Air Pollution Harms Patients After Heart Attack

(HealthDay News) -- Tiny particles in air pollution can harm people with coronary artery disease by crippling the ability of the heart to conduct electrical signals, Harvard University researchers report.

Pollution from cars and trucks and industrial plants has been shown to trigger heart attacks, but exactly how it does that hasn't been well-known, researchers say.

"We found that elevation in fine particles from non-traffic as well as traffic sources and black carbon, a marker for traffic, predicted depression ST-segment levels," said lead researcher Dr. Diane R. Gold, an associate professor of medicine and environmental health. "Effects were greatest within the first month after hospitalization and for patients with heart attack during hospitalization or with diabetes."

The report is published in the Sept. 9 online edition of Circulation.

For the study, Gold's team collected data on 48 patients from the Boston area with coronary artery disease. The researchers monitored the patients for 24 hours using portable electrocardiograph machines looking for changes in the electrical conductivity of the heart called ST-segment depression. This dysrhythmia can indicate inadequate blood flow to the heart or inflammation of the heart muscle.

All patients had been hospitalized for heart attack, unstable angina or worsening symptoms of coronary artery disease. Forty percent had suffered heart attacks, and 25 percent had diabetes.

Gold's group also looked at the average 24-hour levels for all pollutants in Boston. They found that these levels were below accepted or proposed National Air Quality Standard thresholds.

The researchers found that increased levels of a pollutant called PM 2.5 and black carbon, which is found in traffic exhaust, was associated with an increase in ST-segment depression.

In addition, sulfur dioxide, which is the product of combustion, but not from cars, was also associated with an increase in ST-segment depression.

Increases in ST-segment depression were particularly higher in patients recovering from a heart attack compared with other patients, the researchers reported.

"If the air pollution-associated ST-segment changes represent either myocardial inflammation or risk of ischemia, then it is possible that reduction in regional traffic and non-traffic associated air pollution may reduce heart attack or risk for either ischemia, arrhythmia or heart failure in patients with coronary artery disease in the period after hospitalization," Gold said.

For patients who have just been discharged from hospital after a heart attack, guidelines from the American Heart Association and the American College of Cardiology suggest that patients should avoid heavy traffic because of the stress of driving, Gold said.

"Our study provides additional rationale to avoid or reduce heavy traffic exposure after discharge, even for those without a completed myocardial infarction, since traffic exposure involves pollution exposure as well as stress," Gold said.

Dr. Byron Lee, a cardiologist at the University of California, San Francisco, agrees that patients who have had a recent heart attack should avoid air pollution.

"This study provides very strong evidence that environmental pollution puts added stress on the heart," Lee said. "Patients who have just had a heart attack should probably do what they can to avoid pollution exposure. This may mean staying indoors during smoggy days or getting out of the city altogether."

Dr. Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York City, thinks that patients who have suffered a recent heart attack and live in areas where air pollution levels are high and unavoidable need to be monitored more carefully.

"Maybe these patients need close follow-up," Sharma said. "These patients may need an increase in their heart medications or medications need to be changed. Optimal aggressive medical therapy and optimization of medical care could be the answer for these patients."

More information

For more on air pollution and heart disease, visit the American Heart Association.

Chelation Therapy

Here is occlusive coronary atherosclerosis. The coronary at the left is narrowed by 60 to 70%. The coronary at the right is even worse with evidence for previous thrombosis with organization of the thrombus and recanalization such that there are three small lumens remaining.

Atherosclerosis, or "hardening of the arteries", is the cause of two most deadly health problems Unfortunately, it begins quite early in life and continues relentlessly until circulation is so compromised that a heart attack or a stroke is almost certain. The process begins innocently enough, by formation of a small plaque on the wall of an artery. It attracts platelets that form a small blood clot. Later on, additional clotting elements increase the size of the clot. Eventually cholesterol and calcium get deposited into the growing plaque. Calcium completes this process, making the arteries "hard".

This is a normal coronary artery with no atherosclerosis and a wide lumen that can carry as much blood as the myocardium requires. Normally arteries have the ability to expand or contract, depending on the need of the body. But once the calcium is settled on the arterial walls, they become rigid, unable to either expand or contract. That’s where the expression "hardening of the arteries" comes from. The cells of the body require continuous blood supply in order to live. When it stops, most cells die within a few minutes. If this happens in the heart, the result is known as a heart attack. In the brain, it is called a stroke.

MAJOR SYMPTOMS Chest pain (angina) because of decreased circulation within the heart, memory loss, dizziness, poor balance from reduced blood flow to the brain, pain in the legs after walking which is relieved by rest.

TRADITIONAL – TREATMENT Hardening of the arteries is a systemic disease. In other words, it happens throughout the body, not just in one or 2 areas. If you understand this, you will realize that the current approach to treatment is crude, primitive and misguided. Some experts have compared it to putting a band-aid on a major injury.

When a surgeon performs a bypass surgery or an angioplasty, it does nothing to correct the widespread atherosclerosis already present in other parts of the body, such as brain, kidneys, lungs, legs and everywhere else. To complicate matters further, most of the arteries are very small. They are called capillaries, and they comprise the majority of the 40 to 60 thousand miles or arteries feeding the tissues of the body.

The diameter of a capillary is smaller than the size of a red blood cell. This is necessary for the exchange of oxygen and nutrients to take place. Obviously, these arteries can not be bypassed or surgically manipulated. Various medications used for "treatment" of heart disease are designed to deal only with the symptoms, not the real causes of the problem. Clearly, the real treatment for atherosclerosis would be a procedure that removes the plaques from the arteries and restores blood flow all over the body, in large arteries as well as small ones. And this brings us to

CHELATION – THERAPY
Chelation Therapy is probably one of the most effective treatments for hardening of the arteries, yet it is being ignored and even maligned by mainstream medicine. Chelation therapy was used successfully in over 1 million clients over the last 40 plus years. The main ingredient of chelation therapy is a synthetic amino acid known as EDTA (ethylene-diamine-tetra-acetic acid). It has a peculiar ability to strongly attract minerals, especially toxic metals - lead, mercury, cadmium, aluminum and others. Since then, a number of studies published in reputable medical journals have confirmed the effectiveness of IV chelation therapy for treating atherosclerosis and improving blood flow to the heart, the legs and the brain.

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Advanced Therapy Aids Stroke Patients

(HealthDay News) -- Therapies that attack blood clots directly in the brain may benefit ischemic stroke patients who don't respond to the standard treatment using clot-busting drugs.

So says a U.S. study that was to have been presented Tuesday at the 20th annual International Symposium on Endovascular Therapy, in Hollywood, Fla.

Ischemic strokes -- which account for about 83 percent of strokes -- occur when a small clot blocks an artery in the brain and halts blood flow, according to the American Stroke Association. If the clot isn't cleared and blood flow restored, the patient will suffer permanent brain damage or death.

"Often patients who fail to improve with standard intravenous (IV) stroke therapy aren't given the chance to succeed with more advanced intra-arterial (IA) therapy, because it's thought that it won't work if IV therapy didn't, and that it will increase the risk of bleeding in the brain," study author Dr. Christopher Zylak, director of neurointerventional radiology at Sacred Heart Medical Center in Spokane, Wash., said in a prepared statement. "Our data suggest that IA therapy can be highly successful even when IV therapy doesn't work, and that the risk of bleeding is no different between the two therapies."

In IV therapy, clot-busting drugs are delivered through an intravenous device in the patient's arm. IV treatment must begin within three hours of the onset of stroke, which means patients must get to the hospital at the first signs of stroke.

IA therapy involves placing a catheter through a small incision in the patient's groin and moving the catheter through an artery all the way to the site of the blockage in the patient's brain. This enables direct delivery of clot-busting drugs to the area. Doctors also can use the catheter to insert a tiny corkscrew-like device to remove the clot.

In this study, the researchers compared 80 patients who received IV therapy and 43 patients who received IA therapy at Sacred Heart from 2004 through 2007. Some of the patients who received IA therapy had not responded to IV therapy.

Success rates of IA therapy (defined as opening up of the blocked blood vessel) were 85.7 percent in 2006 and 83.3 percent in 2007. Death rates among patients who received IA therapy were 30.8 percent in 2006 and 27.8 percent in 2007. That's half the 50 percent to 80 percent death rates published in the "natural history outcomes" of large-vessel strokes, the study authors said.

"Without any question, we definitely were able to help patients who failed IV therapy by providing IA therapy," Zylak said. "In the future, for large-vessel clots, IA therapy may well be the best direct therapy, bypassing IV therapy."

He noted that many stroke victims don't receive any treatment, because they don't recognize the signs (such as vision and speech problems, paralysis, and memory difficulties) and don't seek medical care. The sooner a stroke is treated, the more likely treatment will be successful.

"Overall, we are under-treating stroke. There are many patients who could benefit from stroke treatment who aren't getting it for various reasons," Zylak said. "Treatment therapies today are getting dramatic results. If a medical center doesn't offer the more advanced IA therapy, the patient can be taken by helicopter to a center that performs the therapy, even if IV therapy wasn't successful."

Stroke is the third leading cause of death in the United States, killing about 160,000 people a year, according to the National Stroke Association. About 750,000 people suffer from stroke annually.

More information

The Washington University School of Medicine has more about ischemic stroke.

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FDA Warns Clot Risk Higher in Birth Control Patch Than Pill

(HealthDay News) -- A birth control skin patch used by many American women carries a risk of serious blood clots that is higher than the risk already recognized for the birth control pill, the U.S. Food and Drug Administration warned late Friday.

Based on the results of a new study that discovered the increased danger, the agency said it has approved changes to the labeling for the Ortho Evra Contraceptive Transdermal Patch, to better warn women and their doctors of the potential risk.

"For women that choose to use contraceptives, it is important that they thoroughly discuss with their health-care providers the risks and benefits involved," Dr. Janet Woodcock, deputy commissioner for scientific and medical programs at the FDA, said in a statement.

The warning followed reports out of Canada last week of two deaths, one heart attack and 16 cases of blood clots since 2004 among women who used the patch.

Approved by the FDA in 2001, the patch is sold by prescription and releases ethinyl estradiol (a type of estrogen), and a progestin called norelgestromin via the skin into the bloodstream. But the FDA noted that the body processes hormones delivered in this way differently than hormones delivered in pill form, so that "women using the product will be exposed to about 60 percent more estrogen than if they were using typical birth control pills."

Blood clots called venous thromboembolisms (VTEs) -- which can travel to the lungs as life-threatening pulmonary embolisms -- have long been known to be a rare but potential side effect of the birth control pill, and for the patch as well. In fact, the FDA had already revised the Ortho Evra label once in 2006, after a study found it doubled women's odds for VTE. Another study found use of the birth control patch boosted women's odds for the clots by about the same amount as did the Pill.

However, an epidemiological study just conducted by the Boston Collaborative Drug Surveillance Program, on behalf of drug maker Johnson & Johnson -- has found the patch may carry an even higher clotting risk than the Pill does. According to the FDA, that study looked at women aged 15 to 44 and "found that users of the birth control patch were at higher risk of developing serious blood clots than women using birth control pills."

The patch does have a checkered past. In November 2006, a group of 43 women sued the product's New Jersey-based maker, Ortho-McNeil Pharmaceutical Co. (a subsidiary of Johnson & Johnson), and San Francisco-based distributor McKesson Corp, alleging that they suffered blood clots and other health woes after being placed on Ortho-Evra.

"This product should not be on the market," Shawn Khorrami, an attorney for the plaintiffs, told the Associated Press at the time. "When you put out a product that gives women more hormones than they need, then you're increasing their risk of developing those ailments."

Similar worries have surfaced in Canada. But Janssen-Ortho, the patch's Canadian distributor, defended the product. "The risk of serious adverse events is small in healthy women, but increases significantly if associated with the presence of other risk factors, such as obesity or smoking," the company said in a statement.

The FDA is also stressing proper use of the Ortho Evra patch. In its statement issued Friday, the agency said it believes the product "is a safe and effective method of contraception when used according to the labeling, which recommends that women with concerns or risk factors for serious blood clots talk with their health-care provider about using Ortho Evra versus other contraceptive options."

Sidney Wolfe, director of the Washington, D.C.-based consumer advocacy group Public Citizen, told Toronto's The Globe and Mail newspaper that women "shouldn't use [the patch]. It shouldn't be used because it's a new product with no unique advantage."

One gynecologist begged to differ, however. "When you look at any estrogen-containing contraceptive product available on the market, whether it's the Pill or the Evra patch or NuvaRing, the vaginal ring, all of them slightly increase the risk of blood clot," Dr. Melissa Mirosh, former fellow of the contraceptive advice, research and education fellowship program at Queen's University in Kingston, Ontario, told the Canadian Press.

More information
There's more on reproductive health at the U.S. Centers for Disease Control and Prevention.

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Low Testosterone Might Shorten Men's Lives

(HealthDay News) -- Men aged 40 or over with low levels of testosterone may be at increased risk of fatal heart attacks or death from any cause, a British study suggests.

In fact, "The magnitude of the effect was very similar to that of [high] cholesterol or blood pressure," said lead researcher Dr. Kay-Tee Khaw, professor of clinical gerontology at the University of Cambridge School of Clinical Medicine.

However, more work is needed to see whether testosterone supplements should be recommended for men with naturally low levels of the hormone, she said.

"We need to replicate these findings," Khaw said. "We hope we can entice other investigators to look at testosterone levels and see if these findings are confirmed."

Her team published the findings in the Nov. 27 issue of Circulation.

The study included more than 11,600 men ages 40 to 79 who were free of known cardiovascular disease and cancer at the start of the trial. It was done because "there have been lots of studies suggesting that low testosterone may not be good for health," Khaw said. "So, we wanted to see if this could be demonstrated in a large population. Testosterone is hard to measure, the test can be expensive."

The men were divided into four groups based on their blood testosterone levels.

Those men in the highest quarter of testosterone readings -- with at least 19.6 nanomoles of the hormone per liter of blood -- had a 41 percent lower risk of dying over 10 years than those in the lowest quarter of testosterone readings -- less than 12.5 nanomoles of testosterone per liter of blood.

One major question is whether low testosterone is a risk factor itself or just a marker for other risk factors, said Dr. Victor Montori, associate professor of medicine at the Mayo Clinic in Rochester, Minn. He has done his own studies on testosterone replacement therapy.

"It does not mean that replacing or normalizing levels of testosterone would reverse the outcome," he said. "There are other hormones in the blood that are related to other risk factors, such as diabetes and hypertension."

In any case, a testosterone replacement regimen "would not be a walk in the park," Montori said. "It would be a major intervention."

According to Dr. Jorge Plutzky, director of the Vascular Disease Prevention Program at Brigham and Women's Hospital in Boston, the experience of women taking hormone replacement therapy (HRT) shows that hormonal regimens can have their dangers.

Beginning in the 1990s, millions of older American women took HRT, which replaced two female hormones, estrogen and progestin. Early trials had indicated that the therapy might reduce the risk of cardiovascular diseases such as heart attack and stroke in older women.

Instead, the Women's Health Initiative, a major study released in 2002, found that women taking HRT were at increased incidence of stroke, blood clots and breast cancer, noted Plutzky, who is also a spokesman for the American Cancer Society. HRT prescriptions dropped off precipitously after the study's release.

So, much more research is needed on the link between testosterone levels and mortality before doctors can recommend the regimen to men, Khaw said. Such studies might provide "insights and better understanding of disease mechanisms, such as how and why testosterone might be related to poorer health through, for example, insulin metabolism, lipid metabolism or inflammation," she said.

More information
There's more on testosterone at the U.S. National Library of Medicine.

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Natural Protein May Hurt Vision

(HealthDay News) -- High levels of an amino acid called homocysteine could harm the eyes, say researchers at the Medical College of Georgia.

They suspect that homocysteine -- already believed to contribute to heart attack, stroke and dementia -- likely helps cause retinal damage and vision loss.

Preliminary evidence suggests that elevated homocysteine levels damage the extensive blood vessel and neuronal network of the retina, said cell biologist Dr. Sylvia Smith.

With a $1.8 million grant from the U.S. National Institutes of Health, Smith hopes to learn more about how elevated homocysteine levels may affect the retina, its structure, functioning, and ability to withstand stress.

The retina, located at the back of the eye, receives light and transforms it into neural impulses that go to the brain.

Homocysteine levels increase when there's a decline in folic acid (folate) levels, Smith noted. This is a problem for many Americans, because they don't eat enough folate-rich fruits, vegetables and grains.

Folate and vitamin B12 convert homocysteine to methionine, an amino acid that plays a vital role in protein synthesis. When this conversion fails to occur, elevated homocysteine levels interfere with the folding and structure of collagen, a component of bone, tissue and blood vessel walls, the team explained.

More information
The American Heart Association has more about homocysteine and cardiovascular disease.

America's Top Hospitals Are Real Lifesavers

(HealthDay News) -- Patients in the top-ranked hospitals in the United States are 71 percent less likely to die than those in the lowest-rated hospitals, according to a new study from the health-care ratings company HealthGrades.

The 10th annual HealthGrades Hospital Quality in America Study looked at 41 million Medicare hospitalization records at 5,000 hospitals from 2004 to 2006.

The study authors contend that if all hospitals performed at the level of the top five-star rated hospitals, the lives of 266,604 Medicare patients could have been saved over those three years.
The hospital rankings are based on 18 procedures and medical conditions, ranging from pneumonia and heart attack to valve-replacement surgery.

The study found that overall death rates at American hospitals declined 11.8 percent from 2004 to 2006, with a 12.8 percent decline at the top-rated hospitals and a 11.4 percent decline at the lowest-ranked hospitals.

Of the procedures and conditions included in the study, the largest declines in death rates were noted for pancreatitis (19.2 percent), pulmonary embolism (17.4 percent) and diabetic acidosis and coma (16.6 percent). The smallest declines were seen in resection/replacement of the abdominal aorta (0.4 percent), coronary procedures such as angioplasties and stents (0.8 percent), and heart attack treatments (8.9 percent).

"While we are pleased to see that the hospital industry's focus on improving care quality has continued to reduce mortality rates, a significant variation in quality among the nation's best- and poorest-performing hospitals persists," study co-author Dr. Samantha Collier, who is HealthGrades' chief medical officer, said in a prepared statement.

"Concentrating on emulating practices from exemplary hospitals can result in improvement. If this focus were targeted to four key quality areas -- heart failure, respiratory failure, sepsis and pneumonia -- the nation could achieve up to a 50 percent reduction in potentially preventable deaths," Collier said.

More information
Here's more on the quality of health care from the Agency for HealthCare Research and Quality.

Heart Attack Boosts Diabetes Risk

(HealthDay News) -- After a heart attack, the risk of developing diabetes and so-called pre-diabetes rises steeply, a new study finds.

In fact, recent heart attack patients are up to four-and-a-half times more likely to develop diabetes compared with the general population and more than 15 times more likely to develop high blood sugar, according to the report in the Aug. 25 issue of The Lancet.

"Having a heart attack means that the chances of getting diabetes later are increased," said Dr. Lionel Opie, director of the Hatter Cardiovascular Research Institute at the University of Cape Town, South Africa, and author of an accompanying journal editorial. "We already know that diabetes predisposes one to heart attack, now we add that heart attacks predispose one to diabetes -- one nasty disease leads to another, and it's a two-way process."

In the study, a team led by Dr. Roberto Marchioli, from the Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri Sud, Chieti, Italy, collected data on almost 8,300 Italian patients who had suffered a recent heart attack and were not previously diabetic.

More than three and a half years after the heart attack, a third of the patients had developed diabetes or had impaired insulin resistance (a precursor to diabetes), as measured by an increase in blood sugar.

When they used a lower threshold for measuring blood sugar, 62 percent of the patients were defined as diabetic.

"These findings further tie the knot between heart attacks and high blood glucose -- each is a risk for the other, the patient thus potentially being caught in a fatal vicious circle," Opie said.
Risk markers for diabetes or high blood sugar include age, high blood pressure, and use of heart medicines such as beta-blockers, cholesterol-lowering drugs, and diuretics.

The researchers found being overweight increased the risk of diabetes. Smoking also increased the risk by 60 percent. In addition, an unhealthy diet and heavy drinking increased the risk of developing diabetes after a heart attack.

"Lifestyle factors can be particularly important in preventing disease," Marchioli said. "The reductions in risk associated with a Mediterranean-type diet suggest that diet could help reduce incidence of pre-diabetes and diabetes after a [heart attack]," he added.

Opie agreed that changing diet and exercising can help cut post-heart attack diabetes risk.

"Once you have had a heart attack, watch for new diabetes -- monitor blood sugar and keep exercising a lot," Opie advised. "This 'eats up' the blood sugar. And eat Mediterranean-style, adding olive oil and nuts -- the Mediterranean diet gives some, but not total, protection from new diabetes after a heart attack."

More information
For more on diabetes, visit the American Diabetes Association.

Restricting Blood Flow May Help Heart Bypass Patients

(HealthDay News) -- In a potentially significant discovery for heart bypass patients, British researchers are reporting that limiting blood flow to an arm before surgery produced better results in a small trial of patients.

Restricting blood flow before surgery reduced levels of troponin T, a cardiac protein that is released into the bloodstream after injury to the heart and is associated with poor outcomes after surgery, the researchers said.

"If you remotely precondition the heart before surgery, you get significant protection," said study researcher Dr. Derek Yellon, of University College London's Hatter Cardiovascular Institute. "You can significantly reduce troponin T in patients undergoing bypass surgery."

"Remote preconditioning is a phenomena in which, if one deprives the blood supply to an organ or tissue, other than the heart, that initiates a protective mechanism on the heart," added study lead author Dr. Derek J. Hausenloy, also from the Hatter Cardiovascular Institute.

The findings are published in the Aug. 18 issue of The Lancet.

Heart bypass surgery is done to reroute -- or "bypass" -- blood around clogged arteries to improve blood flow and oxygen to the heart, according to the American Heart Association.

In the trial, the British researchers restricted blood supply to the heart by restricting blood flow in an arm. Yellon and Hausenloy studied 57 patients undergoing coronary artery bypass surgery. Twenty-seven of the patients underwent heart preconditioning -- restrictions of blood flow -- before the operation.

Preconditioning consisted of three, five-minute cycles of restricting blood flow in one arm by inflating a blood pressure cuff that acted like a tourniquet. Between each cycle, the cuff was deflated.

Before and after surgery, the researchers measured the blood levels of troponin T in all patients. They found that levels of the protein were reduced by 43 percent among patients who had undergone preconditioning, compared with those who hadn't.

"If you can have a noninvasive technique that can reduce by 43 percent the amount of injury sustained by the heart during bypass surgery, then you can improve the morbidity and mortality of patients," Hausenloy said.

More study is needed to see if the technique actually improves clinical outcomes, Hausenloy said. "If this can be shown, it may warrant a change in clinical practice in all patients undergoing bypass surgery," he added.

Another heart expert agrees that if this concept is workable, it could represent a major advance in heart-bypass surgery.

"Revascularization, with angioplasty or bypass surgery, carries risk of heart muscle damage, measured in the study by troponin release," said Dr. Henry Purcell, of the Royal Brompton Hospital in London, and co-author of an accompanying editorial in the journal. "We need to minimize these risks in cardiac and non-cardiac surgery."

"We clearly need more data, and the current team is designing outcome studies to see if this protection translates into clinical benefits," Purcell said.

In another report in the same issue of the journal, South Korean researchers showed that use of the painkiller celecoxib (Celebrex) after implanting a stent to open blocked arteries in people with coronary artery disease is safe and might reduce the need for repeat procedures.

Dr Hyo-Soo Kim, of Seoul National University Hospital, and colleagues studied 274 patients, all of whom were given 100 milligrams of aspirin and 75 milligrams of Plavix -- a drug designed to prevent blood clots -- a day. In addition, 136 were randomly assigned to receive celecoxib before and after the procedure.

"These data suggest that the adjunctive use of celecoxib for six months after stent implantation in patients with coronary artery is safe," the researchers wrote.

In addition, they say that unlike another cox-2 inhibitor, Vioxx, celecoxib does not increase the risk of heart attack. "Administration of celecoxib for six months does not seem to increase the risk of adverse cardiac events in the intermediate term when used with dual anti-platelet therapy," they wrote.

However, another accompanying journal editorial warned that clinical trials suggest that long-term use of celecoxib may increase the risk of heart attack.

More information
To learn more about bypass surgery, visit the American Heart Association.

Obesity Cuts Risk of Dying After Heart Attack

(HealthDay News) -- In what doctors admit is a paradox, new European research shows that obese patients have half the risk of dying after a heart attack compared with normal-weight patients.

"Once a heart attack has occurred and been optimally treated, obese patients switch to a more favorable prognosis compared to normal-weight patients," said lead researcher Dr. Heinz Joachim Buettner, the head of interventional cardiology at Herz-Zentrum Bad Krozingen, Germany.

But the finding is no license for Americans to pile on the pounds, since obesity has long been known as a major factor for bringing on heart attack in the first place.

"Every effort should continue to prevent and treat obesity, and this study should not be taken to mean that it is good for one's health to be overweight or obese," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles.

He was not involved in the new study, which is published in the June 20 issue of the European Heart Journal.

In the study, Buettner's group tracked the health outcomes of almost 1,700 people who were hospitalized and treated for a common type of heart attack known as unstable angina/non-ST-segment elevation.

Among the patients, a third were normal weight, half were overweight, and 18 percent were either obese or very obese. The obese and very obese patients were by-in-large younger and more likely to have high blood pressure and diabetes.

In addition, for most of the obese patients, this was their first heart attack. They were also more likely to leave the hospital with prescriptions for heart medications, such as statins, ACE-inhibitors and beta-blockers.

During three years of follow-up, Buettner's team found that obese and very obese patients had less than half the risk of dying compared with normal weight patients. Among all the patients, 9.9 percent of normal-weight patients died, compared to 7.7 percent of overweight patients.

However, only 3.6 percent of obese patients had died, and none of the very obese patients died.
How might obesity lessen risk for death after heart attack?

The reasons for the paradox remain unclear, but Fonarow speculates that obese people may have more biological resources to draw on than thinner people.

"Patients who are overweight and obese may be able to drawn on greater metabolic reserve than patients who are in the underweight or healthy weight categories," Fonarow said.

"We have previously published on an obesity paradox in patients with acute as well as chronic heart failure, so this paradox applies to a number of cardiovascular disease states," he added.
Buettner stressed that, despite these findings, staying slim dramatically lowers your risk for having a heart attack in the first place.

"It is well known that even a modest intentional weight loss can improve or prevent obesity-related cardiovascular risk factors like diabetes mellitus and arterial hypertension," he said. This means that "obese people have a great potential to influence their prognosis, and they should start the effort before an acute coronary event occurs," he added.

Fonarow agreed that becoming obese is definitely not a good way to protect yourself from having a heart attack or even dying after suffering one.

"The findings from this study further confirm the finding of a number of prior studies that demonstrated an obesity paradox exists in patients with established cardiovascular disease, including those presenting with acute coronary syndromes receiving therapy," he said.

However, even though obese patients with acute coronary syndrome had a lower risk of post-heart attack death, obesity strongly contributes to an increased risk of heart trouble, diabetes, and cardiovascular death, Fonarow added.

More information
For more information on heart attack, visit the American Heart Association.

FDA Seeks Strictest Warning for Diabetes Drugs

(HealthDay News) -- The U.S. Food and Drug Administration has asked that two controversial type 2 diabetes drugs carry a "black box" warning on the potentially heightened risk of congestive heart failure in some patients.

In prepared testimony before a Congressional committee that was convened Wednesday following a published report on the cardiac dangers of Avandia, FDA Commissioner Dr. Andrew von Eschenbach said the agency had asked that Avandia, made by GlaxoSmithKline, and Actos, made by Takeda Pharmaceuticals, carry the more prominent warning because "despite existing warnings, these drugs were being prescribed to patients with significant heart failure."

According to von Eschenbach's testimony, the request for the warning -- the strictest one possible -- was issued to both companies May 23, two days after publication of a study in the New England Journal of Medicine that found Avandia (rosiglitazone) increased the risk of heart attack by as much as 43 percent.

But the decision to request the heightened warning wasn't made public until von Eschenbach's appearance before the House Committee on Oversight and Government Reform, which is reviewing the FDA's role in the Avandia controversy.

The May 21 Avandia study was led by Dr. Steven Nissen, a Cleveland Clinic cardiologist who was among the first to warn about the heart risks posed by the now-banned arthritis drug Vioxx.

Following the release of the NEJM study on Avandia, the FDA issued a safety alert, but stopped short of asking for a stronger warning label, saying more analysis was needed.

"The Food and Drug Administration is aware of a potential safety issue related to rosiglitazone," Dr. Robert J. Meyer, director of FDA's Office of Drug Evaluation II, said during a May 21 teleconference. But, he added, "At this point, we have not reached a definitive conclusion on the data. We don't feel there is consistent enough data to make a decision from a regulatory standpoint. We are not ready to make an action."

On Tuesday, results of a British study, funded by GlaxoSmithKline, were released and showed no significant increased risk for heart attack or death from heart disease associated with Avandia.

The study, which was released early by the New England Journal of Medicine to coincide with the House hearing, also found no increased risk for cardiac events among diabetics taking Avandia and those not taking it.

"Overall, there was no significant difference between those on rosiglitazone and those not on rosiglitazone," study co-author Stuart J. Pocock, of the London School of Hygiene & Tropical Medicine, said Tuesday. "The concern about cardiovascular death, I think, we have clearly deflated. The concern on heart attack -- our data are modifying that concern, but it's still inconclusive."

But one expert pointed out Tuesday that the original goal of the new study was to show a benefit of rosiglitazone in preventing heart disease.

"When you get a finding that is against the hypothesis, it makes me sit up and take note," said Dr. David M. Nathan, of Massachusetts General Hospital, and author of an accompanying editorial in the journal. "None of the data is reassuring. You don't give the drug the benefit of the doubt -- you give safety the benefit of the doubt."

And another expert, Dr. Bruce M. Psaty, who wrote a second editorial in the journal, said Wednesday of the Avandia findings, "I combined the results from this study with the study by Nissen, and there was still a 33 percent increase in risk of a heart attack."

Psaty, of the University of Washington in Seattle, also testified at Wednesday's House hearing.

Afterwards, he said that the FDA needs to have a "black box" warning about heart attack risk, not just heart failure risk, which he said has been known for a long time.

"It sounds like the FDA has had this data on heart attack risk since 2005," he said. "In Europe, the label was revised back in September."

Psaty added that the FDA needs to mandate post-marketing studies to uncover safety problems.

"You need a drug safety system that is complementary to the rapid approval system that we have in place," Psaty said. "What we are seeing with Avandia and Vioxx is the fallout of the system where you sped up approval and did not do anything to test safety."

Meanwhile, the FDA announced Wednesday that an advisory panel will meet on July 30 to weigh the cardiovascular risks of the class of diabetes drugs that includes Avandia.

In response to that announcement, the Cleveland Clinic's Nissen said in a prepared statement: "We published our meta-analysis on the cardiovascular safety of Avandia because we felt it was our obligation to alert the medical and patient community to a potentially serious drug safety problem and urged comprehensive evaluations to clarify the risks."

He added, "We encourage a lively scientific debate about these issues and look forward to the results of the FDA advisory board hearings in July. During today's congressional hearings, we learned that meta-analyses conducted by the FDA and GlaxoSmithKline showed similar results to our findings. We would like to see those analyses published in peer-reviewed journals so that the totality of information on the cardiovascular safety of Avandia is available to doctors and patients."

Also Wednesday, Takeda Pharmaceuticals announced that it would add the boxed warning requested by the FDA to prescription labels for Actos (pioglitazone).

Dr. Robert Spanheimer, the company's senior medical director for diabetes and metabolism, said in a prepared statement, "Takeda remains confident in the safety and efficacy of Actos when used according to its label, and with this revision, we can heighten patient and physician awareness of an already known, but serious side effect."

On Tuesday, GlaxoSmithKline had issued a prepared statement saying that the British study should reassure type 2 diabetes patients that Avandia was safe.

"They [the findings] add to the weight of evidence, from both previously published long-term clinical trials and other studies, that the overall ischemic cardiovascular safety profile of Avandia is comparable to the traditional anti-diabetes treatments. Patients and physicians should find these data reassuring," said Moncef Slaoui, the company's chairman for research and development.

In response to the growing controversy over Avandia's safety profile, the American Diabetes Association on Wednesday issued an advisory statement.

"As a result of all of this information, the American Diabetes Association strongly encourages patients taking this medication to consult with their physician as to its benefits and risks," the statement read. "The Association also reminds patients, however, that they should not stop taking any prescribed medications without first discussing the issue with their health-care provider."

More information
There's much more on type 2 diabetes at the American Diabetes Association.

Feeling Stressed?

(HealthDay News) -- You just missed a deadline at work, you're supposed to chaperone your son's school field trip, and your mechanic called to tell you your car's transmission is shot.
Stressed to the max?

Everyone experiences stress. And many people are stressed every day. But, stress isn't always as obvious as in the example above. In fact, some people don't even realize how much stress they're under until they suffer serious physical consequences of that stress.

Psychologist Anie Kalayjian, professor of psychology at Fordham University, said she's had patients end up in the emergency room, convinced they were having a heart attack, but instead, it was just the body's extreme response to stress.

"If you're a person running around with high energy or nervous energy, you may not realize that you're stressed until you collapse!" said Kalayjian.

According to the American Academy of Family Physicians, some possible signs that you're under too much stress are: Anxiety, back pain, stiff neck, depression, fatigue, trouble sleeping, unexpected weight changes, headaches, relationship troubles and high blood pressure.
"People need to start proactively trying to prevent episodes before they have extreme reactions," recommended Kalayjian.

But that doesn't mean you should make managing stress just another item on your "to-do" list, cautioned Gail Elliott Evo, the integrative medicine coordinator at Beaumont Hospital in Royal Oak, Mich.

"We talk so much about stress now. It's to the point that people are now feeling judgmental when they experience stress and can't eliminate it. But, unless you're a guru sitting in a temple in Tibet, I don't think you can avoid stress. There will be periods where you'll have stress," she said.

Still, managing stress or reducing it as much as you can is a smart idea, because constant stress leaves your body flooded with stress hormones, which can increase your risk of heart attack and other serious health problems.

"Stress causes physical and psychological reactions. It can alter your sleep. It leaves you constantly in fighting-mode and leaves your immune system suppressed. You may get sick a lot," Kalayjian said.

There's no one-size-fits-all approach when it comes to managing stress.

"Some things will be right for one person but not for another. Be open, and try things. Give something a try, and if it's not right for you, move on to something else. You'll eventually find something that's right for you," said Evo.

Some of the approaches she recommends include: Massage, healing touch, yoga, tai chi, walking, meditation and guided imagery.

Kalayjian said a good place to start de-stressing is with deep breathing.

"One minute per each hour of the day, you need to sit and do nothing but focus on breathing. No phones, no lists, no responsibilities. It's almost like how you recharge your battery for your mobile phone. We need to recharge, too," she said.

She also recommends exercise. "Don't wait to feel stressed. Get at least a half an hour of exercise every day. It gets a lot of the toxins and stress out of our bodies," Kalayjian said.
Kalayjian also advocates something she calls "journaling."

"It helps to put things on paper and outside of yourself. You don't have to store it in your heart, body or mind. When we journal, we let go of things and that acts as a release," she said.

She also suggests getting organized. "Many people waste 20 percent of their time looking for things. Try to be organized. Label things. Have organizers. It seems very mundane, but helps tremendously in saving your energy," Kalayjian said.

Evo said many people use a combination of techniques to relieve their stress.
"Be playful with it. Try different things," she said.

Kalayjian agreed, adding that people need to "learn how to have a sense of humor, to laugh and make others laugh, too."

Finally, Kalayjian advised that if you try several different methods to "de-stress" and just can't seem to relax, you could probably benefit from seeing a psychotherapist.

More information
The National Mental Health Association offers tips on coping with stress.

Colon Hydrotherapy - Contraindications

Colon Hydrotherapy (Colon Cleansing) - Contraindications
A contraindication is any indication or symptom that makes it inadvisable to use a particular therapy.

The following are contraindications for colon hydrotherapy.

If any of these apply to you we are not able to treat you with colon hydrotherapy at the present time,

unless you have a written prescription from an MD or ND showing supervision over our services for the contraindication.

If you have any of these contraindications you may still be eligible to receive colon hydrotherapy once they have subsided or been eliminated. We have several forms of massage that can be extremely helpful with constipation, abdominal pain and inflammation issues. As well, nutrition consultations can provide you insight and a reasonable plan to address many of your digestive or reproductive challenges.

Cancer of the colon or GI (gastro intestinal) tract.
Acute abdominal pain (please call us to clarify).
Recent history of GI or rectal bleeding.
Congestive heart failure.
Uncontrolled hypertension.
History of seizures.
Carcinoma of the rectum.
Abdominal surgery* *Please call us to inquire about your situation as this does not apply to all surgeries.
Intestinal perforation.
Abdominal hernia.
Recent colon or rectal surgery.
Diverticulitis.
Recent heart attack.
General debilitation.
Vascular aneurism.
Renal insufficiency.
Epilepsy or psychoses.
Severe hemorrhoids.
Cirrhosis.
Fissures or fistula.
Pregnancy.
Ulcerative colitis.
Acute Crohn's disease.
Rectal or abdominal tumors.

Drinks: Alcohol Lowers Heart Attack Risk

A study shows: Among men with healthy lifestyles, those who consume moderate amounts of alcohol have a 40 to 60 percent reduced risk of heart attack compared with healthy men who don´t drink at all.

"This latest research speaks to how robust the link is between moderate drinking and heart attack risk," explains lead author Kenneth Mukamal, MD, MPH, Associate Professor of Medicine at Harvard Medical School. " Studies have consistently found an association between moderate alcohol consumption and reduced heart attack risk in men.

But up to now they could not answer the question if the men who drank in moderation were the same individuals who maintained good eating habits, didn't smoke, exercised and watched their weight and if their reduced risk of myocardial infarction wasn't the result of one or more of these other healthy habits.

The members of the group that was studied, reported four healthy lifestyle behaviours: body mass index (BMI) of less than 25; moderate to vigorous physical activity for at least 30 minutes per day; abstention from smoking; and a healthy diet. Over a follow-up period of 16 years, the authors assessed the participants' daily alcohol intake (beer, white wine, red wine, or spirits) using a standardized and validated questionnaire. Between 1986 and 2002, 106 men had heart attacks. This included eight of the 1,282 who drank between 15 and 29.9 grams of alcohol per day (the equivalent of two drinks), nine of the 714 who drank 30 grams or more per day (more than two drinks), 34 of the 2,252 who drank .

1 to 4.9 grams per day and 28 of the 1,889 who did not drink at all. Their final analysis showed that among the subjects who were able to maintain all four healthy behaviours for at least a portion of the follow-up time, those who consumed alcohol in moderation had a 40 to 60 percent lower risk of heart attack than either the non-drinkers or the very light drinkers. "Based on these numbers, we estimate that approximately 25 percent of the heart attacks that occurred among these healthy individuals might be attributed to abstention [or extremely light drinking]," explains Mukamal.

Source: Beth Israel Deaconess Medical Center

Exercise Alone Won't Prevent Childhood Obesity

(HealthDay News) -- Physically active preschoolers are on to a good thing, but exercise alone won't keep obesity at bay as they get older, British researchers report.

Instead, a combination of exercise and other lifestyle changes -- especially improved diets -- may be the only solution to the childhood obesity epidemic, experts say.

"Promotion of physically active play per se may not be sufficient to have an impact on the weight status of young children," said lead researcher Dr. John J. Reilly, a professor of pediatric energy metabolism at the University of Glasgow, Scotland.

His team published its finding in the Oct. 5 online issue of the British Medical Journal.
The researchers had already shown in earlier work that Scottish preschoolers have surprisingly inactive lifestyles. They typically get less than 30 minutes of moderate to vigorous physical activity each day, in contrast to the recommended 60 minutes a day.

In their study, Reilly's team looked at whether exercise could reduce the weight of 545 preschool children. Some of the children took part in an active play program, which consisted of three 30 minute sessions each week. In addition, parents received guidance on how to increase physical play at home.

The researchers measured the children's weight at six months and then again at one year. They also assessed the youngsters' movement skills, and tracked whether or not the increase in activity reduced sedentary behaviors.

They found that exercise had some health benefits, but weight loss was not among them.
Exercise had little effect on weight, or on the activity behaviors of the children, compared with the children who did not take part in the program. However, for children in the program, additional exercise did help improve their motor and movement skills.

"We know from older studies that improved motor skills, balance, running, skipping, catching a ball, bouncing a ball, is of benefit to children socially and developmentally, and tends to promote engagement in sport, and may help reduce subsequent excess weight gain," Reilly said.

However, most children, even of preschool age, are relatively inactive, Reilly said. "We can't just assume that they are physically active," he said. "[We] must recognize that we need to change the environment at preschool/day care, at home and in the wider environment in ways which help them become more physically active."

There is great pressure on institutions and politicians in Britain to do something about childhood obesity, Reilly added. "While this is fine, it is possible that we will be doing things that might not have the intended effects. Our study shows the importance of rigorous evaluation of public health interventions before they are rolled out," he said.

One U.S. expert agreed that no single program can attack the obesity epidemic.

"It should come as no great surprise that Reilly and colleagues were unable to demonstrate a significant weight change among nursery school children receiving a physical activity program," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine. "The program in no way represented an 'equal and opposite force' to such factors as fast food, junk food, the temptations of technology, and suburban sprawl that conspire to make us fat."

The message here is not that the program failed, Katz said, but that "we need to do more than fix one thing at a time."

"We need to improve dietary choices and increase physical activity, in school and at home, every day. We need programs that engage families in a shared commitment to healthful practices, and that reach families via schools, work sites, clinics and community portals such as supermarkets, movie theatres and shopping malls," Katz said. "No one program in isolation can, or should be expected to, bear that burden alone."

More information
There's more on kids and exercise at the American Heart Association.

Long Work Days Linked to High Blood Pressure

(HealthDay News) -- Long hours on the job may lead to a greater risk of high blood pressure, particularly for people who don't have much control over their work, a new study found.

"Other studies have focused on job stress, we focused on long work hours," said Dr. Dean Baker, director of the University of California, Irvine's Center for Occupational and Environmental Health, and lead author of the report in the September issue of Hypertension.

Baker said that focus was possible because the study relied on a mass of data from a 2001 survey of more than 55,000 California households. "It gave us the statistical power to control for lots of causes of high blood pressure," he said.

After accounting for many other causes of high blood pressure, the researchers said they found a significant association between working more hours and self-reported high blood pressure.

For example, people who worked 40 hours a week were 14 percent more likely to say they had high blood pressure than those working 11 to 19 hours weekly. For those working 41 to 50 hours a week, the incidence was 17 percent higher.

"We found the type of occupation was independently significant," Baker added. "Clerical workers and unskilled workers had more high blood pressure than those in the professions."
Clerical workers were 23 percent more likely to report high blood pressure than professionals, as were 50 percent of unskilled workers.

High blood pressure can lead to a variety of potentially deadly health problems, including heart attack and stroke.

The findings should be taken into account by the people in charge of work hours, Baker said. "We would like employers to understand the health effects of requiring people to work long hours," he said.

Doctors should also pay attention, Baker said. There's a standard list of risk factors for high blood pressure, including obesity, smoking, physical inactivity and diabetes. "Something I would change is to add long work hours to the list," he said.

But Dr. David Meyerson, a senior cardiologist at Johns Hopkins University and a spokesman for the American Heart Association, said, "We need more information before this finding can be translated into legislation limiting work hours."

"The implication now that Americans seem to be working more hours than their European or Asian counterparts has become an issue," Meyerson said.

But because workers with little control over their jobs report more problems, "if one reads between the lines, the key may be whether job satisfaction plays a role," he said.

Meyerson offered this advice to control high blood pressure: "Get plenty of exercise, eat properly, know what your blood pressure is." At the same time, he added, "If at all possible, find a job that offers satisfaction. And if possible, spend more time with the persons you love, rather than at work."

More information
The risks of high blood pressure and what should be done about them are described by the American Heart Association.

Blood Pressure Woes Start Earlier Than You Think

(HealthDay News) -- Until recently, doctors treating high blood pressure limited their concern to blood pressure that exceeded a reading of 140 systolic (the upper number) and 90 diastolic (the lower number).
About two-thirds of Americans over age 65 have this level of high blood pressure, according to federal health statistics.
But now medical experts say the damage done by elevated blood pressure starts at levels much lower than that, when people are experiencing a less severe condition known as "prehypertension." That's the term given to blood pressure ranging from 120/80 to 139/89, higher than normal but not within the traditional danger zone.
"There's always been this ambiguity about this blood pressure that's not normal, but not high blood pressure either," said Dr. Adnan I. Qureshi, director of the cerebrovascular program in the Zeenat Qureshi Stroke Research Center at the University of Medicine and Dentistry of New Jersey. "But we now know that when you have prehypertension, you have a three-times greater risk of having a heart attack than people with normal blood pressure."
Blood pressure is the force exerted by blood against the walls of arteries. High blood pressure is dangerous because it makes the heart exert itself too hard and contributes to atherosclerosis, or hardening of the arteries, according to the National Institutes of Health.
High blood pressure, also known as hypertension, increases the risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans. It also can result in other conditions, such as congestive heart failure, kidney disease and blindness.
Nearly one of every three American adults, some 65 million people, has high blood pressure. People tend to develop high blood pressure as they get older, with middle-aged Americans facing a 90 percent chance of having it during their lives.
African-Americans are at greater risk of developing high blood pressure and have been shown to get it earlier in life and more often than whites. Others at risk for developing high blood pressure are people who are overweight, those with a family history of hypertension and those with prehypertension.
Recent studies have shown that people with prehypertension are three times more likely to have a heart attack and 1.7 times more likely to develop heart disease. An estimated 59 million Americans have prehypertension.
It's important to detect and treat high blood pressure early, to limit the condition's effects on the body, said Dr. Jeffrey Cutler, a senior advisor for the National Heart, Lung, and Blood Institute.
"Over the years, the higher pressure damages and aggravates diseases of the arteries," Cutler said.
Luckily, blood pressure is a condition that receives regular medical attention. "When you go see a doctor for anything, you get your blood pressure checked," Cutler said.
He recommended that people not rely on automatic blood-pressure machines, like those found in drug stores or supermarkets. "Those cuffs are not well-maintained or very accurate, and we discourage dependence on them for reassurance that your blood pressure's OK," Cutler said.
Once you've got high blood pressure, or prehypertension, a range of treatments are available.
Lifestyle changes are the first line of defense -- keeping your weight down, exercising regularly, reducing salt in your diet, cutting down on drinking, quitting smoking, and following a healthy eating plan that emphasizes fruits, vegetables and low-fat dairy foods.
But that only goes so far, Cutler said.
"Studies have shown that the majority of patients will need some medication," he said. "Some well-motivated people can get there with lifestyle changes, but not many."
The problem with prehypertension is that it falls within a gray area where medicine will not necessarily help, Qureshi said.
"With hypertension, we know that medication may be beneficial. With prehypertension, we don't know that yet," he said.
"It's still an evolving body of knowledge," Qureshi added. "We know prehypertension needs to be addressed, but we don't know what to do with these patients, and there are so many of them that we can't ignore the problem. Whatever we come up with will have true public impact."
For now, doctors are recommending that prehypertensive patients follow the same lifestyle changes as people will full-blown high blood pressure, Qureshi said.
"The real message for the public is that if you are prehypertensive, do not ignore it," he said. "You do have something to worry about."
More information
To learn more about prehypertension, visit the National Heart, Lung, and Blood Institute.

FDA Considers Warnings for Eczema Creams

By Rob Stein Washington Post Staff Writer Saturday, February 12, 2005 Government scientists, concerned that two prescription creams used widely for a common skin condition may increase the risk of certain cancers, especially among children, will propose adding strong new warnings to the product labels. A handful of cases of cancer have been reported among adults and children using the creams, sold under brand names Elidel and Protopic, and animal and laboratory studies suggest the drugs could be to blame, according to a new Food and Drug Administration analysis.

"The evidence raises serious safety concerns in children regarding the potential for carcinogenicity in humans treated with these agents," wrote Jean Temeck of the FDA's division of pediatric drug development in a recommendation posted late yesterday on the agency's Web site. The document was one of several posted in preparation for a meeting of an expert panel next week to assess the safety of the creams and recommend what action the agency should take. Protopic and Elidel were approved in 2000 and 2001, respectively, to treat eczema, a common, chronic skin condition that causes redness and itching.

Before the new creams, the only treatment had been steroid creams and ointments, which can be used only for short periods and can have a variety of side effects. The new creams, which were seen as effective and much safer, immediately became popular. At least 5 million prescriptions have been written for the creams. The creams were approved for short-term or intermittent use by adults and children age 2 and older, but Novartis Pharmaceuticals Corp. has marketed Elidel aggressively, and both creams are believed to be widely used for longer periods and among babies. "These products are being widely used to treat . . . a non-life-threatening disease, and heavily advertised for use in young children without appreciation . . . regarding the potential for carcinogenic risk," Temeck wrote.

Both Novartis and Fujisawa Healthcare Inc., which makes Protopic, defended the safety of their products to the FDA. "Elidel is an effective, steroid-free treatment for mild to moderate eczema and has a well-established safety profile," Novartis spokesman Tom Jones added in an e-mail. Because the drugs work by suppressing the immune system, scientists had been concerned that they could increase the risk of cancer.

As a result, when the FDA approved the creams the agency required both companies to monitor whether any cancers were reported among users. In 2003, the agency convened an expert panel to examine the evidence to date, but at that time only seven possible cases had been reported, so the agency decided to continue to monitor the situation. Since then, however, a study involving monkeys has suggested the creams might cause lymphoma, a cancer of the immune system, and reports of a variety of cancers in humans using the creams have continued to rise. At least seven cases of lymphoma have been reported, as well as at least seven cases of skin cancer and a handful of others, Temeck wrote.

Several children reported infections, including an 8-month-old boy whose infection was so severe he suffered a heart attack after Protopic was applied "over his entire body for six months," she wrote. While it remains far from proven that the creams are causing the complications, "there is a need for a stronger approach to the communication and minimization of the potential risk of cancer," Dianne Murphy, director of the FDA's office of pediatric therapeutics, wrote in another document. "We believe regulatory action is needed at this time since a definitive answer to the carcinogenic risk of these products will not be known for years," Temeck wrote. The addition of a possible "black box" warning to the label is one of several recommendations that the committee will consider, an agency spokesman said.

The concern comes as the FDA has come under intense criticism for failing to protect the public from potentially dangerous drugs. The blockbuster painkiller Vioxx was recently pulled from the market because of concerns that it and similar agents may increase the risk of heart attacks and strokes. The advisory committee will focus on children because exposure to a potential cancer-causing agent poses a greater risk to the young, but its recommendations would apply to adults as well, the spokesman said. Although the FDA is not bound to follow the recommendations of its advisory panels, it usually does.

Can Chocolate Cure Coughs?

Can Chocolate Cure Coughs?
Provided by: DrWeil.com

Q: I've been coughing constantly after a terrible cold, and a friend told me that I should eat chocolate for the cough. She said she read that it really helps. True? -- Betsy

A: Your friend probably is referring to a study from London about the effects on coughs of theobromine, an ingredient found in cocoa. British researchers conducted a small study (including only 10 volunteers) in which they tested theobromine against codeine (used in the most effective prescription cough medicines) and a placebo on coughs induced by capsaicin (the hot compound in red pepper).

They found that higher amounts of capsaicin were needed to produce coughs in the group treated with theobromine and that the theobromine proved more effective than codeine as a cough-suppressant. The researchers theorized that theobromine worked by acting on the vagus nerve, which is responsible for coughing.

The study results were published in the online Federation of American Societies for Experimental Biology Journal on Nov. 17, 2004.

Based on the results of this small study I can't tell you to rush out and buy lots of chocolate to cure your cough. The researchers suggested that their findings might lead to more effective cough remedies since those currently available for persistent coughs commonly cause drowsiness and constipation (some people experience nausea and vomiting from codeine.)

The amount of theobromine used in the study was equivalent to what you would get from two cups of cocoa so, if you can afford the calories, you might try drinking cocoa made from good quality chocolate to see if it helps your cough, though my preference would be to eat an ounce or two of dark chocolate with at least a 70 percent cocoa content.

I'm not surprised to hear that chocolate may yield yet another health benefit. In addition to theobromine, it provides polyphenols, the same kinds of antioxidants found in red wine, and the fat it contains is stearic acid, which doesn't affect cholesterol levels. What's more, recent research suggests that flavonoids in dark chocolate are good for your heart - they reduce the stickiness of platelets and the tendency of blood to clot, lowering risk of a heart attack.

A no-cal herbal remedy for cough is tincture of mullein (Verbascum thapsus). Take a teaspoon in a little warm water every four hours.
Andrew Weil, M.D. –

Author of:

• Eight Weeks to Optimum Health
• Spontaneous Healing
• The Natural Mind
• The Marriage of the Sun and Moon
• Health and Healing
• Natural Health, Natural Medicine
• From Chocolate to Morphine (with Winifred Rosen)

Getting Enough Omega-3?

Getting Enough Omega-3?
Provided by: DrWeil.com

Q: Your recent article mentioned one's "omega-3 level." How do I measure mine or find what my level is? I'm trying to increase my intake of omega-3s with flaxseed (ground), fish and lentils. -- Shirley

A: Omega-3 fatty acids are special unsaturated fats our bodies need for optimum health. Unfortunately, most Americans are deficient in omega-3s, and as a result are more likely to develop cardiovascular disease, cancer, inflammatory disorders, and mental and emotional problems. Eating foods rich in omega-3s can reduce these risks and also help treat depression, bipolar disorder, autism, and attention deficit hyperactivity disorder.

I don't think there is any practical way to measure your omega-3 levels. If there were, and if they were low, the solution would be to do what you should do anyway: increase your intake. Instead of worrying about what your levels are, try to calculate how much omega-3s your diet provides.

These fatty acids are found principally in oily fish that live in cold water, primarily wild salmon, mackerel, herring, and sardines. Bluefish is also rich in omega-3s as is - to a lesser extent - albacore tuna, but both of these tasty fish are contaminated by mercury and should be avoided.

Other dietary sources of omega-3s include walnuts, flaxseeds and hemp seeds - and the oils extracted from them - as well as soy and canola oils and specially fortified eggs. If you're eating three ounces of fish two to three times a week, as I recommend, snacking on walnuts and adding flaxseeds to cereals and salads you're probably getting enough omega 3s.

A 3-ounce serving of Alaskan salmon or herring contains about 2 grams of omega-3 fatty acids, while 3 ounces of sardines has about 1.3 grams. You can substitute one ounce of walnuts for a serving of fish, or add a tablespoon or two of freshly ground flaxseed or hemp oil to your diet.

These plant sources provide you with alpha linolenic acid, which the body converts to the omega-3s the body needs. The only problem with plant sources of these nutrients is that some people may not be able to convert alpha-linolenic acid to the longer-chain forms that occur in fish, the forms the body needs.

If you are not getting adequate amounts of omega-3 fatty acids in your diet, I recommend taking a good quality fish oil supplement. This is particularly important if you have high cholesterol, diabetes, symptoms of PMS, coronary artery disease or a family history of heart attack or sudden cardiac death, breast cancer, memory loss, depression, insulin resistance, high cholesterol, or rheumatoid arthritis. Distilled fish oils are free of mercury and other contaminants, and some taste quite good. Start with one to two grams a day.
Andrew Weil, M.D. –

Author of:

• Eight Weeks to Optimum Health
• Spontaneous Healing
• The Natural Mind
• The Marriage of the Sun and Moon
• Health and Healing
• Natural Health, Natural Medicine
• From Chocolate to Morphine (with Winifred Rosen)