Low vitamin D levels linked to heart disease and death

 In people with low blood levels of vitamin D, boosting them with supplements more than halved a person's risk of dying from any cause compared to someone who remained deficient, in a large new study.

Analyzing data on more than 10,000 patients, University of Kansas researchers found that 70 percent were deficient in vitamin D and they were at significantly higher risk for a variety of heart diseases.

D-deficiency also nearly doubled a person's likelihood of dying, whereas correcting the deficiency with supplements lowered their risk of death by 60 percent.

"We expected to see that there was a relationship between heart disease and vitamin D deficiency; we were surprised at how strong it was," Dr. James L. Vacek, a professor of cardiology at the University of Kansas Hospital and Medical Center, told Reuters Health.

"It was so much more profound than we expected."

Vitamin D deficiency has been linked to a range of illnesses, but few studies have demonstrated the reverse -- that supplements could prevent those outcomes.

Vacek and his team reviewed data from 10,899 adults whose vitamin D serum levels had been tested at the University of Kansas Hospital, and found that more than 70 percent of the patients were below 30 nanograms per milliliter, the level many experts consider sufficient for good health.

After taking into account the patients' medical history, medications and other factors, the cardiologists found that people with deficient levels of vitamin D were more than twice as likely to have diabetes, 40 percent more likely to have high blood pressure and about 30 percent more likely to suffer from cardiomyopathy -- a diseased heart muscle -- as people without D deficiency.

Overall, those who were deficient in D had a three-fold higher likelihood of dying from any cause than those who weren't deficient, the researchers reported in the American Journal of Cardiology. Moreover, when the team looked at people who took vitamin D supplements, their risk of death from any cause was about 60 percent lower than the rest of the patients, although the effect was strongest among those who were vitamin D deficient at the time they were tested.

The study does not prove that vitamin D is the cause of the effects seen -- other factors, like disease, could be responsible both for the differences in health and the differences in vitamin D levels, for instance.

Previous research has indicated that many Americans don't have sufficient levels of vitamin D, however. The latest National Health and Nutrition Examination Survey estimated that 25 percent to 57 percent of adults have insufficient levels of D, and other studies have suggested the number is as high as 70 percent.

Vacek said he believes so many people are deficient because we should get about 90 percent of our Vitamin D from the sun and only about 10 percent from our food. The human body makes vitamin D in response to skin exposure to sunlight.

Certain foods, like oily fish, eggs and enriched milk products are also good sources of D. A sufficient amount of Vitamin D absorption from the sun would require at least 20 minutes of full-body exposure each day in warmer seasons, and most people aren't outside enough, Vacek said.

In the northern United States and throughout Canada, experts say the sun isn't strong enough during the winter months to make sufficient vitamin D, even if the weather was warm enough to expose the skin for a long time.

It means that adults should consider getting their Vitamin D levels checked through a simple blood test, Vacek said, and take vitamin D supplements. Generally, Vacek recommends that adults take between 1,000 to 2,000 international units (IU) of Vitamin D each day.

"If you're not deficient, Vitamin D is not a magic pill that will make you live longer," Vacek said.

"Its benefit is in people who are deficient. If you're low, it makes sense to be put on replacement therapy and have a follow-up a couple months later to make sure your levels come up."

SOURCE: http://1.usa.gov/v61Owu

The American Journal of Cardiology, online November 7, 2011.

Ambulatory blood pressure may best predict brain disease, cognitive decline

November 21, 2011

Study Highlights:

• Ambulatory blood pressure may be the best predictor of progressive blood vessel disease in the brain.
• As a result of tracking ambulatory blood pressure, researchers determined that older Americans who had high ambulatory blood pressure developed more small vessel brain damage over time.
• Patients who want to stay physically and cognitively active should talk to their physicians about tracking out-of-office blood pressure levels

DALLAS, Nov. 21, 2011 — Ambulatory blood pressure — not the doctor’s office blood pressure — can best predict the progression of small vessel brain disease and the decline of cognitive function in older people, according to a new study in Circulation: Journal of the American Heart Association.

 

Ambulatory blood pressure is measured by monitoring blood pressure at regular intervals using a special recording device under normal living and working conditions. Clinical or in-office blood pressure is taken in a healthcare provider’s office.

 

“This study showed for the first time in an older population that blood pressure measured over a 24-hour period was associated with the progression of vascular brain disease, whereas the typical office blood pressure was not,” said William B. White, M.D., senior author of the study and professor of hypertension and clinical pharmacology in the Calhoun Cardiology Center at the University of Connecticut School of Medicine in Farmington.

 

To determine the effect blood pressure had on the progression of brain disease, researchers examined the change in blood pressure and volume of white matter hyperintensities (WMH) in the brain at baseline and after two years.

 

White matter hyperintensities are a sign of small vessel brain damage that can be detected using an MRI. In addition to looking for WMH, researchers measured cognitive ability and physical mobility over the two-year time period. Previous studies by the authors and other researchers have shown that increased WMH is associated with cognitive decline.

 

A worsening in ambulatory blood pressure was associated with an increase in WMH and a decrease in cognitive and mobility functions.

If medical professionals target average ambulatory blood pressure, it could reduce the progression of small vessel brain disease, researchers said.

 

“Interventional studies underway can determine the appropriate level of ambulatory systolic blood pressure for both home and office to prevent the accumulation of cerebrovascular disease in older people,” White said.

 

The two-year study included 72 patients, average age 82. For the group, there were no major changes in body weight, clinical or ambulatory blood pressure during the study, and only three patients had severe medical problems, including the development of stroke, heart failure or valvular disease.

 

Researchers reported:

• No relationship between clinical blood pressure and WMH.
• The average volume of WMH, when adjusted for age and “bad” LDL cholesterol, increased significantly over two years from 13.9 ml to 20.5 ml.
• Three of the four mobility measures and all of the cognitive measures were significantly related to WMH volume at two years.

“The results of this cohort study mean that for older people who aim to stay as functional as possible during advancing age, their blood pressure averaged out of the office, rather than in the office, might be the most important to target and treat,” White said.

 

Co-authors are Leslie Wolfson, M.D.; Dorothy B. Wakefield, M.S.; Charles B. Hall, Ph.D.; Patrick Campbell, M.D.; Nicola Moscufo, Ph.D.; Julia Schmidt, B.S.; Richard F. Kaplan, Ph.D.; Godfrey Pearlson, M.D.; and Charles R. Guttmann, M.D. Author disclosures are on the manuscript.

 

The National Institutes of Health funded the study.

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Genes involved in autism, schizophrenia may be activated in womb

The genes suspected of causing autism, schizophrenia and other mental illnesses are activated in the developing brain before birth, according to a major genetic analysis.

The study by researchers at Yale University also spotted hundreds of genetic differences between males and females still in the womb.

"We knew many of the genes involved in the development of the brain, but now we know where and when they are functioning in the human brain," said study senior author Nenad Sestan, an associate professor of neurobiology and researcher for Yale's Kavli Institute for Neuroscience, in a university news release. "The complexity of the system shows why the human brain may be so susceptible to psychiatric disorders."

In conducting the study, researchers examined more than 1,300 tissue samples taken from 57 people at different stages of brain development, ranging from 40 days after conception to 82 years. They tracked thousands of human genes to determine which are involved in development, where they are located and when they are "expressed," or activated.

The study, published in the Oct. 27 issue of the journal Nature, revealed a significant amount of the human brain is shaped before birth. For instance, the researchers found proof that genes linked to autism and schizophrenia are activated while in the womb.

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Science Probes How Probiotic Yogurts Affect Your Gut

'Friendly' microbes might affect metabolism, but whether they're good for you is still unclear, researchers say

Researchers have put the health promises of popular probiotic yogurts to the test and found they may alter the way in which food is metabolized.

But whether that means probiotic foods and supplements can improve your health remains to be seen, they said.

"Federal regulatory agencies are increasingly interested in evaluating all the health claims being made by probiotic food manufacturers," said study co-author Dr. Jeffrey Gordon, a biologist and director of the Center for Genome Sciences at Washington University School of Medicine, in St. Louis. "So what we did was try to develop a model for the human gut that can give us a way to measure the effects."

What they saw, Gordon said, "is that adding a few billion of these microbial organisms to a gut community already containing tens of trillions of bacteria can, in fact, influence the metabolism of food ingredients. The structure of the microbe community doesn't change. But the function does."

Funding for the research came from the U.S. National Institutes of Health (NIH) and Danone Research, an arm of the food conglomerate that makes Dannon probiotic yogurt Activia.

The study is published in the Oct. 26 issue of Science Translational Medicine.

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Insomnia Can Hinder Your Weight Loss

Sleepless Nights Stop Progress


So you already know that a well-balanced diet and a regular exercise program are keys to your weight loss plan. But are you listening to that other recommendation you’ve heard more than once in your life? Get plenty of sleep. Recent medical studies show that sleep loss can increase hunger and affect your body’s metabolism in a way that makes weight loss more difficult. So if you’re making a good effort in your nutrition and fitness plans, you still might be able to improve your success with better sleep.

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Pumping Iron Helps Smokers Quit Without Weight Gain

Researchers found those who lifted weights regularly were twice as likely to kick the habit



Would-be ex-smokers may want to try weight lifting to help them kick the habit for good, a new study suggests.


The researchers found that three months of pumping iron seemed to help curb cigarette cravings and withdrawal symptoms, while lessening the weight gain that sometimes accompanies quitting.


Overall, men and women who completed the resistance training program were twice as likely to kick the habit as smokers who didn't lift weights.


"Cigarette smoking kills more than a thousand Americans every day, and while the large majority of smokers want to quit, less than 5 percent are able to do it without help," the study's lead author, Joseph Ciccolo, an exercise psychologist with the Miriam Hospital's Centers for Behavioral and Preventive Medicine, in Providence, said in a news release from the Lifespan health system.


"We need any new tools that can help smokers successfully quit and it appears resistance training could potentially be an effective strategy," he added.


In the study, which was funded by the U.S. National Cancer Institute, Ciccolo's team recruited 25 male and female smokers between the ages of 18 and 65 who had smoked at least five cigarettes per day for the past year or more.


All of the participants were counseled on quitting smoking for 15 to 20 minutes and given an eight-week supply of the nicotine patch, before being randomized into two groups, the authors noted.


The first group of smokers was asked to complete two one-hour full-body resistance training sessions involving 10 exercises each week for 12 weeks. The intensity of the training program was also increased every three weeks.


Meanwhile, the second group of smokers ("controls") simply watched a brief health and wellness video twice a week.


After completing the 12-week regimen, 16 percent of smokers in the weight-lifting group had successfully quit smoking, according to the study published in the August issue of the journal Nicotine & Tobacco Research. As an added bonus, they had also lost body weight and body fat.


In contrast, only 8 percent of the smokers in the control group had quit, and they had also gained both weight and body fat, the results showed.


Three months later, 15 percent of those in the weight-lifting group had still not started smoking again, compared to 8 percent of the control group.


However, despite "promising" results, the study authors noted that more research is needed on resistance training before it can be considered a clinical treatment for smoking cessation.


SOURCE: Lifespan, news release, Aug. 9, 2011

Harvard Study finds: Daily Hot Dog May Feed Diabetes Risk

Eating red meat -- especially processed products such as hot dogs -- increases your risk of type 2 diabetes, a new study warns.

It also found that you can significantly lower your diabetes risk by replacing red meat with healthier proteins, such as nuts, whole grains or low-fat dairy products.

Harvard School of Public Health researchers looked at 20 years of data from men in the Health Professionals Follow-Up Study, 28 years of data from women in the Nurses' Health Study I, and 14 years of data from women in the Nurses' Health Study II, which involved more than 200,000 participants in all.

They combined that data with data from other studies that involved a total of 442,101 people, including 28,228 who developed diabetes while participating in a study.

After adjusting for lifestyle and dietary risk factors, the researchers determined that a daily 100-gram serving (about the size of a deck of cards) of unprocessed red meat was associated with a 19 percent increased risk for type 2 diabetes.

A daily serving of 50 grams of processed meat -- equivalent to one hot dog or sausage or two slices of bacon -- was associated with a 51 percent increased risk of diabetes.

Among people who ate one daily serving of red meat, substituting one serving of whole grains per day reduced the risk of diabetes by 23 percent. Substituting nuts resulted in a 21 percent lower risk, and substituting a low-fat dairy product, a 17 percent lower risk.

The study appears online Aug. 10 and in the October print issue of the American Journal of Clinical Nutrition.

"Clearly, the results from this study have huge public health implications given the rising type 2 diabetes epidemic and increasing consumption of red meats worldwide," senior author Frank Hu, a professor of nutrition and epidemiology, said in a Harvard news release. "The good news is that such troubling risk factors can be offset by swapping red meat for a healthier protein."

Current U.S. guidelines that include red meats in the "protein foods" group along with fish, nuts, beans and poultry should be revised to distinguish red meat from the healthier protein sources, the authors said in the release.

SOURCE: Harvard School of Public Health, news release, Aug. 10, 2011

Gene therapy shown to destroy leukemia tumors

Scientists for the first time have used gene therapy to successfully destroy cancer tumors in patients with advanced disease

Researchers at the University of Pennsylvania engineered patients' own pathogen-fighting T-cells to target a molecule found on the surface of leukemia cells.

The altered T-cells were grown outside of the body and infused back into patients suffering from late-stage chronic lymphocytic leukemia (CLL), which affects the blood and bone marrow and is the most common form of leukemia.

Two participants in the Phase I trial have been in remission for up to a year. A third had a strong anti-tumor response, and his cancer remains in check. The research group plans to treat four more patients with CLL before moving into a larger Phase II trial.

"We put a key onto the surface of the T-cells that fits into a lock that only the cancer cells have," said Dr. Michael Kalos, director of translational and correlative studies at the University of Pennsylvania's Perelman School of Medicine and an investigator on the study.

The results provide "a tumor-attack roadmap for the treatment of other cancers," including those of the lung and ovaries as well as myeloma and melanoma, researchers said.

The findings were published simultaneously Wednesday in the New England Journal of Medicine and Science Translational Medicine.

Kalos said past efforts to use the technique, known as "adoptive T-cell transfer," failed either because the T-cell response was too weak or proved too toxic for normal tissue.

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Organic Poultry Farms Have Lower Levels of Antibiotic-Resistant Bacteria

Conventional farms that went organic saw fewer resistant germs in the first flock, researchers found


Poultry farms that have made the transition from conventional to organic farming have significantly lower levels of antibiotic-resistant bacteria than conventional poultry farms, a new study finds.


Scientists are concerned about the use of antibiotics in farm animals because it has been shown to contribute to antibiotic-resistant bacteria that can spread to humans.


The researchers said they expected to see some differences in the farm levels of antibiotic-resistant enterococci when poultry farms transitioned to organic practices.


"But we were surprised to see that the differences were so significant across several different classes of antibiotics -- even in the very first flock that was produced after the transition to organic standards," study leader Amy Sapkota, an assistant professor with the Maryland Institute for Applied Environmental Health, said in a university news release. "It is very encouraging."


The University of Maryland researchers tested 10 newly organic and 10 conventional poultry houses for the presence of enterococci bacteria in poultry litter, feed and water. Any enteroccoci bacteria found by the researchers was checked for resistance to 17 common antimicrobials.


"We chose to study enterococci because these microorganisms are found in all poultry, including poultry on both organic and conventional farms. The enterococci are also notable opportunistic pathogens in human patients staying in hospitals," Sapkota said.


As expected, enterococci bacteria was found at all the farms. However, the organic farms had much lower levels of single and multiple antibiotic-resistant enterococci.


The study was published online Aug. 10 in the journal Environmental Health Perspectives.


"While we know that the dynamics of antibiotic resistance differ by bacterium and antibiotic, these findings show that, at least in the case of enterococci, we begin to reverse resistance on farms even among the first group of animals that are grown without antibiotics. Now we need to look forward and see what happens over five years, 10 years in time," Sapkota said.


SOURCE: University of Maryland, news release, Aug. 10, 2011

Women May Face Greater Heart Risk From Smoking Than Men

Researchers say biological differences may explain 25% higher risk compared to male smokers.



Women who smoke have a 25 percent higher risk of developing heart disease than male smokers do, according to a huge, new study.


Although the reason for the higher risk isn't known, researchers suspect there are biological differences in how women's bodies react to damaging cigarette smoke.


"Women may absorb more carcinogens and other toxic agents in cigarettes compared to men," said lead researcher Rachel R. Huxley, an associate professor of epidemiology at the University of Minnesota.


In addition, women have different smoking habits from men, she added. "Despite smoking fewer cigarettes than men on average, they may smoke more of the cigarette. They might smoke right to the end of the cigarette, compared to men -- we just don't know," she said.


For the study, Huxley and her colleague, Mark Woodward from the department of epidemiology at Johns Hopkins University, gathered data from 75 studies, involving almost 4 million people, that looked at the risk of heart disease between smokers and nonsmokers.


This type of study is called a meta-analysis, the object of which is to pool data from a variety of sources to try to identify significant trends.


Combined, these studies included 3,912,809 people, more than 67,000 of whom had heart disease. In the 75 studies that included data on the differences between men and women and included 2.4 million people, the researchers found that women who smoked had a 25 percent higher risk of having a heart attack than men who smoked.


That risk increased by 2 percent for every year the women smoked, compared with men who smoked equally as long, Huxley and Woodward found.


The risk to women could actually be greater than what was uncovered in this study, Huxley added. On average, women smoke fewer cigarettes than men and while the number of women who smoke has peaked in the United States, in developing countries women are just beginning to take up the habit, she said.


Huxley noted that they also found a higher risk for lung cancer among women who smoked, compared with men. "Women who smoked had twice the risk of dying from lung cancer, compared to men," she said.


"So this is not just a one-off thing," Huxley said. "There is some physiological or behavioral reason why women who smoke have a much greater risk of contracting illness, compared to their male counterparts," she said.


The report was published in the Aug. 10 online edition of The Lancet.


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Screen Time is not Lean Time for Kids and Teens

The nation's leading group of pediatricians is calling for a ban on all junk food and fast food ads during children's television shows as a means of slowing the rising tide of obesity among young people.

In a policy statement published in the July issue of Pediatrics, the American Academy of Pediatrics (AAP) also asks Congress, the Federal Trade Commission and the Federal Communications Commission to eliminate junk food and fast food ads on cell phones and other media, as well as to prohibit companies that make such products from paying to have their products featured in movies.

"Given that we are smack in the midst of an epidemic of child and adolescent obesity, it doesn't seem like all that bad an idea," said Dr. Victor Strasburger, lead author of the statement.

"We have many bans on advertising already," said Dr. Benard P. Dreyer, a professor of pediatrics at New York University School of Medicine in New York City. This latest action identifies just one more toxic thing that children should not be exposed to, he added.

One-third of American children and teens are overweight or obese, double the proportion of 30 years ago, the AAP statement said, and several studies have identified TV watching as a contributing factor.

Watching TV or movies or being engrossed in texting or playing games on a cell phone means that children have less time to run, walk or otherwise exercise and more time to snack, according to the AAP statement.

But what kids are watching also influences their eating habits, and what they're seeing is a preponderance of commercials for high-sugar, high-fat foods. One study found that 98 percent of food ads seen by children on top-rated shows were for junk food. Another study estimated that young people see 12 to 21 food ads every day on average, for a total of up to 7,600 ads a year, the AAP statement noted. And TV or DVD watching also disrupts the quality and length of sleep, a known risk factor for obesity.

The AAP statement reminds pediatricians that they should be asking two critical questions during routine well-child visits: "How much screen time is being spent per day?" and "Is there a TV set or Internet connection in the [child's] bedroom?"

Having a TV set in the child's bedroom seems to have an even more profound impact on children's weight.

"I think [asking these questions] is really an advantageous recommendation," said Dana Rofey, an assistant professor in the Weight Management and Wellness Program at Children's Hospital of Pittsburgh. "Several years ago, the AAP [recommended] that pediatricians track body-mass index. This is the other side of the coin."

"Kids spend an average of seven hours a day with media, and that media potentially affects virtually every concern that parents and pediatricians have about children from sex to drugs to obesity to school achievement," added Strasburger, a professor of pediatrics at the University of New Mexico School of Medicine in Albuquerque. "Spending 20 seconds to ask two media-related questions doesn't seem like that onerous a request."

The policy statement also recommends that pediatricians urge parents to discuss food advertising with their children and discuss healthy eating habits.

And "parents need to understand that the research is now clear and convincing that exposure to screen time is one major factor in child and adolescent obesity," stressed Strasburger. "So if your child is watching five hours of TV a day, his or her risk of being obese is several times increased over a child who watches less than two hours a day, which is what the AAP recommends. If parents would just observe the AAP guidelines about media use, they'd be in great shape and so would their kids."

In response to the AAP recommendation, the Children's Food and Beverage Advertising Initiative issued the following statement: "Much of the American Academy of Pediatrics statement regarding an ad ban is based on old or seriously flawed data. Simply put, if advertising caused obesity, why have obesity rates increased while television advertising has dropped significantly?"

The industry statement added, "With the 17 CFBAI industry participants representing a substantial majority of the ads on children's TV programming, the ad mixture has changed for the better, as the [Institute of Medicine] IOM recommended in its 2006 report. Ads to kids now are for yogurt, soup, canned pasta, cereals, and meals with vegetables or fruit, milk or juice."

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Nearly Half of Older Breast Cancer Patients Don't Get Radiation

Even though radiation after mastectomy for advanced breast cancer has been proven to save lives and multiple guidelines call for it, nearly half of these patients don't receive it, researchers say.

Between 1999 and 2005, only 55 percent of older high-risk breast cancer patients who should have undergone radiation therapy actually received it, according to the study that appears online June 27 in the journal Cancer.

"When physicians are not guided by published evidence, there is the chance that patient outcomes will suffer or that patients will undergo unnecessary treatments and tests," study co-leader Dr. Shervin Shirvani, of the M.D. Anderson Cancer Center in Houston, said in a journal news release.

The M.D. Anderson Cancer Center scientists analyzed data from 38,322 older women with advanced breast cancer who underwent mastectomy (partial or complete removal of one or both breasts) in the United States between 1992 and 2005.

Following the publication of clinical trials that revealed its benefits, the use of radiation after mastectomy increased from 36.5 percent in 1996 to 57.7 percent in 1998, the researchers found. However, no further increase occurred between 1999 and 2005, despite the release of a number of major guidelines endorsing it.

The researchers expressed concern that so many providers appear to be ignoring the evidence-based guidelines.

"Beyond the potential for distress and injury to the individual patient, there is also the strong likelihood that medical resources will be wasted on unproven or ineffective treatments," Shirvani said.

More needs to be done to make sure that helpful findings from clinical trials are widely implemented in patient care, the researchers concluded.

SOURCE: Cancer, news release, June 27, 2011

Tips to Reduce Infection Risk After Ear Piercing

 Newly pierced ears can be prime candidates for infection, but proper care can help reduce the risk.

The American Academy of Pediatricians offers these suggestions:

• Make sure an experienced technician, nurse or doctor performs the procedure, and that a disinfectant is applied to the ears before piercing.
• After the procedure, gently cleanse the ears with rubbing alcohol two to three times a day.
• Apply antibiotic ointment after each cleaning.
• Carefully turn the earring posts each day.
• Do not remove the earrings for at least six weeks.

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Combo Treatment Improves Survival For Some Prostate Cancer Patients

For men who have prostate cancer that's considered "intermediate risk," radiation plus four months of hormone therapy appears to improve survival, a new study finds.

This combination of treatments, however, was not effective in men with either low-risk prostate cancer or advanced disease, the researchers said. Men with high-risk cancer need long-term hormone therapy.

The hormone therapy is known as androgen deprivation therapy. It's designed to reduce the levels of male hormones (androgens) in the body, since they can stimulate the growth of prostate cancer cells.

"For patients with early, localized cancer of the prostate who were treated with radiation therapy, [by] adding short-term androgen deprivation therapy, we improved their cure rates and increased their chance of living 10 years from 57 percent to 62 percent," said lead researcher Dr. Christopher U. Jones, from Radiological Associates of Sacramento, Calif.

But when the researchers looked closely at those findings, they found that patients with low-risk prostate cancer did not need hormone therapy because the chance they would survive with radiation alone was already almost 99 percent, Jones said.

And while short term hormonal therapy is "not very toxic, there are [still] some toxicities," Jones noted. "We don't want to treat any man unnecessarily with that type of treatment. We really want to make sure -- if we are going to recommend that treatment -- the person really needs it," he said.

On the other hand, hormone therapy plus radiation was most effective in patients with intermediate-risk prostate cancer. "We decreased the risk of dying from prostate cancer in those patients from 10 percent to 3 percent, at 10 years," Jones said.

For patients with high-risk prostate cancer, using hormone therapy for just a short while is not effective, he added. "We know from other studies that short-term androgen deprivation therapy isn't enough. You need to give long-term androgen deprivation therapy in addition to radiation to have the best results," Jones said.

The report was published in the July 14 issue of the New England Journal of Medicine.

For the study, Jones' team randomly assigned almost 2,000 men with prostate cancer to radiation therapy alone or in combination with four months of hormone therapy. The hormone therapy started two months before radiation.

Side effects of male hormone therapy can include erectile dysfunction (impotence), loss of sex drive, hot flashes, growth of breast tissue, loss of muscle and bone mass, weight gain, nausea, liver problems, fatigue, memory problems and mood swings.

In October 2010, the U.S. Food and Drug Administration asked manufacturers to add a warning that certain drugs used in hormone therapy (including the one used in the study) were linked to a small but increased risk of diabetes, heart attack, stroke and sudden death in men.

In this study, men treated with hormone therapy experienced a much higher percentage of liver damage; toxic effects of radiation treatment were similar in both groups.

Over an average of over nine years of follow-up, 62 percent of the men who had combination therapy were alive, compared with 57 percent of the men who received radiation therapy alone, the researchers found.

Overall, hormone therapy reduced the risk of dying from prostate cancer over 10 years from 8 percent to 4 percent, Jones said.

He noted that the radiation treatments in use today differ from those given in 1994 when the trial began.

"We can give 15 to 20 percent higher doses of radiation now than we could then, and we can do it more safely and more accurately," he said. So, that brings into question how much, if any, hormone therapy is needed, he added.

An ongoing trial among patients with intermediate risk prostate cancer aims to answer that question, Jones said. "We are going to find out if androgen deprivation therapy still applies to patients treated with modern techniques," he said.

"This study, in conjunction with what we know about hormonal therapy, really nails home the conclusion that hormonal therapy should not be used in men with low-risk disease because the risks outweigh any conceivable benefit," commented Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston and author of an accompanying journal editorial.

D'Amico noted that new studies using up-to-date high-dose radiation also found that the addition of short-term hormone therapy improved outcomes at five years for men with intermediate risk prostate cancer, compared with radiation alone.

"If you are in the low-risk category, stay away from hormone therapy. It does no good. [It] can hurt," D'Amico said. "If you have anything beyond low-risk [prostate cancer], the hormonal therapy helps," he said. "It's just a matter of how long you need it for. It could be four months, six months or longer."

These findings are good news for some men, since the effects of short term of hormone therapy are reversible, D'Amico said. "It's not three years, where men are changed forever," he said.

SOURCES: Christopher U. Jones, M.D., Radiological Associates of Sacramento, Calif.; Anthony D'Amico, M.D., Ph.D, chief, radiation oncology, Brigham and Women's Hospital, Boston; July 14, 2011, New England Journal of Medicine

Placebo effect equals medication effect

A new study finds that the power of the placebo effect left asthma patients thinking that real and fake drugs were doing the same level of good, even though the real medication actually had a much greater physical effect on their lungs.

The effect was so strong that it convinced patients they were breathing much better even if they hadn't taken a real drug and hadn't actually improved much, as measured by a breathing test.

"The placebo doesn't change the actual breathing in asthma patients. But it changes people's experience of what's going on as much as a real drug does," said study co-author Dr. Ted J. Kaptchuk, an associate professor of medicine at Harvard Medical School.

Kaptchuk has noted that the ritual of treatment itself is very powerful, and that in the study "it was apparent that the placebos were as effective as the active drug in making people feel better."

As researchers have long known, you can give a sugar or dummy pill to someone and they often will feel better. Placebos don't cure diseases such as cancer. But they can offer relief from pain, ease gastrointestinal disorders and lower a patient's blood pressure, even though they don't have any active ingredient other than whatever a patient chooses to believe.

The new study aims to find out how the effect of a real drug compares to a fake drug in two areas: the actual effect (in this case, on a patient's ability to breathe) and the perceived effect.

The researchers studied 39 asthma patients who were randomly assigned to be treated with an albuterol asthma inhaler (a common treatment), a placebo inhaler and a sham (fake) acupuncture treatment (in which acupuncture needles are used but the clinician does not stimulate any known acupuncture points ). They also underwent sessions of being treated with nothing at all.

The patients were randomly exposed to each approach during several visits during which their ability to exhale was tested. The visits were three to seven days apart for a total of 12 interventions in all.

Overall, the albuterol inhaler improved exhaling by 20 percent. Each of the other approaches (including no treatment) improved it by just 7 percent overall.

So what did the patients think? Overall, they thought both inhalers (the real and fake ones) and the sham acupuncture improved their breathing by about the same amount (the albuterol inhaler by 50 percent, the fake inhaler by 45 percent, and the sham acupuncture by 46 percent). They thought doing nothing only improved it by 21 percent.

The research raises plenty of questions, said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. For one, he said, "how reliable are patients in terms of their subjective reporting of their symptoms? When a patient tells you that they feel better, and you think they really need more than what you're doing, should you stop? It really calls into question what we're doing, whether it's good enough to help the patients feel better."

The study authors had a similar view of the placebo effect. Due to the wide gap between asthma patients' self-reports and their actual lung function, the researchers concluded that for optimal asthma care, health providers should test lung function rather than rely on patients' self-assessments.

And in clinical trials in general, the authors added, "reliance solely on subjective outcomes may be inherently unreliable."

The study appears in the July 14 issue of The New England Journal of Medicine. It was funded by the National Center for Complementary and Alternative Medicine.

SOURCES: Ted J. Kaptchuk, O.M.D., associate professor, medicine, Harvard Medical School, Boston; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; July 14, 2011, New England Journal of Medicine

Benefits of Meditation: 'Om' is where the heart is

Meditation is gaining attention as a potential way to maintain well-being and good health. It can calm your mind, relax your body, and soothe your spirit. In addition, it's inexpensive and its risks are minimal.

Meditation techniques aren't new. They've been around for thousands of years. Anyone can meditate, regardless of religious or cultural background.

Consider these suggestions from the Mayo Clinic to get you started :

Select a meditation technique that fits your lifestyle and belief system. Many people build meditation into their daily routine.

Set aside some time.
Start with 5-minute meditation sessions once or twice a day and work up to 20 minutes each time.
Keep trying. Be kind to yourself as you get started.
If you're meditating and your attention wanders, slowly return to the object, sensation or movement you're focusing on.

Make meditation part of your life.
Many people prefer to start and end their day with a period of meditation. Others prefer to take meditation breaks during the day.

Experiment and find out what works best for you.

Green tea lowers cholesterol, but only a little

Drinking green tea seems to cut "bad" cholesterol, according to a fresh look at the medical evidence.

The finding may help explain why green tea has been linked to a lower risk of heart disease, the leading killer worldwide, Xin-Xin Zheng and colleagues from Peking Union Medical College in Beijing report.

Because few people in the U.S. drink green tea, encouraging Americans to down more of the brew could have significant health benefits, the researchers write in the American Journal of Clinical Nutrition.

Still, one U.S. expert cautioned the drink shouldn't be used as medicine for high cholesterol, as the effect found in the Chinese study was small.

The new report pools the results of 14 previous trials. In each of those studies, researchers randomly divided participants into two groups: one that drank green tea or took an extract for periods ranging from three weeks to three months, and one that got an inactive preparation.

On average, those who got green tea ended up with total cholesterol levels that were 7.2 milligrams per deciliter (mg/dL) lower than in the comparison group. Their LDL, or "bad," cholesterol dropped 2.2 mg/dL -- a decrease of slightly less than two percent.

There was no difference in HDL, or "good," cholesterol between the two groups.

The cholesterol-lowering effects of green tea may be due to chemicals known as catechins, which decrease the absorption of cholesterol in the gut, according to the researcher.


Some researchers have raised concerns over possible side effects from heavy consumption of green tea or green tea extracts. For instance, there have been a few dozen reports of liver damage, and green tea may also interact with certain medications to reduce their effectiveness.



SOURCE: http://bit.ly/kPFJLS American Journal of Clinical Nutrition, online June 29, 2011.

Psoriatic Arthritis Patients Seem to Lack Enough Vitamin D

Vitamin D insufficiency is common among people with psoriatic arthritis, but levels of the vitamin in the blood do not affect disease activity, a new study finds.

People with psoriatic arthritis have the chronic skin disorder psoriasis accompanied by inflammatory arthritis.

The study, published in the July 11 issue of the journal Arthritis Care & Research, included more than 300 patients living in Toronto and Haifa, Israel, two geographically diverse locations. Vitamin D levels in the blood -- known as 25-hydroxyvitamin D [25 (OH) D] -- were measured in the summer and winter.

Vitamin D is produced by the skin in response to exposure to sunlight. It is also found in certain foods, including eggs, fish and fortified foods such as dairy products and breakfast cereals.

In the Canadian patients, 56 percent had insufficient 25 (OH) D levels during the winter and 59 percent had insufficient levels during the summer. In the Israeli patients, 51 percent had insufficient levels in the winter, and 62 percent had insufficient levels in the summer, the investigators found.

Vitamin D deficiency was found in 3 percent of the Canadian patients only in winter, 4 percent of Israeli patients in winter, and 1 percent of Israeli patients in summer.

Seasonal or geographic differences in vitamin D levels were not statistically significant, and vitamin D levels did not affect disease activity, concluded lead author Dr. Dafna Gladman, director of the University of Toronto Psoriatic Arthritis Clinic, and colleagues.

However, further research is required to determine if psoriatic arthritis patients require a higher-than-normal intake of vitamin D in order to maintain healthy levels, the researchers pointed out in a journal news release.

SOURCE: Arthritis Care & Research, news release, July 11, 2011

July effect, mortality rates rise in hospitals as the new interns arrive

A new study published today in the Annals of Internal Medicine confirms the notorious "July effect" in which mortality rates rise and efficiency declines during the summer month as the new class of medical trainees enter teaching hospitals.

"Patients and physicians have suspected this, but the individual studies often offered inconclusive findings. Now we have the evidence," in an editorial wrote Dr. Paul Barach, a specialist in perioperative and emergency medicine at the University Medical Center in Utrecht, the Netherlands, and Ingrid Philibert, a top official of the Accreditation Council for Graduate Medical Education in Chicago, reports ABC News.

Researchers reviewed 39 published studies to determine whether the academic changeover when residents graduate and interns start their training actually affects patient outcomes, as many have suspected for years. They found that mortality rates did increase between 8 and 24 percent in July, according to a Time blog post.

"At year-end, teaching hospitals experience a massive exodus of highly experienced physician trainees who are also familiar with the working environment of the hospital," said study coauthor John Q. Young, MD, MPP, associate program director, residency training program at the Department of Psychiatry at University of California San Francisco School of Medicine, in a press release. "The 'July Effect' occurs when these experienced physicians are replaced by new trainees who have little clinical experience, may be inadequately supervised in their new roles, and do not yet have a working knowledge of the hospital system. It's a perfect storm."

Researchers recommend that residents have increasing autonomy based on competency, institutions develop changeover systems to avoid fatigue, and systems to prevent system disruption, such as staggered start times for trainees.

Researchers do not recommend that patients avoid care when they need it, even during July.

"Patients shouldn't delay care, but they should be aware," said Young in a Wall Street Journal article. "It's always helpful to have a family member or friend present to serve as an advocate," he said. And "know that every team does have an experienced attending" physician, he says. "You can always ask to speak with that physician."

Study authors said, "Anecdotally, we are aware of training programs that make concerted efforts to have the 'best' attending physicians on service in July or alter rounding practices to provide additional oversight for new physicians," reports The Boston Globe.

Losing Weight and Keeping It Off Require different strategies

Many dieters feel jubilant when they reach their weight goal, only to find that the pounds somehow return after that.

New research may help explain why that is so: The behaviors that help people lose weight don't overlap much with those that help them maintain their new shape, according to scientists from Penn State University.

The team investigated whether two distinct sets of thought patterns and behaviors were associated with weight loss, defined as losing 10 percent of your body weight in a year, and weight-loss maintenance, keeping that 10 percent loss off for a year.

Using a random phone survey of 1,165 adults, they found that there was little agreement between the two. Those who used a consistent exercise routine or ate plenty of low-fat sources of protein were more likely to report weight-loss maintenance, not weight loss. And those who reported doing different kinds of exercises or planning meals ahead of time, for example, were more likely to report weight loss but not weight-loss maintenance.

Therefore, the researchers concluded, diet programs may need to guide participants differently to handle each specific phase.

"They started an important discussion that probably should have occurred earlier," said Alice H. Lichtenstein, a professor of nutrition at the USDA Human Nutrition Center at Tufts University in Boston. "I think they address an important point -- whether more emphasis should be given to stabilizing weight loss than is currently given."

"When you're losing weight, it's kind of exciting. All of these neat changes are happening," added Beth Kitchin, an assistant professor of nutrition sciences at University of Alabama at Birmingham. "When we get to where we want to maintain, the mindset changes. Some struggle with adding more calories back in, and learning how to eat foods that may not have been on their diet plan."

According to study author Dr. Christopher Sciamanna, his group created the basis for their survey by recruiting and interviewing people who were successful in their weight-loss maintenance, which was defined as losing at least 30 pounds and keeping it off for at least a year.

The adults surveyed by phone were then asked about 36 strategies they might think about and do to accomplish losing the pounds and keeping them off.

Fourteen of the strategies were associated with either successful weight loss or successful maintenance, but not both, and the overlap between practices was not much higher than expected by chance, the study said.

The researchers found that strategies associated only with weight loss included participating in a diet program; looking for information about weight loss, nutrition or exercise; limiting sugar intake; planning meals beforehand; avoiding skipped meals; and thinking about how much better you feel when you are thinner.

Strategies associated only with weight-loss maintenance included eating plenty of low-fat protein; following a consistent exercise routine; rewarding yourself for sticking to your eating plan; and reminding yourself why you need to control your weight.

The study is published online July 5 and in the August print issue of the American Journal of Preventive Medicine.

Kitchin noted that the study did not prove a cause-and-effect relationship between the practices and weight loss or maintenance, though she praised the research as "a novel way of looking at it."

"We definitely need more research to look at the different methods used by people who lost weight," she said. "We need to look at different strategies to see what works over the long run. We spend so much time talking about weight loss and don't really focus on weight maintenance."

Lichtenstein, also director of the Cardiovascular Nutrition Lab at Tufts and a member of the nutrition committee of the American Heart Association, said the study offered useful information but didn't determine which behaviors will benefit individual people.

Privately insured heart patients had best treatment outcomes

Patients who had heart valve replacement surgery who were privately insured had better medical outcomes than the uninsured and Medicaid patients undergoing the same procedure, researchers said on Friday.

As a result, the type of primary insurance should be considered an independent risk factor as patients and doctors weigh risks for surgery, they concluded.

The study, published in the Journal of the American College of Surgeons, found that uninsured and Medicaid status independently increased the risk of in-hospital mortality and the likelihood of complications after the surgery. This was true even after accounting for socioeconomic status, hospital-related and other factors associated with low-income patient groups, they said.

In addition, Medicaid patients accrued the longest average hospital stay and highest total costs.

"The study findings indicate that primary payer status should be considered as an independent risk factor during preoperative patient risk evaluation," said the study's lead author, Dr. Damien LaPar of the University of Virginia Health System.

From 2007 to 2008, the number of uninsured Americans rose by 600,000. Patients covered by Medicaid and Medicare, the U.S. government assistance insurance programs, increased by 4.4 million, while the number of Americans covered by private health insurance fell by 1 million.

Previous research has shown that Medicaid and uninsured patients have worse outcomes than privately insured patients after medical admissions.

While there have been studies on insurance status as a predictor of disease and the differences in allocation of surgical treatment as a function of the type of insurance a patient has, no study has fully examined the impact of the type of insurance on patients undergoing cardiac valve procedures, nor have they been evaluated in a national database, researchers noted.

The study examined 477,932 patients undergoing heart valve operations over a six-year period using discharge data from the Nationwide Inpatient Sample database.

Patients in each payer group had different income and risk factors. After adjusting for risk factors, the type of insurance a patient had remained a highly significant predictor of mortality, they said.

Vitamin D supplements improve pancreas function

Vitamin D supplements reduced risk factors for type 2 diabetes by improving the function of insulin-producing cells in pre-diabetic volunteers, a new study has found.

"The results...suggest that vitamin D supplementation may help to improve the main defect in type 2 diabetes," co-author Dr. Anastassios Pittas, an endocrinologist at Tufts University Medical Center in Boston, told Reuters Health in an email.

Type 2 diabetes, the most common form of the disease, affects millions of Americans. The condition is characterized by high blood-sugar levels resulting from the body's poor response to insulin, a chemical that removes sugar from the bloodstream and stores it in the liver and muscles. Insulin is made by beta cells in the pancreas.

To see whether taking vitamin D would improve people's ability to handle blood sugar, researchers gave 92 pre-diabetic adults either vitamin D3 supplements, calcium supplements, both, or placebos. After four months, the participants' blood was tested for several known diabetes risk factors.

The measures included hemoglobin A1C, an indicator of blood-sugar levels over time, and beta-cell function, as reflected by how much insulin is being released and how well the body responds to it.

At the outset, participants were considered pre-diabetic if they were overweight and had blood-sugar levels that were above normal but not high enough to be classified as diabetic.

The researchers found that vitamin D significantly increased the beta-cell function of pre-diabetic adults, according to results published in the American Journal of Clinical Nutrition. The vitamin D group also had slightly more favorable hemoglobin A1C levels.

Calcium had no effect on beta-cell function, either alone or in combination with vitamin D.

Previous research has explored the connection between vitamin D and diabetes, with mixed results. Several studies have shown that people with low levels of vitamin D may be at a higher risk for diabetes, but most have been unable to demonstrate that vitamin D supplementation can help prevent diabetes.

One recent study from Iran did show that vitamin D could help control blood sugar, which in itself may stave off diabetes.

"These findings are interesting but preliminary," cautioned Dr. Susan Kirkman of the American Diabetes Association.

"Vitamin D may have a role in delaying the progression to clinical diabetes in adults at high risk of Type 2 diabetes," wrote the authors of the new study, but they agree that role has not been adequately demonstrated.

"At this point, I would not recommend vitamin D based on the results of our study for prevention of diabetes," Pittas said. However, with larger and longer studies of vitamin D's connection to diabetes currently underway, he said, a more definitive answer could be forthcoming.

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Behavioral Techniques a Better Value for Chronic Migraine Than Meds

Behavioral treatments such as relaxation training, hypnosis and biofeedback to help prevent chronic migraine headaches are cost-effective alternatives to prescription drugs, a new study suggests.

Researchers compared the costs of several types of behavioral treatment with preventive prescription drugs. After six months, minimal-contact behavioral treatment was comparable with drug treatment using medicines that cost 50 cents or less per day.

In minimal-contact treatment, a patient sees a therapist a few times a year and for the most part practices the behavioral techniques at home, helped by literature or audio tapes.

After one year, minimal-contact therapy was nearly $500 cheaper than drug treatment.

The study is published in the June issue of the journal Headache.

Initially, the daily cost of prescription drugs taken as a preventive measure by many chronic migraine sufferers may not seem too high, said study co-author Dr. Donald Penzien, a professor of psychiatry at the University of Mississippi Medical Center.

"But those costs keep adding up with additional doctor visits and more prescriptions. The cost of behavioral treatment is front-loaded. You go to a number of treatment sessions but then that's it. And the benefits last for years," he said in a medical center news release.

SOURCE: University of Mississippi Medical Center, news release, July 5, 2011

Boostrix vaccine to prevent tetanus, diphtheria, and pertussis (whooping cough) in people ages 65 and older Approved by FDA

Currently, there are vaccines approved for the prevention of tetanus and diphtheria that can be used in adults 65 and older. Boostrix, which is given as a single-dose booster shot, is the first vaccine approved to prevent all three diseases in older people.

Tetanus can cause paralysis and is caused by bacteria that live in soil, dust, and manure. The bacteria usually enter the body through a deep cut. Diphtheria is a serious bacterial infection that usually causes a bad sore throat, swollen glands, fever, and chills. If not properly diagnosed and treated, serious complications such as heart failure or paralysis can result. Pertussis is a disease that causes uncontrollable coughing; the infected person makes a noise when they breathe after coughing that sounds like “whoop.” The incidence of pertussis disease in the United States has been increasing since 2007, with large local outbreaks occurring in 2010 in California, Michigan, and Ohio.

“Pertussis is a highly contagious disease, and outbreaks have occurred among the elderly in nursing homes and hospitals,” said Karen Midthun, M.D., director of FDA's Center for Biologics Evaluation and Research. “With this approval, adults 65 and older now have the opportunity to receive a vaccine that prevents pertussis, as well as tetanus and diphtheria.”

The safety and effectiveness of Boostrix was based on a study of about 1,300 people ages 65 and older. To demonstrate its ability to protect against pertussis, the antibody levels among participants were measured and found comparable to the levels in infants who received a closely related vaccine that was shown to prevent pertussis.

The antibody responses to the tetanus and diphtheria components were compared with a licensed tetanus and diphtheria vaccine, and were found comparable. The most common adverse reactions reported by the older adults after receiving Boostrix were headache, and fatigue and pain at the injection site.

Boostrix was originally approved on May 3, 2005, for use in adolescents ages 10 years through 18 years. It subsequently was approved in December 2008, to include adults 19 years through 64 years of age. Boostrix is manufactured by GlaxoSmithKline Biologicals, based in Rixensart, Belgium.

Med schools test candidates' social skills speed-dating style

A select few medical schools are looking at whether new candidates pass the smell test, that is, whether would-be medical students have the people skills to be offered a position.

Breaking with tradition, eight medical schools, including Stanford, the University of California, Los Angeles, and the University of Cincinnati, go beyond the standard test scores and hour-long interviews to determine candidates' social skills and teamwork abilities through the speed-dating equivalent of the medical school interview, the multiple mini interview (MMI), according to the New York Times.

For instance, Virginia Tech Carilion administrators have 26 candidates read an ethical dilemma scenario and, two minutes later, the candidates switch rooms to answer a series of questions from an interviewer. The interviewer asks questions, such as whether giving patients alternative remedies is ethical or whether pediatricians should support parents who want to circumcise newborns. However, the interviewer is really looking at how the candidates respond rather than the answers.

"We are trying to weed out the students who look great on paper but haven't developed the people or communication skills we think are important," said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion, in the NYT article.

Interviewers assess if candidates jump to conclusions or are overly opinionated, which may be in indicator for poor behavior down the road.

If they perform poorly during the interview, the candidates will not be offered positions, according to Dr. Cynda Ann Johnson, the dean of the Virginia Tech Carilion School of Medicine, in the NYT article.

With preventable deaths linked to poor communication, according to Joint Commission research, there has been increasing national efforts to improve communication, as well as implement team approaches to medicine. Selecting medical students with people skills may be one way to improve care.

Mayo Clinic launches its own social networking site

Touting it as the first of its kind, Mayo Clinic last week launched its own version of a free, open social networking community.

In 2010, Mayo launched Center for Social Media to boost engagement between medical professionals and health systems, according to a Minnesota Public Radio article. The newest social networking site promises to be unlike other existing medical group or hospital online communities.

"We're not aware of other online communities like this created by a medical provider group or hospital system," states the Mayo Clinic blog.

With Mayo's 500,000 patients and 50,000 employees and students around the world, the social community is aimed at "connect[ing] patients with each other and with others interested in learning more about Mayo Clinic or a particular health interest," according to the website. It includes discussions, news articles, Mayo Clinic blog posts, and videos.

"We're pleased to now be taking the next step, creating an online site to connect the global Mayo Clinic community," states the blog. "When you're facing a health concern, sometimes, what you really need is someone who has already been there. That's what this community is all about: connecting people who have been through the Mayo Clinic experience with others facing a similar health concern."

The Mayo online community adds on to a growing list of Mayo's social media popularity. Mayo already has the most popular medical provider YouTube channel, about 200,000 Twitter followers, and 53,000 Facebook connections, according to the blog.

The DASH Diet Action Plan: Based on the National Institutes of Health Research: Dietary Approaches to Stop Hypertension

This is the user-friendly guide to the DASH diet. Proven to lower blood pressure and cholesterol without medication, it was developed in research sponsored by US National Institutes of Health, entitled, the Dietary Approaches to Stop Hypertension (DASH). Each new research study continues to prove the benefits of the DASH Diet. The DASH diet is recommended by the U.S. treatment guidelines for hypertension. The 2005 Dietary Guidelines for Americans advocate this eating plan for everyone. And the DASH diet forms the basis for the USDA MyPyramid. It is an eating plan that is rich in fruits, vegetables, low fat or nonfat dairy, is low in sodium, and includes lean meats, fish and poultry, grains, nuts and beans. The DASH diet helps lower cholesterol and supports healthy weight loss. It is flexible enough to meet the lifestyle and food preferences of most people. However, many people have found it difficult to follow the DASH diet. This is the user-friendly book, designed to make it easy to DASH. It was written by a dietitian who is experienced in helping people make sustainable changes in how they eat. Learn how to follow the DASH diet in your real life. Accommodate DASH even when eating on-the-run. Add more vegetables into your diet, even if you think you hate vegetables. Learn how to manage salt intake. Makeover your kitchen to simplify following DASH. Lose weight with the DASH diet. The book has 28 days of meal plans (with adjustments for 1200, 1600, and 2000 calorie plans), and DASH-friendly recipes. And this is the complete healthy lifestyle plan for hypertension. It includes the healthy weight loss and exercise that will lower blood pressure. Make your own personal DASH Diet Action Plan, with the specific steps to fit the DASH diet into your daily routine. Reach your goal to lower blood pressure or just having a healthier lifestyle. Purchasing this book is your first step in improving your health for the long run.
About the Author
Marla Heller is a Registered Dietitian, holding a Master of Science in Human Nutrition and Dietetics from the University of Illinois at Chicago (UIC) where she completed course work towards a PhD in Behavior Sciences and Health Promotion. She is experienced in a wide variety of nutrition counseling specialties. She has been an adjunct clinical instructor in the Department of Human Nutrition and Dietetics at UIC, and also taught at Dominican University, National-Louis University, and the Cooking and Hospitality Institute of Chicago. In addition to The DASH Diet Action Plan, Marla contributed the 4-week menu plan for Win the Weight Game by Sarah, the Duchess of York, and wrote the healthy eating chapter in "I Always Start My Diet on Mondays!" by Janice Alpert. She has been a spokesperson for the Greater Midwest Affiliate of the American Heart Association and is a Past-President of the Illinois Dietetic Association. Marla was diagnosed with high blood pressure in May of 2003. Since that time she has managed to lower her blood pressure by following the DASH diet, and incorporating the other lifestyle changes to support reaching and maintaining healthy blood pressure. Marla lives the program that is featured in her book, The DASH Diet Action Plan.

• Paperback: 224 pages
• Publisher: Amidon Press; 1 edition (March 20, 2007)
• Language: English
• ISBN-10: 097634081X
• ISBN-13: 978-0976340812
• Product Dimensions: 8.8 x 5.9 x 0.6 inches

Smoking during pregnancy cuts child's good cholesterol

Mothers who smoke while pregnant are causing changes to their unborn babies that can lead them to have less of a type of cholesterol known to protect against heart disease, scientists said on Tuesday.

In a study in the European Heart Journal, Australian researchers found that by the age of eight, children born to mothers who smoked in pregnancy had lower levels of HDL cholesterol, at around 1.3 millimoles per liter (mmol/L), than those born to mothers who hadn't smoked, with about 1.5 mmol/L.

High-density lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol and is known to play an important role in protecting against atherosclerosis, where fatty materials collect along the walls of arteries, thickening and eventually blocking them, leading to heart problems and heart attacks.

"Our results suggest that maternal smoking 'imprints' an unhealthy set of characteristics on children while they are developing in the womb, which may well predispose them to later heart attack and stroke," said David Celermajer, a professor of cardiology at the University of Sydney.

"This imprinting seems to last for at least eight years and probably a lot longer," he said, adding that the heart disease risk for smokers' children could be 10 to 15 percent higher.

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Annual Limits Policy will be OFF LIMITS in 2014 according to Obamacare

n 2014, the Affordable Care Act will ensure all Americans have access to high-quality, affordable, and comprehensive health insurance plans that cannot include lifetime or annual dollar limits on benefits.

To implement the ban on restrictive annual limits before 2014, most insurance plans began phasing out their annual limits in September 2010. Millions of Americans are now in plans that cannot impose annual limits below $750,000, and that limit will increase in the coming years until 2014 when no annual dollar limits will be permitted for non-grandfathered plans. The law also restricts the sale of new plans with low annual limits except under very limited circumstances.

Protecting Worker’s Coverage

A small number of workers and individuals only have access to limited benefit, or “mini-med,” plans with lower annual limits than are generally permitted by law and which can provide very limited protection from high health care costs. Employers and insurers estimated that requiring mini-med plans to comply with the new rules could cause mini-med premiums to increase significantly, forcing employers to drop coverage and leaving some workers without even the minimal insurance coverage they have today.

In order to protect coverage for workers in mini-med plans until more affordable and more valuable coverage is available in 2014, the law and regulations issued on annual limits allow the Department of Health and Human Services (HHS) to grant temporary waivers from this one provision of the law that phases out annual limits if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. Plans that receive waivers must comply with all other provisions of the law and must alert consumers that the plan has restrictive coverage and includes low annual limits. Additionally, these waivers are temporary and after 2014, no waivers of the annual limit provision are allowed.

On June 17, 2011, the Centers for Medicare & Medicaid Services (CMS) introduced a process for plans that have already received waivers and want to renew those waivers for plan or policy years beginning before January 1, 2014. The new guidance extends the duration of waivers that have been granted through 2013, if applicants submit annual information about their plan and comply with requirements to ensure that their enrollees understand the limits of their coverage. Existing waiver recipients must apply to extend their current waiver and all applications must be submitted by September 22, 2011; after that date applications for an extension will no longer be considered. Any plans that have not yet applied for a waiver also must apply by September 22, 2011.

Plans with low annual limits (e.g., $10,000) are most likely to need waivers to prevent a significant increase in premiums or decrease in access to coverage to comply with the current limit of $750,000. Many of these plans have already received a waiver. Plans with higher annual limits are less likely to qualify for a waiver because complying with the new rules is unlikely to lead to a significant increase in premiums or decrease in access to care. Still, the policy announced today gives all plans and issuers with restricted annual limits below $2 million a reasonable opportunity to apply for a waiver.

Increasing Transparency for Consumers

The Affordable Care Act includes consumer protections that that will require plans, particularly mini-med plans, to give consumers more information about their health insurance plans. Health insurers offering mini-med plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options.

The new guidance issued on June 17, 2011 imposes more stringent disclosure requirements and requires a new version of this consumer notice that will make the information easier for families to understand. Health plans with waivers must tell consumers that their health care coverage is subject to an annual dollar limit that is lower than what is required under the law. Specifically, the yearly notice must include the dollar amount of the annual limit along with a description of the plan benefits to which the limit applies. Plans must illustrate how the annual limit would impact a consumer who was hospitalized, so families can understand how far their coverage will reach if they become seriously ill. To do so, the updated model notice compares a policy’s annual limit with examples demonstrating the average cost of night’s stay in the hospital. Plans with waivers must attest annually to their compliance with the consumer disclosure requirement.

Phasing Out Annual Dollar Limits

Until annual dollar limits are banned for non-grandfathered plans beginning in 2014, insurers and plans must phase out the use of annual dollar limits on essential health benefits. Today, most plans cannot impose an annual limit that is less than $750,000. That limit will increase to $1.25 million for plan years starting after September 23, 2011 and to $2.0 million for plan years starting after September 23, 2012. No annual dollar limits are permitted with respect to plan or policy years beginning on or after January 1, 2014, except in the case of grandfathered individual market policies.

On September 3, 2010, HHS issued the original guidance laying out the waiver process requiring

plans to demonstrate that complying with a $750,000 annual limit would cause a significant increase in premiums or a significant decrease in access to benefits. This process has ensured that 3.1 million Americans – about 2 percent of people with private insurance – have been able to keep their health coverage during the transition to 2014. The new guidance extends the duration of waivers through 2013, if applicants submit annual information about their plan and comply with disclosure requirements. Existing waiver recipients may apply for an extension of their current waiver, and all applications must be submitted by September 22, 2011. After September 22, 2011, no application for extension will be considered.

Some existing plans have annual limits above $750,000, but below $2 million. Actuarial analysis suggests that plans can meet the increased annual limit of $1.25 million with just minimal premium increases (less than one percent). Similarly, increasing annual limits from $1.25 million to $2 million the following year will have a small impact on premiums. It is therefore unlikely that these plans will qualify for a waiver to comply with the annual limit policy. However, if the circumstances of a particular plan indicate that it will need a waiver from these requirements to prevent a significant increase in premiums or decrease in benefits, the plan can apply for a waiver before September 22, 2011.