Monthly Archives: March 2010

Vitamin D Supplementation Helps Prevent Falls in Older Adults

Each year, one third of adults 65 years and older have at least one fall. And, 9% of those falls require an emergency department visit and up to 6%result in a fracture. Consequently, strategies to prevent falls have become an important public health goal for the elderly.

A recent review of multiple published studies concluded that vitamin D supplementation taken in dosages of 700 to 1,000 IU per day (achieving a serum 25-hydroxyvitamin D level of at least 24) reduces falls in older persons by 26%.

And, for good news for the cost conscious, the more expensive active forms of vitamin D (which also had double the rate of a significant side effect) were no more effective than the very inexpensive and safer over-the-counter supplemental vitamin D.

A vitamin D level (as a blood test) is inexpensive, and treating a low vitamin D level even more inexpensive.

Some studies of vitamin D supplementation in older adults have shown improved strength, function, and balance in addition to reduced falls. Other studies have not found any benefit, which may be attributed to differences in dosing and the use of open trial designs.

Vitamin D is now available as an over-the-counter supplement (vitamin D3 or vitamin D2), or in an active form (1α-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3). So, researcher Bischoff-Ferrari and colleagues conducted a meta-analysis to determine the effectiveness of various vitamin D formulations on the prevention of falls in older persons.

The authors evaluated articles from 1991 to 2008, highlighting randomized, double-blind, controlled clinical trials of fall prevention using defined dosages and types of vitamin D in adults 65 years and older. The primary outcome was the risk of at least one fall while on vitamin D supplementation, with or without calcium, compared with persons on placebo or on calcium alone.

Of 164 articles identified, 10 were included in the final analysis; five trials used vitamin D3, three used vitamin D2, and two studied active forms of vitamin D.

Of the 2,426 participants in the eight trials of vitamin D2 or D3, the average age was 80 years, and 81% were women. All participants were in stable health and were living in the community or in nursing homes.

Daily dosages ranged from 200 IU to 1,000 IU during a treatment course of two to 36 months. Calcium supplementation (500 to 1,200 mg per day) was used in both the treatment and placebo arms in five trials, was used only in the treatment group of one trial, and was not used in two studies (vitamin D compared with placebo). In seven of the eight trials, the rate of adherence was reported to be 80 to 100 percent.

Among the seven high-dose trials (i.e., those that used 700 to 1,000 IU of supplemental vitamin D per day), dose stratification showed that daily dosages of 700 IU or more resulted in a relative risk reduction of 19%.

Subgroup analysis of the trials using high-dose vitamin D3 showed a fall reduction of 26%.

For all supplemental vitamin D, the number needed to treat was 11 for two to 36 months to achieve significant fall reduction.

Dosages of less than 700 IU per day did not confer any benefit in reducing falls.

Serum 25-hydroxyvitamin D levels of 24 ng per mL (60 nmol per L) or more were associated with a 23 percent reduction in falls. And, in a subgroup analysis of the high-dose trials, there were no significant differences among participants who used calcium supplementation and those who did not.

Finally, the two studies using the active forms of vitamin D showed a relative risk reduction similar to that of the supplemental forms, but had twice the hypercalcemia rate compared with placebo.

SOURCE: Bischoff-Ferrari  HA, et al.  Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. October  1, 2009;339:b3692.

Dark chocolate Easter eggs good for your heart?

Easter eggs and other chocolate may be good for you – at least in small quantities and preferably if it’s dark chocolate – according to research that shows just one small square of chocolate a day can lower your blood pressure and reduce your risk of heart disease. The study is published online in the European Heart Journal.

Researchers in Germany followed 19,357 people, aged between 35 and 65, for at least ten years, and found that those who ate the most amount of chocolate – an average of 7.5 grams a day – had lower blood pressure and a 39% lower risk of having a heart attack or stroke compared to those who ate the least amount of chocolate – an average of 1.7 grams a day.

The difference between the two groups amounts to six grams of chocolate: the equivalent of less than one small square of a 100g bar.

For those who believe in the Easter bunny (or at least in what he is believed to bring), good news awaits.
Just one small square of chocolate a day might help lower your blood pressure and reduce your risk for heart disease.
After analyzing the diet and health habits of 19,357 people, aged 35 to 65, for at least 10 years, German researchers found that those who ate the most chocolate (an average of 7.5 grams, or 0.3 ounces, a day) had lower blood pressure and were 39 percent less likely to have a heart attack than those who ate the least amount of chocolate (an average of 1.7 grams, or 0.06 ounces, a day).
“To put that in terms of absolute risk, if people in the group eating the least amount of chocolate [of whom 219 per 10,000 had a heart attack or stroke] increased their chocolate intake by 6 grams [0.2 ounces] a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years,” study leader Dr. Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition, said in a news release from the European Heart Journal, which published the findings online Tuesday.
“If the 39 percent lower risk is generalized to the general population, the number of avoidable heart attacks and strokes could be higher because the absolute risk in the general population is higher,” he said.
Six grams of chocolate is equivalent to about one small square of a 100 gram (3.5 ounce) bar, the researchers said.
But Buijsse cautioned that eating chocolate shouldn’t increase a person’s overall intake of calories or reduce the consumption of healthy foods.
“Small amounts of chocolate may help to prevent heart disease, but only if it replaces other energy-dense foods, such as snacks, in order to keep body weight stable,” he said.

According to a report by HealthDay News, “To put that in terms of absolute risk, if people in the group eating the least amount of chocolate [of whom 219 per 10,000 had a heart attack or stroke] increased their chocolate intake by 6 grams [0.2 ounces] a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years,” study leader Dr. Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition.

“If the 39 percent lower risk is generalized to the general population, the number of avoidable heart attacks and strokes could be higher because the absolute risk in the general population is higher,” he said.

Six grams of chocolate is equivalent to about one small square of a 100 gram (3.5 ounce) bar, the researchers said.

But Buijsse cautioned that eating chocolate shouldn’t increase a person’s overall intake of calories or reduce the consumption of healthy foods.

“Small amounts of chocolate may help to prevent heart disease, but only if it replaces other energy-dense foods, such as snacks, in order to keep body weight stable,” he said.

But, for this Easter weekend, my prescription is a little bit of dark chocolate. Consider it doing your heart a bit of good — in more ways than one.

Have a blessed Easter everyone.

Afternoon Nap Might Make You Smarter

A study is claiming that snoozing refreshes the brain’s capacity to learn. While the findings are preliminary, this new research raises the prospect that sleep, specifically a lengthy afternoon nap, prepares the brain to remember things. Think of it as similar to rebooting a computer to get it to work more smoothly.

Here are some of the details as reported by Health Day News: Want to ace that next test? Try taking a mid-afternoon siesta.

“Sleep is not just for the body. It’s very much for the brain,” said study author Matthew Walker, an assistant professor at the University of California at Berkeley.

Walker and colleagues divided 39 young adults into two groups. At noon, all the participants took part in a memory exercise that required them to remember faces and link them with names. Then the researchers took part in another memory exercise at 6 p.m., after 20 had napped for 100 minutes during the break.

Those who remained awake performed about 10 percent worse on the tests than those who napped, Walker said.

There’s one more twist: People’s ability to learn declines about 10 percent between noon and 6 p.m. normally, but the nappers were able to negate that decline.

The structure of the study suggests that a phase of non-dreaming sleep that the nappers went through is boosting memory, he said.

“This is further evidence that sleep plays a critical role in the processing of memories,” he said. “It provides more evidence that it’s not just important to sleep after learning, but you need it before learning to prepare the brain for laying down information.”

But it’s important to sleep long enough to give the brain an opportunity to go through various cycles of sleep, he said. Using electroencephalogram tests to track electrical activity in the brain, the researchers determined that memory-refreshing seems to occur between deep sleep and the dream state, called rapid eye movement or REM.

“The brain’s ability to soak up information is not always stable,” Walker said. “It seems as though the brain’s capacity may be a little like a sponge. It may get waterlogged with continued learning throughout the day.”

Jessica Payne, an assistant professor at the University of Notre Dame, said the study findings “really add to something we already know about why sleep is important.”

One message from the research, she said, is that sleep can be valuable for “students and for people who are struggling with their memory because they’re aging.”

Other recent research has suggested that sleep can help you think more creatively, have better long-term memory and preserve important memories.

The study findings were presented at the annual meeting of the American Association of the Advancement of Science in San Diego by Matthew Walker, an assistant professor in psychology and neuroscience at the University of California at Berkeley and Jessica Payne, an assistant professor of psychology at the University of Notre Dame.


Superfoods for Women

Most of us love to eat great food. But, we also want to feel great. Can we do both? You bet you can if you choose foods that make you energetic, smarter, leaner, and stronger — and then use them the right way in your daily eating habits. To help you accomplish that, here’s a story reported by CBS News. Registered dietician Frances Largeman-Roth, the senior food and nutrition editor for Health Magazine, made these suggestions on “The Early Show” about what she considered some of the top “superfoods” for women:

What are “superfoods”? As Largeman-Roth explained, the list comes from Health magazine’s experts.

“We went to our experts and said, ‘If you had to compile a list of 10 superfoods based on nutrient profiles and research, what would you choose?'” Health magazine went through the answers and, based on the responses, came up with this list:

  1. Wild salmon
  2. Oats
  3. Wild blueberries
  4. Walnuts
  5. Broccoli
  6. Greek yogurt
  7. Olive oil
  8. Dark chocolate
  9. Avocado
  10. Red beans

Largeman-Roth says superfoods go beyond just eating food for energy. “These foods,” she said, “are like the supermodels and superathletes for the food world, giving you the biggest bang for your buck, as far as health goes.”

Salmon, she said, is important for its heart-healthy omega-3 fatty acids. Largeman-Roth explained omega 3’s also boost mood and fight depression and may protect against Alzheimer’s disease. Plus, salmon has vitamin D which is another essential nutrient that we’re not getting enough of. Largeman-Roth, citing the American Heart Association recommendation, said people should eat 2, 3 to 4-ounce servings of salmon per week.

Oats, another superfood, helps lower cholesterol. In addition, Largeman-Roth said, oats help you feel full – a key component for a weight loss or weight maintenance diet. “I’m a big fan of steel cut oats — they’re a bit higher in fiber,” she said. “But you should get them any way you can. Instant is fine, just don’t get too much sugar. They’re another example of a very versatile food: you can supplement them with other foods (yogurt) or use them to make cookies or pancakes.”

Greek yogurt also made the list, Largeman-Roth said because of its calcium content. Greek yogurt, she explained, is triple strained, meaning it has three times the amount of milk, meaning its good for your bones. Just one serving, she said, provides nearly a quarter of a woman’s daily calcium needs. She added women should have three servings of dairy per day, so Greek yogurt should make up one of those servings.

Superfoods also extend to nuts – walnuts, that is. Not only are walnuts delicious, they are packed with protein, fiber, vitamins, minerals and omega-3s, according to Health magazine. Eating just a handful a day, Largeman-Roth said, can help lower your cholesterol, boost brain power, help you sleep better and cope with stress. Walnuts may also prevent heart disease and fight cancer. She said you need about an ounce a day — about 10 whole walnuts.

Why did olive oil make the Health magazine list? Olive oil is another heart-healthy food, Largeman-Roth said, but it also can help with longevity. “The Mediterranean diet has long been linked to heart health and longevity,” she said. “This diet protects against Alzheimer’s disease, but also helps with mild fuzzy thinking.” She said you can use olive oil in a variety of ways, from drizzling it on top of pasta to using it as a salad dressing or as a substitute for butter on bread.

Some vegetables and fruits also appear on the Health magazine list, including blue berries and broccoli. Blueberries, Largeman-Roth said, are great because they’re super high in antioxidants. “They can help prevent memory loss and improve motor skills and even fight wrinkles,” she said. “They’re an all-natural anti-aging remedy.” Blueberries also may be used in a variety of ways: as a savory sauce to go with meat or fish, or you can eat them plain. She recommended buying frozen blueberries to save money if fresh blueberries aren’t in season. Plus, with frozen berries, Largeman-Roth noted, you can keep them in the freezer, and take them out when you need them. To achieve the maximum effects of blueberries, eat a cup a day.

As for broccoli, this vegetable is considered a superfood because it may potentially help fight breast cancer by reducing levels of excess estrogen. “It’s also rich in vitamin C and a good source of Vitamin A,” Largeman-Roth said. “Broccoli helps you feel full on less than 30 calories per serving. Broccoli and salmon can make a great superfood pairing. You should be eating two or more half-cup servings of cooked broccoli per week.”

Red beans also appear on the list, a food that Largeman-Roth said is an often overlooked food, which ranks high on the ORAC scale for antioxidants. “(They’re) packed with protein, folate, minerals and fiber, including resistant starch,” she said. “They’re also very affordable food and very versatile. You can use them in burritos, dips, etc.” You should eat three cups a week to reap the health rewards.

Avocados made the list, too. Rich in mono-unsaturated fats, avocados, Largeman-Roth said, can help you lose belly fat. “You can eat it plain, or make soup with it, or whip up some guacamole. You can add it do a salad also,” she said. “It is high in calories so you want to stick to a half an avocado a day. It also makes a great baby food — I feed it to my baby.”

But superfoods aren’t all about fruits and vegetables. Dark chocolate, a decadent dessert, also appears in the Health list. Rich in antioxidants, Largeman-Roth said dark chocolate can help strengthen bones, and according to some studies, reduce blood pressure. However, you shouldn’t overdo the dark chocolate. Largeman-Roth said only chocolate that’s 70 percent cocoa will work, and you should only eat a quarter of an ounce a day – about two small squares.

Coffee and Your Health

Today I’m teaching the family medicine residents at the In His Image Family Medicine Residency Program in Tulsa, Oklahoma. One of them asked if there were any health benefits of coffee. Of course, long time readers on this blog know the answer to that question is a qualified YES. There are a number of coffee and health related studies that have come out just this year. In fact, two recently came out at an American Heart Association meeting.

Among the findings: coffee drinkers are less likely to be hospitalized with heart rhythm disorders, which is a bit surprising because heart palpitations are more common among those who drink coffee.

Bloomberg News reported that “while a shot of espresso may give people the sensation their hearts are racing, drinking more coffee reduced the likelihood that patients would be hospitalized for irregular heartbeats,” according to one study presented at the conference.

The “study of 130,054 adults found that people who drank four cups or more of coffee daily had an 18 percent lower risk of being hospitalized for irregular heartbeats and other heart-rhythm conditions than noncoffee drinkers, researchers … said.”

Additionally, the investigators found that “the risk of hospitalization was seven percent lower for people who drank one to three cups of coffee daily.”

Caffeinated coffee consumption was also linked to a LOWER risk for type 2 diabetes in women.

Two caveats: (#1) These studies are association only, meaning it is very difficult to know that coffee is the key factor in the health differences, and (#2) Studies presented at meetings are not always high quality enough to make it into the peer-reviewed medical literature. We’ll have to wait and see if these do.

Eating Processed Meat Riskier Than Red Meat

Here’s some surprising information from the Harvard School of public health. It’s an old news, new news story. First a reiteration of some old news: Eating processed meat such as bacon, salami, hot dogs, or lunch meats is associated with an increased risk for heart disease and diabetes.

But, this old news becomes even more convincing since this particular report is based upon an analysis of 20 studies including more than 1.2 million adults.

However, the new news is that the increased risk of heart disease and diabetes does NOT come from eating UNPROCESSED red meat, such as steak, lamb or pork. How about that for a shocker!?

The risk comes from eating PROCESSED meats.

The researchers theorize that the higher sodium and nitrate levels in processed meats are the main reason for the increased heart and diabetes risk.

The researchers defined the term “processed meat” as meaning “any meat preserved by smoking, curing or salting or with the addition of chemical preservatives.”

They defined “red meat” as unprocessed meats such as beef, hamburger, lamb, and pork.

As most of you know, conventional wisdom has dictated that fat from red meat is a risk factor for diabetes, cardiovascular disease, and a number of types of cancer.

The term “processed meat” refers to any meat preserved by smoking, curing or salting or with the addition of chemical preservatives. The researchers defined “red meat” as unprocessed meats such as beef, hamburger, lamb and pork.
“To lower risk of heart attacks and diabetes, people should avoid eating too much processed meats — for example, hot dogs, bacon, sausage or processed deli meats,” said lead researcher Renata Micha, a research fellow at the Harvard School of Public Health. “Based on our findings, eating up to one serving per week would be associated with relatively small risk.”

“To lower risk of heart attacks and diabetes, people should avoid eating too much processed meats — for example, hot dogs, bacon, sausage or processed deli meats,” lead researcher Renata Micha, a research fellow at the Harvard School of Public Health, told Business Week in an interview. “Based on our findings, eating up to one serving per week would be associated with relatively small risk.”

“This suggests that salt and other preservatives, rather than fats, probably explain the higher risk for heart attacks and diabetes seen with processed meats,” Micha said.

The researchers found that people who ate unprocessed red meat did not significantly increase their chances of developing heart disease or diabetes. However, eating processed meat was linked to an increased risk for the two conditions. In fact, for every 50-gram (1.8-ounce) serving, the risk for heart disease jumped 42 percent and the risk for diabetes increased 19 percent.

Samantha Heller, a registered dietitian, clinical nutritionist, and exercise physiologist interviewed by Business Week said, “Both red and processed meat and other foods, such as butter and cheese, that are high in saturated fat have been linked to chronic disease.” She added, “People should limit consumption of them as well.”

“Going low- or no-fat with dairy products helps lower our intake of saturated fat,” she said.

“Choosing healthy protein sources — such as white-meat poultry, low-mercury fish, soy, nuts and beans — and focusing on moving in the direction of a more plant-based diet will help us all live longer, healthier lives.

The findings were presented at the Nutrition, Physical Activity and Metabolism & Cardiovascular Disease Epidemiology and Prevention Joint Conference in San Francisco.

The caveat is that many findings presented at meetings never make it into the peer-reviewed and published medical literature. So, we’ll have to wait and see if these data and this report of published.

However, given the source (the Harvard School of Public Health), I think I’m comfortable continuing in my recommendation to patients to eat as little processed meat product as possible.

Can Hibiscus Tea lower your blood pressure? Surprising new research says, “Yes.”

When I speak on natural medications (herbs, vitamins, and supplements), I tell folks that my favorite natural medicines website is the Natural Medicines Comprehensive Database which has new information about Hibiscus (Hibiscus sabdariffa). NMCD says, “Hibiscus is getting more attention as a potential treatment for hypertension. New clinical research shows that drinking a specific hibiscus tea (Celestial Seasonings) three times daily for 6 weeks significantly lowers blood pressure by about 7 mmHg in patients with pre-hypertension or mild hypertension.”

According to NMCD, “This is promising, but preliminary.”

Also,  I suspect most people could not (and would not) be compliant with drinking the tea three times a day every single day for years at a time.

So, the Database encourages us physicians to “explain to patients that drinking hibiscus tea might help, but it’s no substitute for conventional treatments that are proven to improve cardiovascular outcomes.”

Loneliness harms blood pressure

Like happiness, loneliness is contagious

In my book, the 10 Essentials of Happy, Healthy People, one of the ten essentials of health I write about is “avoiding loneliness like the plague.” I say, “Avoiding loneliness and pursuing healthy relationships can increase the likelihood of your becoming a highly healthy person … The absence of loneliness, the fostering of socialization and positive rela- tionships, and the development of constructive and graceful communication styles can increase not only the likelihood that you will be highly healthy but that those around you will be healthy as well.”

There are a number of reasons this is true — not the least of which is the association of loneliness with worsening cardiovascular health outcomes. Commenting on the newest research showing this is the Los Angeles Times “Booster Shots” blog which is reporting that loneliness may “affect blood pressure,” according to a study appearing in the March issue of Psychology and Aging.

“Researchers surveyed 229 people ages 50 to 68 who were part of the Chicago Health, Aging, and Social Relations Study, a longitudinal study of white, black and Latino men and women.” After five years, “researchers noted an association between feelings of loneliness and high blood pressure. People who ranked as feeling most lonely had blood pressure levels 14.4 points higher than those who felt least lonely.”

If you are an angry or hostile person, you can drive people away and increase your personal loneliness. If you are cynical or depressed, you’ll be inclined to withdraw from others and increase your personal loneliness. If you have uncaring relationships or refuse to socialize with others, you may suffer dire health consequences.

If any of this is true for you, I assure you that there is hope. To begin on the journey to becoming a highly healthy and happy person, consider ordering my book, 10 Essentials of Happy, Healthy People. Find the chapter on “Avoiding Loneliness Like the Plague” and begin to fill some of this chapter’s prescriptions for building stronger and healthier relationships. As you do, you will, in turn, avoid loneliness like the life-threatening plague it is.

You can read the Table of the Contents of the book here, and read the first chapter here. Also, the Los Altos United Methodist Church developed a Small Group Study Guide for the book that you can download free here.

Here are some of my other blogs on loneliness:

Increased spiritual support may be linked to higher quality of life in cancer patients

This headline is likely not news to most of the readers of this blog — or likely to most people. We all seem to know intuitively that terminal diagnoses cause people to begin to think about spiritaul and eternal issues. HealthDay reports, “Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs.” This is based upon a study appearing in the Journal of Clinical Oncology.

The study of 670 patients showed that 60 percent “said that their spiritual needs either hadn’t been met or were minimally supported,” even though patients ranked “pain control and being at peace with God” as the two most important factors “at the end of their lives.”

Patients who received “greater spiritual support from their medical team” said they had “a higher quality of life as they neared death.” Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs, a new study suggests.

The take home for us healthcare professionals is that we all need to do a better job of taking a spiritual history on our cancer patients. In fact, the Joint Commission requires a spiritual history or assessment for all patients admitted to long-term care, home care, behavioral care, and hospital admission.

What should the assessment include? The Joint Commission says that it “should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to them.”

Why? They say, “This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.”

The take home for the rest of us is to be sure that our family and friends who receive the diagnosis of cancer have the spiritual support upon which their health and well-being may depend.

The famous Johns Hopkins medical professor, Sir William Osler, writing in an editorial, titled “The Faith that Heals,” printed in the first edition of the British Medical Journal (BMJ 1910;1:470-2), wrote, “Nothing in life is more wonderful than faith … the one great moving force which we can neither weigh in the balance nor test in the crucible …” He wrote that faith is”… mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence …”

Psychotherapist Arthur Kornhaber said, in a 1992 interview published in Newsweek magazine, “To exclude God from a medical consultation is a form of malpractice … spirituality is wonder, joy and shouldn’t be left in the clinical closet.”

I was the chief author of a systematic review (Annals of Behavioral Medicine 2002;24(1):69-73) that concluded, “The current evidence would encourage physicians, health-care providers and systems to learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort upon which their hope, health, and well being may hinge.”

“This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.

Here’s the HealthDay report:

When asked what was important to them at the end of their lives, people dying of cancer ranked two factors highest: pain control and being at peace with God, the study found.

“Medicine tends to focus on the more scientific aspects of the person, and we’ve made wonderful strides in improving patient care, but there’s another important component of patient health: spirituality,” explained Dr. Tracy Anne Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston and the study’s lead author. “This is clearly an area where some important advancements can be made.”

The researchers discovered that people with advanced cancer were far more likely to choose hospice care when their spiritual needs had been addressed. And among those who were very religious, meeting spiritual needs increased the odds that a terminal patient would choose to forgo aggressive, yet often unsuccessful, medical treatments, the study found.

However, at least six of 10 people with advanced cancer reported that their spiritual needs were only minimally or not at all supported.

The new study involved 670 people with advanced cancer from seven treatment centers in the Northeast and Texas. The final analysis included information from 343 people who later died and whose caregivers completed a post-death interview. The average time between the start of the study and the person’s death was 116 days.

For purposes of the study, spiritual care was defined as patient-perceived support of their spiritual needs by their medical team and the receipt of pastoral care services.

Most people (60 percent) said that their spiritual needs either hadn’t been met or were minimally supported at the start of the study, and 54 percent had not received pastoral care visits. In the final week of life, 73 percent of the participants received hospice care, and 17 percent received aggressive care.

Those who had greater spiritual support from their medical team, including doctors, nurses, chaplains and more, reported a higher quality of life as they neared death than did those who felt unsupported spiritually.

People who felt they were getting better spiritual support were 3½ times more likely to receive hospice care. And among highly religious people, those whose spiritual needs were supported were five times more likely to receive hospice care and five times less likely to receive aggressive medical care, the study reported.

“We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care,” Balboni said.

Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, “few people are getting their spiritual needs met by the medical system.”

“Many doctors are uncomfortable discussing spirituality and haven’t been trained to do so,” he said. “And churches have a role, too. Although it’s not a popular topic, churches need to talk about the end of life in the pulpit. People don’t know theologically what they’re supposed to do.”

Religious people, Koenig said, are often left to think they should always have hope and should always “give God a chance to provide a miracle.” Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.

Doctors don’t need to actually provide spiritual care, Koenig said, but it’s important for physicians to acknowledge their patients’ spiritual needs and make sure they’re addressed by pastoral care or hospice. “The doctor does have to be the one to orchestrate this,” he said.

But if someone’s spiritual needs are not being met, Koenig and Balboni agreed that the person — or a friend or family member — needs to speak up. And if the patient’s doctor doesn’t feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.

If you take St. John’s wort, here’s another potential side effect you need to know about

My favorite natural medicines website is the Natural Medicines Comprehensive Database and the NMCD has a new warning about St. John’s wort (SJW) and your eyesight: St. John’s wort  has now been linked to an increased risk of cataracts in new research.

There have been concerns for years, based upon animal studies, that SJW might increase cataract risk. Why? The hypericin constituent of SJW is known to be photoactive. In the presence of light, hypericin might damage lens proteins and precipitate cataracts. However, this risk has never been studied in humans — until now.

A new population study shows that taking St. John’s wort is associated with risk of developing cataracts. The researchers used self-reported data on SJW use in the past 12 months and cataracts that were obtained from the 2002 National Health Interview Survey, a nationally representative population-based sample.

After adjusting for potential confounding characteristics, participants that reported having cataracts were 59% more likely to report SJW use (OR 1.59; 95% CI 1.02-2.46). The researchers concluded, “The results of the current study provide support for an association between SJW use and cataracts.”

They also state, “Based on the methodological limitations of this study, further investigation is required.” Nevertheless, people who spend a significant amount of time in the sun may want to consider NOT taking St. John’s wort. And, people who take it may want to wear dark sunglasses whenever outside.

St. John’s wort may cool the hot flashes of menopause

Reuters Health has a nice report on the popular herbal remedy, St. John’s wort, and some news from a small study that says it may help ease menopausal hot flashes. St. John’s wort is probably best known as an herbal antidepressant, with some clinical trials suggesting that it can help relieve mild to moderate depression symptoms. A few studies have also investigated the herb’s effects on menopausal symptoms, but have focused on its impact on mood — and not the so-called vasomotor symptoms of menopause, which include hot flashes and night sweats. Here’s the Reuter’s report:

“(The) findings of our study suggest that this herbal medicine can be used to treat hot flashes due to menopause, and it is a new finding about the usage of St. John’s wort,” Marjan Khajehei, of Shiraz University of Medical Sciences in Iran, told Reuters Health in an email.

Khajehei and her colleagues found that among a group of women they randomly assigned to take either St. John’s wort or an inactive placebo for eight weeks, those using the herb saw a greater reduction in daily hot flashes.

Among women taking St. John’s wort, the average number of hot flashes declined from roughly four per day at the start of the study to fewer than two per day at week eight. In contrast, women in the placebo group were having an average of 2.6 hot flashes per day by the eighth week. The herb also appeared to lessen the duration and severity of the women’s hot flashes, Khajehei and her colleagues report in the journal Menopause.

The study included 100 women who were 50 years old, on average, and had been having moderate to severe hot flashes at least once per day. The women were randomly assigned to take either drops containing St. John’s wort extract or placebo drops three times a day for eight weeks. While women in both groups saw their hot flashes improve, those taking the herbal extract had a better response, on average.

St. John’s wort contains estrogen-like plant compounds called phytoestrogens, and it’s possible that these compounds explain the benefits seen in this study, according to Khajehei. However, she said, further research is needed to confirm that the herb eases hot flashes and that phytoestrogens are the reason.

St. John’s wort is generally considered safe when taken as directed, Khajehei noted. Still, she added, since phytoestrogens have mild estrogen-like effects in the body, women who have any contraindications to using estrogen — such as a history of breast or endometrial cancers — should talk with their doctors before starting St. John’s wort.

The herb has also been shown to interact with certain medications, including antidepressants, the heart medication digoxin, the birth control pill, and the blood thinner warfarin.

I join with many other experts who generally recommend that people on any medication talk with their doctors or pharmacists before starting an herbal remedy.

The study is published in the journal Menopause, March 2010. You can find the table of contents of this edition here. The abstract of the study is available for free toward the bottom of the page.

To learn more about alternative medicine, take a look at my best-selling book, Alternative Medicine: The Christian Handbook. You can also view the table of contents here and read the first chapter here.

You can read more on this topic at my blog entry, Natural Medications (Herbs, Vitamins, and Supplements) for Menopausal Symptomshere.

Amberen a new supplement for hot flashes. Does it work?

According to a new report by the Natural Medicines Comprehensive Database (NMCD), Amberen is a popular new dietary supplement used mainly for menopausal symptoms such as hot flashes. The manufacturer says the product is “Backed by published clinical, toxicology and safety studies, and over 30 years of research, Amberen is your best choice for a natural alternative to HRT.”

The NMCD say, of Amberen, “It contains unusual ingredients including ammonium succinate, calcium disuccinate, magnesium disuccinate hydrate, and others.” But, does it work? The Database relates, “Although patient testimonials suggest that the product might help, there is NO reliable clinical research.”

To doctors NMCD says, “Don’t recommend this product until there is reliable evidence of safety and effectiveness.” For menopausal women, this is one product I’d recommend you skip until there’s more reliable data.

You can read more on this topic at my blog entry, Natural Medications (Herbs, Vitamins, and Supplements) for Menopausal Symptoms, here.

Unvaccinated Children at Center of Measles Outbreak

Many parents who refuse to have their children vaccinated, don’t realize the potential harm of this decision on both their children and the children in their community. The reason? Children whose parents refuse vaccinations for them provide fertile ground for the spread of vaccine-preventable diseases. Here’s another case proving that point. This one is an investigation of a 2008 measles outbreak in San Diego. As one of the researchers reminds us, “It’s very important for parents to understand that the disease itself is always more serious than a true reaction to the vaccine.”

Action Points
Explain to interested patients that all 12 of the measles cases identified in this study were unvaccinated children, most of whose parents had refused the vaccine.

Here are the details, from a MedPage report:

Although the rate of two-dose immunization against measles was 95% in the area, a single case of measles from a 7-year-old child returning from overseas sparked an outbreak that exposed 839 people and sickened 11 other children, according to David Sugerman, MD, MPH, of the CDC’s Epidemic Intelligence Service, and colleagues.

None of the 12 children, who ranged in age from 10 months to 9 years, had been vaccinated — nine because their parents had refused the vaccine and three because they were too young, the researchers reported in the March issue of Pediatrics.

Although the virus was not spread extensively, it came at a substantial cost of $176,980 for investigation, containment, and healthcare.

In San Diego, the overall rate of vaccine refusal — predominantly because of safety concerns — was low at 2.5% in 2008, but it had been rising since 2001.

The possibility that increasing rates of intentional undervaccination could lead to a rise in outbreaks of vaccine-preventable diseases is “a monumental concern,” according to Anne Gershon, MD, a pediatric infectious disease expert at Columbia University Medical Center in New York City.

“It’s very important for parents to understand that the disease itself is always more serious than a true reaction to the vaccine,” she said in an e-mail.

The endemic transmission of measles was declared eliminated in the U.S. in 2000 because of widespread use of an effective vaccine, but the virus remains endemic in other parts of the world.

Occasionally, imported cases cause outbreaks. In 2008, there were 140 measles cases in the U.S., the largest number since 1996, when there were 508.

There are concerns that cases of measles and other vaccine-preventable diseases will continue to increase as public focus shifts from the dangers of disease to vaccine safety.

To explore the effect of intentional undervaccination on an outbreak of a vaccine-preventable illness, Sugerman and his colleagues turned to the January 2008 measles outbreak in San Diego, sparked by a 7-year-old returning from a trip to Switzerland.

The child’s parents had signed a personal-beliefs exemption to refuse vaccination for their children.

The index patient directly infected his two siblings, two classmates, and four children who were treated at the same clinic.

The index patient’s sister then infected two of her classmates. One of the index patient’s classmates infected his brother, bringing the total number of cases to 12.

One child, a 10-month-old, was hospitalized, and received IV hydration for diarrhea.

A vigorous public health response, including quarantine of exposed children who had not been vaccinated, prevented the outbreak from progressing further.

In the study area, parents who refused vaccines for their children tended to be white, well-educated, and from the middle and upper classes.

There were clusters of vaccine refusal, occurring more often in public charter and private schools, as well as in public schools in upper-class areas.

William Schaffner, MD, chair of preventive medicine at Vanderbilt University in Nashville, said in an interview that there is growing concern about these community clusters, because they create a pool of susceptible children who interact with each other on a daily basis.

Although high vaccination rates prevented the San Diego measles outbreak from extending into the general population, Schaffner said “you cannot rely upon herd immunity to protect each and every child.”

In discussion groups and surveys, most parents who refused vaccines for their children were concerned about possible adverse effects, including autism, ADD/ADHD, asthma, and allergies. They expressed skepticism about the government, pharmaceutical industry, and medical community.

In addition, “they believed vaccination was unnecessary, because most vaccine-preventable diseases had already been reduced to very low risk by improvements in water, sanitation, and hygiene and were best prevented by ‘natural lifestyles,’ including prolonged breastfeeding and organic foods,” Sugerman and his colleagues wrote.

But, according to Schaffner, parents harboring those ideas are misguided.

“There’s nothing in that sentence that is correct,” he said. “You can have the purest water, eat the most natural food, be very healthy, and if exposed to measles, your child will get measles and can get a very severe case.”

He noted that people often forget that before vaccination was introduced in the U.S. in 1963, measles killed an average of 400 children a year in the U.S.

“People don’t recognize how potentially very serious these so-called childhood infections can be,” he said.

The best way to help inform parents about the importance of vaccination for their children remains the dissemination of science-based information through the media and doctors, Schaffner said, although he acknowledged that that approach does not seem to be working.

A longer-range solution, he said, would be to make sure school health curricula contain lessons on vaccines and the diseases they prevent. Schaffner said many current curricula are deficient in this area.

“We shouldn’t be surprised that when these teenagers in a few years become young adults and parents that they’re not very educated about vaccines.”

Nearly a third of physicians surveyed unaware of ‘Choking Game’

In the New York Times online Doctor and Patient column, Pauline Chen, MD, observed, “Until recently, there has been little attention among healthcare professionals to” the “choking game” in which “children ages seven to 21 participate … alone or in groups, holding their breath, strangling one another, or dangling in a noose in the hopes of attaining a legal high.”

A study published this month in the journal Pediatrics “reported that almost a third of physicians surveyed were unaware of the choking game” and “could not describe any of the 11 warning signs, which include bloodshot eyes and frequent and often severe headaches.”

To help you be able to know more about this dangerous new phenomena, here’s a CDC report on the topic:

What is the choking game?

The choking game is a dangerous activity that older children and early adolescents sometimes play to get a brief high. They either choke each other or use a noose to choke themselves. After just a short time, children can pass out, which may lead to serious injury or even death from hanging or strangulation.

Who is most at risk for death from playing the choking game?

  • Boys were much more likely to die from the choking game than girls; 87% of victims were boys.
  • Most of the children that died were 11-16 years old (89%).
  • Nearly all of the children who died were playing the game alone when they died.
  • Deaths have occurred all over the United States; the choking game isn’t limited to one area of the country.

What are the warning signs that a child is playing the choking game?

Parents, educators, health-care providers, or peers may observe any of the following signs that can indicate a child has been involved in the choking game:

  • Discussion of the game or its aliases
  • Bloodshot eyes
  • Marks on the neck
  • Wearing high-necked shirts, even in warm weather
  • Frequent, severe headaches
  • Disorientation after spending time alone
  • Increased and uncharacteristic irritability or hostility
  • Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
  • The unexplained presence of dog leashes, choke collars, bungee cords, etc.
  • Petechiae (pinpoint bleeding spots) under the skin of the face, especially the eyelids, or the conjunctiva (the lining of the eyelids and eyes)

What are some of the other names used for the choking game?

  • Pass-out game
  • Space monkey
  • Suffocation roulette
  • Scarf game
  • The American dream
  • Fainting game
  • Something dreaming game
  • Purple hazing
  • Blacking out/blackout
  • Dream game
  • Flat liner
  • California choke
  • Space cowboy
  • Airplaning
  • Purple dragon
  • Cloud nine

How quickly can someone die after playing the choking game?

Someone can become unconscious in a matter of seconds. Within three minutes of continued strangulation (i.e., hanging), basic functions such as memory, balance, and the central nervous system start to fail. Death occurs shortly after.

Are there non-fatal, long-term consequences of the choking game?

  • Loss of consciousness and death of brain cells due to oxygen deprivation in the brain; coma and seizures may occur in severe cases
  • Concussions or broken bones (including jaws) from falls associated with the choking game
  • Hemorrhages of the eye

How can the choking game be prevented?

Research is not available on the best strategies to prevent the choking game. However, parents, educators, and health-care providers should be made aware of this public health threat and the warning signs that adolescents may be playing the game.

Medical community unaware of ‘Choking Game’s’ popularity among teens

The Los Angeles Times “Booster Shots” blog reported that there is a game being played throughout the nation by some teenagers that involves “cutting off oxygen to the brain” to “induce a natural high.”

Although the “choking game may not be as prevalent as other [risky behaviors] like drugs,” the lead author of a paper appearing in Pediatrics points out “a seriously low level of awareness” among members of the medical community.

This raises concerns, because “a recent CDC report estimated that about 85 deaths from 1995 to 2007 were likely caused by participation in choking games, and several incidences of brain injuries have been reported,” according to a WebMD report.

But, 68 percent of the “163 pediatricians and family practitioners” who were surveyed by Rainbow Babies and Children’s Hospital researchers “had heard of the choking game, mostly through media reports.”

And, “among those who were aware of the choking game, 76% could identify at least one warning sign.”

HealthDay also covered the story.

According to the CDC report:

What is the choking game?

The choking game is a dangerous activity that older children and early adolescents sometimes play to get a brief high. They either choke each other or use a noose to choke themselves. After just a short time, children can pass out, which may lead to serious injury or even death from hanging or strangulation.

Who is most at risk for death from playing the choking game?

  • Boys were much more likely to die from the choking game than girls; 87% of victims were boys.
  • Most of the children that died were 11-16 years old (89%).
  • Nearly all of the children who died were playing the game alone when they died.
  • Deaths have occurred all over the United States; the choking game isn’t limited to one area of the country.

What are the warning signs that a child is playing the choking game?

Parents, educators, health-care providers, or peers may observe any of the following signs that can indicate a child has been involved in the choking game:

  • Discussion of the game or its aliases
  • Bloodshot eyes
  • Marks on the neck
  • Wearing high-necked shirts, even in warm weather
  • Frequent, severe headaches
  • Disorientation after spending time alone
  • Increased and uncharacteristic irritability or hostility
  • Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
  • The unexplained presence of dog leashes, choke collars, bungee cords, etc.
  • Petechiae (pinpoint bleeding spots) under the skin of the face, especially the eyelids, or the conjunctiva (the lining of the eyelids and eyes)

What are some of the other names used for the choking game?

  • Pass-out game
  • Space monkey
  • Suffocation roulette
  • Scarf game
  • The American dream
  • Fainting game
  • Something dreaming game
  • Purple hazing
  • Blacking out/blackout
  • Dream game
  • Flat liner
  • California choke
  • Space cowboy
  • Airplaning
  • Purple dragon
  • Cloud nine

How quickly can someone die after playing the choking game?

Someone can become unconscious in a matter of seconds. Within three minutes of continued strangulation (i.e., hanging), basic functions such as memory, balance, and the central nervous system start to fail. Death occurs shortly after.

Are there non-fatal, long-term consequences of the choking game?

  • Loss of consciousness and death of brain cells due to oxygen deprivation in the brain; coma and seizures may occur in severe cases
  • Concussions or broken bones (including jaws) from falls associated with the choking game
  • Hemorrhages of the eye

How can the choking game be prevented?

Research is not available on the best strategies to prevent the choking game. However, parents, educators, and health-care providers should be made aware of this public health threat and the warning signs that adolescents may be playing the game.

Discovering Teenagers’ Risky ‘Choking Game’ Too Late

Here’s a heart rending story from the New York Times about an extremely risky game that is becoming more and more popular with teens. Worse yet, most parents and doctors are unaware of the game. Here are the details:

The patient was already on the operating room table when the other transplant surgeons and I arrived to begin the surgery that would remove his liver, kidneys, pancreas, lungs and heart. He was tall, with legs that extended to the very end of the table, a chest barely wider than his 16-year-old hips, and a chin covered with pimples and peach fuzz.

He looked like any one of the boys I knew in high school.

Those of us in the room that night knew his organs would be perfect — he had been a healthy teenager before death — but the fact that he had not died in a terrible, mutilating automobile or motorcycle crash made us all that much more certain.

The boy had hanged himself and had been discovered early, though not early enough to have survived.

While I had operated on more than a few suicide victims, I had never come across someone so young who had chosen to die in this way. I asked one of the nurses who had spent time with the family about the circumstances of his death. Was he depressed? Had anyone ever suspected? Who found him?

“He was playing the choking game,” she said quietly.

I stopped what I was doing and, not believing I had heard correctly, turned to look straight at her.

“You know that game where kids try to get high,” she explained. “They strangle themselves until just before they lose consciousness.” She put her hand on the boy’s arm then continued: “Problem was that this poor kid couldn’t wiggle out of the noose he had made for himself. His parents found him hanging by his belt on his bedroom doorknob.”

The image of that boy and of the dangling homemade noose comes rushing back whenever I meet another victim or read about the grim mortality statistics associated with this so-called game. But one thing has haunted me even more in the years since that night. As a doctor who counts adolescents among her patients, I knew nothing about the choking game before I cared for a child who had died “playing” it.

Until recently, there has been little attention among health care professionals to this particular form of youthful thrill-seeking. What has been known, however, is that children ages 7 to 21 participate in such activities alone or in groups, holding their breath, strangling one another or dangling in a noose in the hopes of attaining a legal high.

Two years ago the Centers for Disease Control and Prevention reported 82 deaths attributable to the choking game and related activities. This year the C.D.C. released the results of the first statewide survey and found that one in three eighth graders in Oregon had heard of the choking game, while more than one in 20 had participated.

The popularity of the choking game may boil down to one fact: adolescents believe it is safe.

In one recent study, almost half of the youths surveyed believed there was no risk associated with the game. And unlike other risk-taking behaviors like alcohol or drug abuse where doctors and parents can counsel teenagers on the dangers involved, no one is countering this gross misperception regarding the safety of near strangulation.

Why? Because like me that night in the operating room, many of my colleagues have no clue that such a game even exists.

This month in the journal Pediatrics, researchers from the Rainbow Babies and Children’s Hospital in Cleveland reported that almost a third of physicians surveyed were unaware of the choking game. These doctors could not describe any of the 11 warning signs, which include bloodshot eyes and frequent and often severe headaches. And they failed to identify any one of the 10 alternative names for the choking game, startlingly benign monikers like Rush, Space Monkey, Purple Dragon and Funky Chicken.

“Doctors have a unique opportunity to see and prevent this,” said Dr. Nancy E. Bass, an associate professor of pediatrics and neurology at Case Western Reserve University and senior author of the study. “But how are they going to educate parents and patients if they don’t know about it?”

In situations where a patient may be contemplating or already participating in choking activities, frank discussions about the warning signs can be particularly powerful. “The sad thing about these cases,” Dr. Bass observed, “is that every parent says, ‘If we had known what to look for, we probably could have prevented this.’ ” One set of parents told Dr. Bass that they had noticed knotted scarves and ties and a bowing closet rod in their son’s room weeks before his death.

“They had the telltale signs,” Dr. Bass said, “but they never knew what to look for.”

Nonetheless, broaching the topic can be difficult for both parents and doctors. Some parents worry that talking about such activities will paradoxically encourage adolescents to participate. “But that’s kind of a naïve thought,” Dr. Bass countered. “Children can go to the Internet and YouTube to learn about the choking game.” In another study published last year, for example, Canadian researchers found 65 videos of the choking game from postings to YouTube over an 11-day period. The videos showed various techniques of strangulation and were viewed almost 175,000 times. But, Dr. Bass added, “these videos don’t say that kids can die from doing this.”

Still, few doctors discuss these types of activities with their adolescent patients. Only two doctors in Dr. Bass’s study reported ever having tackled the topic because of a lack of time. “Talking about difficult topics is really hard to do,” Dr. Bass noted, “when you just have 15 minutes to follow up.”

But it is even harder when neither doctor nor patient has any idea of what the activity is or of its lethal consequences.

Based on the results of their study, Dr. Bass and her co-investigators have started programs that educate doctors, particularly those in training, about the warning signs and dangers of strangulation activities. “The choking game may not be as prominent as some of the other topics we cover when we talk with patients,” Dr. Bass said, “but it results in death.”

And, she added, “If we don’t talk to doctors about this issue, they won’t know about the choking game until one of their patients dies.”

Understanding the California Law Suit Over PCBs in Fish Oil Supplements

Long-time readers to this blog and my best selling book, Alternative Medicine: The Christian Handbook, know of my enthusiasm for fish oil (omega-3 fatty acid foods and supplements). And, you’ve read where I’ve written that no fish oil supplements have been found “to contain detectable levels of mercury, PCBs, or dioxins.” Now comes news about a law suit over PCBs in fish oil supplements. Who are you to believe? Here are the facts:

According to a report in ConsumerLab.com, “A lawsuit was filed on March 2, 2010 by a group that tested ten fish oil supplements and found that all violated California’s Prop 65 labeling requirement because they contained PCBs.  While it raises legitimate concerns, the suit may have created some confusion.”

Here are some points to keep in mind:

  • Virtually all fish meat and fish oil supplement will contain some PCBs.
  • The samples chosen were oils made primarily made from larger fish (including shark) and fish “liver,” which tend to have higher amounts of contaminants.
  • The majority of the products had extremely low levels of PCBs.  Somewhat higher levels were found in a few products.
  • But, NONE of these pose a health risk in themselves, but those with higher levels might unnecessarily contribute to PCB exposure.
  • The products are identified by name in a news release about the suit which includes two tables.
    • The first table shows total PCBs.
    • The second table shows the amount of dioxin-like PCBs, which may be more meaningful as it focuses on the subset of PCBs known to be harmful in animal studies.
    • Be aware that results in both tables are skewed against products that suggest higher daily serving sizes.

According to ConsumerLab, “To put the findings in perspective, total daily PCBs reported was under 100 nanograms for most supplements and did not exceed 900 nanograms for any.

“The importance of this is that the FDA permits an 8 ounce serving of fish to contain about 450,000 nanograms of total PCBs, 500 times more than in any of these products. The EPA, using a more conservative approach, estimates that the average adult can consume 1,400 nanograms of total PCBs per day without harmful effects.”

So, I, and the experts with whom I’ve spoken, stand by our previously published statements on the safety of omega-3 fish oil supplements.

You can read a couple of my other blogs on the topic here:

Court once again rejects theory that vaccines cause autism

A federal court has determined that the theory that thimerosal-containing vaccines cause autism is “scientifically unsupportable,” and that the families of children diagnosed with the condition are not entitled to compensation. Three special masters in the U.S. Court of Federal Claims determined that the three families represented in the suit didn’t prove a link between the vaccines and autism. The three released more than 600 pages of findings after reviewing these test cases.

Hopefully, this court ruling will put to rest the persisting delusion that some have that vaccines are associated with autism. Whether it’s the MMR vaccine or the vaccine preservative, thiomersol, there is no compelling reason to believe that either are causing the increasing numbers of kids with autism or autism spectrum disorders (ASD).

The New York Times reported, “In a further blow to the antivaccine movement, three judges ruled Friday in three separate cases that thimerosal, a preservative containing mercury, does not cause autism.”

The rulings “are the second step in the Omnibus Autism Proceeding begun in 2002 in the United States Court of Federal Claims,” which “combines the cases of 5,000 families with autistic children seeking compensation from the federal vaccine injury fund.”

The fund pays “families of children hurt by vaccines,” but it “has never accepted that vaccines cause autism.”

The Los Angeles Times reported, “The cases that three judges, called special masters, chose to rule on as test cases were considered among the strongest, so the outlook appears grim for others making the same claim.”

Special Master Denise K. Vowell wrote that “petitioners propose effects from mercury in [vaccines] that do not resemble mercury’s known effects in the brain, either behaviorally or at the cellular level.”

Although Special Master George Hastings was sympathetic with one of the families and believed they brought their claim in good faith, he found “the opinions provided by the petitioners’ experts in this case, advising the … family that there is a causal connection between thimerosal-containing vaccines and Jordan’s autism, have been quite wrong.”

“The cases had been divided into three theories about a vaccine-autism relationship for the court to consider,” the AP reported. The court previously “rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine,” and “a theory that certain vaccines alone cause autism.”

Although, Friday’s “ruling doesn’t necessarily mean an end to the dispute … with appeals to other courts available,” hopefully this will allow physicians, researchers, parents, and child activists to work together to find the real cause(s) of autism, and quit chasing our tails over a theory that no longer holds water or credibility.

You can read some of my blogs on autism here:

Nearly One-Third of Doctors Could Leave Medicine if Health-Care Reform Bill Passes

What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.

The Medicus Firm has announced some astounding data from a recent national survey of physicians. Simply put, if the data are accurate, the passage of health reform as outlined in the current legislations may lead to a significant reduction in the physician workforce.

Meanwhile, nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.

The Medicus Firm, a leading physician search and consulting firm based in Atlanta and Dallas, found that a majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.

The results from the Medicus Firm survey, entitled “Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,” were intriguing, particularly in light of the most recently published career projections from the Bureau of Labor Statistics (BLS).

The BLS predicts a more than a 22 percent increase in physician jobs during the ten-year period ending in 2018. This places physician careers in the top 20 fastest-growing occupations from 2008 to 2018.

“What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer,” said Steve Marsh, managing partner at The Medicus Firm in Dallas. “The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.” Here are more details from the report:

It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system. Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients’ access to medical care while the objective is to improve access.
Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed.
Skeptics may suspect that physicians exaggerate their intent to leave medicine due to health reform. Some experts point to the malpractice crisis of years ago, when many doctors also expressed a desire to leave medicine. Some did quit; many did not. However, health reform could be the proverbial “last straw” for physicians who are already demoralized, overloaded, and discouraged by multiple issues, combining to form the perfect storm of high malpractice insurance costs, decreasing reimbursements, increasing student loan debt, and more.
Do physicians feel that health reform is necessary? The survey indicates that doctors do want change. Only a very small portion of respondents — about four percent — feel that no reform is needed. However, only 28.7 percent of physicians responded in favor of a public option as part of health reform. Additionally, an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform, as opposed to one sweeping overhaul. Primary care, which is already experiencing significant shortages by many accounts, could stand to be the most affected, based on the survey. About 25 percent of respondents were primary care physicians (defined as internal medicine and family medicine in this case), and of those, 46 percent indicated that they would leave medicine — or try to leave medicine — as a result of health reform.
Why would physicians want to leave medicine in the wake of health reform? The survey results, as seen in Market Watch, indicate that many physicians worry that reform could result in a significant decline in the overall quality of medical care nationwide.
Additionally, many physicians feel that health reform will cause income to decrease, while workload will increase. Forty-one percent of respondents feel that income and practice revenue will “decline or worsen dramatically” as a result of health reform with a public option, and 31 percent feel that a public option will cause income and practice revenue to “decline or worsen somewhat” as a result. This makes for a total of 72 percent of respondents who feel there would be a negative impact on income. When asked the same question regarding health reform implemented without a public option, a total of 50 percent of respondents feel that income and practice revenue will be negatively impacted, including 14 percent of total respondents who feel that income and practice revenue will “decline or worsen dramatically.” Additionally, 36 percent feel it would “decline or worsen somewhat.”
What do physicians propose for effective health reform? In the survey, physicians were prompted to provide ideas, and some common themes emerged among the hundreds of comments. Tort reform appeared repeatedly, as did patient responsibility and ownership in their health care and costs. Additionally, many physicians emphasized a need for addressing specific issues with separate legislation, as opposed to one sweeping, comprehensive bill.
What does this mean for physician recruiting? It’s difficult to predict with absolute certainty, but one consequence is inevitable. After health reform is passed and implemented, physicians will be more in demand than ever before. Shortages could be exacerbated further beyond the predictions of industry analysts. Therefore, the strongest physician recruiters and firms will be in demand. Additionally, hospitals and practices may be forced to rely on unprecedented recruitment methods to attract and retain physicians. “Health reform, even if it’s passed in a most diluted form, could be a game-changer for physician recruitment,” said Bob Collins, managing partner of The Medicus Firm in Texas. “As competitive as the market is now, we may not even be able to comprehend how challenging it will become after health reform takes effect.”
The survey sample was randomly selected from a physician database of thousands. The database has been built over the past eight years by The Medicus Firm (formerly Medicus Partners and The MD Firm) from a variety of sources including, but not limited to, public directories, purchased lists, practice inquiries, training programs, and direct mail responses. The survey was conducted via emails sent directly to physicians.

It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system.

Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients’ access to medical care while the objective is to improve access.

Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed.

Skeptics may suspect that physicians exaggerate their intent to leave medicine due to health reform.

Some experts point to the malpractice crisis of years ago, when many doctors also expressed a desire to leave medicine. Some did quit; many did not.

However, health reform could be the proverbial “last straw” for physicians who are already demoralized, overloaded, and discouraged by multiple issues, combining to form the perfect storm of high malpractice insurance costs, decreasing reimbursements, increasing student loan debt, and more.

Do physicians feel that health reform is necessary?

The survey indicates that doctors do want change. Only a very small portion of respondents — about four percent — feel that no reform is needed.

However, only 28.7 percent of physicians responded in favor of a public option as part of health reform.

Additionally, an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform, as opposed to one sweeping overhaul.

Primary care, which is already experiencing significant shortages by many accounts, could stand to be the most affected, based on the survey. About 25 percent of respondents were primary care physicians (defined as internal medicine and family medicine in this case), and of those, 46 percent indicated that they would leave medicine — or try to leave medicine — as a result of health reform.

What do physicians propose for effective health reform?

In the survey, physicians were prompted to provide ideas, and some common themes emerged among the hundreds of comments. Tort reform appeared repeatedly, as did patient responsibility and ownership in their health care and costs.

Additionally, many physicians emphasized a need for addressing specific issues with separate legislation, as opposed to one sweeping, comprehensive bill.

Why would physicians want to leave medicine in the wake of health reform?

The survey results, as seen in Market Watch, indicate that many physicians worry that reform could result in a significant decline in the overall quality of medical care nationwide.

Additionally, many physicians feel that health reform will cause income to decrease, while workload will increase.

Forty-one percent of respondents feel that income and practice revenue will “decline or worsen dramatically” as a result of health reform with a public option, and 31 percent feel that a public option will cause income and practice revenue to “decline or worsen somewhat” as a result.

This makes for a total of 72 percent of respondents who feel there would be a negative impact on income.

When asked the same question regarding health reform implemented without a public option, a total of 50 percent of respondents feel that income and practice revenue will be negatively impacted, including 14 percent of total respondents who feel that income and practice revenue will “decline or worsen dramatically.”

Additionally, 36 percent feel it would “decline or worsen somewhat.”

So, the vote on Sunday is an even bigger deal than many of us realized. As for me, I’ll be praying for wisdom for our leaders in Congress.

BTW, here are some details about how the data were collected: The survey sample was randomly selected from a physician database of thousands. The database has been built over the past eight years by The Medicus Firm (formerly Medicus Partners and The MD Firm) from a variety of sources including, but not limited to, public directories, purchased lists, practice inquiries, training programs, and direct mail responses. The survey was conducted via emails sent directly to physicians.

Expert calls for an end to inappropriate use of PSA screening

Each year some 30 million American men undergo testing for prostate-specific antigen (PSA), an enzyme made by the prostate. Approved by the Food and Drug Administration in 1994, the P.S.A. test is the most commonly used tool for detecting prostate cancer along with a digital rectal exam (DRE — note, the two should ALWAYS be done together for prostate cancer screening).

In an op-ed in the New York Times, Richard J. Ablin, a research professor of immunobiology and pathology at the University of Arizona College of Medicine and the president of the Robert Benjamin Ablin Foundation for Cancer Research, writes, “The test’s popularity has led to a hugely expensive public health disaster.”

He goes on to write, “As Congress searches for ways to cut costs in our healthcare system, a significant savings could come from changing the way [prostate-specific antigen] is used to screen for prostate cancer.”

Ablin notes that the test “can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer.” But, although “the medical community is slowly turning against PSA screening,” drugmakers “continue peddling the tests and advocacy groups push ‘prostate cancer awareness.'”

Ablin urges the medical community to “confront reality and stop the inappropriate use of PSA screening.”

Although it may eventually come to this, I’m choosing to follow the American Cancer Society Guidelines that suggest I sit down, present my patients with their choices and the risks, benefits, and costs of each. I’m finding most are more than capable of making their own decision.

To explore two sides of this debate, read Benefits of PSA Test Are Exaggerated and PSA Cancer Screening, Much Like a Seat Belt, Is a Wise Choice for Men.

Also see my blog New guidelines say physicians should educate men on risks and benefits of PSA testing.

New guidelines say physicians should educate men on risks and benefits of PSA testing

New guidelines say physicians should educate men on risks and benefits of PSA testing

On an edition of ABC World News recently, Dr. Richard Besser reported that “there’s a big change in store” for prostate cancer screening. He went on to say, “Since 1997, the American Cancer Society (ACS) … hasn’t routinely recommended the PSA test, but most doctors have done it. Now they’re saying you need to have a conversation between you and your doctor before that test is done.”

The Los Angeles Times reports, “New (ACS) guidelines … emphasize that physicians should better educate men about both the risks and benefits of using the PSA test for screening.” The ACS “also urged greater use of education specialists, pamphlets, videos, and other materials.”

The AP reported that the ACS “wants doctors to talk to men and give them plenty of information before they have a PSA test to make sure they understand its limits.”

The new guidelines follow recent findings that the “PSA test may lead to unnecessary treatment for many men,” because “the test can’t clearly indicate whether a cancer is aggressive or harmless.”

PSA blood tests can “lead to false readings that require additional tests and biopsies … said” lead author Andrew Wolf, a physician at the University of Virginia, Bloomberg News reports. “If patients do choose to be screened with PSA blood tests, those with low levels can safely be screened every other year instead of every year as suggested previously, according to the new recommendations.”

The Houston Chronicle reports that “the guidelines also urge doctors to … make the digital rectal exam an option rather than using it as a standard screening tool” and to “base the frequency of PSA testing on previous scores.”

And, although the ACS does not “call for eliminating mass screening events,” the group recommends including “high-quality information upfront of screening’s potential risks.”

So, what are most men in my practice who are age 50 and over choosing? Most are choosing to have the PSA blood test (which should ALWAYS be done with a digital rectal exam). But, they are more informed than in the past of the potential risks of doing so.

To explore two sides of that debate, read Benefits of PSA Test Are Exaggerated and PSA Cancer Screening, Much Like a Seat Belt, Is a Wise Choice for Men.

New report questions effectiveness of Saw Palmetto for prostate health

According to a new report by the Natural Medicines Comprehensive Database (NMCD), saw palmetto might not be as effective as we used to think for reducing symptoms of benign prostatic hyperplasia (BPH). Many men take saw palmetto to decrease urinary symptoms associated with BPH.

Several clinical trials have shown that it is modestly effective for this use, and some studies suggest that it can be as effective as finasteride (Proscar) or tamsulosin (Flomax). But not all studies have been positive.

A 2009 meta-analysis suggests that saw palmetto might modestly reduce some measures of BPH symptoms such as nocturia, but does not significantly reduce other measures of BPH symptoms including peak urine flow.

The reason for different study results is unclear. But it might be due to different study designs or different saw palmetto products used in the studies.

The bottom line is that saw palmetto might offer modest benefit for some men with BPH symptoms. Other men may experience no benefit. However, saw palmetto is well-tolerated and safe.

NMCD says, “If a man wants to try saw palmetto, suggest taking 160 mg twice daily or 320 mg once daily of a product standardized to contain 80% to 90% fatty acids … such as ProstActive by Nature’s Way, Super Saw Palmetto by Enzymatic Therapy, or others.” However, if there is no noticeable benefit after a 1-2 month trial, it’s probably not going to help.

Obese children show signs of heart disease

Obese children as young as three years old show signs of future heart disease, say US researchers. In a study of 16,000 children and teenagers, researchers showed the most obese had signs of an inflammatory marker which can predict future heart disease. Here’s a report from the BBC:

In all, 40% of obese three-to-five-year olds had raised levels of C-reactive protein compared with 17% of healthy weight children, a study in the journal Pediatrics reported. But more work is needed to prove the link with heart disease in later life.

The study, carried out by a team at the University of North Carolina (UNC), looked at children aged one to 17. Overall, nearly 70% were a healthy weight, 15% were overweight, 11% were obese and 3.5% were very obese.

In the older age groups, the proportion of those in the very obese category with high levels of C-reactive protein (CRP) increased even further.

By age 15-17, 83% of the very obese had increased CRP compared with 18% of the healthy weight children. CRP is found in the blood, and high levels are a sign of inflammation in the body.

Because the damage seen in heart disease is caused by inflammation in artery walls, CRP can be used as a general marker for the risk of heart disease. In adults, studies have linked high levels with a future risk of heart attacks.

The researchers also looked at two other markers of inflammation in obese children and found levels were higher in one from the age of six and the other from the age of nine.

Study leader Dr Asheley Cockrell Skinner, an assistant professor of paediatrics at the UNC School of Medicine, said the findings were a surprise.

“We’re seeing a relationship between weight status and elevated inflammatory markers much earlier than we expected.”

Co-author Dr Eliana Perrin added: “In this study we were unable to tease apart whether the inflammation or the obesity came first, but one theory is that obesity leads to inflammation which then leads to heart and vessel disease later on.

“A lot more work needs to be done before we figure out the full implication of these findings.

“But this study tells us that very young, obese children already have more inflammation than children who are not obese, and that’s very concerning.”

Judy O’Sullivan, a cardiac nurse at the British Heart Foundation, said it was an interesting finding but whether inflammatory markers in children were related to an increased risk of heart disease later in life needed further research.

“Nevertheless, this study reinforces the importance of ensuring children maintain a healthy weight right from the start, to keep them healthy throughout their lives.

“Children should be encouraged to adopt a healthy lifestyle and as part of this, regular physical activity and a balanced diet should be viewed as vital components.”

So, what’s a family to do? What if you are your children are overweight or obese? How can you help your child get regular physical activity and a balanced diet? I have a number of resources to assist you:

  • My Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat.
    • You can order the book here,
    • read the Table of Contents here, or
    • read the first chapter here.
  • My SuperSized Kids Web site, that you can find here.
  • My SuperSized Kids assessment tool that will help you evaluate the activity and nutrition habits of your family. That assessment tool is available for free here.
  • My 8-Week Family Fitness Plan (SuperSized Kids 8-Week Plan), available for free,here.

Obese kids more likely to injure legs, ankles, feet

Obese kids’ injury patterns look different from those of their slimmer peers, a new study out in Pediatrics shows. According to a report in Reuters Health, Dr. Wendy J. Pomerantz of Cincinnati Children’s Hospital Medical Center, Ohio, and her colleagues reported that obese children had more leg, ankle and foot injuries, but fewer injuries to the head and face, than normal-weight children.

While the researchers had no information on how the children in their study were injured, they speculate that heavier kids may be more vulnerable to getting hurt while walking or running, while thinner kids may be more prone to engage in activities and sports that carry a risk of head injury.

Research has already shown that obesity increases children’s likelihood of getting hurt, and that heavy children take longer to recover from an injury, Pomerantz and her team write in their report. Injuries may also lead to more pain and disability among obese children than normal-weight kids, they add.

Obese adults have more sprains, strains and dislocations than normal weight adults, but fewer brain and internal organ injuries, the researchers note. To investigate whether injury patterns for obese and normal weight kids might also be different, they looked at records for all patients treated at their center’s pediatric emergency room from January 2005 to March 2008.

Adquate information was available for more than 23,000 children 3 to 14 years old, about one in six of whom were obese.

The pattern of injuries to the upper extremities was similar for the obese and non-obese children. But lower extremity injuries were nearly twice as common for the obese children compared to the normal-weight kids – about 30 percent, compared to about 18 percent.

And obese children were about half as likely as normal weight children to sustain head or face injuries overall. About 10 percent of obese children suffered head injuries, for example, compared to more than 15 percent of normal weight children.

Sprains were more than twice as common among obese kids, while concussions and lacerations were significantly less frequent in the heavier children.

Pomerantz said she and her team are now trying to figure out the reasons for these differences so they can develop injury prevention strategies. For example, she explained, obese children may need different types of shoes and ankle supports when walking and running.

It’s important to ease obese children into exercise gradually, she added, to help protect them from getting hurt.

“Everybody says that obesity’s an epidemic, you should get the kids out there, eat right and exercise,” she said. “The question is, how do you get them to exercise without them getting injured?”

So, what’s a family to do? What if you are your children are overweight or obese? How can you get your kids to exercise more? I have a number of resources to assist you:

  • My Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat.
    • You can order the book here,
    • read the Table of Contents here, or
    • read the first chapter here.
  • My SuperSized Kids Web site, that you can find here.
  • My SuperSized Kids assessment tool that will help you evaluate the activity and nutrition habits of your family. That assessment tool is available for free here.
  • My 8-Week Family Fitness Plan (SuperSized Kids 8-Week Plan), available for free,here.

Kids pack on the calories with frequent, unhealthy snacks

Children today snack an average of three times a day, and they are mostly consuming sugary beverages, cookies, cake, candy, salty snacks and other high-calorie junk food, a new study shows. In fact, children are now consuming 168 more calories from snacks than kids did in 1977, new research shows.

The findings confirm previous studies that indicate snacking may have run amok in the USA, and it may be contributing to the rising rates of childhood obesity. USA Today reports:

“Today we think we need to be eating all the time, so we have snack foods available for our kids constantly,” says Barry Popkin, a nutrition professor at the University of North Carolina.

“Kids are not only snacking too often, but essentially the foods they are consuming represent almost completely unhealthy foods.”

He and his colleagues analyzed government data on the eating habits of more than 31,000 children, ages 2 to 18, from 1977 to 2006. Their findings, which are reported in the March Health Affairs, out today, show that children are consuming:

    • About 586 calories a day from snacks, compared with 418 calories from snacks in 1977.
    • An average of 2,111 calories for the entire day, up from 2,000 in 1977.
    • A greater percentage of their snack foods from sweetened beverages, juice, salty foods, candy and cereal than kids did in 1977.
    • A smaller percentage of their snacks from milk and other dairy products than kids in 1977.

Children today consume few whole fruits and vegetables as snacks, Popkin says: “They consume more french fries as snacks than healthy vegetables.”

About 98% of kids today snack, compared with 74% of kids in 1977. Popkin says snacks are important for toddlers and preschoolers because their stomachs are small and they need to keep their energy levels high.

Harry Balzer, vice president of the NPD Group, which does research on snacking, has a slightly different take on today’s snacking habits. He says his data show that kids do eat a lot of high-calorie junk foods but over the last 10 years “parents have been doing better and are cutting back on some of the high-calorie foods they are giving their children, ages 6 to 12, and serving them more fruit.”

So, what’s a family to do? What if you are your children are overweight or obese? I have a number of resources to assist you:

  • My Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat.
    • You can order the book here,
    • read the Table of Contents here, or
    • read the first chapter here.
  • My SuperSized Kids Web site, that you can find here.
  • My SuperSized Kids assessment tool that will help you evaluate the activity and nutrition habits of your family. That assessment tool is available for free here.
  • My 8-Week Family Fitness Plan (SuperSized Kids 8-Week Plan), available for free,here.

Child Obesity Rates Still Going Up

In my Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat, I predicted that if we did not stem the epidemic of childhood obesity, that our children could become the first generation in American history to have a shorter life expectancy than their parents.

Now, a number of studies in the March issue of Health Affairs are reporting that the prevalence of obesity has grown in recent years among children aged 10 to 17, and certain kids are being especially hard hit.

And one new study in Health Affairs points to a possible reason why: Kids are snacking on potato chips, candy, and other fattening foods an average of almost three times per day.

The findings are based on the U.S. National Survey of Children’s Health and found that the obesity rate grew from 14.8 percent in 2003 to 16.4 percent in 2007. But the percentage of children who are simply overweight actually dropped a small amount — from 15.7 percent to 15.3 percent.

“While combined overweight and obesity rates appear to be leveling off, our findings suggest a possible increase in the severity of the national childhood obesity epidemic, especially for certain subgroups of children and in certain states,” principal investigator Christina Bethell, director of the Child and Adolescent Health Measurement Initiative at Oregon Health & Science University, said in a news release from the the journal.

“Nationally, one in three children is overweight or obese, but even in the states where the epidemic appears least threatening, nearly one in four children is affected, and that rises as high as one in every two for some groups of children in some states.”

HON reports:

The study authors found that the highest rate of obesity and overweight combined was in Mississippi (44 percent) and lowest in Utah (23 percent). The rates for both conditions among poor children rose from 39.8 percent in 2003 to 44.8 percent in 2007; it was stable — at about 22 percent — among wealthier children and non-Hispanic children.

Obesity and overweight kids were more common in neighborhoods that lacked a park or recreation center, and in neighborhoods that parents didn’t perceive as safe.

Snacking patterns may also be playing a big role in the pediatric obesity epidemic, according to the second study. Researchers Barry Popkin and Carmen Piernas, of the University of North Carolina at Chapel Hill, looked at data on more than 31,000 American children from 1977 to 2006.

They found that in 1977-1978, 74 percent of children aged 2 to 18 said they snacked on foods outside of regular mealtime, but by 2003-2006 that number had jumped to 98 percent. The biggest jump occurred with salty treats such as crackers or potato chips, but candy was a favorite snack as well.

Overall, kids consumed 168 more calories from snack foods in 2003-2006 compared to 1977-1978, and the increase was greatest among the very young — those aged 2 to 6.

“Kids still eat three meals a day, but they’re also loading up on high-calorie junk food that contains little or no nutritional value during these snacks,” Popkin said in the news release.

He advised parents to limit snack-time to just once per day and turn to healthy alternatives such as apple slices, carrots and other fruits and vegetables.

So, what’s a family to do? What if you are your children are overweight or obese? I have a number of resources to assist you:
My Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat. You can order the book here, read the Table of Contents here, or read the first chapter here.
My SuperSized Kids Web site, that you can find here.
My SuperSized Kids assessment tool that will help you evaluate the activity and nutrition habits of your family. That assessment tool is available for free here.
My 8-Week Family Fitness Plan (SuperSized Kids 8-Week Plan), available for freehere.
So, what’s a family to do? What if you are your children are overweight or obese? I have a number of resources to assist you:
  • My Amazon.com best-selling book, SuperSized Kids: How to protect your child from the obesity threat.
    • You can order the book here,
    • read the Table of Contents here, or
    • read the first chapter here.
  • My SuperSized Kids Web site, that you can find here.
  • My SuperSized Kids assessment tool that will help you evaluate the activity and nutrition habits of your family. That assessment tool is available for free here.
  • My 8-Week Family Fitness Plan (SuperSized Kids 8-Week Plan), available for free, here.

Though unproven, 1 in 4 parents believes vaccines cause autism

The New York Times, in Vital Signs, reports that one in four parents “think some vaccines cause autism in healthy children, and nearly one in eight have refused at least one recommended vaccine,” according to a study published online March 1 in the journal Pediatrics.

The USA covered the story with this article:

Most parents continue to follow the advice of their children’s doctors, according to a study based on a survey of 1,552 parents. Extensive research has found no connection between autism and vaccines.

“Nine out of 10 parents believe that vaccination is a good way to prevent diseases for their children,” said lead author Dr. Gary Freed of the University of Michigan. “Luckily their concerns don’t outweigh their decision to get vaccines so their children can be protected from life-threatening illnesses.”

In 2008, unvaccinated school-age children contributed to measles outbreaks in California, Illinois, Washington, Arizona and New York, said Dr. Melinda Wharton of the U.S. Centers for Disease Control and Prevention. Thirteen percent of the 140 who got sick that year were hospitalized.

“It’s fortunate that everybody recovered,” Wharton said, noting that measles can be deadly. “If we don’t vaccinate, these diseases will come back.”

Fear of a vaccine-autism connection stems from a flawed and speculative 1998 study that recently was retracted by a British medical journal. The retraction came after a council that regulates Britain’s doctors ruled the study’s author acted dishonestly and unethically.

The new study is based on a University of Michigan survey of parents a year ago, long before the retraction of the 1998 study. However, much has been written about research that has failed to find a link between vaccines and autism. Mainstream advocacy groups like Autism Speaks strongly encourage parents to vaccinate their children.

“Now that it’s been shown to be an outright fraud, maybe it will convince more parents that this should not be a concern,” said Freed, whose study appears in the April issue of Pediatrics, released Monday.

Some doctors are taking a tough stand, asking vaccine-refusing parents to find other doctors and calling such parents “selfish.”

A statement from a group practice near Philadelphia outlines its doctors’ adamant support for government recommended vaccines and their belief that “vaccines do not cause autism or other developmental disabilities.”

“Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of other who do vaccinate their children … We feel such an attitude to be self-centered and unacceptable,” the statement says, urging those who “absolutely refuse” vaccines to find another physician.

“We call it the manifesto,” said Dr. Bradley Dyer of All Star Pediatrics in Lionville, Pa.

Dozens of doctors have asked to distribute the statement, Dyer said, and only a handful of parents have taken their children elsewhere.

“Parents have said, ‘Thank you for saying that. We feel much better about it,'” Dyer said.

The new study is based on an online survey of parents with children 17 and younger. It used a sample from a randomly selected pool of nationally representative participants. Households were given Internet access if they didn’t already have it to make sure families of all incomes were included. Vaccines weren’t mentioned in the survey invitation and vaccine questions were among others on unrelated topics.

Twenty-five% of the parents said they agreed “some vaccines cause autism in healthy children.” Among mothers, 29% agreed with that statement; among fathers, it was 17%.

Nearly 12% of the parents said they’d refused a vaccine for their children that a doctor recommended. Of those, 56% said they’d refused the relatively new vaccine against human papillomavirus, or HPV, which can cause cervical cancer. Others refused vaccines against meningococcal disease (32%), chickenpox (32%) and measles-mumps-rubella (18%).

Parents who refused the HPV vaccine, recommended for girls since 2006, cited various reasons.

Parents who refused the MMR vaccine, the shot most feared for its spurious autism link, said they’d read or heard about problems with it or felt its risks were too great.

The findings will help doctors craft better ways to talk with parents, said Dr. Gary S. Marshall of the University of Louisville School of Medicine and author of a vaccine handbook for doctors.

“For our children’s sake, we have to think like scientists,” said Marshall, who was not involved in the new study. “We need to do a better job presenting the data so parents understand how scientists have reached this conclusion that vaccines don’t cause autism.”

U.S. study clears measles vaccine of autism link
Does the MMR vaccine cause autism? A redux
Special court rules against families who claim vaccines caused autism
Vaccine Myth #1: Vaccines Cause Autism
You can read some of my blogs on autism here:

Survey Shows Parents Still Worry Unnecessarily About Vaccines

Most parents believe vaccination is a good way to protect their children from potentially deadly diseases, but a study shows more than half still worry about the possibility of vaccine side effects. The study concludes: Although parents overwhelmingly share the belief that vaccines are a good way to protect their children from disease, these same parents express concerns regarding the potential adverse effects and especially seem to question the safety of newer vaccines. Although information is available to address many vaccine safety concerns, such information is not reaching many parents in an effective or convincing manner.

Here’s an article on the survey from WebMD:

The study shows 88% of parents follow the child immunization schedule recommended by their doctor, but 54% are concerned about serious vaccine side effects.

Researcher Gary L. Freed, MD, MPH of the department of pediatrics and communicable diseases at the University of Michigan in Ann Arbor, and his colleagues say parents who are concerned about vaccine side effects are less likely to vaccinate their children. In fact, the study showed one in every eight parents has refused at least one vaccine recommended by their child’s physician.

Newer vaccines, such as varicella, meningococcal conjugate, and HPV (human papillomavirus) were more likely to be refused than older vaccines like the MMR (measles, mumps, rubella vaccine).

In the study, researchers surveyed 1,552 parents about their attitudes regarding vaccines. Overall, 90% of parents said vaccines were a good way to protect their children from disease, and 88% said they generally do what their doctors say regarding vaccination.

However, the results show that despite a lack of scientific evidence supporting a link between autism and vaccinations, more than one in five parents continue to believe that some vaccines cause autism in healthy children.

Women were more likely than men to believe some vaccines cause autism, to be concerned about vaccine side effects, and to have ever refused a vaccine recommended for their children by a doctor.

The study also showed that Hispanic parents were more likely than white or African-American parents to say they followed their doctor’s recommended immunization schedule and less likely to have ever refused a vaccine. But Hispanic parents were also more likely to believe in a link between autism and vaccinations and be concerned about vaccine side effects.

“Although information is available to address many vaccine safety concerns, such information is not reaching parents in an effective or convincing manner,” write the researchers. “Continued high childhood immunization rates will be at risk if current safety concerns are not addressed effectively and increase in the future, resulting in more parents refusing vaccines.”

You can read more about vaccine myths in my book God’s Design for the Highly Healthy Child.

Here are other blogs in this series you might find useful:

Parents Often Miss Subtle Autism Signs

Action Points
Explain to interested parents that autism may progress more slowly and subtly than previously thought.
Note that parents often miss regressive symptoms of autism in their children.
The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.
At six months, children with autism spectrum disorder demonstrated behavior similar to other children, gazing at faces, sharing smiles, and vocalizing with similar frequency, researchers reported online in the Journal of the American Academy of Child & Adolescent Psychiatry.
However, autistic children displayed fewer of these behaviors as as they got older, and from six months to 18 months the loss of social communication and skills typically became clear.
While doctors typically caught early signs of autism, the declines were more subtle than previously suggested and most parents (83%) did not report regression in the social behaviors and skills.
“These findings lead us to two major conclusions,” Sally Ozonoff, PhD, of University of California Davis Health System in Sacramento, and colleagues wrote.
“First, the behavioral symptoms of autism spectrum disorder appear to emerge over time, beginning in the second half of the first year of life and continuing to develop for several years.
“Second, our most widely used and recommended practice for gathering information about symptom onset, parent-provided developmental history, does not provide a valid assessment of the slow decline in social communication that can be observed prospectively.”
Autism is thought to emerge in two ways: an early onset pattern and a regressive pattern.
A majority of autistic children are thought to experience the early onset pattern, showing clear signs of the disease in the second year of life but in some cases showing signs before the first birthday.
Those with the regressive pattern are thought to develop normally for the first year of life, then begin losing communications and social skills.
However, most previous studies have been retrospective in design, and some children don’t appear to fit either of the typical patterns, bringing into question the validity of this two-pronged model of onset.
More recently, a third category has been suggested, in which children develop normally and then seem to hit a developmental plateau, but not regress.
In an accompanying editorial, Tony Charman, PhD, of the Institute of Education in London, wrote that the design of the new study heralds a new wave of descriptive developmental studies of autism, or features of autism, in infants and toddlers.
“Previously, the only source of information we had about infancy and toddlerhood of children with autism was retrospective reports from parents at the age of diagnosis (often years after the onset),” he wrote.
“Parental report of early history and development still is an important component of the autism diagnostic evaluation. However, the retrospective parental informant biases, particularly through the lens of autism, might lead both to over- and underestimation of atypical features.”
Ozonoff and colleagues conducted a long-term prospective study that compared 25 high-risk infants later diagnosed with an autism spectrum disorder with 25 gender-matched, low-risk children later determined to have typical development.
The children were recruited for the study at University of California Davis and University of California Los Angeles. The high-risk children were identified based on having a sibling who had already developed autism.
The children were evaluated at 6, 12, 18, 24 and 36 months of age for frequencies of gaze to faces, social smiles, and directed vocalizations, which were were coded from video and rated by examiners.
“The results of the current prospective study suggest that the traditionally defined categories of early onset and regressive autism do not portray accurately how symptoms emerge, nor does the newer-onset category involving a developmental plateau,” the authors wrote.
They found that specific social communicative behaviors clearly decreased, rather than failing to progress, as previously thought, with losses especially dramatic between 6 and 18 months.
They concluded that this suggests onset of autism spectrum disorder, marked by loss of social communication behaviors, occurs much more often than has been recognized using parent report methods.
However, rather than the rapid and marked losses typically reported, they saw relatively subtle and gradual declines, which were often preceded by earlier parental concerns and often followed by failures to progress in other areas.
“We urge professionals to refer to intervention any infant or toddler who displays a sustained reduction in social responsivity over time,” they wrote.
“Given the gradual course of symptom emergence and the paucity of diagnostic tools for infants and toddlers with suspected autism, the diagnostic process can be quite protracted and intervention may be needlessly delayed.”

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills. However, according to a new study, these changes may be both more common and more subtle than previously thought. Here are the details from an article in MedPage Today:

At six months, children with autism spectrum disorder (ASD) demonstrated behavior similar to other children, gazing at faces, sharing smiles, and vocalizing with similar frequency, researchers reported online in the Journal of the American Academy of Child & Adolescent Psychiatry.

However, autistic children displayed fewer of these behaviors as as they got older, and from six months to 18 months the loss of social communication and skills typically became clear.

While doctors typically caught early signs of autism, the declines were more subtle than previously suggested and most parents (83%) did not report regression in the social behaviors and skills.

These findings have lead the researchers to two major conclusions:

  • First, the behavioral symptoms of autism spectrum disorder appear to emerge over time, beginning in the second half of the first year of life and continuing to develop for several years.
  • Second, our most widely used and recommended practice for gathering information about symptom onset, parent-provided developmental history, does not provide a valid assessment of the slow decline in social communication that can be observed prospectively.

The bottom line is this: autism may progress more slowly and subtly than previously thought and parents often miss regressive symptoms of autism in their children.

MedPate Today explains:

Autism is thought to emerge in two ways: an early onset pattern and a regressive pattern.

A majority of autistic children are thought to experience the early onset pattern, showing clear signs of the disease in the second year of life but in some cases showing signs before the first birthday.

Those with the regressive pattern are thought to develop normally for the first year of life, then begin losing communications and social skills.

However, most previous studies have been retrospective in design, and some children don’t appear to fit either of the typical patterns, bringing into question the validity of this two-pronged model of onset.

More recently, a third category has been suggested, in which children develop normally and then seem to hit a developmental plateau, but not regress.

What does this mean for doctors and parents? First of all, early diagnosis of autism and ASD is incredibly beneficial. Simply put, it leads to early treatment which is enormously helpful to the child and the family.

Therefore, more than ever, parents and physicians who care for young children will have to carefully address developmental and social milestones in each child at each visit. If there are ANY concerns in the eyes of the parent or the physician, a careful evaluation (a second opinion) by a specialist in child behavior and development would be indicated. And, the earlier, the better.

You can read some of my blogs on autism here:

Kitchens, Bathrooms No Place to Store Vitamins or Medications

The Los Angeles Times “Booster Shots” blog reported that keeping vitamin C supplements in the bathroom or kitchen may expose them to “humidity and high temperatures” that “may seriously degrade” them, according to a study published online in the Journal of Agricultural and Food Chemistry.

After observing “the stability of two types of vitamin C — sodium ascorbate and ascorbic acid, both also used as food additives — under a variety of humidity and temperature states,” food scientists discovered that “humidity and temperature caused degradation in both forms.” In fact, storing vitamin C above a certain humidity level made the vitamin more unstable under higher temperatures.

The UK’s Daily Mail quotes a study author saying that the degraded supplements are “not necessarily unsafe … but why take a vitamin if it doesn’t have the vitamin content you’re hoping to get?”

The bottom line, be sure to store your medications (whether prescription, OTC, vitamins, herbs, or supplements) in a dry, cool, dark environment — and, usually, this is NOT the kitchen or bathroom in most areas. One exception might be environments that have very low relative humidity most of the year.

According to a review of the study in USA Today, “The kitchen or bathroom may be the worst place in the house to store your vitamins.” Here’s the full article:

A new study shows high humidity and temperatures, such as those found in the bathroom and kitchen, can quickly degrade the potency of vitamin C and shorten the shelf life of vitamin supplements — even if the bottle cap is on tightly.

Researchers found the most common types of vitamin C used in vitamin supplements and other fortified products are prone to a process called deliquescence, in which humidity causes a water-soluble substance to dissolve.

“Opening and closing a package will change the atmosphere in it. If you open and close a package in a bathroom, you add a little bit of humidity and moisture each time,” researcher Lisa Mauer, associate professor of food science at Purdue University, says in a news release. “The humidity in your kitchen or bathroom can cycle up quite high, depending on how long of a shower you take, for example, and can get higher than 98%.”

“If you get some moisture present or ingredients dissolve, they’ll decrease the quality and shelf life of the product and decrease the nutrient delivery,” Mauer says. “Within a very short time — in a week — you can get complete loss of vitamin C in some products that have deliquesced.”

Powdered vitamin C is a popular ingredient for food fortification and is one of the most commonly added nutrients to vitamin supplements. Researchers say because vitamin C is very unstable and its content must be declared on nutrient labels, it is commonly used as an indication of the shelf life of foods and supplements.

For example, monitoring deterioration of vitamin C until it no longer meets its declared label value is one way to determine a product’s shelf life.

Researchers say temperature and water are the two most frequently cited factors affecting shelf life. But information on deterioration and shelf life of vitamin C is based on models in which temperature and relative humidity were varied at the same time.

In contrast, this study looked at how various changes in relative humidity and temperature, such as those found in a bathroom or kitchen, affect the deterioration of two common forms of powdered vitamin C, ascorbic acid and sodium ascorbate.

The results, published in the Journal of Agricultural and Food Chemistry, showed relative humidity had the largest impact on vitamin C degradation, and this effect was magnified at elevated storage temperatures.

The study showed that at room temperature, sodium ascorbate and ascorbic acid deliquesce at 86% and 98% humidity, respectively. Once the humidity or temperature level was brought back down, the product will solidify again, but researchers say the damage has already been done.

“Any chemical changes or degradation that have occurred before resolidification don’t reverse. You don’t regain a vitamin C content after the product resolidifies or is moved to a lower humidity,” Mauer says. “The chemical changes we’ve observed are not reversible.”

They say keeping vitamin supplements away from warm, humid environments is the first step to maintaining their effectiveness.

The first signs of nutrient degradation are usually brown spots, especially on children’s vitamins. Maurer recommends discarding any vitamin supplement that is showing signs of moisture in the container or browning.

“They’re not necessarily unsafe, but why give a vitamin to a kid if it doesn’t have the vitamin content you’re hoping to give them?” Mauer says. “You’re just giving them candy at that point with a high sugar content.”