Heading overseas? Here's how to avoid health troubles

Kristin Reinhardt still has the green pills in their original packaging, covered with Chinese characters, a souvenir from a 2004 trip to China that left her at the mercy of local medical practices after her travel party was struck with a stomach bug on a riverboat cruise. "I ended up with these Chinese herbs that flat out made me nervous," says the San Diego, California, resident.

If you're traveling overseas, you may need specific vaccines to protect you from diseases at your destination.

The concoction came not from a doctor but from a shop filled with mystifying medicinal ingredients such as dandelions and pearls. And the package had no English instructions on dosage, drug interactions, ingredients, or side effects. Fortunately for Reinhardt, the pills did not have any adverse effects. "Now when I travel I always make sure I take the medicine that I know," she says. "It was probably the one time I really needed Western medicine the most, or would have felt more reassured with it."

People focus mainly on their itineraries and flights when they travel outside the United States, but many forget about their health -- and that's where our expert tips come in. Here's what you need to know before you leave and remember while you're away.

BEFORE YOU GO

Don't let health risks surprise you

A visit to a travel-medicine clinic will give you a heads up about what to expect when you reach your destination; the doctor there can provide country-specific information and immunizations, says Gonzalo Ballon-Lando, M.D., infectious disease specialist at Scripps Mercy Hospital in San Diego. "Occasionally people will cancel their plans because they don't want to take the risk of the diseases they might be exposed to," he says. Health.com: Secrets to a stress-free vacation

Get vaccine savvy

Besides standard stateside immunizations, such as tetanus and hepatitis A and B shots, you may need other vaccines to protect you from diseases found at your destination. The Centers for Disease Control and Prevention Traveler's Health Web site has information about suggested immunizations and up-to-date health advisories for every region of the world. Also, allow at least six to eight weeks for vaccinations, if necessary, recommends Michael Zimring, M.D., director of the Center of Wilderness and Travel Medicine at Mercy Medical Center in Baltimore, Maryland, and author of "Healthy Travel: Don't Travel Without It."

Pack for any possibility

Women risk developing urinary tract infections, especially when traveling in areas with few bathrooms, says registered pharmacist Lisa M. Chavis, author of "Ask Your Pharmacist." She recommends packing Cystex ($7 to $10 for 40 tablets; at drugstores) for relief of UTI symptoms until a doctor can prescribe antibiotics. Also, experts stress that you need to take along these three travel necessities -- an antidiarrheal (such as Imodium), a basic pain reliever (Motrin, Tylenol, or Advil), and sunscreen. Other recommendations:

Your Health Tools

CDC: Traveler's health

Healthology: Health Video Library

MayoClinic.com: Health Library

• Lotion with aloe for sunburn. Use a formula with lidocaine (such as Banana Boat Sooth-A-Caine Spray Gel; about $6 at drugstores) that will help stop pain, Chavis says.

• Insect repellent. Have it on hand to keep disease-transmitting mosquitoes (think: malaria and dengue fever) at bay.

• Prescription medications. Bring enough to last for the duration of your trip.

• Allergy meds. Take along antihistamines or an EpiPen for emergencies.

WHILE YOU'RE THERE

Stay hydrated

Airplanes are notorious for transmitting germs through recirculated air, but that's not the only issue with the air up there: Dry air in planes can sneakily cause dehydration for even a vigilant traveler. Also, avoid diuretics or substances that strip water from the body. "On a plane, avoid alcohol and caffeine, and drink a lot of water," Zimring says. Health.com: Ready, set, get out of town

Watch what you eat -- and drink

Sip a lot of water to stay hydrated, but be mindful of the water quality overseas: Waterborne E. coli and Salmonella are quick tickets to nasty cases of traveler's diarrhea. Also, drink bottled water overseas -- but only if the bottle's seal is intact, Zimring cautions. Make sure it hasn't been refilled with local water. "Sometimes you're better off with seltzer water because those bottles are harder to fill," he adds. Avoiding local water means carefully watching what foods you eat, too; raw fruits or vegetables may have been washed in unfiltered water. "The best way to avoid food poisoning is to eat food that has been totally cooked or that is served hot," Ballon-Lando says. Health.com: Stay fit on vacation

Listen to your body

Finally, take time to rest. It's a vacation, after all, so go easy. "People overdo it a lot while they're on vacation -- they walk a lot, they carry heavy bags," Chavis says. Same goes for eating: Easing into new menus will help you adjust. "Because it's your holiday, you might have a tendency to eat or drink too much, or to sample a little bit of everything." Your best bet is to introduce new things slowly and avoid overconsumption.

Five breast-feeding mistakes new moms make, and how to fix them

When Erika Clowes was pregnant, she figured breast-feeding would be a breeze. After all, she'd read all the books and taken all the classes. After an easy birth, she brought home her baby, Charlie, and waited for paradise to begin.

The bagged breast milk filling Erika Clowes' freezer is evidence of how nursing dominates a new mom's life.

But instead, it was a nightmare.

Charlie wouldn't latch onto her breast. She was in horrible pain. She had to wake up every two hours around the clock to pump milk and then feed it to Charlie from a bottle. He had colic and cried nearly all the time. She'd been so devoted to the idea of breast-feeding, but now felt like quitting.

"I felt betrayed and completely deceived, because nobody told me it would be this hard," she says. "It was the darkest time of my life."

Clowes almost became a statistic.

According to new numbers from the Centers for Disease Control and Prevention, 74 percent of mothers try breast-feeding, but after three months only 30 percent still exclusively nurse their babies. After six months, the number dwindled to 11 percent. Take our interactive quiz to see how much you know about breastfeeding »

The study didn't track the reasons the women quit nursing, but experts including Los Angeles, California, lactation consultant Corky Harvey said many women have a hard time nursing and don't know where to turn for help. She says one common reason for quitting is that women mistakenly think they don't have enough milk and decide to give the baby formula. Other women quit nursing when they go back to work, and others stop because family members encourage them to give bottles instead of breast milk.

What kept Clowes from giving up was the "Booby Brigade."

Don't Miss

• CDC: More moms nurse, turn to formula too soon

In the middle of the sleep deprivation, hormone rages, and feelings of failure, Clowes figured she had to do something. So she started the Booby Brigade, a group of new mothers near her home in Silver Lake, California, who met online and in person to give each other breast-feeding advice and support. With help from them, and occasionally from a lactation consultant, she was able to nurse Charlie consistently in about four months.

From Clowes, her lactation consultant, and another mother who started a support group, here are five breast-feeding mistakes new moms make, and how to fix them:

Mistake 1: Moms go it alone

Solution: Get out of the house -- fast

Clowes was reluctant to join -- let alone start -- a support group. "I hate that kind of thing," she says. But she did so out of desperation, and found the technical advice (how to latch on, how to deal with nipple pain) and emotional support indispensable.

Anthropologist Katherine Dettwyler, who studies breast-feeding, isn't surprised that women often fail at breast-feeding when they're left alone at home to raise a new baby. "Humans are very social creatures, and most of the world lives in extended families," says Dettwyler, an adjunct professor at the University of Delaware. "You have mothers and grandmothers around who knew everything about breast-feeding. You're not isolated at home for eight or 10 hours a day."

Your Health Tools

MayoClinic.com: Is my baby getting enough milk?

Healthology: Health Video Library

La Leche League USA www.lllusa.org

Advice from Ericka Clowes CrankyLittleMan.com

In addition to the Booby Brigade, Clowes joined a support group at The Pump Station, a local store that sells nursing pumps. La Leche League also has support groups. If you don't find a group, start your own, Clowes suggests. "I walked around my neighborhood and would just hand out a card with my name and phone number on it to other moms," Clowes says.

Mistake 2: Moms forget about their successful breast-feeding friends

Solution: Invite one over

While lactation consultants can be wonderful, they can also be expensive -- a visit from one in the Los Angeles area costs $200-$300 an hour, according to lactation consultant Harvey. Amanda Corbin, a mom who started a support group called "Got Milk?" in Tampa, Florida, says sometimes help can be free. She suggests inviting over a friend who's breast-fed successfully, and show her your attempts at nursing. It might be embarrassing to reveal all to your friend, Corbin says, but "we lay down our dignity during labor, so go ahead and lay down your dignity when it comes to the health of your baby."

Mistake 3: Moms assume they don't have enough milk

Solution: Rethink your baby's nursing behavior

Many times, new moms think if baby won't stop nursing, he must not be getting enough milk, so they give him formula. "Sometimes babies just nurse and nurse and nurse -- that's just what babies do," says Harvey. "It doesn't mean you don't have enough milk. It just means you should keep nursing."

Mistake 4: Moms get intimidated breast-feeding in public

Solution: Have snappy comebacks at the ready

Clowes says occasionally mothers in her group reported getting nasty comments when they've breast-fed in public. She suggests having a few retorts at the ready. On her Web site, crankylittleman.com, she has these two suggestions: "If you're uncomfortable seeing my baby eat, you are welcome to cover yourself with this baby blanket. I'll let you know when we're done," and "You think this is something? You oughtta see where he came out!"

Mistake 5: Moms panic when milk doesn't gush out Solution: Realize that at the very beginning, you're not going to see a lot of milk

Endocrine role for skeleton Bone cell protein regulates insulin, says new study

The skeleton functions as a part of the endocrine system and plays a role in regulating energy metabolism in the body, according to a study published this week in Cell.

"It's a sparkling observation," said Jake Kushner of the University of Pennsylvania in Philadelphia, who was not affiliated with the study. "The findings show that bone is an endocrine organ, and that it affects glucose homeostasis. This concept is totally novel."

The researchers showed that osteocalcin, a protein secreted by bone cells, regulates insulin production and insulin sensitivity in the body, answering a long-standing question about the protein's function. "Osteocalcin has been the flagship molecule of the bone field for decades," said Gerard Karsenty of the Columbia University Medical Center, the study's lead author. "It's the only molecule uniquely secreted by osteoblasts, but no one has been able to show what role it plays in the body."

Karsenty and colleagues first engineered osteocalcin knockout mice ten years ago. They noted that the mice were fatter than normal, but did not measure changes in blood sugar or other markers of energy metabolism.

In the current study, the researchers examined osteocalcin knockouts more closely. Despite being fed a normal diet, osteocalcin deficient mice had increased glucose levels and decreased insulin sensitivity, and developed type II diabetes. Mice engineered to produce excessive osteocalcin showed the opposite characteristics -- namely increased insulin production and greater insulin sensitivity.

In vitro studies confirmed that osteocalcin stimulates beta cells to produce insulin and promotes the growth of new beta cells in the pancreas. The researchers also found that osteocalcin signals fat cells to produce adiponectin, a metabolic hormone that regulates insulin sensitivity.

"That skeletal osteoblasts might now be involved in regulating glucose metabolism should lead to better understanding of diabetes, obesity, and energy metabolism," said Peter Hauschka of Harvard Medical School, who was not a co-author on the study.

The researchers' earlier work showed that leptin, a hormone secreted by fat tissue, inhibits bone formation. While mice lacking leptin are extremely obese, they are also protected against osteoporosis. The finding demonstrated that fat tissue signals bone, but no one has been able to show that bone cells talk back.

Because bone destroys and replaces itself every day -- a high energy process known as bone remodeling-it makes sense that the body's skeletal system must communicate with fatty energy preserves, said Karsenty. "If fat speaks to bone, bone must speak to fat," he said. "The surprise was finding that osteocalcin is the messenger."

The molecular mechanisms underlying this communication remain unknown. While the gene responsible for indirectly increasing osteocalcin activity is known, researchers do not understand how the post translational product results in hormone increases. Similarly, how osteocalcin stimulates insulin producing cells in the pancreas is unclear. "The big question is, how does it all work," said Kushner. "How does this bone specific mechanism influence beta cells to grow?"

Further studies will also have to explain why osteocalcin involved in glucose regulation is slightly different from the version traditionally found in bone. "It is the non-carboxylated fraction of osteocalcin that appears to play a regulatory role," said Haushka "yet most osteocalcin in the bone matrix is carboxylated."

It's possible that carboxylation is only performed by the body to trap osteocalcin in the bone, and that uncarboxylated proteins are used for other purposes. Answering these questions will shed more light on the protein's physiologic role, said Haushka.

Amy Coombs
mail@the-scientist.com

Links within this article:

N.K. Lee et al., "Endocrine regulation of energy metabolism by the skeleton,"
Cell, July 10, 2007.
http://www.cell.com

Jake Kushner
http://www.med.upenn.edu/camb/faculty/cbp/kushner.html

J.B. Weitzman, "Shaping gene expression," The Scientist, February 20, 2002.
http://www.thescientist.com/article/display/20226/

A. Rinaldi, "Boning up on diabetes," The Scientist, June 23, 2003.
http://www.thescientist.com/article/display/21402/

Gerard Karsenty
http://cpmcnet.columbia.edu/dept/genetics/faculties/Karsenty.html

T. Toma, "The link between obesity and diabetes," The Scientist, January 19, 2001.
http://www.thescientist.com/article/display/19400/

K. Grens, "New beta cells without stem cells?," The Scientist, May 29, 2007.
http://www.thescientist.com/news/display/53256/

Peter Hauschka
http://www.childrenshospital.org/cfapps/research/data_admin/Site81/mainpageS81P0.html

E. Florent et al., "Leptin regulation of bone resorption by the sympathetic nervous system and CART," Nature, March 24, 2005.
http://www.the-scientist.com/pubmed/15724149

S.J. Olshansky et. al., "What if humans were designed to last?" The Scientist, March 1, 2007.
http://www.the-scientist.com/article/display/52872/

The GOP's Big Health Scare

Listening to the Republican candidates for president warn against "socialized medicine," you might believe that national health insurance is really a plot to institute Soviet rule in the United States. The most feverish rhetoric comes from Mitt Romney and Rudolph Giuliani, both hoping that their shrillness will prove that they are truly and deeply right wing — all while trying to avoid honest debate about the future of American health care.

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For Romney, health reform is double-edged: As the former governor of Massachusetts, he claims credit for that state's new universal care program — which he calls "fabulous" — but he fears being labeled liberal. His solution is simply to ignore the basic provisions of the legislation that he signed. "This is a country that can get all of our people insured with not a government takeover, without HillaryCare, without socialized medicine," he proclaimed during a Republican debate this past spring. "We didn't expand government programs."

Actually, his fabulous Bay State plan is based entirely on governmental action, from mandating insurance coverage and minimum coverage requirements to subsidizing insurance and imposing fines on those who fail to comply.

Perhaps Romney needs medical attention himself, since he already seems to be suffering from Alzheimer's disease. This isn't the first time his capacity to recall facts about his own career has dimmed out.

As for Giuliani, he, too, sees the frightening specter of foreign ideology in proposals for universal health care, which he denounced the other day as "socialist" schemes that "would bankrupt the government." According to him, Democrats are conspiring to impose the kind of care preferred by citizens across the industrialized world. "That is where Hillary Clinton, Barack Obama and John Edwards are taking you," he thundered. "You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care."

Giuliani's alternative is a retread of rejected Bush administration proposals, dressing up more tax cuts for the affluent as "health savings accounts." Knowing that this would do little to cover more than 45 million uninsured Americans, he also suggests a federal subsidy to help people buy insurance. But he won't say how he would pay for that plan.

Neither the Romney nor the Giuliani proposal would accomplish the modernization and reform that the nation needs, and neither would ever reach universal coverage. What they might achieve, however, is a multibillion-dollar giveaway of taxpayer funds to the insurance industry. In Massachusetts, the bids for subsidized coverage from major insurance companies are already much higher than Romney predicted, and many fewer uninsured have enrolled than he once expected.

An honest discussion of the American health care system would begin by recognizing that government plays an important role and will continue to do so. No candidate is proposing to do away with Medicare, Medicaid and the Veterans Administration. Despite their consistent underfunding, those systems achieve efficiencies that the private sector cannot match.

So when politicians decry health care in France, Britain, Canada and other industrialized countries as "socialist," they're insulting the intelligence of voters. They assume nobody here knows that voters in those capitalist nations overwhelmingly support the national health systems — which happen to spend far less money per capita than ours while providing more care. Even the most conservative politicians in Europe don't dare to suggest replacing those universal public systems with a system of expensive, privatized chaos such as ours.

While health care is a highly complex matter, the reason that other countries can afford to cover all of their citizens — while spending a smaller portion of their national income than we do — is fairly simple. As a study by Physicians for A National Health Program revealed, more than 30 percent of health care costs in the United States represent profits and paperwork. Roughly 20 percent goes to insurance companies alone, which burn enormous amounts of money finding ways to deny care to their policyholders. Remember that every hospital and doctor must cope simultaneously with the demands of numerous insurance companies. The result is an ongoing nightmare of corporate bureaucracy and paper-shuffling waste.

Americans have endured the excessive costs, skewed priorities and terrible inefficiencies of our outmoded health care system for decades while other advanced nations surpassed us. Now our basic industries and our future solvency are threatened by our failure to address this problem realistically and fairly. We need reforms that encourage preventive care, wring out bureaucratic waste, utilize information technology and guarantee the security of every citizen. Scary talk about socialism won't get us there.

UK's Brown says foot and mouth held to limited area

The entrance of the Institute for Animal Health laboratory is seen in Pirbright, near Guildford, southern England August 9, 2007. Health officials said on Thursday they were probing a suspected case of legionnaire's disease contracted by a person who had spent time at a laboratory at the centre of a foot and mouth disease outbreak. REUTERS/Alessia Pierdomenico

LONDON (Reuters) - Prime Minister Gordon Brown reassured farmers on Friday that an outbreak of foot and mouth was restricted to a limited area of Britain and promised swift compensation for those hit by the livestock disease.

The highly infectious virus has been found on two farms in southern England, forcing more than 570 animals to be destroyed and prompting the European Union and other countries to slap a ban on British meat and dairy exports.

The government said tests for the disease on a third farm nearby had proven negative. The BBC said initial tests on cattle at a fourth farm outside the disease area had also been negative, though the government did not immediately confirm it.

"We have restricted the disease to a limited area of this country," Brown told reporters after a government emergency committee met to review progress in fighting the disease.

"The chief veterinary officer now believes the risk of it spreading outside these areas is low if not negligible."

However, Brown said a national ban on the movement of livestock would stay in place "until we are absolutely sure that we have contained and controlled the disease."

The movement ban was eased on Thursday to permit farmers outside the infected area to move animals only for slaughter.

Brown also promised swift compensation for farmers affected by the outbreak.

"We will extend the compensation beyond the statutory requirements to include cleanup costs and I hope that payments will be made in the coming days to all farmers in the infected areas who have suffered these losses," he said.

Farmers say the trade curbs are costing them 1.8 million pounds ($3.6 million) a day.

OPEN FOR BUSINESS

Pledging that Britain is "open for business," Brown promised a campaign to promote rural tourism and said he had ordered a study into boosting the rural economy.

A severe outbreak of foot and mouth disease in 2001 forced the slaughter of six million animals and inflicted billions of dollars of losses on farmers and the tourism industry as much of the countryside was closed to visitors.

British officials said earlier on Friday they were investigating the possibility that the disease had jumped to a farm in a new area, outside the surveillance zone, fuelling fears the disease could spread.

However, a vet who inspected calves at the farm was "absolutely sure" they did not have foot and mouth, farmer Laurence Matthews said.

The BBC reported initial tests found no foot and mouth, but experts were waiting for a second batch of results.

Britain's chief veterinary officer Debby Reynolds said an interim report on the outbreak found it was very likely the source of the infection was the Pirbright research centre, close to the farm where cattle were first infected, she said.

The site houses two foot and mouth laboratories -- one public and one, Merial, owned by U.S. firm Merck and French firm Sanofi-Aventis SA.

UK's Brown says foot and mouth held to limited area

The entrance of the Institute for Animal Health laboratory is seen in Pirbright, near Guildford, southern England August 9, 2007. Health officials said on Thursday they were probing a suspected case of legionnaire's disease contracted by a person who had spent time at a laboratory at the centre of a foot and mouth disease outbreak. REUTERS/Alessia Pierdomenico

LONDON (Reuters) - Prime Minister Gordon Brown reassured farmers on Friday that an outbreak of foot and mouth was restricted to a limited area of Britain and promised swift compensation for those hit by the livestock disease.

The highly infectious virus has been found on two farms in southern England, forcing more than 570 animals to be destroyed and prompting the European Union and other countries to slap a ban on British meat and dairy exports.

The government said tests for the disease on a third farm nearby had proven negative. The BBC said initial tests on cattle at a fourth farm outside the disease area had also been negative, though the government did not immediately confirm it.

"We have restricted the disease to a limited area of this country," Brown told reporters after a government emergency committee met to review progress in fighting the disease.

"The chief veterinary officer now believes the risk of it spreading outside these areas is low if not negligible."

However, Brown said a national ban on the movement of livestock would stay in place "until we are absolutely sure that we have contained and controlled the disease."

The movement ban was eased on Thursday to permit farmers outside the infected area to move animals only for slaughter.

Brown also promised swift compensation for farmers affected by the outbreak.

"We will extend the compensation beyond the statutory requirements to include cleanup costs and I hope that payments will be made in the coming days to all farmers in the infected areas who have suffered these losses," he said.

Farmers say the trade curbs are costing them 1.8 million pounds ($3.6 million) a day.

OPEN FOR BUSINESS

Pledging that Britain is "open for business," Brown promised a campaign to promote rural tourism and said he had ordered a study into boosting the rural economy.

A severe outbreak of foot and mouth disease in 2001 forced the slaughter of six million animals and inflicted billions of dollars of losses on farmers and the tourism industry as much of the countryside was closed to visitors.

British officials said earlier on Friday they were investigating the possibility that the disease had jumped to a farm in a new area, outside the surveillance zone, fuelling fears the disease could spread.

However, a vet who inspected calves at the farm was "absolutely sure" they did not have foot and mouth, farmer Laurence Matthews said.

The BBC reported initial tests found no foot and mouth, but experts were waiting for a second batch of results.

Britain's chief veterinary officer Debby Reynolds said an interim report on the outbreak found it was very likely the source of the infection was the Pirbright research centre, close to the farm where cattle were first infected, she said.

The site houses two foot and mouth laboratories -- one public and one, Merial, owned by U.S. firm Merck and French firm Sanofi-Aventis SA.

Nexium, Prilosec: No Heart Risks Seen

Aug. 9, 2007 -- The FDA today reported that so far, it has found no signs of heart risks associated with long-term use of the drugs Prilosec and Nexium.

Prilosec and Nexium belong to a class of drugs called proton pump inhibitors. They work by reducing the amount of acid produced by the stomach.

Both drugs are used to treat conditions including gastroesophageal reflux disease (GERD) and stomach and duodenal ulcers. Prilosec is also sold over the counter for frequent heartburn.

The FDA is conducting an ongoing review of new safety data on Prilosec and Nexium, which are made by the drug company AstraZeneca.

"The FDA has concluded preliminarily that these data do not suggest an increased risk of heart problems in patients treated with either of these products," the FDA's Paul Seligman, MD, MPH, told reporters today.

"At this time, we are recommending that health care providers and patients do not alter either their prescribing practices or taking of these drugs," says Seligman, who is the associate director of the Office of Safety Policy and Communication at the FDA's Center for Drug Evaluation and Research.

Seligman says the FDA has been in touch with regulators in the U.K, New Zealand, Australia, and Canada, who have reached similar conclusions about Prilosec and Nexium.

However, the FDA hasn't finished its review of the Prilosec and Nexium data. The FDA plans to complete its review within three months.

Prilosec, Nexium Data

On May 29, AstraZeneca informed the FDA of early results from a long-term study of Prilosec and an analysis of an ongoing study on Nexium. Both studies included patients with severe GERD.

In the Prilosec study, which lasted for 14 years, patients took Prilosec or got surgery to treat their severe GERD. In the ongoing Nexium study, patients took Nexium or got surgery to treat their GERD.

"In these studies, AstraZeneca was attempting to ascertain whether drug therapy with either of these drugs or surgery was most effective in relieving and preventing recurrence of symptoms of severe GERD," says Seligman.

The data raised concerns that long-term use of Prilosec or Nexium may have increased the risk of heart attacks, heart failure, and heart-related sudden death in those patients taking either one of those drugs, compared to patients who received surgery.

In the Prilosec study, more patients treated with Prilosec had heart attacks, heart failure, and heart-related sudden death than did the patients who had surgery. The difference between the two groups of patients was seen within the first year of the study, and continued over time.

In the ongoing Nexium study, initial data from this study suggested a difference between treatments in the rate of cardiovascular events. But an updated report submitted by AstraZeneca found that the number of patients who experienced heart problems was similar in both treatment groups.

No Heart Risk Seen

While both studies collected safety data, they didn't specify how heart problems, such as heart attacks, were to be defined or documented. As a result, the FDA says evaluating the information that has been gathered about the safety of either drug in these studies is difficult.

Since May 29, AstraZeneca has provided the FDA with a large amount of additional data from the two trials, along with pooled analyses of other studies.

At this point, the FDA's initial review of that data doesn't suggest an increased risk of heart problems for patients treated with Prilosec or Nexium.

Seligman notes that while the review isn't complete, the FDA issued today's statement as part of its commitment to inform health care providers and patients about emerging safety issues that affect public health.

Diet foods for kids may lead to obesity later

Canadian researchers have found that children who eat diet or low-calorie food can actually cause children to overeat, leading to obesity, according to a study published in the academic journal Obesity.

A team of researchers from the University of Alberta conducted a study on rats and found that animals learn to connect the taste of food with the amount of caloric energy it provides.

The team believes children who consume low-calorie versions of foods that are normally high in calories may develop distorted connections between taste and calorie content, leading them to overeat as they grow up.

The researchers, led by sociologist David Pierce, conducted a series of experiments that proved substituting low-calorie versions of foods and drinks led to overeating in young rats, including ones that were lean and ones that were genetically obese.

Adolescent rats that were also fed diet foods did not display the same tendency to overeat. The researchers believe the older rats did not overeat because they, unlike the younger rats, relied on a variety of taste-related cues to correctly assess the energy value of their food.

"The use of diet food and drinks from an early age into adulthood may induce overeating and gradual weight gain through the taste conditioning process that we have described," Pierce concludes.

Pierce added that his team's theory may explain the puzzling results from other recent studies, such as the one that found a link between diet soda consumption among children and a higher risk of obesity.

Melanie Kurrein, a nutritionist for Vancouver schools, regularly sees students eating diet foods that are no healthier that the full-calorie versions.

"Pop, whether it's diet or regular, doesn't have any nutritional benefit and it's often displacing or replacing more nutritional foods," she says.

Parents assume that "diet," "lite" and "half-fat" are better options for their children, when in fact they're often made with artificial sweeteners.

"They taste sweet but there's no nutrition coming in the animal and or child," says Kurrein.

Pierce says that parents should consider his team's "taste conditioning" theory and recognize that the tried and true ways to keep children fit and healthy -- ensuring they eat well-balanced meals and exercise regularly -- are the best ways to maintain a healthy weight.

"Diet foods are probably not a good idea for growing youngsters," he concludes.

Breast Implants Linked With Triple Risk Of Suicide

Women who have cosmetic breast implant surgery are three times more likely to commit suicide compared with women in the general population, suggests a new study of women in Sweden. The researchers said surgeons should carry out pre-surgery mental health screening and follow up monitoring of patients in receipt of cosmetic breast implants.

The research is published in the August issue of the Annals of Plastic Surgery and was led by Dr Loren Lipworth, of the International Epidemiology Institute in Rockville, Maryland, and the Vanderbilt University Medical Center in Tennessee, both in the US.

Other studies have also reported higher suicide rates among women with cosmetic breast implants. In this study Lipworth and colleagues did a more detailed extended follow up of an earlier study of a nationwide sample of 3,527 women in Sweden who had had cosmetic breast implant surgery between 1965 and 1993.

Using data from death certificates and Swedish national health care records, they compared the number and causes of deaths among the cosmetic breast implant cohort with the number expected among the same age group in the general female Swedish population.

The mean follow up after surgery was 18.7 years (range was 0.1 ro 37.8 years). The results showed that:

• There were 175 deaths overall among women with breast implants compared with an expected 133.4 (standardized mortality ratio (SMR) was 1.3).
• Among women with implants there was a statistically significant three-fold higher rate of suicide (SMR 3.0, based on 24 deaths among implant recipients).
• The risk was nearly seven times higher for women who received their breast implants when they were aged 45 or older. (The average age at breast implant surgery was 32.)
• There was a similar increase in deaths from alcohol or drug dependence among this group (SMR 3.1) which also showed an excess of deaths from accidents and injuries consistent with drug dependence and abuse.
• The increased suicide risk was not apparent until 10 years after implantation surgery.
• After 10 years, however, suicide risk rose with time since surgery. Suicide risk was 4.5 times higher between 10 and 19 years later, and 6 times higher after 20 years.
• The rate of breast cancer deaths was no higher among the implant group compared with the general population.
• Deaths from cancer overall were also close to expectation (SMR 1.1).
• The implant group did however show an elevated risk of death from lung cancer and chronic respiratory diseases.

Lipworth and colleagues wrote that "At least 38 deaths (22 per cent of all deaths) in this implant cohort were associated with suicide, psychologic disorders, and/or drug and alcohol abuse/dependence."

The researchers concluded that:

"The excess of deaths from suicides, drug and alcohol abuse and dependence, and other related causes suggests significant underlying psychiatric morbidity among these women."

The increase in death by these causes suggests that a "nontrivial proportion of women" who have breast augmentation surgery may already have, or later develop, serious long term psychiatric problems, said the researchers. Plus, because they only examined deaths, it may well be that the incidence of psychiatric conditions among women who have cosmetic breast implants is much higher than the general population.

"Such findings warrant increased screening, counseling, and perhaps postimplant monitoring of women seeking cosmetic breast implants," suggested Lipworth and colleagues.

"Excess Mortality From Suicide and Other External Causes of Death Among Women With Cosmetic Breast Implants."

Women With Migraines at Higher Risk of Stroke

THURSDAY, Aug. 9 (HealthDay News) -- Women who suffer from migraines that are accompanied by visual symptoms -- usually called an aura -- are at a slightly increased risk of stroke, especially if they smoke and take oral contraceptives, a new study says.

"This should not be a cause of alarm to women," said lead researcher Dr. Steven Kittner, a professor of neurology at the University of Maryland School of Medicine. "But it is something to take into account and discuss with their physician."

The risk that a young woman with migraines in the 15 to 44 age group will have a stroke might be 20 per 100,000, Kittner said. "That's a very small risk. Even if you increase it to 30 per 100,000, it is still a tiny risk."

But, if the woman smokes and has high blood pressure or diabetes, the risk of stroke will be higher, added Kittner, who's also director of the Maryland Stroke Center.

For the study, Kittner and his colleagues collected data on 386 young women, 15 to 49 years of age, who'd had a stroke. The researchers compared these women with 614 similar women who hadn't had a stroke.

They found that women with migraines with visual symptoms had a 1.5 greater risk of stroke, compared with women with no history of migraine.

However, women who had migraines and used oral contraceptives and smoked had a sevenfold increased risk of stroke, compared with women who had migraines with visual symptoms and didn't smoke or use oral birth control.

The researchers also said that the recent onset of migraines, as well as more frequent migraines and migraines that lasted longer, may play a part in increasing the risk of stroke.

"Migraine with visual symptoms should be considered a weak risk factor for stroke," Kittner said. "You can't do anything about it, but it may influence what other prevention measures one may take," he said.

The findings are published in the September issue of the journal Stroke.

Kittner advised that women who have migraines with visual aura should stop smoking and discuss with their doctor the pros and cons of using oral contraceptives.

One stroke expert said the new study adds to research that had already found that migraines with aura increase the risk of stroke in women.

"Many studies have linked migraine with the risk of stroke," said Dr. Tobias Kurth, an associate epidemiologist at Brigham and Women's Hospital and an assistant professor of medicine at Harvard Medical School. "But this study shows other factors that may increase the risk."

Kurth also advises women with migraines to stop smoking. "It really increases the risk of stroke, especially in combination with oral contraceptives," he said.

Whether treating migraines would lower the risk of stroke isn't known, Kurth said. "It's only speculation that if you treat migraine this risk goes away," he said. "There is no data looking at this question."

Scientists Discover Hormone That Controls Liking For Food

Scientists in the UK have discovered that leptin, one of the hormones that regulates hunger and feeling full, controls our liking for food via a separate but linked pathway in the brain that also affects how much we eat. It is hoped that this discovery and more research will lead to greater understanding of the complex causes of obesity.

The study was funded by the Medical Research Council in the UK and the Wellcome Trust and is published in the early online issue of the journal Science.

The research was led by two scientists at Addenbrooke's Hospital at the University of Cambridge: Dr Sadaf Farooqi from the Departments of Medicine and Clinical Biochemistry, and Dr Paul Fletcher from the Brain Mapping Unit in the Department of Psychiatry.

Eating behaviour is controlled by an interconnected complex of physiological, neural, cognitive and hormonal processes, each of which can be triggered by seeing, tasting, or even just thinking about food. In order better to understand what regulates eating behaviour, scientists have to unravel each process at a time and also try to find out how they work together.

For instance, although hunger affects what people eat and how much they eat, other factors are also involved. The act of eating is a pleasurable and rewarding experience in its own right, and a liking for food can override the biological cues that control feeling hungry and feeling full.

Farooqi, Fletcher and colleagues had a hunch that leptin, a hormone involved in controlling weight gain, played a role in the relationship between the process that controls feeling hungry and full and the process that generates feelings of pleasure and reward from the act of eating food.

Using imaging technology, Farooqi, Fletcher and colleagues showed that a liking for food has strong effects on the brain. When they scanned the brains of leptin deficient patients while they looked at images of food, they noticed activity in the brain regions responsible for emotions of reward and desire.

Leptin is made in fat cells and when it gets to the brain through the bloodstream it reduces feelings of hunger and increases feelings of fullness.

There are a very small number of people in the world who have a rare genetic disorder whereby their bodies can't make leptin. These patients can't stop eating, they like all foods equally, no matter how bland they are, and they become severely obese. When they are given leptin they find some foods tastier and more appetising than others and they begin to lose weight.

Two patients with the leptin deficiency disorder were invitied to look at images while their brains were being scanned using Functional Magnetic Resonance Imaging (fMRI). This technology shows which regions of the brain light up when a patient looks at an image. In this case the patients looked at pictures of food and pictures of objects that were not food such as cars and trees. Among the food images some were what one might classify as appetising such as cakes pizza and strawberries while others were what might be classed as bland (cauliflower and broccoli).

Then the patients were given leptin for 7 days and the experiment repeated.

Healthy volunteers were also invited to do the same: look at various images of non food items, appetising food and the same bland foods, and their brain scans were compared to the leptin deficient patient scans.

The leptin deficient patient brain scans showed that several parts of their brain, the striatal regions, responded to pictures of food. These are the areas of the brain involved in emotions of reward and desire. After they had been taking leptin for 7 days, the activity reduced when they looked at food pictures.

The scientists noticed that one brain region was particularly responsive to images of food that people generally find more appetising. This region was the nucleus accumbens. For instance it responds more to pictures of chocolate cake than it does to pictures of broccoli.

In the healthy volunteers, the nucleus accumbens only responded to appetising food when they were hungry (after fasting overnight).

In the leptin deficient patients, the nucleus accumbens showed the same high level of activity for appetising food both after following an overnight fast and after they had just eaten.

However, after taking leptin for 7 days, the nucleus accumbens of these patients became more like the healthy volunteers': its highest activity for appetising food came only after the overnight fast, when they had had nothing to eat and were hungry. The activity after they had just eaten was reduced.

The scientists concluded there are two distinct pathways that interact: one controls hunger and fullness and the other is involved in liking and desiring food. Hunger evokes responses in the striatal region of the brain when images of food are seen, and eating changes these responses. It is the second process that is affected by the presence or lack of leptin. When leptin is missing, the striatal regions remain sensitive to cues of food, even after just eating a meal.

Commenting on their findings, Farooqi said:

"While body weight remains stable for many people over a long period of time, other people gain weight very easily. More studies are needed to find out how these brain responses vary in people with weight problems in general. Research is needed to find out how leptin triggers other chemicals in the brain and how alteration of these pathways contributes to overeating and obesity."

He said more needs to be understood about how hormones that signal hunger and control energy stores interact in the brain and how this affects eating behaviour, and hopefully this will "take us beyond some of the prevailing and simplistic assumptions about why some people have difficulties in controlling how much they eat."

"Such understanding will be a key step in the prevention and treatment of obesity. Importantly, the finding that the liking of food is biologically driven should encourage a more sympathetic attitude to people with weight problems," he added.

Treading a thin line: Disordered eating or eating disorder ?

It’s not news that a heaping plate of cookies, despite its deliciousness, is not the best meal choice. Neither, however, is a stick of celery.

In a culture of fast food, junk food, and nutrient-starved meals on the run, it’s nearly impossible to achieve the sought-after twiggy arms and leggy legs of today’s ideal, and perhaps unreal, female body. After several futile weight loss attempts via lifting weights and powering through marathon treadmill sessions at the gym, many women find themselves asking: What’s a girl to do?

For some, the solution is dieting. Whileeffective when constructed with health as a priority, a diet can be the literal meal ticket to a thinner physique; when pounds supersede overall wellbeing, however, a diet can border dangerously on the verge of disorder.

As outreach director for the American Anorexia Bulimia Association (AABA), Pamela Guthrie recognizes the distinction between disordered eating and eating disorders as imperative to accurate diagnoses. Both disordered eaters and sufferers of eating disorders fixate on the scale, count calories, and frequently miss meals altogether. Despite the similar nutritional abnormalities, the two conditions diverge into the decidedly devastating anorexia and bulimia nervosa and the comparatively benign routine of disordered eating.

Guthrie explains that although both problems seem to center on weight concerns, eating disorders are often only superficially about weight. For anorexics and bulimics, food presents a means of essentially controlling a life out of control. By monitoring every calorie that enters their body or purging after an indulgent binge, sufferers of true eating disorders not only create the illusion of stability, but also manage to conceal deeper issues. The anxiety, lack of self worth, and depression that encourage the development of eating disorders remain relatively absent from purely pound-driven disordered eating habits.

According to the National Eating Disorders Association (NEDA), there are specific warning signs that are indicative of potential eating disorders.

Signs of Anorexia Nervosa:

-Significant weight loss, often to the point of a less-than-recommended weight for a given height
-Distorted perception of weight and/or body image
-Preoccupation with fat and calories, eventually leading to self-starvation
-Avoidance of mealtimes or situations that involve food
-Amenorrhea, or stopping of menstrual periods

Signs of Bulimia Nervosa:

-Consumption of exceptionally large meals, also known as binge eating or bingeing
-Compensatory behaviors which include self-induced vomiting or purging, the use of diuretics and/or laxatives, and compulsive exercising
-Marks or calluses consistent with purging on hands or knuckles
-Tooth discoloration

Typically, bulimics do not exhibit the intensely thin physique of anorexics and, in many cases, even maintain a normal weight. Because bulimia lacks the tell-tale outward manifestations of an eating disorder, the AABA advises behavioral analysis to diagnose the disorder. Frequent trips to the bathroom after eating a larger-than-normal meal commonly inform observant parents and friends of bulimic tendencies in their family members or peers.

Nutrition experts and psychiatric specialists alike, though primarily concerned with eating disorders, also acknowledge the potentially damaging effects of disordered eating. The possible nutritional deficiencies associated with the occasional skipped meal are not as severe as the brittle bones, dehydration, and heart failure that often occur as a result of anorexia and bulimia, but they do, nonetheless, pose a very real health risk.

Whether the periodically skipped breakfast or lunch of a disordered eater, or the habitual single-snack regimen of an anorexic or bulimic, nutritional issues are problems of increasing prevalence in the United States. I’m, Like, SO Fat!, Dr. Neumark-Sztainer’s 2005 book that promotes parenting to engender health-conscious habits in teens, reveals that over 50% of teenage girls engage in unhealthy dieting. Including fasts, purging, and cigarettes, such attempts at weight control reflect the ever-diverging concepts of the real woman and the female ideal. At 5’11” and under 120 pounds, the models of today’s runway are a constant reminder of the perceived inadequacies of the average 5’4”, 140 pound woman.

While the pressure to be thin will endure for years to come, experts maintain that steps to shed excess weight should be taken only when necessary. If you have weight to lose, the solution should never be skipping meals, but rather sensible exercise and a balanced diet. If you have few, if any, pounds to drop, calories should be the last thing on your mind.

In either case, the occasional cookie—or two—could be just the indulgence you deserve for being a beautiful and talented woman, regardless of the scale’s most recent reading.

The “Evolution” of Beauty : Take Two

A few weeks ago, I posed the question, “What is ‘real’ beauty?” Along with that question, I posted a video from You Tube on the ”Evolution of Beauty” - a short video that, in less than two minutes, reveals the massive amounts of make-up andphotoshopping that goes into producing and reproducing our mainstream cultural ideals of “beauty” and subsequently perpetuating an onslaught of myths pertaining to female beauty. For cultural critics and Internet connoisseurs this is probably old news, but Redbook Magazine recently created quite a controversial stir with its July cover of Faith Hill.

I heard about this earlier in the week, and then Leslie Goldman blogged about it on her blog The Weighting Game; Leslie urged everyone to take a look at the magazine cover so that they might come to realize that “‘perfect’ is not good enough and that what we see truly is not real.” Chilling words, but so true. According to popular definitions of “beauty,” I always thought that country star Faith Hill was pretty “perfect.” Apparently, the folks at Redbook disagree. To check out the July cover - and the mega-photoshop job done to shave 10-15 pounds off of Faith Hill and erase her gorgeous laugh lines - check out the following link: www.Jezebel.com.

My hope is that as fit, healthy, and athletic women, we have different definitions of beauty that do not comply with mainstream notions; my hope is that when we think of beauty, we think of strength, power, endurance, stamina. Beauty cannot be contained by a size, a weight, a wrinkle-free and fat-free body. Re-read the quote of the day . . . Margaret Cho is definitely on to something.

Taking a closer look at dietary guidelines

Every five years the U.S. Department of Agriculture and the Department of Health and Human Services revise a list of Dietary Guidelines that are hailed as the foundation of healthy living for the average American. Unfortunately, the averageAmerican is unaware of what lies beneath this elusive title.

In creating the guidelines, what the government is really doing is sifting the facts from the often contradictory hype purported in the media. They’ve created a master list of positive lifestyle choices that, if followed, could prevent a host of diseases and begin to pull Americans out of the current obesity slump.

“Especially considering the epidemic of obesity we face in our country, people need all the help they can get in understanding the relationships between food consumption, a healthy diet, physical fitness and good health,” said Susan H. Laramee, president of the American Dietetic Association in 2005.

Although many of the suggestions listed in the dietary guidelines are common knowledge- “keep trans fatty acids as low as possible” and “Get enough exercise and healthy eating to balance calories taken in with calories burned to maintain a healthy weight”- experts emphasize the importance of integrating everything from the list.

Integration, they say, is where most individuals slip up.

“It is important to remember that these are integrated messages that should be implemented as a whole,” health officials say. “Taken together, they encourage most Americans to eat fewer calories, be more active, and make wiser food choices.”

The latest revision focuses more attention on the importance of consuming a variety of fruits and vegetables and the role of such foods in combating illness.

“The scientific evidence linking these foods to a host of health benefits is now overwhelming,” said Ritva Butrum, senior science advisor for the American Institute for Cancer Research.

Most Americans, the report says, fulfill their daily caloric quota before taking in the nutrients that are important to good health. Experts recommend that the process be reversed: consume nutrients first and fill in the blanks with a moderate amount of fatty foods.

“The keys are eating a variety of foods in moderation, paying attention to portion sizes and engaging in regular physical activity. Within this framework, all foods can fit into a healthful diet,” said Laramee.

If the average American is confused by the mixed messages she hears in regards to diet and fitness, the comprehensive list of dietary guidelines could be the key to fostering a healthier society.

“This exhaustively researched document is and should remain the basis of all efforts to improve public health in the United States,” said Butrum. “By expanding in scope to include convincing scientific evidence on diet and cancer prevention, the new Dietary Guidelines make the overall ‘take home’ public health message much simpler.”

Dr. Mirkin: How to Become Strong

Would you like to become stronger? Pick 6 to 10 weight-machine exercises and do them in three sessions a week. In each exercise, try to lift the heaviest weight that you can lift comfortably ten times in a row without hurting yourself. When an exercise becomes easy, increase the weight. In five months, you should be able to increase your strength significantly and be proud of your larger muscles.

You now decide that you want to become
even stronger. Would you increase your strength more by increasing the number of repetitions or by increasing the weight that you lift? For example, should you try to do three sets of ten for each exercise or stay at one set of ten, just try to lift a heavier weight once a week? Dr. Michael Pollock of the University of Florida in Gainesville divided recreational weight lifters into two groups. In one group, they tried to do three sets of 10 three times a week. In the other group, they did just one set of 10 three times a week, but tried to lift progressively heavier weights. Those who did one set of ten with heavier weights three times week were stronger than those who did three sets of ten without increasing the weight.

Exercise does not make you stronger. If it did, marathon runners would have the largest muscles of all athletes. The single stimulus to make muscles larger and stronger is to stretch them while they contract. When you try to lift a heavy weight, your muscles stretch before the weight starts to move. The greater the stretch, the greater the damage to the muscle fibers and when they heal after a few days, the greater the gain in strength. The results for this study give a clear message. You become stronger by lifting heavier weights, not by exercising more. If you do too much work, you can’t lift very heavy weights and you do not become stronger. When it comes to becoming very strong, less may be more.

Hass CJ et al. Med Sci Sports Exerc 2000(Jan);32(1):235-242.