of the World Federation of the Catholic Medical Association, calls the editorial “definitively irresponsible" because of the association between breast and colorectal cancer seen with oral contracetpives; noting a 2005 statement from the World Health Organization's International Agency for Research on Cancer.

The Lancet so strongly endorsed the use of oral contraceptives for ovarian cancer prevention that they term this study “hard hitting”, with “public health implications”, and describe this as “unequivocal good news”.

To summarize the results, 100.000 women from 21 countries were studied. Age was not a factor in the outcome. After ten years of oral contraceptive use, the results translate to the following: Among 5000 women using oral contraceptives for 1 year, roughly 2 cases of ovarian cancer and 1 death from ovarian cancer before the age of 75 years would be avoided.

The controversy and varying opinions surrounding this analysis certainly make the issue a bit confusing - for consumer and healthcare providers alike.. It seems that women are going to have to make their own choices about whether they want to take oral contraceptives to prevent ovarian cancer. Many factors will have to be considered. I urge you to remain informed and proactive regarding all of your healthcare choices.

Ref: Lancet. 2008;371:275, 277-278, 303-314.

ZE08012808 - 2008-01-28

Friday, January 25, 2008

Largest Study to Date Shows Simple Walking Will Reduce Mortality. What Is The Problem Then?

I read a quote today from Dr Peter Kokkinos (Veterans Affairs [VA] Medical Center, Washington, DC), and it spawned too many thoughts. I realize how important exercise is to all of us. As a Registered Nurse, I'm also painfully aware of individual limitations toward health maintenance. I recognize the burden on Healthcare. We know beyond a doubt that exercise will reduce mortality. What is the problem then?

Here's the quote: "People are people, and we all get caught up in the excuse, 'I can't exercise I don't have time,'" Kokkinos commented. "But everyone needs to get involved to get this nation going again, because we are the fattest nation, the most sedentary nation in the world. And we need to do something about it." (1)

Dr. Kokkinos also states: "For God's sake, if we could walk on the moon we can certainly walk on earth."

These comments stem from research that included male Veterans who were enrolled in a study designed to measure the incidence of overall mortality as it relates to exercise. It is one of the largest studies ever done.

The results have proven that you can reduce your risk of death from overall causes by 70% by improving your exercise capability. Even moderate fitness yielded a 50% drop in mortality.

I agree with Dr. Kokkinos, and I appreciate the study, but I feel like this really is difficult for too many people. I'd like to see a study that actually targets resolutions to this lack of overall fitness.

Black veterans, white veterans, veterans with heart disease, and those with no heart disease were included in the study. No one socioeconomic group was targeted. The outcome remained the same for everyone - exercise will help you live longer.

Walking just thirty minutes a day would do the trick. Here are some limitations as I see them:

Mall walking means you have to get up pretty early; something than takes away from family time and other personal obligations. Yes, it's a free, viable alternative for winter months, but think about how many people work very long hours. The same limitations regarding family time apply to walking in the evening. Also, during the winter months it's too dark to walk safely. In many parts of the country it's too cold or just impossible due to snowfall and ice.

Too many people don't have space in the home for exercise equipment. Maybe they can't afford this sort of purchase.

Other forms of home exercise may require other expense and space: a computer, training DVD's, or monthly online subscriptions. At the very least, even Fit TV requires Cable.

I suppose you can stand in the room and march in place, but only the truly motivated will do this, bringing us back to square one.

For many, the options are truly limited. No, not everyone can simply walk thirty minutes a day.

Perhaps this is a by-product of capitalism. We have encouraged the work sector to sit in front of computers, allowed employers to remain unconcerned about the health of their employees, and permitted laws requiring mandatory overtime. In many states, an employee can be "fired at will". Many people work long hours, even seven days a week. Fatigue, stress and financial concerns, compounded by increased fatigue and worry stemming from frantic attempts to fit in daily exercise doesn't seem like a good recipe for success.

We have become cogs in the wheel, focused on work and productivity; allowing our own health and well being to be sacrificed. We have lost our substance. The day has to arrive when health takes precedence over money. It's not JUST an individual response to action; initiatives for health should involve changes in employee/employer relationships, legislation and obsession with productivity on the part of Corporate America. Can we never settle for "comfortable" profits?

I realize there are many large corporations who include employee wellness in their structure. On the flipside, I know of one small company that has even removed employee pay lunches, squeezing every sixty seconds possible from their employees. The same company cut employee lunch breaks to twenty minutes, both of these changes applicable to temporary employees.

We need to treat the entire dilemma regarding good health by taking this issue to a higher level for examination and resolution. How about some powerful advocacy in the workplace? Perhaps we could base our economy on individual empowerment rather than control.

That's my opinion, what is yours? Does your workplace provide incentives toward exercise? Can you break away from other obligations to fit in some exercise? Please leave a comment.


Surprising Study Shows Possible Harmful Effects of Calcium Supplements

In a surprising study, researchers have discovered that Calcium supplementation in elderly women may actually increase the risk of heart attack and related vascular disease such as stroke, sudden death, angina and "other chest pain".

The study was initiated in order to see what effect Calcium supplementation really has on improving bone density. The researchers, Dr Mark J Bolland (University of Auckland, New Zealand) and colleagues, expected findings that have previously been published - heart attack prevention. Instead, they found "robust" information indicating that Calcium supplements might increase a woman's chance of heart attack.

There's no way to make absolute sense of the study just yet however, and women are advised to continue Calcium supplements unless medically advised to do otherwise. More studies are recommended to refine and clarify this information.

Issues regarding this study include the following:

The study remains unequivocal, though carefully studied, according to experts.

Initial Vitamin D serum levels were not measured - a factor that may play a role in the current study outcomes.

Vitamin D, combined with Calcium for supplementation was not studied.

The women included in this study were "quite old" compared to previous studies which included women in their 50's. Previous studies have been done in the UK and Australia in the younger age group.

According to senior author, Dr Ian R Reid (University of Auckland, New Zealand, 1Gm of very soluble Calcium was used in the study, "and our study is a bit longer than some of the others, so that may also explain why we've got a more powerful effect."

The combination of high dose calcium with rapid entry into the blood stream(solubility) may contribute to calcium formation in the artery walls, leading to the results of increased vascular disease seen with this particular study.

Here is the information women can take from this study:

High doses of Calcium supplements may lead to increased risk of cardiovascular disease in postmenopausal women. We should anticipate and monitor future studies.

Improvement in bone density was evident with Calcium supplementation of 1Gm/day, but caution should be exercised if you have a history of cardiovascular disease, but you should speak with your doctor first.

Women in New Zealand are presently being advised not to use Calcium supplements if they are elderly and have heart disease.

Lower doses on Calcium (500mg) do not show benefits for bone loss but it is a safer approach if you do take Calcium for other benefits (blood pressure and cholesterol).

If you already have osteoporosis, do not rely on Calcium supplements for treatment.

No one has jumped on the bandwagon to say that Calcium supplements should be completely disregarded, but these findings are noteworthy.

Dr Erin D Michos (Johns Hopkins University, Baltimore, MD), who was not involved with this new study expresses his opinion to Heartwire: "This is a thought-provoking study, although not definitive, but further work should be done." Dr. Michos co-wrote articles regarding Vitamin D and Calcium supplements last year for the Women's Health Initiative (WHI).

This sort of research emphasizes to me how important it is for women to maintain awareness. It's only through education that we can make informed decisions about our own health management.

It's also a good time to again emphasize the necessity of exercise for bone loss and cardiovascular disease prevention. We have many options to protect our own health without relying on supplements and medications that may cause deleterious effects and expense.

There has been a huge initiative from the healthcare sector toward emphasizing the value of exercise and nutrition. So many health problems are related to inactivity and poor dietary choices. It seems so simple, but it's a problem that seems to defy solution when you look the obesity "epidemic" and statistics related to diabetes and heart disease.

I feel certain that each and every practicing physician would welcome the opportunity to successfully drive this message to their patients.

Ref: BMJ January 15, 2008

Why Should I be Physically Active?

Wednesday, January 23, 2008

Stress Linked to Later Heart Disease According to 911 Survey

Adults who took place in a national online health assessment, conducted by the University of California, Irvine were found to have a 53% increase in the diagnosis of heart disease following 911; strengthening opinions that stress and heart disease are related. Over three thousand adults were enrolled in the online survey.

The initial health assessment was performed just before the 911 attacks; a second survey was conducted nine to fourteen days later, requesting information about the groups stress levels. Those who reported the highest levels of anxiety and related symptoms following 911 showed a threefold increase in the development of hypertension, and were twice as likely to report the development of some form of heart disease several years later. Contributing factors such as metabolic index, smoking, mental health, and level of exposure to 911 events were adjusted for the study.

Only 21.5% of those surveyed had a diagnosis of heart disease before the attack; the number jumped to 30.5% three years later - a 53% increase.

The authors of the study believe this survey highlights the role of acute stress and future incidence of heart disease. It is suggested that physicians consider acute stress as a risk factor for the development of delayed heart disease.

The findings were published in the January issue of the Archives of General Psychiatry.

Ref: Cardiosource Video Network

Tuesday, January 22, 2008

Adequate Levels of Vitamin E Delays Disability in Elders

A recent study confirms that adequate levels of serum Vitamin E can delay the onset of disability, especially if you're over age 65.

The research was initiated in an effort to clarify whether or not there is a link between the rate of age related physical decline and poor nutrition - an answer that past studies have failed to reveal.

The results, reported in the January 23 issue of the Journal of the American Medical Association is considered conclusive: low levels of Vitamin E significantly contribute to physical decline and disability among elders.

According to Benedetta Bartali, RD, PhD, from Cornell University in Ithaca, New York, and colleagues, "Maintaining independence of older persons is a public health priority, and identifying the factors that contribute to decline in physical function is needed to prevent or postpone the disablement process".

The randomized study was performed in Tuscany, Italy from November 1, 1998 through May 28, 2000, and the participants were followed until 2003. Men and women were both included in the study.

The group performed specific activities to determine their physical capability. The following were measured: 4-meter walking speed, repeated chair rises, and a test of standing balance using increasingly more challenging positions.

Following a thorough analysis, only low serum levels of Vitamin E were found to correlate with physical disability.

According to the authors of the study, "Clinical trials may be warranted to determine whether optimal concentration of vitamin E reduces functional decline and the onset of disability in older persons with a low concentration of vitamin E."

Foods that are rich in Vitamin E include green leafy vegetables, egg yolks, nuts, seed, sardines, oats, whole grains and wheat germ.

JAMA. 2008;299:308-315

Thursday, January 17, 2008

High Plasma Vitamin C Levels Shown to Reduce Risk of Stroke by 42%

A visit with the family doctor probably means you'll end up with a prescription for some sort of medication. We're either treating an existing illness or trying to prevent the next.

Blood pressure medication, cholesterol lowering drugs and even blood thinner prescriptions are doled out in an effort to prevent stroke and cardiovascular disease. What if your doctor "prescribed" fruits and vegetables for stroke prevention?

A recent analysis shows that by eating vitamin C rich fruits and vegetables, you can cut your risk of stroke by 42%. That's pretty significant, especially when you compare drug trials for stroke prevention.

Plavix is recommended for many high risk patients, and it does reduce your risk of stroke - by 8.7 - 9.4% (1).

Don't stop taking your Plavix in favor of fruits and vegetables. Read the following and incorporate good eating into your daily medical regimen. It only makes sense that you'll cut your risk of stroke even further.

Lead author Phyo Kyaw Myint, MRCP, from the clinical gerontology unit at Addenbrooke's University Hospital in Cambridge, United Kingdom writes: "We explored the relation between baseline plasma vitamin C concentrations and future stroke risk in British participants in the European Prospective Investigation into Cancer (EPIC)–Norfolk," study, a population-based prospective study. "Measuring plasma vitamin C levels may identify those who will most benefit from established risk factor management such as blood pressure control."

The reason for this finding is possibly due to the antioxidant effect of Vitamin C, something not reproducible with Vitamin C supplements. It's not time to change current treatments, but the message to the public and to patients should be clear: eat your fruits and vegetables. You should consume 5-9 servings per day. That sentence almost wrote itself because it's been repeated so many times, but the message deserves notice.

No one in this study group was asked to alter their diet. This research took place between 1993 and 1997 and included 20,649 men and women aged 40 to 79 years. Plasma levels of Vitamin C were measured at the beginning of the study. The group was followed through March 2005.

Individuals who took part in the study with the highest Vitamin C levels showed a 42%reduction in stroke risk than those with lower plasma Vitamin C levels. By adding one fruit or vegetable a day you can reduce your chance of stroke by 17%.

Since Vitamin C has a short half life, it's important to eat fruits and vegetables daily - throughout the day. Cooking reduces the Vitamin C content of vegetables so stick with raw or lightly steamed vegetables.

I wonder if pharmaceutical companies could provide vouchers for fresh fruits and vegetables? I'm all for it!

Ref: Am J Clin Nutr. 2008;87:5-7, 64-69.

Wednesday, January 16, 2008

Avian Flu Continues to Cause Disease and Deaths

Today, the New England Journal of Medicine released updates regarding Avian Flu, or the H5N1 virus. The review contains updates from a 2005 report, along with World Health Organization recommendations.

What do we really need to know about this potential pandemic. What about vaccines and what are the current predictions?

According to the update, the Avian flu virus has evolved into distinct groups since it was first identified. This makes vaccine choices difficult, even though vaccine is plentiful and available. The necessary antibody levels required for protection have not been established. Studies have shown that antibody response may be age related and vaccination guidelines are simply not yet established.

The virus group (or clade), varies by geographic location. Not all of the virus groups have produced disease in humans. Exposure to poultry infected with Avian flu has been seen widely, yet human infection continues to be rare. Success toward prevention with Avian flu vaccine remains undefined as well as costly even though it has been produced.

It is not certain if migratory birds should be viewed as a potential source of Influenza A, or H5N1 virus, but it is felt that the risk of spread to North American from this source is low. The chance of Avian flu transmission from other domesticated animals to humans remain theoretical.

The incidence of the virus has increased since 2005, and the spread is recognized as being group specific; cited as clade (group) 2.2. The number of confirmed cases as of December 2007 is 340. The increase is believed to be the result of virus proliferation in Eurasia and Africa.

The least amount of deaths from Avian flu (HN51 virus, Influenza A) occurs in people over age 50, with the highest incidence in persons aged 40 or younger. The disease is worse in cooler months when poultry outbreaks are more common.

Avian flu outbreaks continue to occur in clusters, the largest being eight persons. More than ninety percent of those infected have been family members, making genetic predisposition to avian flu a possibility. Since this is only speculative, it is recommended that all body fluids be treated as infectious in anyone who has contacted H5N1 or Influenza A. We cannot make assumptions about genetic predisposition.

Physicians are being urged to suspect avian flu in travelers, though no cases have yet been reported as the result of short term visits to affected countries.

The main method of transmission is still identified as bird to human. Questions remain about how the virus enters the respiratory tract, but it's suggested that it may be through inhalation of aerosolized excrement. It's not known if the virus can enter the gastrointestinal tract, though it has been detected in the feces of infected persons before respiratory symptoms of viral pneumonia were manifested.

Specific inflammatory changes have been detected on autopsy. These markers provide differentiation from human influenza A, but lack of knowledge about the mechanism that produces the inflammation makes it impossible to guide treatment. The amount of time it will take for the avian flu to progress to death has remained the same (9-10 days after onset).

Recommendations for identifying Influenza A include a very close look at anyone who rapidly develops pneumonia. Healthcare providers are being urged to include H5N1 infection when differentiating causes of pneumonia in high risk populations and in those whose illness follows an abnormal course.

Early treatment with the antiviral agent oseltamavir has been shown to improve survival rate, but no optimal dose or length of time for administration has been absolutely determined. In spite of this fact, recommendations are being provided to physicians regarding dosing. The mainstream recommendation for H5N1 treatment is to provide support - oxygen administration, fluids, and prevention of opportunistic infections.

The World Health Organization has stockpiled antiviral agents in case of a predicted widespread outbreak. A current model predicts spread of the disease in rural Asia. The plan is to provide antiviral agents for prophylaxis. Included in this plan are "social distancing" measures to curb spread of the disease.

The CDC and WHO have published guidelines designed to prevent infection, such as using soaps, disinfectants, chlorination and alcohols. The guidelines are available from the U.S. Centers for Disease Control and Prevention and the WHO. It has been established that avian influenza A can be readily deactivated by a variety of chemical agents.

The above information doesn't seem earth shattering, but one thing is very striking to me. Prevention is key. It is the most clearly defined, understood and attainable recommendation regarding the control of Avian flu.

It's obvious - the future of Avian flu appears to lie solely in the hands of conscientious poultry handlers.


Tuesday, January 15, 2008

Is Your Cardiologist Cranky? Analysis Reveals Unnecessary Cardiac Catheterizations.

An analysis published last month in the Journal of the American Medical Association reveals that 14% of patients who go to the emergency room for suspected heart attack are sent for cardiac catheterization unnecessarily. This means that the Cardiologist and the cardiac cath team are called to action to treat non heart attack patients - at any hour. No wonder your Cardiologist may be cranky.

Furthermore, 10% of "clot busting" medication is given to patients who later have no indication of heart attack.

The analysis was carried out by examining the prospective registry of a regional health system that transfers patients with suspected STEMI (ST elevation myocardial infarction) to a cardiovascular center in Minnesota for treatment. The investigation took place between March, 2003 and November 2006.

The goal of assessing the data was to determine how frequently this occurs and what factors contribute to misdiagnosis.

The results reveal that out of 1335 patients who received cardiac catheterization, 187 patients had no blockage in their coronary arteries, 9.5% did not have significant blockage, and blood tests indicative of heart attack were negative in 11.2% of these patients.

The outcome revealed that false positive cardiac catheterization laboratory activation is fairly commonplace.

Perhaps if the Cardiologist would examine patients in the Emergency room instead of relying on the diagnosis of the Emergency room physician, 1 in 10 patients would be spared this invasive procedure - but your Cardiologist might still feel cranky.

Ref: JAMA. 2007;298(23):2754-2760. ◦

Sunday, January 13, 2008

Exercise, Drink Alcohol, Live Longer

Danish researchers have determined that people who are physically active and consume alcohol weekly live longer than their non drinking counterparts.

The Danish scientists set out once and for all to determine whether the combination of the two might provide some health perks. The benefits of alcohol and exercise have been separately studied in recent years. This study is the first to explore the effects of combining the two activities.

The Copenhagen Heart Study reveals that you can lower your overall risk of death and prevent heart disease by drinking moderate amounts of alcohol and remaining physically active.

The participants for this study were split up into three categories:

Physically inactive/ low level of activity
Light physical activity for two to four hours a week, or moderate to high level of physical activity
Light physical activity for more than four hours a week, or more vigorous activity for two or more hours a week.

Alcohol intake was classified as:

Non drinkers (less than one drink a week)
Moderate drinkers (one to 14 drinks a week)
Heavy drinkers (15 or more drinks a week).

The group was followed over a period of twenty years, and the conclusions are certainly enlightening, as follows:

Those who drank moderate amounts of alcohol, in any physical activity category, had the lowest hazard ratio for heart disease and overall mortatlity.

Dr Morten Grønbæk from the National Institute of Public Health, Copenhagen, said: "Our study shows that being both physically active and drinking a moderate amount of alcohol is important for lowering the risk of both fatal IHD and death from all causes.

Physicians may have a difficult time delivering such a message to their patients; for others this may be some of the best medical news to date.

Tea drinking may be your preference for imbibing. You can still add years to your life by increasing your level of exercise.

Ref: Eur Heart J. 2008; DOI:10.1093/eurheartj/ehm574 ◦

Thursday, January 10, 2008

Can Antioxidants Kill You?

Studies have proven without a doubt that taking Vitamin E, Beta Carotene or Vitamin A supplements can have an adverse effect on your health. The warnings come from one of the largest studies ever conducted by a group of researchers, led by Goran Bjelakovic, MD, of the Copenhagen University Hospital in Denmark.

The study shows that these antioxidants do not contribute to the prevention of disease, and that they actually accelerate the progression of cardiovascular disease and cancer, increasing mortality.

The reasons for the harmful effects are not entirely clear. Study co-author, Christian Gluud, MD, of the Copenhagen University Hospital in Denmark speculates that by clearing the body of free radicals, our body's defense mechanisms may be somehow affected. Another suggestion offered by Dr. Gluud is that the supplements actually produce a pro-oxidant effect in the body. He takes it further by warning that health supplements should not be allowed to be added to foods without a complete evaluation of their risks and benefits.

Antioxidants also included in this study were Vitamin C and selenium. Though Vitamin C was not found to be harmful, there was no proven decrease in mortality. Selenium supplementation showed no obvious benefits but did not contribute to mortality.

The doses of beta-carotene, vitamin A, vitamin C, vitamin E, and selenium utilized in the study were 17.8 mg, 20,219 IU, 488 mg, 569 IU, and 99 µg, respectively.

This study is strong, and the wording is exact with regards to antioxidant use. The research performed was of high quality. Dr. Gluud states "The question has been thoroughly addressed and we now know the answer — these agents are harmful."

It should be interesting to see what changes, if any will result in the marketing of vitamin supplements. This study result is certain to be referenced in the ongoing push for government regulation of food supplements.

Ref: JAMA. 2007;297:842-857. ◦

Wednesday, January 9, 2008

PMS Symptoms Linked to Autonomic Nervous System Depression

Most women experience some degree of PMS. According to a recent study, premenstrual syndrome is thought to be related to depression of the autonomic nervous system (ANS). The most severe symptoms of PMS were directly correlated with an even greater decline in ANS function.

The autonomic nervous system is the body's regulatory response to stress. The two components of the autonomic nervous system, the sympathetic and parasympathetic nervous system, normally serve to keep the body in balance.

A study conducted by researchers at the International Buddhist University, in Osaka, Japan shows that women with PMS experience decreased function of the autonomic nervous system as menstruation approaches. In addition, women who suffer from premenstrual dysphoric disorder (PMDD) seem to have permanent ANS dysfunction. PMDD affects approximately 3%-5% of women.

The women who were studied received a standardized questionnaire, received urinary hormone testing, and were divided into three study groups: PMS, PMDD, and control. Variability in heart rate was tested during the late-luteal phase of the menstrual cycle. The group who experienced PMS symptoms was proven to have decreased ANS function. The PMDD group showed a decline in ANS function that was unrelated to the phase of their menstrual cycle.

Further research is needed to tie together all of the factors that may be associated with this complex issue, but it is another step toward discovering a treatment for women who experience disturbing symptoms of PMDD and PMS.

Ref: Biopsychosoc Med. 2007; 20;1:24 ◦

Tuesday, January 8, 2008

Women's Health

Blood Pressure Management for Women - Go (Soy) Nuts

Women who go nuts (soy nuts, that is) are likely to find a reduction in blood pressure and a healthier heart. Soy nuts are tasty, and provide an easily obtainable overall health benefit for women.

A handful of unsalted, roasted soy nuts daily can significantly reduce both systolic and diastolic blood pressure. The women who took part in this referenced study ate 1/2cup of soy nuts and took a thirty minute walk each day. All the women were also required to maintain an overall healthy diet. The results yielded a 15mm/Hg drop in systolic blood pressure and 6mm/Hg drop in diastolic blood pressure. This equates to the same effect as taking a blood pressure medication.

Even if your blood pressure is normal at age 55, you still run a 90% lifetime risk of developing high blood pressure, increasing the risk of cardiovascular disease. The chance of developing cardiovascular disease becomes twice that with even minor blood pressure elevations. You can cut your risk of coronary heart disease by 6% by lowering the diastolic (bottom number) blood pressure by just 2mm/Hg.

The current thinking is that the Isoflavin content of soy nuts is as protective to the heart as estrogen.

Besides ingesting this specific form of soy protein, women should take note of the following dietary guidelines:

Take 1200mg of Calcium daily.
Limit your total cholesterol intake to less than 200mg/day.
Limit your carbohydrate intake to 55% of your total calories. Total fat intake should be 30% daily (12% monounsaturated, 11% polyunsaturated,(≤
7% saturated).
Eat two meals containing fatty fish per week.
If you have existing high blood pressure, limit your salt intake to

Ref: Welty FK, Lee KS, Lew NS, Zhou JR
Arch Intern Med. 2007;167:1060-1067

Meal Suggestion (modified from "Everday Food")

Salmon steaks with white-beans and olive
4 salmon steaks, about 8 oz. each
2 cans (14oz) cannelli beans
2 Tbsp. olive oil
2 Tbsp. Lemon juice
1/2 cup pitted Kalamata olives, halved

1. Heat broiler with rack set 4in. from heat. Line a rimmed baking sheet with
aluminum foil. Place salmon on baking sheet; season to taste.
Broil until opaque throughout, 10-12 minutes.

2. While the salmon is broiling heat 2 Tbsp. oil in a large skillet over medium
heat. Add 2 14 oz. cans cannellini beans, rinsed and drained and season to
taste. Cook about 2-4 minutes or until warmed throughout. You can add some
water after cooking if the beans are dry. After cooking stir in some lemon
juice for added flavor.

Acute Coronary Syndrome Misdiagnosed in Women

Women often have different symptoms of acute coronary syndrome than men. Women who experience heart attacks are more likely to die when compared to men. Women also experience heart attacks on the average of ten years later than men.

It is now thought that the diagnosis of acute coronary syndrome, (MI, heart attack) is frequently missed in women because women have symptoms that are not recognized. Women are more likely to have symptoms of palpitations, upper back pain, shortness of breath, indigestion, loss of appetite, cough, dizziness, weakness and fatigue rather than chest pain. This has lead to misdiagnosis. In a recent large study it was found that approximately one third of patients who are having a heart attack had no symptoms of chest pain and that women were the least likely to have any chest pain.

The message about heart attacks will remain the same for now, but research suggests that a different approach toward the recognition of heart attack symptoms should be presented. It would probably be more valuable to instruct the public that symptoms of heart attack can vary. A new approach might prevent delays in treatment. Targeted research that includes the collection of hospital data should be pursued in order to provide a different standard of teaching regarding heart attack symptoms and when to seek help.

Ref: Arch Intern Med. 2007;167:2396, 2405-2413.

Helpful links:
Go Red for Women
More Tips for Heart Health from Healthy Inspirations

Female Sexual Health

Female sexuality is complex. It also has been poorly studied. Since the creation of Viagra, healthy sexuality is more openly discussed - but mostly that of men. This is in part due to the strong correlation between erectile dysfunction and heart disease. What about women in midlife and older? Little research has been devoted to this area of a woman's health.

Data from the National Health and Social Life Survey (NHSLS) suggests that sexual problems affect 43 percent of women in the United States (compared with 31 percent of men).[1] This has spawned an interest from the pharmaceutical companies to develop medication to treat female sexual dysfunction. But where would they begin? The problem is that sexual dysfunction in women is poorly defined. What actually constitutes "sexual dysfunction" for a woman?

Erections are measurable. Discomfort during sex, female orgasm and sexual performance anxiety for women are not so easily measured. In other words, these are not physical events, as is an erection, making research more difficult. Medical researchers realize the inequity and are starting to shift their focus more toward women's sexual health issues. The medical community seems very clear that a woman's sexuality is complex and involves psychosocial and physical aspects.

Here are some views that are currently being challenged by experts:

• A woman's physical and psychological problems can be separated - the challenge here is that a woman's sexuality involves complex issues - psychological, physical, biological and personal
• Women desire sex because they fantasize about it and are aware of sexual desire - This may not be entirely correct. Women in new relationships are most likely to feel a spontaneous desire for sex but women in established relationships think about sex infrequently: women desire sex for more complex reasons than men.
• A woman desires sex before she becomes aroused - It is now recognized that sexual arousal often occurs before the desire or at the same time. Women have sex because they desire intimacy with their partners as well as a variety of other reasons that still need to be studied.
• A woman's sexual arousal is characterized by vaginal lubrication and swelling - The fact is most women aren't aware, or don't correlate these bodily responses with sexual arousal (this has been measured). In addition, women experience vaginal lubrication even when they are not sexually stimulated.
• A woman's sexual response doesn't change much throughout life - More accurately, a woman's sexual response changes, depending on a multitude of factors: interpersonal relationship, the context of sexual interaction, pregnancy, medical conditions, menopause, and the natural decline that occurs with age.
• Women become distressed when their sexual response changes - Most women really don't seem to get upset, making no treatment necessary.
It will be interesting to see what positive changes this new focus will bring to women's health issues.

(1)Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999; 281:537-544, 1174.

Breast Cancer

I'm beginning to see a strong link here between obesity and cancer. According to the latest research, keeping your weight stable decreases the risk of breast cancer by 1.4%.

Apparently, estrogen is stored in fat cells. Increased levels of estrogen are a known contributor to breast cancer.

The study is published in the Archives of Internal Medicine.

Ovarian Cancer

There is very strong evidence that eating a low fat diet reduces the risk of ovarian cancer in post menopausal women. Statistics report that the risk reduction is a whopping forty percent after eight years. Ovarian cancer is potentially lethal and such a simple change in dietary habits is well worth the effort, especially if you are high risk.

The changes took four years to "kick in" according to this study which was published in The Journal of the National Cancer Institute.

Helpful Link:
Women’s Health –

Thursday, January 3, 2008

January Health News

The year 2007 yielded both notable and major advances in cancer treatment, according to the annual review of the American Society of Clinical Oncology (ASCO). The summary has been published in the December issue of Clinical Cancer Advances 2007.

Here are a few of the highlights from their review:

The use of aspirin has been studied for the prevention of colorectal cancer, and is showing promise. Colorectal cancer is the most commonly diagnosed cancer in the United States.

The drug Trisenox™ (ARSENIC TRIOXIDE) has been shown to improve the survival rate in patients with promyelocytic leukemia.

Fewer radiation treatments (higher dose) are being used to treat breast cancer. Less radiation treatments for those diagnosed with breast cancer is certain to have a postive affect on quality of life.

The drug Sprycel is now being used as a first line treatment for myelogenous leukemia. Sprycel is now very specific for leukemia treatment. It acts by targeting the protein in the cancer cells, causing them to stop growing.

BEVACIZUMAB (Avastin™) is being used to treat Glioma, a type of cancer that targets the brain, spinal cord, and central nervous system. Avastin has been used to treat many other types of cancer, and now has been shown to be effective for the treatment of Glioma.

The use of MRI to diagnose breast cancer is considered to be a major breakthrough.

Patients with advanced small lung cell cancer are less likely to experience metastasis to the brain when treated with preventive radiation therapy. Lung cancer most often attacks the brain when it spreads, and this has greatly decreased the survival rate of lung cancer patients. This is considered to be another major advance in cancer treatment.

There has been a reduction in the rate of breast cancer. It is believed that the decline is due to decreased hormone replacement therapy in women

We can only hope that this trend continues well into the New Year and beyond.

Mouthwash Test for Oral Cancer Shows Promise

A simple and noninvasive test is being developed to detect oral cancer. The test involves the use of a mouthwash to "spit" genetically altered cells from the oral mucosa for cancer testing.

The test is currently undergoing refinement, but researchers are hopeful that the mouthwash test will provide a useful diagnostic tool for early detection of oral cancer.

In April 2007, a similar test to diagnose head and neck cancer was proposed by Elizabeth Franzmann, MD from the University of Miami.(1) Joseph Califano, MD, associate professor of otolaryngology from Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland has been conducting further research.

The mouthwash test, known as the "swish and spit test", is considered to be more effective than a traditional blood test. Cancer genes are more prevalent in the saliva than they are in the blood when oral cancers develop. Early detection and treatment will greatly improve the survival of patients with oral cancer. The mouthwash test would also detect cancer recurrence much earlier than past methods.

Rather than focusing on routine cancer screening, researchers are suggesting that the test should be used to target patients at high risk for oral cancer - tobacco users and those who have already undergone cancer treatment.

The test is performed by using an exfoliating brush inside the mouth and throat. After the cells are 'loosened' a salt solution is used to rinse and gargle. The salt solution is expectorated; then examined for the presence of abnormal cells and cancerous genes.

Clinical trials on the general population have not yet begun. Researchers have had some difficulty balancing test specificity and sensitivity. It is felt that more hypermethylated (cancerous) genes must be identified by scientists before clinical trials are started. Hypermethylated genes are currently considered a biomarker for cancer.

Ref: Clin Cancer Res. 2008; 14:97-107

(1) American Association for Cancer Research 2007 meeting: Abstract
3506. Presented April 15, 2007

Wellness Blog News

I've particularly enjoyed the great posts at Living Well, and felt it newsworthy (it's new!). We're all about living well, preventing health problems and remaining happy and stress free.

Living well covers topics related to living a healthy life, tips for reducing your exposure to chemicals wherever possible both inside and outside of your home, along with gardening and landscaping topics.

A recent article, that particularly appealed to me is regarding the use of anti-perspirants. It's been long noted that antiperspirants contain potentially toxic aluminum. In fact I have a friend who completely develops a rash whenever he tries to use them and has reverted to simply using deodorants, but the truth is, they're really hard to find.
Living well has an excellent natural recommendation.

For gardeners, there is a wonderful list of what you should be doing in the garden in January. I highly recommend reconnecting with nature - it really is something we're missing. You will enjoy the list, broken into zones to help you know what to do in your specific area.

I have to say, my favorite post might be "Wordless Wednesday". Ahhhh....peace. Check it out - you can't NOT like it. ◦