Exercise Protects Women From Diabetes
December 31, 1999
Postmenopausal women who exercise regularly are about half as likely to
develop diabetes as their more sedentary counterparts, study results show.
The findings suggest that "up to 8% of cases of diabetes in inactive older women
might be prevented if they began regular physical activity,'' according to Dr. Aaron
Folsom and colleagues from the University of Minnesota in Minneapolis.
Even more cases of diabetes might be prevented, they add, if overweight women took off
pounds as a result of increased activity.
In 1986, Folsom and his colleagues mailed a questionnaire to more than 41,000 older women,
ages of 55 to 69, to study the effect of physical activity on their risk of developing
diabetes over the next 12 years. Women who regularly engaged in any physical activity were
31% less likely to develop diabetes during the study period than women who did not
exercise regularly, the team reports in the January issue of the American Journal of
Women who exercised moderately or vigorously more than four times per week had half the
risk of diabetes compared with women who never or rarely exercised moderately or
vigorously. This finding that exercise need not be vigorous is particularly
important for older women to know, Folsom's group says, since many older women are not
used to participating in sports.
The researchers found that the protective effect of regular physical activity was not as
strong in women who were overweight. They explain that weight gain is an important
contributor to the development of diabetes at least 80% of adults who develop
diabetes are overweight.
SOURCE: American Journal of Public Health 2000;90:134-138.
Replacement Theray Advice Urged For Low-Income, Black Women
December 21, 1999
Only one in five low-income African-American women use potentially bone-
and heart-saving hormone replacement therapy (HRT) after menopause, according to new study
"Women are significantly more likely to use hormone replacement therapy if their
healthcare provider has discussed the therapy with them," said lead researcher
Jerilyn K. Allen, an associate professor at Johns Hopkins University School of Nursing in
"African-American women are at greater risk for cardiovascular disease and other
health problems that HRT might be able to prevent," Allen said in a Johns Hopkins
statement. Other studies have shown that postmenopausal women who use HRT may reduce their
risk of developing heart disease by 20% to 50%.
"It is important for healthcare providers to consider the impact of HRT on heart
disease risk reduction in this vulnerable population," Allen said. "This study
and previous ones show low-income African-American women lack knowledge about menopause,
but have a high interest in learning more about it. It is our job as (healthcare)
providers to teach them," she added.
The study, published in the December issue of Women's Health Issues, examined what factors
were associated with use of HRT in low-income urban women. It found that less than half of
the 215 women in the study knew that the risk of heart disease increases after menopause.
However, those who knew more about menopause were 31% more likely to be using HRT. Women
who had been under the care of a physician for a hysterectomy were nearly three times more
likely to be taking HRT.
"Information about menopause needs to be provided by anyone who is delivering
healthcare to women," Allen said. "This type of education is not just a
gynecologist's role; it is the responsibility of all healthcare providers. Women cannot
make educated decisions unless they have the proper information," she added.
Allen said that information about HRT and menopause should be available at places in the
community that low-income women visit, such as churches, neighborhood community centers,
and beauty parlors.
SOURCE: Women's Health Issues 1999;9.
Finds It's Harder For Women To Quit Smoking
December 20, 1999
New findings might help explain why women have a harder time quitting
smoking than men. Apparently women tend to become more psychologically dependent on
According to a study led by Thomas Eissenberg, of Virginia Commonwealth University's
Department of Psychology and Institute for Drug and Alcohol Studies (http://www.vcu.edu,
in Richmond, women find greater relief than men from withdrawal symptoms of smoking,
including restlessness and difficulty concentrating.
The study, sponsored by the National Institute on Drug Abuse (www.nida.nih.gov), looked at
the subjective and physiological effects of smoking on a group of men and women who were
experienced with tobacco products. Findings are reported in the December issue of Nicotine
& Tobacco Research (www.srnt.org).
Physiologically, men and women experienced similar effects of smoking, including increased
heart rate and blood pressure and a decrease in skin temperature. These effects are
usually attributed to the nicotine in cigarettes.
Subjectively, however, smoking had a more profound effect on women, and it may be harder
for them to quit. After each of the two cigarettes that subjects smoked in the study,
women reported that their desire to smoke was decreased compared with men, and their
relief from withdrawal symptoms decreased significantly more than their male counterparts.
This means that women may be getting more relief and feelings of satisfaction from smoking
than men, which helps to explain why past studies have shown that women have more
difficulty quitting smoking.
The most common withdrawal symptoms that differed in ratings substantially between men and
women were the desire to smoke, the urge to smoke, difficulty concentrating and
Eissenberg commented on the findings: ``It's a little-known fact that soon after smokers
have had a cigarette, their reports' of various withdrawal symptoms will start to
increase.'' Eissenberg reported that these effects are sometimes evident as soon as 10 or
15 minutes after smoking a cigarette.
Another curious finding in the study was that compared to men, women take shorter, smaller
puffs when smoking. There is no evidence, however, that this means female smokers receive
less nicotine than their male counterparts.
``I'd certainly be able to entertain the hypothesis that women were receiving less
nicotine, and that would mean that they have a lower level of physical effects as far as
the response of the body to repeated administrations of the drug,'' said Eissenberg. ``But
that doesn't mean that their psychological dependence is less. In fact, it may be more.''
Eissenberg added: ``It seems to me and it's going to take more work that this study might
be telling us that the response to nicotine is the same for men and women, but there are
some other effects of smoking to which women are more sensitive.''
Dr. Sheila B. Blume, clinical professor of psychiatry at the State University of New York
at Stony Brook, said she was ``delighted that the research is going on in this area. When
I started in this field in 1962,'' she explained, ``we had no idea how addiction worked at
all. But now, due to modern methods of neuroscience, it's understood that addictive
substances share a final common pathway to the brain, probably to the part that nature put
there or that evolved there to assure that we repeat the kinds of behaviors that keep us
alive, such as finding food and water, and that give us a kind of pleasure.'' Substances
such as nicotine stimulate this same area of the brain, said Blume.
Eissenberg said that further study on the topic is needed. He added that he hopes to see
enhancements of the popular nicotine replacement products, such as patches, gum, sprays
and inhalers. Eissenberg emphasized that relapse prevention is another key area to address
when researching the best ways to help people quit smoking.
Blume, too, stressed the significance of quitting smoking and added that due to its
obvious addictive effect, it should be done with medical or group support assistance:
``When women are ready to quit, they should get some help with it. Don't try it on your
Nicotine & Tobacco Research (1999;1: 317-324)
Milk Thistle for Liver
If you've got liver problems, maybe even chronic inflammatory liver
disease, you might want to talk with your doctor about milk thistle.
This purple, prickly herb with small, hard fruits is described by U.S. herbal expert Varro
E. Tyler as "an undeniable giant in the field of liver-supportive herbs."
Milk thistle binds to the liver's surface so that poisons can't enter, according to the
magazine Better Nutrition. It also is said to stimulate production of a compound that
prompts liver cell regeneration. In the magazine Prevention, Tyler reports that the herb
also acts as an antioxidant, scavenging toxic radicals.
Milk thistle grows in the United States and Europe. "It has milky white lines on its
leaves," says Kara Dinda, director of education for the American Botanical Council in
In use in biblical times, the herb was long offered as a folk remedy in Europe, primarily
as a liver tonic. Today the drug -- still used more extensively in Europe than in the
United States -- is even given intravenously, Dinda says, for more serious conditions like
cirrhosis and liver cancers.
Consumer Reports lists milk thistle as an "herb that can help" and reports that
human trials of the herb have been called "encouraging."
The Journal of Hepatology recently reported great successes for patients who took extracts
of milk thistle daily, compared with those who had taken a placebo.
The herb has other uses, as well, experts say. In Europe, those who have eaten poisonous
mushrooms, deadly amanitas, survive because of injections made from the seeds of milk
thistle, Dinda says.
And one of the more practical applications in Europe, she adds, has been in preventing
The herb is known to help the liver operate more productively, perhaps enabling it to
process alcohol better, according to Dr. Mary Hardy, medical director of the Integrative
Medicine Medical Group at Cedars-Sinai Medical Center in Los Angeles.
What To Do
This is an appealing herb, especially if you have liver problems. But nothing at all is
known about how the herb affects pregnant or lactating women, and in any case, you'll want
to consult your doctor before you attempt any sort of treatment. "Herbs produce
chemicals," says Erica Kipp, manager of the Plant Research Laboratory for the New
York Botanical Garden. "I think people have the misconception that anything from a
plant is natural and good and benign -- and this is not necessarily the case."
Alcohol Can Lead to Kidney Failure
December 23, 1999
Moderate drinking may have health benefits, but drinking more than a
couple of drinks a day may increase the risk of kidney failure, according to the results
of a new study.
Several factors -- such as high blood pressure, diabetes and exposure to some chemicals --
are known to increase the risk of kidney failure, but the cause of the disease often
remains unknown, according to a report in the current issue of the American Journal of
Epidemiology. While some research has found that alcohol increases the risk of kidney
failure in people with certain diseases, it has not been clear whether drinking is linked
with kidney disease in the general population, according to Dr. Thomas V. Perneger, of the
Johns Hopkins University in Baltimore, Maryland, and colleagues.
To test the connection between drinking and kidney disease, Perneger's team compared the
drinking habits of 716 kidney failure patients with those of a 'control' group of 361
people without kidney disease.
The risk of kidney failure was four times greater in people who drank more than two
alcoholic beverages each day, the investigators report. Assuming that the results are
accurate, the authors predict that the risk of kidney failure could be reduced by as much
as 9% if those at risk stopped drinking more than two alcoholic beverages a day.
There are several potential reasons why too much drinking may be bad for the kidneys,
according to Perneger and his colleagues. Excessive drinking may lead to or cause a number
of health problems to worsen, such as high blood pressure and diabetes. Also, alcohol or
substances in alcoholic beverages may somehow be toxic to the kidney, the researchers
But the findings do not necessarily mean that teetotalers are at lowest risk for kidney
disease. In fact, moderate alcohol (two or fewer drinks a day) appeared to offer some
protection against kidney failure. Although the researchers cannot prove that moderate
drinking is the reason for the reduced risk, they speculate that alcohol's effects on
blood fats and blood clotting may account for the benefits.
SOURCE: American Journal of Epidemiology 1999;150:1275-1281.
Cigarette Takes 11 Minutes Off Man's Life
December 31, 1999
Male smokers are robbed of an average of 11 minutes of lifespan with each
cigarette smoked, UK researchers estimate.
Smokers could be missing out on a lot of living, they say, pointing out that 11 minutes is
enough for a phone call to a friend, a healthy walk, or a bout of ``fairly frantic sexual
Dr. Mary Shaw and colleagues, from the University of Bristol in England, based the
estimate on data from a survey of British households. They calculated that the typical
male smoker ``will consume a total of 311,688 cigarettes'' from age 17 until death at age
In a separate analysis, they found that a lifetime of smoking reduces the lifespan of the
average male smoker by 6.5 years, compared with non-smokers. This means, the research team
writes, that ``each cigarette has cost him, on average, 11 minutes of life.''
Eliminating a full carton of cigarettes would buy the smoker an extra day and a half of
life enough time to fly round the world, take in a Wagner opera, or enjoy a
``romantic night away,'' the researchers say.
SOURCE: British Medical Journal 2000;320:53.
linked to breast cancer risk
December 22, 1999
Women with apple-shaped bodies may be more likely to develop breast cancer
than their pear-shaped counterparts, a new study suggests.
The new study of 47,382 nurses, which appears in this month's issue of the American
Journal of Epidemiology, found that women who are heaviest around the middle are 34% more
likely to develop breast cancer than women with hour-glass figures.
When Zhiping Huang of Harvard School of Public Health in Boston and colleagues limited
their analysis to study breast cancer risk among postmenopausal women who had never taken
hormone replacement therapy (HRT), the risk was even higher, with larger-waisted women
appearing to be 88% more likely to develop breast cancer than smaller-waisted women. While
HRT use can reduce the risks of heart disease and the bone-thinning disease osteoporosis,
it can increase the risk of breast cancer, regardless of waist size.
Exactly why fat distribution affects breast cancer risk is not fully understood. But
perhaps, the researchers, speculate, upper or central body fat is deeper and may be closer
to the important organs and glands that regulate hormone balance than fat in the other
areas of the body. These hormonal changes may be responsible for the increased risk of the
Taking supplemental hormones further raises hormone levels and may somehow modify the
relationship between fat and breast cancer, the researchers suggest.
The women in the new study reported their waist and hip circumferences in 1985 and were
followed through May 1994. In that time, 1,037 of the women developed breast cancer, the
study authors report.
"In conclusion, we found that waist circumference to be associated with a moderately
increased risk of breast cancer, especially among postmenopausal women who have never
received hormone replacement therapy," Huang and colleagues conclude.
SOURCE: American Journal of Epidemiology 1999;150:1316-1324.
Mind, Unhealthy Body: The Power Of Negative Thoughts
December 20, 1999
To assess a diabetic's risk of heart disease, a doctor typically takes a
blood sample to look for biochemical telltales such as the level of insulin.
The traditional method certainly does not involve sitting the patient down on a
psychiatrist's couch to see if a glass of water looks half empty or half full.
The latter technique may, however, turn out to be as much to the point as blood tests,
because some new research suggests that depressed diabetics are, quite literally, prone to
getting their hearts broken.
This study, which is to be published in January's "Atherosclerosis" by Trevor
Orchard, an epidemiologist at the University of Pittsburgh, is one piece of a mosaic that
psychologists and epidemiologists have been fitting together over the past few years.
Another piece is an answer to the question of why depressed people seem particularly
susceptible to infection.
The picture that is emerging as the pieces fit together suggests that the old tag "a
healthy mind in a healthy body" frequently needs to be inverted.
An unhealthy mind can lead directly to an unhealthy body - and therefore another old
medical tag "treat the patient, not the disease" takes on a new significance.
Dr. Orchard explored this interaction between mind and body using data collected during
the Pittsburgh Epidemiology of Diabetes Complications Study, which was designed to
identify those factors that worsen the health of people already suffering from diabetes.
In "juvenile-onset" (type-I) diabetes, these complications can be as deadly as
the ailment itself. Type-I diabetics cannot produce insulin - a hormone which regulates
the level of sugar in the blood. They must therefore inject themselves with insulin at
regular intervals or else risk coma or sudden death.
And, as if this were not sobering enough, type-I diabetics also have a tendency to suffer
from early and severe arteriosclerosis, a condition in which the walls of the blood
vessels thicken and harden.
Arteriosclerosis of the coronary arteries is particularly dangerous, for these vessels
supply blood to the muscle of the heart. As the coronary-artery walls narrow, the flow of
nutrients and oxygen to the heart slows, and coronary heart disease (CHD) follows.
Dr. Orchard's analysis involved more than 600 diabetics, who were examined at two-year
intervals over six years.
In addition to undergoing the usual physiological tests, the participants were also
evaluated at the beginning of the study by the "Beck Depression Inventory." This
test rates individual symptoms of depression (such as pessimism, suicidal ideas, social
withdrawal and loss of libido).
The more depressed a patient is, the more points he accumulates. A patient's score on the
Beck scale turned out to be a good predictor of his eventual level of CHD - better,
indeed, than high levels of blood sugar, the standard symptom of diabetic disorder.
Those without CHD scored significantly lower than those with it. And patients who
developed angina, a painful heart condition resulting from arteriosclerosis, had
depression scores that were nearly twice as high (12.2) as diabetics whose hearts stayed
Diabetics, of course, whether depressed or not, are seriously ill people. But it has been
known for a long time that people with no serious illness other than depression are more
likely to die than those who are otherwise similar, but mentally healthy.
Many of their causes of death have some visible connection with their disease - suicide,
violent accidents and drug abuse are high on the list. But depressed patients also die
more often than the mentally healthy from "natural" causes such as pneumonia and
The question of why severely depressed patients suffer from infections more often than the
average person attracted the attention of Gregory Miller, a psychologist at Carnegie
Mellon University, also in Pittsburgh.
In a normal body, infectious organisms are met by a battalion of cells known as
lymphocytes. Some of these attack the invaders directly. Others produce antibodies that
gum them up. But the immune systems of the severely depressed tend to mount a weaker
counterattack than those of the mentally fit.
Dr. Miller and his colleagues think they have the explanation for this immunological
apathy. In the past, studies relating mental depression to depression of the immune system
have usually been performed on patients stuck in hospital. This complicates matters,
because the mere fact of being in a hospital affects a patient's mood and behavior.
Instead, Dr. Miller studied 32 depressed women who were not in hospital, and matched them
with a control group of healthy women. As he reports in the latest issue of
"Psychosomatic Medicine," lymphocytes from the depressed women responded much
less than those from the normal women when exposed to agents that induce proliferation.
One explanation for this relies on the observation that depression is often accompanied by
a hormonal imbalance in the brain. The disease is associated with abnormal levels of
norepinephrine and estradiol, hormones that are known to help regulate the immune system.
Dr. Miller's results, however, showed that this biochemical difference could not, by
itself, account for the weakness of the responses shown to infection by the depressed
women. There must be something else involved.
When he and his colleagues started examining the women in question, they found that the
depressed subjects had very different ways of life from the controls. They smoked more,
drank more caffeinated drinks, slept more fitfully, and exercised less.
But, perhaps surprisingly, only one of these differences, that in physical activity,
proved to have a significant relationship with lymphocyte production. Dr. Miller found
that physical activity accounted for about half of the difference in immunity between
depressed and normal women.
He believes that exercise represents the first clear behavioral link between depression
and a dysfunctional immune system.
If that speculation proves correct, encouraging depressed people to exercise should help
to protect them from illness - and the strange correlations between depression, pneumonia
and influenza may finally make some sense.