Saturday, September 8, 2012

Elderly women on Bone Drugs May Live Longer

Text courtesy: Reuters
While bone drugs have gotten a bad rap in the media recently, experts hope mounting evidence of benefits may convince patients not to shun the medicines.

This month, Australian researchers published the latest report to hint that elderly women who take bisphosphonates - as the bone drugs are known -- live longer than those who don't get treatment.

Out of every hundred women in their study, three who were not taking bone drugs died every year, compared to less than one of those who were on the drugs.

Although the findings don't prove the bone drugs actually boost longevity -- it's possible that women on treatment are generally healthier, for instance -- they fit with earlier studies.

"To me, this was good news," said Dr. Ethel S. Siris, who heads the Toni Stabile Osteoporosis Center at Columbia University in New York and was not involved in the study.

Examples of bone drugs are Merck's Fosamax, Roche's Boniva, Novartis's Reclast, and Warner Chilcott's Actonel.

They are usually prescribed for the bone-thinning disease osteoporosis, which affects about 10 million Americans, the majority of them postmenopausal women.

The disease makes the bones brittle and raises the chance of fractures, which have been linked to earlier death.

Estimates from Siris' team published in January show the drugs may have staved off more than 144,000 fractures among post-menopausal American women over an eight-year period.

Last year, the U.S. Food and Drug Administration warned that the medications might raise the risk of an unusual type of thigh fracture, and there have also been a few cases of bone death, or osteonecrosis, of the jaw.

After Australian national television reported on that side effect in December 2007, prescription rates for bone drugs dropped sharply, leading to an estimated 130 extra fractures and 14 deaths over the following nine months, according to one study.

"The bad news is that overstating the levels of risk of side effects with these drugs -- which the media have been doing for some time now -- has led people to stop the drugs when they should be taking them," said Siris, who is also past president of the National Osteoporosis Foundation.

Experts hope the new survival findings may help reestablish confidence in the drugs, some of which can be bought for about $10 per month in the U.S.

Led by Dr. John A. Eisman of the Garvan Institute of Medical Research in Sydney, the researchers tapped into an ongoing study following elderly people in a small Australian city.

They grouped more than 2,000 people according to three kinds of drugs - bone drugs, hormone replacement therapy or calcium supplements with or without vitamin D.

Over about 15 years of follow-up time, 466 women and 400 men died. After accounting for several health factors, women who took the bone drugs were about two-thirds less likely to die during the study than those who weren't getting any treatment.

The reduction was 52 percent for men taking these drugs, but neither hormone treatment nor calcium was linked with a decrease in death rates.

"These findings have potentially extremely important consequences, which should have a major impact on the way osteoporosis treatment is viewed and used," the researchers, who report funding from drugmakers, write in the Journal of Clinical Endocrinology and Metabolism.

They add that many patients, even those with fractures, are not currently getting treatment, an "apathy (that) should no longer be tolerated," they say.

In an email to Reuters Health, Dr. Murray Favus, who directs the bone program at the University of Chicago Medical Center, said the new findings might ease concerns about the drugs.

Only about one in 100,000 people taking bone drugs actually develop osteonecrosis of the jaw, he said, and the atypical fractures linked to the drugs are also very uncommon he said.

"The concern about complications or just not being committed to the medication has led many patients to stop oral bisphosphonate therapy," he said.

"However, if one adds extended lifespan to the equation, will patients be willing to assume some risk for the long term complications in the pursuit of a longer life?"

Experts generally recommend screening for osteoporosis in anyone over 65, and as young as 50 if they have risk factors.

SOURCE: The Journal of Clinical Endocrinology & Metabolism, online February 2, 2011.

Alcohol linked to Complications After Join Surgery

Text courtesy: Reuters

The more people drink before having a hip or knee replaced, the higher their risk for complications right after the surgery, a new study suggests.

Doctors have long suspected that excessive drinkers have more problems after surgery, but "this is the first study that really shows, with data and statistics," that it's true, said Dr. Nicholas Giori, from Stanford University, Palo Alto, California, who presented the results this week at the 2011 Annual Meeting of the American Academy of Orthopedic Surgeons in San Diego.

Giori and his colleague Dr. Alex Harris looked at surgical complication rates in 185 men who had hip and knee replacement surgery at the Palo Alto Veterans Affairs Hospital.

They found that men who admitted alcohol abuse at their annual check-up were more likely to have complications in the period right after their surgery compared to men who said they didn't drink too much.

Complications included pneumonia, delirium, stroke, life-threatening infections, blood clots in the lungs and in major blood vessels, gastrointestinal bleeding, major infections of the surgery site, serious heart rhythm abnormalities, urinary tract infection, and shock.

Every year at their annual check-up, VA patients answer questions on the Alcohol Use Disorders Identification Test (AUDIT-C). Each man in the study had reported at least some drinking in the past year.

Alcohol misuse, as defined by the AUDIT-C test, includes drinking more than four times a week, having more than nine drinks in a typical day, or regularly having more than six drinks a day.

After taking patients' age and other illnesses into account, each additional point on the 12-point scale corresponded to a 29 percent increase in the average number of complications.

The next step would be to see whether screening for drinking problems and trying to treat them before the surgery would help lower the complication risk, Giori said.

"We could intervene in anyone who tests over 5 and try to have them reduce their drinking for a month or so before surgery and see what happens," he said.

"We might really scare some people into stopping because I certainly do find that during the perioperative period people start to get serious about their medical care," Giori added. "If I have a serious conversation with them about their risks and behaviors, most people will listen and it is actually a good time to intervene."

Doubt cast on salt Guidelines for Diabetics

Image and text courtesy: Reuters
Australian researchers are challenging guidelines that urge diabetics to cut back on salt in their diet.

In a study that seems to turn conventional wisdom on its head, they found patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period.

"Such data call into question universal recommendations that all adults should endeavor to reduce their salt intake," Dr. Elif I. Ekinci of the University of Melbourne in Victoria and colleagues write in the journal Diabetes Care.

But don't reach for the pretzels just yet.

Although it isn't the first time findings like these have surfaced, the Australian researchers, like others before them, relied on observations only and didn't actually run an experiment to test the direct impact of eating more or less salt.

Instead, they followed 638 people with longstanding type 2 diabetes, often accompanied by heart disease and high blood pressure. At the outset of the study, all the patients were in their 60s on average and nearly half of them were obese.

"These are precisely the patients in whom more aggressive lifestyle interventions are often applied," the researchers note.

All the patients were treated at a single diabetes clinic, and doctors determined the daily amount of sodium in their urine when the study began. That's the gold standard of measuring salt intake, because it doesn't rely on patients remembering or jotting down what they ate.

The average amount of sodium in their urine, 4.2 grams per day, was in line with earlier global surveys, the researchers say.

Over the decade the study spanned, 175 patients died, mostly due to heart disease.

For every extra 2.3 grams of sodium in their urine, their risk of dying during the study dropped by 28 percent -- even after accounting for kidney disease, age and other factors likely to be important.

"This is unexpected," Dr. Ekinci and Dr. George Jerums, who also worked on the study, told Reuters Health by e-mail. "It raises the possibility that in people with type 2 diabetes, low salt intake is not always beneficial."

More than 23 million Americans have type 2 diabetes. According to the 2010 Dietary Guidelines for Americans, they should eat no more than 1.5 grams of sodium -- about two-thirds of a teaspoon of salt -- per day.

Most Americans consume more than twice that amount, U.S. government researchers said last year in a study that pointed to foods like pizza, cookies and meats as the main culprits.

At this point, nobody is recommending any change to the current dietary advice, because the new study doesn't prove that extra salt helps diabetics live longer.

The main problem is that the patients who had lower sodium levels in their urine were sicker and older, said Dr. Paul Elliott, who studies the link between diet and high blood pressure at Imperial College London.

"Although the authors used statistical models to try to 'correct' for these imbalances, it remains likely that the results are still confounded by them," he said.

That reasoning seems to be bolstered by the finding that higher blood pressure was tied to longer survival in the study, "which just isn't plausible," Elliott added in an email to Reuters Health.

But another expert said the Australian researchers might be onto something.

"The reality is that reducing sodium has many effects, some good like reducing average blood pressure, and others bad," said Dr. Michael H. Alderman of the Albert Einstein College of Medicine in New York.

For instance, he said, reducing sodium increases insulin resistance, which is the main problem in diabetes. It also ups the production of certain other hormones that have been linked to heart disease.

"The impact of reducing sodium must be the sum total of all these physiological effects," Alderman told Reuters Health in an e-mail.

To get to the bottom of the issue, a clinical trial comparing people told to eat less sodium to those who maintain their usual intake is necessary.

"It is surely safer, and probably cheaper than to ask 300 million Americans to reduce their sodium intake because of the hope that it will actually extend or improve life," Alderman said.

SOURCE: Diabetes Care, online February 2, 2011.

Food Tax Could Trim Some People's Calorie Intake

Image and text courtesy: Reuters

People are generally more likely to pass on high-calorie food when there is a tax on it -- though it might not matter to everyone, a small study suggests.

In a computer-based experiment with 178 U.S. college students, researchers found that the students generally "bought" fewer lunchtime calories when sugary, high-fat fare came with a tax of 25 percent or more.

The exception was when calorie-conscious eaters were given calorie information on their lunch options; the tax did not seem to sway their decisions.

Junk food taxes and greater openness with calorie information have both been advocated as ways to help consumers limit their calories -- and, the hope is, keep their weight in the healthy range.

In the U.S., proponents of taxes on soda and junk food argue that it would not only discourage people from buying them, but could also help offset the estimated $147 billion cost of treating obesity-related ills.

Supporters also point to research suggesting that cigarette taxes have helped curb tobacco use.

Policies to require restaurants and other vendors to be frank with calorie information have made greater gains. In 2008, New York City became the first U.S. city to mandate that fast-food and coffee chains put calorie information on their menus. And in 2010, the federal healthcare reform law set national labeling requirements for certain restaurants and vending machines.

But just how effective such measures have been, or could be, is controversial.

A study reported on Tuesday, for example, found that New York City's law has so far done little to change children and teenagers' eating habits at fast-food restaurants.

The current study, reported in the American Journal of Clinical Nutrition, suggests that the effectiveness of junk food taxes might partly depend on whether calorie information is given or not -- and the customer's own calorie-consciousness.

For the study, researchers led by Dr. Janneke Giesen of Maastricht University in the Netherlands had 178 U.S. college students choose a hypothetical lunch from a computer menu on three separate occasions.

Each time, the prices for high-calorie items -- like bacon cheeseburgers, brownies and chips -- were increased, first by 25 percent and then 50 percent.

About half of the students were given calorie information at all lunches, while the rest were not.

Overall, Giesen's team found, students tended to order fewer calories when a junk food tax was in place. They curbed their average calorie intake by about 100 to 300 calories depending on the tax in place.

The only students who did not respond to the price increases were those who were already watching their diets and were given calorie information. They ate fewer calories than their peers without any food tax, and showed little change in their eating when taxes were added.

"The most important finding of our study is that a tax of 25 percent or more on (high-calorie) foods makes nearly everyone buy fewer calories," Giesen told Reuters Health in an email.

For people who are weight- and diet-conscious, calorie information might trump price, according to Giesen. "However, if one wants to help people in general to prevent caloric overconsumption," the researcher said, "then our results indicate that imposing a high tax on (high-calorie) food items is much more efficacious."

A researcher not involved in the study noted that it had a number of limitations, including a small sample size.

Still, it jibes with larger experiments suggesting that food taxes might work, said Dr. Barry Popkin, a professor of nutrition at the University of North Carolina, Chapel Hill, who has studied the potential effects of junk food taxes on people's food choices.

In an email, he pointed to a recent study by Harvard researchers in which they added a 35-percent tax to sugary sodas sold in the cafeteria at Brigham & Women's Hospital in Boston. They found that sales of sugar-sweetened sodas dropped by 26 percent, and that people tended to replace those drinks with diet soda or coffee.

In contrast, an educational campaign -- where signs were posted recommending that people cut back on sugary soft drinks -- failed to make a dent in sales.

According to Giesen, studies are still needed to see whether smaller tax increases -- something closer to 10 percent, which would be more politically viable -- influence people's buying habits. 

Industry trade groups like the American Beverage Association and anti-tax activists like Americans Against Food Taxes (which has industry backing) argue that there is no evidence that junk food taxes will fight the U.S. obesity problem. They also assert that such taxes will only unduly burden low-income families.

SOURCE: American Journal of Clinical Nutrition, online January 26, 2011.

Is the Mediterranean Diet Good for Me?

That’s a good question and to find out whether the Mediterranean diet is good for you, me or your next door neighbour, we first need to understand it. If you live in civilised society, chances are you’re inundated with information about olive oil, salads, and whole grains being healthy, mostly by way of diets like the South Beach diet and this one. You’ve probably slowed down while crossing the organic foods aisle in the supermarket, wondering if the Mediterranean diet is good for you, and if you should switch from heavy meals to light salads and grilled fish. It’s the hype around the Mediterranean diet that makes you do this and the idea that, despite their dull performance in the 2010 World Cup so far, the Italians enjoy greater health than you.

What do the Italians, Greeks, and Spanish have to do with the Mediterranean diet? Well, it’s their strip of land, isn’t it? In 1945, Ancel Keys, an American doctor working in Italy, realised that the dietary habits of the poor coastal areas of Spain, Italy, Crete and Greece were remarkably healthy. He wrote home about the Mediterranean diet’s virtues, much like Giacomo Castelvetro did in early Renaissance England, but it wasn’t till the 1960s that the diet gained momentum worldwide. By the 1990s, when Harvard University’s, Dr Walter Willett, presented his version of the Mediterranean diet, everyone was ready to listen. While Giacomo Castelvetro failed to convince the English to eat their vegetables and fruits, Dr Walter Willet succeeded in convincing the world that the Mediterranean diet is indeed good for every one.

Why is the Mediterranean Diet Good for Me? The Mediterranean diet has what most marketing campaigns kill for – living examples of its success, and it doesn’t hurt that these living examples are fine Mediterranean specimens in great health, of great physique and with interesting accents. Several independent studies have found that despite a high fat diet, people living in the Mediterranean countries have much lower rates of cardiovascular diseases than their counterparts in other countries. Why? Here’s a Mediterranean Diet chart, courtesy Mediterranean Book, to help us understand that:

The Mediterranean Diet Guideline for Novices:
  1. Eat your vegetables and fruits –7 to 10 servings of fruits and vegetables daily.
  2. Switch to whole grains – The lesser it’s processed the better it is.
  3. Nut it out – Almonds, pistachios, cashews, walnuts, they’re all good.
  4. Switch from animals and dairy fats to olive oil or canola oil.
  5. Spice instead of salt – Use herbs and spices instead of extra salt.
  6. Eat fish – Once or twice a week.
  7. Red meat becomes a treat – Only recommended about once or twice a month. If you’re a regular red meat eater. you’ll have to replace it with fish and poultry.
  8. Drink a lot of wine – Not a lot, but a couple of measures a day are good for you.
  9. Drink 6-8 glasses of water a day.

A Second Look at whether the Mediterranean Diet is Good for You, or Not: 
Every day new studies pop up about how the Mediterranean diet helps fight cardiovascular diseases, depression, hormonal imbalances, and just about everything short of cynicism. But one particular hypothesis suggests that the Mediterranean belt’s differential exposure to solar ultraviolet radiation could be the reason why the Mediterraneans enjoy better cardiovascular health than their western and northern counterparts. Add to that the fact that the Mediterraneans are known to be fit and physically active people. In conclusion, the Mediterranean diet is good for you and for the rest of us as well, but to really make it work all of us need to migrate to the Mediterranean, because living healthy is an important life goal that must be achieved at any cost.

The Pitfalls of Overtraining

Of all the phrases thrown around by people I personally feel “Too much of A Good Thing” makes the most sense. It just goes to show that excess of even something  good could prove harmful in the long run. This is especially true when it comes to working out.

Making a decision to lead a healthy life and then sticking by it with dedication is awesome but you have to make sure this dedication does not border on obsession as it could lead to what is commonly known as “Overtraining”. Overtraining is a condition where your body is pushed beyond its means and is not given the adequate rest it deserves to recuperate. Not only does this take a serious toll on an individual’s physical well being but it also affects his/her mental makeup as one of the biggest pitfalls of overtraining is not seeing any significant gains. And we all know how badly this can bum us out especially after the gallons of blood, sweat and tears spilt at the gym.

Besides psychological ramifications like depression, anger and frustration brought on by a plateau, overtraining also leads to a bunch of issues such as:
Soreness and muscle ache
Loss of appetite 
Chronic Fatigue
A weaker immunity system
Sleeping disorders

As you can see over training is a serious concern that should be avoided at all costs so make sure your enthusiasm doesn’t get the best of you.

Top 10 Foods for a Healthy Heart

Men will be boys, 'cause Dil toh bachcha hai ji. But is it really? Here’s how to keep that heart of yours in shipshape

1. Oats

Before you say "Get oat" to this one, forget not that it's a nourishing whole grain that's filling, reduces cholesterol and is super rich in vitamins, minerals and fibre. Oats porridge or desi style upma is a great breakfast option; home-baked oatmeal cookies make for a perfect mid-meal snack.  

With a twist: Powder oatmeal and blend with milk/yoghurt for thick pancakes topped off with dried/cut fruit and honey; mix with dosa batter or use as dosa batter!

2. Spinach
Palak is packed with phytochemicals, minerals such as folate and iron, calcium and B complex vitamins that keep your eyes healthy and even protect against heart disease. 

With a twist: If you're bored or palak paneer and keerai molagutal (South Indian curry with tamarind paste), blend with mint and basil for a cool pesto pasta sauce. Or use it by itself.

3. Almonds
Rich in protein, healthy oils, fibre, vitamin E, magnesium and heart-favourable mono and polyunsaturated fats, badam helps check cholesterol level. 

With a twist: Chuck a few into a fruit salad or low-fat yoghurt for a pick-me-up energy booster when your energy levels dip at work. 

4. Tomatoes
Who hasn't heard about its lycopene content which is said to lower heart disease risk? Not to mention that it also a great source of beta and alpha-carotene, vitamin C, potassium, folate and fibre. But do we really get enough of this little powerhouse?

With a twist: Add finely chopped tomatoes to your omelette for a more wholesome dish.

5. Olive Oil
O' live it up with olive oil; studies have that it lowers your LDL (or bad) cholesterol, while raising HDL (good) cholesterol. The extra virgin variety is the best because it undergoes least processing. 

With a twist: Cook desi recipes with olive oil. It may take some time to get used to, but the change will be well worth it.

6. Kidney beans
Good ol' rajma is rich in cholesterol-lowering fiber. This is what keeps your blood sugar levels from rising rapidly after a meal. It also contains B-complex vitamins, niacin, folate, magnesium, omega-3 fatty acids and calcium.

With a twist: A few boiled and seasoned kidney beans are a great way to liven up a salad.

7. Apples
Loaded with vitamins and fibre, an apple a day can help keep heart disease away. The phytochemical quercetin present in this fruit is an anti-oxidant with anti-inflammatory properties that prevents the formation of blood clots. 

With a twist: If you're bored of eating apples whole (though they're easily the most portable fruits), cut it up into slices and use it for your oatmeal pancakes.

8. Salmon
The omega-3 fatty acids in this fish keep both blood clots and inflammation at bay, and help maintain healthy cholesterol levels. 

With a twist: Marinate salmon and chop it up into a pasta or a salad.

9. Prunes
Prunes are extremely filling and thanks to their fibre content. Regular consumption has been shown to reduce LDL cholesterol, and protect you against colon cancer. These little wonders also contain iron and beta-carotene.

With a twist: Wedge a few prunes between two bread slices or into your chapati and eat as a Frankie on the go.

10. Soy
Seen to lower LDL cholesterol and triglycerides, soy helps take on both heart disease and cancer - two deadly killers. It's rich in B-complex vitamins; niacin, folate, calcium, magnesium and potassium.

With a twist: Pick up soy milk cartons - a great snack while commuting. 

Include these heart-friendly foods in your diet to keep it younger, longer!