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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)—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 (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)—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)

Healthnotes Newswire (May 29, 2008)—The President’s Council on Physical Fitness and Sport recently released a fitness test for people over age 18. The test helps estimate aerobic fitness level, muscle strength and endurance, flexibility, and body composition.

Better overall physical fitness helps lower the risk of cardiovascular disease, diabetes, high blood pressure, stroke, and certain cancers. It can also improve mood and help avoid accidents and muscle strain due to underused and inflexible muscle groups.

The new President’s Challenge and Adult Fitness Test was created to help people understand their own fitness level and make positive gains in physical fitness. The test is available as a downloadable booklet at www.adultfitnesstest.org/resources/testbooklet.pdf; individual results can be entered and evaluated online.

Each test section is followed by a “FITT” box which stands for Frequency—how often the exercise is performed; I—the intensity at which the exercise is carried out; T—time, or how long the session lasts; and T—type of exercise being performed. These boxes help users customize their fitness goals.

Aerobic Fitness

To test aerobic, or cardiovascular, fitness, choose a 1-mile walk or a 1.5-mile run. For the walk, after a brief warm up, have a partner time you walking at a brisk pace for one mile, and take your pulse immediately after finishing. For the running option, warm up with a light jog. Then, having a partner time you, run as fast as possible for 1.5 miles. Only attempt the run if you currently run for at least 20 minutes three or more times per week.

FITT tips

Frequency: Depending on the level of intensity, exercise three to five days per week.

Intensity: Moderate-intensity exercise is a brisk walk; vigorous activity is running.

Time: For moderate activity, do at least 30 minutes per session; vigorous activity should last for 20 to 30 minutes.

Type: Examples are walking, running, dancing, cycling, and swimming.

Muscular Strength and Endurance

These tests assess basic muscle strength required to carry out household or work-related tasks. Do half sit-ups by lying face-up on a rug or mat with knees bent at a right angle and feet flat on the floor. With palms flat on the floor, sit up and slide hands forward 3.5 inches (mark distance with masking tape on the working surface before starting). Having a partner time you, do as many sit-ups as you can in one minute. Then do push-ups with legs extended (men) or with knees touching the floor (women). Do as many push-ups as you can and record the number.

FITT tips

Frequency: Do muscular strength and endurance exercises on at least three days per week.

Intensity: Vary the intensity during the workout.

Time: Gradually increase the number of half sit-ups and push-ups until you can do three sets of 25 half sit-ups and three sets of 10 to20 push-ups.

Type: Master the test movements and then add other equipment (balance balls, weights, or elastic tubing).

Flexibility

These tests assess the range of motion of muscles needed to walk, lift, and step normally. Sitting on the floor, place a yardstick between the legs with feet about a foot apart. Place a piece of tape across the yardstick at the 15-inch mark. With fingers on the yardstick, slowly reach forward as far as possible. Record to the nearest inch that your fingertips can reach.

FITT tips

Frequency: Do flexibility exercises at least three days per week.

Intensity: Stretch to the point of tension, never to pain.

Time: Hold each stretch for 20 to 30 seconds, repeating three times.

Type: Begin with static stretches, gradually adding dynamic (moving) stretches. Try learning a practice that includes flexibility exercises, such as yoga and Pilates.

Body Composition

Body mass index (BMI) and waist circumference can be measured to estimate disease risk. To calculate BMI, weigh yourself and have a partner measure your height with shoes off. Wrap a flexible tape measure around your abdomen just above the hip bones; measure and record. Determine your BMI using the booklet’s chart.

A normal BMI is between 18.5 and 24.9; overweight is between 25 and 29.9; obese is greater than 30.

If you are overweight or obese, you can improve your BMI and waist circumference by making sure that you burn more calories than you eat. In order to lose weight, emphasize whole grains, fiber, fruits and vegetables; limit processed and high-carb, high-fat foods, and work in 60 to 90 minutes of daily moderate intensity exercise.

(www.adultfitnesstest.org/adultFitnesstestLanding.aspx; accessed 26 May 2008.)

Healthnotes Newswire (May 1, 2008)—Weight-loss diets can lead to a modest decrease in blood pressure among people with hypertension, confirms a recent review published in the Archives of Internal Medicine.

Modern weight-loss programs range from dietary changes, weight-loss pills, and surgical procedures. A recent review looked at seven studies that compared a weight-loss diet with usual care among 1,632 people who had high blood pressure. After 12 months, the people on the weight-loss diet saw a decrease in their systolic blood pressure (the top number of the blood pressure reading). A weight loss of 4 kg (about 9 pounds) was necessary to achieve a reduction of 6 mm Hg in systolic blood pressure.

High blood pressure and being overweight are both major risk factors for developing cardiovascular problems such as heart disease and stroke. Maintaining a healthy weight and lowering blood pressure can decrease cardiovascular disease risk.

“High blood pressure is estimated to lead to more than 7 million deaths each year, approximately 13% of the total deaths worldwide,” said lead author of the review, Karl Horvath, MD, and his colleagues from the Department of Internal Medicine, Medical University of Graz, in Austria. “Lowering blood pressure levels in hypertensive patients has been shown to be a very effective means of reducing patients’ cardiovascular risk, with a significant reduction in cardiovascular morbidity and mortality.”

How to lower your risk

Being overweight and having high blood pressure are two independent risk factors for cardiovascular disease. But when you have both conditions, the risk is even greater. The following lifestyle tips may help you lower your risk of cardiovascular disease by maintaining a healthy weight and keeping blood pressure down:

• If you’re overweight, lose weight to maintain your optimal weight, which can be determined based on your height, body composition, and level of physical activity.

• Regular exercise is important for keeping weight down and for lowering blood pressure. Adults should engage in moderate physical activity for one hour each day.

• Follow a healthy diet that is low in cholesterol, added salt, and total fat, and emphasizes fruits, vegetables, and whole grains.

• Don’t smoke. Smoking is a risk factor for cardiovascular disease and other serious diseases.

If you are overweight or have high blood pressure, see a doctor to determine your optimal weight and to discuss other lifestyle changes that can help lower your risk for cardiovascular disease.

(Arch Intern Med 2008;168:571–80)

Healthnotes Newswire (May 1, 2008)—What do men in their 90s have in common? They exercise regularly, don’t smoke, have normal blood pressure, and keep their figures, says a new study.

The study, published in the Archives of Internal Medicine, examined the health and lifestyles of 2,372 senior men and followed them for 25 years. The men were age 65 or older and generally healthy at the beginning of the study, giving them all the possibility of reaching 90 by the end of the study, which 41% of them did.

• Smoking was the strongest predictor of dying before 90—nonsmokers were twice as likely to live past their 90th birthday.

• Diabetes was the second strongest risk factor for not seeing 90, followed by obesity and high blood pressure.

• Vigorous exercisers were 20 to 30% more likely to reach their 90s. Nonsmoking men who exercised and did not have diabetes, obesity, or high blood pressure in their 70s were nearly 14 times more likely to live into their 90s than those who had none of these factors in their favor.

The men who lived to 90 or older reported better physical functioning, mental well-being, and self-perceived health on a survey they completed 16 years into the study. Smoking, obesity, and inactivity were also associated with poorer functioning in these elderly men.

While a number of studies have similarly and consistently demonstrated the benefits of good lifestyle habits on health and longevity, none have looked at men who reach this exceptional age. These findings suggest that maintaining good habits even in old age can have an important effect on how long men live and how well they feel and function.

“Our study provides evidence that certain negative health behaviors continue to pose a risk very late in life, and shows the detrimental and long-term effects of smoking, obesity, and inactivity on late-life functioning and well-being,” commented Dr. Laurel Yates of Brigham and Women’s Hospital in Boston, lead author of the study. “Based on our findings, the factors closely associated with exceptional life span, good health, and good functional status are strongly related to lifestyle choices.”

(Arch Intern Med 2008;168:284–90)

Healthnotes Newswire (February 14, 2008)—To address the special nutritional needs of older adults, the US Department of Agriculture (USDA) has now created a graphic representation of an age-modified food pyramid, which highlights the importance of some easy-to-miss nutrients.

The USDA issued a revised Food Guide Pyramid in 2005—the “MyPyramid”—which is customizable through an Internet-based program that takes a person’s body size, gender, and physical activity level into account. While the Internet program has helped many people identify and reach their dietary goals, it hasn’t been as effective for the less computer-savvy 70-and-over crowd.

“The greater than 70-year-old group can be vulnerable to compromised nutritional status,” says Alice Lichtenstein, nutrition expert at Tufts University and codeveloper of the new MyPyramid graphic published in the Journal of Nutrition.

The Modified MyPyramid for Older Adults graphic helps seniors better understand their complex nutritional needs by highlighting several “potential shortfall nutrients” for people over 70. A flag at the top of the pyramid emphasizes that extra calcium, vitamin D, and vitamin B12 might be needed.

Nutrients needed in a senior diet

• Calcium: Low-fat dairy and fortified foods are emphasized as rich sources of this bone-healthy nutrient.

• Vitamin D: Most elderly people don’t get enough of the sunshine vitamin. The skin’s ability to convert vitamin D to its active form diminishes with age, and many seniors shun the sun for fear of skin damage. Older people can increase their vitamin D intake by eating fortified foods; some people may also need to take a vitamin D supplement to ensure adequate intake.

• Vitamin E, vitamin K, and potassium: To help decrease the risk of high blood pressure, stroke, cardiovascular disease, and diabetes, the pyramid emphasizes eating a variety of deeply colored fruits and vegetables such as carrots, spinach, and peppers—which are good sources of potassium and vitamins E and K, as well as other protective nutrients. Icons depict bags of frozen veggies that make preparing and storing these foods easier for older people. Canola and soybean oils are also pictured as rich sources of vitamin E and K; saturated and trans fats are discouraged.

• Fiber: Foods that are high in fiber also tend to be more nutrient-rich. The pyramid shows legumes, whole grains, and fruits and vegetables as great fiber sources.

• Vitamin B12: Vitamin B12 deficiency becomes more common with increasing age, as many people lose the capacity to produce stomach acid, which is necessary for its absorption. It might be wise to take a B12 supplement or talk with your doctor to determine if B12 injections would be beneficial.

• Fluids: The “thirsty cues” also diminish with advancing age, leaving seniors vulnerable to dehydration. As a reminder to stay hydrated, the pyramid shows a row of water glasses. A good rule of thumb is to drink eight 8-ounce glasses of water per day.

The Modified MyPyramid for Older Adults also emphasizes the importance of staying physically active in later years.

It is important to consider that while many nutrients might be lacking in a senior diet, others could be too plentiful. With fortification of foods and widespread use of multivitamin preparations, some seniors may get too much folic acid, which can mask the laboratory diagnosis of vitamin B12 deficiency, potentially leading to neurological damage. “It is preferable to get essential nutrients from food rather than supplements,” Lichtenstein says; this can decrease the risk of overdoing certain nutrients.

“On the other hand, elderly people with low stomach acid may need to take a vitamin B12 supplement,” said Alan R. Gaby, MD, chief science editor for Healthnotes. “Food-derived vitamin B12 is poorly absorbed by people with low stomach acid, whereas vitamin B12 in supplement form is well absorbed.”

Since many seniors take medications that may be impacted—positively or negatively—by adding supplements to the mix, seniors should look for a healthcare practitioner knowledgeable in nutritional medicine to help them be aware of potential nutrient and drug interactions and make appropriate recommendations for nutrient supplementation.

(J Nutr 2008;138:5–11)