Tackling a sugar rush (May 5, 2002)

Everyone's training table needs carbohydrates. There's no argument about that. Our bodies convert carbohydrates to glycogen, which serves as our main fuel in muscles.

The hottest debate about "carbs" focuses on how many you need in your diet compared with protein and fat. For most active people, consuming 55 percent to 65 percent carbohydrates, plus 15-20 percent protein and 20-25 fat are ideal ranges. Some individuals feel better eating a bit more protein and less fat, but sports nutritionists don't recommend cutting corners on the carbs.

Nonetheless, more than a few nutritionists say Americans are missing a more fundamental question about carbohydrates: Just which ones are best for feeling good and increasing energy?

Time was, in the 1970s, carbohydrates were divided into "simple" or "complex" groups. Nutritionists suggested eating mostly complex carbs, which are plentiful in whole plant foods such as produce and beans, while avoiding the simple sugars in table sugar and sweets.

Then in the early 1980s, a University of Toronto researcher, David Jenkins, discovered some complex carbohydrate foods actually rushed their way into the bloodstream. Foods such as potatoes and rice led to a fast rise in blood sugar or blood glucose, followed by the matching rapid drop in glucose levels. Jenkins' research intention was to discover the best foods for people with diabetes.

A carbohydrate catalog

He created the "glycemic index," which measures how fast carbohydrates in a certain food convert to glucose, which then enters the bloodstream and muscles (as glycogen). The glycemic index basically tracks how fast your blood sugar rises after eating carbohydrate-dense foods, such as fruits, vegetables, grains and processed foods (pasta, bread, cereals, crackers and cookies are measured most often).

In his first study, Jenkins listed values for a variety of foods. The value of glucose (a simple sugar) was 100. All other foods were matched against it and slotted as "low-, medium- or high-glycemic" foods.

The concept caught the attention of other researchers, nutritionists and media reporters during the next decade. More than 300 foods have been cataloged on glycemic indexes.

Other glycemic indexes were produced, using white bread as the 100 value because it is a common food among Americans. If you are ever confused about why certain foods have different glycemic index values, that's why.

Other times you may see a food higher in one listing than another. Whether the food is cooked or raw can change values; the same goes for ripeness. An unripe banana is about 30 points lower in glycemic effect than a ripe one.

Using the index

Proponents of the glycemic index recommend eating carbohydrate foods lower on this scale for optimal health. Some champions of the index, including nationally known authors, contend that using the rating system is the best way to lose weight and feel healthy.

Janet Rankin, a professor in the human nutrition, foods and exercise department at Virginia Tech, isn't that enthralled with the glycemic index.

"People tend to overuse the glycemic index," she said. "It is more valuable at snack time, since that is when we tend to eat single food items."

In general, Rankin said, Americans consume lots of high glycemic foods, such as white bread and bagels. Recognizing high-glycemic foods can help you make better choices. Or you can alter the food's blood sugar effect by combining it with low-glycemic foods. For example, Rankin said drinking a glass of non-fat milk with your bagel "significantly lowers the glycemic value."

Rankin said high-glycemic foods are most valuable during exercise: "Research shows these foods do their job by getting glucose into the bloodstream quickly when you need it."

The studies are less clear about consuming high-glycemic foods after a workout, though some nutritionists suggest this is about as good a time as any to munch on a sugary treat because your body needs the carbs for recovery.

Dan Benardot, associate dean of nutrition research at Georgia State University, said the glycemic index is a clearly designed instrument. What's confusing, he said, is "how to apply it" to our everyday meals and snacks.

"The glycemic index itself is an abstraction," said Benardot, who has worked with many Olympic athletes. "The better approach is to look at the total volume of calories in your day."

Benardot said the single best change you can make in your daily diet is reducing the size of meals. He proposes eating six small meals rather than three larger ones. Each small meal should be about two to three hours apart.

This matches up best with the typical blood-glucose cycle of rise, level out and fall.

"The goal is not to eat more frequently but to reduce total caloric load at any one time," Benardot said. "When you eat a meal or snack, blood sugar, or glucose, increases, then levels off, then decreases. You want to eat frequently enough to catch the blood sugar before it drops outside the normal range."

If you eat more frequently, your body has a more controlled response to foods. Going too long between meals or snacks causes your body to pump out more insulin when you do eat, Benardot said, a condition that causes too much flux in blood glucose.

This hypersensitivity to insulin production upon eating is virtually constant in obese individuals. Eating foods lower on the glycemic index will help, but the wise strategy is not skipping meals or snacks. You feel less edgy or irritable, plus become stronger and leaner.

"It looks to me like Americans are eating about twice as much as optimal," Benardot said. "You can begin to change the pattern by splitting breakfast and lunch into four smaller meals [say, at 7 a.m., 10 a.m., 12:30 p.m. and 3:30 p.m.]. If you bring a sandwich to work, eat half at lunchtime and the other half during midafternoon."

A global view of eating

Benardot said he recently attended a meeting in Australia. At exactly 10 a.m., a school bell sounded and the conference meeting was adjourned for coffee, tea, cakes and cookies. The same bell sounded for a break at 3:30 in the afternoon. Lectures were suspended to stay faithful to eating something every three hours.

As for dinner, Benardot said, we need look no further than Paris cafes, where portions are much smaller than the typical American nighttime meal.

"France has the lowest obesity and overweight rate among industrialized countries at 7 percent [the U.S., by comparison, is 55 percent]," said Benardot. "But no one can convince them they are eating all foods low on the glycemic index or low in fat."

The glycemic value of some food items

The glycemic index serves as a guide to how rapidly carbohydrate foods increase your blood sugar. Foods lower on the index will release glucose more evenly into your bloodstream. Consuming food items high on the index can make you feel a bit edgy or irritable if you don't combine them with foods lower on the index (or foods with significant protein or fat that naturally take longer to digest).

Nutritionists generally recommend eating more foods low or moderate on the index (less than 50) and selecting more healthy foods among those high on the index.

The index has some surprises in its values, such as similar values for both white and whole wheat breads. But that doesn't mean the two slices are interchangeable. Whole-wheat bread has more fiber, which helps protect against heart disease and cancer while promoting digestive well-being.

In fact, the value for whole-wheat bread is similar to orange soda pop.

Values also can vary among the same foods. For instance, long-grain rice is lower on the index than short-grain rice, and brown rice is lower than white rice. Though Idaho potatoes (best for baking) are sky-high on the glycemic index, new potatoes (low starch because they are picked before they mature) are low glycemic.

Be careful about processed foods--even soy milks--they contain too many sugars. Those sugars (listed on nutrition labels; compare carbohydrates and sugars) can significantly boost the glycemic value.

Here are some sample glycemic values, using glucose as the 100-point comparison value. (For one of the most complete listings, check out www.mendosa.com/gilists.htm.)

Copyright © 2002, Chicago Tribune 

HHS Launches campaign to "Take time to care about diabetes" (May 3, 2002)
Free Risk Assessments for Women Offered in 10 Cities 
HHS Secretary Tommy G. Thompson today launched a nationwide campaign to raise women's awareness about diabetes, a serious condition that affects more than 17 million Americans, more than half of them women. 
The campaign, which is sponsored by HHS' Food and Drug Administration (FDA), the American Diabetes Association (ADA), and the National Association of Chain Drug Stores (NACDS), emphasizes that women -- the family's primary caregivers -- can make a positive difference to the whole family's health, including their own. 

As part of the kickoff, about 500 local screening events also will take place in 10 key cities where residents have a high incidence of diabetes. Local pharmacies will offer free risk assessment and clinical testing, free educational materials and a Diabetic Management Kit. 

"Women need to recognize that diabetes is a growing health hazard they can and should do something about," Secretary Thompson said. "Because more than 5 million people are undiagnosed, we want women, who serve as primary caregivers in the family, to learn about the early signs of diabetes and see their doctor about detection." 

Today, about 9 million women have diabetes, including an estimated 3 million women who do not even know they have the disease. Women are at somewhat higher risk than men for diabetes and pre-diabetes -- disorders that can lead to complications such as heart attack or stroke, as well as blindness, kidney disease and loss of limbs. (Pre-diabetes occurs when blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes.) 

"This campaign will help women recognize the warning signs for diabetes, so that they and their families can take proactive steps to improve their health," said FDA Deputy Commissioner Dr. Lester M. Crawford. "Armed with the key facts, all Americans can take steps to prevent type 2 diabetes and to ensure that they get appropriate, effective treatments once diagnosed." 

Today's announcement is part of HHS' weeklong effort to highlight disease prevention as the primary way that Americans can improve their health and personal well-being while reducing their health care costs. Secretary Thompson has made disease prevention and health promotion a top priority, and the President's budget for fiscal year 2003 proposes a $20 million new pilot program, "Healthy Communities," to help deliver community-wide prevention support. Overall, HHS would spend more than $16 billion for all disease prevention activities under the President's budget. 

Diabetes affects the body's ability to produce or respond to insulin, a hormone that allows blood glucose to enter the cells and be used for energy. Diabetes can cause difficulties during pregnancy and raises women's risks of heart attacks and strokes, as well as blindness, kidney failure and loss of limbs. 

"With the nation facing a growing epidemic of diabetes, pharmacists are critical not only to helping patients manage their disease, but also providing information about risks," said Craig L. Fuller, NACDS president and CEO. "We are partnering with the FDA and the ADA in this national campaign because nearly one in 10 women over 20 have diabetes, but one-third are unaware they have the disease. It is imperative they understand their risk factors and we encourage them to participate in over 250 free diabetes risk assessment events that will be conducted at chain pharmacies in 10 cites from May 28 to June 22." 

"The Take Time to Care" campaign is an important collaborative effort to get valuable health information out to women who are at risk or who have diabetes," said Anne Daly, president, Healthcare & Education, ADA. "The American Diabetes Association is proud to be part of this important public awareness effort." 

The main tools of the campaign -- diabetes-related brochures, wallet-sized calendars, and cards with recipes for nutritious meals -- will be distributed in grocery stores and pharmacies in the 10 cities: Atlanta, Baltimore, Chicago, Dallas, Detroit, Los Angeles, Miami, New Orleans, Indianapolis and Philadelphia. The brochures are being provided in English and Spanish. NACDS alone will distribute 5 million brochures. 

The brochure highlights the warning signs that women need to recognize including fatigue, frequent urination, unusual thirst, extreme hunger, unusual weight loss and irritability. Recurring skin, gum, and bladder infections, blurred vision, cuts and bruises that are slow to heal are also potential signs and symptoms. 

Three key messages are highlighted: 


Get tested for diabetes, 
Watch what you eat and get exercise, 
Use medicines wisely. 
Additional information about the "Take Time to Care" campaign will be available on a newly created website http://www.fda.gov/womens/taketimetocare/diabetes. The site provides information about the campaign and diabetes and is being linked to the websites of all the partners and HHS agencies, including the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA) and Centers for Medicare & Medicaid Services (CMS). 

Consumer information about diabetes is available through the National Diabetes Education Program, an effort sponsored jointly by NIH and CDC, and 200 public and private partners, at http://www.ndep.nih.gov/, or from the ADA at http://www.diabetes.org or by calling 1-800-DIABETES (1-800-342-2383).

Casting new light on eating disorders (May 1, 2002)
Rebecca Theim
New research co-authored by a University of Illinois psychologist that explores the causes of eating disorders in young women refutes earlier findings that suggested a troubled family life alone makes them more susceptible to eating disorders.

Instead, the new study found that female college students whose difficult childhoods lead to depression and difficulty expressing their feelings are at greatest risk to develop anorexia, bulimia or other eating disorders.

The findings are significant, the study concludes, because they suggest that individuals struggling with eating disorders may benefit from "a holistic approach" in their treatment, aimed at helping them cope with depression and identifying and coming to terms with difficult emotions.

Eating disorders are a serious concern because they plague more than two-thirds of all college women, psychologists Dorothy L. Espelage of the University of Illinois at Urbana-Champaign and Suzanne E. Mazzeo of Virginia Commonwealth University noted.

In their study of 820 undergraduate female college students, Espelage and Mazzeo found that college women with depression and alexithymia--difficulty in identifying and describing one's feelings--were more susceptible than women who experienced childhood physical and emotional abuse or neglect, but did not subsequently succumb to depression or alexithymia. The psychologists cited earlier research that suggested depressed or self-unaware women may turn to binge eating as a distraction from dealing with difficult emotions. Other studies also have suggested that depression may be either a consequence of nutritional deficiencies many women with eating disorders have or the physical degeneration that can result, the researchers added.

When treating young women with eating disorders, college counselors and psychologists should not only evaluate their patients' family histories, but also should determine whether they are depressed or have difficulty identifying and talking about issues currently bothering them, the researchers recommend.

"These results indicate that several factors simultaneously influence the severity of eating disorders," according to Espelage and Mazzeo.

Study participants were exclusively female because eating disorders disproportionately affect women. Espelage and Mazzeo also specifically targeted sorority members for inclusion because research showed that eating disorders are more common in sorority settings.

Copyright © 2002, Chicago Tribune

Soy enhanced supplements may stop tamoxifen (May 1, 2002)
Source: (cancerfacts.com)
Supplementing one’s diet with soy and other nutritional aids rich in isovlavones and the derivative genistein may be the wrong thing to do for women battling estrogen-dependent breast cancer say researchers. 
Postmenopausal women with estrogen-dependent breast cancer often face an emotional roller coaster. Physicians prescribe tamoxifen to suppress the tumors and recommend against the use of hormone-replacement therapy (HRT). While tamoxifen stops estrogen from stimulating breast cancer cells, it also can cause menopausal symptoms. Some women turn to over-the-counter products containing isoflavones as an alternative to HRT to treat their menopausal symptoms. 

In a study in mice, a research team led by Dr. William Helferich at the University of Illinois at Urbana-Champaign. found that isoflavone-enhanced dietary supplements containing genistein counteracted the tumor-fighting effects of tamoxifen, a commonly prescribed medication for women whose breast tumors have estrogen receptors. The findings appear in the May 1 issue of the journal Cancer Research. 

“This new study takes our previous findings a step further,” Helferich said in a press release. “These results raise concern about consuming dietary isoflavone supplements in conjunction with tamoxifen in postmenopausal women who have estrogen-dependent breast cancer.” 

In a series of studies published last year, Helferich’s laboratory demonstrated that various dietary products containing genistein can stimulate the growth of estrogen-dependent human breast tumors implanted into adult mice. 

In this current study, researchers divided 66 mice, with their ovaries removed, into six groups to monitor the effects of estrogen and various amounts of tamoxifen and genistein, an estrogen-like component found in legume plants such as soy, peas and certain beans. 

Before adding genistein to the diet, the tamoxifen had stopped tumor growth. The addition of genistein resulted in enhanced growth of estrogen-dependent tumors and increases in estrogen-responsive gene markers. 

Blood concentrations of genistein in these mice were similar to those levels that people can get by consuming isoflavone-rich dietary supplements, Helferich said. 

Genistein often is identified as one of several desired isoflavones in soy products, including soy-enhanced drinks and dietary supplements. 

Ironically, isoflavones in soy are believed to be responsible for anti-cancer effects observed in numerous human and animal studies. In Asia, where cancer rates are low, people often consume diets rich in soy products that contain about 20 to 30 milligrams of isoflavones a day, Helferich said. However, many isoflavone-enhanced drinks and supplements now available in the United States may contain 30 to 150 milligrams per serving, and two or more servings a day are recommended on the labels, he added.

Polyunsaturated Fatty Acids Reduce Women's Risk Of Type 2 Diabetes
(April 30, 2002)

Trans fatty acids increase the risk of type 2 diabetes in women, while polyunsaturated fatty acids reduce that risk.

Total fat intake as well as saturated and monounsaturated fatty acid intake are not associated with type 2 diabetes risk in women, an international team of researchers reports.

"Substituting non-hydrogenated polyunsaturated fatty acids for trans fatty acids would likely reduce the risk of type 2 diabetes substantially," say investigators from Harvard University and Brigham and Women's Hospital in Boston, Massachusetts and the Instituto Mexicano del Seguro Social in Mexico City.

They followed 84,204 women aged 34 to 59 years for a total 14 years. All were free of diabetes, cardiovascular disease and cancer at baseline in 1980.

Detailed dietary information taken at baseline was updated three times¯in 1984, 1986 and 1990.

Investigators used pooled logistic models, adjusted for non-dietary and dietary covariates, to obtain relative risks for type 2 diabetes.

They documented 2,507 incident cases of diabetes among participants during follow-up.

"Total fat intake, compared with equivalent energy intake from carbohydrates, was not associated with risk of type 2 diabetes," the researchers concluded. They point out that for a 5 percent increase in total energy from fat, the relative risk was 0.98.

Intake of saturated and monounsaturated fatty acids were also not significantly associated with diabetes risk. "However, for a 5 percent increase in energy from polyunsaturated fat, the relative risk was 0.63, and for a 2 percent increase in energy from trans fatty acids the relative risk was 1.39.

"We estimated that replacing 2 percent of energy from trans fatty acids isoenergetically with polyunsaturated fat would lead to a 40 percent lower risk." 

American Journal of Clinical Nutrition, 2001; 73: 1019-1026. 

New Oral Drug for Type 2 Diabetes (April 26, 2002)

NEW YORK, Apr 26 (Reuters Health) - A drug that blocks a particular enzyme that affects blood-sugar control has shown early promise in treating type 2 diabetes, according to study findings released Friday. 

Type 2 diabetes, which usually strikes in adulthood, is marked by poorly controlled blood sugar, or glucose, and arises from the body's inability to properly use the hormone insulin, the body's key blood-sugar regulator. The study of 93 adults in the early stages of type 2 diabetes found that over 4 weeks, the oral drug lowered patients' levels of blood glucose. 

The new drug acts by inhibiting an enzyme known as DPP IV, which breaks down other hormones that help control blood glucose. 

"This study provides the first evidence that...DPP IV inhibition is feasible for the treatment of type 2 diabetes in humans," Dr. Bo Ahren of Lund University in Malmo, Sweden, and colleagues report in the May issue of Diabetes Care. 

In their study, two or three daily doses of a DPP IV inhibitor before meals lowered patients' glucose levels overall, according to the report. All of the patients were in relatively early stages of type 2 diabetes and had been treated with exercise and diet regimens alone. Oral drugs and insulin injections are often also needed to manage the disease. 

The researchers conclude that inhibition of DPP IV is a "feasible approach" to treating the early stages of type 2 diabetes. They add that further research will be needed to look at the long-term effects of such treatment, as well as how it works against more advanced diabetes and in combination with other diabetes drugs. 

The drug company Novartis, in Basel, Switzerland, partially funded the study. 

SOURCE: Diabetes Care 2002;25:869-875.

Dairy Intake Linked to Diabetes Prevention (April 25, 2002)

High Dairy Intake May Reduce Risk of Heart Disease and Diabetes 

By Melinda T. Willis 

For those concerned about weight and health, the first things often cut from the diet are high-fat dairy products. But new research suggests high dairy intake may be healthier than once thought, and actually protect overweight adults from developing diabetes and heart disease. 

After tracking more than 3,000 adults for 10 years, researchers report in the Journal of the American Medical Association that overweight subjects who consumed dairy products more than 35 times a week suffered 72 percent less insulin resistance syndrome than those who consumed dairy less than 10 times a week. This relationship did not hold true for those of normal weight. 

Insulin resistance syndrome, or IRS, is a constellation of four risk factors for heart disease and diabetes. An individual with two of the four risk factors — obesity, high blood sugar, high blood pressure or cholesterol problems — is considered to have the syndrome. 

According to recent estimates by the Centers of Disease Control and Prevention, approximately one-quarter of adults in the United States have insulin resistance syndrome. And disturbingly, it has also been characterized in children. 

"This is recent, and it certainly must be due to the fact that the prevalence of obesity in children has doubled in the last decade," says Mark Pereira, lead author of the study and an epidemiologist at Children's Hospital in Boston. 

These trends cause some experts to fear that heart disease rates, which have been declining since the 1950s and have started to level off in recent years, will increase and may even occur in younger individuals. While these trends are worthy of concern, it appears that dairy consumption, by not contributing to the syndrome, does not contribute to a major risk component of heart disease. 

Dairy and Health 

According to Pereira, these results counter previous findings that consuming dairy products might promote obesity. "We found that intake of all types of dairy products appeared to be protective," he says. Experts say that the protective benefits of dairy could be explained by the fact that it is rich in healthy nutrients like protein and calcium. Yet they acknowledge that different mechanisms may also be at work. Pereira cites U.S. Department of Agriculture data stating that while children have decreased their milk consumption over the past 30 years, their intake of soda has steadily increased. 

"It could be that dairy is inherently good for you, but it also could be that if you are replacing dairy with [unhealthy] things, you are going to drive your risk up," he explains. 

Regardless, experts say dairy remains an important component of a healthy diet. 

"Whether the health benefit is from what is included vs. what is excluded always remains a tricky question, but the evidence continues to mount that including dairy foods is important to health for more than the calcium it provides," says Connie Diekman, a registered dietitian and director of university nutrition at Washington University in St. Louis. "Once again, we are seeing a health and of course nutritional benefit to including dairy foods in eating plans." 

However, consuming too much of the saturated fat that is found in dairy foods can increase levels of LDL, or "bad" cholesterol — something the current study did not address. 

"The amount of fat in the dairy was not important," says Pereira. "The current dietary recommendations are to include reduced-fat dairy products in the diet. We're certainly not even beginning to discuss any possible changes to the dietary recommendations based on this single study." 

"I would say that overweight children and their parents should be concerned about their weight, but that dairy consumption is not the problem, and may in fact confer some benefit," says Dr. Christopher D. Saudek, president of the American Diabetes Association.

Fertility News for Older Women (April 22, 2002)
 (Ivanhoe Newswire) -- Women considered "old" by in vitro fertilization standards have new research on their side. A study in the current issue of Fertility and Sterility shows age plays a factor in only part of the fertility process.

It is well known that female fertility declines with age, because of the quantity and quality of the eggs. Fewer eggs are harvested and fewer embryos make it to a healthy stage of progression. Doctors commonly wait to transfer the embryos into a woman's body until after the blastocyst stage. At this stage -- five days into growth -- the embryos are considered strong.

Doctors from the Las Vegas Fertility Center and the University of Nevada School of Medicine reviewed records of 300 women between ages 18 and 45 who had embryos grow to the blastocyst stage before implantation. They found older women have as good a chance of becoming pregnant as younger women, if the embryos make it to this stage. Researchers write, "In the current study, although pregnancy rates per stimulation declined with age, implantation rates per transfer remained remarkably steady across the age range studied."

Authors of the study say it is important to further understand the connection between age and in vitro fertilization because more women are delaying childbearing until later years. At that point, many have to rely on fertility treatments to achieve pregnancy.

SOURCE: Fertility and Sterility, 2002;77:700-705

The Cost of Allergies (April 22, 2002)
 (Ivanhoe Newswire) -- Seasonal allergies affect about 20 percent of Americans and cost the United States as much as $2 billion a year. In a report in this month's Annals of Allergy, Asthma, and Immunology, researchers from Emory University address the high cost of the condition.

For the study, a research team, led by Stanley Fineman, M.D., reviewed past studies to determine the cost of allergies on society. They found even more than the financial burden, allergies have a significant impact on a person's quality of life. They say it impacts work productivity, learning, cognitive function, decision making abilities, and self-perception.

More specifically, Dr. Fineman writes that the medications used to treat the symptoms of allergic rhinitis can have a negative impact. Using a computer simulation, researchers found children on medication for allergies had reduced levels of factual and conceptual knowledge.

Additionally, researchers say allergies can cause a general feeling of uneasiness and the inability to perform daily activities. Patients in the study also reported feeling tired and "unattractive."

Based on these findings, Dr. Fineman writes, "Because allergic rhinitis influences many aspects of daily living, it is important to be diagnosed and treated properly. Physicians' and patients' education will increase their awareness and signs and symptoms of allergic rhinitis."

SOURCE: Annals of Allergy, Asthma, and Immunology, 2002;88:2-7

Exercise for Burn Victims (April 22, 2002)
 (Ivanhoe Newswire) -- When a person is severely burned, it is very difficult for them to return to everyday activities. They often lose a lot of muscle during their recovery and scars can lead to depression. Now, an exercise program in Texas helps burn victims get back to their normal routines faster. 

This is more than a workout for 18-year-old Hugo Laureano -- it's his road to recovery. An accident left Laureano's arms, back and legs severely burned. A year ago, he couldn't even sit.

"I have told my family I can do a lot of things I couldn't do before. I can sit down with no problems," Laureano tells Ivanhoe (translated from Spanish).

Eighteen-year-old Marcos Mendoza is burned on 88 percent of his body. He was putting inflammable paint on the floor when someone dropped a lit cigarette.

His sister, Aida, tells Ivanhoe (translated from Spanish), "In Mexico, they told us that Marcos was going to live only 72 hours."

Two years later, Marcos keeps quite a clip on the treadmill.

Exercise physiologist Oscar Suman, Ph.D. runs this exercise program for burned victims at the Shriners Burns Hospital for Children at the University of Texas. He says it's not always easy to get a patient started.

"They think they're going to break if they take too many steps or if they jog or lift weights," Suman tells Ivanhoe.

Once they get comfortable with exercise, the benefits are plenty, including increased muscle mass, improved movement and psychological benefits.

Marcos says (translated from Spanish), "[I feel] pretty good because before I couldn't run, I couldn't do any type of exercise."

While the program lasts just three months, Suman hopes the lessons will be life-long. He says, "Now they can go home, they're not just going to sit in front of a TV and be sedentary, but they're actually going to incorporate some of the habits they learned here."

Suman says he hopes exercise will become a standard part of the recovery process for burn victims. He points out that above and beyond the standard physical and occupational therapy programs, both cardiovascular and weight training exercises are beneficial for burn victims.

If you would like more information, please contact:

Oscar Suman, Ph.D. 
Shriners Burns Hospital for Children
University of Texas Medical Branch 
815 Market Street
Galveston, TX 77550
(409) 770-6557

Exercise lowers blood pressure regardless of weight (April 22, 2002)
 WASHINGTON (AP) -- Fifty-four studies' combined data put the weight of evidence behind the benefit of aerobic exercise to control blood pressure. 

Exercise pushes down blood pressure, regardless of age, weight, or what blood pressure was when the person started to exercise, according to a statistical analysis of the studies. 

The average reduction was 3.8 milligrams of mercury in systolic pressure -- the measurement taken when the heart contracts and pushes blood through the arteries. The average diastolic reduction, taken when the heart relaxes, was 2.58 milligrams of mercury lower. 

"If we can reduce systolic pressure by 3.8, we can reduce a lot of risk of cardiovascular disease, stroke -- everything," said Dr. Jiang He of Tulane University. 

Being physically inactive raises the risk of developing high blood pressure. And federal surveys find 25 percent of all adults are not active at all. About a quarter of American adults have high blood pressure, and the risk of problems resulting from the condition gets worse as pressure rises. 

Normal blood pressure in an adult is lower than 130 systolic, 85 diastolic. High blood pressure is 140 over 90 or above. Readings between those are considered borderline. 

The report in the April issue of Annals of Internal Medicine examined studies involving 2,419 participants. 

The researchers pooled cases from smaller studies in which some people did aerobic exercise and others did not. The scientists counted on the resulting larger number of cases to give a more accurate assessment of the effect of aerobic exercise on blood pressure. Evidence on the size of the effect had been inconsistent in the smaller groups, they said. 

The pooled figures showed the extent of the drop in blood pressure was fairly consistent regardless of what form of exercise the participants did. 

"For someone who is sedentary, even small things like walking or riding a bike, the study shows, can significantly reduce their blood pressure," said researcher Seamus P. Whelton of Princeton. 

It also did not make a difference whether the participants were overweight or at normal weight. "Blood pressure was significantly reduced even in participants who did not lose weight overall," the report said. 

The benefit was there whether the participants had high blood pressure or normal blood pressure. And the extent of the reduction from exercise was greater than what was found in similar studies on reducing salt in the diet or reducing alcohol use. 

The reduction cited in the paper is modest but valuable, said Dr. Gerald Fletcher of the Mayo Clinic in Jacksonville, Florida, who is also a spokesman for the American Heart Association. 

"It's a good additional bit to know for our pitch on lifestyle changes rather than taking pills or other things that may give side effects," Fletcher said. 

The benefits of exercise may vary among individuals, but the paper in the journal "probably shows us the average to expect," Fletcher said. Overweight people, for instance, may draw reassurance from the paper's finding that their blood pressure can improve from physical activity even if they don't lose weight, he said. 

Study reveals gene linked to breast cancer (April 21, 2002)
 LOS ANGELES, California (AP) -- Researchers have identified a gene that when mutated can lead to an elevated but modest risk of breast cancer. 

The altered gene, called CHEK2 or CHK2, can double the estimated 13 percent lifetime risk of breast cancer that U.S. women face, researchers said. 

About 1 percent of people -- both women and men -- carry the mutated gene. 
Carrying it does not necessarily mean someone is destined to develop breast cancer, the scientists stressed. Instead, the risk is comparable to that faced by women who have a mother or sister with breast cancer, who never have children or who experience menopause at a later age. 

"CHK2 is not something anyone should go out and get tested for," said Michael Stratton, of the Institute of Cancer Research in London. Stratton is co-author of a report detailing the finding published online Sunday by the journal Nature Genetics. 

The gene is also estimated to increase the risk of breast cancer in men tenfold. However, the cancer remains extremely rare in men, accounting for less than 1 percent of all breast cancer cases. 

A pair of genes -- BRCA1 and BRCA2 -- remain the only genes linked to a significantly elevated risk of breast cancer. Carriers of those genes face a risk of developing inherited forms of the cancer as high as 85 percent. 

In the study, an international group of researchers led by teams in the United Kingdom and Netherlands studied 1,071 breast cancer patients who had a family history of the disease, but who hadn't inherited BRCA1 or BRCA2. Their histories were compared with a group of 1,620 healthy individuals. 

In the patient group, 5.1 percent of women and 13.5 percent of men had inherited the faulty version of CHK2, compared with 1.1 percent overall in the control group. 

Having the bad CHK2 did not raise the cancer risk for women who also had abnormal versions of BRCA1 and BRCA2, researchers said. 

Healthy copies of all three genes are believed to be involved in genetic repairs within cells. 
Dr. Kenneth Offit, of the Memorial Sloan-Kettering Cancer Center in New York, stressed that the findings are of limited relevance to the clinical treatment of breast cancer. 
"While these findings are of scientific importance, their use for patient care is limited by the relatively low predictive power of these tests, compared to other known markers -- for example, BRCA mutations," said Offit, who was not involved in the study.

++++++++

FDA Issues Healthy advisory on puffer fish from FLORIDA
(April 15, 2002)
 The Food and Drug Administration (FDA) is warning consumers not to eat puffer fish harvested from the Titusville, Fla., area because these fish may contain a naturally occurring toxin that can cause serious illness or death. Such marine toxins are known to be a byproduct of algae found in seawater. The symptoms of this toxin are predominately neurological: tingling and burning of the mouth and tongue, numbness, drowsiness, and incoherent speech. These symptoms develop fairly rapidly, within 30 minutes to two hours after eating the fish, depending on the amount of toxin consumed. However, in severe cases, respiratory paralysis and even death may occur. This toxin cannot be destroyed by cooking or freezing. 

The FDA has recently learned from the New Jersey Department of Health that three New Jersey residents have become ill from eating puffer fish, also known as blowfish or sea squab, harvested near Titusville, Fla. In two situations, patients ate puffer fish caught by a recreational fisher, but the third patient reported buying the puffer fish from a local New Jersey retail fish market. Further investigations with the Centers for Disease Control and Prevention (CDC) have revealed that there have been additional reports of similar illnesses in Florida and Virginia. 

"It is imperative that consumers not eat puffer fish from the Titusville, Fla. region," said Dr. Lester M. Crawford, FDA Deputy Commissioner. " The FDA continues to work closely with the CDC and the state authorities to protect the public health, but in the meantime anyone who may have eaten puffer fish should be alert to these possible neurological symptoms and seek medical help if it is needed." 

Consumers who have symptoms like those described above and suspect that they have consumed puffer fish harvested from the Titusville, Fla. area should contact their physician or local poison control center immediately. Consumers with questions may call the FDA Center for Food Safety and Applied Nutrition Center's Outreach and Information Center at 1-888-SAFEFOOD. 

The FDA, Centers for Disease Control and Prevention, and the states of Florida and New Jersey continue to investigate this situation. In the interim, consumers are advised to avoid consuming puffer fish from the affected area.

Internet Help for Back Pain (15 April, 2002)
(Ivanhoe Newswire) -- Internet discussion groups could help your aching back. In one of the first studies of its kind, researchers find Internet discussion groups can improve health and may have a place in the treatment of chronic recurrent back pain.

There are hundreds, if not thousands, of health-related Internet support groups. However, researchers have evaluated few of these groups. Investigators from Stanford University School of Medicine conducted a study looking at the effectiveness of on-line discussions about back pain.

The study included 580 participants from 49 states. All of the participants had made at least one outpatient visit to a doctor for back pain. Half of the participants were part of an e-mail discussion group and received a book and videotape about back pain. The other half, the control group, received a subscription to a non-health related magazine of their choice.

After one year, researchers found the people in the discussion group had greater improvements in pain compared to the control group. The participants in the first group also had fewer visits to the doctor and fewer days spent in a hospital for back pain.

Researchers admit there is much more to be learned about the use of Internet discussion groups for persons with chronic health conditions. However, they say in their study, "The results suggest that a combination of information and support largely offered through an Internet discussion group improves health status and health care utilization for up to one year." They hope that in the future researchers can learn more about the potential and limitations of this new media for delivering health care interventions.

SOURCE: Annals of Internal Medicine, 2002;162:792-796

Tofu Benefits (15 April, 2002)
(Ivanhoe Newswire) -- There are dozens of studies that support the health benefits of a soy-based diet. One common soy product is tofu. If you are someone who turns your nose up at the sight of the rubbery concoction, this story is for you. 

Tofu. It's made from soybeans. It may not look appealing to everyone, but "soy sisters" Alesia Lacina and Francene Coons say they can change that.

Lacina tells Ivanhoe, "What I'm making today is glazed tofu."

Start by slicing tofu into small chunks. Next, place the pieces in hot peanut oil. She says the chunks will immediately stick, but that's ok.

"I'm going to come back in about five minutes and by that time it will have released, and I'll be able to just flip it right over," says Lacina.

While you wait, prepare the glaze.

Lacina says, "The glaze is soy sauce, maple syrup and orange juice." Pour it in, and swish it around. She says, "This dish has turned many a skeptic into a tofu lover."

Studies show soy lowers cholesterol, reduces hot flashes, and may even protect against breast and colon cancer.

Coons tells Ivanhoe you will be surprised at how you can sneak it in. She says, "We have incorporated tofu with the Jell-O and it is absolutely excellent.

You can replace cheese with tofu or, says Lacina, "I think the most surprising one is that you can put it in cookies. You can use a half a pound of tofu to replace two eggs" -- a creative way to get the benefits of soy.

The soy sisters have an entire cookbook of tofu recipes. If you're interested in getting three more recipes, click here.

If you would like more information, please contact:

Alesia Lacina
Midwest Harvest
3635 Highway 146
Grinnell, IA 50112
(641) 236-5170
http://www.midwestharvest.com

FDA Approves BOTOX To Treat Frown lines (15 April, 2002)
 FDA today announced the approval of Botulinum Toxin Type A (Botox Cosmetic) to temporarily improve the appearance of moderate to severe frown lines between the eyebrows (glabellar lines), a medical condition that is not serious. The product's manufacturer, Allergan, Inc., Irvine, California, is now allowed to market Botulinum Toxin Type A for this new indication.

Botulinum Toxin Type A is a protein produced by the bacterium Clostridium botulinum. When used in medical settings as an injectable form of sterile, purified botulinum toxin, small doses of the toxin are injected into the affected muscles and block the release of the chemical acetylcholine that would otherwise signal the muscle to contract. The toxin thus paralyzes or weakens the injected muscle. 

Botox was first approved in December 1989, to treat two eye muscle disorders (blepharospasm and strabismus) and in December 2000 to treat cervical dystonia, a neurological movement disorder causing severe neck and shoulder contractions.

In placebo-controlled, multicenter, randomized clinical trials involving a total of 405 patients with moderate to severe glabellar lines who were injected with Botox Cosmetic, data from both the investigators' and the patients' ratings of the improvement of the frown lines were evaluated. After 30 days, the great majority of investigators and patients rated frown lines as improved or nonexistent. Very few patients in the placebo group saw similar improvement. 

In these studies, the severity of the glabellar lines was reduced somewhat for up to 120 days for those patients who received Botox Cosmetic. Most of the patients in the study were female, and the majority was under 50 years old. It is recommended that Botox Cosmetic be injected no more frequently than once every three months, and the lowest effective dose should be used. 

The most common adverse events following injection were headache, respiratory infection, flu syndrome, blepharoptosis (droopy eyelids) and nausea. Less frequent adverse reactions (less than 3% of patients) included pain in the face, redness at the injection site and muscle weakness. These reactions were generally temporary, but could last several months.

Because Botox Cosmetic is a prescription drug, it must be used carefully under medical supervision.

FDA Approves New Indication and Label Changes for the Arthritis Drug, Vioxx (11 April, 2002)
FDA has approved a supplemental application for the use of Vioxx (rofecoxib) for rheumatoid arthritis adding the indication to the previously approved indications for osteoarthritis and pain. FDA has also approved new label text and precautions that are based on the results of the Vioxx Gastrointestinal Outcomes Research (VIGOR).

The VIGOR study, a prospective, randomized, double-blind, one year study, evaluated approximately 4000 patients on Vioxx 50 mg a day (twice the highest approved dose for chronic use) and approximately 4000 patients on the standard dose of naproxen (1000 mg a day), a non-steroidal anti-inflammatory drug (NSAID). Patients who were under treatment with low dose aspirin for heart attack prevention were excluded from the study. 

The study demonstrated that Vioxx was associated with a lower incidence of serious upper gastrointestinal(GI) adverse events of major bleeding, perforation and obstruction compared to naproxen. The reduction in risk was over 50 percent in cumulative rates for Vioxx (.52%) compared to naproxen (1.22%).

An additional finding in the study, however, was that there was a higher cumulative rate of serious cardiovascular thromboembolic adverse events (such as heart attacks, angina pectoris, and peripheral vascular events) in the Vioxx group (1.8%) compared to the naproxen group (0.6%). Data from two smaller studies comparing placebo and Vioxx 25 mg daily did not show a difference in the rate of serious cardiovascular thromboembolic adverse events. The relationship of the cardiovascular findings in the VIGOR study to use of Vioxx is not known. 

After carefully reviewing the results of the VIGOR Study, FDA agreed with the Arthritis Advisory Committee recommendations of February 8, 2001 that the label for Vioxx should include the gastrointestinal and cardiovascular information. The committee advised that the NSAID-class warning regarding GI adverse events should be modified, but not removed from the VIOXX label. This warning advises patients and their doctors about the risks of GI ulcers, bleeding, and perforation. 

The committee also advised that the CV findings should be included in the Vioxx label to provide doctors and patients with the available data on the potential risks and benefits of Vioxx compared to naproxen. The new labeling information approved by FDA will advise doctors to use caution in prescribing Vioxx for patients with ischemic heart disease and notes that Vioxx 50 mg is not recommended for chronic use.

In addition, the new label provides information from studies of patients with rheumatoid arthritis at the chronic dose of 25 mg, showing that Vioxx was associated with a higher incidence of hypertension compared to naproxen 1000 mg.

In addition, the geriatric section of the label will reinforce information in the existing standard warning section of all NSAIDs indicating that the elderly are at higher risk of serious GI and renal events such as GI bleeding and acute renal failure.

Help for Rheumatoid Arthritis ( April 8, 2002)
(Ivanhoe Newswire) -- A new study shows how a treatment for rheumatoid arthritis may extend the life expectancy for patients who suffer with the condition.

Rheumatoid arthritis, a chronic inflammatory disease, has long been associated with a shortened life expectancy due, in part, to complications with cardiovascular disease, infection and cancer.

Researchers now believe methotrexate, an arthritis therapy, may substantially improve survival among rheumatoid arthritis patients.

Researchers studied more than 1,200 rheumatoid arthritis patients after dividing them into those who took methotrexate and those who took either a different antirheumatic drug, prednisone, or nothing at all.

Methotrexate was found to reduce risk of all-cause mortality by 60 percent when compared to those not taking the drug. The risk of cardiovascular death, a substantial threat to patients with rheumatoid arthritis, was reduced by 70 percent.

Hyon Choi, M.D., from Harvard Medical School, says, "Our data indicate that methotrexate may provide a substantial survival benefit, largely by reducing cardiovascular mortality."

Studies show methotrexate can improve mobility and decrease systematic inflammation, both speculated causes for excess cardiovascular deaths from rheumatoid arthritis. Researchers say this drug not only extends life, but seems to improve the quality of life as well.

Researchers say this is one of the largest and longest prospective rheumatoid arthritis cohorts ever studied. They conclude, "This gain in life expectancy could be considered in selecting a cost-effective, disease-modifying antirheumatic drug on a long-term basis."

SOURCE: The Lancet, 2002;359:1173-1177

Natural Estrogen Good for the Brain ( April 8, 2002)
(Ivanhoe Newswire) -- A new study shows elderly patients with lower estrogen levels may have cognitive impairment and may be less able to perform common daily activities than those with higher levels. 

Researchers in Thailand studied the relationship between a person's natural estrogen level and the risk of dementia in the elderly. They evaluated 135 men and women in Bangkok between ages 52 and 85. Of the study participants, 72 had dementia and 63 did not.

Results show a direct correlation between natural estrogen levels (E2) and cognition and behavior in the elderly. In fact, lower E2 levels were associated with a higher risk in the occurrence of dementia, worse cognition and more behavioral disturbances. However, researchers believe that while optimal levels of E2 are needed to maintain brain function in later life, estrogen replacement therapy may not be effective once symptoms of Alzheimer's disease are present.

Estrogen is already known to have many beneficial effects on the brain and after evaluating the results of the current study, researchers believe it may well have a positive effect on cognition, behavior and function in the elderly as well.

SOURCE: Archives of Neurology, 2002;59:385-389

FDA Approves First Synthetic Secretin ( April 8, 2002)
The Food and Drug Administration (FDA) has approved SecreFlo™ (secretin) for Injection for use as an aid in confirming the diagnosis of pancreatic dysfunction and the presence of a pancreatic tumor (gastrinoma) that may become cancerous.

Secreflo™ is a synthetic formulation of the naturally occurring porcine hormone secretin. As such, it is the first of its kind to receive FDA approval. Since 1999, no secretin product of any kind has been available to patients in the United States except through participation in clinical research.

Patients with pancreatic dysfunction are unable to digest food properly. Thick mucus obstructs the pancreas and prevents essential enzymes from breaking down food. Left untreated, this condition can cause patients to become severely malnourished and dehydrated.

Secreflo™ aids in confirming the diagnosis of pancreatic dysfunction by stimulating the pancreas to secrete pancreatic juice and bicarbonate that is used to measure the functioning of the pancreas.

Secreflo™ aids in confirming the presence of a gastrinoma by stimulating the stomach to release a hormone called gastrin that is further tested to confirm the diagnosis.

ChiRhoClin, Inc. of Silver Spring, Md. is the sponsor of the approved New Drug Application (NDA) for SecreFlo™.

Secreflo™ is manufactured by Chesapeake Biological Laboratories of Baltimore, Md. for RepliGen Corporation of Needham, Mass.

Anti-cholesterol drugs lower bone fracture risk ( March 30, 2002)
NEW YORK, Mar 28 (Reuters Health) - Patients who take statin drugs to control their cholesterol levels appear to get the added benefit of fewer broken bones, according to Australian researchers.

Previous work in the laboratory and in animals had suggested that statins could strengthen bones, but studies in people have had mixed results. Now, Dr. Julie Pasco and colleagues report that statins by themselves may increase a woman's bone density.

As women age, and especially after menopause, their bone mineral density tends to decrease, upping the risk of the bone-thinning disease osteoporosis, and painful and disabling fractures of the hip, spine and other bones.

In an interview with Reuters Health, Pasco said that based on her team's findings "statin drugs, used for the treatment of hypercholesterolaemia (high levels of cholesterol circulating in the bloodstream), may increase bone mineral density and protect against fracture."

Pasco and her colleagues at the University of Melbourne and Geelong Hospital in Australia published their findings in the March 11th issue of the Archives of Internal Medicine.

"The participants in earlier studies were not well characterized and it had been suggested that differences in risk factors for osteoporosis between statin-users and non-users might have accounted for the apparent fracture protection and better bone mineral density," Pasco told Reuters Health.

"We were able to explore the relationship between statin use, bone mineral density and fracture in a well-characterized female population and were unable to find any difference in risk factors for osteoporosis between those using statins and non-users that might explain earlier observations," she added.

"Furthermore, we were the first to examine both bone mineral density and fracture risk in the same study population," Pasco said.

The researchers evaluated the association between statin use, fracture risk and bone mineral density in more than 1,370 women. Of this group, 573 had previously experienced a bone fracture. All of the women also answered questions about their diet and calcium intake.

In all, there were 16 statin users in the fracture group and 53 in the no-fracture group, the report indicates.

Statin users had a 60% reduction in fracture risk associated with statin use, which is "greater than what would be expected from increased bone mineral density alone," Pasco's team reports.

"Our data suggest that the increase in bone mineral density among statin-users might not fully explain the observed decrease in fracture rates and that the effect of these drugs may be operating through other mechanisms than simply increasing bone mineral density," she told Reuters Health.

"Medications used in the treatment of hypercholesterolaemia may have additional benefits in terms of the skeleton. Understanding the mechanisms behind the bone-protective effects of these medications may lead to new approaches to prevent osteoporotic fracture," she concluded.

Archives of Internal Medicine 2002;162:537-540. 

Gene boosts good cholesterol in women on estrogen ( March 30, 2002)
NEW YORK, (Reuters Health) - The effect of hormone replacement therapy (HRT) on levels of HDL, or "good," cholesterol may depend at least in part on a woman's genes, results of a new study suggest.

In the study of 309 postmenopausal women with coronary artery disease who were taking hormones or a placebo, levels of HDL cholesterol were more than doubled in women with a common gene variation.

The effects of this variation on the cardiovascular risk of women taking HRT is still uncertain, but the findings raise the possibility of using genetic screening to decide whether a woman will benefit from HRT, according to the study's lead author.

High levels of HDL are known to protect against heart disease, but "we don't know for sure" whether the dramatic increases in good cholesterol in the study will translate into dramatic decreases in heart attacks, explained Dr. David M. Herrington of Wake Forest University School of Medicine in Winston-Salem, North Carolina.

More research is needed, Herrington said in an interview, to see whether the high levels of HDL linked to the gene variation can protect women against heart disease. The researcher added that it will be important to see whether the variation affects other favorable effects of estrogen including increased bone density and relief of menopausal symptoms such as hot flashes.

The influence of the variation on negative effects of estrogen, such as an increased risk of breast cancer and certain blood clots, also needs "to be looked at carefully," Herrington said.

Estrogen raises HDL levels in women, which is often considered one of the reasons that the risk of heart disease is low in women before menopause. For years, HRT was widely thought to reduce the risk of heart disease in postmenopausal women, but recent studies have failed to document its protective effects.

The effects of estrogen--both natural and HRT--on HDL levels have been shown to vary widely, and genetic factors are thought to be involved.

Herrington and his colleagues report in the March 28th issue of The New England Journal of Medicine that when women with a certain type of variation in the estrogen receptor alpha gene were taking HRT, their HDL levels were more than twice as high as in women who did not have such a variation. About 18% of women in the study had one of several closely related variations in this gene.

The idea that a person's genes can influence the effects of medications is not new, Herrington said. Genes have been shown to affect several commonly used drugs, including cholesterol-lowering medications called statins, diuretics used to treat high blood pressure and some asthma medications, he pointed out.

Within the next decade or so, according to Herrington, doctors should be able to conduct simple genetic tests in their offices that will help them select the most appropriate type and dose of medication. Though this type of genetic testing is not available now, Herrington said, "This is right around the corner."

The benefits of screening for gene variations that are involved in HRT's effects on HDL levels are still uncertain, however, since the variation has not been shown to reduce the risk of heart disease, Dr. Ronald M. Krauss of the University of California at Berkeley cautions in a related editorial.

But Krauss states that "it is conceivable" that one day it will be possible to tailor HRT to the needs of individual women. He points out, however, that the increasing availability of other drugs that prevent and treat cardiovascular disease, such as statins, "may obviate the need to deal with the complexities of HRT for many women."

The New England Journal of Medicine 2002;346:967-974, 1017-1018.

Day night light cycles help preemies gain weight  ( March 29, 2002)
NEW YORK, (Reuters Health) - Preterm babies exposed to light cycles that mimic day/night rhythms gain weight faster than those kept in near-darkness, results of a study suggest.

Many neonatal units maintain near darkness to simulate the womb environment. "Constant bright light has been shown to be too stressful on preterm infants, causing irregular heart rates and decreased sleep," researchers from the Duke University School of Nursing explain in a press release.

"Probably, cycled light is a better light environment for preterm infants at some point, but it is not totally clear at what age," lead investigator Dr. Debra H. Brandon told Reuters Health.

Writing in a recent issue of The Journal of Pediatrics, Brandon and her Durham, North Carolina-based associates describe the effects of cycled light on 62 infants born at less than 31 weeks gestation. Normal gestation is 37 weeks or longer.

The babies were randomly assigned to one of three groups: cycled light from birth, cycled light at 32 weeks postconceptual age, and cycled light at 36 weeks postconceptual age. "The kids who got the cycle light from birth had a mean gestational age of 28 weeks," Brandon noted.

"Cycled light establishes a day/night rhythm, mimicking the circadian rhythm cues that are established for full-term babies in the womb," Brandon said in a university statement. "Light is one method that we can use to promote circadian rhythms for these infants and encourage growth and healthy sleep patterns."

The babies who received cycled light from birth and from 32 weeks postconceptual age gained weight faster than those infants exposed to cycled light after 36 weeks postconceptual age, the investigators found. However, even those infants not exposed to cycled light until 36 weeks after conception began to have accelerated growth after cycled light exposure began, Brandon said.

"We still need to determine at what gestational age cycled light has the most benefit, because there may be some outcomes that are not positive from being exposed to cycled light," she said. For younger infants, the stress of cycled light exposure might outweigh any benefits that they would get from circadian rhythm development, Brandon added.

In the next phase of her research, Brandon plans to study the long-term outcomes of infants exposed to cycled light.

The Journal of Pediatrics 2002;14. 

Low iron in pregnancy may affect baby's skills ( March 29, 2002)
NEW YORK, (Reuters Health) - Children deprived of iron in the womb may lag behind their peers in terms of language and motor skills by the time they enter school, researchers report.

The study "supports the findings by many researchers that adequate iron nutritional status is important for normal brain development," according to Dr. Tsunenobu Tamura and colleagues from the University of Alabama at Birmingham.

The investigators found that children with the lowest levels of iron were nearly five times more likely to score poorly in tests measuring fine motor skills, compared with children whose blood iron concentration was in the middle range. Those youngsters also had low scores on tests of language ability, according to a report in The Journal of Pediatrics.

In the study, the researchers measured iron concentration in blood collected from the umbilical cords of 278 newborns. The children underwent a series of tests measuring language ability, motor skills, attention and intelligence at age 5 years.

At this point, it is not clear whether taking an iron supplement during pregnancy would boost the mental and motor skills of children, Tamura and colleagues note.

"If the results of (further studies) are positive, the prevention of poor development by iron supplementation would then be a high priority in terms of public health policy," they write.

The researchers note that children with the very highest level of iron in the study tended to have lower scores on intelligence tests, although the reason for the association is unknown.

In the meantime, all pregnant women would be wise to adhere to current recommendations to take an iron supplement or to be screened for iron deficiency, Dr. Robert E. Fleming, from Saint Louis University in Missouri, writes in an accompanying editorial.

He argues that the study does not "definitively implicate" low iron stores at birth with developmental problems in childhood, however, and suggests that more studies are needed to determine the effect of the mother's level of iron on the developing brain.

Iron is a mineral that is essential for normal growth and development of fetuses and children, and a lack of adequate iron during early infancy and childhood is associated with a delay in mental and motor development. Exactly how iron may boost brainpower is not clear but studies in animals have shown that a lack of iron disrupts the brain's neurotransmitters.

The current study is among the first to study the relationship with iron concentrations in the womb, and mental and motor development during childhood.

The Journal of Pediatrics 2002;140:165-170. 

Vitamin E fights arthritis-like damage in mice ( March 29, 2002)
NEW YORK, (Reuters Health) - French scientists have found that vitamin E can reduce joint destruction in mice with a rheumatoid arthritis-like condition--suggesting, they say, that the vitamin should be studied as a potential therapy for the human disease.

The vitamin did not help the symptoms of the disease in mice, but it did prevent some breakdown in the animals' joints, according to researchers led by Dr. Michel De Bandt, of the Centre Hospitalo-Universitaire Xavier Bichat in Paris.

Rheumatoid arthritis is an inflammatory condition in which the immune system mistakenly attacks the lining of the joints, leading to pain, swelling and loss of mobility. Joint destruction occurs over time.

According to De Bandt's team, potentially damaging forms of oxygen in the body called reactive oxygen species are thought to play a role in this process. In line with this theory, rheumatoid arthritis patients have been found to have low blood levels of antioxidants like vitamins E and C, which help neutralize reactive oxygen species.

There have been some clinical trials of using antioxidants to treat rheumatoid arthritis, but the results have been mixed, the researchers note. So they sought to weed out the effects of vitamin E alone in a mouse "model" of the disease.

The investigators found that after 6 weeks of vitamin E treatment, mice with the arthritic condition showed symptoms, but the destruction in their bone and cartilage was much less severe than that in animals not given the vitamin. The vitamin-treated mice also showed lower blood levels of an inflammatory protein produced by the immune system called interleukin-1beta--which, De Bandt and colleagues note, is involved in joint destruction.

Exactly how vitamin E might have prevented joint destruction is unclear. The researchers found no evidence that the antioxidant altered the oxidation process in the animals' circulation.

"Our results," they conclude, "emphasize the potential interest of vitamin E in arthritis and deserve further evaluation in order to fully understand its precise mechanism of action."

Arthritis and Rheumatism 2002;46:522-532. 

Pump Better, but not Necessary, for Diabetics ( March 25, 2002)
(Ivanhoe Newswire) -- Better blood sugar control seems to come from insulin pump therapy when compared to multiple injections, according to a new study. However, it may not be a necessary step for best control. 

In a recent study, researchers from London studied 301 type 1 diabetics who were on an insulin pump and compared them to 299 diabetics who took insulin injections. They measured blood sugar control and other important "control" markers.

Results show average blood sugar concentration was lower in patients who were on pump therapy when compared to those receiving insulin injections. Authors of the study write, "This improved control during insulin infusion was achieved with an average reduction of 14 percent in insulin dose." However, the improvement in overall blood sugar control was relatively small.

Researchers write, "Glycemic control is better during [pump therapy] compared with … injection therapy, and less insulin is needed to achieve this level of strict control. The difference in control between the two methods is small but should reduce the risk of [diabetic] complications."

Researchers point out this study shows insulin pump therapy may be unnecessary for most people with type 1 diabetes and should be reserved for those with special problems related to insulin injections.

SOURCE: British Medical Journal, 2002;324:705-708

Drug Reduces Stroke Incidence ( March 25, 2002)
(Ivanhoe Newswire) -- A new study shows, despite causing only a modest reduction in blood pressure, the drug ramipril reduces the incidence of stroke in high-risk patients.

Researchers studied more than 900 patients over age 55 to determine the most effective way to reduce their risk of stroke. Patients at high risk of having a stroke were assigned to receive either the drug ramipril or a placebo. Doctors gathered data from these patients every six months for more than four years. Ramipril is an ACE inhibitor and is given as a blood-pressure lowering drug.

Results show patients who received ramipril had only a modest reduction in blood pressure but their risk of stroke was reduced by 32 percent. The risk of a fatal stroke was reduced by 61 percent.

Stroke is the second leading cause of death in the world and researchers conclude ramipril could have a significant impact on patients who are at high risk for stroke.

SOURCE: Britain Medical Journal, 2002;324:699-702

Good Bacteria may Prevent Allergies ( March 25, 2002)
(Ivanhoe Newswire) -- If results from a new study out of England are confirmed, parents may one day be feeding their infants bacteria to reduce their risk of developing allergic conditions such as eczema. 

In recent years, scientists have been studying a hypothesis known as the "hygiene theory". It links allergic conditions to greater cleanliness in modern households. In short, researchers believe certain beneficial bacteria ingested early in life help to develop tissue in the intestines that counteracts the cells responsible for producing allergic effects.

The fact that the prevalence of atopic eczema and related diseases has doubled in developed countries over the past two decades leads them to suggest infants aren’t getting the beneficial bacteria they need to avoid allergic conditions.

In this study, investigators divided a group of 159 women who either suffered from allergies themselves or had a first-degree relative or partner with eczema, hay fever, or asthma into two groups. One group took two daily pills that contained probiotics, cultures of potentially beneficial bacteria found in healthy intestines. They took the pills for two to four weeks before giving birth. The other group took a placebo. After birth, the women either continued to take the pills for six months if they were breastfeeding or they gave the contents of the capsules mixed with water to their infants.

Researchers followed the mothers and babies for two years and found half as many of the children in the bacteria group developed atopic eczema as compared to those in the placebo group.

The study was published in an issue of The Lancet last year and an abstract appears in the current Archives of Dermatology. In an accompanying editor’s comment, Hywel C. Williams, Ph.D., says the results are impressive but questions whether doctors should use the findings to prescribe probiotics for their patients at risk for allergies. He writes, "Additional studies are required to confirm the findings, and longer follow-up is needed to see whether the benefits are sustained and whether the interventions are free of serious adverse events."

SOURCE: Archives of Dermatology, 2002;138:1076-1079

Study Reveals Estrogen Role in Diabetes ( March 25, 2002)
(Ivanhoe Newswire) -- A new study reveals using estrogen after menopause may increase the risk of type 2 diabetes in American Indian women.

Use of estrogen replacement therapy has been widely studied, and both health benefits and risks have been identified. Doctors know the therapy helps protect some women from osteoporosis, and some believe it may play a role in preventing cardiovascular disease. Other studies have shown a link between estrogen use and endometrial and breast cancer.

The effect of estrogen use on type 2 diabetes, however, has not been extensively studied, and the studies that have been conducted have been in white women who already have lower incidence of the disease as compared to other ethnicities.

This study examined the relationship between estrogen use and glucose and insulin levels, along with the risk of type 2 diabetes, in American Indian women, a population known to be at high risk for the disease.

Results of the current study, conducted by researchers from the University of Oklahoma Health Sciences Center, associated estrogen use with lower fasting blood sugar levels, but higher levels of a test measuring the 2-h glucose level. Estrogen use was not associated with an increased risk of diabetes overall, but when researchers took into account the length of time on the therapy, an increased risk became apparent. The study involved about 850 women.

The investigators conclude longer use of the therapy may be related to an increased incidence of the disease and suggest more study is needed to clarify the association.

SOURCE: Diabetes Care, 2002;25:500-504

Reduce Your Colon Cancer Risk ( March 18, 2002)
(Ivanhoe Newswire) -- People with a family history of colon cancer may be able to reduce their own risk of developing the disease with a few simple dietary changes. 

A new study reports approximately 135,000 new cases of colon cancer are diagnosed each year. This makes colon cancer the third most commonly diagnosed cancer in the United States and one of the leading causes of cancer-related deaths.

Charles Fuchs, lead author of the study, says, "Previous research has demonstrated that people’s risk of developing colon cancer is two times greater if they have a parent or sibling who has been diagnosed with the disease. Our study points to steps that such individuals can take to substantially lower those odds."

The study is based on the Nurses’ Health Study, an ongoing project that has tracked the health of more than 100,000 female registered nurses in the United States for more than 25 years. From this, researchers analyzed information from nearly 89,000 nurses whose family health histories and dietary habits have been recorded.

Fuchs reports that his research reveals three behaviors consistently associated with colon cancer and people with a family history of the disease. He says a diet high in folic acid, high in methionine (an essential amino acid), and low in alcohol intake, when followed for at least five years, significantly reduced colon cancer risk in those with a family history of the disease.

Fuchs says, "It appeared that either a high-folate diet or use of folate-containing multivitamins virtually eliminated the excess risk of colon cancer associated with a family history of the disease." Fuchs also reports that consumption of more than two glasses of wine per day appeared to dramatically increase one’s risk.

Fuchs believes these findings may have other implications. He says: "This research may make it possible to identify genes that confer a greater risk of the disease in families with a history of it. That would be an important step toward therapies able to reduce that risk. Our findings involving folate may offer the first clue."

SOURCE: Cancer Epidemiology Biomarkers and Prevention, 2002;11:227-234

Height may Increase Diabetes Risk ( March 18, 2002)
(Ivanhoe Newswire) -- Kids who are taller than their peers may be at increased risk for developing type 1 diabetes, a new study reports. Researchers say the reason may lie in their genes -- taller kids in the study also had taller parents. 

Scientists know children who eventually develop type 1 diabetes first exhibit increased insulin secretion before the first symptoms occur. This increased insulin secretion could, in turn, lead to increased growth in terms of height. While previous studies have looked at the height of children who are diagnosed with diabetes, results have been inconclusive.

Investigators from the University of Illinois studied 451 children who were being seen at a pediatric diabetes clinic and compared data on them with growth information on more than 10,000 children enrolled in a national nutrition study.

Results showed children with diabetes were actually shorter than their non-diabetic peers during their first year of life. However, from age 3 until they reached puberty, the diabetic children were taller.

Most of the excess height, however, was attributed to the fact that these children had taller parents. The researchers say this is the most likely explanation for the link found between childhood diabetes and a taller stature, explaining that increased parental height leads to increased childhood height, which increases the risk for diabetes.

SOURCE: Pediatrics, 2002;109:479-483

Too Much of a Good Thing? ( March 18, 2002)
(Ivanhoe Newswire) -- It seems that when it comes to the heart-healthy benefits of alcohol, it could be that there's such a thing as too much of a good thing. 

Researchers from the Massachusetts General Hospital and Brigham and Women's Hospital in Boston conducted a study looking at women who consume alcohol and the impact it has on their hearts.

They found, in a study of close to 71,000 women between ages 25 and 42, that a little bit of alcohol is a good thing, but too much becomes bad for the heart. More specifically, as compared to nondrinkers, those who consumed .26 to .5 drinks per day had a 14 percent lower risk of hypertension. And, when the number of drinks per day exceeded 1.5 drinks, an increased risk of hypertension became evident (a 44 percent increased risk).

Researchers say the benefits were not based on the type of drink consumed.

Some argue the findings may be the result of previously hypertensive individuals lowering their alcohol intake. To get around this problem, researchers specifically excluded women who had hypertension at the start of the study.

The study contained a few weaknesses that researchers were sure to point out. These include a reliance on self-reported diagnosis of hypertension and self-reported alcohol consumption. They anticipate the most likely error in reporting was at the higher levels, suggesting the connection of increased risk to 1.5 drinks per day may underestimated.

These findings, report researchers, "...refine our understanding of alcohol consumption and risk of hypertension and may be used by primary physicians in counseling young women."

SOURCE: Archives of Internal Medicine, 2002;162:569-574

Exercise Helps Lower Blood Pressure ( March 18, 2002)
(Ivanhoe Newswire) -- A new study finds exercise not only lowers blood pressure during the immediate post-exercise period, but it also maintains those lower pressures for nearly a day. 

People with high blood pressure are at increased risk for heart disease and stroke, and lowering pressures can significantly decrease these risks. Studies have shown exercise significantly lowers blood pressure for a short period after the exercise has been completed, but doctors have not been sure whether this lower pressure can be maintained. They also have not fully understood how exercise produces this effect.

Researchers from the University of Sao Paulo in Brazil published their findings in the recent Journal of the American College of Cardiology. They studied 24 elderly patients with high blood pressure and 18 elderly people without high blood pressure, who served as controls. All of the participants took part in a low-intensity, 45-minute exercise session during which they rode a stationary bicycle, and then had various tests to determine the effect on blood pressure and other physiologic factors.

The study showed exercise lowers blood pressure by having a positive effect on a number of important factors related to good cardiac health and maintained those lower pressures and positive benefits over a 22-hour period.

The researchers write, "Low-intensity dynamic exercise should be strongly recommended to elderly hypertensive patients, because, in addition to reducing cardiac work during the post-exercise period, it provokes a decrease in blood pressure that lasts for 22 hours."

SOURCE: Journal of the American College of Cardiology, 2002;39:676-682

Soy may Reduce Chronic Pain ( March 18, 2002)
(Ivanhoe Newswire) -- A new study reveals a diet rich in soy may reduce chronic pain associated with inflammation. 

Previous research shows consumption of soy reduces pain resulting from nerve injury. Johns Hopkins’ researchers conducted this study to determine if soy could also reduce pain resulting from inflammation.

In the study, researchers divided rats into two groups of 10. They fed one group a diet based on casein protein, the milk protein found in cheese. The other group ate a diet rich in soy protein.

After two weeks, researchers randomly selected which animals would receive injections of a placebo and which would receive a solution designed to induce inflammatory pain behind one of their paws.

Researchers measured paw thickness to assess fluid build-up. They also used a heat stimulus to measure pain tolerance and measured reactions to different pressures applied to the paw.

Tests were administered before injections and again 6, 24, 48 and 96 hours after the injection.

Authors of the study report rats on the soy diet had significantly less swelling and a higher pain tolerance than those on the casein diet. Diet did not affect reaction to pressure stimuli.

More than two-thirds of patients with advanced cancer suffer pain similar to that induced on the animals. Authors of the study say managing this pain is a complex issue for physicians. Current approaches involve medications, generally opioids, which can have adverse side effects.

Jill Tall, Ph.D., lead author of the study, says, "Our generation is very open to the idea of dietary methods of pain control. We hope to find complimentary and alternative treatments to help people suffering from pain."

Future studies will help determine if a soy diet can reduce the opioid dosage currently necessary for treating chronic pain and, therefore, reduce side effects associated with treatment.

SOURCE: Presented at the annual meeting of the American Pain Society in Baltimore; March 15, 2002