Running
By Drs. Kevin M. Wong and Dr. Peter Carr, the running chiropractor in Seattle
The average person burns more than 500 calories per hour of moderate jogging. Whether you're a brisk walker or a marathon runner, these activities exert forces that can damage your feet. Wearing the right footwear and learning proper running technique can ensure your feet keep working for you. Can you remember a time when you were particularly physically active? Think back to those days of elementary school and high school when much of your physical activity involved running in one form or another.
For some of you, this enjoyment of running followed you into adulthood. The next time you are driving in your neighborhood, look around; you may be surprised to see how many people are out running. Running has always been one of the most popular forms of exercise. It has many benefits including improved cardiovascular health, circulation and state of mind. However, it also is one of the prime activities that can cause significant damage to the human body. When patients come to my office for pain related to their love of running, they don't want to hear me say, "Stop running." This very well may be what they need, but they are looking to me for answers to help them stay in their sport. The physical act of running has different meanings to different people. Some of you may prefer walking with alternating spurts of running. You may like running at an easy or medium pace. You may prefer distance running. Regardless of your preference, there is an impact on your body, so take a moment to imagine these scenarios.
Picture yourself walking at a slow or comfortable pace. For the most part, during the walking cycle, one leg is swinging through the air and one leg is touching the ground. At one point, both legs touch the ground for a second or so (when the heel of one foot touches and the forefoot of the other takes off). Did you know that during regular walking, there are 5 G's of force that hit our heel with every step we take? That is a pretty significant amount of force, and that's just with walking. Also realize that when the force hits our heels, it doesn't stop there. It then moves across our feet to the toes and up into the ankles, knees, hips, lower back and to the upper body. Think of it as a force wave that goes from the ground upward. Now picture yourself walking as fast as possible. You progress from walking to a lightly paced jog to a medium-paced run and then to full-bore running. Do you understand that the force coming from the ground into the heels increases as you go from walking to running? The answer likely is yes, but let's put it into perspective. When we run, the force coming up to our heels from the ground is increased by three to four times our body weight. The harder the running, the more the force put onto our feet and our body. In other words, 5 G's of force coming into our heels with walking can become more than 20 G's with running. My goal for all of my patients is to keep them functioning at their highest level and allow them to perform whatever activities they choose to their fullest. Here is the framework and subsequent advice I give to all my runners. I hope it gives you some ideas that allow you to take care of your body so it takes care of you.
Start Slow, End Slow
Stretching is an important part of most workout routines, running included. Unfortunately, stretching is the first thing that gets left out if you are in a hurry or you're trying to squeeze in your exercise for the day. You should be stretching before and after you run. Even five minutes of stretching after youwarm up your muscles and five minutes of stretching after for a cool down can prevent serious injury. I normally recommend 15-20 minutes of stretching to my patients before and after their workouts. There are many different stretches. Regardless of which ones you choose to do, make sure you stretch into comfort and not pain. If a stretch is hurting, back off or don't do it. Pain is an indicator that something is wrong, and pushing past this point can invite injury to your door. Since we all run at different paces, try the following protocol the next time you finish stretching. After stretching, begin walking at a slow, comfortable pace. After a few minutes, increase your pace gradually to a faster walk, then to a light jog and then into your full, usual running speed. Obviously, the time it takes you to get to a full run will vary, but it is a nice way of getting your body into the groove. Once you are almost finished with your run, gradually slowing your pace to a walk is a nice way to start your cooldown.
Shoe Shopping
There are many types of running shoes available. It can be confusing trying to find the one that works best for you. Whether you're in love with your running shoes and always buy a particular brand or you're on a continual search for shoes and are never sure which ones to get, I always tell my patients to bring their shoes into my office so I can check them. Whichever shoe you buy, consider the following:
There should be good heel support to absorb the shock from the ground.
The middle of the shoe should have arch support for your inner and outer arches so the foot is protected during full weight bearing. This means that the shoe should not be able to bend in the middle.
The front of the shoe, or forefoot, should have a toe box that is wide enough to be comfortable for your toes so they don't scrunch together.
The shoe should feel rigid or supportive enough that when you grab the shoe with both your hands and "wring it out" like a towel (twist the shoe in opposite directions), it does not twist very easily.
Another great idea is to go to your local athletic store, particularly one with knowledgeable staff. They often can evaluate your running style and recommend types of shoes that are good for you. I do have some "no brainers": If you weigh over 200 pounds, I recommend the Brooks Beast, if you are a man, and the Brooks Addiction if you are female. Personally, I like Mizuno, and Adidas, provided they are not too cushiony.
Form
How a person runs is vitally important, and is something we address in my office. I often will take a patient and put them on a treadmill in our gym, and evaluate their running form. Loss of energy in running is why you are slower than the next guy/ gal. After all, we all generate approximately the same amount of horsepower. Eliminating the losses of energy, and returning them to your running will make you a faster runner.
Road Rules
The type of surface you run on impacts the forces exerted on your body. Obviously, the harder the surface, the more stress is placed on your joints. Surfaces like concrete and pavement are so rigid that when your feet hit the ground, there is a lot of shock coming into your heels. Running on dirt, grass and tracks will soften the impact, but still give you enough firmness to make running safe. People also can cause injury to themselves if they run on terrain that is too uneven or irregular, such as trails and sand. For those of you who have run on sand before, you understand how hard your feet and legs have to work. The softer the sand, the more this effect is exaggerated. When your feet and legs have to constantly adjust to the changing terrain, the muscles and joints are working much harder than you may realize. This means you can strain a muscle or cause injury if you are not careful. I am not saying to never run on sand - just run on the part that is closest to the water so that the ground is a bit firmer to support your body while running.
Arch Support
This is potentially the most important part of the shoe because there are very few styles out there that have the kind of arch support your body needs. Again, there are many types of orthotics on the market, so you have to choose. Remember, you have two arches: an inner arch, an outer arch. I always recommend custom-made, flexible (not hard plastic), two-arch supportive orthotics. That way, I know my patients are getting adequate support while allowing their feet to move normally as they are walking and running. Your doctor can evaluate whether you need orthotics and which type of athletic shoe is right for you. Running can be an excellent way to get exercise and it is my hope that you will take what you have read and see how it may help you walk or run more safely. Now lace up those running shoes and have fun!
Arthritis
Stinging Nettle for Arthritis
A British study of arthritis sufferers concludes that the stinging nettle plant greatly reduces pain and stiffness in arthritic joints. Researchers gave one group of volunteers the plant to rub around the affected joint once a day; another group was given a similar-appearing (but entirely different) plant as placebo. After one week of treatment, the stinging nettle group reported a significant improvement over the placebo group. The benefits were most dramatic; the patients who reacted to the plant enough to produce wheals (a type of lesion, or welt), which the patients found to be an acceptable side-effect. Most of the patients preferred stinging nettle to their previous medication.8
8. Journal of the Royal Society of Medicine, June 2000.
Exercise Degenerative Joints
An article in the Journal of the American Medical Association3 says that regular exercise can increase mobility and decrease the pain of osteoarthritis. This study examined exercise's effect on 439 people with knee degeneration. The authors concluded that both aerobic exercise and weight training were safe and effective means of treatment. Volunteers worked out three times per week for 18 months, while a control group listened to health lectures.
3. JAMA, Jan. 1, 1997.
Arthritic? Exercise
You can add new research done at the University of Missouri, Columbia to the growing number of studies that conclude exercise is good for patients with arthritis. In a study of about 200 arthritis patients averaging 49 years old, those who stayed with the program significantly improved their general physical condition over the two-year study. Exercises included walking, stretching, stationary biking, aquatics, or aerobic dance. By comparison, non-exercisers tended to get worse as time went on.10
10. Preliminary results presented at a news conference by Marian A. Minor; Associated Press, May 4, 1997.
Vitamin D for Osteoarthritis
X-ray studies of osteoarthritis progression in 516 patients' knee joints suggest that vitamin D has a role in preventing joint degeneration. Subjects who had less of the vitamin in their body, whether from lowered nutritional intake or less time in the sun, were four times more likely to exhibit worsening of their condition. The researchers think that the outcome is best if action is taken early, before major degeneration has begun.4
4. Annals of Internal Medicine, September 2, 1996.
Osteoporosis from Arthritis Treatments
The president of the National Osteoporosis Foundation is recommending that older persons who are being treated medically for arthritis might want to be periodically tested for osteoporosis. Corticosteroids, quite often the drug used by medical physicians on these people, contribute to bone demineralization and may thus cause or accelerate a crippling osteoporotic condition in the patient.9
9. United Press, reporting on a statement by Dr. Robert Lindsay of the National Osteoporosis Foundation, November 25, 1997.
Osteoporosis from Arthritis Treatments
The president of the National Osteoporosis Foundation is recommending that older persons who are being treated medically for arthritis might want to be periodically tested for osteoporosis. Corticosteroids, quite often the drug used by medical physicians on these people, contribute to bone demineralization and may thus cause or accelerate a crippling osteoporotic condition in the patient.9
9. United Press, reporting on a statement by Dr. Robert Lindsay of the National Osteoporosis Foundation, November 25, 1997.
NSAID Deaths
Advisors to the FDA are expressing concern over signs that many popular nonsteroidal anti-inflammatory drugs are more dangerous than doctors and the public think. Most NSAIDs are believed to contribute to gastrointestinal problems. Forty-one thousand hospitalizations and 3,300 deaths each year are blamed on such side effects.11 The consumer group Public Citizen is asking the FDA to ban piroxicam (sold as Feldene), a more potent form of this class of drugs used to treat arthritis. According to FDA records, 299 Americans deaths have been linked to this one drug since 1982.
Ten Deaths in Drug's First Three Months
The popular "super aspirin" Celebrex, during its first three months on the market, was linked to 10 deaths and a number of lesser reactions.10 Half of the deaths were due to gastrointestinal bleeding and ulcers, according to "adverse incident" reports filed with the FDA. In its first 13 weeks on the market, 2.5 million prescriptions were filled. The drug is used to treat arthritis. When asked about these incidents by the Wall Street Journal, the FDA said more research would have to be done before any conclusions were drawn about the drug's safety. The FDA has received 53 reports of doctors and pharmacists being confused about the drug's name. Doctors have mistakenly prescribed Celexa and Cerebyx for Celebrex.
10. Associated Press, April 20, 1999
Literary Therapy
A study published in the Journal of the American Medical Association15 concludes that patients with chronic conditions such as arthritis and asthma tend to improve after putting past stressful incidents from their lives onto paper. A group of 112 patients was divided into two groups: one wrote for a total of one hour (20 minutes a day for the first three days of the study) about a terrible experience, such as the death of a loved one or a car wreck. The other wrote about their plans for the day. The patients were tested for four months.
Nearly 50 percent of the patients who wrote about their stresses improved significantly by the end of the study, compared to less than one quarter of the other group. You might also be interested to know that more than 20 percent of the group writing their daily plans were worse at the end of the study; less that five percent of those writing about past stressful events deteriorated. Other findings: improvements were noted in the asthmatics' lung capacities in about two weeks; the arthritis patients took the entire four months to improve.
15. Smyth J, Stone A, Hurewitz A, Kael A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA 1999;281:1304-1309.
Cherries for Pain
Research from the American Chemical Society1 suggests that tart cherries may offer natural pain relief. About 20 cherries a day, say researchers from Michigan State University, will relieve inflammation and pain in arthritis and gout patients. Anthocyanins are thought responsible for the effect. Fresh, tart cherries seem to contain a particularly effective variety of anthocyanins, which are also known to exhibit antioxidant activity. In this work, researchers found that the effectiveness was equal to or greater than many common nonsteroidal pain and anti-inflammatory drugs.
1. Journal of Natural Products, January 29, 1999.
Smoking
Don't do it!- Outlawed in Seattle for good reason!
Ahh, Factoids, Dr. Carr's favorite past time.
Smoked Gums
Smoking is a major cause of tooth loss, according to the Centers for Disease Control. Periodontal disease (deterioration of the gums) is responsible for most of the tooth loss in older persons and smoking is responsible for the majority of periodontal disease, says a report published in the Journal of Periodontology.10 Smokers are affected by gum disease four times as often as nonsmokers. It is thought that smoking decreases blood flow and nutrition to the gum tissues, as well as lowering resistance to bacteria growth. 10. Journal of Periodontology, May 2000.
Smoking and Behavioral Problems
Another study correlating pre-natal smoking with behavioral problems in offspring has been published, this time in the AMA's Archives of General Psychiatry.3 "Conduct disorder," a diagnosis designating serious antisocial behavior, is more than four times as common in boys whose mothers smoked more than 10 cigarettes per day during pregnancy. The six year study involved 177 pre-teenage boys. 3. Archives of General Psychiatry, July 1997.
Smokers More Likely to be Overweight
Austrian researchers are reporting evidence that contradicts popular belief that smoking helps control obesity. In their study, they found that smokers were more likely to be overweight than nonsmokers. Smokers are also, as a group, less interested in eating healthy meals and are more inclined to subsist on junk foods. The higher the nicotine intake, researchers say, the less likely a person is to practice good nutrition.5 5. Reuter, reporting on the work of Dr. Rudolph Schoberberger of the University of Vienna, September 23, 1997.
Passive Smoking Stats
Two papers published in the British Medical Journal offer compelling evidence that secondhand smoke is a real health threat to live-in companions of smokers.9 Both are an analysis of a number of published studies on the subject. One concludes that non-smokers increase their risk of heart disease by 30 percent if they live with a smoker. The other work says that lung cancer rates increase a similar amount, and finds a correlation to the number of cigarettes smoked in the household and the length of time living with the smoker. 9. BMJ, October 18, 1997.
Smoking Makes You Age Faster
A study published in the Journal of the American Medical Association finds that elderly women who smoke have less strength, balance, and agility than their non-smoking counterparts. The study, done on over 9,000 women, suggests that smokers might feel physically older because of their habit. Some activities evaluated were walking, standing up from a seated position, grasping, and climbing stairs. Also compared were the effects of chronic alcohol consumption on similar activities. Surprisingly, and for reasons not yet understood, moderate drinkers outperformed nondrinkers in almost all the activities.
Smoking and SIDS
Another study reports on smoking's contribution to sudden infant death syndrome. Not just any ordinary increase in risk, according to this work published in the British Medical Journal,3 but a major cause. This government-funded study concludes that 60 percent of SIDS cases are due to tobacco smoke during pregnancy and after delivery. The results "astonished" the researchers, who apparently didn't expect the effect to be quite so dramatic. Previous studies have linked smoking to miscarriages and birth defects as well. 3. BMJ, July 27, 1996.
Smoking and Drug Use Linked
A Florida study has found that teenagers who smoke are also much more likely to be involved in illegal drug and alcohol usage. The survey of 22,000 middle and high school students found that smokers are eight times more likely to be using cocaine; six times more likely to smoke marijuana; and drink alcohol three times as often as non-smokers. It is estimated that more than 85,000 children and adolescents in Florida are candidates for drug or alcohol treatment programs.8
War on Cancer: a Qualified Failure
A University of Chicago researcher who follows cancer trends says that research has failed to make any significant progress in cancer treatment. This study, which examined cancer mortality from 1970 through 1994, comes to a similar conclusion as an earlier one by the same author. In 1986, Dr. John Bailar concluded that "some 35 years of intense effort focused largely on improving treatment must be judged a qualified failure." Bailar says his latest study is just as disheartening. He urges that efforts be redirected into prevention. Even though certain types of cancers have declined somewhat in recent years, he says treatment has little to do with the improvement. Instead, decreases in smoking and other factors seem to have more of an effect.14 14. New England Journal of Medicine, May 19, 1997
Other "Benefits" of Smoking: Less Hair and More Gray
As if cigarette smoke wasn't already bad enough, a researcher at the Leigh Infirmary in Lancashire, England, reports that it will also turn your hair gray -- if you get to keep any hair at all. He found a significant increase in hair loss and graying among smokers, reporting that they are twice as likely to lose your hair or be gray at a certain age. Combine this with previous research that indicates that smoking gives you wrinkles, perhaps vanity could be a good motivation to kick the habit.2 2. British Medical Journal, December 21, 1996.
Smoking and Hip Fractures
A report in the British Medical Journal4 contends that in the elderly one of every eight hip fractures is attributable to metabolic changes caused by cigarette smoking. This study of over 11,000 people finds that smoking speeds age-related bone loss, which in turn makes fractures much more likely. In women nearing the age of 90, smoking increases their risk of a hip fracture from 22 percent (for a non-smoker) to 37 percent. 4. BMJ, October 4, 1997.
Die Sooner
You may already have suspected this, but a British study reinforces the argument that tobacco use shortens life. This 15-year study released by the British Heart Association was done on 7,735 men by London's Royal Free Hospital School of Medicine. At age 73, 78 percent of men who had never smoked were still surviving. But only 42 percent of men who started smoking before they were 20 years old lived to see that age.8 8. Reuter, October 11, 1996.
Smoking and Sight
Two long-term studies published in the Journal of the American Medical Association12 find an increased risk of vision loss in smokers as they age. The research projects examined smoking physicians and nurses over about a 12 year period. Macular degeneration was found more than twice as often in the smoking group. Smokers who had quit a number of years earlier were at nearly the same risk level. Macular degeneration is the leading cause of blindness in persons 65 years and older in the United States. 12. JAMA, October 9, 1996.
Nicotine up Your Nose
A new gimmick is about to be marketed to smoking addicts: the nicotine nose spray. When the craving strikes, you can squirt the equivalent of one milligram of nicotine into your nose to get relief. Unfortunately, FDA officials warn that the spray itself is likely to be addictive. One participant in the three month efficacy study was found to be plotting ways to obtain a year's supply of the stuff. FDA guidelines specify that it should be used no longer than six months.1 1. Associated Press, March 25, 1996.
Smoking and Cervical Dysplasia
A study of 82 smokers finds that cessation of the habit can improve pap smear results. Researchers conducted pap smears at the beginning of the study, and compared them at a later time when a number of the subjects had cut back on their habit. They found that 80 percent of the women who had quit or greatly reduced their consumption of cigarettes showed improved scores. The study is reported in The Lancet.7 7. The Lancet, April 6, 1996.
Smoking and Emotional Problems
New research from a five-year study in Michigan reports a strong correlation between smoking and depression. Persons who smoked every day were nearly twice as likely to suffer major episodes of depression when compared to occasional smokers. Those who were depressed at the onset of the study were also three times more likely by the end of the study to be smoking daily. Researchers have no explanation for these statistics, or even a major hypothesis of which problem may lead to the other.1 1. Archives of General Psychiatry, February 1998.
Smoking and Ear Infections
Another study has linked second-hand smoke to ear infections in children. A report in the Archives of Pediatrics & Adolescent Medicine2 details a Canadian study of the effects of parental smoking on 625 first-graders. Compared to children who lived in smoke-free homes, those residing with two smoking parents were 85% more likely to suffer from frequent ear infections. 2. APAM, February 1998.
Smoking Babies
Hong Kong researchers report that babies who live in households with two or more smokers are 30 percent more likely to be hospitalized than those from smoke-free homes. The study looked at 8,300 babies born in 1997, for the first 18 months of their lives. The hospitalizations were typically for respiratory problems. The authors of the study estimate that health costs due to smoking during the first year amount to about 10 percent of all health care costs for this age group.7 For households with only one smoker, the hospitalization rate was about seven percent higher than normal. 7. Reuters, March 7, 2002.
Smoking for Breast Cancer
A new study sponsored by the World Health Organization concludes that cigarette smoking may decrease the risk of breast cancer in certain women. The study1 examined women who were more at risk for the disease because of a genetic weakness and found that the smokers developed breast cancer at half the rate of non-smokers. Researchers were both "surprised and dismayed"2 with the results. They worry that tobacco companies will try to exploit these findings, presumably before some kind of tobacco-derived drug can be developed. 1. Published in May's Journal of the American Cancer Society. 2. "Surprise finding ..smoking may prevent breast cancer." Reuter, May 19, 1998.
Nicotine Withdrawal Risks
British doctors have discovered another symptom of nicotine withdrawal: an increase in accidents at work. Upon examining workplace safety records, they discovered that on National "No Smoking Day," there was a significant increase in such accidents. Irritability and lack of concentration are thought to be the most likely contributors.12 12. Nature, July 1998, reporting on the work of Andrew Waters, et al.
Smoking Decreases Fertility
A study from the University of California School of Public Health finds that compared to non-smokers, women who smoke one to nine cigarettes per day take twice as long to become pregnant after stopping contraceptives. The study was done on over 1,300 first-time mothers.8
Birth Defect Associated with Smoking
According to a recently published John Hopkins University study, pregnant women can trigger formation of a cleft palate in their offspring by smoking, perhaps even before they know they are pregnant. This study, done on 467 children from Maryland, found a high incidence of the birth defect among children of mothers who smoked during early pregnancy.9
Wounds Heal Faster without Nicotine
A study at Baylor College of Medicine in Houston concludes that when a patient stops smoking before surgery, the surgical wounds heal faster and more completely. One of nicotine's actions is to restrict the blood flow around healing sites. The study subjects wore a nicotine patch to obtain a controlled dosage.11
Smoking Blamed for 7.5% of Miscarriages
In a "meta-analysis" of about 100 studies of the effects of smoking,12 researchers estimate that 7.5 percent of all miscarriages are due to tobacco usage. A meta-analysis is an attempt to draw general conclusions by analyzing data and outcomes of different studies. Other conclusions relating to maternal smoking were: · as many as 26,000 newborns are admitted to intensive care units each year because of smoking-induced low birth weights; · elevated risk of stillbirths and neonatal deaths; · a tripling of the risk of SIDS. It is estimated that somewhere between 18 and 27 percent of pregnant females smoke.
Smoking Risks Include Diabetes
The British Medical Journal reports that smokers are twice as likely to develop adult-onset diabetes. The study performed by the Harvard School of Public Health involved 40,000 men over a six year period.1 The smokers averaged about one pack per day and were otherwise relatively healthy. Moderate drinkers fared much better. It was found that they had a 40 percent less risk of developing diabetes compared to non-drinkers.
Smoking, Sleeping, and SIDS
It appears that cigarette smoke proportionately increases an infant's risk of Sudden Infant Death Syndrome (SIDS). A baby in the average smoking household has a doubled risk of SIDS, and the more smoke present, the greater the risk.10 Interestingly, in households where just one person smoked, the risk was much higher if the smoker was the father as opposed to the mother. In that case, the risk was nearly 3.5 times higher than in a non-smoking household. This same study also tracked sleeping position, but this time (unlike other recent studies) no correlation was found. Yet, in the same journal, a report from Tasmania noted the steady decline in SIDS since officials there began persuading parents to put children to sleep on their backs or sides.
Smoking Anxiety
Teenagers who smoke a pack of cigarettes each day are five times more likely to suffer from a generalized anxiety disorder and/or agoraphobia, concludes a study by researchers from Columbia University and the New York State Psychiatric Institute. They were also 12 times more likely to have a panic disorder during early adulthood. The researchers say that their data indicate that smoking itself leads to the anxious states, not that the individuals sought relief from anxiety by smoking. The study examined 976 randomly sampled families in upstate New York.5 5. Journal of the American Medical Association, November 8, 2000.
Smoking Injuries
A new study of Army recruits in basic training concludes that smokers are more likely to sustain a variety of exercise-related injuries. The research involved 2,000 men and women and was statistically adjusted for a number of factors that might have skewed the results, such as smokers starting out in poorer physical shape at the onset. The recruits, who were not permitted access to cigarettes during basic training were significantly more likely to suffer from blisters, bruises, sprains and broken bones if they were smokers.1 Other studies have found decreased healing time among smokers, suggesting that these new findings may be due to cumulative microtraumas. 1. American Journal of Preventive Medicine, April 2000
Smoking and Offspring Behavior
Researchers from Mount Sinai School of Medicine in New York report that mothers who smoke during pregnancy are far more likely to experience behavioral problems with their offspring. This study of 99 mothers and their two-year-old children found a fourfold increase of rebelliousness, impulsive behavior, and other parental stressors among those that smoked while carrying children. The researchers speculate that smoking influences the structure and function of the nervous system during the early stages of development, possibly by interfering with fetal oxygen supply.1 1. Archives of Pediatrics & Adolescent Medicine, April 2000.
Smoking Triggers LDL Oxidation
A study7 performed at the University of Southern California School of Medicine has found that the low density lipoprotein of smokers oxidizes 40 percent faster than non-smokers, thus accelerating arterial plaque build-up. This seems to be a promising lead in determining the precise mechanism of smoking's effects on the cardiovascular system. Researchers believe that this oxidation accounts for the largest portion of smokers' poor cardiovascular health.
Childhood Respiratory Infections and Smoking
A study published in The Lancet12 says that tonsillitis, laryngitis, bronchitis and middle ear infections occur three times more frequently in households where the parents smoke. Researchers measured a urinary by-product of nicotine in samples from children one to five years old for the study, correlating the results to their respiratory health.
Cigarettes and Mental Disorders
A Harvard Medical School study10 reports that persons with diagnosable mental illnesses are twice as likely to smoke cigarettes. Extrapolating data from the study of over 4,000 people, the authors suggest that nearly half of all cigarettes smoked in the United States are consumed by people who can be considered mentally ill, using a rather broad definition. The researchers do not know if mental illness makes one susceptible to tobacco addiction, or if smoking leads to mental illness. 10. JAMA, November 22, 2000.
Coffee and Cigarettes
Researchers looking into the effects of coffee and cigarettes on bladder cancer were intrigued by their findings in a study published recently in the Journal of Epidemiology and Community Health.6 Tabacco and caffeine are thought to increase the likelihood of the disease, with smoking more likely so. However, they found that while smokers who didn't drink coffee were seven times more susceptible than nonsmokers, those that did had only three times the risk. The researchers aren't sure why coffee would offer a protective benefit, but one might hypothesize that the diuretic affect should reduce the relative concentrations of toxins in the bladder. The authors of the study point out that it still makes more sense to quit smoking than to take up drinking coffee as a precaution. The study involved 1,500 volunteers; those drinking two cups of coffee or fewer per week were classified as non-coffee drinkers for the purpose of this study. 6. JECH, December, 2000.
Smoking Aggravates Back Pain
Heavy smokers who are injured on the job appear to suffer more often with residual back pain, according to a study at the Carolinas Medical Center in Charlotte.3 The smokers also seemed to suffer more from leg cramps and pain. This follows one study that showed a near doubling of the healing time needed for fractures in smokers and another that found slower surgical wound healing because of nicotine's constrictive effects on blood vessels.
Lung Cancer and Former Smokers
A study of 685 lung cancer patients at Brigham and Women's Hospital in Boston13 has gathered some statistics about smoking and that disease. Patients who smoked comprised 41 percent of the group, a statistic which by itself might lead one to believe that smoking has little effect on lung cancer. However, 51 percent of the group were former smokers, leaving only eight percent who never smoked. The average former smoker had quit six years before, though about one-quarter had stopped smoking more than 20 years earlier. While nearly everyone agrees that you can help yourself avoid lung cancer by kicking the habit, this study suggests that the effects of smoking are not as quickly reversed as some might think. Smoking in the United States has decreased from 42 percent in 1965 to 25 percent in 1993. About 25 percent of the population are now former smokers.
The Price of Being First
China is the largest tobacco producing and consuming country in the world with about 30 percent of all cigarettes in the world being consumed there. In 1989, tobacco pumped about $3 billion into the Chinese economy and in that country. However, the Chinese Academy for Preventive Medicine reports that direct economic losses due to smoking were more, weighing in at $3.3 billion. Essentially, the Chinese spent more on treating tobacco related health conditions that they made in sales.
Gene Mutations Associated With Smoking
A John Hopkins University study published in the March 16, 1995 issue of the New England Journal of Medicine has found a high incidence of mutation in the genetic material of smokers. The gene p53, which appears to protect the body from some types of cancer, was mutated twice as often in smokers as non-smokers. Persons who both smoked and used alcohol increased their risk to three times that of the control group.
Smoking Infections
Aside from the long-term effects of cigarette smoking, a study from the Centers for Disease Control and Prevention reports that smokers stand a much higher risk of contracting acute life-threatening infections such as pneumonia or meningitis. The effect seems to relate directly to the amount of tobacco usage. Smokers were four times as likely to come down with pneumonia, but those who smoked 25 or more cigarettes each day had 5.5 times the risk. Those who kicked the habit gradually gained a normal resistance to infection in about 10 years.8 8. NEJM, March 9, 2000.
Smoking Moms
If you're a mother who doesn't want her children to fall into the smoking habit trap, consider this. Research shows that if you smoke, your preschoolers are six times more likely to already be planning to smoke when they grow up. Researchers interviewed 504 preschoolers in upstate New York and note that 70 percent said they expected to smoke when they were older. The largest percentage of these had mothers who smoked. A father who lights up also had an impact, but only to half the extent.11 11. Reported by Dr. Christine Williams of the Child Health Center at the American Health Foundation, Valhalla, N.Y., to the American Heart Association meeting in Dallas, November 10, 1998.
Work to Quit Smoking
A new study from Miriam Hospital in Providence, Rhode Island reports that exercise may be a helpful adjunct to people trying to quit smoking. Researchers followed 281 females in a 12-week "stop smoking" program. About half the women participated in a supervised, vigorous workout program three days each week. The exercisers were nearly twice as successful in kicking the habit as those that did not. This was still the case when a follow up was done a year later. More good news: women from the exercise group gained only about half as much weight after quitting.17 17. Archives of Internal Medicine, June 13, 1999.
Another Effect of Smoking
New research suggests that smoking is related to yet another undesirable condition: lessened sexual satisfaction. A survey of nearly 300 men between the ages of 24 and 36 found that smokers experienced sex only about half as frequently as non-smokers. Not only was quantity reduced among smokers, but also quality: on a scale of one to 10, smokers rated their enjoyment a "5" compared to the non-smokers' "9."10 The study does not, however, definitively answer the question of whether smoking is the cause or merely a type of compensatory behavior. 10. Panayiotis Zavos of the American Institute of Andrology, Lexington, KY, reported by United Press, September, 1999.
Water
A new study of close to 48,000 male health professionals suggests that bladder cancer is influenced by fluid intake.7 A higher fluid intake, especially of water, seems to decrease the risk in a somewhat proportional manner. The study concludes that, on average, each glass of water (per day) decreases the risk of bladder cancer by seven percent. It is thought that diluted urine decreases the bladder wall irritation caused by chemicals being held there. Researchers did not find any increased risk of bladder cancer attributable to coffee or alcohol consumption. Smoking was a factor, nearly quadrupling the risk. Fruit juices, for some as-yet unknown reason, seemed to increase the risk very slightly. 7. Michaud D, Spiegelman D, Clinton S, et al. Fluid intake and the risk of bladder cancer in men. N Engl J Med 1999;340:1390-7.
Early Smoking
A new study16 concludes that there is an amount of DNA damage attributable to smoking that never gets repaired, even after the habit is kicked. The exact amount of this damage does not seem to depend on how often a person lights up or for how many years, but at what age the smoking started. Smokers who had started by age 15 showed twice the DNA damage as those who began in their 20s. One researcher commented, "There is something uniquely bad about starting young."17 Other studies have shown that smoke in developing lungs stunts their growth, increases breathing problems, and is more addictive.18 16. Journal of the National Cancer Institute, April 1999. 17. John K. Wiencke, genetics expert at the University of California, San Francisco. 18. Associated Press, April 6, 1999
Pregnancy & Chiropractic
I've composed this list of research and reports from around the world and thought I'd post them again.
Take them for what they are, and only that. Enjoy!
Prenatal Folic Acid
By now, everyone must know of the importance of folic acid in the diet of mothers-to-be. However, women taking prescription vitamins may be getting shortchanged. Researchers at the University of Maryland have noticed that such vitamins don't dissolve well. Of the preparations they tested, two-thirds released less than 75 percent of the amount listed on the label in standard one hour tests. The author of the study cautions that these supplements may provide "inadequate" nutrition.1 1. Steven Hoag, University of Maryland.
Prenatal Calcium
A study of nearly 600 children sponsored by the World Health Organization concludes that the calcium intake of a mother during pregnancy can influence the blood pressure of her offspring. Systolic pressure was lower in older children whose mothers took two grams of calcium a day while pregnant, compared to those taking a placebo. The effect was especially noticeable in overweight children.8 8. British Medical Journal, August 2, 1997.
Hungry Mothers Have Weak Babies
Research in Gambia is illustrating how important prenatal nutrition is to children. In Gambia, the months of July through October are known as the "hungry season," when food is scarce but work is hard. Researchers found that children born at that time were up to 10 times more likely to die prematurely by the time they were young adults, mostly from infective disease. The study spanned over 40 years.12 12. Reuter, July 30, 1997.
Phenobarbital Lowers I.Q.
A study published in the Journal of the American Medical Association1 reveals that males who were exposed to phenobarbital while still in their mothers' wombs show a seven percent decrease in intelligence as adults. Other prenatal factors decreasing I.Q. turn out to be maternal poverty and unwanted pregnancy, combining with the drug treatment to lower I.Q. by an average of 20 percent. It is estimated that there are 23 million Americans who were exposed to the drug in utero. 1. JAMA, November 15, 1995.
Cerebral Palsy Lessened by Pre-Eclampsia
A report in the Lancet medical journal11 detailing the relationship between chorioamionitis (a prenatal bacterial infection) and cerebral palsy, describes another interesting finding. Researchers found a significant decrease in babies born with cerebral palsy when the mothers experienced pre-eclampsia, normally considered a bad syndrome. No medical treatment was rendered for the elevated blood pressure and blood albumin, so apparently the syndrome itself seems to offer some benefit to the baby. The authors suggested that further investigation was urgently needed. Factors increasing the incidence of cerebral palsy were maternal infections (such as the chorioamionitis) and premature rupture of the membranes. 11. Lancet, December 2, 1995.
Let Your Body Rest After Pregnancy
The report in the New England Journal of Medicine that describes increased risk of infant mortality with back-to-back pregnancies may shed some light on why infant mortality rate is so high among blacks in America. The study found that black women tripled their risk of premature delivery if they became pregnant before nine months of their last delivery. White women however, for a reason not yet clear, needed only a three month interval. The study was conducted at an Army hospital where the economic status and quality of prenatal care of the women were nearly identical.
Prenatal Stress
A study conducted at the University of California7 suggests that psychological stress in a pregnant woman can translate into temperamental and behavioral difficulties in her offspring. This preliminary research involved 120 infants and toddlers, relating maternal stress during pregnancy to resultant behavior using interviews and psychological testing.8 7. By Dr. Pathik Wadhwa et al., University of Kentucky Chandler Medical Center. 8. Presented to the 19th annual meeting of the Society of Behavioral Medicine, March 26, 1998.
More Prenatal Care Better?
The National Center for Health Statistics reports that pregnant women in both high and low-risk groups have received more prenatal care in the United States in recent years. However, at the same time for some reason, premature and low-weight births increased as well.16 Explanations range from suggestions that the wrong women are getting care to problems associated with overutilization of invasive procedures. 16. Journal of the American Medical Association, May 24, 1998
Teenagers Not Ready for Pregnancy
A new study at the University of Utah concludes that most premature births to teenager mothers are not due to poverty and poor prenatal care as is commonly believed, but are more a result of the mother's youth. Middle-class teenagers were nearly twice as likely to deliver prematurely as older women.3 The reason for this is not understood, though researchers speculate that teenage girls require more nutrients and energy because their bodies are still growing, thus creating a competition between the baby and mother. About 13 percent of all births in the United States are to teenage mothers.
Eczema and Yogurt
Another study published in the Lancet7 suggests that prenatal and six-month postnatal supplementation of lactobacillus Gorbach Goldin (LGG) can significantly reduce incidence of eczema in the offspring. This was a double-blind study of 132 pregnancies and subsequent births. The babies were checked for a diagnosis of eczema at age two. The rate of eczema in the lactobacillus group was half that of those given placebos. These children were all considered high risk, as a close relative had been diagnosed with eczema. The lactobacillus was given in the form of capsules. 7. The Lancet, April 7, 2001.
Ecstatic Memory Problems
Research published in the Journal of Neuroscience suggests that the drug ecstasy, when used during pregnancy, can result in learning and memory problems. The drug, given to rats at the equivalent of a human's third trimester, produced problems with learning how to navigate mazes that lasted into adulthood. Reference: Journal of Neuroscience, May 1, 2001
Breast Feeding and Pregnancy Don't Hurt Bones
The findings of British researchers who studied new mothers recently should help calm the fears of women worried about osteoporosis. Their study concludes that pregnancy and breast feeding are no reason to worry about osteoporosis later in life. The doctors measured bone densities in women for a number of years before and after weaning their children. They found that while some did lose bone calcium while nursing, it was later replaced when there was more available in the mother's system.2 Many people, doctors included, seem to have trouble grasping the concept that osteoporosis is due to a loss of bone substrate, while a simple loss of calcium would cause the bones to soften, as in osteomalacia. 2. The Lancet, May 24, 1997.
Marijuana: How Addictive?
Research from the Medical College of Virginia suggests that marijuana is more addictive than many think. Rat studies there produced bizarre symptoms when the drug was withheld, such as arching backs, walking backwards, and what they call "wet-dog shakes."11 Another study has found late effects on children whose mothers smoked marijuana during pregnancy. At age 4, the children began showing signs of impairment of verbal reasoning and memory. Attention spans suffered by age 7, and by their pre-teen years they were less able to do strategic planning.12 Marijuana use in the United States was declining until 1992; it has been steadily increasing since then. 11. Presented at the National Institute on Drug Abuse's Conference on Marijuana, July 19, 1996. 12. Peter Fried from Carlton University in Ontario, presenting at the same conference.
Shrinking Brains?
A study by neurological researchers8 offers "concrete evidence"9 that a pregnant woman's intellectual abilities decrease during the final month or two of her pregnancy. The women performed 15 to 20 percent poorer on learning and cognitive tests during the last month than they did a few weeks after delivery. This surprised the researchers, who expected the higher estrogen levels of pregnancy to enhance mental ability. Another group of researchers at the Royal Postgraduate Medical School in London says that women's brains temporarily shrink during pregnancy. 8. J. Galen Buckwalter, et al., from the University of Southern California. The findings were presented at an international symposium in Orlando on February 7, 1997. 9. United Press, February 7, 1997.
Abortion and Cancer -- Again
A meta-analysis published in the Journal of Epidemiology and Community Health7 suggests that abortions may increase a woman's breast cancer risk. This work encompassed 23 studies on 60,000 women. One of the authors theorizes that the effect is caused by breast cells being stimulated to grow and replicate during pregnancy, but never having the chance to fulfill their ultimate function. He thinks that these immature cells, having nothing better to do, go bad and begin to cause trouble. That would seem to fit in with general patterns apparent in other areas of life ... 7. JECH, October, 1996.
D & C Study
A study published in the January 14th issue of The Lancet concludes that most women who suffer a miscarriage within the first 13 weeks of their pregnancy do not need the dilatation and curettage surgery routinely given. In fact, the surgery itself more than triples the rate of infection. Without the surgery, bleeding lasts for slightly more than a day longer, but some feel that this is part of the body'_s way of expelling remaining fetal tissue. Miscarriage occurs in about 15 percent of all pregnancies.
Womb Tunes
A British researcher6 reports that awareness and memory may develop sooner that previously thought, and in a different area of the brain. The cerebral cortex is thought to not be sufficiently developed by the 20th week of pregnancy to store memories. However, he has found that unusual melodies listened to by theΠthree weeks after birth. He hypothesizes that the thalamus is responsible for this learning. Some scientists feel that this and other studies may help relate some behaviors to early pre-birth trauma. 6. Stephen Evans of Kelle University in central England, reporting to a meeting of the British Psychological Society, March 29, 1998
Pregnancy Drug Warning
The FDA, prompted by the National Women's Health Network, has issued warnings against the use of at-home terbutaline pumps. These are devices used by thousands of pregnant women in the hopes of preventing premature labor. The device continuously pumps the asthma drug "terbutaline" into the women's system. This drug is not approved for such use, though many hospitals use it for that purpose routinely. The FDA says there is no evidence that it does any good, and quite a lot (including at least one woman's death) that it is harmful.13 13. Associated Press, November 19, 1997.
High U.S. Infant Mortality May Be Due to Term, Not Weight
The infant mortality rate of Norway is among the lowest in the world. The United States does poorly by comparison. Researchers at the National Institute of Environmental Health Sciences in North Carolina are attributing the U.S.'s poor showing to high numbers of preterm births. Most previous research attributes the difference to birth weight, but this study took into account the term of the pregnancy. The U.S. preterm birth rate is nearly 50 percent higher than that of Norway, and when you remove those from the equation, there is not much difference in the statistics of the two countries.8
Heavy Workload during Pregnancy Robs Baby
In a preliminary report of a study10 of pregnant women in active jobs, researchers conclude that long periods of activity will lower the birth weight of the baby. The effect is most pronounced during the second trimester when rapid growth is occurring. Lack of periodic rest is blamed for a large part of the problem, but it was also discovered that many of the women were so busy they were skipping meals. A more conclusive data analysis will be available in about a year.
Acne Drug and Birth Defects
Back in 1988, after Accutane (isotretinoin) was suspected of causing dozens of birth defects, the drug was nearly banned. However, the manufacturer agreed to implement an extensive program, concurrent with their marketing plan, to eliminate the chance that women taking the drug might become pregnant. While the program has been very effective, there are still a lot of women who don't realize the possible implications of having the drug in their system when they conceive a child. Also, many physicians are not following required federal guidelines when prescribing the drug, according to a study published in the New England Journal of Medicine.9 For example, the FDA requires a pregnancy test before administration of the drug, but about one-third of women surveyed reported no pregnancy test before initiation of the regimen.
Zinc Supplementation during Pregnancy
A study of 420 Bangladesh infants suggests that mothers who have an adequate supply of zinc in their diets during pregnancy produce healthier babies. More than 40 percent of the babies in this study had low birth weight, suggesting nonoptimal nutrition, and zinc did not appear to make a difference in birth weight. But babies from zinc-supplemented pregnancies had 32 percent less diarrhea,5 a 61 percent less incidence of impetigo, and 74 percent less dysentery.6 5. http://www.babyworld.co.uk/news/Apr01/100201zincboosts growth.html 6. The Lancet, April 7, 2001.
Folic Acid in Pregnancy
A new study published in the New England Journal of Medicine confirms the significance of folic acid in preventing birth defects. This study focused on medications that interact with the nutrient. Among pregnant women who took such medications, the incidence of cleft palate, heart defects, or urinary defects were two to three times higher than normal. Drugs that block folic acid include certain antibiotics, blood pressure medications, and epilepsy treatments.5 5. NEJM, November 30, 2000.
Epilepsy Drugs during Pregnancy
A new study published in the New England Journal of Medicine9 reinforces earlier studies that have reported increased birth defects when women take anti-epilepsy drugs during pregnancy. However, this study goes further in comparing the risks when the medication is withheld. Often, doctors will continue to prescribe the drugs thinking that uncontrolled seizures will also cause birth defects; however, this study contradicts that belief. The women who abstained from the drugs showed no significant increase in birth defects compared to a normal control group. This research also suggests that switching medications during pregnancy amplifies the risk, and that the drugs often considered safer during pregnancy (such as phenobarbital) actually may be worse. 9. NEJM, April 12, 2001.
Pregnancy Helps Prevent Cancer
According to a study published in the journal Genetics,4 pregnancy relatively early in life activates a gene5 that helps females resist breast cancer. The researchers suggest that the effect may be permanent. This study was done on mice, but correlates with other studies showing that women who give birth at age 18 have less than half the risk of breast cancer as someone who waits until age 30.
Placenta Size Related to Maternal Protein Intake
A study at Baylor College of Medicine has found that restricting protein intake during pregnancy can decrease the size of the placenta by 21 percent, at least in pigs. This decreased size seems to have impaired the transport of nutrients to the fetus, stunting fetal growth.6 When protein intake was increased later in the pregnancy, the diminished nutrient transportation problem persisted, suggesting that the stunting is irreversible.
More Problems with Teen Pregnancies
Teenage pregnancies have been associated with low birth weight babies; now researchers are saying that severe birth defects are also more likely. A study by the California Birth Defects Monitoring Program17 of more than a million births finds that children born to teenage moms are 11 percent more likely to have birth defects when compared to those born to mothers in their 20s. That translates to about one out of every 32 births to adolescents. Problem areas include the brain, spinal cord, kidneys, limbs, and intestines.18
Anxious Mothers and Anorexia
A study published in the British Journal of Psychiatry11 suggests that a strong contributor to anorexia nervosa in teenage girls is the anxiety level of their mothers during pregnancy and the girls' upbringing. Three times as many mothers of the anorexic group in this study had experienced a stillbirth or miscarried pregnancy before giving birth to their daughters. The researchers believe that the mothers projected their anxieties and insecurities onto their offspring, both during pregnancy and childhood. These mothers were also more distressed when their daughters first started nursery school. As the girls grew older, the girls that eventually suffered from anorexia were typically the last ones allowed to spend a night away from home. 11. BJP, February 1, 2000.
Birth Defects from Solvents
A Canadian study of 250 women concludes that common solvents found in a wide variety of work environments can lead to birth defects in humans. Half of the women had been working with industrial solvents during the first three months of their pregnancy. Thirteen of these bore children with defects such as deafness, clubfoot, neural tube defects and other major malformations. The concentration of the chemicals in many of these environments was strong enough to cause symptoms such as eye irritation, headaches or respiratory problems. Among the control group exposed to only agents not generally considered toxic, only one baby had a birth defect.9 9. JAMA, March 24, 1999.
Epson Salts for Eclampsia
United Kingdom researchers have found that Epsom salts, which has been used by some to treat eclampsia for as many as the past 60 years, is more than twice as effective as two of the most popular newer drugs, diazepam and phenytoin. The study involved 1,680 women in nine countries.4 It makes you wonder how such new drugs come to be so popular in the first place.
Vitamins for Preeclampsia
A study published in The Lancet13 reports that vitamins C and E have a protective effect against preeclampsia. Women at high risk of the disorder who were given supplements (1,000 mg of vitamin C, 400 IU of vitamin E daily) experienced the problem at less than half the rate of a placebo group. Three hundred women were involved in the study. A similar but larger study is now being planned to verify the results. 13. The Lancet, September 4, 1999
Drugs
For more information, please talk to Dr. Carr
Medicines Kill 100,000 U.S. Citizens Each Year
Now for some real scientific medicine. A study in the Journal of the American Medical Association10 suggests that adverse reactions from properly prescribed(?) drugs are among the top causes of death in the United States each year. The authors estimate that more than two million adverse drug reactions (ADRs) occur yearly, 106,000 of which result in death. In 1994, they say, this would account for 4.6 percent of all recorded deaths, just behind heart disease, cancer and stroke. Deaths from adverse drug reactions therefore were ahead of pulmonary disease, accidents, pneumonia and diabetes. This study only counted deaths from drugs prescribed in a hospital setting. If you were to combine these results from a recent study (see "Hospital Infections Rising" in last month's column) that found 90,000 deaths per year from hospital-induced infections, one could easily place hospitals as the third leading cause of death in the U.S., ahead of strokes by about 45,000. The researchers suggest that deaths from ADRs have not changed much in the past 32 years. I'll let you do the math. 10. JAMA 1998;279:1200-1205.
Hold the Antibiotics
A study from Children's Hospital and Regional Medical Center in Seattle1 reports that antibiotics given to children suffering from E. coli infection may trigger complications that can result in the child's death. (The bacteria, E. coli 0157:H7, causes about 73,000 cases of food poisoning in the United States each year.) This study looked at the medical records of 71 children infected. Nearly half who received antibiotics contracted hemolytic uremic syndrome, a complication of the infection that results in kidney damage and blood cell destruction, a significant contributor to death. Among the children that were not treated with antibiotics, the rate of syndrome contraction was about eight percent. The connection to antibiotics, which has been suspected for some time, is thought to be due to toxins being released from the bacteria into the intestines after contact with the drugs.1 1. New England Journal of Medicine, June 29, 2000.
Recreational Ritalin
The U.S. Drug Enforcement Administration reports a growing pattern of recreational use of the drug methylphenidate (MPH) among pre-teen and teenaged children. MPH (street names "Vitamin R" and "R-Ball") is favored for its stimulant and psychotropic effects, and is among the top 10 controlled substances most frequently reported stolen each year. The pattern of abuse is found by examining data from emergency room reports, poison control centers, adolescent drug treatment centers, and school surveys. MPH is sold by prescription under the brand name Ritalin.3 3. Associated Press, May 5, 2000. Recreational Ritalin.
HIV Drug Mimics Infection
A spokesman for the National Institutes of Health says that a drug commonly used to treat HIV patients can easily fool a physician into believing the patient has a urinary tract infection. Indinavir (brand name Crixivan) tends to crystalize in the urine, causing flank pain and urethral burning. A high water intake is recommended by the drug maker to minimize the effect.4 4. United Press, July 14, 1997.
Antidepressants and Intestinal Bleeding
Spanish researchers report a statistical correlation between antidepressant drugs and intestinal bleeding. Actually, the danger appears to be taking the drugs with aspirin or other nonsteroidal anti-inflammatory drugs. The combination appears to produce a larger risk than the individual risks added together. The antidepressant drugs studied were selective serotonin reuptake inhibitors (SSRIs), a class that includes Prozac. The study involved 1,600 people with upper GI bleeding.7 7. British Medical Journal, October 23, 1999.
Study Reports Acceptance of Unresearched Drugs
Researchers from the University of North Carolina at Chapel Hill are questioning the casual prescription of serotonin selective reuptake inhibitors (SSRIs) to hundreds of thousands of children each year. "Our survey data suggests that despite a lack of research support, adequate training and comfort with the management of depression, SSRIs are gaining physician acceptance and becoming incorporated into primary care practice," said a university spokesman recently.8 He warns that it is not prudent to use these drugs for "school problems or nebulous behavioral problems." While SSRIs are approved for patients over 18 years of age, there is little scientific evidence that they are safe and/or effective for mental illness in children. These drugs, which include Ritalin and Prozac, are known to cause sleep disturbances and untoward behavioral changes in children. Nothing is known about their effect on developing nervous systems. They are frequently prescribed in the U.S. to treat children for hyperactivity and ADD, obsessive-compulsive disorder, aggression-conduct disorder and even bed-wetting. 8. Jerry Rushton, a researcher quoted by Reuters news service, May 1, 1999.
Estrogen Drugs Stimulating Ovarian Cancer
Researchers from the University of Southern California report that one of their studies suggests that a drug commonly used in postmenopausal women to prevent osteoporosis may encourage growth of ovarian cancer. The drug, an estrogen supplement called raloxifene, does not appear to affect breast cancers or the uterine lining. However, in a laboratory setting, ovarian cancer cells showed increased growth when exposed to the drug. Reference: Reuters, July 3, 2001, reporting on the work of Dr. Richard Paulson, an ob/gyn professor. The results varied widely according to geographical area as well as other factors. Independent drug stores warned customers less often, as did stores in lower income neighborhoods. In Denver, one dangerous combination was quietly dispensed more than half the time, while the vast majority of pharmacists in Indianapolis refused to fill the prescription.4 4. U.S. News & World Report, August 19, 1996.
Heartburn Drug Warning
The FDA has issued a warning about a drug commonly used for the treatment of night©time heartburn. Cisapride (also known as Propulsid) is believed to have caused at least 38 deaths from cardiac side©effects. The drug is also thought to interact unfavorably with a number of other drugs, and there is a long list of physiological illnesses that preclude its use. The manufacturer plans to send a letter to doctors asking them to use caution when prescribing the preparation.13 13. United Press, July 6, 1998.
Copper for E. Coli
British doctors report that when at least one harmful strain of e. coli bacteria comes into contact with copper surfaces, it dies within hours. Further studies are planned to test the effectiveness of copper counter tops in food preparation, and whether copper water pipes decrease the risk of water-borne contamination.14 14. United Press, July 6, 1998.
Animal Antibiotics
Did you think doctors prescribed a lot of antibiotics to their patients? Farmers give their animals eight times as many as the average person gets in the United States, according to a report from the Union of Concerned Scientists. The practice, which spurs livestock growth, is seen as contributing greatly to the problem of antibiotic resistance that has many health officials very worried.10 10. Reuters, January 8, 2001.
Salmonella Developing Drug Resistance in Cattle
A recent case of salmonella infection in a young boy is worrying health officials, because the strain turned out to be resistant to one of the very few antibiotics thought to be still effective against most bacteria: ceftriaxone (brand name Rocephin). The bacteria was also resistant to a dozen other antibiotics. Further tests revealed that the bacteria came from cattle (from the family's ranch in Nebraska), which had been recently treated with ceftriaxone. The case is documented in the New England Journal of Medicine.10 10. NEJM, April 27, 2000.
Birth Control and HIV
New research from Kenya again implicates contraceptive usage in the spread of the HIV virus, but this one is a little different. Instead of showing that birth control pills make a mother more susceptible to HIV infection, this study reports that women who use these drugs will transmit the virus more easily to sexual partners and to babies during birth. Lack of vitamin A also seems to be a factor. The researchers found that such women tend to "shed" HIV-1 viruses at a higher rate in cervical and vaginal secretions.4 4. Lancet, September 27, 1997.
Hormone Replacement Therapy
A review of 22 separate studies published in the British Medical Journal8 concludes that, at least in the short term, hormone replacement therapy (HRT) offers no protection from heart disease in post-menopausal women. Doctors have long thought that maybe they would and have prescribed accordingly. Now they have to rely on faith that maybe they help in the long-term. 8. BMJ, July 19, 1997.
Acne Antibiotics
British researchers at a meeting of the American Society for Microbiology13 warned that antibiotic treatment of acne is producing some very hardy germs that spread quite easily to other members of the population. They have found that the majority of acne patients on antibiotics harbor highly resistant bacteria on the surface of their skin. These can be passed on to others by casual contact. Acne patients treated with antibiotics are typically on the drugs for 8-10 years. "Long-term treatment with antibiotics is insane," one expert opines.14 13. American Society for Microbiology Meeting in Toronto, September, 1997. 14. United Press, September 29, 1997, quoting Marilyn Roberts, pathobiology professor at the University of Washington School of Public Health and Community Medicine, Seattle.
Prozac Preemies
A study published in the New England Journal of Medicine1 suggests that Prozac taken during a woman's pregnancy can lead to premature birth and a number of other complications in the infant. This study of 482 pregnancies found that mothers taking the chemical were many times more likely to not carry their babies to full term. Also, many of the Prozac babies had other problems that while not life-threatening, required admission to special care facilities. Prozac is taken by 12 million people world-wide. 1. NEJM, October 3, 1996.
Prescribing Doctors Fail Drug Survey
The results of a survey7 of medical practitioners who regularly treat patients for angina were announced at a September meeting of the American Federation for Aging Research and Key Pharmaceuticals. Researchers wanted to know if physicians paid attention to labeling information changes of drugs they prescribe. In this case, they specifically queried doctors about isosorbide dinitrate drugs, a common treatment for angina. A year ago, the label and prescription information began noting that the drug was only effective for two hours. Three out of four doctors did not know about the new information, and most were under the impression that the medicine was good for 12 hours. Nearly all the doctors surveyed prescribe the drug regularly.8 7. Conducted by Yankelovich Partners, Inc. 8. United Press, September 5, 1996.
Misplaced Faith in the PDR
A study published in the Annals of Emergency Medicine1 concludes that the popular Physician's Desk Reference contains bad information that can cost lives. The researchers examined the advice for overdose treatment of the 20 most commonly prescribed drugs associated with deaths from overdose and found it outdated (up to 25 years old) and inadequate. Many times, the PDR does not mention treatments that could save lives and recommends harmful advice, considering current toxicology knowledge. For example, the PDR advises treatment of Elavil toxicity with physostigmine, a drug that many years ago was found to increase the risk of death in these cases.2 However, patients may be comforted (or not) by another finding of the group: They surveyed doctors and found that less than half had consulted the PDR at all in the past year. 5. AEM, February 1, 1997. 6. United Press, January 31, 1997.
Antibiotics and Birth Control Pills
Some antibiotics may interfere with the absorption of oral contraceptives leading to an increased risk of pregnancy, according to a Stanford University pharmacist. Also, breakthrough bleeding during the menstrual cycle may be increased by the drugs and metabolic changes can result in body temperature changes that work to counteract the action of the birth control pills.
Painkillers Slow Healing
New research reinforces what many of us were taught in college decades ago: deadening pain resulting from an injury appears to interfere with healing. Research at the University of Medicine and Dentistry of New Jersey found that NSAIDs appeared to slow or modify bone healing after a fracture. Researchers administered Celebrex or Vioxx to rats with broken legs, and noted that most fractures had not fully healed after two months. When new bone formation did occur, it was often weak and superficial. The significant component appears to be the cox-2 enzyme (associated with inflammation and pain) blocked by these drugs. Researchers are starting to realize that the enzyme (and maybe the inflammation itself) plays an important role in healing.4 4. Journal of Bone and Mineral Research, May 2002.
Therapy Better than Drugs
A study8 from Vanderbilt University in Nashville suggests that cognitive therapy treatment may be a better way to manage depression than pharmaceuticals. The costs and effectiveness for both types of treatment were about the same over a four-month period, but the cognitive therapy appears to have a more permanent effect, with relapses occurring much less often. In the long term, cognitive therapy (which is somewhat slower to show results initially) appears to be much more effective, both clinically and economically. The conclusions of this study are expected to come as a big surprise to many psychiatric professionals who have strong faith in the drugs they prescribe. 8. Reuters, May 24, 2002.
Antibiotics in the Food Chain
More researchers are warning about the dangers of using antibiotics to enhance food production. Researchers from the University of Maryland School of Medicine have found, in the intestinal tracts of chickens, bacteria that are highly resistant to antibiotics generally considered to be the last remaining drugs effective against many infectious diseases. In addition, they have found resistance to what were thought to be very powerful drugs still under development. These germs are being found in animals raised on antibiotics, which are given in an effort to boost growth andΠ7. United Press, September 25, 1998.
"New" Theory: Fevers Are Beneficial
A new book, Evolution and Healing,1 promotes some "radical"2 health concepts. The authors, a psychiatrist and an evolutionary theorist instructor, say that fevers are an adaptation by natural selection specifically to fight infection; that treating fevers with aspirin may be doing the patient harm. The authors go on to say that "we should respect the evolved wisdom of the body," and make other statements reminiscent of a philosophy course at a chiropractic college, such as the need to know when to act and when to leave the body alone. The authors also note that modern medicine uses drugs mainly to treat symptoms instead of causes. In addition to some basic concepts taught to every chiropractic student, the book also explains a great deal about how modern lifestyles make us prone to problems such as heart disease and nearsightedness, and help to create deadlier bacteria and viruses. Virulence among pathogens, the authors say, will increase as populations become denser. Germs are less virulent if transmission avenues are few, since they will not reproduce if the host dies. But increased avenues caused by poor sanitation, sexual promiscuity, shared needles, confined living and working quarters, etc., allow much deadlier forms to survive and prosper. The authors base their theories on a large number of studies relating to various causes of illness.
Nursing Home Drugs
A study by the U.S. Inspector General of the Department of Health and Human Services paints a sorry picture of medical treatment in Texas nursing homes. This work reports that one in five residents receive drugs that are inappropriate for elderly citizens. Another 20 percent are getting at least two drugs with potentially dangerous interactions. The report was released by Senator Chuck Grassley of Iowa, who chairs the Senate Special Committee on Aging.14 14. Reuter, November 17, 1997.
Lowering Your Cholesterol Can Be Depressing
Psychiatrists often notice that their patients who are under concurrent medical treatment for heart problems are more prone to episodes of anxiety and crying. A study at the Henry Ford Hospital in Michigan is blaming their emotional instability on cholesterol-lowering drugs.3 Researchers are starting to associate artificial decreases in cholesterol levels with emotional stress. Statistically, such patients are more likely to die by murder, suicide, or some kind of traumatic accident.
More Calcium Channel Blocker Effects
Another study is warning about the hazards of calcium channel blockers used in the medical treatment of high blood pressure. Swedish doctors found a five-fold increase in the incidence of suicide among patients who used these drugs, compared to those undergoing a different course of therapy for their hypertension. The suicides are thought to result from depression induced by the CCBs.10 10. British Medical Journal, March 7, 1998.
Withholding Antibiotics
A group of pediatric physicians in Rochester, N.Y. conducted a novel study on 383 of their child patients. They practiced what they term "judicious antibiotic use" in children with colds and other upper respiratory infection, i.e., the doctors didn't use antibiotics unless there were clear indications that the child might be suffering from an infection for which antibiotics were effective. The study involved children from infancy to age 12. About 25 percent received antibiotics. In many pediatric practices, most children with upper respiratory infections are given the drugs routinely. The study7 concludes that withholding antibiotics from these children did no harm; in fact, fewer children from the nontreatment group needed follow-up care. 7. Pediatrics, April 2000.
Drug Use on the Rise
Americans will be using about six percent more drugs in 1998 than the year before, according to estimates by the National Association of Chain Drug Stores. This figure is for prescription drugs based on sales during the first six months of this year. Increasingly popular new drugs that contribute to this trend range from Viagra to toenail fungus remedies. Analysts credit a number of factors, not the least of which is advertising, for this increase. Another factor is the availability of an array of new drugs going through an accelerated FDA approval. One 34-year-old Manhattan resident went from taking only insulin for her diabetes in 1995 to her now 52 daily doses of 19 different drugs, many of which were not on the market last year. An average of 11 prescriptions will be picked up each year for every man, woman and child in America.4 I wonder who's been picking up mine for the past 25 years? 4. Associated Press, August 30, 1998.
Steroid Stunts
The FDA is warning that recent studies suggest that steroid inhalers used in the medical management of asthma appear to delay a child's growth. The long©term effects are not yet known, but many lung specialists and drug manufacturers are hoping that the children will experience a growth spurt later in life that will let them catch up. As it stands, though, current research indicates that during a year's worth of inhaling the drugs, a child will grow 1/2 to one inch less than expected. The FDA wants to put warning labels on inhalers recommeding the need for frequent height measurements.11 11. Associated Press, August 14, 1998.
Ritalin Legislation
In June 2001, Connecticut became the first state in the United States to pass legislation aimed at combating the growing abuse of prescription drugs among children in school. The unanimously approved law prohibits teachers, counselors, and other school officials from recommending psychiatric drugs for any child. The school can still recommend that a student be evaluated by a doctor, but it is the doctor who must suggest the mode of treatment. Many legislators are becoming alarmed at the number of children taking such drugs, which they see as an all-too-easy solution for parents, teachers or doctors who don't want to deal with individual situations. Some schools were even demanding that certain children be medicated before being allowed into the classroom. The federal Drug Enforcement Administration says that, in some elementary and middle schools, as many as six percent of all students are taking these drugs.7 7. Associated Press, July 17, 2001.
Elderly Deaths from Medication
A new study of hospital patients in Norway suggests that many elderly people are dying not from disease, but from fatal-side effects of their medications. The project determined that 18 percent of the deaths among the elderly patients studied were due, either directly or indirectly, to the medications they were given. This rate is much higher, say the researchers, than that for the general population. They suggest that doctors take more care when prescribing drugs for older patients with complicated conditions. Most of the deaths resulted from drugs used to treat cardiovascular disease (including circulatory problems) or asthma.15 15. Archives of Internal Medicine, October 22, 2001
FDA Considers Relaxing Drug Ad Restrictions
The FDA is trying to decide if it should allow pharmaceutical companies more freedom in advertising their prescription drugs. In 1994 manufacturers spent $250 million advertising prescription- only drugs; many of those ads were aimed directly at potential patients. Analysts say that amount could increase $1 billion a year if current restrictions (such as requirements to reveal side effects) are relaxed. It has been contended that an increase in such advertising will increase the pressure doctors are under to prescribe "trendy" medications at the expense of more conservative measures such as diet and exercise. It has already been established that doctors give in to such pressures rather easily, as evidenced by the widespread prescription of antibiotics for colds and flu to placate patients even though the doctors know better.
NSAID Deaths
Advisors to the FDA are expressing concern over signs that many popular nonsteroidal anti-inflammatory drugs are more dangerous than doctors and the public think. Most NSAIDs are believed to contribute to gastrointestinal problems. Forty-one thousand hospitalizations and 3,300 deaths each year are blamed on such side effects.11 The consumer group Public Citizen is asking the FDA to ban piroxicam (sold as Feldene), a more potent form of this class of drugs used to treat arthritis. According to FDA records, 299 Americans deaths have been linked to this one drug since 1982.
Cholesterol-Lowering Drugs
Researchers analyzing studies for the effects of cholesterol- lowering drugs on women with high cholesterol but no other heart disease risk factors have concluded that the drug therapy is useless.12 The regimen, which can cost as much as $1,000 per year, can produce many side effects (such as heart arrhythmias) without reducing deaths from heart disease related to elevated cholesterol levels. The long-term effects of the drug therapy are not known. The lead author even goes so far as to say that it may be pointless to even test the cholesterol levels of otherwise healthy women.
Epileptic Drugs Demineralization
Scientists from the University of Washington were surprised to find that young men taking anti-convulsant drugs for epilepsy appear to lose a large amount of bone mass. They found that some in the 22 to 43 year age group had skeletal densities that resembled that of 70 year old men, with an accompanying four-fold increase in fracture risk. One researcher estimates that about half of persons on such medications are affected, but more research needs to be done to quantify the effects, as well as to follow the long-term effects.11
Psychotropic Preschool Drugs
A study published in the Journal of the American Medical Association7 reports that the use of psychotropic drugs such as Ritalin and Prozac is increasing at a dramatic rate. This work finds that from 1991 to 1995, such prescriptions increased by 50 percent, from 100,000 to 150,000, for children aged 2-4. In 1995, 60 percent of these youngsters on the drugs were age four; 30 percent were three; and 10 percent were two year-olds. The authors of the study are concerned with the trend, especially since there is little evidence to show the drugs offer more benefit than harm, and that the potential damaging effects on brain development have not been investigated. The FDA has asked the drug manufacturers to look into this.8 7. JAMA, February 23, 2000. 8. Associated Press, February 22, 2000.
Drug Dispensing Errors
An investigative report,11 stimulated by recent media attention involving the high number of deaths due to medical mistakes, attempted to quantify any such problem involving the dispensing of drugs at your local pharmacy. They found that no such data exists, primarily because pharmacies are not required to report errors to any authority (except in Georgia and North Carolina - those states require a report in the case of "significant" harm, and death). No industry-wide statistics are kept, as errors might be handled (and go no further) at any level including: the pharmacist; his/her manager; the store or corporate office; an insurance company; a complaint to the state regulatory agency; or, if litigation results, the court system. North Carolina officials say that 36 deaths were reported in 1999, but believe that many more are never reported. The nonprofit Institute for Safe Medication Practices estimates that 2-3 percent of filled prescriptions are erroneous. Many pharmacists blame mistakes on ever-increasing workloads. In one case that went to court, the pharmacist was working 12 hours each day, five days per week. The AP report blames the increased workload on insurance companies for encouraging doctors to prescribe a pill instead of using a more expensive treatment that might require hospitalization or other physician-intensive attention. 11. "Deadly Doses." Associated Press, February 12, 2000.
Antibiotic Resistance Fears Grow
The American Society of Microbiologists have called for a national program of research and education to raise awareness of growing bacterial resistance to antibiotics. A University of Alabama microbiologist3 says that the United States will "pay dramatically"4 if action is not soon taken. The problem is known to be growing, but no one really knows how quickly or to what extent. However, the U.S. Centers for Disease Control and Prevention estimates that at least $4 billion is spent each year treating antibiotic-resistant infections in America. The task force recommended a number of things that could be done immediately to at least lessen the problem, such as asking doctors working in intensive care units to wash more frequently and to choose organism-specific antibiotics instead of the shotgun-type, broad-spectrum varieties when possible. Another interesting recommendation was to ask patients to stop pressuring their doctors for antibiotics that they do not need (for example, treatment of viral infections), because many doctors apparently cannot turn them down, even when they know better! Some interesting facts:5
Over 90 percent of staphylococcal strains are now resistant to penicillin and related antibiotics.
Resistance in pneumococci, the most common organism in middle ear infections, is increasing rapidly. Resistance was extremely rare before 1987.
Resistance to vancomycin, "the last weapon available against potentially deadly hospital-acquired infections"6 has increased 20 times in five years.
A Shigella dysentery outbreak that killed 60,000 people in Burundi in 1990 proved to be resistant to most drugs that previously would have been effective.
Almost half of all antibiotics made are used in farm animals.
Ulcer Patients Not Warned about NSAIDS
A study published in the Journal of the American Medical Association reports that most Medicare patients being treated for peptic ulcers are not warned about the dangers of taking over-the-counter nonsteroidal anti-inflammatory medications. Drugs such as aspirin and ibuprofen can create or increase the severity of ulcers and lead to increased hospitalizations or death from internal hemorrhage. Guidelines issued by the National Institutes of Health in 1994 recommended that doctors determine if their ulcer patients use NSAIDs and, if so, have them discontinue their use. However, this study says that there was no such change in clinical practice. Less than one third of patients are warned that NSAIDs could cause or aggravate their problem.1 1. JAMA, October 24, 2001.
NSAIDs and Miscarriage
A report in the British Medical Journal6 suggests a connection between nonsteroidal anti-inflammatory drugs (NSAID) and miscarriages. There has been little research on the subject, but this study concludes that there is a significant increase among women who took the drugs. The study involved more than 18,000 pregnancies, 1,462 of which involved NSAIDs. The researchers did not find any increased incidence of birth defects or pre-term delivery. 6. BMJ, February 3, 2001.
Super Aspirin Study Outcomes
For the past five years or so, pharmaceutical companies have spent hundreds of millions of dollars to prove that the new "super aspirins" (IIb/IIIa antagonists) are the new wonder drugs for heart and stroke patients. Unfortunately, each of the five major studies thus far suggests that, far from saving lives, the treatment is killing patients. The director of two of the studies estimates that up to 200 patients have died from the experimentation.10 The patient deaths appear to be related to excessive blood clotting, which is unfortunate, since the drug is supposed to work by blocking the clot mechanism. The prevailing theory of why so many patients die is that the body adapts to the drug's effects by lowering the clotting threshold. When blood levels of the drug become low (for example, just before the patient takes their next dose), clots form much easier than normal. So far, about 42,500 volunteers have participated in super-aspirin studies. Another study of DuPont's version (Roxifiban) is expected to recruit 2,000 more volunteers by the end of this year. 10. Associated Press, January 27, 2001.
Children's Anesthetics
A report in the journal Science suggests that drugs routinely used to anesthetize children may kill developing brain cells. Researchers from the Washington University School of Medicine found that developing rat brains are sensitive to toxic effects of nitrous oxide (laughing gas) and ketamine. The damage occurred at a time corresponding in humans to the sixth month of pregnancy through the second birthday. Angel dust (PCP) produced similar findings.6 6. Science, January 1, 1999.
Drugging School Children
Researchers from the Center for Pediatric Research in Virginia report that doctors appear to be overprescribing drugs to grade-school children.1 Attention deficit-hyperactivity disorder (ADHD) is thought to affect only three percent of children to the extent that medication is prescribed. However, this study finds that between 8-10 percent of children in second through fifth grades routinely take medication for ADHD. Among fifth graders, one of every five white males is taking ADHD medication. Most experts seem to think that doctors are misdiagnosing these children. 1. American Journal of Public Health, September 1999.
Painkillers and Heartburn
New research from the University of Georgia suggests that nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen and others) may increase the likelihood that a patient will suffer from heartburn. Researchers compared 12,500 Medicaid patients who regularly took such drugs with a similarly matched group that didn't. Patients on NSAIDs were twice as likely to have been diagnosed with gastroesophageal reflux disease.8 Many NSAIDs have been associated with a number of gastrointestinal disorders and are blamed for the deaths of 16,500 Americans each year.9 8. Presented to the American Association of Pharmaceutical Scientists meeting in New Orleans by Jeffrey Kotzan, November 17, 1999.
Pain and People Killers
Swiss researchers report3 that painkillers are probably killing 2,000 patients each year in the UK. Nonsteroidal anti-inflammatory drugs (NSAIDs) are causing bleeding ulcers responsible for most of these deaths, they say.4 NSAIDs appear to block a coenzyme (COX-1) that protects the stomach lining. This research suggests that about one in 1,000 patients who take these drugs for at least two years will die from them. 3. Pain, March 2000. 4. Martin Tramer, et al., University Hospital, Geneva
Placebos for Depression
A study in Prevention and Treatment12 concludes that for many anti-depressive drugs the placebo effect is the main curative agent. Researchers analyzed data from 19 randomized, placebo-controlled studies and found that while 25 percent of any improvements seen could be attributed to pharmacological effects, 75 percent of a given patient's recovery was attributed to the simple fact that the patient was taking a pill -- any pill. Even the 25 percent improvement credited to the medication may be suspect, however, as the researchers speculate that for some patients, drugs may enhance the placebo effect because the patients "could tell by the side effects that they had taken something," thereby enhancing their faith in the medication. 12. Prevention and Treatment, July 1998.
Drug Rush at FDA
Concerns are mounting that the FDA is too quick to approve new and exciting drugs for distribution in the marketplace. Over a period of 10 months ending last July, nearly as many drugs have been pulled off the market as had been during the entire previous decade, because of dangerous side-effects. Insiders say that the FDA is under political pressure to speed up approvals; that safety problems that arise are ignored; and that inspectors should "give the drug company the benefit of the doubt."13 Many of the drugs suddenly removed from the market this past year had prompted warnings from experts before the drug was approved. The FDA maintains that the current system is working, though, since drugs are quickly pulled off the market as soon as it is obvious that they are killing people. 13. Associated Press, July 10, 1998, quoting Elizabeth Barbehenn, a former FDA employee who spent 13 years monitoring experimental drug safety.
Accidents and Anxiety Treatments
Common anti-anxiety drugs seem to be contributing to the frequency of automobile accidents, according to a new study published in the British Medical Journal.14 This research finds that people taking drugs such as valium are more than twice as likely to be involved in an accident, and more than three times as likely if they are under 45 years old. These findings apply even if the patient does not feel drowsy after taking the drug. The study looked at drugs taken for anxiety, other stress-related disorders, and muscle spasms. 14. BMJ, October 31, 1998.
Beer & Alcohol
Plus du vin?
As of August 2007, Dr. Carr's favorite is Sauvignon...
The Beer Vitamin
Dutch researchers report that drinking beer may provide cardiovascular benefits not seen with red wine, because of beer's vitamin B6 content. They measured the blood levels of homocysteine and vitamin B6 among men who drank varying types of alcoholic beverages or plain water with their meals. They found that beer drinkers were the only ones who did not experience an increase of homocysteine (linked to heart disease risks) after meals. However, vitamin B6 levels did increase in these volunteers by 30 percent.4 4. The Lancet, April 29, 2000.
Beer to Fight Cancer
Japanese researchers report that they have a novel preventive measure for persons concerned about colon cancer: drink more beer. Laboratory rats were given a potent carcinogen, then fed a diet that included water, beer, or beer-related products such as malt. About 90 percent of the water-drinking rats developed tumors, but only two-thirds as many of the beer-consumers did so. The researchers believe that nonalcoholic ingredients, such as vitamins and amino acids, were responsible for the results. The researchers also note that they had no trouble convincing the rats to drink their beer.6 6. OTC, April 7, 2002, reporting on the annual meeting of the American Association for Cancer Research in San Francisco
Beer Won't Spoil Your Appetite
Two Canadian studies have confirmed what many people have long suspected: that the calories in a glass of beer do nothing to sate your appetite.6 Normally, the carbohydrates (and fats and proteins) you consume accumulate until your body decides it has its energy quota. You then lose your hunger until the next mealtime. However, it appears that the calories in beer are ignored for all practical purposes. The net result is that however many beers you drink with a meal (within reason I assume), that many extra calories are consumed for the same amount of hunger satisfaction. This may help to explain beer bellies.
Cancer-Inhibiting Beer
Japanese researchers report that an as-yet unidentified component of beer appears to be a strong cancer inhibitor. Researchers studied 24 different beers from 11 countries and found the effect most pronounced among stout beers. After being given cancer-causing chemicals, mouse volunteers that consumed the beer exhibited fewer carcinogenic changes than the abstainers.11 Followup research in humans is likely. 11. Journal of Agricultural and Food Chemistry (published by the American Chemical Society), January 1999.
Scottish Alcohol Study
In a study that reached conclusions directly contradicting a number of other recent works, Scottish researchers report no health benefits from alcohol consumption. Researchers from the University of Bristol tracked 5,766 men over a 21-year period and correlated their health and mortality statistics with their drinking habits. They found no difference in deaths between abstainers and moderate drinkers (up to 14 units of alcohol per week).
A unit of alcohol was defined as eight ounces of beer, a glass of wine or a shot of liquor. Heavy drinkers, though (more than 35 units), died from stroke twice as often as the moderate or non-drinkers. The stroke risk became statistically significant at about 22 units of alcohol per week.
The researchers speculate that the differences between their study and others with different outcomes may be in the drinking patterns. It could be, they say, that health benefits may become apparent if the drinking is evenly spaced over the week instead of the majority of alcoholic drinks being consumed during weekend binges. 15. British Medical Journal, June 26, 1999
Irish Coffee for Stroke
University of Texas researchers, studying the effects of strokes on rats, reportedly have found an improbable new stroke treatment: a swig of alcohol with a coffee chaser. They say the combination works just as well as potent drugs now in use for stroke treatment. For ischemic strokes (80 percent of stroke cases), alcohol administered by itself made the stroke worse. Caffeine alone had no effect, but the equivalent of one alcoholic drink followed by two or three cups of coffee offered "almost complete protection" from stroke damage. The effect is lost if the proportions are modified too much, and taking the mixture as a preventive measure (daily before the stroke happens) does not seem to work. More research is expected to follow, though the researchers are not getting many offers of funding from the major drug companies.10 10. Reported to the American Neurological Association meeting in Seattle, October 13, 1999, by Dr. James Grotta.
Drunk Driving Increases
A survey of 102,000 people finds that more people are driving under the influence of alcohol than experts had suspected. While automobile-related deaths attributed to drunk driving have declined in recent years, the researchers say that Americans are still driving drunk 123 million times each year. A typical drunk can get behind the wheel 82 times before he is caught. About 17,000 people die each year in the United States in alcohol-related accidents.9 9. United Press, January 7, 1997.
Alcohol Prominent in Lower Class Mortality
Researchers from Finland say that one reason members of lower economic groups die at a younger age is alcohol. Examining the death certificates of working class men, they found that 10 percent cited alcohol as a contributing factor. It wasn't liver disease and nutritional deficiencies that killed these people though, but violence. In fact, half of all violent and accidental deaths were alcohol-related. For women, that figure was 38 percent.4 4. British Medical Journal, July 26, 1997.
Alcohol and Infant Leukemia
A paper published in the Journal of the National Cancer Institute9 suggests that pregnant mothers who imbibe alcoholic beverages during the last six months of their pregnancy increase the risk that their child will suffer from infant leukemia by a factor of 10. The study was based on data from about 800 children and, according to the writers, the correlation is "very significant."10 9. Journal of the National Cancer Institute, January 3, 1996. 10. Associated Press, January 2, 1996.
Have a Few, Teetotalers
A 10-year Harvard study of physicians reports that alcohol can have both positive and negative effects on a person's longevity, depending on the quantity consumed. In this study of 20,000 men, two to four drinks per week was judged to cut the risk of death by 28 percent compared to non-drinkers. The benefits seem to come from healthier cardiovascular, pulmonary, immune, and nervous systems. However, too much of a good thing (two or more drinks per day) increased death rates 51 percent, with lung cancer being a major cause of death.2 2. Archives of Internal Medicine, January 13, 1997.
A Few Will Help Your Circulation Too
While large amounts of alcohol can make your legs wobbly, a Harvard Medical School study suggests that smaller amounts will increase your distal circulation. Over an 11 year period of time, the study followed 22,000 male doctors, watching for peripheral artery disease. Moderately light drinkers (one or two drinks per day) had a 32 percent less incidence of the disorder compared to abstainers.3 Researchers advise, though, that if you are a smoker you would achieve much better results by quitting cigarettes than by taking up the bottle. 3. Circulation, February 4, 1997.
Young Brains on Alcohol
Alcohol affects children and teenagers differently than adults, according to research at Duke University Medical Center and the Durham VA Medical Center in North Carolina. Their study, done on animals but thought to extrapolate well to humans, finds that alcohol causes learning and other mental problems in adolescents. Alcohol seems to interfere with development of the brain's circuitry, which is not thought to be complete until a person is about 20 years of age. Also, alcohol does not seem to have the sedative effect on teenagers that it does on adults, which permits more consumption.13 The authors think that this and future research will support legal prohibitions against underage drinking. 13. Alcoholism: Clinical and Experimental Research, November 1996
Alcohol-Triggered Metastasis
Animal studies at Ohio State University suggest that a single episode of binge drinking can trigger the spread of tumor cells throughout the body. Researchers found that the effect, which doesn't occur until the blood alcohol level reaches .2 percent, is that the "natural killer" cells' activity is reduced to 1/40th normal. These cells normally eliminate roaming tumor cells, so their diminished effectiveness can result in a tumor spreading to another location in the body. The NK cells can recover quickly at first when the alcohol is cleared from the bloodstream, but repeated episodes seem to cause permanent damage. These findings may help explain why heavy drinkers suffer from such high cancer rates.9 9. Nature Medicine, April 1996.
Non-alcoholic Wine
If you're a non-drinker and feel cheated by the recent reports of the cardiovascular benefits of wine, there may yet be some good news for you. A group of British researchers has found that a non-alcoholic extract of a French wine, Cabernet sauvignon, seems to show similar (though possibly less pronounced) effects on the cardiovascular system. Volunteers who consumed the concoction, a drink called Nutrivine, showed increased antioxidant action in their blood stream within two weeks. The product will be test marketed in Singapore.15 15. Reuters, February 20, 1997.
Maternal Alcohol Usage and Cerebral Palsy
An article in the January issue of the journal Pediatrics describes a study that finds a strong relationship between alcoholic consumption during pregnancy and brain damage in premature infants. 349 preemies underwent ultrasound evaluations of their brains. In the group whose mothers reported seven alcoholic drinks per week, brain hemorrhage increased five times, while white matter damage was nearly ten times as frequent. The white matter changes were similar to those seen in cerebral palsy.
Health Benefits of Unhealthy Lifestyles
The magazine Sports Afield reports in their January issue the following benefits of decadent lifestyles: Married men who spend significant effort in pursuit of recreational distraction with friends such as a night out with the boys at the local sports bar live longer than single teetotaling vegetarian joggers. Moderate amounts of alcohol, as has been much discussed recently, seems to increase both the span and perhaps quality of life. Red wine may even be anti-carcinogenic. Many heart disease patients have been found deficient in essential fatty acids, presumably from avoiding fatty foods such as butter, pizza, and steak. Some think the heart disease is related to a lack of those compounds. Parkinson's and Alzheimer's diseases, prostate, and endometrial cancers strike smokers only half as often as they do non-smokers.
Alcohol Craving Hamsters
A Chinese herb called Kudzo vine contains a component that seems to reduce alcohol cravings in hamsters. Researchers at Harvard Medical School summarized their findings in the Proceedings of the National Academy of Science.2 Hamsters seem to have a natural liking of a little alcohol in their drinking water, but an extract from the herb seemed to curb that appetite. Researchers expect human trials to begin within a year.
St. John's Wort for Alcoholism
In a study of rats bred to have a thirst for alcohol, researchers at the University of North Carolina (Chapel Hill)12 have found that the popular St. John's Wort appears to cut alcoholic cravings. Rats were given free access to both water and an alcoholic beverage, but among those given the herbal remedy alcohol consumption decreased nearly 50 percent. Researchers speculate that the herb acts by increasing serotonin levels. 12. Led by Amir Rezvani, who reported the findings at the annual meeting of the Research Society on Alcoholism in Chapel Hill, June 23, 1998
Alcohol Against Heart Failure
Studies published in the Journal of the American Medical Association11 appear to bolster the role of alcohol in fighting heart disease. One study found that the likelihood of survival after a heart attack is proportional to the amount of alcohol consumed each week, at least to a point. Moderate drinkers (seven or more drinks each week) were 30 percent more likely to survive than abstainers. The beverage of choice did not seem to matter in this study of nearly 2,000. Another study found that those who drank at least 1-1/2 drinks each day were 20-50 percent less likely to develop congestive heart failure; the benefit gained, again, was proportional to the quantity consumed. 11. JAMA, April 18, 2001.
Alcohol and the Brain
Research published in the journal Stroke10 concludes that moderate alcohol consumption has both positive and negative effects on the human brain. On the positive side, the study confirms previous research that suggests a lowered risk of stroke and subsequent brain scarring when compared to total abstainers. Included in the stroke category is a type called a silent stroke, which goes unnoticed by the patient. The effects of silent strokes accumulate over time to produce gradual impairments of intellectual ability or motor skill function. The white matter scarring produced by such strokes is visible on MRI scans. Unfortunately, the study also suggests that each alcoholic drink contributes to brain atrophy, which is associated with dementia. Previously, it was assumed that this shrinkage only occurred in heavy drinkers, such as alcoholics, but this study suggests a more linear relationship. The authors are reluctant to speculate on which is the less desirable outcome. 10. Stroke, September 7, 2001.
Alcohol: Not for the Very Young
A new study published in Science7 concludes that permanent serious brain damage can be inflicted on a fetus if the mother becomes intoxicated for four hours or more. The researchers say that a blood alcohol level about twice the legal limit triggers a massive brain cell suicide in the fetal brain, destroying as much as 30 percent of the brain neurons if it happens during a time of crucial brain development. The study was done on rats, but the writers think the effects are similar in humans. The outcome could be brain disorders, including learning disabilities and memory problems. The critical time, they say, is from the sixth month of pregnancy through the second birthday. The mechanism appears to be an interference with glutamate and GABA neurotransmitters, the lack of which acts as a signal for the cells to self-destruct. Most anesthesias used in pediatric surgeries are thought to have a similar effect. 7. Science, February 2000.
Another Reason to Take a Drink
A new study published in the Journal of the American Medical Association8 concludes that alcohol can help prevent strokes. Volunteers from New York City who drank one or two alcoholic beverages each day had a 45 percent lower incidence of ischemic strokes. This is the most common type of stroke, due to a lack of blood reaching the brain. It is generally thought to be caused by a blood clot or blood vessel constriction. Too much alcohol, though, can make things much worse: seven or more drinks per day caused strokes to increase by 300 percent. 8. JAMA, January 6, 1999.
Diabetes and Alcohol
A recent study published in the Journal of the American Medical Association6 suggests that the recently touted cardiovascular benefits of alcohol apply equally, if not more so, to diabetics. This 12-year study of 983 type II diabetics over the age of 40 concludes that one or two drinks each day can decrease the risk of death from heart disease in diabetics by up to 80 percent. Alcohol also appears to help diabetics by reducing insulin resistance, a problem that makes it harder for diabetics to take advantage of the little insulin they are able to produce.7 6. JAMA, July 21, 1999. 7. Associated Press, July 20, 1999.
Red Wine and Immunology
Much has reported on the health benefits of drinking red wine. However, many worry about the effects of alcohol on the immune system. It has long been known that alcohol tends to suppress the immune response. New research from the University of Florida, however, suggests that the alcohol in red wine does not behave in this manner. Researchers studied white blood cell responses to mild infections in alcoholic mice. While they observed suppression in those that consumed ethanol from other sources, those that regularly drank red wine only (as their alcoholic beverage) showed no ill effects. The mice were all given the equivalent of a human's two to three glasses of alcoholic drinks per day.7 7. Reuters, reporting on research by Susan Percival of the University of Florida's Institute of Food and Agricultural Sciences. Smoking is a major cause of tooth loss, according to the Centers for Disease Control. Periodontal disease (deterioration of the gums) is responsible for most of the tooth loss in older persons and smoking is responsible for the majority of periodontal disease, says a report published in the Journal of Periodontology.10 Smokers are affected by gum disease four times as often as nonsmokers. It is thought that smoking decreases blood flow and nutrition to the gum tissues, as well as lowering resistance to bacteria growth. 10. Journal of Periodontology, May 2000.