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April 1999

Hopkins: Genetic Predisposition To Alcoholism
April 16, 1999

Much evidence suggests that genes play a role in the development of alcoholism. If that's so, how exactly does it happen?

Brain chemistry appears to be a major factor, according to recent research from Johns Hopkins. The brain controls production of the natural opioids that may influence a person's craving for and reaction to alcohol. The Hopkins team tested two groups of people: children of alcoholics and children of non-alcoholics. Both were given a drug that artificially blocked opioid activity in their brains. In measuring the body's response, researchers found that the two groups reacted very differently.

"So this suggests that both the reward system and the stress response are altered in the offspring of alcoholics," says lead researcher Dr. Gary Wand. "And it may be a predisposing factor for the future development of the disorder."

It's already known that drug-seeking behavior, such as the use of alcohol, is linked to the body's response to stress. The study provides the first evidence that opioid activity is altered in the brains of children of alcoholics and that the differences are probably inherited.

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Heart Disease Rates Drop For All But Diabetics
April 15, 1999

Although Americans have reduced their risk factors for cardiovascular disease in past decades -- and enjoyed a reduction in heart disease mortality as a result -- diabetics have not shown as much benefit from reducing heart risks.

Heart disease mortality has fallen by 36.4% in nondiabetic men, while declining by only 13.1% in diabetic males, according to a report in the April 14th issue of The Journal of the American Medical Association.

Among women, heart disease mortality has fallen by 27% in nondiabetics but increased by 23% in women with diabetes, report Dr. Maureen I. Harris, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, and colleagues.

The researchers analyzed data from the First National Health and Nutrition Examination Survey, conducted between 1971 and 1975, and a follow-up survey done between 1982 and 1984.

The study "indicates that mortality rates for all causes, heart disease, and ischemic heart disease in men and women with diabetes have not decreased to the extent that they have for adults without diabetes," the researchers write.

They suggest possible reasons for this difference, including that risk factors for heart disease may have decreased less over time in diabetics compared with nondiabetics, or that heart disease may have decreased less in diabetics.

"With the increasing prevalence of diabetes in the United States and the smaller decline in mortality for these individuals," they continue, "we anticipate that diabetes may become an increasingly important factor for heart disease mortality in the United States."

SOURCE: The Journal of the American Medical Association 1999;281:1291-1297.

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What Foods Cause Migraines
April 14, 1999

Approximately 30 million Americans suffer from migraines that can bring a grown person to his or her knees (or bed or couch) and even cause nausea. Emotions, hormones, weather , stress levels, and certain medications may all contribute to migraine attacks. It's best to speak with your doctor about your headaches to ensure that you are getting proper treatment.

However, what's on your plate may also be in your head, so to speak: Certain foods, fluctuating eating patterns, or sudden decreases in caffeine may also be headache triggers. Although there's no iron-clad proof, some foods or food additives may feed into an attack. Some headache sufferers point to monosodium glutamate (MSG), a food enhancer that is sometimes added to processed foods or restaurant meals, and the preservative benzoic acid. Sodium nitrates, often found in hot dogs and cold cuts, are the problematic preservative. Other foods that may trigger a headache are aged cheeses, some types of beans such as lima, lentil, and soy, overripe bananas, peanuts, peanut butter, and chocolate. Alcohol may also trigger headaches.

Skipping meals and fasting may expedite a headache. Too much java drinking or changing your typical caffeine intake may also contribute to a throbber.

If you suspect that your diet contributes to your headaches, start jotting down what you eat along with your headache patterns and report your findings to your doctor. If adjusting your diet looks like it might help, meet with a registered dietitian to outline a plan.

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Smoking Linked To Genetic Damage
April 14, 1999

Smokers, even those who quit years ago, have damage to their genes that can lead to cancer, scientists said on Monday.

Although many studies have shown that kicking the habit has immediate health effects, leading to a decreased risk of heart disease and cancer, it is also clear that smoking has permanent effects.

"In this country now we have as many former smokers with lung cancer as current smokers," Dr. Adi Gazdar of the University of Texas M.D. Anderson Cancer Center in Houston told a news conference.

"The damage never goes away," he said. "We see molecular damage in the lungs of people who smoked only a pack a day for a year."

But Gazdar said that is no reason for smokers to be fatalistic and keep on smoking. "It's not as high as people who (still) smoke, because people who smoke continue to damage their lungs," he said.

A second study adding to that evidence was presented to the annual meeting of the American Association for Cancer Research on Monday.

Dr. Curtis Harris of the National Cancer Institute and colleagues examined 131 women, including 121 never-smokers, and 10 ex-smokers.

The investigators looked specifically for mutations of the p53 gene -- a tumor suppressor gene that is damaged by smoking in a way that can lead to cancer.

"Even after 15 years of smoking cessation, ex-smokers have a p53 mutation frequency characteristic of current smokers," they told the conference.

"That implies that these genetic mutations, these kinds of changes, occur very early," Curtis told the news conference.

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Cabbage, Broccoli Lower Bladder Cancer Risk
April 13, 1999

Men who consume a lot of cruciferous vegetables -- specifically, broccoli and cabbage -- may reduce their risk of bladder cancer.

This is true regardless of total vegetable intake, or consumption of other fruits and vegetables, according to a study of 47,909 men published in the April 7th issue of the Journal of the National Cancer Institute.

Dr. Dominique S. Michaud and colleagues from the Harvard School of Public Health, Boston, Massachusetts, found 252 cases of bladder cancer in the men enrolled in the Health Professionals Follow-up Study between 1986 and 1996.

The higher the intake of cruciferous vegetables, the lower the bladder cancer risk. Of all the vegetables, only broccoli and cabbage intake seemed to have an impact on bladder cancer risk.

"Intakes of yellow or green leafy vegetables or carotenoid-rich vegetables were not associated with (reduced bladder cancer) risk," so a high intake of fruit and vegetables in general does not confer an appreciable benefit, according to the report.

Because the rate of bladder cancer in men is three to four times higher than in women, the researchers note that the findings may not apply to women.

"Biologic responses to certain carcinogens may well vary by sex; thus, chemopreventive agents may be equally affected," they write, adding that more study is needed to confirm the study findings.

SOURCE: Journal of the National Cancer Institute 1999;91:605-613.

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Tomato Nutrient May Fight Cancer
April 12, 1999

A study has found the first direct evidence that the nutrient that makes tomatoes red may protect men against prostate cancer by shrinking tumors and slowing their spread.

The nutrient, lycopene, has emerged as one of the trendiest of all nutritional supplements in recent years. Large population surveys have suggested that those who eat plenty of tomatoes - the primary natural source of lycopene - are less likely to get prostate cancer and some other malignancies.

To see if tomatoes are truly the reason why, researchers from the Karmanos Cancer Institute in Detroit gave lycopene capsules to men who were about to undergo surgery to remove their cancerous prostate glands.

The study involved 33 men who were randomly assigned to take lycopene or nothing for 30 days before their prostate operations. Before surgery, the volunteers showed no obvious signs that their cancer had spread.

After surgery, the doctors found that cancer tissue was less likely to extend clear to the edges of the lycopene users' prostate glands. And pre-cancerous cells in their prostates were less abnormal-looking.

``This suggests that lycopene results in a decrease of the tumor size and makes the cancer less aggressive,'' said Dr. Omar Kucuk, who directed the study.

The findings were presented in Philadelphia on Monday at a meeting of the American Association for Cancer Research.

Kucuk warned that his study is small, and cautioned against routine use of lycopene supplements without further evidence.

Lycopene pills are widely available. In the study, financed by the Karmanos institute, volunteers were given two daily 15-milligram capsules of Lyc-O-Mato, a lycopene extract made by LycoRed Natural Products of Israel.

Kucuk said this is the amount of lycopene found in about a pound of tomatoes. However, since lycopene is not easily absorbed from raw tomatoes, it might take two or three pounds to actually raise blood levels as high as were seen in the study.

``The results are significant,'' said Dr. Frank Rauscher of the Wistar Institute in Philadelphia. ``It's remarkable that lycopene may have both therapeutic and preventative value.''

Prostate cancer is the most common malignancy among American men. The American Cancer Society estimates that 179,300 men will be diagnosed with prostate cancer this year, and 37,000 will die from it.

Among the study's findings:

-Cancer had spread to the very edge of the prostate gland or beyond in seven of the 21 men on lycopene, compared with nine of the 12 in the comparison group.

-Levels of PSA - prostate specific antigen, a measure of tumor activity - fell 20 percent between the start of treatment and surgery in the lycopene patients. They were unchanged in the comparison group.

-Pre-cancerous but worrisome tissue in the lycopene patients was also less abnormal-looking.

``If this is real, I would expect to see a decrease in the relapse rate and increased survival in these patients'' taking lycopene, Kucuk said.

One of the most influential pieces of research on tomatoes and cancer was a large Harvard study released in 1995. It followed the eating habits of 47,000 men for six years. Those who had at least 10 weekly servings of tomato-based foods were up to 45 percent less likely to develop prostate cancer.

In an analysis published in February, Dr. Edward Giovannucci of Harvard Medical School reviewed 72 studies that looked for a link between cancer risk and food made with tomatoes. In all, 57 linked tomato intake with a reduced risk, and in 35 of these, the association was strong enough to be considered statistically meaningful.

The data were most compelling for cancers of the prostate, lung and stomach. They also suggest links between tomatoes and lower levels of several other tumors, including pancreatic, colorectal, esophageal, oral, breast and cervical cancer.

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Arterial Disease Main Cause Of Impotence in Hypertensive Men
April 8, 1999

Penile artery dysfunction caused by high blood pressure and arterial disease is the main cause of impotence in hypertensive men, according to research published in the American Journal of Hypertension.

``Impotency is a major problem, especially in older hypertensive men,'' said Dr. Michael Weber, an editor of the journal, in a press statement. ``Many patients tend to blame the blood pressure medicine itself for causing the impotency, but this new study... indicates that the underlying medical condition of atherosclerosis and the physical effects of blood pressure reduction itself are the primary cause of the problem.''

In a study of 101 hypertensive men evaluated at a hypertensive clinic in Denmark, 27 were impotent -- a much higher rate than the 4% impotence rate found in the general population, according to lead investigator Dr. Jesper Jensen of Glostrup University Hospital of Copenhagan, Denmark.

Eighteen of the 27 impotent men were found to have penile arterial dysfunction, which is largely due to atherosclerosis in the penile arteries.

Not surprisingly, impotence was related to age, but the prevalence was also ``remarkably high (23% to 45%) in middle-aged patients (40 to 69 years of age),'' according to the study.

The investigators also found that intermittent claudication, or cramping in the calves due to poor circulation, was the one variable with the highest correlation to impotence, followed by ischemic heart disease.

While some patients reported that impotence only became a problem once they started on antihypertensive medication, the researchers report that their results ``pointed towards a mechanism related to blood pressure reduction rather than to specific drug side effects'' as the cause.

The researchers advise physicians to ask patients taking antihypertensive medication about their sexual functioning.

``Frank and open discussions will help physicians determine the cause of impotency and then initiate treatment,'' said Weber, who is also president of the American Society of Hypertension.

SOURCE: American Journal of Hypertension 1999;12:271-275.

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Stress Linked To Arterial Disease In Men
March 31, 1999

Job-related stress may increase the risk of cardiovascular disease, but it appears to have a greater impact on a man's arteries than a woman's, according to US researchers.

Men who report the most stress have almost five times the risk of having atherosclerotic lesions -- fatty plaques -- in their carotid arteries, compared with men with the lowest stress level, even after taking into account high blood pressure, lack of exercise, smoking or other heart disease risk factors, according to the study.

"Men (under stress) also have thicker arteries," said Cheryl Nordstrom of the University of Southern California in Los Angeles, who presented the findings at the American Heart Association's conference on Cardiovascular Disease Epidemiology and Prevention in Orlando last week.

The study included 464 healthy utility workers aged 40 to 60 who lived in southern California. Nordstrom and colleagues measured stress levels among the workers using a questionnaire, and also used ultrasound imaging to measure fatty plaque in their carotid arteries -- large arteries in the neck that supply blood to the brain. Atherosclerosis in the lining of the carotid arteries can increase the risk of stroke, and may indicate that an individual also has a greater risk of heart disease.

Unlike the men, the researchers found there was no link between a woman's stress level and atherosclerotic lesions in the carotid arteries.

"Maybe it's not workplace stress that affects women," said Nordstrom in an interview with Reuters Health. "Women have better social support -- that may be a partial explanation."

It is also possible that estrogen may have a protective effect, she said. Women who had had their ovaries removed or were postmenopausal -- two factors that lower estrogen -- were more likely to have thicker artery walls and a greater risk of lesions, but the small study population renders the findings inconclusive, Nordstrom noted.

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Incontinence Suffered in Silence
April 16, 1999

"You know one of the secrets no one tells you about childbirth?" a woman rocking her new baby in the doctor's waiting room reluctantly confided. "Incontinence. I couldn't believe nobody warned me."

Members of the American Urological Association would have loved to hear that complaint, because it backs up their contention that urinary incontinence is one of those embarrassing conditions that millions, mostly women, suffer in silence.

That's sad, says Dr. Alan Wein of the University of Pennsylvania, because a lot of treatments work very well if only women, and their doctors, knew about them.

Pregnancy and childbirth aren't the only causes. So is aging: Some 40 percent of women over age 60 experience incontinence, the involuntary loss of urine. It can be a result of weakened muscles that control urination, radiation therapy, pelvic injury or surgery, urinary tract infections or neurological diseases.

Urologists estimate that 17 million Americans, 85 percent of them women, suffer incontinence. Yet just one in five sufferers seeks a doctor's help - even though 80 percent of patients can be cured or significantly improved.

So the urology association is conducting a national campaign to teach patients and doctors about incontinence therapies and offer referrals to patients seeking a specialist near where they live.

You don't necessarily need a urologist, Wein said, acknowledging his candor might upset urology colleagues. "A good primary care physician can start you on the way to diagnosis and treatment." If you're not helped, then seek a specialist, he said.

For healthy bladder control, strong pelvic floor muscles must hold up the bladder, sphincter muscles must keep the urethra closed and nerves must properly signal those muscles to work.

When patients complain of incontinence, doctors first must determine the type and whether it's temporary - like many women's experience after childbirth - or chronic.

Stress incontinence is leakage caused by physical stress to the abdomen, such things as coughing, sneezing or laughing, or lifting a heavy object. It's a frequent problem for female athletes, especially during exercise that causes abdominal pressure, such as jogging.

Urge incontinence involves the sudden, uncontrollable urge to urinate, sometimes called "overactive bladder."

Some people have both types - mixed incontinence.

"Every treatment regimen ought to begin with the simplest type of therapy," Wein said - behavior therapy.

Top of the list: Perform "Kegels," pelvic exercises named after the Los Angeles physician who in the 1940s first proposed the therapy to tighten bladder-control muscles. Simply tense pelvic muscles, so that it feels like you're inwardly lifting and squeezing, and then release.

Losing excess pounds that put pressure on the bladder also can help.

Other behavior therapy includes such commonsense steps as voiding frequently, so the bladder is never too full, and drinking less, Wein said.

Adding medication to behavior therapy can significantly help some incontinence, mostly by blocking the enzyme that causes bladder contractions, he said.

There are devices other than bulky pads or diapers: tiny foam "plugs" that form temporary seals over the urethra, and tampon-like barriers.

Collagen injections can bulk up the area around the urethra, so that sphincter muscles have an easier time keeping the urethra closed.

If those steps aren't enough, surgical treatments are highly effective, but Wein stressed that they're reserved for severe cases because surgery is risky.

An implanted nerve stimulator can send tiny electric shocks to the nerve that controls the bladder. Doctors can stitch tissue in ways to hold up the bladder so it's not under pressure to leak, or in drastic conditions they can even enlarge the bladder.

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Cervical Cancer: Who's At Risk?
April 15, 1999

Seventy thousand women are diagnosed with cervical cancer in its earliest stage each year. It's vital to catch the disease before it spreads. CBS This Morning's Health Contributor Dr. Bernadine Healy has more on the risk factors and treatment.

Who is at risk?

Unlike most other cancers, cervical cancer hits women when they're young. The earliest and more easily treated form of cervical cancer tends to show up when a woman is in her mid-to-late thirties, and the more advanced forms in her mid-forties.

Risk Factors

The major risk factor for this cancer is an active sex life. What that means is having multiple sex partners, having a first sexual encounter before age 18, having had more than five pregnancies, and having a history of virtually any sexually transmitted disease from herpes to HPV, the human papilloma virus. Another risk factor is smoking. It increases your chance of getting cervical cancer fourfold, no matter how safe the sex you practice.

Is cervical cancer easily detected?

Most of the time cervical cancer is picked up through a pap smear before a woman experiences its symptoms of abnormal vaginal bleeding or bleeding after sexual intercourse.

To get the pap smear, the physician uses a small spatula to scrape off cervical cells, which are then smeared on a glass slide, processed and looked at under a microscope. If the cells in the pap smear suggest cancer, the next diagnostic step is a closer examination of the lining of the vagina and cervix with a special magnifying instrument called a colposcope, and a biopsy.

How is it treated?

Seventy thousand woman a year are diagnosed with cervical cancer in its earliest stage. At that point it is microscopic, involving only the cells lining the cervix, and is highly curable. The abnormal tissue is removed in a simple outpatient operation using local anesthesia. The cervix and uterus stay intact, so there is no concern about affecting a woman's ability to have children after the procedure. And as long as the diagnosis was accurate, the recovery rate is 100 percent.

When the cancer has spread out of its original site but is still present only in the cervix, a total hysterectomy is necessary, but the chance of a complete cure is excellent, in the range of 90-98 percent.

The New England Journal of Medicine looked at the treatment of invasive cervical cancer - that is, when the cancer has spread beyond the cervix. A total 14,000 women are diagnosed with invasive cervical cancer every year in the United States, and nearly 5,000 die from it. Treatments for it have not advanced since the 1950s.

Radiation has been the standard treatment after surgery to remove the tumors. But now, three separate studies point to a major advancement combining two modes of therapy. Researchers found that the risk of death fell by as much as 50 percent when chemotherapy - particularly the drug cisplatin combined in some cases with fluorouracil - was added to radiation therapy.

How can a woman reduce the risk?

If we think back to the risk factors, protection is key. If you aren't absolutely sure about your partner's sexual history, use a condom. Knowing your partner is AIDS free isn't enough to save your life. All types of sexually transmitted diseases put you at risk. Stop smoking. Any woman who is sexually active or over the age of 18 should see her gynecologist yearly and have a pap smear. Catch this cancer early. It makes all the difference to your quality of life, your ability to have children, your happiness and your survival.

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Regular, Moderate Exercise Cuts Heart Risk
April 13, 1999

Regular, moderate exercise may reduce the risk of having a first heart attack just as much as high-intensity workouts, according to a report in the April 12th issue of the Archives of Internal Medicine.

The study found that people who walk for exercise can reduce the risk of having a first heart attack by 73% and those who garden can reduce the risk by 66% compared with people who do not exercise regularly.

"When performed for more than 60 minutes a week, walking for exercise or gardening was associated with a similar risk reduction to that of high-intensity leisure-time physical activity," conclude Dr. Rozenn N. Lemaitre and colleagues with the University of Washington in Seattle and the University of Michigan in Ann Arbor.

Their findings support current exercise recommendations from the American Heart Association, the Centers for Disease Control and Prevention, and the American College of Sports Medicine to strive for at least 30 minutes of moderate-intensity physical activity on most days.

The researchers looked at data from 333 patients between 25 to 74 years who had a first heart attack. Their spouses were interviewed to assess participation in 15 high-intensity and 6 moderate-intensity activities during the years.

The patients were compared with 503 "control" subjects who had not had a heart attack, selected randomly and matched for age and sex. None of the control group had heart disease or other serious health conditions.

When compared with subjects who did not exercise at all, subjects who gardened for more than an hour a week were at equal risk of having a first heart attack as subjects who engaged in high-intensity exercise, the study found. The risk of heart attack was lowest for subjects who walked for more than an hour a week.

However, their study measured only a handful of physical activities that could be performed for the purpose of exercise and not all activities -- such as home repair and walking for pleasure.

The authors point out that their findings agree with the results of a study of men participating in the Multiple Risk Factor Intervention Trial. This study found that modest levels of activity could lower the risk of sudden heart attack by 40%.

SOURCE: Archives of Internal Medicine 1999;159:686-690.

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