Health Topics - Health-and-Age

Tuesday

09Feb2010

Too-Strict Glucose Control in Diabetes May Be Harmful

Tue, February 9, 2010 at 03:00AM

I’ve posted before about too-strict glucose control in type 2 diabetics – it can backfire. Confirmation of this comes from a British article in the Lancet.

Two groups of type 2 diabetes patients aged 50 or older were enrolled and followed between 1986 and 2008. There were 27,965 patients whose treatment had been intensified from one oral antidiabetic drug to two or more oral drugs, and 20,005 who had switched regimes to include insulin injections. Overall mortality was examined in relation to the HbA1c levels (the blood level of glycated hemoglobin that’s regarded as a good indicator of blood sugar levels over the previous weeks or months). The subjects were classified into 10 groups (or deciles) according to their HbA1c levels.

During the 5 years after starting the more intensified therapy, there was a U-shaped curve in both groups: patients with the lowest HbA1c levels (average 6.4%) and those with the highest (10.6%) had significantly higher mortality rates than those at the middle level (7.5%).

A U-shaped (or J-shaped) response has been observed before – for instance with the number of hours of nightly sleep. This sort of relationship is common in nature – “not too little, not too much” says it all. Other examples include: body mass index (BMI) or waist circumference, alcohol consumption, blood pressure and blood cholesterol. This means one shouldn’t be too slavish in working towards the lowest HbA1c possible; 7.5% is most probably enough!

Robert Griffith |

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Monday

08Feb2010

Not Lying Straight in Bed

Mon, February 8, 2010 at 03:00AM

Believe it or not, this may be a new test for cognitive impairment (one of the steps on the way to Alzheimer’s disease). German neurologists, reporting in the British Medical Journal, found that older patients with cognitive impairment, when asked to lie down on a bed, failed to align their body ‘along the longitudinal axis of the bed’.

Samples of 110 patients over 60 with neurological conditions along with 23 staff neurologists were given this simple test. The results were compared with those of 3 recognized cognitive screening tests – the Mini-Mental State Exam, DemTect, and the clock drawing test.

Cognitive impairment was found in 34 patients and dementia in 8 (Mini-Mental State Exam) or 11 (DemTect test). The angular deviation of the body from the longitudinal axis of the bed correlated significantly with the Mini-Mental State Exam scores, the DemTect test results, and the clock drawing test, even after adjusting for the age of the patients.

The researchers conclude: “clinicians might suspect cognitive impairment in mobile older patients with neurological disorders who spontaneously position themselves obliquely when asked to lie on a bed”. An interesting finding, but not necessarily a very practical one – the clinician will still want to do a further test or two to ascertain cognitive impairment or dementia. And what’s “obliquely”? An angle of more than 7 degrees from the axis, according to the 23 neurologists. (I think I’d reach that easily if I was asked to lie down!)

Robert Griffith |

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Friday

05Feb2010

In Evaluating Seniors’ BMI, Maybe We Should Move the Goalposts

Fri, February 5, 2010 at 03:00AM

The generally accepted thresholds for body mass index (BMI), established by the WHO, are as follows: below 18.5 = underweight, 18.5 to 25 = normal weight, 25 to 30 = overweight, and over 30 = obese. However, Australian researchers, reporting their study in the Journal of the American Geriatrics Society, find that these limits are too restrictive.

Over 9,000 men and women aged 70 to 75 were recruited in 1996 and followed for up to 10 years. They were classified as underweight, normal, overweight, or obese, using the established thresholds. Mortality was measured for each class of BMI.

The mortality risk was lowest for the overweight class (BMI 25 to 30) – 13% less than that for the normal-weight class, in fact. The risk for obese and normal-weight persons was roughly the same. The findings were the same for men and women; the chief causes of death (cardiovascular and cancer) showed similar BMI-related differences. A self-reported sedentary lifestyle doubled the mortality risk for women across all the BMI classes, whereas for men it only increased it by 23%.

The researchers conclude that “overweight people are not at greater mortality risk, and there is little evidence that dieting in this age group confers any benefit”. I think I’ll have another slice of pie . . .

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Thursday

04Feb2010

Surgery for Low Back Pain? It Depends Who You Ask

Thu, February 4, 2010 at 03:00AM

There’s no doubt that surgery can benefit patients with low back pain due to a degenerative lumbar spine. However, the optimal selection of patients for surgery isn’t always clear, as a study reported in the journal Spine shows.

Canadian researchers presented hypothetical patient scenarios to surgeons (orthopedic surgeons and neurosurgeons), family doctors, and patients with back pain. Each scenario contained information on key clinical factors: walking ability, pain location, duration and severity, neurological symptoms (pins-and-needles, numbness), and factors causing or worsening the pain. Each group rated their preference for surgical treatment, giving their reasons.

The surgeons had the lowest overall preference for surgery, and the family doctors the highest. And among the surgeons, the orthopedic surgeon rated surgery lower than the neurosurgeons. Both the family doctors and the patients preferred surgical treatment more than the surgeons.

The surgeons considered the location of pain the most important factor in their recommendation; in particular, pain in the leg was a greater factor than back pain. For the family doctors, the most important factors were neurological symptoms, walking ability, and pain severity. The patients in the study selected pain severity, pain duration, and walking ability.

The surgeons’ preference was probably guided by their experience. Surgery gives better results in patients with problems affecting their spinal nerve roots, which cause leg pain. The factors that influenced the family doctors and patients were “quality of life” considerations, but they didn’t take account of the relative likelihood of a successful outcome.

The best solution to this discrepancy of viewpoints would be for all parties to recognize “where the other person is coming from”. A conference between surgeon, family doctor, and patient should provide a better-informed decision by the patient.

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Wednesday

03Feb2010

Homeopathy Meds Undergo Mass Tests of Overdose Levels

Wed, February 3, 2010 at 03:00AM

On Saturday, January 30, several hundred volunteers lined up in front of 6 branches of a major pharmacy chain in the UK, and each swallowed up to 80 homeopathic “pillules”. The idea was to show that massive overdoses of such homeopathic remedies are without any obvious effect. No one died or reported any serious reaction. The participants were on pretty safe ground, given our present knowledge of homeopathic medicines.

One purpose of the action was to embarrass the pharmacy, Boots, into withdrawing homeopathic meds from sale. Boots doesn’t believe that the meds contain anything active, but says it’s committed to providing customers with a wide range of products. The UK National Health Service covers $6 million of the $60 million spent annually on homeopathic medications.

Homeopathy is alive and well in the USA. However, the absence of clinical studies demonstrating any effectiveness has led homeopathic medications to be on many people’s quack list. I suggest you save your money, and hope that we don’t follow the attitude taken by the Royal Family and the UK National Health Service.

Robert Griffith |

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Supplements, Alternative Medicine

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Tuesday

02Feb2010

Feeling Stressed? Have Some Chocolate!

Tue, February 2, 2010 at 03:00AM

There have been quite a few reports on the health benefits of chocolate in recent years. The latest one provides findings suggesting that chocolate can have a variety of anti-stress changes – in metabolism, energy consumption, and intestinal microflora. It’s posted online in the Journal of Proteome Research.

Thirty volunteers, who were classified as having low or high anxiety traits using a validated questionnaire technique, ate 40 grams (about an ounce and a half) of dark chocolate daily, for up to 14 days. Blood and urine samples were collected from them at baseline, and at 7 and 14 days.

The subjects with higher anxiety scores had, at baseline, a distinct metabolic profile that covered hormone metabolism and intestinal microbial activity. In the dark chocolate eaters, there was reduced urinary excretion of the stress hormones cortisol and catecholamines (epinephrine and nor-epinephrine), together with partial normalization of stress-related markers for energy metabolism and gut microbial activity. The researchers conclude that this is strong evidence that 40 grams of dark chocolate daily is sufficient to modify the metabolism in an anti-stress direction.

This is a small study using a simple design and measures that are insufficient to support a relevant “medicinal” effect of chocolate. However, it provides another instance of possible health benefits of your favorite treat that can help you rationalize your next indulgence.

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Monday

01Feb2010

Quitting Smoking – Better Late than Never

Mon, February 1, 2010 at 03:00AM

There are two research reports that demonstrate that it’s never too late to stop smoking (though it would obviously be better if quitting had occurred before the events in question). The first report concerns the benefits of quitting smoking in early-stage lung cancer; it appears in the British Medical Journal.

A mete-analysis, based on 10 published observational studies, yielded a theoretical 5-year survival at age 65 in patients who quit after a diagnosis of primary early-stage non-small-cell or limited-stage small-cell cancers. In both types of cancer, there was a greater chance of achieving 5-year survival than in those who continued smoking.

For non-small cell tumors, quitters had a 70% chance, versus 33% in continuing smokers. For limited-stage small-cell tumors, the survival rates were 63% in quitters and 29% in continuing smokers. This study shows there is a strong case that smoking cessation can have an important role in preventing recurrence or exacerbation of lung cancers.

The second example of so-called ‘secondary prevention’ is with smoking after a heart attack (myocardial infarction, or MI). It’s published online in the Journal of the American College of Cardiology. This was a study of 1,500 consecutive patients aged 65 and above who were discharged from Israeli hospitals after their first heart attack. They were followed for 10 to 13 years.

Those subjects who had never smoked had a 43% lower risk of dying than those who continued to smoke, whereas those who quit smoking after their first heart attack had a 37% lower risk of death compared to the persistent smokers.

Only 35% of the smokers at the time of their heart attack managed to quit completely afterwards. In the remainder, there was an 18% reduced risk of dying with each five cigarettes cut daily, i.e. cutting down is also better than nothing.

I think these two reports show conclusively that, even if you still smoke after the initial severe event (diagnosis of cancer or a heart attack), stopping ‘after the event’ brings substantial benefits, i.e. it’s not too late to quit.

Robert Griffith |

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Cancer,

Friday

29Jan2010

Why You Should Cut Your Salt Intake

Fri, January 29, 2010 at 03:00AM

There’s more to cutting your salt intake than just remo9ving the salt shaker from the table. Any number of foods usually contain too much sodium – cereals, ketchup, most processed foods and restaurant meals, for example. But it’s hard to cut down on salt. To help motivate us, Californian scientists have quantified the benefits of reducing dietary salt; their report is in the New England Journal of Medicine.

The scientists used a computer simulation model – the Coronary Heart Disease Policy Model established in 1987 – to determine the projected benefits to the US adult population with a reduction of daily salt intake by 3 grams daily. The change would result in 60,000 to 120,000 fewer cases of coronary heart disease, 32,000 to 66,000 fewer strokes, 54,000 to 99,000 fewer heart attacks, and 44,000 to 92,000 fewer deaths from any cause.

The average US daily salt intake is about 10 grams a day; the WHO recommends only 5 grams daily, and the Us Department of Agriculture sets a limit at 5.8 grams daily. So 3 grams less daily (which is only a teaspoonful) ought to be in reach. But it’s not so simple; most salt comes from processed and restaurant foods, and such a change would require a ‘concerted national effort’, according to one expert.

Individuals, especially those with high blood pressure, should take the results of this report to heart, and practice salt reduction within their own capabilities. Apart from its benefits on the cardiovascular system, salt reduction has been reported to improve kidney health, and reduce the risk of stomach cancer and osteoporosis.

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