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January 1999

Have a healthy New Year: Realistic goals you can reach in 1999
December 31, 1998

Instead of the usual New Year's resolutions such as "fit into a size 6 dress" or "work out every day," consider taking a few smaller steps toward better health in 1999. CBS News Health Correspondent Dr. Emily Senay suggests New Year's goals that can lead you toward a healthier lifestyle.

Reduce Stress

For many people, the holiday season is one of the most stressful times of year. The danger of high stress is that it can weaken the immune system, making the body vulnerable to colds or more serious illnesses.

To help alleviate stress, you can:

Set realistic goals. Make a list of things you want to accomplish, and keep it to the most important goals. If the list overwhelms you, scratch off the least important ones.

Get exercise when you feel tense. Even just walking around is helpful.

As many stress experts say, "breathe." Take eight seconds to inhale, hold for eight seconds, and exhale slowly for eight seconds. Repeat until you feel the stress slip away.

Avoid caffeine. Studies have shown that caffeine can increase stress hormones. Limit your intake to one cup of coffee or other caffeinated beverage in the morning.

Get More Folic Acid

While you can't change your genes, you can reduce your risk for certain diseases by watching what you eat. Folic acid, also called folate or Vitamin B9, can be found naturally in many foods.

The federal government now requires that all breads be fortified with folic acid because it reduces the chance of babies in the womb developing neural tube defects such as spina bifida. Pregnant women can avoid this by eating foods rich in folic acid.

For women of childbearing years, eating fortified foods may not be enough. They should consult their doctor about taking a 400 mg supplement daily. Research shows that folic acid may help reduce the risk of heart disease in older people, too.

You can get more folic acid from the following foods:

Vegetables such as spinach, broccoli, turnip greens, and asparagus

Green peas, black beans, navy beans, soybeans, black-eyed peas, nuts, and sunflower seeds

Chicken or beef liver

Breads and many cereals and pastas are fortified with folic acid

Get More Sleep

Not getting enough sleep can lead to poor health, says Dr. Senay. Like stress, it weakens the immune system, which can lead to colds and other illnesses.

Sleep deprivation can also interfere with a person's ability to think clearly, and can cause irritability.

If you find yourself falling asleep at inappropriate times, or you find it easy to take a nap, you may be one of the millions of Americans who are not getting enough sleep.

Dr. Senay recommends taking the following steps to help remedy the problem:

Try to go to bed and get up at the same time every day.

Adopt a routine that helps you wind down before you go to bed.

Use your bedroom for only two things -- sleep and sex.

Avoid caffeine, and don't use alcohol to help you fall asleep. Alcohol may seem to help at first, but it disturbs your overall sleep patterns.

Get More Calcium

Calcium is a key nutrient everyone needs for better health. It helps keep your bones strong, and it may guard against cancer and help your heart as well.

Why is calcium so vital for your health? We know it helps prevent osteoporosis, or brittle bone disease, in both women and men. Recent research has found that calcium can also help control or prevent the symptoms of pre-menstrual syndrome. Another study found that men who ate a diet high in calcium had a reduced risk of colon cancer.

Ideally, you should get all the calcium you need from your food, but consult your doctor about taking a supplement, especially if your are over 50 or post-menopausal.

You can find calcium in:

milk and dairy products

vegetables such as broccoli and spinach

tofu, black beans, kidney beans, and almonds

canned sardines or salmon with bones

some brands of orange juice are fortified with calcium

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Hepatitis B prevalent in US despite vaccine
December 31, 1998

Although the hepatitis B vaccine has been available since 1981, hepatitis B infection remained as prevalent in the US in the early 1990s as it was in the early 1980s, according to a report in the January issue of the American Journal of Public Health, a journal of the American Public Health Association.

Dr. Geraldine M. McQuillan and colleagues with the Centers for Disease Control and Prevention (CDC) explain this finding by the fact that widespread vaccination programs were not launched until the early to mid-1990s.

For the last two decades, an estimated 200,000 to 300,000 people in the US have contracted the hepatitis B virus annually. The virus is associated with inflammation of the liver and an increased risk of liver cancer. It can be transmitted via blood transfusions, sex, and contaminated needles.

The CDC researchers analyzed data from the National Health and Nutrition Examination Survey II (NHANES II), which was conducted between 1976 and 1980, and NHANES III conducted between 1988 and 1994. NHANES II included more than 28,000 people in the US, while NHANES III included an estimated 40,000. The survey design includes the results of blood tests for hepatitis B.

The overall prevalence of hepatitis B infection did not change significantly between NHANES II, when it was 5.5%, and NHANES III, when the prevalence was 4.9%, the researchers determined.

In both surveys, the prevalence of hepatitis B was low until age 12, when it increased significantly. In addition, prevalence was higher than average among those who had multiple sex partners, those who began having sex at an early age, cocaine users, and men who had sex with men, McQuillan and colleagues report.

"In both surveys and in all racial/ethnic groups, the prevalence of hepatitis B virus infection did not begin to increase until puberty, suggesting that sexual transmission is the primary mode of spread in the United States," they explain.

In light of this finding, it is "not surprising" that the prevalence of hepatitis B infection did not decline between the early 1980s and the early 1990s, they add. Although a Hepatitis B vaccine was first licensed in the US in 1981, federal hepatitis B vaccination programs for infants did not begin until late 1992, and programs for adolescents did not start until 1995.

Vaccination of healthcare workers and others with work-related risks of infection began in 1981, but did not become widespread until 1991, according to the CDC researchers.

"Data from NHANES demonstrate that children have a low but appreciable risk of hepatitis B virus infection that increases significantly at adolescence, presumably with the onset of sexual activity and other high-risk behaviors; this supports the need to routinely vaccinate," McQuillan and co-authors conclude. "Future NHANES should provide a means to evaluate the age-specific effect of hepatitis B immunization on infection prevalence."

SOURCE: American Journal of Public Health 1999;89:14-18.

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Drawbacks to aspirin, but benefits outweight the risks
December 23, 1998

One of the most interesting realizations of the past decade has been that aspirin yup, plain old aspirin, is truly a miracle drug. But even miracle drugs have a downside.

It's been known for many years that aspirin "thins out" the blood, reducing its ability to clot. That explains its wondrous capacity for reducing the risk for ischemic strokes, in which arterial blockage deprives the brain of blood flow and oxygen. But aspirin's great effect on the blood has a drawback: a recently published study found that it increases the risk for a brain hemorrhage leading to another kind of stroke. Are its pluses and minuses a draw? Not really, say the experts - and Johns Hopkins professor of medicine Dr. Michael Klag agrees.

"We now know that increased risk is about an 80 percent increased incidence of hemorrhagic stroke," says Klag. "However, the risk of a man, for example, who's fifty having a heart attack or an ischemic stroke is so much greater, that the benefits of aspirin outweigh the risks in groups like we have here in the U.S."

In other words, says Klag, if you're taking aspirin to reduce the risk for heart trouble, there's no reason to stop.

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DHEA ups survival in men with sepsis
December 31, 1998

Following severe injury-induced blood loss, male sex hormones appear to depress immune function, leaving men at increased risk of life-threatening infection, or "sepsis." But giving men the hormone dehydroepiandrosterone (DHEA) after injury may restore immune function, lowering their risk of sepsis and increasing their odds of survival, researchers report in the December issue of the Archives of Surgery.

"Our study indicates that administration of DHEA after hemorrhagic shock restores the depressed immune functions and improves survival from subsequent sepsis," according to Dr. Martin K. Angele and colleagues at Brown University School of Medicine in Providence, Rhode Island.

"Since short-term therapy with the steroid hormone DHEA has no adverse effects, administration of this inexpensive agent in male patients should be considered a novel and useful adjunct for the treatment of immune dysfunction encountered in trauma patients," the investigators write.

Several previous studies had found that, in men who were resuscitated after suffering traumatic injury and hemorrhagic shock, certain immune responses remained depressed for as long as 10 days. These men also had "an increased susceptibility to and mortality due to subsequent sepsis," the authors explain.

Results of earlier animal studies have suggested that male sex hormones play a role in suppressing immune function after trauma-induced blood loss. In one study, administration of flutamide -- a substance that blocks the effects of testosterone -- restored depressed immune responses and improved survival rates in animals who developed sepsis after severe injury.

To determine what effect DHEA -- the most abundant steroid in the bloodstream -- might have on risk of sepsis and survival after trauma and hemorrhagic shock, Angele and colleagues performed a series of experiments on anesthetized male mice.

The researchers induced hemorrhagic shock in the animals, followed by sepsis.

Mice treated with DHEA for 3 days after the procedure had the strongest immune function and highest survival rates, followed by mice given a single dose of DHEA, Angele and colleagues report. Mice that did not receive DHEA had the highest rates of sepsis, and the lowest survival rates.

"The finding that DHEA markedly improves the depressed immune functions and survival of animals subjected to subsequent sepsis suggests that short-term treatment with DHEA after trauma-hemorrhage is a safe and novel approach for preventing immunodepression and for decreasing the mortality rate due to subsequent sepsis," the authors conclude.

SOURCE: Archives of Surgery 1998;133:1281-1288.

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High homocysteine levels dangerous for elderly
December 30, 1998

High levels of the amino acid homocysteine, put elderly men at increased risk for heart attack and stroke, according to the results of a study of nearly 900 men.

Studies have previously linked high homocysteine levels to vascular disease in the young and middle-aged. This report, published in Arteriosclerosis, Thrombosis and Vascular Biology, the journal of the American Heart Association, is the first to focus on the elderly.

The study authors, led by Dr. Coen D.A. Stehouwer, of the National Institute of Public Health and the Environment in Bilthoven, the Netherlands, measured homocysteine levels of study subjects on two occasions, 10 years apart.

At the start of the study, the participants ranged in age from 64 to 84. Those with higher homocysteine levels were more likely to have experienced heart attack or stroke.

During the 10-year follow-up, high levels of the amino acid were ``associated with a modest, borderline significant increase in the risk of dying of coronary heart disease and, in (non-hypertensive) subjects, with a large increase in the risk of fatal cerebrovascular disease and a nonsignificant increase in the risk of first-ever stroke,'' the authors write.

Study participants with high blood pressure had a higher likelihood of experiencing strokes, but high homocysteine levels did not seem to increase their risk.

High homocysteine levels are extremely common in the elderly, according the study authors. This amino acid is thought to contribute both to the thickening of arteries, and the impairment of their ability to dilate.

Homocysteine levels depend on genetics and nutrition, decreasing with greater intake of folic acid and other B vitamins, and increasing after meat and dairy consumption.

``Because high homocysteine levels can be reduced by simple treatment with folic acid and vitamin B-6 even in the absence of deficiencies of these vitamins,'' the study authors comment, ''studies are now needed of the effect of treatment with these vitamins and with vitamin B-12 on cardiovascular disease not only among the middle-aged, but also in the elderly.''

SOURCE: Arteriosclerosis, Thrombosis, and Vascular Biology 1998;18:1895-1901.

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Fiber can be first-line treatment for high cholesterol
December 23, 1998

Adding oat bran or another type of fiber known as psyllium to your diet may help lower levels of harmful cholesterol, a new study from Mexico suggests.

But don't think that eating a few bran muffins for breakfast will neutralize the effect of a burger and fries at lunch. Besides eating cookies fortified with fiber, all of the men in the study reduced the amount of fat in their diets.

In the study, 66 men ages 20 to 45 consumed cookies containing one of three types of fiber: oat bran, psyllium or wheat bran, according to the study in the December issue of the Journal of the American College of Nutrition.

At the end of eight weeks, those who ate the oat bran cookies reduced their LDL, or "bad," cholesterol levels by an average of 26 percent, the study showed. And those in the psyllium group experienced a nearly 23-percent drop in levels of the fatty substances, which are believed to increase the risk of heart disease.

In contrast, a control group of men who ate cookies made with wheat bran _ which is not believed to reduce cholesterol levels _ experienced a drop of slightly more than 8 percent, reported a team of researchers led by Maria Luz Fernandez, a nutritionist at the University of Connecticut in Storrs.

The study is good news for people who are trying to lower their cholesterol levels, according to a California expert.

For many people, oat bran and psyllium "may well be the first line of defense before we go to cholesterol-lowering drugs," commented Jo Ann Hattner, a clinical nutritionist at Stanford University Medical Center in Palo Alto. Although some people do need medication to reduce cholesterol, oat bran and psyllium are "definitely worth a trial."

The men in the study consumed 2.6 grams of oat bran a day, which is easy to obtain from food, Hattner said. She pointed out that one cup of a toasted oat cereal contains about one gram of oat bran. The Stanford nutritionist said that psyllium is available at health food stores or in some over-the-counter laxatives.

But oat bran is not a "magic bullet," Hattner cautioned. "It's important to remember that they did change their saturated fat intake."

In fact, some research suggests that oat bran is not as effective at lowering cholesterol in people who eat large amounts of fat, according to Fernandez.

Besides supplying the men with fiber cookies, the researchers counseled them on ways to cut down on how much fat they consumed. They encouraged the men to eat less meat, including organs, bacon and sausage. Over the course of the study, the men did eat fewer fatty foods, based on questionnaires they filled out each week.

The researchers found no significant differences when they compared the eating habits of the three groups of men.

Journal of the American College of Nutrition (1998;17:601-608)

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Annual review of Santa's health
December 17, 1998

Santa Claus may be able to travel around the world in a single night, but when it comes to his health, he's no Superman, according to the latest medical research. That bowl full of jelly, a diet rich in fatty cookies and a lack of regular exercise all put Santa at risk for a number of health problems.

But adopting a healthier lifestyle won't be as difficult for Santa as it may sound, according to Dr. Joseph A. Lieberman, the chairman of the department of family and community medicine at the Christiana Care Health System in Wilmington, Del., and a clinical professor of family medicine at Jefferson Medical College in Philadelphia. And Santa's jolly nature already gives him a head start on improving his health, he said. While Lieberman has never examined Santa himself, he has taken a peek at the Jolly One's medical records.

Here is Medical Tribune News Service's annual review of the state of Santa's health.

--Santa needs to trim a few pounds. This may seem obvious, but the importance of weight loss continues to be a subject of debate in the medical community.

Early this year, the editors of a prestigious medical journal, The New England Journal of Medicine, published an editorial stating that Americans are too obsessed with trying to lose weight.

But in the spring, the American Heart Association placed obesity in the same risk-factor class as smoking, high cholesterol, high blood pressure and a sedentary lifestyle.

And the National Heart, Lung, and Blood Institute in Bethesda, Md., announced new obesity guidelines, which declared that 55 percent of American adults need to lose weight.

Faced with these mixed messages, Santa should stay calm, according to Lieberman. The Delaware expert recommended that St. Nick "use an exercise program and dietary discretion to keep his weight under control," but that he should "not be so obsessed that it affects his jolly disposition."

--Year-round exercise can boost Santa's health. Besides helping him trim down his bowl full of jelly, research published this year has highlighted a number of exercise's health benefits.

A Finnish study of about 8,000 sets of twins found that those who walked or jogged for just 30 minutes six or more times a month had a 43 percent lower risk of death than sedentary people.

Exercise may also help ward off Alzheimer's disease, according to a study conducted at Case Western Reserve University in Cleveland. In a group of 370 people, those who did not have Alzheimer's had engaged in significantly more exercise during their lifetimes than people with the disease.

Santa may not have much room for error, since "he's already making his list and checking it twice," Lieberman commented. "We want to insure that he forestalls the development of Alzheimer's," he said.

Lieberman recommended that Santa exercise for 20 minutes at least three times a week.

--Lay off the cookies. "An occasional indulgence in cookies is OK, but kiddies may also want to put out other things," Lieberman advised.

Veggies may be good substitutes, since they are rich in nutrients and fiber. And a study from Italy found that some vegetables, carrots in particular, may help prevent certain types of cancer. Vegetables and fruits rich in potassium, such as bananas, may also lower the risk of stroke, according to a Harvard study of more than 44,000 men.

--Have an occasional glass of wine. While earlier research has shown that a daily drink or two -- especially red wine -- may help protect the heart, the habit may also help preserve Santa's sight, according to a study of more than 3,000 adults that found that moderate wine drinkers were less likely to develop age-related macular degeneration, the leading cause of blindness among the elderly.

Lieberman agreed, but he warned against drinking while behind the reins. "It would be wonderful to have wine, but not while he's driving the sled," he advised.

--That jolly disposition counts for something. University of Kentucky researchers have discovered that optimism may improve more than a person's mood: it may also boost the immune system. "We should learn a lesson from Santa that a pleasant disposition may prolong life," Lieberman said.

Santa's outlook may be getting rosier. In a nationwide poll of 2,727 people ages 25 to 74, older men and women were more likely than younger folks to say that they had felt happy, cheerful or satisfied in the last month.

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Diet Change May Help Prevent Cancer, Doctors Say

Many cancers common in the developed world can be attributed to environmental factors, which means that they may be largely preventable, British doctors claimed Friday.

Diet is one of the most important lifestyle factors, and up to 80 percent of the bowel, breast and prostate cancer cases may be preventable by dietary change, researchers from Dunn Clinical Nutrition Center in Cambridge, wrote in the British Medical Journal.

The authors highlighted red and processed meats and alcohol as the highest risk foods and cited a diet rich in vegetables and fruit as the most protective against cancer.

The researchers also found that there is no evidence that vitamin supplements help to prevent cancer.

Other environmental factors known to affect susceptibility to cancer include physical activity, reproductive and sexual behavior, infection with hepatitis B or C viruses and exposure to sunlight and chemicals, the scientists said. Enditem

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Beta-carotene linked to lower breast cancer risk
December 28, 1998

A diet rich in sources of the antioxidant beta-carotene may help lower a woman's risk of breast cancer after menopause, according to a study in the January issue of the journal Epidemiology.

Yet unclear, however, is how early in life a woman should begin to pay careful attention to beta-carotene-rich foods such as spinach, broccoli, and cantaloupe.

``These findings indicate that although diets high in beta-carotene may be associated with lower breast cancer risk, there does not seem to be evidence of a critical time period during which such diets are more relevant,'' according to the researchers, Aisha Jumaan of the Centers for Disease Control and Prevention in Atlanta, Georgia, and multicenter colleagues in the US and Sweden.

The authors write that a diet high in beta-carotene at least 1.5 years before the date of diagnosis of breast cancer in subjects, or the date of screening mammography in the controls, was associated with reduced breast cancer risk. The relationship was stronger in women whose diets had been rich in sources of beta-carotene for at least 20 years before diagnosis or screening.

However, the authors note that recall bias may cause small but significant differences in the eating habits of the subjects to remain undetected. ``Such misclassification might impair our ability to identify a critical time period when dietary beta-carotene may exert a protective effect on breast cancer risk,'' they said.

The case-control study included 273 women with breast cancer and 371 women without breast cancer, who ranged from 40 to 70 years of age. Researchers conducted telephone interviews with subjects about diet at various periods throughout their lives. The subjects were selected from of a group of women screened for breast cancer in Sweden.

Beta-carotene intake was divided by quartiles at various reported years before the reference date, defined as 6 months before the date of diagnosis of breast cancer in the cases, or 6 months before the date of screening mammography in the controls. Researchers examined beta-carotene intake at 5-year increments before the reference date in order to gauge the effect of exposure to beta-carotene on breast cancer risk.

SOURCE: Epidemiology 1999;10:49-53.

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Estrogen cuts cardiac death risk
December 18, 1998

Estrogen replacement therapy (ERT) appears to reduce the risk for fatal heart attack or stroke in postmenopausal women, according to researchers.

``The most important finding in the present study was the striking decrease in cardiovascular mortality - especially in sudden cardiac death -- among current users of ERT compared with former and never users,'' write Dr. Leif Sourander and colleagues at the University of Turku in Turku, Finland. Their findings are published in the December 19th issue of The Lancet.

In their study, the Finnish team followed the 1987-1995 medical histories of 7,944 postmenopausal women. Nearly 1,000 of the women started on ERT during the period of the study, while another 757 were former users of estrogen supplements.

The authors found that current users of estrogen replacement therapies had a 79% reduced risk of cardiovascular death, compared with never-users.

But the cardiovascular benefits of ERT may depend on continuous use. ``The survival (rates) for former and never users of ERT are very similar,'' the researchers explain, ''indicating that protection against cardiovascular death can only be achieved with continuous ERT.''

However, estrogen replacement therapy did not seem to influence whether or not women actually got cardiovascular disease in the first place, according to the authors. ``The effect of ERT is more likely to be protection from the progression of an already existing disease,'' they say, ''...than (from) primary prevention of the disease.''

Contradicting the results of some previous studies, Sourander's team report ``no overall association... between breast cancer risk and the use of ERT.'' However, they note that current ERT users had five times the risk for endometrial carcinomas (cancers of the lining of the uterus) compared with never-users.

SOURCE: The Lancet 1998;352:1965-1969.

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Baseball commissions study of andro
December 14, 1998

Major league baseball commissioned two Harvard researchers to conduct a study on the effects of androstenedione, the muscle-building supplement used by Mark McGwire and other players.

Joel Finkelstein and Benjamin Leder told a gathering of team doctors and trainers at baseball's winter meetings Saturday there is not enough evidence yet to determine its overall effect on athletes.

"They said it looks likes andro does raise testosterone levels," said Dr. Jack Failla, the team doctor for the Pittsburgh Pirates. "But they stressed that it is a small study right now and they need more time to definitively answer that question."

Baseball began its inquiry into andro shortly after The Associated Press reported in August that McGwire had been using it for more than a year.

Sometime before the start of the 1999 season, baseball expects to announce its decision on whether to ban andro, discourage its use, or allow it to be taken unchecked. The International Olympic Committee, NFL and NCAA already prohibit the supplement.

Officials are concerned about the supplement's potential performance-enhancing ability and that players are risking the long-term effects associated with prolonged steroid use, including a higher incidence of heart and liver disease.

"We still need to determine what andro does, whether it has the same effect as testosterone and anabolic steroids," Failla said. "We know that anabolic steroids, which are banned, do enhance performance. We are not certain with andro and more importantly we don't know the side effects."

Champion Nutrition Inc., the company which supplies McGwire with andro, estimates at least 100 ballplayers in the majors and minors use andro. The company wouldn't release names, but Colorado's Dante Bichette and Tampa Bay's Jose Canseco acknowledge using andro.

The two researchers, along with Dr. Robert B. Millman, medical adviser to the commissioner's office, and Dr. Joel Solomon, the union's medical adviser, made presentations Saturday. Millman stresses that research is still in the early stage.

"This was just an educational meeting," Millman said. "There was no policy discussed. We need to wait until we can get more evidence."

Eugene Orza, who is spearheading the union's investigation, said he thought it was a positive session but that basebll shouldn't rush into a decision.

"I think the scientists demonstrated just how little we know about the basic pharmacology of most nutritional supplements, but particularly androstenedione," he said. "It also became clear by the end of the meeting this is not a time for anyone to be forming firm judgments in such an uncertain area."

Before finalizing its policy, baseball will consult with the IOC and the medical directors of all the major professional sports. But the only way to effectively ban andro would be to implement a random drug-testing program similar to the NFL.

There is no chance that the union, which heard a presentation on andro at its board meeting in Las Vegas earlier in the week, would ever agree to such testing.

"I can't imagine the circumstances under which we would do that," Orza said.

Still, Orza thought the study would be worthwhile.

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