Blame Your Brain for Binges

Why does it sometimes feel guiltless to reach for sweets and other high-calorie foods? New research from Yale and the University of Southern California suggests that when our glucose (blood sugar) levels drop, certain areas of the brain free us to yield to temptation. This new finding comes from a study with only 14 participants, some of normal weight and some of whom were obese. When investigators intravenously lowered the participants' glucose levels and then showed them pictures of food and other images, functional MRI scans (fMRI) revealed changes in specific zones of the brain that encourage eating. Brain responses - in areas called the insula and striatum, both associated with reward - ignited a desire to eat.

And another brain area, the prefrontal cortex, appeared to lose its ability to interfere with the increasingly urgent signals to eat. This sequence of events occurred in normal weight study participants only when their glucose levels were lowered, but among the obese participants, the brain's brake on "reward" (meaning more food) didn't seem to work even when glucose levels were normal. The study was published online Sept. 19 by the Journal of Clinical Investigation.

My take? These are interesting findings that may help explain why so many people have such a hard time controlling cravings and losing weight. If confirmed, the results could lead to the development of better strategies to lose weight. In the meantime, I suggest trying to satisfy cravings with low glycemic index fruits (berries, cherries, apples, pears) that are healthier than other sources of sugar and give you the added benefit of fiber. Working with a hypnotherapist in an effort to reduce cravings might also be helpful.

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Breast Cancer Risk Higher If Estrogen Or Testosterone Levels Higher

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The risk of breast cancer is greater if levels of hormones estrogen or testosterone are higher in post-menopausal women, researchers from Brigham and Women's Hospital reported in Breast Cancer Research, an open-access BioMed Central journal. The researchers examined six different growth and sex hormones and discovered that higher levels raised breast cancer risk by 16% for each one.
Dr Shelley Tworoger and team examined blood samples of nurses up to nine years before their breast cancer status was recorded. They matched post-menopausal females who had been diagnosed with breast cancer with two controls of the same age.
The following hormones were individually linked to a 50% to 200% rise in breast cancer risk:

• Estrone - one of several natural estrogens.
• Estradiol - one of several natural estrogens.
• Testosterone - steroid hormone from the androgen group. Secreted in the testes of males and ovaries of females.
• Androstenedione - a 19-carbon steroid hormone. An intermediate step in the biochemical pathway that produces testosterone, estrone and estradiol.
• DHEA (Dehydroepiandrosterone) - a 19-carbon endogenous (originates from within the organism) steroid hormone. The most abundant circulating steroid in humans.
• DHEA-sulfate - a metabolite of of DHEA.

Breast cancer risk increases with the number of high level hormones

The higher the number of hormones at elevated levels, the higher the breast cancer risk, the scientists found. For example, a woman with one elevated hormone may have a 10% higher risk when compared to those with normal levels, while women with five or six hormones with elevated levels would have double (100% higher) the risk. For those with seven or eight hormones at high levels, there can be triple the risk.
The risk was a little higher for females with estrogen receptor (ER) positive disease.
Dr Shelley Tworoger said:

"Elevated estrogens had the biggest effect on risk, especially for ER positive cancer. However, androgens, and prolactin also contribute to increasing risk of breast cancer.
These hormones are known to stimulate the growth of breast cancer cells in the lab and, while androgens can be converted to estrogen in the body, these hormones have also been found to stimulate cancer cell growth in the absence of ER.

Our results suggest that models used to assess breast cancer risk could be improved by taking into account multiple sex hormone and growth hormone levels."

Written by Christian Nrodqvist

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Women Do Not Get Enough Vitamin D During The Menopause

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A healthy diet is especially important during the menopause a period in which the risk of suffering from health problems increases. Various studies analyse the diet of peri and postmenopausal women in Spain alongside the troubles that come with this transition. The results show that all of those groups studied have a deficient intake of vitamin D.
Marina Pollán, researcher at the Carlos III Institute of Health and one of the authors of the study explains that "biological and physiological changes in women caused by the menopause come with a greater risk of developing health problems in which diet plays an important role. These include diabetes, osteoporosis, cardiovascular disease and certain types of cancer."

Therefore, the analysis of dietary patterns during and after the menopause is of particular interest because of its health implications. However, in Spain there have been very few studies that have assessed the diet of peri- and postmenopausal women.
In order to study these dietary habits, the authors of the study analysed 3574 women from the age of 45 to 68 from October 2007 to July 2008. Each programme contained a minimum of 500 women from seven Spanish cities (La Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia and Zaragoza) and involved a food frequency questionnaire validated by the Spanish population.

The results show that obesity rates stand at 29% whereas 42% of subjects are overweight. Average calorie intake was 2053 kilocalories (with 43% of energy intake coming from carbohydrates, 36% from fats and 20% from proteins). Researchers highlight that practically all of the women received the recommended intake of all the vitamins, apart from D and E.
The case of vitamin D is striking given that none of the groups reached 50% of their RDA (Recommended Daily Allowance). The average total intake was 2.14 micrograms per day, which constitutes just 39% of the RDA for women of this age group.

"A diet with less fat and protein that is high in vegetables, nuts, and carbohydrate-rich foods will even out the energy balance and corrects levels of vitamin D and E,"according to the researchers. "This is especially important in places that are far away from the Mediterranean Sea where women have a greater tendency to fall short of the current recommendations."
A greater risk of obesity

Another study lead by Faustino R. Pérez-López, coordinator of the study group of the Spanish Association for the Study of the Menopause, links body weight with metabolic and hormonal parameters in 574 postmenopausal women.
Published in the Gynecological Endocrinology journal, the results confirm that Body Mass Index (BMI) during the menopause increases with ages, the time that the menopause began, the number of children and also with blood sugar levels, triglyceride levels and systolic blood pressure.
Pérez-López points out that "this allows us to propose lifestyles changes that could improve quality of life and reduce the mortality rate associated with obesity if they are adopted early on."

Body fat mass distribution, weight regulation and hormone secretion of fat are all different when it comes to men and women. Abdominal obesity is more frequent in postmenopausal women. It increases the risk of heart disease, high blood pressure, diabetes, sleep apnoea, cancer, arthrosis, mental health problems and even death.
Furthermore, peri- and postmenopausal obesity intensifies the symptoms of the menopause and it is associated with a lower quality of life than that of women of normal weight. "Experimental studies of animals and women show that treatment with ovarian hormones can impede weight gain and muscle mass loss," according to the researcher.

Sexuality during the menopause

Another study by Faustino R. Pérez-López, published in the Journal of Sex Medicine, deals with the female sexuality during the menopause. This is usually characterised by organic changes within themselves and their partner alike, previous sexual dysfunctions and socio-demographic factors that change from region to region, or even from one period of time to another.

Experts used the Changes in Sexual Function Questionnaire (CCFS) which consists of 14 simple questions. Its results show that 64.1% of the 117 volunteers (between February and November of 2010 in the Hospital Central de Asturias in Oviedo and the Hospital Cabueñes in Gijón, Spain) admitted to suffering from female sexual dysfunction.

Pérez-López outlines the importance of highlighting that "a third of Western women display some form of sexual dysfunction throughout their lives. This sometimes comes hand in hand with depression, anxiety, low self-esteem and a decrease in their quality of life."

Sexual arousal problems are related to a lowered quality of life and also to urogenital tract problems whereas orgasm problems maintain a link with a decrease in the quality of life. Signs of depression are associated with the supposed onset of female sexual dysfunction.

The score from the CCFS showed a positive correlation between the educational attainment of the woman and her partner and the frequency with which she engages in sexual relations. They showed a negative correlation with depression," according to the conclusions of Pérez-López, who points out that more studies are necessary before we take these findings as a given when talking about other population groups.

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Breastfeeding May Reduce Pain In Preterm Infants

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Poorly managed pain in the neonatal intensive care unit has serious short- and long-term consequences, causing physiological and behavioral instability in preterm infants and long-term changes in their pain sensitivity, stress arousal systems, and developing brains. In a study published in the November issue of PAIN®, researchers report that breastfeeding during minor procedures mitigated pain in preterm neonates with mature breastfeeding behaviors.

Currently, pain associated with minor procedures such as pricking for blood tests is managed with interventions such as skin-to-skin contact, pacifiers, and sweet tastes, but these produce only modest and/or inconsistent relief. In normal term-born infants, breastfeeding during painful procedures has been shown to reduce pain response by 80-90% and has no serious side effects, but this approach had not previously been tested in preterm infants. One concern is that preterm infants might come to associate breastfeeding with the painful procedure, jeopardizing their ability to feed effectively enough to adequately gain weight.

In a randomized clinical trial, investigators from the Child & Family Research Institute at BC Children's Hospital and The University of British Columbia in Vancouver, BC, conducted a study to learn if preterm infants would show lower pain scores when breastfed during blood collection. They also looked at whether breastfeeding during the painful procedure would have a negative impact on the development of breastfeeding skills, and whether infants who had more mature breastfeeding behaviors would have lower pain scores and heart rates during blood collection than less experienced feeders.

Fifty-seven infants born at 30 to 36 weeks gestational age were divided into two groups. One group was breastfed during blood collection. The other group was given a pacifier. During the procedure, their faces and hands were videotaped, their responses were scored using the Behavioral Indicators of Infant Pain, and their heart rates were measured. Breastfed babies were also scored according to the Premature Infant Breastfeeding Behaviors scale.

For the group as a whole, breastfeeding did not reduce either behavioral or physiological pain during blood collection. Nevertheless, no immediate adverse effects were found on breastfeeding skill development. "Our sample of infants was assessed early in their breastfeeding experience; none of our infants were fully established on breastfeeds," says lead investigator Liisa Holsti, PhD, Clinician Scientist at the Child & Family Research Institute; Assistant Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia; and a Canada Research Chair in Neonatal Health and Development. "For infants whose breastfeeding skills are inconsistent, it is unlikely to mitigate pain effectively."

In the breastfed group, however, infants who were more advanced in their ability to feed did have significantly lower behavioral pain scores. Despite concerns that blood sampling during breastfeeding may be more difficult, the authors report that the time taken for the procedure in the breastfed group was significantly shorter, making blood collection more efficient.
"Finding creative ways to apply breastfeeding for pain mitigation in premature infants is important, because recent research suggests that sweetening agents used to reduce minor procedural pain may act as sedatives rather than analgesics, and they may have negative effects on development," says Professor Holsti. "Our findings support further research on the effects of breastfeeding for more mature feeders over repeated events to assess both the short- and long-term benefits of the treatment."

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Preeclampsia: Early Detection And Immediate Treatment

A blood test can help to assess whether a pregnant woman who suffers from pregnancy induced hypertension, so-called preeclampsia, is at risk for an imminent delivery. This knowledge can be used to determine the due date as well as avoid complications for mother and child. This was now reported by a team of scientists at Charité Universitätsmedizin Berlin in the American Journal of Obstetrics & Gynecology. The assay was put to the test in collaboration with Universitätsklinik Leipzig and five other European research centers.
Preeclampsia is the most common of the dangerous pregnancy complications.

It is characterized by elevated blood pressure, protein in the urine and accumulation of excess fluid beneath the skin. If not treated in time, preeclampsia may progress to eclampsia, characterized by tonic-clonic seizures which can possibly result in maternal and infant death.

Dr. Stefan Verlohren from the Klinik für Geburtsmedizin and his team examined a total of 630 pregnant women. 388 of those were having a normal pregnancy whereas 164 suffered from preeclampsia. The scientists closely observed the remaining time of pregnancy in patients with preeclampsia. In cases where the concentration of two certain placenta-derived growth factors, so-called sFlt-1 and PlGF, exceeded a certain value the duration of pregnancy was significantly shorter. In patients with especially high test results delivery resulted within 48 hours.

"With this test we can assess the severity of preeclampsia and give a short-term prognosis of the disease course", explains Dr: Verlohren. Further studies will have to evaluate the test´s validity in women who have an elevated risk of developing preeclampsia.

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Bad News for Night Owls

A new study from England suggests that early birds are slimmer, healthier and happier than people who stay up - and get up - later. Researchers at Britain's Roehampton University questioned 1,068 men and women about their eating and sleeping habits as well as how they rated their levels of happiness, anxiety and their physical health and weight.

Other findings of the online survey showed that, on average, the early birds were out of bed a few minutes before seven a.m. on weekdays while the night owls typically arose a few minutes before nine. Both groups reported spending an extra hour in bed on the weekends. But the lead researcher didn't have much to offer on why early birds do better: he suggested that perhaps getting morning chores out of the way and getting kids out of bed allowed the early risers to cope better with the hectic pace of modern life. The study results were presented at a conference of the British Psychological Society.

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Top Natural Ways to Increase Energy

Forget about energy drinks and coffee. It is possible to increase energy naturally, and have a healthy steady supply to get you through each day. By adjusting your personal eating, sleeping and exercise patterns, you can fight tiredness and boost your energy level fast and naturally. Read on and find out how.

1. Getting adequate sleep at night is key to staying energized throughout the day. Try to sleep at the same time everyday and aim to get at least 7 hours of quality sleep. Eliminate as much light and other distractions from your bedroom as possible in order to get the best quality sleep possible. Avoid napping during the day especially in the late afternoon.

2. Try to add at least 20 minutes of cardio exercise into your daily routine. Do it regularly but do not push yourself to the point of exhaustion. Exercise is an excellent metabolism booster. Not only will exercising regularly boost your energy during the day, it will also help you sleep better at night, provided you don't exercise up to 3 hours before bedtime.

3. Your body needs fuel to keep your energy levels up. The following are things to watch out for food in your diet.

• Drink more water.
Dehydration causes fatigue, so keep your body hydrated throughout the day.

• Cut down on caffeine.
Caffeine may give you that initial kick but overuse of it will lower blood sugar and consequently energy levels.

• Eat more protein.
Insufficient protein is a common reason for fatigue. Pack some almonds and nuts for a quick and convenient protein snack or have a hard-boiled egg for breakfast.

• Watch out for excess sugar.
Excess sugar causes fluctuating blood sugar levels, which can result in plummeting energy levels. Try to decrease all forms of refined sugars, including the "hidden sugars" in low-fat foods.

• Eat small and frequent meals.
Maintain a steady supply of nutrients to your body and increase your long-term energy levels. Incorporate proteins, wholegrains, high-fibre vegetables and nuts into your diet to keep blood sugar levels balanced.

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5 Ways to Boost Your Energy Levels

Energy is essential in this sleep-deprived, high-speed, modern world. Here are 5 simple ways to recharge your batteries and increase productivity and energy levels. If your energy reserves are running low, consider implementing a few of these recommendations over the next few weeks and see how you feel:

1. Get a good night's sleep.
Getting the right amount of sleep at the right times is critical to staying energized during the day. Eliminate as much light as possible from your bedroom as light interferes with the body's circadian rhythm thereby interfering with sleep. Avoid napping during the day especially in the late afternoon.

2. Get your body moving – exercise.
Implement at least 20 minutes of cardio exercise at least 4 times a week. By expending energy on a regular basis, you actually boost your energy levels. Do it regularly but do not push yourself to the point of exhaustion.

3. Slow down and do less.
Evaluate your to-do lists and list down your priorities. Get rid of the less important items. Schedule leisure time for yourself. Stress from any source is an energy zapper, and will have an adverse impact on your general health.

4. Eat small but frequent meals.
By maintaining a steady supply of nutrients to your body, you increase your long-term energy levels. Incorporate proteins, wholegrains, high-fibre vegetables and nuts into your diet to maintain balanced blood sugar levels. Also, make sure your bigger meals are in the middle of the day rather than at night.

5. Cut out energy zappers from your diet.
Fluctuations in blood sugar can cause plummeting energy levels. Decrease or cut out refined sugars from your diet. Caffeine intake should also be limited to the mornings. Overuse of caffeine especially in the afternoons will lower energy levels after they give you an initial kick.

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Steroids Given to Preemies May Harm Brain Growth: Study

Steroids Given to Preemies May Harm Brain Growth: Study

By Jenifer Goodwin

Giving premature babies even low doses of steroids after birth interferes with development of the brain's cerebellum, which is important to motor skills, learning and behavior, new research finds.

For the study, researchers analyzed MRIs of 172 babies born very early (under 32 weeks' gestation) at two medical centers, the University of British Columbia and the University of California, San Francisco. Full term is considered 40 weeks' gestation.

Preemies are sometimes given steroids known as glucocorticoids after birth to improve lung function and to stabilize low blood pressure, both of which are common problems.
The study found that preemies given the steroids hydrocortisone or dexamethasone had on average a 10% smaller cerebellum than premature babies not given the drug. Most of the infants had their brains scanned shortly after birth and again at around what would have been full term.

"Their cerebellums were growing slower," said lead study author Dr. Emily Tam, an assistant professor of neurology and pediatrics at University of California, San Francisco. "And we know from other studies that a smaller cerebellum in preemies is associated with poorer outcomes."
Mothers-to-be who are at risk of preterm labor are also often given steroids (usually betamethasone) before the baby is born to speed up maturation of the lungs. Researchers did not see any connection between prebirth steroids and smaller cerebellums. More controversy surrounds their use in babies after birth.

The study is published in the Oct. 19 issue of Science Translational Medicine.
About 13% of babies are born prematurely each year in the United States, according to the study. Premature babies can have all sorts of difficulties. Some 5 to 10% of very preterm infants have cerebral palsy, and up to half have behavioral disorders or learning disabilities.
Prior research has found that high-dose steroids may interfere with cerebellum growth, Tam said. Previous research has also found that children given steroids right after birth are more prone to learning and behavioral problems, said Dr. Pierre Gressens, a professor of pediatric neurology at the Centre for the Developing Brain at Imperial College in London and a lab chief at INSERM in Paris.

The American Academy of Pediatrics recommends avoiding high-dose dexamethasone in babies after birth, according to background information in the study.
In practice, some hospitals never use steroids in premature babies, while others routinely give steroids, Gressens said. In the study, about 20% of the 172 babies had been given steroids post-birth, Tam said.

The new research suggests that steroids should be given after birth only with the utmost caution, carefully balancing potential risks and benefits, Gressens said.
"There are situations where steroids are useful for a short time for the lungs, but doctors have to remember there is a particular toxicity of this steroid," Gressens said.
Tam agreed that doctors should be very cautious in giving steroids to premature babies.
"Even a low dose of dexamethasone or hydrocortisone are associated with decreased brain development, which would make us need to be careful when using these drugs," she said.
"They are very effective drugs," she continued. "We wouldn't want to say don't use them entirely, because we don't have very good alternatives. But when you think about options, don't jump straight to the steroid. You always have to think about the risk and benefit balance. Now there's more risk they have to consider when they think about using this drug."
Tam and her colleagues plan to follow the children as they get older to see if the smaller cerebellums result in motor, learning or behavioral issues.

In a second study, also led by UCSF researchers and published in the same journal issue, researchers showed that a small molecule drug blocked the negative effects of steroids on the cerebellum in mice.
The drug worked by stimulating a pathway that's involved with growth of neurons, which is what steroids appear to hamper, Gressens said.
"If you give a small molecule which stimulates the pathway, in a way you reverse the toxicity of the steroid, and if you reverse the effect on growth, the cerebellum goes back to normal size," he said. "There is potential for application in humans, but it's still a long time from clinical applications, maybe 5 to 10 years."

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Sperm Moves Best for Moderate Exercisers: Study

Sperm Moves Best for Moderate Exercisers: Study

Men who get moderate amounts of exercise have better sperm motility than men who are less or more physically active, a new study finds.
Motility refers to the sperm's ability to swim and move towards an egg, an important factor in fertility.

The study by researchers at Yamaguchi University in Japan included 215 men who provided semen samples and information about their physical activity levels. The men were divided into three groups: strenuous, moderate or light exercise. Age and body mass index were similar among the three groups.

The moderate-exercise group had the highest average sperm motility and the fewest men with less than 40% sperm motility (14.3%), while 31% of those in the light-exercise group and 27% of those in the strenuous-exercise group had less than 40% sperm motility.
The study was slated for presentation Wednesday at the annual meeting of the American Society for Reproductive Medicine in Orlando.

"Exercise is a component of an overall healthy lifestyle which contributes to reproductive health. This study, which uses frequency, intensity and duration to quantify the amount of exercise a subject gets, shows that a moderate exercise routine may be recommended to modestly improve semen parameters in men with no known conditions that impair their reproductive capacity," ASRM president-elect Dolores Lamb said in a society news release.
Because this study was presented at a medical meeting, the data and conclusions should be considered preliminary until published in a peer-reviewed journal.
-- Robert Preidt

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Foods that May Protect Against Stroke

Pop quiz: What do apples, pears, cucumbers and cauliflower have in common? Answer: The edible parts of all of them are white. And these fruits and vegetables have now been identified as foods that may dramatically lower the risk of stroke. This news comes from a decade long Dutch study that involved more than 20,000 adults age 20 to 65, none of whom had cardiovascular disease when they enrolled. Over the 10 years, 233 of the study participants suffered strokes. Researchers have since compared the diets the participants reported eating to see which fruits and vegetables, if any, were associated with a lower risk of stroke.

Based on information contained in the questionnaires all participants filled out, those who ate the most "white" fruits and vegetables were 52 percent less likely to have had strokes than those who didn't eat as much of these foods. The amount that seemed to make a difference was 171 grams, the equivalent of one medium to large apple daily. The most commonly eaten white foods were apples, pears and applesauce. The study was published online September 15 in Stroke.

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False Positive Mammograms Affect Most Women After A Decade

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A new investigation of national Breast Cancer Surveillance Consortium data in the Annals of Internal Medicine reveals that, in one decade of yearly mammograms, over half of women without cancer will be called back for further testing, and approximately 1 in 12 women will be referred for a biopsy.
Investigation leader Rebecca Hubbard, PhD, an assistant researcher at Group Health Research Institute explained:

"We conducted this study to help women know what to expect when they get regular screening mammograms over the course of many years. We hope that if women know what to expect with screening, they'll feel less anxiety if - or when - they are called back for more testing. In the vast majority of cases, this does not mean they have cancer. When a woman without breast cancer is called back after screening mammography for extra testing, she has a "false positive."

We wanted to understand better how likely false-positive test results are when women receive annual screening mammograms compared to every other year - and starting at age 50 compared to age 40."

Hubbard and her team analyzed data from over 169,000 women who were aged between 40 to 59 years across seven regions in the U.S..
According to Hubbard, women's chances of having a false positive over the course of a decade was reduced from 61% to 42% when they were screen every other year, instead of annually. The probability of false positives was cut in half when women had previous mammograms available for comparison. Hubbard advises that women who don't return to the same facility where they had their previous mammogram, should arrange ahead of time for their previous mammograms to be sent to the new mammography facility.
Hubbard continued:

"We found that women in their 40s and 50s had similar risks of having false positive during 10 years of screening. But over the course of a lifetime, starting screening at age 40 would make a women more likely to have a false positives than if she had started at age 50, because of that extra decade of screening."

Their results revealed that women who were diagnosed with cancer from screening every other year were not considerably more likely to be diagnosed with late-stage cancer, compared to women who were screen annually. Hubbard explained: "Women should talk with their doctors to make informed decisions about how often is best for them to get screening - and when to start."
Mammography is the only screening test to reduce the risk of a women dying of breast cancer that has been verified in clinical trials. For women who receive a false-positive it can be an extremely stressful experience, and may prevent women from getting regular screening.
In the same issue of Annals, an associated Breast Cancer Surveillance Consortium study led by Karla Kerlikowske, MD, of the University of California, San Francisco, is the first to examine the accuracy of digital mammography in comparison to film mammography in U.S. community practice. Newer digital mammography has been replacing older film mammography over the past few years.
The investigators, including Dr. Hubbard, discovered that both digital and film mammograms performed similarly for those aged between 50 to 79 years for detecting cancer. In addition they found that digital mammography might be better than film mammography in detecting cancer for women in their 40s with dense breasts, who had not gone through menopause. However, for women aged 40 to 49, the risk of having a false-positive was a little higher with digital mammography compared with film.

An associated report, from the International Prevention Research Institute in Lyon, France, puts the two investigations in context.

Both investigations were funded by The National Cancer Institute, which supports the Breast Cancer Surveillance Consortium. The collection of cancer data was also supported in part by several state public health departments and cancer registries across the United States.

As well as Drs. Kerlikowske and Hubbard, the additional co-authors of both investigations were Diana L. Miglioretti, PhD, of Group Health Research Institute and Bonnie C. Yankaskas, PhD, of the University of North Carolina at Chapel Hill.

In addition to Drs. Hubbard, Kerlikowske, Miglioretti, and Yankaskas, the other co-authors of the study on false positives were Weiwei Zhu, MS, of Group Health Research Institute and Chris I. Flowers, MD, of the Moffitt Cancer Center and Research Institute, in Tampa, FL.

And the other co-authors of the investigation on digital vs. film mammography were Constance D. Lehman, MD, PhD, of the University of Washington, also an affiliate investigator at Group Health Research Institute; Berta M. Geller, EdD, of the University of Vermont in Burlington; Stephen H. Taplin, MD, MPH, of the National Cancer Institute; and Edward A. Sickles, MD, of the University of California, San Francisco.

Written by Grace Rattue

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Improving Health By Moving Poor Women To Lower-Poverty Neighborhoods

Low-income women with children who move from high-poverty to lower-poverty neighborhoods experience notable long-term improvements in some aspects of their health, namely reductions in diabetes and extreme obesity, according to a new study by researchers at the University of Chicago and partner institutions.

The study was the first to employ a randomized experimental design - akin to a randomized clinical trial used to test the efficacy of new drugs - to learn about the connections between neighborhood poverty and health. The study was published Oct. 20 in the New England Journal of Medicine in a special article, "Neighborhoods, Obesity and Diabetes - A Randomized Social Experiment." The lead author for the collaboration was Jens Ludwig, the McCormick Foundation Professor of Social Service Administration, Law and Public Policy at UChicago.

For the study, Ludwig and a team of scholars from around the country studied 4,498 poor women and children, who from 1994 to 1998, enrolled in a residential mobility program called Moving to Opportunity. The U.S. Department of Housing and Urban Development operated MTO in five United States cities - Baltimore, Boston, Chicago, Los Angeles and New York.

The MTO program enrolled low-income families with children living in distressed public housing. Families volunteered for the experiment, and based on the results of a random lottery, were offered the chance to use a housing voucher subsidy to move into a lower-poverty community. Other families were randomly assigned to a control group that received no special assistance under the program.

The study collected information during 2008-10 on families who had enrolled in the program 10 to 15 years before. The research team directly measured the heights and weights of MTO participants, and it also collected blood samples to test for diabetes.
At the time of follow-up, 17 percent of the women in the study's control group were morbidly obese (body mass index at or above 40), and 20 percent had diabetes. However, in the group of women who were offered housing vouchers to move to lower-poverty neighborhoods, the rates of morbid obesity and diabetes were both about one fifth lower than in the control group. "These findings provide strong evidence that the environments in low-income neighborhoods can contribute to poor health," said Ludwig.

The research team included another UChicago faculty member, Dr. Stacy Tessler Lindau, associate professor in obstetrics and gynecology, and an expert in urban health.
"Obesity and diabetes are among the biggest health problems facing our country, and they are preventable. But preventing these conditions through interventions that target individual behavioral change has proven very difficult," she said.

"This study shows that where a woman lives with her children may, in part, determine whether she develops serious, costly, life-shortening diseases like diabetes and extreme obesity. Giving a low-income woman the opportunity to move with her children to a less impoverished neighborhood appears to lower her risk of diabetes and extreme obesity," she said.

The study's findings that disadvantaged community environments contribute to extreme obesity and diabetes could help explain the increase over time in these health problems. The study's findings could also help explain disparities in obesity and diabetes prevalence across race and ethnic lines in the U.S.

"The increase in U.S. residential segregation according to income in recent decades suggests that a larger portion of the population is being exposed to distressed neighborhood environments," they write in the paper. "Minorities are also more likely than whites to live in distressed areas."

"These results highlight the great importance of learning more about what specific aspects of the social or physical environment reduce the risk of diabetes and obesity; for example, greater access to grocery stores, more opportunities for physical activity, or feelings of greater safety and reduced psychological stress," said Ludwig.

"Given that diabetes and obesity are associated with a large number of health complications and higher cost for medical care, the findings from this study suggest that improving the environments of low-income urban neighborhoods might improve the duration and quality of life for the residents and lower health care expenditures," said another study co-author, Dr. Robert Whitaker, Professor of Public Health and Pediatrics at Temple University, and an expert on obesity and diabetes.

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Does Fertility Treatment Raise Breast Cancer Risk?

Does Fertility Treatment Raise Breast Cancer Risk?

Breast Cancer Diagnosis for Giuliana Rancic Raises Questions About In Vitro Fertilization
By Sonya Collins

When E! News anchor Giuliana Rancic made her breast cancer diagnosis public, there was speculation about whether fertility treatment might have been a factor.
On NBC's Today show, Rancic, 37, said she got a mammogram when her doctor strongly recommended it before starting another round of IVF (in vitro fertilization). On their reality TV show, Rancic and her husband, Bill, have chronicled their previous fertility treatments.
Rancic's diagnosis has raised questions about whether fertility treatment can increase the risk for breast cancer. WebMD got answers from fertility and breast cancer specialists.

Is there a link between IVF and breast cancer risk?

Fertility and cancer experts interviewed for this story agree that there is no strong evidence to connect fertility drugs with increased risk for breast cancer. Oncologists add that there is a need for studies that follow women who have undergone IVF for longer periods of time.

Couldn't the increased levels of estrogen in fertility treatments increase risk for breast cancer?

Exposure to estrogen and progestin after menopause has been linked to increased risk for breast cancer for women in their 50s and 60s, but fertility drugs do not expose women to estrogen at that age, says Samantha Pfeifer, MD. She is chair of the practice committee at the American Society for Reproductive Medicine.
Pfeifer says fertility drugs raise estrogen levels for up to seven days at a time. "Estrogen levels are not significantly raised for a prolonged period of time."

Is it possible that women undergoing fertility treatment have other risk factors unrelated to fertility drugs?

Yes. There are many factors that affect breast cancer risk.
Most women undergoing fertility treatment are over 32 and have never had a child, which is a risk factor for breast cancer, says Jennifer Litton, MD. Litton is a breast medical oncologist at the University of Texas M.D. Anderson Cancer Center.

Are there special recommendations for women who want to undergo IVF but who have increased risk factors for breast cancer, such as the BRCA gene mutation or a family history?

Recommendations about undergoing fertility treatment are no different for women who have breast cancer risk factors. "As long as you don't have a cancer diagnosis," Litton tells WebMD, "at this point, there is no evidence that IVF will increase risk for patients with greater risk factors, even those with the BRCA gene mutation or family history."

Is it common for fertility doctors to recommend a mammogram before a woman undergoes IVF?

Any woman who is trying to get pregnant should be following the regular guidelines for health maintenance. "You want to make sure the Pap smears are up to date and that any routine screening has been done," Pfeifer says. "We follow the established guidelines of mammograms starting at age 40 for women who don't have significant risk factors."
The guidelines about when to start screening mammograms are also controversial.

Is fertility treatment an option for breast cancer survivors?

"It can be an option, but it depends on several factors," says Eric Widra, MD, who chairs the practice committee for the Society for Assisted Reproductive Technologies.
These factors include a woman's age at the time of treatment because fertility naturally decreases over time, and most oncologists recommend a woman be cancer-free for around five years before trying to get pregnant. Future pregnancy also depends on the damage chemotherapy may have done to a women's reproductive system. It is ideal to see a fertility specialist before beginning cancer treatment rather than after.
"What we often do for our patients, especially if they are over 30, is consider fertility preservation before they go through chemo," Litton tells WebMD, "by retrieving eggs and freezing the eggs or embryos. Freezing embryos is the standard. Freezing eggs is still considered experimental."

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25 Deaths Now Blamed on Cantaloupe-Linked Listeria Outbreak

25 Deaths Now Blamed on Cantaloupe-Linked Listeria Outbreak

By Amanda Gardner

The death toll from the listeria outbreak first linked to tainted cantaloupes has risen to 25, and a total of 123 people have been sickened across 26 states, the U.S. Centers for Disease Control and Prevention reported late Tuesday.

The agency said that even though the cantaloupes in question were recalled in mid-September, more cases might still emerge since Listeria monocytogenes infection has a long lag time between diagnosis and laboratory confirmation "and also because up to two months can elapse between eating contaminated food and developing listerosis."
The listeriosis-linked deaths have occurred in Colorado (6), Indiana (1), Kansas (2), Louisiana (2), Maryland (1), Missouri (1), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2) and Wyoming (1). The people who have died ranged in age from 48 to 96, the CDC said.

One pregnant woman who contracted the illness had a miscarriage, the CDC said.
Pennsylvania has reported its first case of infection, the agency said Tuesday.
On Sept. 14, the agency announced that Jensen Farms, of Granada, Colo., had voluntarily recalled its Rocky Ford-brand cantaloupes and the produce is "now off store shelves." Consumers -- especially older adults, people with weakened immune systems and pregnant women -- should discard this brand of cantaloupe if it is in their refrigerator, the agency said. Other brands of cantaloupe are safe to consume, however.
In a news conference recently, CDC director Dr. Thomas R. Frieden called the cantaloupe-linked outbreak "the deadliest outbreak of a foodborne disease that we've identified in more than a decade."

Unlike other bacteria, listeria can flourish in colder temperatures. So, "if you've got a contaminated cantaloupe in your refrigerator, the listeria will continue to grow," Frieden said. "That's one of the reasons why we may see continued cases from cantaloupe already in people's refrigerators in the days and weeks ahead."
Although listeria tends to infect fewer people, it is typically deadlier than other foodborne germs and disproportionately affects the elderly, newborns, pregnant women and anyone with a weakened immune system. People can develop meningitis from the organism, but many people only experience milder diarrhea.
According to the CDC, some 1,600 cases are reported annually in the United States, resulting in 260 deaths.

The bacterium tends to grow in soil and water. But animals can also carry the germ and pass it on to humans through meats, dairy products and other foods of animal origins. Most listeria outbreaks are from animal products, not produce, the CDC said.

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Obese Women Have Higher Risk Of Suffering Breast Cancer

University of Granada researchers have proven that overweight women -especially those with morbid obesity- develop this disease at an earlier age.
A total of 524 women with breast cancer participated in the study. The researchers found that women who started menstruating at a very early age between 9 and 10 years- developed breast cancer at a younger age.
Obese women develop breast cancer at a younger age than other women. Furthermore, the likelihood of developing breast cancer is much higher in patients with morbid obesity.
This is one of the main conclusions drawn in an article recently published in the Spanish journal Nutrición Hospitalaria by the University of Granada research group CTS 367, coordinated by the Nursery Department professor María José Aguilar Cordero.
The researchers examined a sample of 524 women diagnosed with breast cancer who were treated at the university hospital San Cecilio from January 2009 to September 2010 in Granada, Spain. They assessed the nutritional status of these patients (normal weight, obesity and morbid obesity) and their age at diagnosis. Women with a family history of breast cancer were separated from those lacking it.
The researchers found that obesity in women is associated with diagnosis of breast cancer at a younger age. This finding contrasts with the results obtained in previous studies that demonstrated that individuals with higher body mass index had lower risk of suffering breast cancer.
Age At First Menstruation
The University of Granada researchers found that women diagnosed with breast cancer at an earlier age were those who started menstruating when younger than 10 years. Thus, age at menarche is determinant in the development and diagnosis of breast cancer, especially in women with morbid obesity.
Therefore, although genetics and family history of cancer are very relevant factors (up to 18% of breast cancer in obese women had a genetic factor), this study proved that obesity -especially the most severe cases- is the most relevant factor in early development of breast cancer.

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Blood Type May Affect Survival After Heart Bypass

Blood Type May Affect Survival After Heart Bypass

How well you fare after coronary artery bypass graft (CABG) surgery may depend on your blood type, a new study finds.
Patients with AB blood type are 20% less likely to die after heart bypass surgery than those with A, B or O blood types, Duke University Medical Center researchers found.
Nearly half the population has type O blood and may be at greater risk for bleeding and blood transfusions after surgery, the researchers said.
The findings from more than 15,000 patients were scheduled for presentation Monday at the American Society of Anesthesiologists' meeting in Chicago.
The reason for the differences in risk could be two proteins in the blood responsible for clotting, the von Willebrand factor (vWF) and Factor VIII (FVIII).
The gene that passes on group O is associated with lower levels of these clotting proteins, explained lead author Dr. Ian J. Welsby and colleagues in a society news release.
A person's blood type is determined by two genes, one from each parent. People with type O blood have two O genes. Some patients have one A or B gene and one O gene (AO and BO), which confer medium levels of the clotting proteins. People with AB blood type have no O genes and the highest level of clotting proteins.
This study found that patients with AB blood have the lowest risk for bleeding after CABG surgery, but further investigation is needed to determine the order of risk for patients with other blood types and whether boosting their vWF levels will improve their outcomes after heart surgery, the researchers said.
Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal, experts say.
-- Robert Preidt

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Healthier Diet, Stronger Sperm?

Healthier Diet, Stronger Sperm?

 For years, nutritionists have rallied around the notion that "you are what you eat."Now, new research suggests this adage might even extend to the strength and quantity of sperm.
The observation stems from a pair of studies slated for presentation Monday at the American Society for Reproductive Medicine annual meeting in Orlando, Fla., both of which highlight an apparent linkage between nutrition and semen quality.
The upshot: Diets rich in red meat and processed grains seem to impair the ability of sperm to move about, while diets high in trans fats appear to lower the amount of sperm found in semen.
"The main overall finding of our work is that a healthy diet seems to be beneficial for semen quality," said Audrey J. Gaskins, lead author of the first study. Currently a doctoral candidate in Harvard School of Public Health's department of nutrition in Boston, Gaskins' colleagues included researchers from both the University of Rochester and the University of Murcia in Spain.
"Specifically, a healthy diet composed of a higher intake of fish, fresh fruit, whole grains, legumes and vegetables seems to improve sperm motility," Gaskins explained, "which means a higher number of sperm actually move around, rather than sit still."
Gaskin's conclusions are based on work with 188 men between the ages of 18 and 22, who were recruited in Rochester. Food questionnaires were completed, and participant diets were categorized as being either "Western" in content (including red meat, refined carbs, sweets and energy drinks) or so-called "Prudent" (composed of fish, fruit, vegetables, legumes and whole grains).
Semen tests were then conducted to assess sperm movement, concentration and shape.
Although diet seemed to have no impact on either sperm shape or number, motility was impacted, with "Western" diets linked to reduced movement, even after accounting for factors such as race, smoking history and body-mass index (BMI).
Gaskins stressed, however, that more work is needed to better understand exactly how nutrition can affect sperm.
"This was a small study, and we don't know if there's something else about the men that causes them to have worse motility," she noted. "We don't know if nutrition actually causes the change. So, for now all we can say is that there's an association between nutrition and sperm quality."
On a similar front, a second study led by Dr. Jorge Chavarro, an assistant professor of nutrition and epidemiology at the Harvard School of Public Health, revealed that men who eat diets that contain a relatively high amount of trans fat had lower sperm concentration levels. What's more, the amount of trans fat found in their sperm and semen went up.
The conclusion was drawn from work with nearly 100 men, all of whom underwent a nutritional and semen quality analysis.
Even after adjusting for a wide array of factors such as age, drinking and smoking histories, BMI, caffeine intake and total calories consumed, the authors found that although trans-fat intake appeared to have no impact on sperm movement of shape, the more trans fatty acids consumed the lower an individual's sperm concentration.
Dr. Edward Kim, from the University of Tennessee's graduate school of medicine in Knoxville, reacted to both studies with enthusiasm and caution.
"I think that this research is certainly very suggestive that dietary factors may have an impact on male infertility," said Kim, who also serves as president of the Society for Male Reproduction and Urology.
"And the studies point us in a direction that suggest that a healthy lifestyle may correlate with better quality sperm," he added. "But clearly further research in this area is needed to come up with definitive conclusions."
Because both studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.tes

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How Laughing Fights Pain

We all know that laughing makes us feel good, but research has never shown exactly how this happens or how laughter fights pain, which it definitely can. An interesting investigation from England has demonstrated that the physical act of laughing - the actual muscle contractions involved - lead to the release of "feel good" endorphins, the same brain chemicals responsible for the runner's "high." Endorphins are also known to influence our perception of pain. Researchers at Oxford University studied reactions to pain both before and after bouts of laughter. Participants agreed to the use of a freezing sleeve slipped over their forearms, a blood pressure cuff that kept tightening and an uncomfortable ski exercise while they watched comedy videos, as well as some videos that weren't funny at all. The results of five sets of studies were published in the Proceedings of the Royal Society B: Biological Sciences and confirmed that laughter activates the release of endorphins. The results also indicated that pain thresholds were significantly higher in participants after laughter than in members of control groups who watched factual videos instead of funny ones.

My take? The findings from this study are important. The results help us better understand something we've long observed and that earlier studies have shown: laughter can influence health by relieving pain, lowering stress and even helping protect against heart disease. When you're stressed, nothing works better to counter it than a first-class belly laugh. I recommend seeking out laughter whenever you're stressed or feeling down. Call your funniest friend, rent a video comedy or you can try Laughter Yoga (seriously, there are more than 6,000 clubs in 60 countries). Bottom line: lighten up and laugh! It's good for you.

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Women's Heart Disease Tied To Small Blood Vessels

Heart disease affects men and women in different ways. In women, symptoms of burgeoning heart disease are often more insidious, but when a heart attack strikes, it is more lethal than it is in men. Roughly 25 percent of men will die within a year of their first heart attack, but among women, 38 percent will die. Women are twice as likely as men to have a second heart attack within 6 years of their first one, and women are twice as likely as men to die after bypass surgery.

Yet after a heart attack, women's hearts are more likely to maintain their systolic function - their ability to contract and pump blood from the chambers into the arteries. According to C. Noel Bairey Merz, MD, Director of the Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles, this suggests that heart disease manifests differently in women, affecting the microvasculature (small blood vessels) instead of the macrovasculature (major blood vessels) as it does in men.
Dr. Bairey Merz provided an overview of the sex differences in heart disease at the Physiology of Cardiovascular Disease: Gender Disparities conference, October 12-14 at the University of Mississippi in Jackson. The conference was sponsored by the American Physiological Society with additional support from the American Heart Association. Dr. Bairey Merz's presentation was 'Ischemic Heart Disease in Women: Microvascular Coronary Dysfunction.'

Function Indicates Form
The heart is a muscle, and as with other muscles, depriving it of oxygen causes damage that diminishes its ability to function. Conventional wisdom notes that the most prevalent form of heart disease is coronary artery disease, in which atherosclerotic plaque narrows and eventually blocks the major arteries leading into the heart, thus cutting off the heart's supply of oxygen. The damage to the heart tends to be permanent, and after a heart attack, the heart never quite regains its former power.
But when reviewing the medical literature, Dr. Bairey Merz and her colleagues found that women's hearts were less likely than men's to lose their ability to pump blood after a heart attack, and that female heart patients were less likely to present with obstructive coronary artery disease. Instead, the oxygen deprivation and subsequent damage to the heart is more likely to occur when small blood vessels, not major arteries, become dysfunctional.
"That is the reason women are often misdiagnosed and suffer adverse events," said Dr. Bairey Merz. "Physicians have been looking for male pattern disease, when we need to start looking at female patterns." Likewise, more research is needed to develop appropriate treatments and reduce risk in women, she added.
According to Dr. Bairey Merz, the good news is that it is possible to measure damage to small blood vessels objectively. "The gold standard is reactivity testing, angiograms, and other physiologic measures, rather than anatomic study."

Dr. Bairey Merz provided an overview of the latest data about these methods and how they can be applied to help clinicians understand gender differences in the pathophysiology of heart disease during her presentation.

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