Natural Remedies

Depression During Pregnancy Regaining Control – Part 7

2008-08-16T13:05:00.000+10:00

Depression During Pregnancy: Consequences of Becoming the best mom that I can – Re-grounding self and regaining control.

Re-grounding self and regaining control describes the consequences of the strategies undertaken in confining the threat. All women had undergone counseling; ten took antidepressant medication during pregnancy, five commenced antidepressant medication within two months of delivering, and one woman delayed commencing antidepressant medication until she had weaned her baby.

Three women elected not to use antidepressants at anytime during the pre- and postpartum periods. The properties of this category are: Being in a better place and Knowing self.

Being in a better place

As a result of counseling, medication, or a combination of both, most of the women felt that they had arrived at a better place. Life still had moments of being "up and down" but, there were "far less bad days than there are good days". One woman, who managed her depression with a combination of counseling and antidepressant medication said:

I'm in a much better place now than I was before even becoming pregnant. I still have ups and downs, but my ability to deal with some of the things that are
triggers for me, is much better. (#18).

Another woman, who had received counseling, but remained medication-free during the obstetric and postpartum periods, explained how she was feeling:

For me I know it's slowly going. I do get depressed sometimes. I still do get angry, exasperated. I still haven't regained my full patience. It will take work, and that's what I believe – understand, it's a work in progress. It's like building a beautiful couture dress, it takes time. It's a work of art. It takes time. You are the art piece, and you are just slowly, you know, getting primped up. (#17).

Knowing self
All women felt that they had learned about the self and were regaining control of their life. Many felt confident that they were better able to recognize their needs, what triggered their moods, and that they could identify ways and means to ensure that those needs were met:

There's so much more to juggle. When you come home, you be [come] a wife, you be [come] a mother, and ... something, one time or another has got to give, you can't always be catching the ball. You need to take a break to recharge. I think that's important, sometimes we just forget to recharge. (#3).

Some women felt that having had depression and attended to its management, that they had undergone a "growing experience". One woman expressed this sentiment as:

I learned about myself. It was almost a gift in that, I don't know how to describe this..... I learned about myself... I've learned to take time for myself. (#19).

Some were surprised to realize that they had not been able to communicate how they had felt when they were at their lowest. As well, many identified a previous lack of awareness about the possibility of experiencing depression during pregnancy:

I never thought that I would have worries. I didn't know that I should look out for, you know, these types of things. (#16).

As the research participants recounted their experiences, many told of why they had participated in this study. Women felt it was important that other women be aware that depression can occur during pregnancy, and if it does, women should talk about their problems. Indeed, all of the women in this study identified a need to talk as part of the therapeutic process.

One of the reasons I wanted to do this study was because I really think it's important for women that are pregnant, either the first time, the second time, that if they really think that they can't handle it any more, they really need to talk to somebody. It's important. (#3).

Part 8 will be published soon.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Reference:
Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0

Related articles:
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Depression During Pregnancy – Part 2
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Dealing With Depression During Pregnancy – Part 6

The Atkins Low Carbohydrate Diet: Does It Work?

2008-06-15T09:46:00.001+10:00

The Atkins low carbohydrate diet is the diet that promotes weight loss through the consumption of foods low in carbohydrates and quite high in fat and protein contents, but not necessarily low in calories.

It was the brain-child of Dr. R. C. Atkins who claimed that it would initiate a greater weight loss than a conventional, low calorie diet composed of a "balance" of carbohydrates, fats, and proteins.

In addition, it was supposed to be friendly to those prone to diabetes because of the low intake of carbohydrate; it might reduce the body's need for insulin.

The Atkins diet concept is diametrically opposed to that used for years by traditional nutritionists and medical specialists.

Our initial response to the Atkins diet was that it might not be safe because years of scientific evidence suggested that high fat intake would surely raise blood cholesterol, thus increasing the risk of cardiovascular disease.

What ensued were numerous heated debates in print and on television about the worthiness of this diet.

Unfortunately, most of the battle lines were drawn on shaky grounds because they were based on age-old dogma, and lacked serious scientific inquiry.

Fortunately, this was about to change. Some results of very important research are now beginning to appear in the scientific literature. Hopefully, this new information will eventually determine unequivocally which side is right.

One of these studies was reported in the New England Journal of Medicine in 2003. The investigators' aim was to conduct a controlled experiment to determine the differences in weight loss of both obese men and women who consumed either the basic low carbohydrate Atkins diet or a conventional diet of reduced total calories. The study lasted for one year.

Besides weight loss, a number of other tests also were conducted, including blood sugar, blood cholesterol, HDL cholesterol (the good cholesterol), insulin levels, and blood pressure.

The results were interesting and different than most traditional nutritionists would have expected.

As Dr. Atkins had claimed all along, after 3 months, the volunteers who ate the Atkins diet lost 7-10% of their original body weight while those who ate the conventional low-calorie diet only lost 3-5% of their original weight.

After 6 months, the results were similar to those at 3 months; however, after one year, those on the Atkins diet had regained enough weight so that differences in weight loss between the two diets were not significant.

Another interesting result supported the view of the traditional nutritionists in that total serum cholesterol was increased about 3% while those fed the conventional diet had reduced their cholesterol about 5%.

However, the "good" cholesterol was increased about 20% in those consuming the Atkins diet but only about 3% in those consuming the conventional diet.

Neither diet affected blood sugar, blood pressure, or insulin levels, although the insulin levels of those consuming the Atkins diet tended to be lower than of those consuming the low calorie conventional diet.

The final results of the study suggested that volunteers who consume the Atkins diet may initially lose weight faster than those consuming the conventional diet, but after a long period of consuming the diets, the differences may be lost.

The investigators suggested that a longer and larger study be carried out before conclusive assessments are made about the benefits or dangers of consuming low-carbohydrate, high-fat, and high-protein diets.

Another interesting study appeared recently in the journal Perception and Motor Skills.

This group studied the effects of the Atkins diet on the response of volunteers to acute physical exercise.

Although this study was only 3 weeks long, the results strongly supported the hypothesis that individuals who consume the Atkins-type diet will experience more fatigue, more negative and less positive effects of exercise than those consuming the more conventional low-calorie diet.

However, humans are amazingly adaptable, and it would be interesting to see if they would overcome these negative effects after having consumed the diet for a much longer period. However, it's also possible that the effects could become even more detrimental.

Although these types of studies provide important scientific information to help the consumer make decisions about food consumption, the power of myth is strong.

Most of us believe what we want to believe, and most of us need a crutch or gimmick to get us through life, whether that gimmick is proven or not.

As most non-conventional diets, the Atkins diet started out as a gimmick, and as a result, numerous individuals have tried it, or are currently using it.

One estimate is that over 10 million copies of the book have been sold and that four times more people have read about the Atkins diet than any other.

We can only hope that further scientific experimentation can tell us whether this type of diet is indeed worthwhile or worthless.

Reference:
U.S. Department of Agriculture, Agricultural Research Service.

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Alcohol’s Effect on Heart Disease Risk

2008-05-31T11:01:00.000+10:00

Alcohol’s Effect on Heart Disease Risk - Frequency of Light-to-Moderate Drinking Reduces Heart Disease Risk in Men.

A 12-year study of 38,077 male health professionals found that men who drank alcohol three or more days per week had a reduced risk of heart attack compared with men who drank less frequently. Men who drank less than one drink a day had similar risk reduction to those who drank three.

Many epidemiologic (population) studies have reported that moderate drinking — for men two drinks a day — is associated with a reduced risk of heart disease.

This study looked at the relationship between quantity and frequency and found that it was the frequency of drinking — not the amount, the type of alcohol, or whether or not it was consumed with a meal — that was the key factor in lowered heart disease risk.

Compared with men who drank less than once a week, men who consumed alcohol three or four days a week had approximately 2/3 (68 percent) the risk of heart attack, and men who consumed alcohol five to seven days per week had slightly less (63 percent) the risk. Study data suggested no additional cardiac benefit to drinking more than 2 drinks a day.

Also, the study authors point out that the small number of study participants who drank roughly three and a half or more drinks (50 or more grams of alcohol) per day limited their ability to study the harmful effects of heavy drinking. However, heavy drinking has well documented adverse health effects.

The study, published in this week’s New England Journal of Medicine, was based on an analysis of data from the Health Professionals Follow-up Study, which has followed a population of male dentists, veterinarians, optometrists, osteopathic physicians, and podiatrists, ages 40 to 75, for 12 years.

Kenneth J. Mukamal, M.D., M.P.H., at Beth Israel Deaconess Medical Center, was lead author for the project, which included scientists from the University of Sydney, Sydney, Australia; the Harvard School of Public Health, Boston; Brigham and Women’s Hospital, Harvard Medical School, Boston; and the Massachusetts General Hospital, Boston. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Heart, Lung, and Blood Institute (NHLBI), and the National Cancer Institute, all components of the federal government’s National Institutes of Health, supported the study.

NIAAA director Ting-Kai Li, M.D., said, "This rigorously conducted observational study adds to the epidemiologic evidence of a strong association between light-to-moderate alcohol consumption and reduced risk of heart disease. Only by research on the mechanisms of alcohol’s effects on the cardiovascular system, and perhaps the liver, and the genetic background of how individuals respond to alcohol, will we provide a scientifically informed means for assessing the risks and benefits of alcohol use on a person-to-person basis."

NHLBI director Claude Lenfant, M.D., said, "There are well-proven ways to prevent cardiovascular disease and reduce its risks, including lowering cholesterol levels and blood pressure, maintaining a healthy weight, being physically active, and stopping smoking. These preventive measures do not have the risks associated with alcohol consumption. Therefore, we do not advise the public to begin drinking alcohol to prevent heart disease. However, those who already drink alcohol should be aware that current evidence suggests that moderate drinking may reduce the risk of heart disease in some individuals."

At entry into this study, all participants had to be free of heart disease. Participants in the study completed questionnaires on diet every four years. Investigators confirmed the validity of the questionnaire responses by comparing them with seven-day dietary records in 127 participants.

The investigators controlled for numerous health and dietary factors, including smoking, exercise, diet, and family history of premature heart attack. Also, because alcohol use changes over time, and the effects of alcohol may be short-term, the study tracked the effect of recent versus baseline alcohol consumption, and found that the level of risk was more strongly related to recent, rather than past, consumption.

By the end of the 12-year follow-up, the investigators had documented 1,418 heart attacks. Men who consumed alcohol three or more times a week had a reduced risk of fatal or nonfatal heart attack, even when the amount consumed was only 10 grams of alcohol a day or less. A standard drink — a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits — has between 11 and 14 grams of alcohol. Dr. Mukamal, the study’s lead author, said, "We found little difference among different alcoholic beverage types in our study. This further emphasizes the role of frequent intake, rather than any specific beverage type, in the link between moderate drinking and heart attack risk."

In an accompanying editorial, Ira J. Goldberg, M.D., of the Columbia University College of Physicians and Surgeons, New York, points out that some studies show a reduction in cardiovascular disease, but not overall mortality, in patients who drink alcoholic beverages (this study did not report on overall mortality). He notes that alcohol has toxic effects that are well established and that additional research is needed to inform physicians on how to advise their patients.

The paper, "Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men," appears in the January 9, 2003 issue of The New England Journal of Medicine 348(2): 109-118. An accompanying editorial appears on pages 163-164.

The Dietary Guidelines for Americans, issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, defines moderate drinking for men as no more than 2 drinks per day. The Guidelines can be viewed on-line at the website http://www.nutrition.gov.

Reference: NHLBI National Heart, Lung, and Blood Institute and NIAAA.

Diabetes Health News 16 May 2008

2008-05-16T10:28:00.002+10:00

Not All Fat Created Equal
It has long been known that type 2 diabetes is linked to obesity, particularly fat inside the belly. Now, researchers at the Joslin Diabetes Center have found that fat from other areas of the body can actually reduce insulin resistance and improve insulin sensitivity.

In a study published in the May issue of Cell Metabolism, a team lead by C. Ronald Kahn, M.D. found that subcutaneous fat -- fat found below the skin, usually in the hips and thighs -- is associated with reduced insulin levels and improved insulin sensitivity.

Understanding Red Wine's Potential Benefit For Diabetes
New research suggests that resveratrol, a chemical commonly found in red wine, has the ability to lower blood sugar levels, but might have certain untoward side effects. This research will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical Congress by Kimberly Martin, MD, and mentor, Dr. F. Ismail-Beigi, on Friday, May 16th, at the Walt Disney World Dolphin Resort in Orlando.

Resveratrol is a naturally occurring chemical found in grapes that has been reported to have cardioprotective, anti-inflammatory, anti-viral, and glucose-lowering properties. The effect of resveratrol on lowering blood glucose in diabetic rats has been reported by several investigators in the past.

High Beta-Glucan Barley Helps Manage Diabetes And Heart Health
Governor Brian Schweitzer appeared at Montana State University to celebrate Montana's scientific contribution to the development of barley varieties that serve as a natural way to help manage diabetes, heart disease and obesity.

The Governor congratulated MSU-trained researchers for their development of BGLife™ Barley, a new strain of barley that promotes healthy blood sugar, is proven to reduce cholesterol, promotes healthy blood pressure and helps control weight, all conditions associated with diabetes and heart disease. These patented barley varieties are the result of almost 30 years of agricultural research.

Diabetes And Alzheimer's Disease Linked By Salk Institute Study
Diabetic individuals have a significantly higher risk of developing Alzheimer's disease but the molecular connection between the two remains unexplained. Now, researchers at the Salk Institute for Biological Studies identified the probable molecular basis for the diabetes - Alzheimer's interaction.

In a study published in the current online issue of Neurobiology of Aging, investigators led by David R. Schubert, Ph.D., professor in the Cellular Neurobiology Laboratory, report that the blood vessels in the brain of young diabetic mice are damaged by the interaction of elevated blood glucose levels characteristic of diabetes and low levels of beta amyloid, a peptide that clumps to form the senile plaques that riddle the brains of Alzheimer's patients.

New Study Finds California Neighborhoods "Designed For Disease"
Californians face an added challenge as they battle expanding waistlines and obesity-related diseases - their address. A landmark study released shows the state's first direct correlation between where you live and your risk for obesity or diabetes.

The groundbreaking study, Designed for Disease: the Link Between Local Food Environments and Obesity and Diabetes, examines the correlation between the health of nearly 40,000 Californians and the mix of retail food outlets near their homes. The key finding: people living in neighborhoods crowded with fast-food and convenience stores but relatively few grocery or produce outlets are at significantly higher risk of suffering from obesity and diabetes.

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Causes of Memory Loss – Low Folate Levels

2008-05-12T12:25:00.000+10:00

High homocysteine levels and low folate levels cause memory loss. The B vitamin folate may help reduce memory loss according to data from a recent nationwide health and nutrition survey, NHANES III.

Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Mass., were looking for a relationship between blood homocysteine levels and memory loss.

Earlier, their research had established that homocysteine levels were higher in elderly people with low intakes of B vitamins, especially folate.

They had also validated reports that homocysteine - a byproduct of our own amino acid metabolism - increases risk of stroke, which is a major player in the loss of cognitive function.

But they wanted to see if high homocysteine levels or low B vitamin status had a more subtle influence in memory loss among people over age 60.

That’s because B vitamins are involved in the synthesis of chemicals crucial to brain function, according to nutritional epidemiologist Martha Morris, who led the study. Or, homocysteine itself might be toxic to nerve cells.

Morris collaborated with Paul Jacques, Irwin Rosenberg and Jacob Selhub at the Boston center, which is funded by the Agricultural Research Service, USDA’s chief scientific research agency.

Luckily, the NHANES III included a sensitive test of recall after a short delay, one that can identify individuals with a milder loss of recall.

Others had reported that homocysteine was related to Alzheimer’s disease, as well as to poor cognitive function in elderly both with and without dementia.

Perhaps 75 percent of dementia is due to stroke or Alzheimer’s disease, which is now thought to develop from minor strokes. So the researchers excluded data from people who had suffered a stroke.

Their analysis showed elevated homocysteine levels were associated with memory loss. But the survey subjects whose blood folate levels were in the upper half appeared to be protected from memory loss even if their homocysteine levels were high.

Reference:
Judy McBride, USDA, Agricultural Research Service.

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ADHD Stimulant Medications - Heart Attack, Strokes and Mental Problems

2008-05-10T10:14:00.000+10:00

ADHD Stimulant medications increase stroke and heart attack risks and risks of adverse mental symptoms. On February 21, 2007, the FDA directed the manufacturers of all ADHD stimulant medications approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to develop Patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines, and to advise them of precautions that can be taken.

An FDA review of reports of serious cardiovascular adverse events in patients taking usual doses of ADHD products revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors.

Another FDA review of ADHD medicines revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems.

The FDA recommends that children, adolescents, or adults who are being considered for treatment with ADHD drug products work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current status, particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems).

As part of the Agency’s ongoing regulatory activity, in May 2006 the FDA directed manufacturers of these products to revise product labeling for doctors to reflect concerns about adverse cardiovascular and psychiatric events.

These changes were based on recommendations from the FDA Pediatric Advisory Committee and the Drug Safety and Risk Management Advisory Committee. To help patients understand these risks, an additional part of this revised labeling process is the creation of a Patient Medication Guide for each individual product.

The medicines that are the focus of the revised labeling and new Patient Medication Guides include the following 15 products:

• Adderall (mixed salts of a single entity amphetamine product) Tablets

• Adderall XR (mixed salts of a single entity amphetamine product) Extended-Release Capsules

• Concerta (methylphenidate hydrochloride) Extended-Release Tablets

• Daytrana (methylphenidate) Transdermal System

• Desoxyn (methamphetamine HCl) Tablets

• Dexedrine (dextroamphetamine sulfate) Spansule Capsules and Tablets

• Focalin (dexmethylphenidate hydrochloride) Tablets

• Focalin XR (dexmethylphenidate hydrochloride) Extended-Release Capsules

• Metadate CD (methylphenidate hydrochloride) Extended-Release Capsules

• Methylin (methylphenidate hydrochloride) Oral Solution

• Methylin (methylphenidate hydrochloride) Chewable Tablets

• Ritalin (methylphenidate hydrochloride) Tablets

• Ritalin SR (methylphenidate hydrochloride) Sustained-Release Tablets

• Ritalin LA (methylphenidate hydrochloride) Extended-Release Capsules

• Strattera (atomoxetine HCl) Capsules

Reference:
FDA News - ADHD Medications and Cardiovascular, Psychiatric Adverse Events - Accessed 1 March 2008.

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Trans Fats Increase LDL Cholesterol Levels

2008-05-06T11:49:00.000+10:00

Research conducted by scientists at the Beltsville (Maryland) Human Nutrition Research Center (BHNRC) contributed to the 2005 Dietary Guidelines for Americans including recommendations that people in the United States limit their intake of fats and oils that are high in trans fatty acids.

Joseph Judd (now retired), and nutritionist Beverly A. Clevidence, and colleagues fed 58 male and female volunteers, aged 26 to 64, four controlled diets, characterized as moderately high trans fat, high trans fat, high saturated fat, and high “heart healthy” oleic acid.

LDL cholesterol levels were measured each time the volunteers completed one of the diets for a 6-week period. The study showed that after they consumed any of the trans-fat or saturated-fat diets, as opposed to the oleic-acid diet, their LDL cholesterol levels were significantly increased.

Trans fats cause changes in metabolism that increase the amount of circulating LDL cholesterol, which in turn can get deposited in blood vessel walls.

The scientists also reported that it’s important not to replace dietary trans fats with saturated fats. In fact, the 2005 Dietary Guidelines recommend consuming less than 10 percent of daily calories from saturated fatty acids. That’s 22 grams or less for a 2,000-calorie diet.

Saturated fats and trans fats tend to be solid at room temperature. The thick, yellow grease that forms in a cool pan after cooking meat is saturated fat. Both types of fats can collect in the body and clog arteries, leading to heart disease.

A 2007 Agricultural Research Service data analysis shows that U.S. consumers aren’t winning the battle on staving off fats.

The analysis, which was based on nationally representative dietary-intake survey data from What We Eat in America/NHANES 2003-2004, was led by nutritionist Alanna J. Moshfegh who heads the Food Surveys Research Group at BHNRC.

The researchers studied the levels and sources of saturated and unsaturated fats in the American diet and found that about 64 percent of adults in the United States exceed the dietary recommendation for consuming saturated fat.

New labelling laws require foods to be labelled for their trans fat as well as their saturated fat content, therefore people can keep an eye on their fat intake by reading food labels.

For example, a croissant has about the same number of calories as a bagel. But a croissant, which is a buttery puff pastry, has 32 times as much saturated fat (6.6 grams compared to an oat-bran bagel’s 0.2 grams).

Reference:
Rosalie Marion Bliss, Agricultural Research Service Information Staff, USDA, ARS (28/2/2008).

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When Weight Loss Diets Don’t Work, Adopt a Healthy Lifestyle Instead

2008-05-03T13:45:00.000+10:00

The “Every Size” strategy, a health-centered rather than weight-centered program, may help chronic dieters reshape their thinking, shed unhealthy habits, adopt new patterns of eating, become more physically active, and increase their self-esteem. That’s according to Nancy L. Keim, a chemist with ARS.

“Chronic dieters are those who either have failed at a sequence of diets, or, after successfully losing weight, gain back the pounds and start the dieting cycle all over again,” explains ARS physiologist Marta D. Van Loan. “For obese folks who can’t find a healthful weight loss regimen that gives them lasting results, this alternative to conventional dieting may offer greater and more sustainable improvements to several key indicators of their health.”

Keim and Van Loan are with the ARS Western Human Nutrition Research Center at Davis, California. The two scientists collaborated with Judith L. Stern and Linda Bacon of the University of California, Davis, in a study of the “Health at Every Size” approach.

Van Loan says the novel experiment rates as “one of the most rigorous comparisons of conventional dieting versus the Every Size lifestyle.” The results? Remarkable improvements for the obese, chronic dieters assigned to the Every Size cohort, one of two teams for the study.

Seventy-eight obese women, ages 30 to 45, participated in either the health-centered Every Size team or the weight-centered traditional diet team. The teams met for specialized, 90-minute educational sessions every week for the first 6 months of the year-long study, then met for six once-a-month sessions.

Both groups were instructed in nutrition basics. Women on the conventional diet track were schooled in topics that are typically covered in many popular weight-loss programs, such as how to monitor their weight, control their eating, and exercise briskly.

Meanwhile, their Every Size colleagues learned how to build their self-esteem; recognize and follow the body’s natural, internal cues to hunger and satiety (a feeling of fullness); make healthy choices at mealtimes and in between; and enjoy some form of physical activity—an approach that’s different from exercising mainly to lose weight.

Two Years Later: The Results

A total of 38 women, 19 from each team, participated in a panel of follow-up exams - lab tests and questionnaires - 2 years after the study’s start.

Every Size volunteers had kept their weight stable, neither gaining nor losing a significant number of pounds. In contrast, the dieters had lost weight by the sixth month, but regained it by the 2-year checkpoint. Their beginning weights and their weights 2 years later weren’t significantly different.

The Every Size women held onto the progress that they had made in several health risk factors such as cholesterol levels and systolic blood pressure - the amount of pressure in blood vessels when the heart pumps blood through them.

At the start and end of the study, total cholesterol and systolic blood pressure were in the normal range for all the women. Within this range, however, the Every Size women lowered their total cholesterol and their systolic blood pressure and were able to maintain those reductions for the entire course of the study.

In contrast, the dieters didn’t lower their total cholesterol at any point in the study. And they weren’t able to maintain the healthful decrease in systolic blood pressure that they’d achieved just after the 6-month reducing-diet phase.

What about physical activity?

At the 2-year point, Every Size team members had nearly quadrupled the amount of time they spent in moderate, hard, or very hard physical activity, compared to what they had reported at the study’s outset.

The dieters didn’t fare as well. At the 1-year point, they were exercising more than at the start, but they didn’t sustain their improved level to the 2-year checkpoint.

Although all the dieters made a lasting improvement in at least one of the food-related habits called “eating behaviors,” the Every Size volunteers improved in more of the categories.

For example, both groups did a better job of regaining control of their eating after they’d broken some eating-related rule that they had imposed on themselves. But the Every Size women made more progress, and sustained it, in other facets of eating behavior.

The Every Size team members, for instance, had apparently come to terms with issues such as bulimia (binge eating followed by purging), a “drive for thinness,” and dissatisfaction with their body size.

Dieters made initial improvements in handling bulimia, dealing with body size, and learning to follow the body’s natural signals of hunger and fullness, but they didn’t maintain the progress they’d achieved in these areas.

The researchers also monitored depression, a common problem among large-sized women whose low self-esteem may be related to their body image. Both groups made significant strides in lessening depression, but only the Every Size women were able to preserve a more optimistic outlook.

At the 2-year point, volunteers answered questions about how helpful the program was to them. When asked whether they’d continued to implement some of the tools they’d learned, 89 percent of the Every Size women answered “regularly” or “often.” Only 11 percent of the dieters did so.

Focusing on health and on changing behavior, instead of on weight loss, apparently acted as “keys to the successes of the Every Size team,” Van Loan points out. The scientists discuss these and other conclusions in an article in a 2005 issue of the Journal of the American Dietetic Association. The National Institutes of Health and National Science Foundation provided some of the funding for the study.

For many people, weight-loss diets “simply don’t work,” says Van Loan. The Health at Every Size strategy “may break the cycle of unsuccessful dieting” and open the door to happier, healthier lives.

Reference:
Marcia Wood, Agricultural Research Service Information Staff. USDA, ARS.

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High Homocysteine Levels and Heart Disease

2008-05-03T12:49:00.001+10:00

High levels of homocysteine are strongly associated with heart disease. Cholesterol isn't the only blood component associated with the risk of heart disease and stroke. Since the early 1990s, the amino acid homocysteine-a byproduct of amino acid metabolism-has emerged as another important risk factor.

Researchers believe that when body cells dump too much homocysteine into the blood, artery linings become irritated, encouraging the formation of plaque—fatty deposits that cling to artery walls.

One cause of this dumping is a low intake of folate, vitamin B6, or vitamin B12, according to earlier findings by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts.

Body cells need these three B vitamins to convert the amino acid methionine to cysteine. When any one is lacking, the intermediate product in the conversion, homocysteine, builds up.

In 1993, the Boston researchers were first to report homocysteine levels in any population-more than 1,100 elderly in the original Framingham (Massachusetts) Heart Study.

Even in this relatively narrow age range-67 to 96 years-homocysteine levels increased with age. Men had higher levels than women, but the difference narrowed at the upper ages.

Two years later, Norwegian researchers reported similar age and gender differences among the middle-aged population in their country. Smaller population samples in the United States and Europe generally support these findings.

"We wanted to describe serum homocysteine concentrations across our population and test for differences among sex, age, race, and ethnicity," says Paul F. Jacques, an epidemiologist at the USDA center involved in the earlier study.

But the studies covered specific age groups and were not representative of the U.S. population as a whole.

In the current study, Jacques and his Boston colleagues collaborated with scientists affiliated with the Centers for Disease Control and Prevention in Atlanta, Georgia, and Hyattsville, Maryland.

Using blood serum samples from the latest National Health and Nutrition Examination Survey, they measured homocysteine levels for 3,766 males and 4,819 females from age 12 up.

The results "confirm the age and sex differences reported in non-representative samples," says Jacques. Homocysteine levels increased with age. They were also significantly higher in males than females, regardless of whether the subjects were white or black with no Hispanic or Mexican-American background.

Levels were closest between the two genders in the young and old, diverging around puberty and converging after menopause.

The researchers suspect that impaired kidney function may contribute to the higher levels in older people. Body size, estrogen, and vitamin status may explain the difference between genders, they say.

Larger people have more creatinine-a protein breakdown product-circulating in their blood. And studies show a strong correlation between circulating creatinine and homocysteine levels.

Also, "estrogen seems to protect against high homocysteine," says Jacques, judging by the lower levels in premenopausal women. Further, women are more conscious about nutrition. The women in the study had a higher folate status than the men.

Mexican-American females had the study's lowest homocysteine levels-significantly lower than non-Hispanic black and white subjects. Jacques says nutrition may explain part, but not all, of the difference. He has not yet analyzed the data to look for other factors.

"It's crucial we understand the basis for these age and gender differences," he adds, "because fairly modest increases in homocysteine are strongly associated with higher risk of vascular disease."

Reference:
Judy McBride, Agricultural Research Service Information Staff.

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Menopause: Hormone Replacement Therapy and NSAIDs

2008-04-30T12:59:00.001+10:00

There is currently a great deal of uncertainty regarding the effect of hormone replacement therapy on heart disease in women subsequent to menopause. Premenopausal women are much less likely to experience heart attacks and strokes than men, a difference that does not exist between postmenopausal women and men.

One mechanism that might explain these observations relates to the effect of estrogen, which is thought to have a protective effect on the heart. Hormone replacement therapy consisting of replacement estrogen, and sometimes progesterone as well is often taken by women experiencing symptoms of menopause.

Evidence from observational studies and the Women’s Health Initiative (WHI) trial has suggested that hormone therapy protects against heart disease in the time just before and after menopause in women (perimenopause).

However, researchers have suggested that any beneficial effect of hormone replacement therapy on the heart might be counteracted by the effects of certain types of painkillers also being taken by women involved in the studies.

These painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), prevent production of a molecule called prostacyclin. Prostacyclin plays a role in preventing blood clotting and is therefore thought to be important in protecting the heart.

Estrogen, however, acts to increase production of prostacyclin, and it is therefore theoretically possible that hormone replacement therapy does have a beneficial effect on heart health, but which is counteracted by the negative effects of NSAIDs.

In a 2007 study carried out by researchers in Spain and the United States, researchers wanted to find out whether there was any evidence for an interaction between NSAID use, hormone replacement therapy, and heart disease. Such understanding in turn might help to identify more clearly whether hormone replacement therapy protects against heart disease in specific subgroups of postmenopausal women.

This study was carried out using information from the UK's General Practice Research Database, which is the largest computer database of anonymous medical records from primary care anywhere in the world. It contains information entered by UK general practitioners on their patients' drug prescriptions, diagnoses, referrals to hospital, and other data.

The researchers searched for all individuals from the database who were aged between 50 and 84 years on 1 January 1997, and then followed them up through the database for four years, or until the individual died, reached 85 years of age, or was diagnosed with a heart attack or cancer.
From this search, the researchers found 1,673 women who had heart attacks or who died from coronary heart disease; these were considered “cases.” Then, these 1,673 women were matched against 20,000 “control” women of similar age.

Information was pulled out for each case or control on their use of hormone replacement therapy, NSAIDs (covering 21 different drugs, but most commonly diclofenac, ibuprofen, and naproxen), and various risk factors for heart disease.

The researchers then compared the use of hormone replacement therapy and NSAIDs between the cases and controls, while making statistical adjustments for other risk factors (such as diabetes and smoking, for example).

The researchers found that current use of hormone replacement therapy was associated with a lower risk of heart attack than non-use. The odds ratio (chance of a heart attack among hormone replacement therapy users compared to the chance among non-users of hormone replacement therapy) was 0.78.

However, when looking at women who used NSAIDs at the same time as hormone replacement therapy, the researchers found no suggestion of a reduction in risk of heart attack: the odds ratio for the chance of heart attack among this group of women, as compared to nonusers of both NSAIDs and hormone replacement therapy, was 1.50.

The researchers findings suggest that hormone replacement therapy and NSAIDs might interact, with NSAIDs acting against a role for hormone replacement therapy in preventing heart attacks.

Citation: Editors' Summary: García Rodríguez LA, Egan K, FitzGerald GA (2007) Traditional Nonsteroidal Anti-Inflammatory Drugs and Postmenopausal Hormone Therapy: A Drug–Drug Interaction? PLoS Med 4(5): e157 doi:10.1371/journal.pmed.0040157. Copyright: © 2007 Rodríguez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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COPD Awareness and Neglect

2008-04-26T11:19:00.001+10:00

Chronic obstructive pulmonary disease (COPD) is a major and increasing global health epidemic that has received insufficient attention from the health-care profession, governments, and the pharmaceutical industry. Urgent action is now required to recognise COPD, predicted to soon become one of the major causes of death and disability, and to develop more effective prevention and treatment strategies in the management of COPD.

What Is COPD?

COPD is described by the Global Initiative for Chronic Obstructive Lung Disease as “a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases”.

This progressive and relentless loss of lung function is caused by emphysema due to destruction of lung parenchyma and by narrowing of small airways as a result of chronic inflammation and fibrosis and loss of elastic recoil. This results in progressive airflow limitation, air trapping, and progressive shortness of breath on exertion.

Despite growing recognition as an important international health problem, COPD has suffered neglect from clinicians, researchers, and the pharmaceutical industry. (Lancet 364: 564–565).

This is largely because COPD is viewed as self-inflicted (by smoking) and also because the underlying disease process is generally perceived to be irreversible. Consequently, there is a fundamental lack of knowledge about the cellular, molecular, and genetic causes of COPD.

Existing therapies for COPD are inadequate and none have been shown to slow the relentless progression of the disease.

In terms of research funding, COPD has been relatively neglected among common diseases, with little investment in research into its underlying cellular and molecular mechanisms.

COPD is now recognised to have the greatest socioeconomic inequality of any common disease. It is also suggested that there are environmental factors other than smoking contributing to the disease.

Indeed, over 10% of patients with a clinical diagnosis of COPD are non-smokers, and this proportion is much higher amongst women in developing countries such as India, where exposure to biomass fuels in an enclosed space is an important cause of COPD. (Proc Natl Acad Sci U S A 97: 13286–13293).

The epidemiological (population) studies of Fletcher and Peto demonstrated that death and disability from COPD were related to an accelerated decline in lung function with time, with a loss of 50–100 ml in forced expiratory volume in one second (FEV1) per year, compared to the normal loss of less than 30 ml per year.

Only about 10% of smokers were thought to develop COPD, suggesting that genetic or other environmental factors may play an important role in susceptibility. Apart from FEV1, exercise capacity, exacerbation frequency, and systemic features all indicate a poor prognosis. (N Eng J Med 350: 1005–1012).

A more recent epidemiological (population) study with a longer follow-up (25 years) suggests that over 25% of smokers may develop COPD, with no difference in susceptibility between men and women. (Thorax 61: 935–939).

The implication of this study is that the prevalence of COPD amongst smokers is likely to rise even more as people survive longer.

Smoking cessation strategies have a poor success rate, with the most effective approaches yielding a quit rate of only about 15%. (Lancet 357: 1571–1575).

In any case, stopping smoking as the disease becomes more severe has little impact on its progression. (Am J Respir Crit Care Med 161: 381–390).

Several studies have now shown that smoking cessation fails to reverse the chronic airway inflammation. (Eur Respir J 26: 835–845).

This stresses the need for more effective anti-smoking strategies, including new and more effective drugs for nicotine addiction, and earlier intervention.

Anti-inflammatory drugs, which are used so successfully to manage asthma, have few clear beneficial effects in COPD and there is a very poor response to corticosteroids due to an active resistance against the anti-inflammatory actions of steroids. (Chest 129: 151–155).

Bronchodilators, which are the mainstay of current drug therapy, do not significantly affect the underlying disease process and therefore do not slow disease progression towards respiratory failure and death.

Although progress has recently been made in understanding the molecular, cellular, and genetic mechanisms involved in COPD, far more research is required in this area. This may lead to a better understanding of the mechanisms for disease progression and to the development of effective therapies in the future.

It is clearly necessary to increase awareness of COPD amongst health-care professionals, the general public, and governments.

General practitioners must be educated about how to recognize COPD and institute the most appropriate therapy.

The Global Initiative for Chronic Obstructive Lung Disease plays an important role in raising awareness of COPD amongst health-care professionals and has formulated updated evidence-based guidelines for diagnosis, therapy, and prevention. (Global Initiative for Chronic Obstructive Lung Disease 2006).

Stopping smoking early is very important, particularly for those in the early stages of the disease, in whom smoking cessation has a clear benefit and reduces mortality. (Ann Intern Med 142: 233–239).

More research is needed into the underlying disease mechanisms, to identify the genetics of susceptibility and to identify new targets for treatment. It is increasingly recognised that there is heterogeneity in the disease and more careful phenotyping is required in the future to elucidate disease mechanisms and optimise novel therapies. This will require much more investment from funding bodies and governments.

The attitude that smoking-related lung diseases are self-induced and therefore less worthy of attention needs to be changed; this attitude does not appear to apply to the same extent to ischemic heart disease, diabetes, or obesity.

Non-smoking causes of COPD will require far more attention in the future and the genetic and environmental cofactors that interact with COPD need to be more carefully explored.

Far more research needs to be done in developing countries where non-smoking causes of COPD account for a much greater proportion of COPD than in developed countries.

The striking socioeconomic disparities in COPD prevalence implicate factors other than smoking, but these factors have so far largely been ignored.

In the UK, respiratory disease, which includes COPD, receives less funding in relation to the burden of disease than any other disease area.

COPD will undoubtedly place an increasing burden on health resources and this burden is likely to be particularly severe in developing countries.

Finally, COPD needs to be more prominently featured in peer-reviewed journals that address global health issues - as recently pointed out by the editors of this journal. (PLoS Med 3: e512).

The author of this paper, Peter J. Barnes, is with the Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.

Reference:
Extracted and adapted from: Barnes PJ (2007) Chronic Obstructive Pulmonary Disease: A Growing but Neglected Global Epidemic. PLoS Med 4(5): e112 doi:10.1371/journal.pmed.0040112. Copyright: © 2007 Peter J. Barnes. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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Coenzyme Q10: Exercise Duration Is Increased

2008-04-22T12:39:00.000+10:00

Coenzyme Q10 appears to increase the duration of exercise to exhaustion in healthy untrained and trained individuals.

Coenzyme Q10 is a vitamin like, fat-soluble substance existing in all cells. Coenzyme Q10 acts as an essential antioxidant and supports the regeneration of other antioxidants. Coenzyme Q10 has been used as a supplementary treatment for chronic diseases such as Chronic Heart Failure (CHF), muscular dystrophies, Parkinson's disease, cancer, and diabetes.

In Chronic Heart Failure patients, a disease characterized by lower than normal Coenzyme Q10 levels, Coenzyme Q10 supplementation has shown to improve stroke volume, ejection fraction and exercise capacity in several double-blind, placebo-controlled studies.

In athletes, Coenzyme Q10 deficiency may also be experienced as metabolic stress and free radical formation is elevated during times of intense training.

Several studies have found that Coenzyme Q10 supplementation (60–100 mg/day for 4–8 weeks) improves aerobic power, anaerobic threshold, exercise performance, and/or recovery after exercise in trained athletes and untrained individuals.

Other studies using similar dosages have found no ergogenic benefit on maximal or submaximal exercise capacity in untrained and trained individuals.

One possible explanation for these inconsistent findings is that the absorption of Coenzyme Q10 into the mitochondrial membrane (part of a cell containing enzymes responsible for producing energy) or non-deficit tissues is rather inefficient.

Coenzyme Q10 is a relatively large, hydrophobic molecule, therefore absorption of Coenzyme Q10 into tissues is often slow and limited. Formulations that could maximize Coenzyme Q10 absorption would not only improve its uptake into the blood plasma, but potentially improve its absorption into the skeletal muscle.

Recently, the bioavailability and absorptive properties of several Coenzyme Q10 preparations were examined (i.e., fast-melt tablet, effervescent tablet, soft gelatin liquid capsule, and a hard shell powdered capsule).

Results indicated that the fast-melt tablet and effervescent formulation provided a more rapid delivery of Coenzyme Q10 to the blood, while exhibiting similar pharmacokinetic properties (the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body) compared with the soft gel and hard capsule forms of Coenzyme Q10, suggesting that Coenzyme Q10 in a fast-melt or effervescent form may facilitate Coenzyme Q10 delivery and uptake to the muscle.

Researchers in the United States, reporting in the Journal of the International Society of Sports Nutrition, conducted a study to determine whether acute (single dose) and/or chronic (14-days) supplementation of Coenzyme Q10 would improve anaerobic and/or aerobic exercise performance by increasing blood plasma and muscle Coenzyme Q10 concentrations within trained and untrained individuals. (The above information is extracted from the same study).

The results of their study demonstrated that a fast-melt form of Coenzyme Q10 is a safe and effective supplement that prolongs exercise performance in healthy individuals. Further, acute Coenzyme Q10 supplementation increased total Coenzyme Q10 concentration within the skeletal muscle and lowered blood plasma oxidative stress during and following exercise.

Studies that have reported improvements in aerobic power, anaerobic threshold, and/or recovery following Coenzyme Q10 supplementation have not generally been published in peer-reviewed journals.

The authors of this study stated that, to their knowledge, this is the first study to demonstrate both improvements in exercise performance and increased muscle Coenzyme Q10 concentration in healthy trained and untrained humans following Coenzyme Q10 supplementation.

This study showed a strong trend for increased time to exhaustion following Coenzyme Q10 supplementation. Additionally, acute Coenzyme Q10 supplementation tended to increase Coenzyme Q10 levels within the muscle, albeit not significantly.

Though no significant changes were observed following chronic supplementation, it is evident that muscle Coenzyme Q10 concentration was generally higher at the end of the study, compared to the start of the study, in the Coenzyme Q10-supplemented group compared to the placebo group.

In fact, muscle Coenzyme Q10 levels declined in the placebo group over the 2-week period.

The findings indicate that ingestion of a fast-melt form of Coenzyme Q10 will increase blood plasma availability of Coenzyme Q10 and may also influence muscle concentrations on an acute and/or chronic basis.

The authors concluded that their study demonstrated that a fast-melt Coenzyme Q10 formulation appears to be a safe dietary supplement that tended to increase the duration of exercise to exhaustion in healthy untrained and trained individuals.

Reference:
Extracted and adapted from: Matthew Cooke, Mike Iosia, Thomas Buford, Brian Shelmadine, Geoffrey Hudson, Chad Kerksick, Christopher Rasmussen, Mike Greenwood, Brian Leutholtz, Darryn Willoughby and Richard Kreider. Effects of acute and 14-day coenzyme Q10 supplementation on exercise performance in both trained and untrained individuals. Journal of the International Society of Sports Nutrition 2008, 5:8. © 2008 Cooke et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).

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Homocysteine Levels: What Lowers Homocysteine Levels Effectively and Safely?

2008-04-20T10:23:00.002+10:00

In people who have dramatically elevated levels of homocysteine, different food supplements have been shown to bring down homocysteine levels and to reduce the risk of heart disease and strokes.

A link between high levels of homocysteine, a sulfur-containing amino acid, and heart disease was first suggested in the 1960s, when it became clear that patients with inborn errors of homocysteine metabolism were prone to develop severe cardiovascular disease in their teens and twenties.

Treatment with homocysteine-lowering substances such as folate, vitamin B12, vitamin B6 and betaine reduces the incidence of heart attacks and strokes in these patients.

Homocysteine is an amino acid in the blood (amino acids are the building blocks of proteins). Too much homocysteine in the blood is related to a higher risk of stroke and heart disease. Mildly elevated levels (which are quite common) might promote atherosclerosis (furring up of the arteries), but this link has not been proven yet. Studies are currently under way to test whether reducing homocysteine levels in people who have mildly elevated levels could prevent heart disease or stroke.

Several studies have found higher homocysteine levels in patients with coronary, peripheral, and cerebral vascular disease, particularly in those with vascular disease (vessels of the body, especially the arteries and veins) not readily explained by conventional risk factors such as high low-density lipoprotein (LDL) cholesterol, diabetes, or smoking.

Several studies then sought to determine whether elevated homocysteine levels were a cause or effect of cardiovascular disease, and evidence for a causal relationship is accumulating.

A study conducted in the Netherlands looked at the effects of betaine, folic acid, and phosphatidylcholine on blood lipids (fats) in healthy people. The researchers wanted to study blood lipids (fats), especially “bad” cholesterol (LDL cholesterol), because they are known to influence the risk of heart disease.

“We are keenly awaiting the results from several ongoing trials. In the meantime, our group is trying to determine the risks and benefits associated with different homocysteine-lowering nutrients,” said Margreet Olthof.

She and her colleagues at the Wageningen Centre for Food Science analysed four independent, placebo-controlled, randomized intervention studies that examined the effects of betaine, folic acid, and phosphatidylcholine on blood plasma homocysteine concentrations in healthy volunteers.

They analysed the blood samples (which had previously been used to measure homocysteine) for lipid levels (fats such as cholesterol and triglycerides) from the individual studies and compared changes in blood lipid concentrations between individuals taking homocysteine-lowering nutrients and those taking placebo.

The researchers found that betaine increased the level of “bad” cholesterol. Folic acid did not affect lipid (fat) levels. The data for phosphatidylcholine were not conclusive.

This suggests that the beneficial effects of betaine (which lowers homocysteine) might be undone at least in part by its negative effects on blood lipids.

Based on these results, folic acid would be a better choice for people who want to lower their homocysteine levels, since folic acid doesn't cause a rise in “bad” cholesterol.

References:
Olthof MR, van Vliet T, Verhoef P, Zock PL, Katan MB (2005) Effect of Homocysteine-Lowering Nutrients on Blood Lipids: Results from Four Randomised, Placebo-Controlled Studies in Healthy Humans. PLoS Med 2(5): e135 doi:10.1371/journal.pmed.. Copyright: © 2005 Olthof et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

(2005) Comparison of Homocysteine-Lowering Drugs. PLoS Med 2(5): e145 doi:10.1371/journal.pmed..

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Heart Health and Healthy Eating Habits

2008-04-18T11:28:00.001+10:00

The health consequences of eating one large meal a day compared with eating three meals a day has not been established. Now two recently published journal articles are among the first to report the effects of meal skipping on key health outcomes, based on a study involving a group of normal-weight, middle-aged adults.

For the study, a small group of male and female volunteers participated in two eight-week meal-treatment periods.

The study's crossover design meant that each volunteer completed both of the treatment diets, enabling them to serve as their own controls.

Volunteers were divided into one of two groups during each treatment period.

They consumed either all of their required weight-maintenance calories in one meal a day or in three meals a day.

Agricultural Research Service physiologists David Baer and William Rumpler and National Institute on Aging neuroscientist Mark Mattson designed the study.

The first study analysis showed that consuming a one-meal-per-day diet, rather than a traditional three-meal-per-day diet, is feasible for a short duration. It showed that when the volunteers were "one-mealers," they had significant increases in total cholesterol, LDL "bad" cholesterol and in blood pressure, compared to when they were "three-mealers."

The changes in cardiovascular disease risk factors occurred despite the fact that the one- mealers saw slight decreases in their weight and fat mass in comparison to when they were three-mealers.

Those findings were published in the April 2007 issue of the American Journal of Clinical Nutrition.

Further analysis of the study group showed that when the volunteers were one-mealers, they had higher morning fasting blood sugar levels, higher and more sustained elevations in blood sugar concentrations, and a delayed response to the body's insulin, compared to when they were "three-mealers."

Insulin is required to lower blood sugar levels.

Those findings were published in the December 2007 issue of Metabolism.

Reference:
Rosalie Marion Bliss, U.S. Department of Agriculture, Agricultural Research Service February 15, 2008.

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Dealing With Depression During Pregnancy – Part 6

2008-04-15T12:19:00.000+10:00

Whether or not to take antidepressants drugs was a difficult decision.

Stage 2. Gaining knowledge.

Hearing the diagnosis.
Receiving a definitive diagnosis, while difficult for some women, created a sense of relief and hope, and was a turning point for the women: it signified an identifiable, manageable disorder, justified and explained how they were feeling, and created a sense of relief, comfort, and hope upon hearing that they were “not the only one” to feel this way.

Many of the women had knowledge of postpartum depression, but few knew that depression could occur during pregnancy. One woman summed up this turning point as follows:

So, it's sort of almost a relief to find out that you are not the only
one, and there are actually reasons behind it. (#20) (Note: As mentioned in Part 1, confidentiality was maintained by assigning each participant a code number).

Although many of the women were embarrassed and ashamed, they were not surprised to be diagnosed with depression; it confirmed what they “already knew”. This was expressed by one participant as:

It was one of those things that you kind of know, but you don't
really admit it to anyone, even to yourself. (#19)

Seeking information
The question that was paramount to the women was whether or not to take antidepressants. The experiences of women varied considerably in their quest for information. Some found their family physician helpful:

But, he [family physician] was very open, probably because I
came with some informed sort of knowledge already, but he was
very willing, he did research on it as well, and he brought a
couple of studies to my attention. (#7)

Others reported that their family doctor "wasn’t really equipped to deal with the question” of antidepressant use. However, all women received information about depression and its management from the psychiatrist which was “really helpful”, and which many found sufficient.

She told me everything, and she also told me I could call
Motherisk and ask them. I didn’t call them, because I
thought about it, and her information was good. (#21)

Motherisk is a teratogen information counseling service based in Toronto, Canada. This program offers women who are pregnant, planning, or breastfeeding, a phone-in help service to answers questions about the risk or safety of medication use.

Others “wanted to check it out” for themselves and actively engaged in obtaining information via the Internet. One woman described her search for information as follows:

I started off with Motherisk and then medical journals online and
abstracts. I've definitely read stuff like on Safe Parent Web Site,
or Baby Centre Web Site. I tend to not trust them as much….. I
don't go into the whole journals, but usually just reading the
abstracts is enough to get a summary. (#7)

Stage 3. Taking control

The process of taking control, which is grounded in the personal and social context of the women’s lives, has three interrelated properties, making a plan, assessing progress, and balancing the risks. It is important to note that the properties making a plan, assessing progress and balancing the risks are not unidirectional, that is, the information flow and subsequent actions, may occur in either direction. As the depressive symptoms change over time, the assessment is updated, and the plan is reformulated. Nevertheless, the overall process is cyclical and moves in a clockwise direction. This is signified in the text and in Figure 1 by preceding the first word of each property with (Re).

(Re)Making a plan
Women spoke of “making a plan” in collaboration with their psychiatrist for managing their depression. Making a plan was informed by the women’s recently acquired knowledge, pragmatic knowledge, and their own and their husband’s values and beliefs about medication use. All women actively participated in, and took responsibility for, the management decision.

Although influenced by their husband’s concerns and beliefs, none of the women relinquished control of the management decisions to their husband. The act of doing so afforded the women a sense of regaining control over themselves and their lives and gave hope when they had been without hope.

It was comforting, and prepared me to say okay, how far am I
willing to go, not only medication, but therapy wise. I think that
set me in motion to say I am taking control over my moods, my
disorder. (#16)

Re(Assessing) progress
Assessments of the women’s mood were formally undertaken by the psychiatrist, and informally by the women themselves. If a woman’s mood worsened, or if she saw herself as “stagnating”, the plan was modified.

Changes included increased frequency of counseling sessions, incorporation of antidepressants in a management strategy that had been free of antidepressants, or, for those already taking antidepressants, an increase in dose.

She was doing that test, the EPDS. She would check the score each
time. It was very high in the beginning, and then slowly when I
started taking the medication, it became low. (#21)

(Re)Balancing the risks
In order to determine an acceptable management plan the majority of women undertook a risk assessment of the available management options. Accepting psychotherapy or counseling was not problematic for any of the women. However, for many women, whether or not to take antidepressants was a difficult and multifaceted decision. The women lamented the fact that there were no “black and white” answers, and struggled with what they perceived to be a complex decision.

The women considered: the risk of untreated depression to the fetus and to themselves; the likelihood of developing postpartum depression (PPD) and the associated risk to the baby, themselves and their family; and the potential risks to the baby of antidepressant use during pregnancy.

One woman articulated her concerns as follows:

You want to put the baby first, but, at the same time, you’re just
balancing out what is the risk to the baby of having a mom who is on
Prozac versus what is the risk to the baby of having a mom who is,
really can’t cope and is falling apart. I kind of got to the point where
I was like, well, I can only do the best I can as a mom. (#7)

Women tried to decrease the perceived risk to the fetus by taking as low an antidepressant dose as possible. For example, “I was kind of just teetering on, like I was trying to take the lowest dosage possible to treat my symptoms.” (#18).

Part 7 will be published soon - Consequences of Becoming the best mom that I can – Regrounding self and regaining control.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Reference:
Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).

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Foods High in Antioxidants

2008-04-13T14:38:00.001+10:00

We’ve all read about the foods high in antioxidants but few studies have been aimed at investigating how well our bodies use these antioxidant-rich foods, and whether or not their ORAC (oxygen radical absorbance capacity) scores really translate into practical, disease-fighting capabilities in humans.

The ORAC method, which was developed and refined by ARS scientists, measures the capacity of a food to mop up the destructive free radicals that are generated when we engage in such everyday activities as eating, breathing, and exercising. Our bodies also stir up these unstable molecules when we’re battling a cold or a disease - or are exposed to pollution, cigarette smoke, or the sun’s ultraviolet rays.

So, to combat such oxidative assaults, is it enough to just feast on foods that researchers tell us are high in antioxidants?
Not necessarily. According to Ronald Prior, a chemist at USDA’s Arkansas Children’s Nutrition Center in Little Rock, to be clear about which foods offer the best antioxidant delivery system, we need a better understanding of how our bodies absorb and metabolize the many phytochemicals found in richly colored fruits and veggies.

“These plant compounds really vary in their bioavailability and may influence our bodies’ biological processes in many different ways,” he says.

And while several studies have linked the increased consumption of fruits and vegetables to a lower incidence of cancer and other diseases, Prior says that scientists haven’t really been able to pinpoint which components in foods are responsible for the beneficial effects.

To learn more, Prior and colleagues recently investigated how various fruits, all known for their impressive antioxidant content, affected the blood antioxidant levels of volunteers.

Collaborators included researchers at the USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts; the USDA Western Human Nutrition Research Center in Davis, California; and the University of Maine in Orono.

Volunteers were asked to eat varying amounts of the fruits, which included Bing cherries, dried plums, kiwifruit, red grapes, strawberries, and wild blueberries. Most of the servings were relatively large.

For instance, volunteers in the cherry study popped down 45 of the small fruits; those enlisted in the kiwi study ate 4 entire fruits. Then, using the ORAC method, Prior and colleagues analyzed each volunteer’s blood levels for the fruit’s antioxidant capacity.

The grapes, kiwifruit, and wild blueberries were the best performers, according to Prior, whose findings were reported in the April 2007 issue of the Journal of the American College of Nutrition.

Wild blueberries are certainly one of the most-heralded antioxidant-rich fruits. But the study revealed that a larger serving of the berries - at least a half-cup to more than one cup - was needed to register a real spike in volunteers’ blood antioxidant levels. A so-called high dose, equalling one and one-third cups of the berries, triggered the most significant leap.

“The predominant phytochemicals in blueberries are anthocyanins, which aren’t readily absorbed or perhaps are unstable in the body and are degraded in the gastrointestinal tract before they are absorbed,” says Prior. But there’s still more to learn about the digestibility of this important class of compounds, he notes, since at least 27 different anthocyanins are found in wild blueberries.

Kiwifruit also drove up volunteers’ blood antioxidant capacity. “But we’re not really sure which compounds were responsible,” says Prior. “At least part of the increase can be attributed to the high vitamin C content of kiwis. That goes for strawberries as well.”

Plums, on the other hand, were a bit of a disappointment. Despite their inherently high levels of an antioxidant called “chlorogenic acid,” they didn’t induce an uptick in volunteers’ antioxidant levels. That’s because the pure form of chlorogenic acid isn’t readily absorbed by the human body.

The study yielded a few surprises, including the finding that blueberries and cherries increased volunteers’ lipophilic, or fat-soluble, antioxidant capacity. “We didn’t expect that,” says Prior, “since fruits and berries don’t contain a large amount of lipophilic antioxidants.”

Eating Is Stressful - Antioxidants Can Help

Making wise food choices is hard enough work. But who knew that the mere act of eating can leave our bodies’ cells battered and beleaguered?

In the process of breaking down and metabolizing food, our bodies generate a lot of free radicals. “And without any antioxidants present, like those from colorful fruits and vegetables, for instance, there’s nothing to counteract this detrimental effect,” says Prior.

Antioxidants can almost be viewed as an antidote to the body’s problematic, not-100-percent-effective, energy-processing system.

This cause-and-effect relationship between consumption of foods lacking in antioxidants and decrease in antioxidant blood levels was backed up by the study ARS conducted.

In it, volunteers who drank a shake containing carbohydrates, protein, and fat, but no antioxidants, produced blood samples with a reduced ability to counter noxious free radicals.

“We’re learning that antioxidants should be consumed with every meal,” says Prior. “And if you routinely skip antioxidants in your diet, over time, the excess number of free radicals being produced may begin damaging cellular components, ultimately leading to atherosclerosis, cancer, and other diseases.”

Eventually, Prior would like to make preliminary projections of antioxidant needs based on a person’s energy intake or calorie consumption. Of course, other factors - such as age, health, and environmental exposures to damaging oxidants - all influence an individual’s bodily antioxidant status.

In the meantime, most Americans can do their bodies good by eating the recommended amount of fruits and veggies every day.

Reference:Erin K. Peabody (formerly with ARS), U.S. Department of Agriculture, Agricultural Research Service. Photo courtesy ARS, USDA.

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Foods That Lower Cholesterol, Triglycerides and Prevent Cancer - Muscadine Grapes

2008-04-10T09:16:00.000+10:00

Muscadine grapes are a natural food source for lowering both total cholesterol and LDL (bad) cholesterol levels, blood pressure, triglycerides and also protects against coronary heart disease, gastrointestinal diseases, and colon cancer.

Research conducted by ARS horticulturist James B. Magee and Mississippi State nutritionist Betty J. Ector predicts that the muscadine will not only be an alternative crop for growers in the Southeast, but a new health food as well.

Magee and Ector have found significant amounts of resveratrol the compound in French red and white wines that is being touted as an agent for lowering cholesterol levels and the risk of coronary heart disease - in the skin, pulp, and seeds of these grapes.

In a study reported January 1997 in Science, researchers at the University of Illinois at Chicago purified resveratrol from grape sources and showed it to have anticarcinogenic activity, meaning that it inhibits tumor promotion.

Muscadines also contain ellagic acid, a natural organic compound thought to inhibit the start of cancer caused by certain chemicals.

Muscadines are now marketed as juice, jellies, jams, preserves, syrups, and dessert toppings.
In processing muscadines, about 900 to 1,000 pounds of waste come from each ton.

Muscadines have tough, thick skins and yield less juice than other grapes, leaving the skin, pulp, and seeds as waste, or pomace. Some of this is used as fertilizer and livestock feed. But most remains to be disposed of in an environmentally acceptable way.

Betty J. Ector has big plans for the muscadine. In research jointly funded by USDA, the Mississippi State University nutritionist found that a puree of muscadine skins and pulp is an excellent source of resveratrol, dietary fiber, and some essential minerals and is high in carbohydrates and low in fat and protein.

"We found that powdered muscadine puree has more dietary fiber than oat or rice bran," Ector says. "And we know that high fiber consumption lowers blood pressure, serum triglycerides, and both total and LDL (bad) cholesterol levels.

It also protects against coronary heart disease, gastrointestinal diseases, and colon cancer.

Soluble fiber has extra benefits for diabetics by delaying glucose absorption and increasing the sensitivity of skeletal muscles to insulin."

In a study at Mississippi State University in which rats were fed diets containing three levels of powdered muscadine pomace puree, Ector found that those eating the muscadine showed significantly lower LDL cholesterol levels and higher HDL (good) levels than a control group.

Statistics show that French consumers drink a lot of wine and eat a lot of dietary fat, yet have low incidence of coronary heart disease. Researchers say that resveratrol in red wine probably accounts for this.

Resveratrol is a phytochemical in grapes and other plants that helps protect them from attack by pests or diseases.

"If you don't drink wine, try some jam or a muffin made from muscadines," says Ector. "They're an even better source of resveratrol.

One-half serving (2 fluid ounces) of unfiltered muscadine juice, one serving of muscadine jam, one medium muffin, or one-tenth serving of muscadine sauce contains about the same amount of resveratrol as 4 fluid ounces of red wine.

"We're also trying it as additive to beef patties containing 15 to 20 percent fat," Ector reports. "Eating foods made with muscadine products is a good way to get a significant amount of resveratrol in the average diet. And they taste great!"

Reference:
Doris Stanley, USDA, Agricultural Research Service. Photo courtesy UDSA, ARS.

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Natural Remedies for ADHD Children - Zinc

2008-04-08T13:23:00.001+10:00

Most notable among ADHD studies are the ones particularly examining the relation between zinc and ADHD. Indeed, zinc is basic for the production and modulation of melatonin, which helps regulate dopamine function, supposed to be an important factor in ADHD and its treatment.

Therefore, ADHD children with zinc deficiency might benefit from a change in diet or from a therapeutic trial with zinc supplementation.

The present study shows the Parent and Teacher Rating Scale scores improved with zinc sulfate over this 6-week, double blind and placebo controlled trial. The efficacy of zinc sulfate to obtain a better improvement in children with ADHD seems to support the role of zinc deficiency in the etiopathogenesis [the cause and development] of ADHD.

The present study is in line with the recent trial that suggests a beneficial effect of zinc sulfate in the treatment of ADHD. (BMC Psychiatry 2004, 4:9).

…this group, least expected to have marginal zinc deficiency and with a nutritionally adequate diet by the Food Frequency Questionnaire, showed an involvement of zinc levels in ADHD symptoms. The data reported here suggest that zinc nutrition is involved in symptoms of inattention and, therefore, improving zinc nutritional status might improve inattentive symptoms. (J Child Adolesc Psychopharmacol. 2005 Aug;15(4):628-36).

Zinc supplements may exert their positive effects by helping to regulate the function of the neurotransmitter dopamine.

…a dopamine deficiency may underlie ADHD. Nora Volkow, M.D., a psychiatrist with Brookhaven National Laboratory in Upton, N.Y., and her colleagues found that intravenous injections of the drug most often prescribed to treat ADHD - methylphenidate (Ritalin) - increased dopamine levels in the brain. This result suggests that methylphenidate counters ADHD by increasing brain levels of dopamine. (Psychiatric News 16/3/2001 Volume 36 Number 6).

In a study led by scientists with USDA’s Agricultural Research Service, daily zinc supplements helped Chinese schoolchildren with very low body zinc levels to score better in perception, memory, reasoning and psychomotor skills such as eye-hand coordination.

Findings of the study with 372 Chinese schoolchildren - conducted in three poor, urban areas of China - support previous adult studies and have important implications for countries where low zinc intakes are common. They could also apply to the 10 percent of U.S. grade-school-age girls and 6 percent of boys who get less than half the Recommended Dietary Allowance of zinc through their diets. The RDA for this age group is 10 milligrams daily.

The Chinese children, age 6 to 9 years, were divided into three groups. One group took a 20-milligram zinc supplement daily for 10 weeks. A second group took the zinc supplement plus a micronutrient supplement containing all essential vitamins and minerals, except for zinc and four other minerals known to interfere with its absorption. A control group got only the micronutrients to alleviate any other deficiency that could affect performance on the psychological tests.

Before and after the supplement period, each child took a series of computer-administered tasks developed by the ARS psychologist. The tasks measured attention, perception, memory, reasoning and motor and spatial skills necessary for successful school performance.

The children who got the zinc supplement or zinc plus the micronutrients had the most improved performance, especially in perception, memory and reasoning skills.

In addition to peanuts, popcorn and whole wheat products, the most common source of zinc is red meat. Oysters are the richest source. (Judy McBride, USDA’s Agricultural Research Service).

References:

Shahin Akhondzadeh, Mohammad-Reza Mohammadi and Mojgan Khademi. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: A double blind and randomized trial [ISRCTN64132371]. BMC Psychiatry 2004, 4:9doi:10.1186/1471-244X-4-9. © 2004 Akhondzadeh et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. http://www.biomedcentral.com/1471-244X/4/9

Judy McBride, USDA’s Agricultural Research Service.

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A Natural Remedy for Depression - Alleviating Sleep Apnea?

2008-04-06T09:31:00.000+10:00

Could correcting sleep apnea remedy depression? Studies link sleep apnea and depression, therefore the correction of sleep apnea may be a remedy for depression. For more than twenty years studies have suggested the existence of a relationship between depression and obstructive sleep apnea in the general population.

A researcher at Stanford University found that in the general population of the United Kingdom, Germany, Italy, Portugal, and Spain about 800 of 100,000 individuals have both a breathing-related sleep disorder and a major depressive disorder with nearly 20% of the subjects who had one of these disorders also having the other. (J Clin Psychiatry 2003, 64:1195-200; quiz, 1274-6).

In clinical practice, the presence of depressive symptoms is often considered in patients with obstructive sleep apnea although sleep problems and specifically obstructive sleep apnea are rarely assessed on a regular basis in patients with a depressive disorder.

It is speculated that obstructive sleep apnea might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to pharmacological treatment and that undiagnosed obstructive sleep apnea might be exacerbated by antidepressant medications, such as benzodiazepines.

Although the benzodiazepines (central nervous system depressant drugs) may reduce sleep fragmentation, their long-term use may also cause health problems, such as complete obstructive sleep apnea in heavy snorers…(Am J Med. 1990 Mar 2;88(3A):25S-28S).

Obstructive sleep apnea is the most common form of sleep disordered breathing and is defined by frequent episodes of obstructed breathing during sleep. It is characterized by sleep-related decreases or pauses in respiration.

The prevalence of obstructive sleep apnea is higher in men than in women and is found in all age groups but its prevalence increases with age. In children, the prevalence of obstructive sleep apnea is less well known and has been estimated to be between 2-8%.

The estimated prevalence of sleep-disordered breathing in people between the ages of 30 to 60 years old was 9 percent for women and 24 percent for men. Male sex and obesity were strongly associated with the presence of sleep-disordered breathing. (N Engl J Med. 1993 Apr 29;328(17):1230-5).

Abnormal respiratory events are the hallmark of obstructive sleep apnea and are generally accompanied by heart rate variability and arousals from sleep, with frequent arousals being the most important factor resulting in excessive daytime sleepiness.

The extent to which daytime functioning is affected generally depends on the severity of obstructive sleep apnea. Symptoms other than excessive daytime sleepiness which greatly impact daytime functioning are neuropsychological symptoms such as irritability, difficulty concentrating, cognitive impairment, depressive symptoms, and other psychological disturbances. Therefore obstructive sleep apnea can easily mimic symptoms of a major depressive episode.

In 1997 researchers studied the relation between obstructive sleep apnea and depression and reported that 24% of 25 male patients with obstructive sleep apnea had previously seen a psychiatrist for anxiety or depression. (Arch Intern Med. 1977 Mar;137(3):296-300).

In 1989 researchers at the University of California Irvine Medical Center, found 67% of patients who presented to a major sleep disorders center reported an episode of depression within the previous 5 years, and 26% described themselves as depressed at presentation. (J Clin Psychol. 1989 Jan;45(1):51-60).

Of 50 patients who had severe obstructive sleep apnea most patients showed cognitive impairment; 76% had suspected or mild to severe deficits in terms of thinking, perception, memory, communication, or the ability to learn new information, resulting in a greater potential for being distractible, confused, and irritable. (J Chronic Dis. 1985;38(5):427-34).

In 1992 researchers in Spain found elevations in several depression scores in 23 obstructive sleep apnea patients (moderate to high severity) compared to 17 controls. Depression, schizophrenia, and hypochondriasis [chronic and abnormal anxiety about imaginary symptoms and ailments] were the highest scales. (Int J Neurosci. 1992 Feb;62(3-4):173-95).

Compared to patients who snore but do not have apnea, those with obstructive sleep apnea have more intense depressive symptoms (e.g., pessimism, inactivity, guilt) and somatic [physical] concerns. However, patients who snore but do not have apnea show psychological maladjustment that is in quality similar, but in quantity less severe, than those with obstructive sleep apnea. (Sleep. 1999 May 1;22(3):355-9).

Contradictory Research with Due to Limitations:

Researchers at the University of Kentucky, Department of Medicine, conducted a 5-year study of 95 normal older persons and did not find any significant depressive symptoms in elderly patients with a relatively mild obstructive sleep apnea, when compared to a control group without obstructive sleep apnea. (Chest. 1996 Sep;110(3):654-8).

However, there are multiple limitations to this study, besides a relatively small sample size for group comparisons and a non-representative study population.

Obstructive sleep apnea was only assessed at the start of the study, but not repeated at the five-year follow-up, i.e. neuropsychological data were compared between two groups based on obstructive sleep apnea status five years earlier.

Second, obstructive sleep apnea severity was mild even in the obstructive sleep apnea group.

Third, the groups differed significantly by age, with the obstructive sleep apnea group being older than the control group.

Finally, the drop out rate over the five years was very high with only 42 out of the initial 95 subjects completing the follow-up assessment. (Annals of General Psychiatry 2005, 4:13).

In 1998 researchers in Israel conducted a study comprising 2,271 patients (1,977 men, 294 women) with suspected Sleep Apnea Syndrome. They did not observe any association between respiratory disturbances and Symptom Check List 90 psychiatric questionnaire. (Chest. 1998 Sep;114(3):697-703).

However, the SCL-90 psychiatric questionnaire was developed as a screening tool for psychiatric patients, and not for a normal study population. Therefore, it might be a less sensitive tool with regards to milder forms of mood disturbances than other scales. (Annals of General Psychiatry 2005, 4:13).

However, the researchers in the abovementioned study did observe that among the minority of women in the study, those with severe obstructive sleep apnea had higher depression scores than those with mild obstructive sleep apnea. (Chest. 1998 Sep;114(3):697-703).

Fewer studies have focused on the screening for obstructive sleep apnea in primarily depressed study groups.

Sleep apnea was found in 42.9% of demented patients, 17.6% of depressives, and 4.3% of controls. A significant association between sleep apnea and dementia of the Alzheimer type was found in women but not in men. Moreover, severity of dementia was significantly correlated with apnea index. (J Clin Psychiatry. 1985 Jul;46(7):257-61).

All of the above suggests that obstructive sleep apnea might be an important confounding factor for studies on mood disorders in general, as its presence is not routinely determined in either research studies examining mood or clinical settings.

More studies are required to assess the prevalence of obstructive sleep apnea in primarily depressed patients, particularly as it can be suspected from existing studies that obstructive sleep apnea is greatly under diagnosed in depressed patients.

Reference: Adapted from: Schröder CM, O'Hara R. Depression and Obstructive Sleep Apnea (OSA). Annals of General Psychiatry 2005, 4:13 (27 June 2005). Review. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).

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Do Leptin Supplements Help Burn More Calories?

2008-04-04T08:49:00.001+10:00

Leptin has become a hot area for obesity research since the discovery of a mutation in the mouse leptin gene that increases the animals' appetite while lowering their metabolic rate.

New findings, however, dampen the prospect that this hormone-like signal may explain differences in body fat among people.

The research was done at the Human Nutrition Research Center on Aging at Tufts, Boston. The center is funded by the Agricultural Research Service, USDA’s chief scientific agency.

The researchers found no relationship between the amount of leptin circulating in the blood of 61 men and women and the total number of calories they burned each day or their metabolic rate while resting or after eating.

The study volunteers ranged in age from 18 to 81, and none were obese.

The researchers concluded in the September issue of Obesity Research that leptin doesn't influence energy regulation in adults by increasing their energy expenditure.

In a study by others, young children with higher leptin levels reportedly burned more calories during physical activity. But the recent study indicates adults apparently lose their responsiveness to this signal.

Maintaining a stable body weight is a matter of burning as many calories as we consume.

In people whose weight control mechanism is working properly, the body's metabolic rate automatically revs up after periods of overeating and slows down after periods of undereating to maintain this balance.

Similarly, appetite automatically adjusts by decreasing or increasing. This process of energy regulation is controlled by a sequence of metabolic signals. But the details of that sequence are still sketchy.

To better understand leptin's role, Susan B. Roberts, who heads energy metabolism studies at the Boston center, and her colleagues examined how leptin might affect metabolic rate in adults.

Because leptin is produced by fat cells, the volunteers who had more body fat also had higher blood leptin levels. But that didn't prompt them to burn more calories.

Reference:
Agricultural Research Service, USDA’s chief scientific agency.

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Facts about Chocolate & Antioxidants & Cocoa

2008-04-03T08:44:00.000+10:00

Cocoa powder contains more beneficial antioxidants than other chocolate products, but processing decreases their contents.

Those are the results of a study by Agricultural Research Service (ARS) scientists and their cooperators interested in the total antioxidant capacity and procyanidin levels of six chocolate and cocoa products: natural (unsweetened) cocoa powders, Dutch processed (alkalinized) cocoa powders, unsweetened baking chocolates, semi-sweet chocolate baking chips, dark chocolates, and milk chocolates.

Chocolate and cocoa powder are derived from beans that contain hefty quantities of natural antioxidants called flavonoids.

The researchers found natural cocoa contains the highest capacity of the antioxidant procyanidin. Antioxidants are thought to be effective in helping to prevent cancer, heart disease, and stroke.

Ronald L. Prior, an ARS nutritionist at the Arkansas Children's Nutrition Center (ACNC) in Little Rock, Ark., presented the study's results in San Diego, Calif., today with Liwei Gu and Xianli Wu of ACNC and Jim Harnly, a chemist at the ARS Beltsville (Md.) Human Nutrition Research Center. They presented the findings at Experimental Biology 2005, an annual meeting that brings together 16,000 biological and biomedical scientists from dozens of different disciplines.

The researchers found natural cocoa powders contained the highest levels of total antioxidant capacity and procyanidins, which were found to be the dominant antioxidant in chocolates.

Milk chocolates, which contain the least amount of cocoa solids, had the lowest total antioxidant capacity and procyanidin levels.

Baking chocolates contained fewer procyanidins, because they contained more fat (50-60 percent) than natural cocoa.

Alkalinization, used to reduce the acidity and raise the pH of cocoa, such as Dutch chocolates, was found to markedly reduce procyanidin content.

Researchers concluded that chocolates containing higher amounts of cocoa ingredients have higher procyanidin contents, therefore, higher antioxidant capacities.

Nine major manufacturers provided commercially available chocolate and cocoa samples and the National Institute of Standards and Technology provided its Standard Reference chocolate for analysis. The study was partially funded by a grant from the American Cocoa Research Institute.

Source: Jim Core, U.S. Department of Agriculture, Agricultural Research Service. Photo courtesy USDA, ARS. Used with permission.

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Dealing With Stress at Work

2008-04-01T11:02:00.002+10:00

K-State professors offer tips on de-stressing your workspace. Believe it or not, some stress at work is good for you. A certain amount of stress can make you more productive on the job. Too much stress can have detrimental effects on your output and, ultimately, your health.

"Work in itself is stressful enough," said Michael Bradshaw, associate professor in the School of Family Studies and Human Services at Kansas State University. "Some stress is helpful, but those external stresses that maybe aren't related to our work can put us in a state where we are less productive. We can just wear down."

You could do more than wear down. Bradshaw said a stress-filled workplace could cause depression, burnout, ulcers and fatigue.

There is a fine line between healthy stress and harmful stress. To guard against too much stress, workers should be aware there are different ways they can de-stress their workspace.

To ensure a healthy work environment, workers must learn how to handle the distractions that can keep them from doing their job and know how to maximize their workspace potential.

Cindy Mohr, assistant professor of clothing, textiles and interior design at K-State, said there are various ways design comes into play to reduce stress at work. What color a workspace is, the type of artificial light used and the flexibility of office furniture all play a part in making up a good work environment.

From a design aspect, she said, soft or neutral colors should be used inside work stations as opposed to bright colors.

"You want to make a workspace pleasing, but you don't want to inhibit your workers from working," Mohr said.

Artificial light is another important aspect. For years, she said, the consensus was to light all corners of the office, something that is not always necessary. Today designers use more and more task lighting - lights used for one specific purpose, such as lighting a desk.

Mohr said one of the biggest improvements came about in the 1970s and 1980s with the introduction of systems furniture. Commercial designers have replaced the traditional work desk with workspaces that are more flexible for companies and their workers.

Office chairs and desks now come with adjustable work surfaces. This is due in part to the emergence in recent years of repetitive stress injuries.

"Systems furniture has the flexibility to work with employees, not against them," she said.

Not all of the changes have to deal with design. Sometimes things can be done by the individual to help relieve some of the stress in a workspace. Bradshaw said there are several ways an individual can make a job easier to handle.

"We can't always do something about the workload, but we can control some of the time wasters or those things that distract us and keep us from getting our job done," he said.

The telephone, mail and co-workers are all potential time wasters, Bradshaw said. The key is to learn how not to get bogged down with the trivial things that might hinder job performance.

He suggests distancing yourself from anything that could distract you while working. If you have a report due, go to a quite out-of-the-way place so you can concentrate on the report and not have to deal with a ringing telephone.

Bradshaw said workers need to be careful about stress because the body's response to stress is subtle. Often people are not aware of the seriousness of a stress-filled workspace until it is too late.

Hormone Therapy for Menopause - Increased Risk of Breast Cancer

2008-03-31T12:54:00.001+10:00

Women who take combination (estrogen plus progestin) hormone therapy for menopause continue to be at increased risk of breast cancer, even years after stopping therapy. Also, women on combination hormone therapy for menopause are also at increased risk of stroke, blood clots, heart disease and cancer.

WHI Follow-up Study Confirms Health Risks of Long-Term Combination Hormone Therapy Outweigh Benefits for Postmenopausal Women

New results from the Women's Health Initiative (WHI) confirm that the health risks of long-term use of combination (estrogen plus progestin) hormone therapy in healthy, postmenopausal women persist even a few years after stopping the drugs and clearly outweigh the benefits.

Researchers report that about three years after women stopped taking combination hormone therapy, many of the health effects of hormones such as increased risk of heart disease are diminished, but overall risks, including risks of stroke, blood clots, and cancer, remain high. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).

Results of the WHI three-year follow-up study of the estrogen-plus-progestin clinical trial are published in the March 5, 2008, issue of the Journal of the American Medical Association.

"The good news is that after women stop taking combination hormone therapy, their risk of heart disease appears to decrease," noted Elizabeth G. Nabel, M.D., NHLBI director. "However, these findings also indicate that women who take estrogen plus progestin continue to be at increased risk of breast cancer, even years after stopping therapy. Today's report confirms the study's primary conclusion that combination hormone therapy should not be used to prevent disease in healthy, postmenopausal women."

The FDA recommends that hormone therapy never be used to prevent heart disease, and, when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible.

The new findings are from a follow-up study of 15,730 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment, who participated in the WHI estrogen-plus-progestin clinical trial.

Participants were randomly assigned to receive a combination of estrogen (0.625 milligrams of conjugated equine estrogens per day) plus progestin (2.5 mg of medroxyprogesterone acetate) or placebo (inactive pill). The main estrogen-plus-progestin study was stopped in 2002 after an average of 5.6 years of treatment due to an increase in breast cancer. Women on combination hormone therapy were also at increased risk of stroke, blood clots, and heart disease, while their risk of colorectal cancer and hip fractures was lower, compared to women who did not take hormone therapy.

The follow-up study began in July 2002 after women in the study were instructed to stop taking combination hormone therapy, and continued through March 2005, with participants followed for an average of 2.4 years.

All study participants were examined at least once a year by a WHI clinician and received an annual breast examination and mammogram, with biopsies performed as needed.

During the follow-up study, the numbers of heart attacks, strokes, and blood clots were not significantly different between the two groups (overall, 343 cardiovascular events among those who initially received hormone therapy versus 323 among those who did not).

In addition, the number of deaths was not significantly different (233 women who had been in the hormone therapy group died, versus 196 women who had been in the placebo group).

"After being on combination hormone therapy for several years, the women's risk of cardiovascular disease was significantly higher – from a 29 percent increase in heart attacks to a 41 percent increase in strokes and nearly twice the risk of serious blood clots – compared to the women who did not take hormones," said Michael S. Lauer, M.D., director of the NHLBI Division of Prevention and Population Sciences.

"While it is reassuring that heart attack risk decreased and that the risks for stroke and blood clots did not grow after the women stopped taking hormones, this study provides further evidence that five years of combination hormone therapy is harmful. All the accumulated risks do not simply disappear."

The study also found that other effects of combination hormones, such as decreased risk of colorectal cancer and hip fractures, also stopped when therapy ended.

"We continue to encourage women to use hormones only if needed for menopausal symptoms, and for the shortest time possible, and to adopt and maintain a healthy lifestyle, that is, engage in regular physical activity, maintain a healthy body weight, consume a diet low in saturated fat, and to not smoke, to reduce their risks of cardiovascular and other chronic diseases," said Marcia Stefanick, Ph.D., professor of medicine at Stanford University, Stanford, Calif., and a coauthor of the paper, as well as chair of the WHI Steering Committee.

She added that women should know their cholesterol and blood pressure levels and other health risks and take preventative measures, as needed.

In contrast to the other effects, the risk of breast cancer continued at a rate similar to that seen during treatment. Women who had stopped taking estrogen plus progestin were about 27 percent more likely to develop breast cancer than the women who didn’t take hormones during the study, with 79 women in the post-treatment group developing breast cancer during the three-year follow-up study, compared to 60 women in the non-treatment group.

"The hormones’ effects on breast cancer appear to linger," noted Leslie Ford, M.D., associate director for clinical research in the Division of Cancer Prevention of the NIH's National Cancer Institute. "These findings reinforce the importance of women getting regular breast exams and mammograms, even after they stop hormone therapy."

Researchers also report a 24 percent increased risk of developing any form of cancer among women who had been in the treatment group. Overall, there were 63 more diagnoses of cancer during the follow-up study, or three per 1,000 participants per year, among women who had taken combination hormone therapy compared to women who did not take hormones during the study (281 diagnoses compared to 218). A more detailed analysis on the cancer findings is underway.

"The continued increased risk of breast cancer clearly plays a role in the increased overall risk of cancer years after stopping long-term estrogen plus progestin therapy, and it is important that we continue to follow these women," added Stefanick, noting that the new results provide further evidence that the health risks of long-term combination hormone therapy outweigh the benefits.

The WHI is a major, 15-year research program designed to address the most frequent causes of death, disability, and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis. The principal findings from the two WHI hormone therapy trials, which studied 27,347 postmenopausal women on estrogen plus progestin, estrogen-alone, or placebo, found that the overall risks of long-term use of hormone therapy outweigh the benefits.

Both of these trials were stopped early because of increased health risks and failure to prevent heart disease, a key question of the studies.

In addition to NCI, NHLBI collaborates on the WHI with the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, and the Office of Research on Women’s Health, all parts of the NIH. Wyeth-Ayerst Research provided the medication and placebo for the hormone study.

To interview Dr. Lauer, call the NHLBI Communications Office at (301) 496-4236. To speak with Dr. Ford, please contact the NCI Office of Media Relations at (301) 496-6641. To speak with Dr. Stefanick, please contact Susan Ipaktchian at 650-725-5375

Source: National Heart, Lung, and Blood Institute News Room.

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Celiac Disease Diet: Oats Intolerance Does Exist

2008-03-29T13:34:00.000+10:00

Most patients with celiac disease can eliminate their symptoms by life-long adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats in their diet. Some recent studies suggested that oats did not cause the intestinal inflammation characteristic of celiac disease, and therefore oats are now often included in the celiac disease diet.

Celiac disease is a digestive disease that damages part of the gut (the small intestine) and interferes with absorption of nutrients from food. Patients with celiac disease do not tolerate a protein called gluten, which is found in wheat, rye, and barley.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. The disease is quite serious in some patients, but eating a strictly gluten-free diet can eliminate all of the symptoms.

Unfortunately, wheat, barley, and rye products like flour are found in many common foods, and patients have to avoid them for the rest of their lives.

A study by Ludvig Sollid and colleagues in the October 2004 issue of PLoS Medicine suggests that oats are not safe in all cases.

The researchers applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease.

The nine patients were not a random sample: all of them had been eating oats, and four of them had shown clinical symptoms after oats ingestion. All patients were on a gluten-free diet and ate oats that were free of contamination by other cereals.

The goal of the study was to characterize the intestinal T cell response to oats in these patients, and to relate it to clinical symptoms and intestinal biopsy results.

Three of the four patients who had reported problems after eating oats showed intestinal inflammation typical of celiac disease.

Contrary to other studies, this one demonstrates that oats intolerance does exist in some people with celiac disease. These patients have an immune reaction to oats that is similar to the reaction most celiac disease patients have to wheat, barley, and rye.

However, identical reactions were also seen in two of the patients who were clinically tolerant to oats. They had oats-reactive intestinal T cells which may or may not lead to enhanced susceptibility to oats intolerance.

Oats are not safe for all people with celiac disease, but future studies are needed to determine the frequency of oats intolerance.

Patients who eat oats as part of a gluten-free diet should discuss their diet and any symptoms with their doctors; doctors should keep in mind that patients might develop symptoms when they eat oats.

References:
(2004) Oats Intolerance in Celiac Disease. PLoS Med 1(1): e23 doi:10.1371/journal.pmed.. Copyright: © 2004 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, et al. (2004) The Molecular Basis for Oat Intolerance in Patients with Celiac Disease. PLoS Med 1(1): e1 doi:10.1371/journal.pmed.. Copyright: © 2004 Arentz-Hansen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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Women Benefit More From Quitting Smoking Than Men

2008-03-27T14:57:00.000+10:00

Quitting Smoking - Lung Health Benefits - Women benefit more from quitting smoking than men.

New findings from the Lung Health Study (LHS) indicate that, in general, women’s lung function improves significantly more than men’s after sustained smoking cessation.

LHS researchers previously published results showing that both men and women benefit from smoking cessation; this new analysis indicates that the benefits to the lungs are greater in women than in men. The results are published in the June 1 issue of the American Journal of Epidemiology.

Supported by the National Heart, Lung, and Blood Institute (NHLBI), the study followed more than 5,300 middle-aged smokers for five years. All participants had mild or moderate chronic obstructive pulmonary disease (COPD).

In the first year after quitting, women’s lung function improved more than twice that of the men’s. Among those who quit, improved lung function remained greater for women than for men throughout the study, although the differences between the genders narrowed over time. The decline in lung function in those who continued to smoke was on average similar for men and women.

Cigarette smoking is a leading cause of COPD, a slowly progressive disease of the lung that is characterized by a gradual loss of lung function. COPD is the fourth most common and the most rapidly increasing cause of death in the United States. Emphysema, chronic bronchitis, chronic obstructive bronchitis, or a combination of emphysema and chronic bronchitis are forms of COPD.

Dr. Gail Weinmann, a lung specialist with the NHLBI, is available to comment on the study and on the health benefits of smoking cessation. To arrange an interview with Dr. Weinmann, please call the NHLBI Communications Office at (301) 496-4236.

Source: NHLBI. Used with permission.

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