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January 2000

Regular 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 Public Health.

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.

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Hormone 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 findings.

"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 Baltimore, Maryland.

"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.

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Study 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 smoking.

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 restlessness.

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 own.''

Nicotine & Tobacco Research (1999;1: 317-324)

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Milk Thistle for Liver Problems

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 Austin, Texas.

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 hangovers.

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."

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Too Much 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 note.

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.

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Every 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 intercourse.''

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 71.

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.

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Waist size 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 cancer.

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.

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Unhealthy 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 healthy (6.6).

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 influenza.

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.

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