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
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
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
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
SOURCE: The Journal of the American Medical Association
What Foods Cause
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
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
"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.
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
"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
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
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
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
``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.
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
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
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
SOURCE: American Journal of Hypertension 1999;12:271-275.
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
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
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.
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
Urge incontinence involves the sudden, uncontrollable urge to urinate, sometimes called
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.
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
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.
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
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
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
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.