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Healthnotes Newswire (July 31, 2008)—Women over 50 are usually reminded to have their bone density evaluated every couple of years, but many healthcare providers don’t know when to recommend this screening to men. To help pinpoint the right time for testing men’s bone density, a new review has identified the major factors that put men at risk for fracture from osteoporosis. The review, published in the Annals of Internal Medicine, analyzed the findings from 177 studies performed between 1990 and 2007 that assessed risk factors for osteoporosis-related fracture in men, and 20 studies that evaluated various screening tests for osteoporosis. The findings from a previous review were also included in the analysis.

What puts men at risk

It comes as little surprise that the two most important risk factors identified for men were the same as those for women: being over 70 years old and being thin (having a low body mass index). Other risk factors included sedentary lifestyle, having taken prolonged courses of steroid medications, weight loss, and having had a previous fracture due to osteoporosis. Androgen deprivation therapy, a prostate cancer therapy that reduces testosterone levels, was also found to significantly increase fracture risk.

Smoking was found to slightly increase fracture risk, while low dietary calcium from milk was not consistently associated with fracture risk. Drinking alcohol had no apparent effect on fracture risk or bone mineral density.

Although some studies identified rheumatoid arthritis, respiratory diseases such as asthma, and gastrointestinal disorders such as celiac disease as risk factors for low bone density and fracture, the evidence was not strong.

Are you a good candidate for screening?

Dual-energy x-ray absorptiometry (DEXA) is the current gold standard for diagnosing low bone density and osteoporosis in men and women. It is regularly recommended for women but less commonly for men, despite the fact that 25% of men over age 60 will have a fracture due to osteoporosis sometime in their lifetime.

A simple osteoporosis screening questionnaire involving age and weight as the only variables was found to be an accurate predictor of osteoporosis in men, and one study found that the strongest predictor for hip fracture risk was weight under about 150 pounds (70 kilograms).

“Osteoporosis in men is substantially underdiagnosed and undertreated in the United States and worldwide,” said lead study author Dr. Hau Liu of the Santa Clara Valley Medical Center in San Jose, California. “We determined that men of advanced age and low body weight are the best candidates for osteoporosis screening. Identifying other important risk factors, particularly weight loss, physical inactivity, corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy, can help healthcare providers select other men who are good candidates for screening.”

(Ann Intern Med 2008;148:685–701)

Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (July 17, 2008)—If you are chronically tired, getting moving might be just the thing to put some pep in your step. A new study has found that exercise can improve energy and lessen feelings of tiredness in people who suffer from persistent fatigue.

The effects of exercise on people with certain chronic medical conditions (heart disease and cancer, for example) are well documented, but less is known about its role in improving stamina in people suffering from fatigue without an underlying disease. The new study aimed to determine how exercise affects feelings of fatigue and energy in young people with fatigue unrelated to a medical condition.

In the study, published in Psychotherapy and Psychosomatics, 36 sedentary people with persistent fatigue ranging in age from 18 to 35 were assigned to a low- or moderate-intensity exercise group, or to a no-treatment control group. The low-intensity group worked out on a stationary bicycle at 40% of their peak oxygen consumption (roughly equivalent to walking at a leisurely pace) and the moderate intensity group at 75% of their peak oxygen consumption (about the same as walking at a fast pace), for 30 minutes three times per week for six weeks.

Slow and steady the best bet for persistent fatigue

People in the low- and moderate-intensity exercise groups had a 20% improvement in energy levels after six weeks compared with levels at the beginning of the study. Low-intensity exercise decreased feelings of fatigue by 65%, compared with 49% in the moderate-intensity group. The changes in fatigue and energy levels were unrelated to changes in aerobic fitness. The authors suggested that energy and fatigue improvements are due to the direct effects of exercise on the central nervous system.

Exercise professionals agree

“I have found that maintaining a consistent exercise routine keeps me feeling well balanced and energized,” says Rachel Weisz-Nesshoever, Aerobic and Fitness Association of America certified group exercise instructor in Narragansett, Rhode Island. “Exercise has a way of lifting the spirits and combating fatigue. Sometimes people who are chronically tired tend to avoid exercising. What they don’t realize is that—if it’s done right—exercise can actually give you more stamina and energy to do the things you want to do.”

(Psychother Psychosom 2008;77:167–74)

Healthnotes Newswire (July 3, 2008)—It’s well known that vitamin D is needed for proper bone growth in children and general bone health in children and adults, but it appears that adolescents worldwide are vitamin D deficient, and that current recommendations for daily D may not be enough for health and disease prevention. The good news: a recent study finds that giving teens higher amounts of vitamin D can raise them to healthy levels after one year of treatment.

The value of the “sunshine vitamin”

Vitamin D deficiency may lead to abnormal bone growth and development and to the development of chronic diseases in adulthood such as osteoporosis, cancer, and multiple sclerosis, and research suggests that the recommended daily intake of 200 IU of vitamin D may not be enough to prevent deficiency. The authors of this new long-term study suggest that a vitamin D blood level of 30 ng/ml (measured as 25-hydroxyvitamin D) is desirable based on expert recommendations, but many people have much lower levels. They tested a higher dose of vitamin D to see if it was safe for teens and effective in raising vitamin D levels.

In the study, 340 students, ages 10 to 17, were randomly assigned to take low-dose vitamin D3 (1,400 IU per week), high-dose vitamin D3 (14,000 IU per week), or placebo. After one year of treatment, adolescents who received the high-dose vitamin D had significantly higher blood levels (average, 38 ng/ml of 25-hydroxyvitamin D) compared with the levels in the low-dose vitamin D (17 ng/ml) and placebo groups (16 ng/ml).

The authors claim that vitamin D deficiency “is prevalent in children and adolescents worldwide.” They add that the high worldwide prevalence of vitamin D deficiency, the fact that many adult diseases begin in childhood because of vitamin deficiencies, and increasing evidence for the safety of higher doses of vitamin D should prompt a change in the current recommendations for an adequate daily amount. More research is needed to determine the safety of taking higher daily doses of vitamin D and to determine optimal levels for health and disease prevention.

Get your daily D

A person gets vitamin D several ways:

• Modest sun exposure (approximately 20 minutes per day)—people who get very little sun exposure, such as those who live in cloudy climates and at northern latitudes, may need to rely on diet and supplements to achieve adequate vitamin D levels

• Supplements such as vitamin D3 and cod liver oil—1 teaspoon of some brands provides 400 IU of natural vitamin D

• Some foods and beverages—fortified milk and cereal, fatty fish such as salmon and mackerel, and, to a lesser extent, eggs, beef, some cheeses, and other foods

According to the American Academy of Dermatology, most people get the current recommended amounts of vitamin D through incidental sun exposure. They recommend using sunscreen when outdoors in the sun and obtaining needed amounts of vitamin D through foods and supplementation. However, for those not likely to take supplements or deliberately get enough D in the diet, it is important to weigh the risks and benefits of sun exposure against your risks for bone disease and other health issues. Talk to your doctor about your vitamin D needs and what combination of sources might be best for you.

(J Clin Endocrin Metab 2008:doi:10.1210/jc.2007-2530)

Healthnotes Newswire (July 3, 2008)—Reishi, shitake, and maitake are among the mushrooms long known to contain medicinal properties that help with health and healing, but the Journal of the Science of Food and Agriculture reports that a mushroom doesn’t need to be exotic to pack a healthy punch. It turns out that common white button mushrooms are rich in antioxidants, making them a wise choice for healthy eating.

Whitecoats study white button mushrooms

In the study, extracts from two wild strains and one cultivated strain of button mushrooms (Agaricus bisporus) were tested for their antioxidant activity. The cultivated strain had the highest, quenching more free radicals than either of the wild strains. In all of the mushrooms, the gills had stronger antioxidant effects than the stems and caps.

Some extracts were tested in the lab for their effects on replenishing glutathione, a molecule sometimes referred to as the body’s “master antioxidant.” All of the mushrooms were strong promoters of restoring glutathione to its beneficial active form. Other tests demonstrated their ability to preserve other important antioxidant enzymes.

Eating your favorite fungus may have health benefits

Button mushrooms are the most commonly eaten mushrooms in the United States. Preliminary studies have found that these mushrooms can stimulate the immune system and block cancer growth in test tubes. Several recent studies have linked eating high amounts of button mushrooms with lower risk of breast and stomach cancers.

The degree of antioxidant activity measured in the white button mushroom extracts was similar to that seen in extracts of other Asian mushrooms that have historically been used as food and medicine, such as himematsutake, basket stinkhorn, maitake, lion’s mane, white matsutake, and poplar fieldcap. Studies of these mushrooms and two other well-known medicinal mushrooms, reishi and shitake, suggest that they have immune-enhancing and anticancer properties.

Research shows that dietary antioxidants are important nutrients for preventing chronic diseases including heart disease and cancer. Eating lots of colorful fruits and vegetables is the best way to support a healthy immune system and prevent cancer, and adding more white button mushrooms to your meals may be one easy way to do so.

“The results presented here indicate that the premier cultivated mushroom, the white button mushroom, might be an important source of dietary antioxidants that could have protective effects in the body,” said Dr. Jean–Michel Savoie of the French National Institute for Agricultural Research, Laboratory Mycology and Food Safety in Bordeaux, France. “This common mushroom could be included in the growing group of mushrooms that have demonstrated excellent antioxidant activity.”

(J Sci Food Agric 2008;88:970–5)

Healthnotes Newswire (July 3, 2008)—Eating less and exercising more leads to weight loss. But does it matter which diet you follow? A new study suggests that it does: researchers found that a low-fat diet might be more effective than a low-carbohydrate diet at preventing cardiovascular disease in the long term, as it has better effects on the blood vessels.

Atkins vs. the American Heart Association

The study, published in Hypertension, included 20 obese but otherwise healthy adults who were assigned to eat either a low-fat diet or a low-carb diet for six weeks. The low-fat diet was based on the American Heart Association’s diet, which limits calories from fat to 30% of total calories. The low-carb diet was based on the Atkins diet in which only 20 grams of carbs (approximately the amount in one medium apple or two slices of whole-wheat bread) are allowed each day. The diets were designed to provide the same number of calories.

At the end of the study, people in both groups had lost about ten pounds, and blood pressures had decreased, though they were normal throughout the study. Vascular ultrasound showed that blood vessels dilated more readily in response to increases in blood flow after six weeks on the low-fat diet, indicating improved vascular health. In the low-carb group, this measure of blood vessel health had worsened.

Low-Fat Best for Heart Health, but Low-Carb Can Still Help

The low-carb diet was not without benefits, however. Fasting insulin levels decreased in this group, indicating that their insulin sensitivity and ability to control blood sugar had improved. This suggests that the relative benefits of the two diets might be different in people with diabetes. In addition, triglyceride levels, which are associated with heart disease risk, fell in the people consuming the low-carb diet.

Weight loss can help lower the risk of high blood pressure and hardened arteries (atherosclerosis) and their associated conditions: stroke and heart attack. People with obesity will benefit from losing weight, and a low-fat diet might be healthiest for their blood vessels. In addition, quitting smoking, exercising, and reducing stress can all contribute to a lower risk of cardiovascular disease and a healthier life.

Obesity is a major risk factor for cardiovascular disease, the number one cause of disability and death in the developed world. In response to rising obesity rates, weight-loss diets and fads continue to rotate through awareness and popularity. An estimated 45% of women and 30% of men in the United States diet to lose weight, but their choice of diets—and their results—vary widely.

“The composition of diet may be as important as the degree of weight loss in determining the effect of dietary interventions on dietary health,” said the study’s authors in their conclusion. “Low-fat diets may confer greater cardiovascular protection than low-carbohydrate diets.”

More information about the American Heart Association’s low-fat diet recommendations can be found at www.americanheart.org.

(Hypertension 2008;51:376–82)

Healthnotes Newswire (June 26, 2008)—Yet more proof points to the importance of exercise and healthy eating to reduce the chance of developing diabetes in people at risk for the disease. With the onset of type 2 diabetes, the body’s ability to keep blood sugar (glucose) levels in check begins to diminish. Losing weight, exercising regularly, and eating well can help improve insulin sensitivity, protecting against diabetes or possibly halting its progression.

“In people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes,” said the authors of a new study in the Lancet.

As part of the 20-year study, 577 people with impaired glucose tolerance (a prediabetic condition) were assigned to a control group (no intervention), or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). The dietary intervention focused on eating more vegetables and consuming less sugar and alcohol. The exercise intervention concentrated on increasing leisure time physical activity.

The interventions lasted for 6 years; then the people were followed for 14 more to determine the long-term effects of the lifestyle changes on the risk of developing diabetes and related complications, including heart disease.

During the first 6 years, the people in the intervention groups had a 51% lower incidence of diabetes than did people in the control group. After 20 years, the intervention groups sustained a 43% lower diabetes incidence, and people in the intervention groups were diabetes-free for almost 4 years longer than people in the control group. The interventions did not seem to affect the risk of cardiovascular disease and other diabetic complications.

The World Health Organization estimates that at least 180 million people worldwide are living with diabetes. The risk of type 2 diabetes is higher in people with a family history of the disease; being overweight, having high triglycerides (a fat in the blood), and high blood pressure also raise risk.

Simple steps to protect your blood sugar

Dr. Leon Hecht, a New Hampshire naturopathic doctor specializing in diabetes, offers these tips for stabilizing blood sugar and avoiding diabetes and related problems.

• Focus your diet on whole foods, including vegetables, fruits, whole grains, lean animal proteins, legumes, nuts, and seeds.

• Eat a larger breakfast and a smaller dinner.

• Each day, make one meal a large salad with all the fixings.

• Decrease foods with flour in them—this means all cakes, cookies, and breads—as these foods will raise your need for insulin, causing you to store fat.

• Aim to lose abdominal fat, as weight in this area is a principal risk factor for type 2 diabetes.

(Lancet 2008;371:1783–9)

Healthnotes Newswire (June 12, 2008)—A cup of ginger tea is often just the thing to settle an upset stomach—but little is known about how it actually works. A new study, published in the European Journal of Gastroenterology and Hepatology, found that ginger stimulates digestion by speeding up the movement of food from the stomach into the upper small intestine.

Soothing to the stomach

After having nothing to eat or drink for eight hours, the 24 healthy men in the study were given either 1,200 mg of ginger or placebo, and then ate a bowl of soup. They answered questions about their digestive comfort, and digestive activity was measured by ultrasound. One week later, they repeated the test, but the ginger and placebo groups were reversed.

Muscle contractions in the stomach, which help to move food into the upper small intestine, were more frequent and the stomach emptied more quickly after ginger than placebo. After eating the soup, mild digestive discomfort was reported in those who had placebo but not ginger.

From the kitchen to your medicine cabinet

Ginger (Zingiber officinale) is popular as a culinary spice and as a medicinal herb. It is used all over the world to treat indigestion, gas and bloating, nausea, diarrhea, and irritable bowel syndrome. A well-known remedy for nausea during pregnancy and motion sickness, ginger has also has anti-inflammatory effects that make it a good choice for treating arthritis.

“Since low gastric motility has been associated with the digestive symptoms for which ginger is frequently used, if ginger improves the movement of food through the upper digestive tract in people with digestive problems, this could help to explain how it exerts its benefits,” said Dr. Rebecca Chollet, a naturopathic doctor who practices in New Hampshire and Vermont.

Ginger is often taken as tea, prepared by simmering the cut root in a covered pot. It can also be used as tincture (an alcohol-based extract), in capsules (as in this study), or added to common gas-producing foods like beans and lentils to prevent gas. At times when nausea makes eating or drinking difficult, crystallized ginger can be used like a lozenge.

A multifaceted approach may help your digestion

Other methods for preventing indigestion include eating slowly and being careful not to overeat. Like ginger, caraway, cumin, and fennel can be added to foods to reduce the chance of developing gas after eating. Digestive enzyme supplements are sometimes helpful when these measures are not enough.

(Eur J Gastroenterol Hepatol 2008;20:436–40)

Healthnotes Newswire (June 12, 2008)—A study in the Journal of Clinical Oncology found that cancer survivors who practiced the positive lifestyle behaviors recommended by the American Cancer Society had a higher quality of life than those who made fewer changes.

Over ten million Americans have had some form of cancer; fortunately, certain lifestyle behaviors can help beat it and keep it from coming back. For example, physical activity helps prevent many types of cancer. The American Cancer Society recommends that cancer survivors get at least 150 minutes of moderate to strenuous or 60 minutes of strenuous exercise per week. They also recommend eating “5-A-Day”—five daily servings of fruits and vegetables—and not smoking.

The new study surveyed 9,105 survivors of six different kinds of cancer—breast, prostate, colorectal, uterine, skin melanoma, and bladder—to see the extent to which the survivors followed the American Cancer Society’s recommendations and how their habits affected their health-related quality of life.

A range of healthy habits is the key

Physical activity goals were met by 30 to 47% of the survivors, while only 15 to 19% met the 5-A-Day fruit and vegetable recommendation. Most survivors (up to 92%) did not smoke. “This suggests that it may be important to develop a multibehavioral lifestyle intervention rather than develop single behavior interventions,” the study’s authors commented.

Survivors of breast, prostate, and colorectal cancers who met the 5-A-Day or not smoking recommendations had a significantly higher quality of life than those who didn’t, and survivors of all types of cancer who were more physically active reported a higher quality of life. “Physical activity is a key lifestyle behavior that should be incorporated into all the interventions to improve health-related quality of life,” concluded the authors.

Dr. Lise Alschuler, author of Definitive Guide to Cancer: An Integrated Approach to Prevention, Treatment and Healing, said, “It seems to me that the main reason for the low rate of healthier lifestyle adoption is the difficulty of the changes themselves. It is hard for anyone to change their diet and equally as difficult to increase exercise. People who are successful in making positive changes to their dietary and exercise patterns feel better. As a result of eating differently and exercising regularly, people become more engaged in the process of living and as a result have more vitality and wellness.”

(J Clin Oncol 2008;26:2198–204)

Healthnotes Newswire (June 12, 2008)—As the summer solstice approaches, many of us notice how much long, sunny days can lift the mood. New research suggests there may be a physiological basis for this phenomenon. A recent study found that people with minor or major depression had lower vitamin D levels than people without depression.

The study, published in the Archives of General Psychiatry, was conducted in the high-latitude country of the Netherlands (where sun exposure is limited) and included people age 65 and older. Vitamin D levels in 169 people with minor depression and 26 people with major depression were compared with those from 1,087 people without depression.

Vitamin D levels were 14% lower in the people with major and minor depression compared with nondepressed people. Levels of parathyroid hormone, the hormone that helps regulate calcium levels in the body, was 5% higher in people with minor depression and 33% higher in people with major depression. When vitamin D levels are low, parathyroid hormone levels tend to rise, and high levels of this hormone have been linked to depression in the past.

D is for daylight

Vitamin D, produced through a chemical reaction that begins in sun-exposed skin cells, plays a critical role in calcium metabolism by increasing the absorption of dietary calcium and decreasing the amount of calcium lost through urine. Long known to be necessary for healthy teeth and bones, recent evidence has pointed toward its importance in preventing depression and some cancers.

Older people tend to spend less time outside than younger people, and many don’t get adequate sunshine, making them more susceptible to vitamin D insufficiency and deficiency. In the current study, almost 39% of men and 57% of women had levels of vitamin D that are considered insufficient, which means they were low but not low enough to be called deficient. The rate of depression in older people, estimated to be about 13%, is higher than in younger people.

Easy does it

“The dilemma is that sun exposure without sunscreen, which is necessary for vitamin D production, increases the risk of skin cancer,” commented Dr. Julianne Forbes, a naturopathic doctor who practices in Maine.((Same comment as on other.)) “Be sensible—cover up or use sunscreen if you plan to be in the sun for an extended period, but don’t be afraid to head out for a short walk or get short bursts of sun exposure over the course of an ordinary day.”

People can take several steps to prevent depression:

• Stay active—There is a wealth of research demonstrating a link between inactivity and depression.

• Avoid too much alcohol, which is a natural depressant.

• Eat foods rich in folic acid and vitamin B12, especially if you’re an older adult. Deficiencies in both of these vitamins are more common in seniors and are linked with depression.

• Get a little sunshine when possible, and consider supplementing with 1,000 IU of vitamin D per day, especially in the winter and if you live in a northern latitude.

(Arch Gen Psychiatry 2008;65:508–12)