Metabolic Syndrome: you can decrease your risk

Most people have heard about common diseases like high blood pressure, diabetes, and arthritis. However, few people know about the metabolic syndrome, which is a disorder that affects an estimated 25% of Americans (and growing), and is associated with serious disease.

The metabolic syndrome is a group of conditions related to your metabolism that occur at the same time. These conditions include: (a) obesity, especially around your belly/mid-section; (b) high blood pressure; (c) abnormal cholesterol levels, including low levels of the "good cholesterol" (HDL) and high levels of triglycerides, or fat in your blood; and (d) insulin resistance, where the normal process your body uses to get sugar (glucose) into your cells does not work, resulting in increased levels of both insulin and glucose in your blood. Having any one of these conditions increases your likelihood of heart disease, heart attack, type 2 diabetes, and stroke. However, having them in combination can double and even triple your risk.

The good news is that lifestyle changes are key to preventing and treating the metabolic syndrome. In a study published in this month's International Journal of Obesity, researchers followed 224 people (80% of whom were women) for one year after assigning them to one of four groups: (1) use of an appetite suppressant alone, (2) a lifestyle modification program to lose weight, (3) the appetite suppressant plus the group lifestyle modification, and (4) the appetite suppressant plus brief meetings with their primary care physicians on weight loss, food diaries, healthy food choices, etc.

All weight loss treatments were successful in helping participants lose weight. Further, they found that weight loss decreased risk for metabolic syndrome: for every 2.2 pounds lost, there was an 8% reduction in the risk for the disorder. Additionally, participants who lost at least 5% of their starting body weight were 59.2% less likely to have the metabolic syndrome, and those who lost at least 10% of their starting body weight were 83.2% less likely to have the metabolic syndrome. Essentially, lose weight - even just a couple of pounds - and you can reduce your risk for the metabolic syndrome and related diseases.

Other ways to prevent and treat the metabolic syndrome? Stop smoking, exercise most days, and eat fiber-rich foods. Sounds like just healthy living to me. Couldn't we all use a little more of that?

It's okay to feel blue

September 11th is a day that was forever changed in 2001. Despite six years having passed and despite your emotional and physical proximity to the events of that day, it is not unusual to feel unsettled on this anniversary.

There has been a fair amount of research on the psychological aftermath of 9/11. One of the most common mental health disorders associated with the terrorist attacks is post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that develops in response to trauma. Symptoms, which must be present for at least one month, include: being easily startled, losing interest in things you used to enjoy, irritability, aggression and/or violence, difficulty feeling affectionate, feeling emotionally numb with loved ones, flashbacks (reliving the trauma through thoughts and nightmares), and avoiding situations that remind you of the original incident. Symptoms generally develop within three months of the incident, but can emerge years later. The course of PTSD varies with individuals: some will recover within three to six months, while others will develop a chronic condition that lasts several years. Other mental health problems often accompany PTSD, including depression and substance abuse.

A recent review of the research on PTSD after 9/11 identified several groups at higher risk for PTSD. Most obviously, individuals who were directly exposed to the attacks are at high risk for developing PTSD with chronic symptoms. However a number of other groups also are vulnerable to PTSD. These include: people who were geographically close to the attacks, low-income individuals, people with low education, women, Latinos living in New York, and those with poor social supports. Additionally, the researchers noted that repeated exposure to graphic media portrayals of the attacks contribute to PTSD, especially among vulnerable groups.

So if you find yourself feeling low, irritable, or just not yourself today, give yourself a break. Take five minutes several times throughout the day to sit quietly, breathe, mediate, pray - whatever cultivates peace and calmness. The Department of Veterans Affairs also has some good information on self care. In addition, you might want to limit your television viewing and other media coverage this week, so you do not continue to expose yourself to the images of that day - especially if you are among one of the groups identified as more vulnerable to PTSD. Finally, if you think you have undiagnosed PTSD, see your health care provider who can provide the necessary referrals for treatment.

Red, red wine - go to my heart?

I was reading the newest issue of Food & Wine magazine this weekend when I came across an article touting all the health benefits of wine (yeah! for my love of red wine). I was pleased to see they were citing premier medical journals as the sources of their information. However, as I read the fine print, I was dismayed they were making broad claims about wine promoting longevity and reducing heart attack risk "for all" based on studies conducted on men.

So, I did what any good researcher of women's health would do - I went to Pubmed and searched both for the articles they cited and to see whether there were similar findings about women available. I found a couple of things.

The blanket statement that drinking wine "promotes longevity" may be misleading. While the authors of the study cited in F&W indeed found that men who preferred to drink wine had a 34% reduction in mortality because fewer died cardiovascular-related deaths, it is important to note some key limitations of this research, acknowledged by the investigators themselves. For one, this study is of a fairly homogeneous sample of older men. Second, the wine drinkers were healthier to start, including fewer smokers, lower triglycerides, and lower BMIs (all of which are associated with cardiovascular disease). Thirdly, the authors explicitly state that caution must be used when trying to extend these findings to the general population and especially to women. Finally, the authors note the relationship between wine and lower mortality rate may reflect other research that has shown wine drinkers tend to make healthier food choices than drinkers of other alcoholic beverages, rather than reflect the benefits of wine itself. Future research is most definitely needed before making claims about longevity.

Although F&W's claim that wine reduces heart attack risk referred to (yet another) study of men, there is research out there on women, heart attacks, and alcohol. Investigators studied 1,885 women's drinking patterns and history of non-fatal heart attacks. They found that women who drank alcohol were consistently less likely to have had a heart attack than women who abstained, and this trend was related to how much women drank. Women who drank less than 1 drink per day cut their risk by 4%, whereas women who drank 3 drinks per day cut their risk nearly in half. This is not a license to down a bottle of wine a day, however. The researchers also found that women who drank enough to become drunk at least once a month were three times as likely to have a heart attack as those who did not drink and six times as likely to have a heart attack as those who did drink without becoming intoxicated. Finally, they found that women who drank wine were less likely to have a heart attack than women who drank liquor.

Now I won't argue with F&W about their finding that red wine has tannins, and tannins do protect against heart disease. I also won't argue too much with them about evidence that suggests wine MAY protect against type 2 diabetes, stroke, cataracts, colon cancer, and brain decline, except to say that many of these benefits probably reflect healthier lifestyles rather than properties of wine. What I will say is that you should consume your research as you would a fine wine - pay attention to its complexity and character, gauge its potential, be clear about its possible faults, and know know how to compare it to recognized standards.

Depression more damaging to daily health than other common conditions

After today's headline about the increase in suicide rates among teen girls, new research on the effects of depression on daily health status should come as no surprise.

In a study published in this week's Lancet, researchers examined the effects of depression on everyday health status for 245,404 people living in 60 countries in all regions of the world who participated in the World Health Organization's World Health Survey. They defined everyday health as encompassing several domains, including general health, vision, mobility, self care, pain/discomfort, sleep/energy, emotional processes, and thinking processes. In addition to studying the effect of depression on health status, the researchers also studied and compared the effects of four chronic health conditions on health status: angina, arthritis, asthma, and diabetes.

Several significant findings emerged from this research. First, people who had depression AND one of the four chronic health conditions had significantly worse daily health than people who had depression alone or one of the four conditions alone. Second, people who had angina, arthritis, asthma, or diabetes were significantly more likely to be depressed than people who did not have one of these conditions. Third, women had worse daily health than men. Finally, depression contributed to poor daily health more so than any of the other chronic health conditions. These findings were consistent even across different countries with different demographic characteristics.

This study demonstrates that depression continues to be a public health problem that needs greater attention not only in the United States, but around the world. Unfortunately, much of our lack of attention to this important health issue reflects the stigma associated with mental health problems in our society. If there is an upside to this research, it is that women with chronic health conditions should be aware they are at greater risk for developing depression. If you think you may have symptoms of depression, talk to your health care provider when you see her for your chronic health condition. She should be able to diagnose and treat your depression if necessary, or refer you to someone who can.

Maybe breastfeeding isn't better

After all my ranting about breastfeeding yesterday, I see an article in Pediatrics today that caused me pause. Apparently, women who smoke and breastfeed are lacing their milk with nicotine, and it's having a negative effect.

Researchers in Pennsylvania studied 15 mother-infant pairs to better understand how nicotine affects infants in the short-term. Moms were asked to breastfeed their babies on two separate occasions. On one occasion, the moms dressed in disposable lab coats and gloves and entered a 700 square foot stainless steel chamber to smoke without their babies present. Then they removed their protective garb, washed their hands, provided a sample of breast milk, and breastfed their babies upon demand. The babies were then placed in a crib or on a carpeted floor to sleep. On the second occasion, the moms did not smoke before breastfeeding their babies and putting them down for a nap. On both occasions, researchers monitored the babies' sleep patterns and movement.

The first relevant finding in this study was that both nicotine and cotinine (a metabolite of nicotine) were present in the mothers' breast milk. The researchers estimated the infants received 4.3 times the amount of nicotine when moms smoked before breastfeeding, compared to when they did not.

The second relevant finding is that infants who fed after their mothers' smoked slept 36.7% less than when their mothers did not smoke beforehand. Further, there was a direct and negative relationship between nicotine exposure and sleep: the more nicotine the infants were exposed to, the less they slept. This is not wholly surprising - after all, nicotine is a stimulant.

The researchers suggest that although nicotine has been removed from the list of drugs contraindicated during lactation, nursing mothers who smoke still should consider the negative effects of nicotine on their infants. Since nicotine is not stored in breast milk, they suggest these mothers time their breastfeeding and avoid nursing 30 to 60 minutes after smoking, when nicotine levels peak. They also caution there may be other chemicals transferred in breast milk that we don't know about, and these unknown compounds may have negative health consequences.

What's the moral of this story? Quit if you smoke - it's better for you and your baby. If you don't quit, at least avoid nursing when nicotine levels are highest. You'll transfer less nicotine to your baby, and you both may get more sleep. And that's something everyone in the household can benefit from.

Breastfeeding is better for babies AND moms - so why is it discouraged?

As if it weren't enough that Applebee's in Lexington pushed a mom out of their restaurant for breastfeeding her baby in a back corner booth. (So much for that Kentucky law that states breastfeeding in public is legal. Of course, why we need laws for this I'm unclear, but that's for another post).

Now the federal government has toned down its ads to promote breastfeeding. You read correctly, toned down its ads, even though media relations experts advised them against softening the ads, because they wouldn't increase breastfeeding. I mean, why would the federal government want to increase breastfeeding rates? Who cares about the study published this year by the Agency for Healthcare Research and Quality (yes, an agency of the federal government) that showed breastfeeding contributes to good infant AND maternal health? According to this AHRQ study, children who are breastfed get fewer ear and respiratory infections, GI illnesses, and skin rashes. They're also less likely to have asthma, obesity, type 1 and 2 diabetes, and childhood leukemia, and less likely to die from sudden infant death syndrome (SIDS).

As for moms - women who breastfed were less likely to have type 2 diabetes, breast cancer, and ovarian cancer. Conversely, women who stopped breastfeeding early (before 6 months) or never breastfed at all were more likely to have postpartum depression.

So why are we spending money on an ad campaign for breastfeeding that will essentially have no effect on a mother's decision to breastfeed? Talk to your neighborhood pharmaceutical company - apparently it was the infant formula/pharmaceutical lobby that got the Department of Health and Human Services to tone down its ads, because they need to keep those revenues up. And not just in infancy mind you. They want to make sure kids keep needing their prescriptions well into childhood to take care of the asthma, ear infections, and diabetes they develop.

Are we really making health policy based on an industry that does better when people are unhealthy? I say nurse-in at Applebee's today - big PHRMA tomorrow.

Household mold may cause depression

For those of us who are neat freaks, this headline may come in handy the next time you have to nag your partner/roommate/child to clean up. It seems researchers have identified a link between damp, moldy homes and depression in adults.

Most people know that mold can cause some physical health problems, including nasal congestion, coughing, headache, and allergic reactions. A study released last week suggests that mold and dampness also may affect mental health. Researchers from Brown University interviewed nearly 6,000 people in six European cities. For each person, they measured dampness and mold characteristics of the home, as well as depressive symptoms.

They found that people who lived in homes that had any dampness or mold - from minimal to extreme - were more likely to have depressive symptoms than people who lived in homes without any mold or dampness problems. Further, women were one and a half times more likely than men to report depression. The researchers suggest that exposure to the toxins released by household mold may affect the brain's ability to regulate emotions.

If you live in a humid climate, have an older home, or have ever had water damage in your home, you are more likely to have problems with household dampness and mold - and perhaps depression. The EPA provides some great resources on cleaning up mold and preventing mold from invading your home in the first place. You also can monitor your mental health online.

And to all the neat-freaks like me out there --- dehumidifier anyone?