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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 24, 2008)—The Journal of the American Medical Association reports that bright light may help improve symptoms caused by dementia such as altered moods, disturbed sleep, and the inability to carry out activities of daily living.

Dementia is a common condition worldwide, and Alzheimer’s disease is its most common form. Dementia impairs a person’s memory and ability to think normally and is often associated with changes in behavior, mood, sleep, and the ability to carry out activities of daily living such as bathing or eating. With few simple remedies available, these symptoms create challenges for people with dementia and their caregivers.

Testing showed some clear improvements

In this study, 189 elderly people with Alzheimer’s or other types of dementia were randomly assigned to receive bright light (indirect, ceiling-mounted, whole-day bright light), melatonin (2.5 mg per day), a combination of bright light and melatonin, or neither melatonin nor bright light. Treatments were given daily for an average of 15 months.

When compared with other treatments or no treatments, bright light was associated with no worsening of mental status, an improvement in depressive symptoms, and improved functioning. Melatonin alone improved the ability to fall asleep earlier and increased sleep duration but had an adverse effect on behavior and mood, and increased withdrawn behavior. Bright light plus melatonin improved sleep disturbances, improved agitated behavior and restlessness during sleep, and decreased the duration of awakenings during sleep.

The study’s authors concluded, “The simple measure of increasing the illumination level in group care facilities ameliorated symptoms of disturbed cognition, mood, behavior, functional abilities and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood.”

People with dementia need structure and safety

Caring for a person with dementia can be challenging, but the following tips may help make it easier:

• It is important for caregivers to work closely with people who are highly trained and familiar with the specific challenges of dementia, such as geriatricians and/or social workers. These professionals can educate caregivers about ways to improve symptoms and keep a person with dementia safe from harming themselves or others. Medications may help improve symptoms or slow the condition’s progression, but many needed changes are often behavioral or environmental.

• A structured, supervised environment is important for people with moderate to severe dementia who cannot care for themselves. A stimulating and caring environment can help them stay active and functional for a longer period of time.

• Consider the following safety precautious if you are caring for someone with dementia: lock doors so that he or she cannot leave the house unsupervised and get lost; keep car keys in an inaccessible place; and put safety latches on appliances such as ovens. It is also a good idea to get a medical alert bracelet for the person under your care to wear.

(JAMA 2008;299:2642–55)

Healthnotes Newswire (July 17, 2008)—Everyone knows that fish is good for you, but it turns out that some is better than others for certain health needs and goals.

A new study, published in the Journal of the American Dietetic Association, analyzed 30 species of wild and farmed fish and found that while wild fish is generally more healthful than farm-grown, fish such as salmon and trout still maintain a beneficial fatty acid profile. Other farmed fish, such as talapia, do not, so while these may be incorporated into a regular diet as an occasional inexpensive, low-fat protein source, people wanting to maximize disease-fighting health benefits from fish will opt in favor of those with a better balance of fatty acids.

The ratio is the real measure of risk

A wealth of research shows that eating fish rich in omega-3 fatty acids may help prevent and treat diseases such as heart disease, diabetes, inflammatory and autoimmune diseases, and some cancers. However evidence increasingly points to the ratio of omega-3 to the less discussed omega-6 fatty acids in the diet as the indicator of disease risk.

• Fish with an omega-3 to omega-6 ratio of greater than one are considered beneficial because of their effect on the fatty acid profile of the entire diet.

• Fish with a ratio of 0.5 or lower are considered not protective against disease.

As a polyunsaturated fat, omega-6 also plays a role in supporting health, as long as it is consumed in moderation.

The best fish for fending off disease

The authors of the study collected samples of commonly eaten fish—including tuna, snapper, mahi-mahi, cod, sole, halibut, haddock, talapia, swordfish, catfish, salmon, and trout—from distributors in the US and Chile, from fish farms in the US, Chile, Canada, Ecuador, Honduras, Norway, and New Zealand, and from supermarkets in the US. Some highlights of their findings include:

• Sockeye salmon, Coho salmon, Copper River salmon, and farmed rainbow trout had a beneficial fatty acid pattern—in other words, a high ratio of omega-3 to omega-6 fatty acids.

• Farm-raised Atlantic salmon had high levels of omega-3 fatty acids but their levels of omega-6 fatty acids were higher than those of the wild salmon, making their ratio slightly less favorable, though still healthy.

• Tuna, one of the most commonly eaten fish in the US, had a low level of omega-3 fatty acids, but it also had a low omega-6 level, so its ratio remained favorable.

• On the other end of the spectrum, farmed talapia and catfish had low levels of omega-3 and poor ratios of omega-3 to omega-6 fatty acids.

Balancing factors besides fatty acids also important

Of all the fish reviewed in this study, tilapia has received the most attention for its unfavorable fatty acid content. “All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia,” the article cautions. However, keep in mind that a fish not being highly protective against heart disease does not mean it needs to be avoided entirely. Other health factors, such as heavy metal contamination—which are high in otherwise healthful fatty fish like tuna, but low in less heart-healthy fish like tilapia—should also be taken into account.

To give the pros and cons of fish consumption some real world perpective, consider that eating moderate amounts of farmed tilapia is roughly equivalent to other staples of the average diet, and may be a reasonable option for some people. For those at risk for inflammatory diseases such as heart disease, fish with a good omega-3 to -6 ratio such as salmon or trout are the best choice.

(J Am Diet Assoc 2008;108:1178–85)

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 10, 2008)—When applied to the skin, honey may help prevent and treat skin diseases caused by bacteria, according to a new study published in Clinical Infectious Diseases. As the number of antibiotic-resistant infections increases, alternative solutions are needed for infections.

Some research has already demonstrated that honey may help with wound healing. In the new study, Revamil, a medical-grade honey, was effective in killing or reducing many types of bacteria on the skin of healthy volunteers, including bacteria that are susceptible to or resistant to antibiotics.

Compared with the control group, bacteria on the forearm were reduced 100-fold after honey was applied for two days, and more than 80% of the honey-treated skin patches showed no evidence of bacteria compared with only 21% of the control patches. Test tube studies also showed that within 24 hours honey killed all antibiotic-resistant and -susceptible strains of Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecium, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca.

The study’s authors commented that since very few new antibiotics are being developed, alternative solutions are needed. Honey, they said, could be helpful in treating wound infections and in preventing infection at skin sites where bacteria are likely to thrive, such as catheter sites in ill patients. Further research is needed to understand the potential role of medical-grade honey in preventing and treating skin infections.

Honey may kill or suppress bacteria growth because of its high sugar content, high acid content, natural production of hydrogen peroxide, or because of other actions related to flower or bee components. Though the authors warn that pulling a jar of honey off of the shelf to treat skin infections may not get the job done (Revamil is produced in a greenhouse under standardized conditions), evidence from other studies suggests that raw, unprocessed honey may be effective.

(Clin Infect Dis 2008;46:1677–82)

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 (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 19, 2008)—Older women with low back pain might benefit by getting some extra vitamin D, reports a study in the Journal of the American Geriatrics Society. Low levels of vitamin D can lead to weakened bones, lowered immune function, and sometimes pain.

The new study included 958 people over age 65 who gave information about the location of their pain, from their midback to their feet. Blood samples were taken to measure vitamin D levels.

Women were more likely than men to have moderate or severe pain in some part of their bodies, and women who were vitamin D deficient were almost twice as likely to suffer from low back pain as were people with normal vitamin D levels. Vitamin D status didn’t seem to affect low back pain in men, nor did it influence pain in other parts of the bodies of men or women.

How (and how much) do you D?

The “sunshine vitamin” is produced in the body after exposure of the skin to sunlight. Exposing the face, arms, and hands to sunlight for 15 minutes three times per week year-round can help boost vitamin D levels. Vitamin D also occurs naturally in a few foods like egg yolks and fatty fish such as salmon and mackerel. Dairy products, juices, and cereal products are often fortified with vitamin D.

Just how much vitamin D is best for optimal health is a hot topic. A growing body of evidence suggests that 400 IU per day, the amount found in many multivitamin products, is not enough to maintain optimal levels. Many people appear to need 1,000 IU per day and in some cases even more. The body’s ability to synthesize vitamin D diminishes with age, putting older people at increased risk for deficiency.

The Institute of Medicine has concluded that long-term intake of 2,000 IU per day is safe for most people. Some doctors recommend even more, such as 2,000 to 4,000 IU per day depending on the season, but people taking those amounts should be monitored by a doctor.

Along with the many other benefits adequate D offers the body, such as supporting calcium absorption that keeps bones strong, the authors of the new study conclude that the new study’s “findings suggest it may be worthwhile to question older adults about their pain and screen older women with significant back pain for vitamin D deficiency.”

(J Am Geriatr Soc 2008;56:785–91)

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)