Simple Steps for a Healthier You

Quit Smoking. Lose weight. Get more exercise. These are popular New Year’s resolutions, but they are undoubtedly a chore. A third of resolutions, however well motivated, are broken within a week.

If better health is your aim, there are many other simple, less obvious things you can do – without a great deal of effort. Here are a few recommended by physicians at Rush University Medical Center.

Have fun to help de-stress. Experts recommend regular exercise, meditation and breathing techniques to reduce stress, but even something as simple as listening to soothing music, reading a good book, soaking in a hot tub or playing with your pet can help you relax. “Spending just 30 minutes a day doing something you enjoy can go a long way toward beating the stressors of everyday life,” says cardiologist Dr. Annabelle Volgman, director of the Rush Heart Center for Women. That’s advice you should take to heart because prolonged stress can cause or exacerbate a number of health problems — some serious — including heart disease, stroke, hypertension, depression, ulcers, irritable bowel syndrome, migraines and obesity.

Practice good oral hygiene. Spend a minimum of two minutes to brush your teeth twice a day — and don’t forget the dental floss. Daily flossing and brushing of teeth not only help prevent cavities but may keep other diseases at bay as well. Experts suspect that bacteria-producing dental plaque, which leads to gum inflammation, can result in or exacerbate heart disease. Although the exact mechanism of why this occurs is not clear, a connection has also been found between poor periodontal health and stroke, diabetes, premature births and low birth weights. “It’s also a good idea to take a three-hour break between eating foods that contain sugar,” says Dr. Joel Augustin, a family medicine physician at Rush.

Do a crossword puzzle. Researchers at Rush have found that mentally challenging activities, such as reading and playing chess, may have a protective effect on your brain. “Regularly engaging your mind may help lower your risk for the dementia associated with Alzheimer’s disease,” Dr. Augustin says.

A little red wine is fine. Recent studies have shown that the powerful antioxidants found in red wine protect against heart disease, colon cancer, anxiety and depression. So unless there is a medical reason why you shouldn’t imbibe, go ahead and enjoy that glass of merlot with your nightly meal — you can even toast to your good health.

But don’t drink excessively. Just as a small amount of red wine has health benefits, too much alcohol — even red wine — can cause a variety of health problems, including liver and kidney disease and cancer. Women, in particular, need to be careful about alcohol consumption. “Women are at higher overall risk of liver problems than men, so they are more likely to experience liver problems from smaller amounts of alcohol,” says Dr. Carline Quander, a gastroenterologist at Rush. “They simply shouldn’t drink as much as men.” For a healthy man, two drinks a day is not likely to do harm; women, on the other hand, should limit themselves to one daily drink.

Stop the snore cycle. When half of a couple snores, the other person loses sleep. The snorer is frequently tired too because people who snore loudly often have sleep apnea. In the most common form of this condition, the airway is blocked, causing the person to stop breathing and wake up repeatedly. Physicians at the Sleep Disorders Service and Research Center at Rush found that treating the snorer with continuous positive airway pressure, which keeps the airway open, results in better sleep for both people.

Don’t skip the seatbelt — ever. Even if you’re driving only a short distance or are in a parking lot, take a few seconds to fasten your safety belt, which prevents you from being tossed around the car or thrown from it in the event of a crash. Most cars these days are equipped with air bags, but these lifesaving features are designed to work with safety belts. According to National Highway Traffic Safety Administration, air bags alone are only 42 percent effective in providing protection.

Check your ergonomics. If you work at a computer, look at the ergonomics of your workstation — how you fit and move in your environment. You can start by visiting the Division of Occupational Health and Safety at http://dohs.ors.od.nih.gov. “An ergonomics review can help you avoid neck, back and eye strain,” Dr. Augustin says.

Even small steps toward better health can yield surprising rewards.

Menarcheal Age Affects Bone Density

A South Dakota State University study showed that women who began menstruating at an earlier age had a higher percentage of body fat as adults than women who began menstruating later.

But women who began menstruating earlier also had higher bone mineral density in the hip as adult women. They also had greater bone mass and bone density in the femoral neck region of the hip, a common site for hip fracture.

These are among the findings in a study by assistant professor Teresa Binkley at SDSU’s Ethel Austin Martin Program in Human Nutrition. Binkley worked on the project with Courtney Grimsrud, an undergraduate research assistant at the time, and professor Bonny Specker, director of the Ethel Austin Martin Program.

The SDSU researchers published the results of their study in 2008 in the American Journal of Human Biology. The study looked at the effect of menarcheal age on body size and bone measures in adult women.

“ ‘Menarcheal age’ refers to the age at which a female first begins menstruation,” Binkley explained.

“If the age at which a female starts menstruating, or her menarcheal age, is early, then she has an increased exposure to estrogen compared to a female with a later menarcheal age.”

Estrogen exposure leads to growth plate closure, or the stage at which bones stop growing in length, as well as to mineral packing in bone. Studies have associated early menarcheal age with increased bone density. Some research has also associated early menarcheal age with shorter stature and greater percent body fat as an adult, while later menarcheal age is associated with taller stature and leaner body composition.

The purpose of the SDSU study was to determine in adult women the effect of menarcheal age on weight, body fat, height, limb length and bone measurements.

To measure bones, the study used two technologies. Dual energy X-ray absorptiometry, or DXA, is used routinely in hospitals and clinics to measure bone density of the spine or hip. Peripheral quantitative computed tomography, or pQCT, is a method that measures density, size and shape of the arm or leg bones and is used for research purposes.

“Our hypotheses were that women with young menarcheal ages compared to those with higher menarcheal ages would have higher adult percent body fat and higher adult weight, shorter height and limb length, and greater bone mass and bone mineral density.”

The subjects were a subset of South Dakota Rural Bone Health Study, 260 women with regular menstrual cycles from two ethnic groups (140 were Hutterite, 120 were non-Hutterite). They ranged from 20 to 40 years old.

The study measured weight, standing height, sitting height (defined as the length from the stool seat to the top of the head), leg length (standing height minus the sitting height), and forearm length.

The study assessed menarcheal age by asking women in the study when they began menstruating. Fifty percent of the study participants said that was before age 13; the other 50 percent said it was at age 13 or after.

“Although it wasn’t in our hypothesis, we did find a trend in menarcheal age,” Binkley noted. “Women born in 1960 tended to have an older average menarcheal age than women born toward the 1980s,” Binkley said.

“Although it was not statistically significant, it is interesting that in this population, the trend over the 20-year-age-range was 2.3 months per decade.”

In line with their hypothesis, SDSU researchers found that women with younger menarcheal ages had on average a higher percent body fat as adults than women with later menarcheal ages. They also weighed more.

However, the study found no associations between menarcheal age and height, sitting height or limb lengths.

Interestingly, women with an early menarcheal age had a smaller bone size at the distal radius, the end of the arm bone near the wrist, than women with a later menarcheal age.

“Women with a later menarcheal age have more time for the adolescent growth spurt, and their bones probably grow bigger,” Binkley said.

The Ethel Austin Martin Program in Human Nutrition at SDSU and a grant from the National Institutes of Health supported the research.

Assistant professor Teresa Binkley at SDSU’s Ethel Austin Martin Program in Human Nutrition studied menarcheal age as a factor in body size and bone measurements in adult women.

Alzheimer: Women Affected More Often than Men

Nearly 4.5 million people suffer from Alzheimer’s disease (AD) in our country, and more than half of them are women, according to the National Institute on Aging in Bethesda, Md. As the general population continues to age, this number is expected to increase significantly over the next few decades.

Alzheimer’s disease is the most common form of dementia, a group of brain disorders that interferes with a person’s ability to carry out daily activities. In AD, areas of the brain change and deteriorate, which causes a decline in cognition and memory functioning. In some patients, the deficits are large enough to get in the way of performing normal, everyday tasks.

There is evidence that AD affects women differently than men. “Many studies of gender differences in cognition have pointed to greater language deficits in women with Alzheimer’s disease as compared to men,” explains Michael S. Rafii, M.D., Ph.D., director of the Memory Disorders Clinic and an attending neurologist at the Shiley-Marcos Alzheimer Disease Research Center at the University of California, San Diego. “Naming and word-recognition skills have been reported to be more adversely affected in female patients with AD than in male patients, and the differences have been shown to be sustained over time.”

Notable sex and gender differences in behavior among Alzheimer patients have been observed as well. “Male patients exhibit greater problems than female patients in wandering, abusiveness and social impropriety, particularly in the more advanced stages of the disorder,” Rafii points out. In fact, major tranquilizers and behavior management programs are used more frequently on male patients.

While there is currently no cure for AD, researchers continue to make progress. More drugs are being studied, and researchers have identified several genes associated with the disease. “Recent work has been focused on identifying the molecule that may be causing AD symptoms,” says Rafii. Researchers from the University of Minnesota and Johns Hopkins University “discovered a protein complex in the brain that appears to impair memory.”

Combined with sophisticated imaging techniques, this discovery is enabling scientists to take a clear picture of the protein deposits in the brain. According to Rafii, “This could lead to accurate diagnosis of AD at very early stages.

Previously, a definitive diagnosis of the disease could only be made through an autopsy after the patient's death, typically at a very late stage of the illness.”

Diagnosing AD can be tricky, especially because many people are under the assumption that forgetfulness is a normal part of the aging process. But patients with AD suffer from much more than simple memory lapses. Here are a few common signs and symptoms of the disease:

• Persistent forgetfulness or memory loss
• Disorientation
• Problems performing routine tasks
• Inability to express thoughts coherently or finish sentences
• Loss of judgment
• Changes in personality

As in other diseases, early diagnosis is very important for patients with AD. Certain medications have been found to be useful in the earlier stages of the disease, so the sooner the diagnosis is made, the better.


Source: National Institute on Aging: www.nia.nih.gov

Surgeons Predict Foot Pain Will Increase in January

You've signed up for the gym membership. You've bought new workout clothes and shoes. You've made a promise to yourself to stick to your New Year's resolution to exercise and lose weight.

You hit the gym, you work out hard for a week, then you wake up one morning and pain is shooting through your heel. Exercise now hurts so much that you stay home on the couch watching the new season of American Idol.

Soon after the last gulp of New Year's champagne, foot and ankle surgeons see the annual influx of patients with foot pain caused by exercise. Doctors interviewed by the American College of Foot and Ankle Surgeons (ACFAS) say the most common problems are heel pain, pinched nerves and sore Achilles tendons. They shared tips for preventing and treating these conditions.

Heel pain

Most heel pain cases are caused by plantar fasciitis. Foot and ankle surgeons recommend athletic shoes that support the arch and cushion the heel. Buy shoes designed for the sport. Over-the-counter orthotics may help some people.

To treat heel pain, first trying icing the bottom of the foot before bed.

Performing stretching exercises two to three times a day can also help. Sit on the floor barefoot with the knees straight. Hook a towel around the toes of the foot. Pull back on the towel, count to 10, then relax. Repeat several times.

Pinched nerves

Have your feet measured before you buy athletic shoes. Foot and ankle surgeons say many people wear shoes that are a half-size too tight. Exercising in tight shoes can cause a neuroma, or a pinched nerve. Patients with this condition say they feel pain in the ball of their foot and tingling in their third and fourth toes.

Achilles tendon pain

Instead of going from couch potato to a high intensity workout, doctors recommend easing into a new exercise routine. Try to alternate a hard workout one day with an easy workout the next.

New Year's exercisers who ignore this advice risk Achilles tendonitis. The back of the foot becomes tender and painful.

When Achilles tendon pain occurs, foot and ankle surgeons recommend first using RICE therapy (Rest, Ice, Compression, Elevation).

Additional advice

Consult a physician or trainer before starting a new exercise routine.

Foot pain doesn't have to sabotage New Year's resolutions to exercise. Listen to your body. If pain in the foot or ankle lasts five to seven days in a row, see a foot and ankle surgeon. They'll be expecting you.

For more information on foot and ankle pain, visit http://FootPhysicians.com.

Lighting Tips for Low Vision

Eyesight can fade over time because of aging or an eye disease. The December issue of Mayo Clinic Health Letter offers tips to help compensate for low vision:

Around the house:

-- Reduce differences in brightness -- Equalize indoor and outdoor light sources by leaving some house lights on during bright sunny days.

-- Reduce glare -- Cover shiny surfaces, such as a polished table, with a cloth. Dark-colored place mats can help at mealtime. Opt for furnishings with a flat or matte finish.

-- Light up dark spots -- Install lighting in dark areas, such as inside closets. Keep a pocket flashlight handy for dark areas.

For better close-up vision:

-- Use bright, direct lighting -- Position an adjustable lamp about four to eight inches from reading material or a close-up task. Keep the lamp slightly to one side to reduce glare. If possible, position the light over the shoulder on the side of the better-seeing eye.

-- Use daylight -- To take advantage of natural light, position yourself so that windows are to the side or behind you.

-- Use a dark background -- When reading, reduce glare by using a piece of dark construction paper to cover areas of text you’re not reading at that moment.



Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com.

Great Depression Spurred Great Creativity

“If it’s true that adversity and hardship can bring out creativity,” said Miles Orvell, professor of English and American studies at Temple University, “then the Great Depression was one of the great creative periods of our time.”

The Great Depression is currently all the rage, with New Yorkers hosting Depression parties, peasant skirts and newsboy caps making a return on the runways, and Netflix rentals of The Grapes of Wrath on the rise. But that 1939 Steinbeck novel is not the only Depression-era work worth taking a second (or a first) look at from our current perspective in what some are calling the New Depression.

Common themes found in the literature of the period are despair, poverty, corruption, strife between labor and management, and the need to work together, noted Orvell. Does any of that sound familiar?

“The period also birthed several new genres, such as the melodrama, which laid the foundation for today’s soap opera, and it brought the detective novel to fulfillment, with the heroic detective stoically dealing with corruption and the underside of life in cities like New York, Los Angles and San Francisco,” he said.

“The literature of the Depression has been largely dismissed from the cultural record,” explained Orvell. “By the post WWII era, the anti-communist and neo-conservative movements looked back at the depression and anything from the left as the work of the ‘communist devil.’ And that has carried over into our own day” he added.

According to Orvell, a current standard survey textbook of American literature devotes just three pages out of 1500 to Depression Era literature. “Yet, the literature of the Depression reflects a critical period in our history and one that had a lasting impact by bringing us social security, roads, post-offices, and banking regulations,” he noted.

Two-Drug Blood Pressure Therapy Reduces Heart Attacks

While doctors are urged to start with a diuretic-based strategy to control patients’ high blood pressure, an international blood pressure study shows a different single-pill drug combination is more effective at preventing heart-related events such as heart attacks and strokes. The findings challenge the way blood pressure is usually treated worldwide.

The randomized study led by a University of Michigan Health System researcher compared two drug combinations. The results, which appear in today’s New England Journal of Medicine, were so significant that the trial was stopped early.

Both single-pill combination drugs helped more than 75 percent of people who had high blood pressure and other cardiovascular risk factors get their blood pressure down. But even more important, patients in the study taking the combination that included a calcium channel blocker had 20 percent fewer heart-related events than the patients taking the other combination.

In all, 11,506 study participants took a single tablet that includes two medications. One group received a tablet containing benazepril, which is a type of drug called an ACE inhibitor, and amlodipine, which belongs to a class of drugs known as calcium channel blockers or CCBs. The other pill combined benazepril and hydrochloro-thiazide, a type of diuretic or “water pill.” The 20 percent reduction in cardiovascular events was observed with the ACE/CCB combination tablet.

Cardiovascular events were defined as cardiovascular deaths, heart attacks, strokes, hospitalizations for unstable angina and treatments to re-open blocked heart arteries.

Currently, national guidelines for the treatment of high blood pressure (also called hypertension) call for patients who need medication to start out on a single pill, usually a diuretic, or water pill, and to add other drugs only as needed to bring pressure down. But the new results may signal a need to change those guidelines.

The ACCOMPLISH study suggests physicians no longer give diuretics preferred status in treating patients.

“This robust study showed us that switching patients to a single-pill combination meant that twice as many patients got to their blood pressure goal, regardless of previous therapy,” says University of Michigan Health System’s Kenneth Jamerson, M.D., the leader of the study.

“The significant reduction in cardiovascular events we observed in patients will, I hope, show physicians that earlier use of a combination medication, especially with amlodipine, may be in the best interest of patients,” he says.

Jamerson is a professor of internal medicine at the University of Michigan Medical School and a member of the U-M Cardiovascular Center.

Results from the ACCOMPLISH trial show that just six months of treatment with either drug combination was enough to bring the blood pressure of 73 percent of
patients into an acceptable range – despite the fact that two-thirds were already taking some other medication before they entered the study. At the beginning of the trial, only 37 percent had blood pressure below 140/90.

However, by the end of the three-year trial blood pressure control rates were 80 percent, with average systolic blood pressure less than 130 mmHg. This represents exceptional blood pressure control when contrasted to the current control rate of about 30 percent in the United States.

Participants from five countries – the United States, Sweden, Norway, Denmark and Finland – were part of the trial, and all patients were at risk for cardiovascular events.

Many studies have already shown that reducing blood pressure can reduce the risk of stroke, heart attack, heart failure and other conditions, but many people have a very difficult time achieving blood pressure control.

As many as 73 million Americans have high blood pressure. But because high blood pressure doesn’t cause symptoms, most people who have it, don’t know it.

Over time, uncontrolled blood pressure affects the blood vessel walls, encouraging the growth of weak spots called aneurysms and the formation of narrowed and inflamed areas that can lead to clots that can break off and cause heart attacks and strokes.

Fortunately, once the condition is diagnosed, doctors have a broad range of medicines to choose from to try to get it under control, including many inexpensive generic medicines.

But studies have found that patients often have trouble taking the multiple medications they need. As a result, many companies have developed combination pills.

The study was funded by Novartis, which is among the companies that offer two-drug combination tablets for blood pressure treatment.
ACCOMPLISH stands for Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension.