Top 5 Motivation Tips for Those Who Hate to Exercise

http://www.healthy-environments.com/exercise-tips.asp

You know those people that get up before dawn to exercise and the ones that work out for hours at the gym like its their part-time job? They seem to live for exercise! Maybe you are not one of them. Even those who hate to work out may come to learn to enjoy the benefits of exercise with these 5 easy exercise tips. Just by moving more you could experience some natural allergy relief as well.

1) Set small goals. You are setting yourself up for failure if you think you are going to lose 30 lbs. next month or if you sign up for a marathon when you can't walk a mile. Take 'baby steps' for success. Make your goals more realistic, like losing 2 lbs., or walking 20 min. 3 times a week. When you see you have achieved those smaller goals you'll feel better about what you are doing.

2) Use others successes to motivate you. If you see a friend lose weight you might feel a bit envious. You might even think that losing weight is just easier for them. Instead of feeling discouraged, make your friend's success a motivation for you. "If she can do it, so can I!" It makes it seem more possible...so cheer your friend on !

3) Say Good-bye to negative self-talk. It's really easy to get down on yourself, especially at the beginning of an exercise program. You know the words: "How did I get so fat? I can never look as good as I used to." So, while working out concentrate on what your body can do. Avoid negative thoughts and say things like, " I am getting stronger every day." Studies show that your body believes what the mind keeps telling it.

4) Finish with a 'Bang'... Studies show that if you finish your workout doing things you like that are relaxing and pleasurable, you will have the tendency to come back. If you finish your work out with a series of grueling exercises that cause you pain, that is what you'll remember and you'll avoid coming back. So, finish that workout with a relaxing stretch, maybe to some fun music, and your mind will remember that good feeling. You want to keep up the exercise routine for the best health benefits so do what you can to make that happen.

5) Treat yourself. This doesn't mean to treat yourself with a double-dip ice cream cone. Set your small goals for the week...like 3 mornings a week of 30 min. exercise = a hot bubble bath or a massage. Pick something you enjoy and set your sites to having it when you achieve your goals. Your body will thank you by feeling more energetic and looking better!

For more info on how to lose fat and build muscle FAST

Brain Plasticity - how learning changes your brain

http://www.sharpbrains.com/blog/2008/02/26/brain-plasticity-how-learning-changes-your-brain/

You may have heard that the brain is plastic. As you know the brain is not made of plastic! Neuroplasticity or brain plasticity refers to the brain’s ability to CHANGE throughout life. The brain has the amazing ability to reorganize itself by forming new connections between brain cells (neurons).
In addition to genetic factors, the environment in which a person lives, as well as the actions of that person, play a role in plasticity.

Neuroplasticity occurs in the brain:
1- At the beginning of life: when the immature brain organizes itself.
2- In case of brain injury: to compensate for lost functions or maximize remaining functions.
3- Through adulthood: whenever something new is learned and memorized
Plasticity and brain injury
A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience, brain damage or recovery.
In his book “The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science”, Norman Doidge describes numerous examples of functional shifts.
In one of them, a surgeon in his 50s suffers a stroke. His left arm is paralyzed. During his rehabilitation, his good arm and hand are immobilized, and he is set to cleaning tables. The task is at first impossible. Then slowly the bad arm remembers how too move. He learns to write again, to play tennis again: the functions of the brain areas killed in the stroke have transferred themselves to healthy regions!
The brain compensates for damage by reorganizing and forming new connections between intact neurons. In order to reconnect, the neurons need to be stimulated through activity.
Plasticity, learning and memory
For a long time, it was believed that as we aged, the connections in the brain became fixed. Research has shown that in fact the brain never stops changing through learning. Plasticity IS the capacity of the brain to change with learning. Changes associated with learning occur mostly at the level of the connections between neurons. New connections can form and the internal structure of the existing synapses can change.
Did you know that when you become an expert in a specific domain, the areas in your brain that deal with this type of skill will grow?
For instance, London taxi drivers have a larger hippocampus (in the posterior region) than London bus drivers (Maguire, Woollett, & Spiers, 2006)…. Why is that? It is because this region of the hippocampus is specialized in acquiring and using complex spatial information in order to navigate efficiently. Taxi drivers have to navigate around London whereas bus drivers follow a limited set of routes.

Plasticity can also be observed in the brains of bilinguals (Mechelli et al., 2004). It looks like learning a second language is possible through functional changes in the brain: the left inferior parietal cortex is larger in bilingual brains than in monolingual brains.

Plastic changes also occur in musicians brains compared to non-musicians. Gaser and Schlaug (2003) compared professional musicians (who practice at least 1hour per day) to amateur musicians and non-musicians. They found that gray matter (cortex) volume was highest in professional musicians, intermediate in amateur musicians, and lowest in non-musicians in several brain areas involved in playing music: motor regions, anterior superior parietal areas and inferior temporal areas.

Finally, Draganski and colleagues (2006) recently showed that extensive learning of abstract information can also trigger some plastic changes in the brain. They imaged the brains of German medical students 3 months before their medical exam and right after the exam and compared them to brains of students who were not studying for exam at this time. Medical students’ brains showed learning-induced changes in regions of the parietal cortex as well as in the posterior hippocampus. These regions of the brains are known to be involved in memory retrieval and learning.
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You will find more related information on how to improve concentration and memory by checking out these resources:
- Neuroscience Interview Series: interviews with over 15 brain scientists and experts.
- Collection of brain teasers and games: attention, memory, problem-solving, visual, and more.- Brain Training Games and "Games": a 10-Question Checklist on how to evaluate programs that make brain-related claims.

Hydration tips:

Source: Backcountry.com Newsletter Articles -
Cold Sweat: Winter Dehydration - How winter conspires to dehydrate you by Chris Solomon

1. Start right. Slowly drink about 17 oz. of water more than one hour before you exercise.
2. Drink early. Studies show that people are already about 2 percent dehydrated by they time they feel thirsty.
3. Drink often. It's not rare for a hard-charging skier to perspire one quart of fluid an hour, or more. Drink 6 to 10 oz. every 15 minutes.
A general rule of thumb: Your urine should be no darker than lemonade, and ample.

Gatorade or Water?
Sports drinks may help the gut absorb fluid a modest amount faster than water alone, but water is a perfectly fine hydrator, says Dr. John Castellani, research physiologist at the U.S. Army Research Institute of Environmental Medicine's Thermal and Mountain Medicine Division. (Carry an energy bar for carbs, though.)
4. Don't stop when the lifts stop. Alcohol dessicates an already-dehydrated body. Replace sweat with water before you hit the bar or hot tub.

Treadmill Improve Stroke Recovery

(WebMD)
http://www.cbsnews.com/stories/2008/08/28/health/webmd/main4394326.shtml?source=RSSattr=HOME_4394326

Treadmill exercise may improve stroke survivors' walking ability by rewiring parts of the brain, according to a new study. The study also shows treadmill exercise may be better than stretching, the traditional exercise prescribed after a stroke, both for walking and overall fitness.

Researchers at the University of Maryland and Baltimore Veterans Affairs Medical Center compared 37 patients who performed "progressive task repetitive treadmill therapy" with 34 patients who did stretching. The patients had chronic hemiparesis, which is weakness on one side of the body, at least six months after a stroke. The patients had all completed conventional rehabilitation. The treadmill group was given the goal of three 40-minute sessions per week on the treadmill at 60 percent of their heart rate reserve. They started out slower, adding duration and intensity every two weeks. The exercise program lasted six months. The stretching group had the same number of sessions, and the length of each session was also the same. They performed a variety of traditional stretches on a raised mat table with the assistance of an instructor.
Researchers measured results in three ways: by looking at brain activity on MRIs, by measuring walking ability, and by evaluating overall fitness level.

The treadmill group performed better in all three categories. Treadmill participants increased their activity in certain parts of the brain by 72 percent on imaging tests. Brain activity changes did not occur in patients who did stretching exercise. Researchers checked brain MRIs while participants did knee-flexing exercises that mimic walking. The MRIs showed increased blood oxygenation and flow in the brain stem and cerebellum of the stroke survivors who had used the treadmill but not in those who did stretching.

Researchers say the increases in blood oxygenation and flow indicated that the cerebellum and brain stem had been "recruited" to replace some of the walking functions of the cortical brain that had been damaged by the strokes. "We saw what we call an equivalent of neuroplasticity - a change in brain activation that reflects the brain's adaptability," says Andreas Luft, MD, in a news release. Luft is one of the study's lead authors and a professor of clinical neurology and neurorehabilitation in the department of neurology at the University of Zurich, Switzerland.

The treadmill group also increased their walking speed and their fitness more than those in the stretching group. This is particularly important because stroke survivors' immobility can lead to cardiovascular disease and diabetes. In the study, published in Stroke: Journal of the American Heart Association, the authors argue that treadmill exercise should be included in long-term therapy programs for stroke survivors. "It is promising that treadmill exercise can stimulate new or underused brain circuits and improve walking in stroke survivors even after completion of conventional rehabilitation therapy," Luft says.

By Caroline WilbertReviewed by Elizabeth Klodas

Connection between Brain and Physical fitness

Brain and Mind Fitness News
Brain Weightlifting: More Weight, Less Memory – Connections Between Physical and Brain Fitness
October 11, 2006

A recently published study in the journal Neurology shows that people who were tested cognitively at age 11 in 1932 and were tested again almost 70 years later showed better cognitive function if they were in good physical shape. “The important result of the study is that fitness contributes to better cognitive ability in old age,” according to psychologist Ian J. Deary, Ph.D., of the University of Edinburgh. “Thus, two people starting out with the same IQ at age 11, the fitter person at age 79 will, on average, have better cognitive function.”

In a separate study published by The American Academy of Neurology, researchers found the corollary that “a higher BMI was associated with lower cognitive test scores. Results from a test involving word memory recall show people with a BMI of 20 remembered an average of nine out of 16 words, while people with a BMI of 30 remembered an average of seven out of 16 words.”
They did not, however, find a correlation between a change in BMI and a change in cognitive performance, according to epidemiologist Maxime Cournot, M.D. of Toulouse University Hospital.

Take-Home Points

Managing obesity in middle-aged adults might help reduce dementia later. John Gunstad, PhD, an assistant professor of psychology at Kent State University in Kent, Ohio says “We’ve known [for many years] that obesity is linked to high blood pressure and other problems. The fact that its impact on brain function may be independent [of other problems] is newer.”
It’s never too late to get your brain or your body in shape.

Physical Fitness – Brain Fitness – Social Fitness … they are all interconnected and essential to your general wellbeing.

Can food improve brain function?

by Pascale Michelon, Ph. D
http://www.sharpbrains.com/blog/2008/09/08/can-food-improve-brain-health/

In other words, may some foods be specifically good for brain function?
For a great in-depth review of the effects of food on the brain you can check out Fernando Gomez-Pinilla’s recent article in Nature Reviews Neuroscience (reference below). Here is an overview of the state off the research.

Several components of diet seem to have a positive effect on brain function.

Omega-3 fatty acids
These acids are normal constituents of cell membranes and are essential for normal brain function. Omega-3 fatty acids can be found in fish (salmon), kiwi, and walnuts. Docosahexaenoic acid, or DHA, is the most abundant omega-3 fatty acid in cell membranes in the brain. The human body produces DHA but not enough. So we are dependent on the DHA that we get from what we eat.

A randomized double-blind controlled trial (which means seriously conducted scientific study) is currently looking at the effect of taking omega-3 fatty acids on children’s performance at school in England. Preliminary results (Portwood, 2006) suggest that the group of children who received omega-3 fatty acids showed some level of improvement in school performance compared to the group of children who received a placebo. More research is needed to confirm these results but they look promising.

Fatty acids are also regarded as a promising but untested treatment as mood stabilizer. Hibbeln (1998) showed a negative correlation between fish consumption (i.e., omega-3 fatty acid intake) and major depression in many countries including the United States, Canada, Germany and France. A negative correlation means that as consumption of omega-3 decreases, the prevalence of major depression increases. Note that a correlation does not imply causation: we cannot conclude that low omega-3 consumption causes major depression.

Folic acid (or folate)
Folate is generated by the liver, after the intestine has absorbed vitamin B. It is found in spinach, orange juice and yeast. Adequate levels of folate are essential for brain function.
Corrada and colleagues (2005) have shown that people who take more folate than others have less risks of developing Alzheimer’s disease. Note again that this is a correlation so more research is needed to determine whether folate is indeed responsible for the risk reduction.

Flavonoids
These are found in cocoa, green tea, Ginko biloba tree, citrus fruits, wine and dark chocolate. The antioxidant effects of flavonols have been shown in vitro (in the test tube) but more research is needed to establish the effects of flavonols in vivo (in a living organism). So far, Ginko biloba extracts have been shown to reduce memory impairment in mice…with mixed effects in humans, at best.

Antioxidant foods
The brain is highly susceptible to oxidative damage. This is why antioxidant food has become popular for their positive effects on brain function.
Antioxidants are found in a variety of food: Alpha lipoic is found in spinach, broccoli and potatoes; Vitamin E is found in vegetable oils, nuts, green leafy vegetables; Curcumin is found in the curry spice; Vitamin C is found in citrus fruit and several plants and vegetables. Berries are well known for their antioxidant capacity but it is not clear which of their many components has an effect on cognition.

Guts and the brain
We have seen that what we eat can affect brain function. Interestingly, it has also been shown that guts hormones themselves can directly influence brain function. Indeed, several gut hormones such as leptin (which sends signals to the brain to reduce appetite), ghrelin (which acts as an appetite stimulant) or insulin (which is secreted by the anticipation of meals and during digestion) have been found to enhance memory formation through their action on the hippocampus. As you know, the hippocampus is one of the brain structures crucial for spatial learning and memory formation. These gut hormones have an effect on the plasticity (the ability to change) of the connections between neurons in the hippocampus. For instance ghrelin promotes the formation of new synapse during learning. Insulin can enter the brain and interact directly with cells in the hippocampus.

Final note of caution
Please note that most of the studies showing positive effects of all these nutrients on the brain have been conducted in mice. A few human studies are now published but more research is clearly needed to establish and understand the effects of specific foods on brain function.

Guidelines Updated for Diagnosis and Treatment of Rhinitis

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD

August 18, 2008 —The Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology have issued updated guidelines for the diagnosis, management, and treatment of rhinitis. The updated recommendations are published in the August issue of the Journal of Allergy and Clinical Immunology.

"Rhinitis is characterized by 1 or more of the following symptoms: nasal congestion, rhinorrhea (anterior and posterior), sneezing, and itching," write Dana V. Wallace, MD, from Nova Southeastern University in Davie, Florida, and colleagues from the Joint Task Force on Practice Parameters. "Rhinitis is usually associated with inflammation, but some forms of rhinitis such as vasomotor rhinitis or atrophic rhinitis are not predominantly inflammatory. Rhinitis frequently is accompanied by symptoms involving the eyes, ears, and throat."

Key updates included in these guidelines are as follows:

• Pharmacologic products that have become available since publication of the previous 1998 guidelines on diagnosis and management of rhinitis are reviewed.
• On the basis of more recent evidence, positioning of agents used in management, such as leukotriene receptor antagonists (LTRA), is better defined.
• The term episodic is introduced referring to rhinitis brought about by sporadic exposures to inhalant aeroallergens, and implications for treatment of episodic rhinitis are discussed.
• Certain agents, namely intranasal corticosteroids (INS), are recommended for use on an as-needed basis.
• The importance of recognizing comorbidities of allergic rhinitis (AR) is emphasized. These include asthma, sinusitis, and obstructive sleep apnea. Also highlighted is the importance of conducting appropriate studies, such as pulmonary function testing and sleep apnea studies.
• Evidence regarding use of combination therapy is reviewed, particularly the use of LTRA with antihistamines.
• The updated guidelines highlight the need to consider the benefits vs recently raised safety concerns regarding oral decongestants before using them in children younger than 6 years of age.
• It is now recommended that second-generation antihistamines be considered as safe agents for use during pregnancy.
• INS may be used for symptoms of allergic conjunctivitis associated with rhinitis.
• Use of a Rhinitis Action Plan should be considered.
• Recently available and emerging diagnostic and surgical procedures, including acoustic rhinometry and radiofrequency volumetric tissue reduction, are reviewed.

The main pharmacotherapeutic options for AR are as follows:

• When used continuously, oral antihistamines, or oral H1-receptor antagonists, are most effective for seasonal AR and perennial AR, but their relatively rapid onset of action also makes them appropriate for as-needed use in episodic AR.
• Oral antihistamines are less effective for nasal congestion vs other nasal symptoms, and other options are generally preferred for more severe AR. For AR, oral antihistamines are less effective for AR vs INS, but they are similarly effective to INS for associated ocular symptoms.
• Oral antihistamines are typically ineffective for non-AR, resulting in other choices being better for mixed rhinitis.
• Second-generation oral antihistamines are usually preferred over first-generation antihistamines to minimize sedation, performance impairment, and anticholinergic effects. At recommended doses, the second-generation oral antihistamines fexofenadine, loratadine, and desloratadine do not cause sedation.
• Oral corticosteroids may be appropriate for very severe nasal symptoms when given as a short course (5 - 7 days) and are preferred to single or repeated administration of intramuscular corticosteroids, which should be discouraged.
• Oral decongestants include pseudoephedrine, which reduces nasal congestion, although adverse effects include insomnia, irritability, palpitations, and hypertension.
• Of the LTRA, montelukast is approved for seasonal AR and perennial AR, and adverse effects are minimal. However, with loratadine as the usual comparator, LTRA have not been shown to have significantly different efficacy from oral antihistamines. Because LTRA are approved for both rhinitis and asthma, they may be considered in patients who have both conditions.
• Intranasal antihistamines are effective for both seasonal AR and perennial AR. Their clinically significant, rapid onset of action also makes them suitable for as-needed use in episodic AR. Although their efficacy for AR is as good as or better than oral second-generation antihistamines, with a clinically significant effect on nasal congestion, they are not as effective as INS for nasal symptoms. Because they are also approved for vasomotor rhinitis, they are a suitable option for patients with mixed rhinitis. The adverse effects of intranasal azelastine are a bitter taste and somnolence.
• Intranasal anticholinergic (ipratropium) has a rapid onset of action and is therefore appropriate for episodic rhinitis. Although it reduces rhinorrhea, it is ineffective for other symptoms of seasonal AR and perennial AR. There may be dryness of nasal membranes, but adverse effects are otherwise minimal.
• INS are the most effective monotherapy for seasonal AR and perennial AR because of their efficacy for all symptoms of seasonal AR and perennial AR, including nasal congestion. As-needed use of INS may be effective for seasonal AR and may also be considered in patients with episodic AR. The typical onset of action is within 12 hours, which is less rapid than with oral or intranasal antihistamines, but symptom relief may begin within 3 to 4 hours in some patients.
• For seasonal AR and perennial AR, INS are more effective than combination therapy with oral antihistamine and LTRA. For associated ocular symptoms of AR, efficacy of INS is similar to that of oral antihistamines. INS are also a suitable option for mixed rhinitis, because agents in this class are also effective for some non-AR. INS do not have significant systemic adverse effects in adults, and when used at recommended doses, they have not been shown to cause growth suppression in children with perennial AR. Local adverse effects are minimal, but nasal irritation and bleeding occur, and nasal septal perforation has rarely been reported.
• Intranasal cromolyn may be useful for maintenance treatment of AR. The onset of action is within 4 to 7 days, but the full benefit may not be evident for weeks. Administration just before allergen exposure for episodic rhinitis protects against the allergic response for 4 to 8 hours. Intranasal cromolyn is not as effective as INS, and data are insufficient to compare INS with LTRA and antihistamines.

"Initial treatment of nonsevere rhinitis may include single-agent or combination pharmacologic therapy and avoidance measures," the guidelines authors conclude. "Oral antihistamines are generally effective in reducing rhinorrhea, sneezing, and itching associated with allergic rhinitis but have little objective effect on nasal congestion."

J Allergy Clin Immunol. 2008;122:S1-S84.

Rhinitis Often Accompanies Hard-to-Control Asthma

News Author: David Douglas
CME Author: Charles Vega, MD

May 2, 2008;

May 2, 2008 — Patients who have a poor response to asthma treatment are likely to also have moderate-to-severe rhinitis, Brazilian researchers report in the May issue of Allergy.

As senior investigator Dr. Alvaro A. Cruz told Reuters Health, "this article reports on strong evidence for an association between moderate-to-severe rhinitis and uncontrolled asthma."

Dr. Cruz, of Universidade Federal de Bahia, and colleagues also note that asthma and rhinitis share many similarities and the prevalence of rhinitis among asthmatics is high.

To further investigate the relationship between the conditions, the researchers prospectively studied 557 patients with severe asthma. In all, 31% had moderate to severe rhinitis, 54% had mild rhinitis and 15% had no rhinitis.

Compared to the other subjects, patients with moderate-to-severe rhinitis were more than 3 times as likely (odds ratio, 3.83) to visit the emergency room during a year of follow-up.

By the end of follow-up, they were also almost 3 times as likely (odds ratio, 2.94) to show a less than 10% improvement in airway obstruction and were more than 12 times as likely to have uncontrolled asthma.

The team found a positive correlation between the severity of rhinitis and severity of asthma, and a negative correlation with quality-of-life scores.

"Taking into consideration that the patients were receiving the best treatment options for asthma and rhinitis," Dr. Cruz said in conclusion, "the most likely explanation for the observed inter-relationship is that both rhinitis and asthma were manifestations of the same disease affecting the entire airway, for which the degree of severity of the upper and lower airway processes is correlated."

Allergy. 2008;63:564-569.

Reuters Health Information 2008. © 2008 Reuters Ltd.

Sugar-Sweetened Soft Drinks, Fructose Linked with Increased Gout Risk in Men

High consumption of sugar-sweetened soft drinks and fructose may increase the risk for gout in men, BMJ reports.

More than 46,000 male health professionals aged 40 to 75 completed food-frequency questionnaires at baseline and every 4 years thereafter. During 12 years' follow-up, 1.6% developed gout.

After multivariable adjustment, gout risk rose significantly with increasing consumption of sugar-sweetened soft drinks. Compared with men who consumed less than one sugary soft drink a month, those consuming five to six drinks a week had a 29% increased risk; one a day, a 45% increase; and two or more daily, an 85% increase. Risk also rose with increasing consumption of other high-fructose products, such as fruit juice, apples, and oranges.

As a potential mechanism underlying the association between fructose and gout risk, the authors note that fructose increases ATP degradation to AMP, thereby increasing production of uric acid.

source: BMJ article (Free)

High Caffeine Intake During Pregnancy Increases Risk for Miscarriage

High caffeine consumption early in pregnancy increases risk for miscarriage, according to a study in the American Journal of Obstetrics & Gynecology.

Roughly 1000 women in the San Francisco area completed interviews at a median 71 days' gestation about the type and amount of caffeine they consumed. After adjusting for potential demographic and lifestyle confounders, as well as nausea and vomiting, researchers found that women who consumed 200 mg of caffeine or more (e.g., 10 oz. or more of coffee or five 12-oz. cans of caffeinated soft drinks) daily had more than double the risk for miscarriage by 20 weeks' gestation (hazard ratio, 2.23).

The authors conclude that "it may be prudent to stop or reduce caffeine intake during pregnancy."

source:

American Journal of Obstetrics & Gynecology early-release page

Keeping Active, Not Smoking Can Reduce but Not Abolish CV Risks of Obesity

News Author: Shelley Wood
CME Author: Désirée Lie, MD, MSEd

From Heartwire — a professional news service of WebMD

June 16, 2008 — What people do, whether they smoke, and what they eat can mitigate the adverse cardiovascular effects of obesity, but they cannot do away with them altogether, researchers say. While other studies have investigated the relationship between fitness and fatness, this latest study also factors in dietary habits and smoking.

"Our study confirms the findings observed in some epidemiological studies, that although physical activity is important, it does not abolish the excess cardiovascular risk observed among the obese," first author on the study, Dr Majken K Jensen (Aarhus University Hospital, Aalborg, Denmark), told heartwire. The results, Jensen continued, "suggest that both obesity and physical activity affect the risk of acute coronary syndrome (ACS) and that the lowest risk is observed among the leanest individuals who are the most physically active. The new information is really not on physical activity, but that we extended the investigation to include the role of obesity in combination with other lifestyle risk factors."

Jensen et al report the results of their study published online June 9, 2008 in Circulation.

Does weight matter?

Jensen and colleagues reviewed a median of 7.7 years of follow-up data for the almost 55,000 participants in the Danish Diet, Cancer, and Health study. All participants were middle-aged (50-64 years) and free of coronary artery disease (CAD) and cancer at baseline.

"Some people might think that it doesn't matter if they are overweight as long as they are active," Jensen explained. "Or, similarly, think that it doesn't matter that they are overweight because they otherwise adhere to a healthy lifestyle, with regard to not smoking, eating healthy, and being physically active. We wanted to explore this further."

They found that developing acute coronary syndromes over this period was significantly associated with increased body-mass index (BMI): for every unit of BMI increase, risk of ACS was increased by 5% in women and by 7% in men.

Nonsmokers who were obese had a reduced risk of ACS as compared with people who were obese and heavy smokers (≥ 15 g/day). Similarly, obese but physically active people (≥ 3.5 hours per week) fared slightly better than inactive obese subjects (less than one hour per week). By contrast, adherence to a Mediterranean-style diet, suggested by high scores on the Mediterranean diet scale, appeared to have no impact on risk of future events in obese subjects.

Pearls for Practice

• Increasing BMI vs healthy BMI is associated with a strong and graded increase in the risk for ACS in men and women.
• The increased risk for ACS in obese participants is further increased by the presence of hypertension, diabetes, hypercholesterolemia, smoking, and a sedentary lifestyle but not by lack of adherence to the Mediterranean diet.

Stroke Treatment and Prevention Are Not the Same in Men and Women

Helmi L. Lutsep, MD

Posted 02/01/2008 ; http://www.medscape.com/viewarticle/569133?src=mp

Major acute stroke treatment and prevention trials have shown significant differences in the natural history of stroke and the effects of stroke treatment and prevention in men and women.

Women have worse outcomes after acute stroke than men if they do not receive thrombolytics. However, women have more benefit than men with acute stroke treatment, as shown in a pooled analysis of intravenous tissue plasminogen activator trials and in a post hoc analysis of a study investigating intra-arterial prourokinase.^[1,2] The findings emphasize the need to consider acute stroke treatment in women, who currently tend to receive treatment less often than men.^[3]

Because the best data demonstrate major differences in how men and women respond to prevention strategies, different approaches must be used. For example, aspirin has not been shown to prevent strokes in men believed to be healthy at the initiation of the trial.^[4] On the other hand, healthy women, especially those over the age of 65, can benefit from taking aspirin, 100 mg on alternate days, for stroke prevention.^[5]

Women with stenosis of the carotid artery have a lower risk of recurrent stroke than men. Comparison of surgical and medical treatment of symptomatic carotid artery stenosis shows no benefit from surgery in women with moderate stenosis, although there is benefit in men.^[6] This finding should lead to fewer referrals of women than men for carotid surgery. On the other hand, women with symptomatic intracranial stenosis have a higher risk of recurrent stroke than do men.^[7] Endovascular treatment could have greater benefit in women than men with intracranial stenosis, although this remains to be proven.

Physicians should understand these substantial gender differences and tailor their treatment and prevention strategies appropriately. All future clinical trials involving studies of stroke must also give serious consideration to gender differences.

Sweet Soft Drinks, Fructose Linked to Increased Risk for Gout

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

http://www.medscape.com/viewarticle/569656?src=mp

February 4, 2008 — Consumption of soft drinks sweetened with sugar and fructose is strongly associated with an increased risk for gout, according to the results of a prospective cohort study reported in the February 1 Online First issue of the BMJ.

Gout is the most common inflammatory arthritis in men. Its prevalence has doubled in the United States within the past few decades and increased 61% from 1977 to 1997, the same period in which sugar-sweetened soft drinks represented the largest single source of calories in the US diet with yearly per capita use increasing from 0 to 29 kg. Fructose administration in humans is associated with a rapid increase in serum levels of uric acid, which are greater in those with gout. The study authors hypothesized that increased intake of sweetened fructose-containing drinks was linked to the incidence of gout.

This is a prospective evaluation of the association between intake of sugar-sweetened soft drinks, juice, and fruit intake and the incidence of gout in a cohort of healthy men without a previous history of gout.

• Consumption of sugar-sweetened soft drinks high in fructose, fruit juices, oranges, and apples are associated with an increased risk for gout in men.
• Intake of diet soft drinks is not associated with an increased risk for gout in men.

Calcium supplements interfere with blood pressure drugs

Mayo Clinic hypertension specialist Sheldon Sheps, M.D.,

In large amounts, calcium supplements may interfere with some blood pressure medications. Interactions may occur with the following blood pressure medications:

• Thiazide diuretics. Ingesting large amounts of calcium with thiazide diuretics — such as chlorothiazide, hydrochlorothiazide and indapamide — can result in milk-alkali syndrome, a serious condition characterized by excessively high levels of calcium and a shift in the body's acid-base balance to alkaline. In general, avoid consuming more than 1,500 milligrams of calcium (supplements and food sources combined) a day if you're taking a thiazide diuretic. If you do take calcium supplements while taking a thiazide diuretic, talk to your doctor about the appropriate dose and have your blood pressure and calcium levels monitored.
• Calcium channel blockers. When taken intravenously, calcium may decrease the effects of calcium channel blockers such as nifedipine, verapamil, diltiazem and others. In fact, intravenous calcium is used to help reverse calcium channel blocker overdose. However, there's no evidence that standard calcium supplements interfere with calcium channel blockers. To be safe, check your blood pressure regularly if taking calcium channel blockers and calcium supplements concurrently.

Calcium supplements don't appear to interact with other commonly prescribed blood pressure medications, such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers or renin inhibitors. Talk to your doctor if you take high blood pressure medications and calcium supplements and are concerned about interactions.

source:http://www.mayoclinic.com/health/calcium-supplements/AN01871

Weight loss: Better to cut calories or exercise more?

Mayo Clinic dietitian Katherine Zeratsky, R.D., L.D., and colleagues answer select questions from readers.

You may be referring to a study published in the Journal of Clinical Endocrinology & Metabolism. This six-month study examined the effects of diet alone (25 percent fewer calories consumed) versus diet plus exercise (12.5 percent fewer calories consumed and 12.5 percent more calories burned) in overweight but otherwise healthy adults.

Researchers hypothesized that the diet plus exercise group would lose more body fat, but results showed equal amounts of weight and fat lost in both groups.

This confirms that weight loss is all about calories: If you burn more calories than you eat, you'll lose weight. It doesn't mean exercise isn't important. Exercise has many health benefits. Plus, it can be tough to create a calorie deficit by diet alone.

Can I lose weight if my only exercise is walking?

Mayo Clinic dietitian Katherine Zeratsky, R.D., L.D., and colleagues answer select questions from readers.

Consuming fewer calories is often the most effective way to lose weight. Still, an increase in physical activity is an important part of any weight-loss program. And walking is a great way to get started. For motivation, do the math:

To lose 1 pound, you must burn 3,500 calories.

If you cut 250 calories from your daily diet, you could lose that pound in about two weeks. If you add 30 minutes of brisk walking to your daily routine, you could burn another 150 calories a day. Make that 60 minutes of brisk walking and you could burn about 300 calories a day. Of course, the more you walk and the quicker the pace, the more calories you'll burn. Keep it up and you'll walk your way to a healthy weight. Better yet, walking can help you keep the weight off for good.

Coffee Good for Health?

Coffee May Reduce Mortality in Women

Long-term consumption of coffee may reduce the mortality rate in women, according to a study in Annals of Internal Medicine.

Researchers looked at data from some 130,000 healthy women and men from two large cohorts — the Nurses' Health Study and the Health Professionals Follow-Up Study — who regularly answered dietary questionnaires.

After roughly 20 years' follow-up and adjustment for other risk factors, they found that higher coffee consumption in women was associated with a slightly lower risk for all-cause mortality — largely due to a reduced risk for cardiovascular death. The effect was observed with as few as five to seven cups per week and was independent of caffeine intake.

Men who drank more coffee also saw a benefit, but the association did not reach statistical significance.

The authors say that coffee's potential perks could be due to its effects on inflammation, endothelial function, and insulin sensitivity.

Annals of Internal Medicine article (Free abstract; full text requires subscription

Vit D deficiency increases heart attacks in men

Vitamin D Deficiency Associated with Increased MI Risk in Men

Low levels of vitamin D in men are associated with double the risk for myocardial infarction, reports Archives of Internal Medicine.

Researchers assessed plasma 25-hydroxyvitamin D concentrations in some 18,000 men aged 40 to 75. After 10 years, roughly 450 men had had a nonfatal MI or fatal coronary artery disease. This group was matched to a control group (from among the participants) free of cardiovascular disease.

Men who had deficient vitamin D levels (15 ng/mL or less) were at significantly higher risk for MI by follow-up, compared with men whose levels were at least 30 ng/mL (relative risk, 2.4). The results remained significant after adjustment for cardiovascular risk factors and lipid levels.

The authors propose several possible mechanisms for the association — among them, vitamin D's effects on vascular smooth muscle cell growth, vascular calcification, inflammation, and blood pressure (through the renin-angiotensin system).

Archives of Internal Medicine article (Free abstract; full text requires subscription

International Travel Health Guide

Physician's First Watch for July 16, 2007

David G. Fairchild, MD, MPH, Editor-in-Chief

CDC Releases Updated "Yellow Book" on International Travel

CDC Releases Updated "Yellow Book" on International Travel

The CDC has released its biennial revision of "the yellow book," a health guide for international travel.

The book describes travel-related infections and diseases endemic to each region. Changes in the latest edition include updates on recommended immunizations, developments in malaria treatment and prevention, advice for avoiding deep vein thrombosis while flying, and a section on avian influenza.

The yellow-covered book, officially titled "CDC Health Information for International Travel 2008," is available free online (and can also be purchased in bookstores).

Margarine or Butter?

Margarine usually tops butter when it comes to heart health.

Margarine is made from vegetable oils, so it contains no cholesterol. Margarine is also higher in "good" fats — polyunsaturated and monounsaturated — than butter is. These types of fat help reduce low-density lipoprotein (LDL), or "bad," cholesterol, when substituted for saturated fat. Butter, on the other hand, is made from animal fat, so it contains cholesterol and high levels of saturated fat.

But not all margarines are created equal — and some may even be worse than butter. Most margarines are processed using a method called hydrogenation, which results in unhealthy trans fats. In general, the more solid the margarine, the more trans fats it contains — so stick margarines usually have more trans fats than do tub margarines. Like saturated fats, trans fats increase blood cholesterol and the risk of heart disease. In addition, trans fats can lower high-density lipoprotein (HDL), or "good," cholesterol levels.

When selecting a margarine, choose one with the lowest trans fat content possible and less than 2 grams total of saturated plus trans fats. Manufacturers are required to list saturated and trans fats separately on food labels. Also, margarines fortified with plant sterols can help reduce LDL cholesterol levels by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams. The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

However, if you don't like the taste of margarine and don't want to give up butter completely, consider using whipped butter or light or reduced-calorie butter. There are also spreadable butters with vegetable oils added. Per serving, these products have less fat and calories than regular butter. The important thing is to use these products in small amounts — just enough to add flavor to the foods you're eating.

Mayo Clinic cardiologist Martha Grogan, M.D.

Home BP Monitoring

• Home Is Where the Heart Is: Call for Greater Use of Home Blood-Pressure Monitoring

  Michael O'Riordan

• Monitors that use oscillometry to measure the blood pressure at the brachial artery are preferred as are those with electric inflation of cuffs and memory.
• Wrist monitors are not recommended.
• Patients should follow similar procedures for HBPM as followed in the clinical measurement of blood pressure. For example, HBPM should be performed after resting for at least 5 minutes, with the upper arm supported at the level of the heart and both feet on the floor.
• At least 2 to 3 readings should be taken at 1 sitting, during intervals as little as 1 minute. Readings first thing in the morning and at night are preferred.
• HBPM by the oscillometric method may be unreliable among patients with atrial fibrillation or frequent ectopic beats.
• Readings may be continued for at least 1 week. Medical decisions should be based on 12 or more readings.
• Up to 10% of patients will have higher home blood pressure levels vs levels measured in the medical office (masked hypertension). This form of hypertension is associated with the same cardiovascular risk as sustained hypertension and mandates treatment.
• HBPM has been demonstrated to be useful in the prediction of target organ damage, cardiovascular events, and cardiovascular mortality. It has been demonstrated to be superior to office blood pressure monitoring in the prediction of microvascular and macrovascular complications of diabetes. 4 of 5 studies comparing home vs office blood pressure monitoring found that HBPM was the stronger predictor of cardiovascular events and mortality.
• The target home blood pressure for most patients with hypertension is less than 135/85 mm Hg. HBPM is useful in patients with a blood pressure goal of less than 130/80, such as those with diabetes, coronary heart disease, and chronic kidney disease.
• HBPM may improve medication adherence and blood pressure control. Blood pressure has been demonstrated to be 2.2/1.9 mm Hg lower among patients who use HBPM.
• HBPM may be particularly useful among older adults because this group is more likely to have white-coat hypertension, and patients may also be assessed for changes in orthostatic blood pressure.
• Blood pressure during pregnancy decreases and then increases. HBPM may detect abnormalities to this pattern, suggesting preeclampsia, sooner than office visits alone.
• The usual out-of-pocket cost for a home monitoring device is $80 to $100. HBPM is generally most cost effective when used to diagnose white-coat hypertension and therefore avoid treatment with antihypertensive medication. The authors of the scientific statement call for reimbursement for these devices.
• Overall, the current statement recommends that HBPM become a routine part of the management of hypertension, especially for patients with diabetes, coronary heart disease, chronic kidney disease, suspected medication nonadherence, or substantial white-coat hypertension.

Eggs: Are they good or bad for my cholesterol?

It's understandable that you're confused. Eggs are high in cholesterol, and a diet high in cholesterol can contribute to elevated blood cholesterol levels. However, the extent to which dietary cholesterol raises blood cholesterol levels isn't clear. Many scientists believe that saturated fats and trans fats have a greater impact than does dietary cholesterol in raising blood cholesterol.

Adding to the confusion, the American Heart Association recently acknowledged that as long as you limit dietary cholesterol from other sources, it may be possible to include a daily egg in a healthy diet — a statement that was heavily reported in the media.

Here are the facts: One large egg has about 213 milligrams (mg) of cholesterol — all of which is found in the yolk. If you are healthy, it's recommended that you limit your dietary cholesterol intake to less than 300 mg a day. If you have cardiovascular disease, diabetes or high LDL (or "bad") cholesterol, you should limit your dietary cholesterol intake to less than 200 mg a day. Therefore, if you eat an egg on a given day, it's important to limit or avoid other sources of cholesterol for the rest of that day.

If you like eggs but don't want the extra cholesterol, use egg whites. Egg whites contain no cholesterol. You may also use cholesterol-free egg substitutes, which are made with egg whites. If you want to reduce cholesterol in a recipe that calls for eggs, use two egg whites or 1/4 cup cholesterol-free egg substitute in place of one whole egg.

Mayo Clinic cardiologist Gerald Gau, M.D.

Bad Breath - Prevention

Self-care

Try the following steps to improve or prevent bad breath:

• Brush your teeth after you eat. Keep a toothbrush at work to brush after eating.
• Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth.
• Brush your tongue. Giving your tongue a good brushing removes dead cells, bacteria and food debris. Use a soft-bristled toothbrush and brush your tongue with at least five to 15 strokes. Pay particular attention to the middle third of the tongue, where most of the bacteria tend to collect.
• Clean your dentures well. If you wear a bridge or a partial or complete denture, clean it thoroughly at least once a day or as directed by your dentist.
• Drink plenty of water. To keep your mouth moist, be sure to consume plenty of water — not coffee, soft drinks or alcohol. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates saliva, washing away food particles and bacteria. If you have chronic dry mouth, your dentist or doctor may additionally prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
• Use a fairly new toothbrush. Change your toothbrush every three to four months, and choose a soft-bristled toothbrush.
• Schedule regular dental checkups. At least twice a year, see your dentist to have your teeth or dentures examined and cleaned.

You can teach your school-age children to brush and floss their teeth regularly and to brush their tongues to prevent bad breath. However, don't give children mouthwash to use, because many mouthwash products contain alcohol and can pose a risk for children if swallowed.

source: http://www.mayoclinic.com/health/bad-breath/DS00025/DSECTION=4

Home BP Monitoring

Guidelines Urge Home BP Monitoring for Patients with Hypertension

Patients with hypertension should be encouraged to take regular readings with home blood pressure monitors — just as those with diabetes check their blood glucose — according to a new scientific statement released online by the American Heart Association, the American Society of Hypertension, and the Preventive Cardiovascular Nurses Association.

The article includes an algorithm for using home BP measurements to aid in clinical decision-making. To that end, patients with elevated BP at the office should take home measurements at least 12 times over a week. The preferred devices attach to the upper (usually nondominant) arm, have cuffs that inflate automatically, use oscillometric detection, and store results in memory.

Patients should bring their home monitors to the office to ensure they are using the proper technique and to calibrate their devices.

source: physician's first watch

Cholesterol Lowering Foods

Cholesterol: The top 5 foods to lower your numbers

Diet can play an important role in lowering your cholesterol. Discover five foods that can lower your cholesterol and protect your heart.

Can a bowl of oatmeal help prevent a heart attack? How about a handful of walnuts, or even your baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet — like these — may be enough to lower your cholesterol to a healthy level and help you stay off medications.

Oatmeal and oat bran

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, psyllium, barley and prunes.

Soluble fiber appears to reduce the absorption of cholesterol in your intestines. Ten grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

MORE ON THIS TOPIC

• Dietary fiber: An essential part of a healthy diet

Walnuts, almonds and more

Studies have shown that walnuts can significantly reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy and elastic. Almonds appear to have a similar effect, resulting in a marked improvement within just four weeks.

A cholesterol-lowering diet in which 20 percent of the calories come from walnuts may reduce LDL cholesterol by as much as 12 percent. But all nuts are high in calories, so a handful (no more than 2 ounces or 57 grams) will do. As with any food, eating too much can cause weight gain, and being overweight places you at higher risk of heart disease. To avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

MORE ON THIS TOPIC

• Nuts and your heart: Eating nuts for heart health

Fish and omega-3 fatty acids

Research has supported the cholesterol-lowering benefits of eating fatty fish because of its high levels of omega-3 fatty acids. Omega-3 fatty acids also help the heart in other ways such as reducing blood pressure and the risk of blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — significantly reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in mackerel, lake trout, herring, sardines, albacore tuna and salmon. However, to maintain the heart-healthy benefits of fish, bake or grill it. If you don't like fish, you can also get omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the beneficial effects, but you won't get all the other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

• Fish FAQ: The merits and hazards of eating fish
• Omega-3 in fish: How eating fish helps your heart
• Ground flaxseed: Better than whole?

Olive oil

Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched.

The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat.

Some research suggests that the cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But avoid "light" olive oils. This label usually means the oil is more processed and lighter in color, not fat or calories.

Olive oil: What are the health benefits?

Foods fortified with plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Margarines, orange juice and yogurt drinks fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237 milliliters) servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of "good" high-density lipoprotein (HDL) cholesterol. Nor do they interfere with the absorption of the fat-soluble vitamins — vitamins A, D, E and K.

The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

Consider your diet first

Before you make other changes to your diet, think about cutting back on the types and amounts of fats you eat, which can raise your cholesterol. That way, you'll improve your cholesterol levels and health overall.

When cutting fat from your diet, focus on saturated and trans fats. Saturated fats, like those in meat and some oils, raise your total cholesterol. Trans fats, which are sometimes used to make store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels because they raise low-density lipoprotein (LDL), the "bad" cholesterol and lower high-density lipoprotein (HDL), "good" cholesterol. You should try to limit the number of calories you eat daily to less than 10 percent from saturated fat, and eliminate as many trans fats from your diet as possible.

source: from Mayoclinic.com

Vary Your Exercise to Maximise impact

Walk Out On Your Favorite Exercise

This Week's Tips on RealAge.com:

• The Fruit That Fights Wrinkles
• Do This to Lower Your Blood Pressure
• Walk Out On Your Favorite Exercise
• Turn Off Hunger with This Drink
• The Calm, Quiet Vitamin -- and Why You Need It

There's a lot to be said for being faithful to one thing. But not when it comes to this: exercise.

So don't just walk. Hop, skip, jump, and gallop, too! Doing more than four different activities a week protects your brain as well as your body.

Your Brain on Exercise
And the rewards will be sweet, not just sweaty. In a study of more than 3,000 people 65 and older, those who engaged in four or more physical activities a week were less likely to develop dementia than those who did one or none (assuming they hadn't inherited a gene linked to Alzheimer's disease). Being active defends your brain in half a dozen ways -- from keeping your neurons sharp to releasing mind-enhancing hormones. Here are three more reasons to cross-train.

A Walk . . . and Then Some
Already walking 30 minutes a day? Good for you. Now, dust off the stationary bike, and push the lawn mower around the yard, too. Any type of physical activity counts -- from line dancing to training your dog. Doing more than four yet? Here's a little help to nudge you over the edge:

• Do chores. Check out this list of calorie-burning round-the-house work.
• Try the YOU2 Workout. Choose from 18 different at-home moves.
• Become a chi-gong expert. The YOU Docs show you the moves in this online video.
• Jump rope. Here's how many calories you'll burn in 1 hour.

Get the lowdown on all the bodywide benefits of aerobic exercise. RealAge Benefit: Exercising regularly, expending at least 3,500 calories of energy a week, can make your RealAge 3.4 years younger.

Breast Cancer Diagnosis Improved

Physician's First Watch for May 14, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief

Adding Ultrasound to Mammography Identifies More Cancers — but Also Yields More False-Positives

Ultrasonography, when added to mammographic screening, increases the number of breast cancers found in high-risk women — but at the cost of increased false-positives — researchers report in JAMA.

More than 2600 high-risk women underwent both mammography and ultrasonography, in random order. If either test was positive, then both results were examined and interpreted together. By 1-year follow-up, 40 participants were diagnosed with breast cancer, 8 of whom tested negative with both techniques.

Of the cancers detected during screening, mammography's diagnostic yield was 7.6 per 1000 women screened; when combined with ultrasound, the yield was 11.8. Mammography's false-positive rate was 4.4%; ultrasound's, 8.1%; and for combined modalities, 10.4%.

An editorialist writes that despite the high number of false-positives, what high-risk women "probably fear most is a late diagnosis." That, she continues, is "the real threat they want to be protected against, not false-positive diagnoses."

JAMA article (Free)

Water: How much should you drink every day?

Water is essential to good health, yet needs vary by individual. These guidelines can help ensure you drink enough fluids.

By Mayo Clinic Staff

How much water should you drink each day? A simple question with no easy answers. Studies have produced varying recommendations over the years, but in truth, your water needs depend on many factors, including your health, how active you are and where you live.

Though no single formula fits everyone, knowing more about your body's need for fluids will help you estimate how much water to drink each day.

Health benefits of water

Water is your body's principal chemical component, making up, on average, 60 percent of your body weight. Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.

Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.

How much water do you need?

Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water.

Several approaches attempt to approximate water needs for the average, healthy adult living in a temperate climate.

• Replacement approach. The average urine output for adults is about 1.5 liters (6.3 cups) a day. You lose close to an additional liter of water a day through breathing, sweating and bowel movements. Food usually accounts for 20 percent of your total fluid intake, so if you consume 2 liters of water or other beverages a day (a little more than 8 cups) along with your normal diet, you will typically replace the lost fluids.
• Eight 8-ounce glasses of water a day. Another approach to water intake is the "8 x 8 rule" — drink eight 8-ounce glasses of water a day (about 1.9 liters). The rule could also be stated, "drink eight 8-ounce glasses of fluid a day," as all fluids count toward the daily total. Though the approach isn't supported by scientific evidence, many people use this basic rule as a guideline for how much water and other fluids to drink.
• Dietary recommendations. The Institute of Medicine advises that men consume roughly 3 liters (about 13 cups) of total beverages a day and women consume 2.2 liters (about 9 cups) of total beverages a day.

Even apart from the above approaches, if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate.

Factors that influence water needs

You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you're pregnant or breast-feeding.

• Exercise. If you exercise or engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. An extra 400 to 600 milliliters (about 1.5 to 2.5 cups) of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour (for example, running a marathon) requires more fluid intake. How much additional fluid you need depends on how much you sweat during exercise, the duration of your exercise and the type of activity you're engaged in.

  During long bouts of intense exercise, it's best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be life-threatening. Also, continue to replace fluids after you're finished exercising.

• Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Further, altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves.
• Illnesses or health conditions. Signs of illnesses, such as fever, vomiting and diarrhea, cause your body to lose additional fluids. In these cases you should drink more water and may even need oral rehydration solutions, such as Gatorade, Powerade or CeraLyte. Also, you may need increased fluid intake if you develop certain conditions, including bladder infections or urinary tract stones. On the other hand, some conditions such as heart failure and some types of kidney, liver and adrenal diseases may impair excretion of water and even require that you limit your fluid intake.
• Pregnancy or breast-feeding. Women who are expecting or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink 2.3 liters (about 10 cups) of fluids daily and women who breast-feed consume 3.1 liters (about 13 cups) of fluids a day.

Beyond the tap: Other sources of water

Although it's a great idea to keep water within reach at all times, you don't need to rely only on what you drink to satisfy your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake, while the remaining 80 percent comes from water and beverages of all kinds.

For example, many fruits and vegetables, such as watermelon and tomatoes, are 90 percent to 100 percent water by weight. Beverages such as milk and juice also are composed mostly of water. Even beer, wine and caffeinated beverages — such as coffee, tea or soda — can contribute, but these should not be a major portion of your daily total fluid intake. Water is one of your best bets because it's calorie-free, inexpensive and readily available.

Staying safely hydrated

It's generally not a good idea to use thirst alone as a guide for when to drink. By the time you become thirsty, it's possible to already be slightly dehydrated. Further, be aware that as you get older your body is less able to sense dehydration and send your brain signals of thirst. Excessive thirst and increased urination can be signs of a more serious medical condition. Talk to your doctor if you experience either.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. Nearly every healthy adult can consider the following:

• Drink a glass of water with each meal and between each meal.
• Hydrate before, during and after exercise.
• Substitute sparkling water for alcoholic drinks at social gatherings.

If you drink water from a bottle, thoroughly clean or replace the bottle often.

Though uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia. Endurance athletes, such as marathon runners, who drink large amounts of water are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who consume an average American diet.

If you're concerned about your fluid intake, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that's best for you.

Water after meals: Does it disturb digestion?

Vitamin water: Better than plain water?
Diet soda: Is it bad for you?

By Mayo Clinic Staff

Coffee Good for Health?

Coffee Talk: Some Surprising Health Benefits
Written by RealAge, Inc., peer-reviewed by Dr. Axel Goetz, October 2005

One of the best ways to ward off chronic conditions, including cardiovascular disease, diabetes, and cancer, is to eat a diet rich in antioxidants. But many of us do not eat the recommended amounts of fruits and vegetables—considered superior sources of antioxidants.

So guess where many people are getting their antioxidants instead? Recent studies reveal coffee may be a surprising source. In fact, it is the top dietary source of antioxidants in many populations, including in the United States. Moreover, roasted coffee residues retain their antioxidant ability; it isn't lost in processing.

Enjoy your java? You're not alone . . . Researchers estimate about 54% of U.S. adults drink coffee every day. Countries such as Germany, Austria, and Finland consume twice as much coffee as the United States.

And there may be related benefits to this brew. Although most of the research is in the early stages, studies show that drinking coffee may be linked to some desirable health outcomes, such as:

• decreased risk of Parkinson's disease: A study revealed that men may experience up to a 40% reduction in risk by drinking as little as one cup per day. However, the effects were not observed in postmenopausal women who take estrogen replacement. In this case, coffee drinking may actually increase Parkinson's risk.
• reduced risk of type 2 diabetes: However, this reduced risk is only linked to people who drink excess amounts of coffee, which is not recommended; the risks of drinking too much coffee outweigh this possible benefit.
• decreased risk of liver cancer: Drinking coffee may be especially helpful reducing the risk of liver cancer caused by cirrhosis, a type of liver disease that causes scarring of the liver.

If coffee does have health benefits, it's not clear what they are from. Coffee contains not only antioxidants, but also caffeine and other yet-to-be researched compounds.

But even if there are clear health benefits to the brew, there are caveats. Although coffee consumption does not seem to raise the risk of cardiovascular disease, research shows that chronic consumption may increase aortic stiffness. Plus, unfiltered coffee can raise levels of blood fats, and excessive caffeine intake may be bad for people who are sensitive to caffeine. Coffee can contain anywhere from 72 to 130 milligrams of caffeine per 8-ounce serving, depending on the bean source and the brewing methods.

So there is give and take with coffee. If you don't already drink it, the recent news about antioxidants is not necessarily a reason to pick up the habit. And for people who already drink it, it's no excuse to stop eating fruits and veggies. Finally, because of the caffeine content, moderation is still the key to enjoying it healthfully.

Your best bet is to eat your fruits and veggies, and try to limit yourself to about one or two small cups—about 8-ounces—of coffee per day. That way you stay within the recommended limit of no more than 250 milligrams of caffeine per day.

Tea time
If you're not a coffee drinker, there's another steamy brew with multiple health benefits and less need for moderation. The health benefits of tea are widely established and are likely due to antioxidant flavonoids, as well as possibly the caffeine. Tea contains less caffeine than coffee, though, so you can drink more without worrying about excessive caffeine intake. Green tea can contain anywhere from 9 to 50 milligrams per 8-ounce serving while black tea typically contains between 42 to 72 milligrams per cup.

The well-established health benefits of tea include:

• decreased risk of LDL cholesterol oxidation and improved blood lipids after eating a high-fat meal, which may in part translate into reduced risk of cardiovascular disease • decreased risk of heart attack and stroke Regular tea drinkers might also have: • a possible decreased risk of Parkinson's disease • a possible decreased risk of Alzheimer's disease Although several compounds in tea

The downside of caffeine Caffeine may cause: • nervous, jittery feelings • sleeplessness • rapid heartbeat • increased blood pressure • stomach upset Caffeine may not be recommended for people who have: • overactive bladder • heartburn • high blood pressure • arrhythmia • anxiety disorder • insomnia

have been found to have anticancer properties in both cell and animal studies, no definitive evidence exists yet proving tea's anticancer potential in humans. Larger studies are needed to prove or disprove these findings. RA