GOOD AND HEALTHY LIFESTYLE

No More Headaches: 10 Surprising Headache Triggers

2012-01-14T08:20:00.000+08:00

Could it be something you ate? Not enough sleep? Want to know what could be causing your headache? Our comprehensive list just might help you out.

1. Your weight
In a recent study, researchers found that women with mild obesity (a body mass index of 30) had a 35 percent greater risk of headaches than those with a lower BMI. Severe obesity (BMI of 40) upped the chances to 80 percent.

What really triggers that debilitating pain in your head? Read more2. Your personality
Certain traits, including rigidity, reserve, and obsessivity may make you headache-prone. If that sounds like you, it could be time to sign up for relaxation training.

3. The big O
In one survey, 46 percent of headache sufferers said sex had triggered a headache. Usually, this is an overexertion headache (like joggers and weightlifters sometimes get); you may feel a dull pain that builds during foreplay or get a sudden headache around orgasm (more likely in men). In rare cases, such an intense headache could be caused by a tumor or aneurysm. For most folks, though, sex headaches are harmless.

4. That three-day vacay
Weekend or “let-down” headaches can happen when you take a break from your routine, says Alexander Mauskop, MD, founder and director of the New York Headache Center and co-author of What Your Doctor May Not Tell You About Migraines. Ease into the change by keeping your sleep time as normal as possible—you’ll end up feeling more rested than if you stay in bed until noon.

5. Your bathroom paint job
It’s not just arguing over paint colors that can give you a headache; fumes from traditional paints can trigger pain. Many companies now make nearly odorless, low-VOC (volatile organic compound) formulas, like Benjamin Moore’s Natura line or Devoe’s Wonder Pure.

6. Dehydration
You don’t have to drink gallons of water to stay hydrated, says John La Puma, MD, author of ChefMD’s Big Book of Culinary Medicine, “I’d love it if people got more water from eating fruits and vegetables because then they’d get all the other good things that come with them.”

7. Skipping meals
We know you’re busy, but hunger is a common headache trigger.

Take the Migraine Quiz: Find out what really triggers that debilitating pain in your head.

Headache Remedies: How to Kill the Pain

2012-01-14T03:35:00.000+08:00

A variety of drugs have been used to help treat headache pain. Aspirin, ibuprofen, and naproxen all are NSAIDs, which work by blocking natural enzymes and proteins that contribute to pain and swelling. And prescription triptans, including Imitrex, act on the neurochemicals that cause pain. But experts say there are other options.

Alternative remedies:
Biofeedback: This form of relaxation training teaches you to read your body’s responses to stress. As you become more aware of your own signals—a clenched jaw, shallow breathing, a tight neck—you learn to control them, and this results in fewer and less-severe headaches. This nondrug treatment may teach you a useful lifelong skill, but it can be a bit pricey. Formal training, which is offered at many headache clinics, can run as much as $850 for 10 sessions; some insurance programs will cover a portion of the cost. Home systems are available for as little as $100.

What really triggers that debilitating pain in your head? Read moreAcupuncture: In a huge German study, researchers looked at more than 15,000 people with migraine and tension-type headaches. Results showed that those treated with both acupuncture and regular medical care improved significantly more than those who had regular medical care alone.

Botox: Widely known as a beauty procedure, Botox is also used off-label to treat migraines. Injections are given in the forehead, around the eyes, at the temples, or on the back of the neck. Treatment costs $700 to $1,200, and studies show that it can relieve headaches for up to three months.

Supplements: Magnesium, co-enzyme Q10, vitamin B2, feverfew, and butterbur all have been shown in studies to help ease headaches. Talk to your doctor before taking them. Upside: These treatments are all-natural and relatively inexpensive. Downside: It may take a few months to see results.

The new meds:
Treximet: This Rx, which became available last year, combines the existing migraine medicine Imitrex with naproxen to treat migraines. Studies show the two-drug combo can be more effective than taking either medication alone, and a single dose has a longer effect.

Migralex: Just out this spring, this over-the-counter pain reliever combines aspirin and magnesium. The magnesium relieves headaches on its own and may also help the stomach absorb and tolerate aspirin. On the downside, aspirin may upset some people’s stomachs, and magnesium can sometimes cause diarrhea, says Merle Diamond, MD, a headache specialist at the Diamond Headache Clinic in Chicago.

Coming soon:
Telecagepant: This drug blocks the receptor of calcitonin gene-related peptide (CGRP), a substance that’s released during migraines. Doctors often prescribe triptans to deal with CGRP, but some people can’t take them. Telecagepant is about a year away from receiving approval.

Transcranial Magnetic Stimulation (TMS): Used as a depression treatment, this technique may work on headaches, too. A device would deliver a powerful—but painless—electromagnetic pulse to zap headache-related electrical activity in your head.

This article was first published in Health magazine, May 2009.

Is Chronic Pain Ruining Your Relationship?

2012-01-13T22:39:00.000+08:00

Athena Champneys, 37, has been in near-constant pain since 2003, when she was diagnosed with fibromyalgia, a chronic condition characterized by widespread pain and tenderness. Her husband hasn't always been 100% sympathetic, however.

“I was in so much pain that I couldn’t bend over to put on my own shoes or socks,” recalls Champneys, who lives in Salt Lake City. “And my husband was like, ‘You've got to be kidding me! Get up and deal!’”

Fibromyalgia affects an estimated 5 million Americans (80% to 90% of them women), but until relatively recently many doctors have pooh-poohed the condition. Women like Champneys have long been told that the pain is “all in their head,” a message that their partners have sometimes taken to heart as well.

Champneys' husband, Adam, acknowledges that he found himself growing skeptical as Athena grew more disabled by her condition. “I started doubting whether it was real,” says the 36-year-old real estate agent. “I even started doubting our relationship, because I was having to do a lot of the same things for her that I have to do for our children. She was in her 30s, but it was like taking care of an 80-year-old grandma.”

The Champneys’ experience isn’t unique. Chronic pain—whether it stems from fibromyalgia, back pain, arthritis, or some other condition—can have a toxic effect on relationships, especially if one partner is skeptical about the source or the severity of the pain, and the other feels that he or she isn’t receiving the proper understanding and support.

“People who have chronic illnesses desire support from their loved ones,” says Annmarie Cano, PhD, an associate professor of psychology at Wayne State University, in Detroit. “We all want to feel loved and cared for, but if the people around us are not supporting us the way we want them to, we might become resentful and feel like we are entitled to support.”

But let’s face it: Hearing about pain can be a drag, and if you’re the one in pain, the strongest potential sources of support—your partner, spouse, or kids—may simply tune you out when you talk about it. The good news is that how you talk about pain matters. There are things you can do that can help you win—not lose—your loved ones’ support.

Why expecting more help can backfire
Cano has studied the unhealthy dynamics that pain can create among couples like the Champneys.

In a study in the December 2009 issue of the journal Pain, Cano and her colleagues followed 106 couples in which one partner had a chronic pain condition, such as arthritis or back pain (the most common condition). The researchers found that people in pain who felt entitled to more support from their partners were more likely to have excessive or exaggerated perceptions and thoughts about the extent of their pain and the disability it caused. (This is known as catastrophizing.)

Prescription Medications for Fibromyalgia: Lyrica, Cymbalta, Savella, and Off-Label Remedies

2012-01-13T18:54:00.000+08:00

Cymbalta is an antidepressant that may help control fibromyalgia pain and fatigue.In 2007, Pfizer’s Lyrica became the first prescription medication approved for the treatment of fibromyalgia. Since then, two more drugs—Cymbalta and Savella—have joined its ranks, expanding the options to treat this painful chronic condition.

But because so much is still unknown about what causes fibromyalgia, there is no go-to treatment. In fact, typically only “35% to 40% of patients will respond well to any one of these three drugs,” says Daniel Clauw, MD, the director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.

The painful condition couldn't keep Caitlyn, or her family, down Read moreResearch suggests that people with fibromyalgia may have extremely sensitive central nervous systems that perceive pain much more acutely than those with normal pain responses. There is also some evidence that people who suffer from fibromyalgia experience a range of sleep disturbances that may leave them more prone to pain. An even newer theory is that fibromyalgia may be related to compression of the cervical spinal cord, which can lead to sleep disruptions as well as widespread pain.

The three drugs currently approved for fibromyalgia are thought to ease the pain by acting on either the nerves or brain chemicals called neurotransmitters. Since these drugs do not have a high success rate, patients often use more than one or try several before finding one that works well with the least side effects.

“People should be encouraged to find someone who is willing to work with them to find that combination or single treatment that works well,” says Charles E. Argoff, MD, a professor of neurology at Albany Medical College in New York.

You may find that over-the-counter medications help to alleviate some of the pain flare-ups associated with fibromyalgia. But if you’ve been diagnosed with the condition and are looking for long-term treatment, talk to a doctor about prescription drugs. Here’s a brief breakdown of different medications used to treat fibro pain, both on- and off-label.

Lyrica
How it works: The first drug approved to treat fibromyalgia, Lyrica (pregabalin) is an anticonvulsant that the U.S. Food and Drug Administration (FDA) previously approved in late 2004 to treat pain associated with diabetic neuropathy and shingles. The medicine is believed to calm overactive neurons as well as possibly influence the release of neurotransmitters.

Recommended dosage: Begin at 150 mg daily, and can be increased to a maximum of 450 mg per day

When it may be prescribed: “Most of us think that if people have a prominent sleep disturbance, we should use Lyrica or Neurontin first,” says Dr. Clauw. Neurontin (gabapentin) is an anticonvulsant that has not been approved for, but is often used to treat, fibromyalgia.

What to consider: The most common side effects are dizziness, weight gain, fatigue, difficulty concentrating, and swelling in the hands and feet. In April 2009, the FDA also began requiring Lyrica to carry a warning that the drug increases the increase the risk of suicidal thoughts or behavior.

Study: Signs of Fibromyalgia Show Up on Neurological Exam

2012-01-13T14:19:00.000+08:00

FRIDAY, Sept. 25, 2009 (Health.com) — People with fibromyalgia seem to have more neurological abnormalities than those without the chronic pain condition, according to a new study.

The new research may shed light on fibromyalgia, a condition that is characterized by chronic widespread pain.

However, lead author Nathaniel Watson, MD, emphasizes that the findings are preliminary and should be used more as a hypothesis to be explored in future research, rather than as proof of a distinct neurological cause for fibromyalgia.

“I don’t think these findings are significant enough to suggest we should change the way fibromyalgia should be evaluated or managed,” says Dr. Watson, who performed the blinded neurological exams in the study. “But it’s a starting point.”

In addition to chronic pain, people with fibromyalgia may have symptoms such as fatigue, insomnia, depression or anxiety, and numbness and tingling of the limbs. About 2% of Americans have the condition, which is often debilitating and more common in women than in men.

Dr. Watson and his colleagues at the University of Washington Medicine Sleep Institute, in Seattle, compared a group of 166 adults with fibromyalgia with 66 people who did not have any pain problems. Compared to their pain-free counterparts, the people with fibromyalgia were more likely to have neurological abnormalities, including greater cranial nerve dysfunction and more sensory, motor, and gait problems, according to the study in the September 2009 issue of Arthritis and Rheumatism. The doctors performing the exams were not aware if the patients had fibromyalgia or not.

In addition, the fibromyalgia patients’ self-reported neurologic symptoms often correlated with the results of the physical exam. In fact, they had more symptoms in 27 of the 29 categories. In particular, light sensitivity (70% versus 6%) was more common in those with fibromyalgia, as were poor balance, weakness, and tingling in the arms and legs.

The results support the possibility that fibromyalgia might be related to a neurological or anatomical problem in the head or neck. Some possibilities include the narrowing of the spinal canal or Arnold-Chiari type I malformation, a genetic defect that affects the brain.

Dr. Watson also says that some of the neurological results could be caused by pain sensations themselves and not other neurological or anatomical issues.

Cleveland Clinic pain management specialist Phil Berenger, MD, does not believe that the neurological exam itself can yield purely objective findings, as the responses patients give during the exam are still subjective. “The exam depends upon what the patient tells you he or she is experiencing, like ‘I can’t feel that pin prick,’ so it’s really hard to say that these findings are totally objective,” says Dr. Berenger, who was not involved in the study.

Dr. Berenger also notes that fibromyalgia patients could be experiencing symptoms from other undiagnosed conditions—such as rheumatoid arthritis, lupus, hypothyroidism, or Parkinsonism—highlighting the difficulty doctors face in accurately diagnosing fibromyalgia. Since its symptoms often overlap with those of various ailments, people may be diagnosed with fibromyalgia if they have widespread pain and symptoms that are not explained by other diseases. People with chronic pain lasting more than three months should see a doctor and undergo a thorough neurological exam, Dr. Berenger says.

Although the precise cause of fibromyalgia remains at large, recent research points to possible central-nervous-system functioning problems that might amplify normal pain signals. Several hormonal abnormalities have been associated with the condition, including unusual levels of a chemical known as substance P, circulating growth hormone, and serotonin. Still, none of the potential explanations have gained widespread acceptance or been proven conclusively.

Fibromyalgia can be treated in a number of ways. The U.S. Food and Drug Administration has approved the anti-epileptic Lyrica as the first drug to treat the condition. Some other types of drugs, such as antidepressants, tricyclic compounds, and dual reuptake inhibitors, can also be effective, along with alternative therapies such as massage. Regular exercise, relaxation techniques, and a regular sleeping pattern can be beneficial for patients as well.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases funded the study.

No More Headaches: Ask the Headache Doctor

2012-01-13T09:35:00.000+08:00

This article was first published in Health magazine, May 2009.

From eyestrain-induced headaches to memory loss, our resident headache expert, Christina Peterson, MD, author, The Women’s Migraine Survival Guide, and founder of the Oregon Headache Clinic, weighs in.

Q: I get a killer migraine every time I have my period. It must be hormones, right?

A: For most women, hormone-related migraines occur a day or two before their periods, and may continue or occur again during their period. If you track your periods, you can try taking a mini-prevention medicine such as ibuprofen, Aleve, or aspirin before menstruation starts. Once the headache begins, your regular migraine medicine may help.

Migraines can flare up or even appear for the first time during perimenopause, when hormones are fluctuating like crazy. The good news is that headaches may diminish or go away once you fully enter menopause.

Q: Why do I wake up every morning with a headache?

A: You might have sleep apnea, a potentially serious condition in which your breathing stops and starts during sleep. Or you could be clenching or grinding your teeth while you sleep. If everything checks out OK with your doctor, you may want to consider investing in a new mattress or pillow. A lack of support can also lead to headaches.

Q: I get a headache from working on a computer all day. Help?

A: You’re probably suffering from eyestrain, in addition to stress from poor posture. Have an ergonomic evaluation done to make sure your workstation is set up correctly. (Some companies offer this service for employees, or you can request a physical therapy referral from your doctor.)

If you use a laptop, connect it to a larger monitor, which will be easier to read. During any computer work, take a two-minute stretch break every hour; set an e-mail alert if you need a reminder. If you wear glasses or contacts, make sure your eye doctor knows that you work at a computer; you may need a different correction for computer work and book work.

Q: My friend says headaches can cause memory loss. True?

A: Unless your headaches are frequent and severe, it’s unlikely that they’ll cause any permanent problems. Recent evidence suggests that in some forms of migraine brain-cell loss can occur during the earliest beginning phases of the attack—and that’s why preventive treatment is so important if you have frequent migraines.

No More Headaches: What Kind of Headache is It?

2012-01-13T05:45:00.000+08:00

Got a headache? No wonder. A recent survey by the National Headache Foundation showed that the tough financial times are hiking anxiety and wrecking sleep for many of us, triggering even more headache pain.

Sadly, we can’t do much about Wall Street. We can help with that headache, though—whether it’s a throbbing in your temples after skipping lunch, a pain behind your eyes from staring at your computer, or a dull ache the morning after you’ve had a little too much to drink.

What really triggers that debilitating pain in your head? Read moreUse our handy guides on the following pages to learn about the most common headache types—then talk to your doctor.

TENSION
Who gets them The most common form of headache, tension-type headaches strike 100 million Americans a year. Some sufferers get them every day.

What happens in your head Stress makes muscles (neck, scalp, jaw) spasm, stimulating pain receptors in the brain. Some experts now believe changes in brain chemicals may be another culprit.

Where it hurts Top or both sides of the head

How it feels Steady, bandlike pressure around the head that doesn’t get worse with normal physical activity

Other symptoms May feel pain in the neck and shoulders or become sensitive to light or sound

Common triggers Lack of sleep, eyestrain, poor posture, irregular meals, stress, worry

Treatment OTC meds with acetaminophen (Tylenol, Excedrin) usually lessen pain. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) with ibuprofen (Motrin, Advil) or naproxen (Aleve) can zap pain and reduce inflammation. Overuse can cause rebound headaches, though, so see your doc if you’re popping pills more than two days a week.

Good to know Tension-type headaches typically last 30 minutes or even a few days.

No More Headaches: When Your Headache is an Emergency

2012-01-13T02:40:00.000+08:00

Suzy Koelker had been in pain for two weeks before she got help for her headache. “I’d always had a lot of headaches,” the Dubuque, Iowa, woman recalls. “But this one was intense, like a pulsing pain across my temples.”

She tried over-the-counter painkillers with no relief. And no wonder: When she finally went to an urgent-care center, a CAT scan revealed swelling in her brain and an MRI showed a brain tumor pressing against the top of her skull.

What really triggers that debilitating pain in your head? Read moreDays later doctors removed a growth the size of a tennis ball. Fortunately, the tumor—a kind known as meningioma, which develops in the brain’s surrounding membrane—was benign, and Koelker, now 49, is pain-free and in good health. “I was lucky I got a doctor in urgent care who said we should check into this further and do a scan,” she says.

A severe headache should never be ignored, says Alan Carver, MD, assistant professor of neurology and director of headache and pain management at Mt. Sinai School of Medicine in New York City.

“It can be a warning sign of something more ominous: a brain tumor, stroke, or aneurysm.” Patients worry about stirring up drama for nothing, but it’s not worth taking chances. “You don’t have to apologize,” Carver says. “Headaches aren’t always just headaches.”

Call 911 if …
You feel like it’s the worst headache you’ve ever had in your life.The headache is accompanied by a loss of vision, seeing double, weakness or numbness in your body, difficulty speaking or hearing, or trouble with balance or walking.You’re afraid you may pass out.This article was first published in Health magazine, May 2009.

Atherosclerosis Can Cause a Stroke

2012-01-12T22:15:00.000+08:00

A stroke occurs when a blood vessel in the brain is blocked or bursts . Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

Symptoms of a stroke happen quickly. A stroke may cause:

Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.Sudden vision changes.Sudden trouble speaking.Sudden confusion or trouble understanding simple statements.Sudden problems with walking or balance.A sudden, severe headache that is different from past headaches.

If you have any of these symptoms, call 911or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.

There are two types of stroke:

You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

For an ischemic stroke, treatment focuses on restoring blood flow to the brain. If you get to the hospital right away after symptoms begin, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms.1 Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

After your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure, high cholesterol, and diabetes. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).

The best way to get better after a stroke is to start stroke rehab. The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke. So it is important to start rehab soon after a stroke and do a little every day.

After you have had a stroke, you are at risk for having another one. You can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.

Treat any health problems you have

Manage high blood pressure or high cholesterol by working with your doctor.Manage diabetes. Keep your blood sugar levels within a target range.If your doctor recommends you take aspirin or a blood thinner, take it. This can help prevent having a stroke.Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

Do not smoke or allow others to smoke around you.Limit alcohol to 2 drinks a day for men and 1 drink a day for women.Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.Eat a balanced diet that is low in cholesterol, saturated fats, and salt. These foods can make hardening of the arteries worse. Eat more fruits and vegetables. Eat fish at least once a month.

Why the Day After Christmas Is Hazardous to Your Heart

2012-01-12T17:43:00.000+08:00

If you aren't careful, your holiday fun could quickly turn fatal. December 26 is historically one of the most dangerous days of the year for people vulnerable to cardiac problems, including heart attacks, arrhythmias, and heart failure. And many of these so-called Merry Christmas coronaries will hit people who didn't even realize they were at risk when they unwrapped their gifts the day before.

But the holiday season isn't good for heart health to begin with. A 2004 study by researchers at the University of California, San Diego and Tufts University found that heart-related deaths increase by nearly 5% during the holidays, perhaps because patients delay seeking treatment for heart problems or because hospital staffing patterns change. But anecdotally, doctors say that their ERs stay quiet on Christmas Day itself. Then, come December 26, they see a surge of cardiac traffic. A 2008 study found that daily visits to hospitals for heart failure increased by 33% during the four days after Christmas.

"This time of year is notorious for heart attacks, heart failures, and arrhythmias," says Samin Sharma, MD, director of interventional cardiology at Mount Sinai Medical Center in New York. Here's how to steer clear of the hospital.

Keep your ticker ticking
It's easy to knock back several glasses of wine when you're sitting around the holiday table for long stretches of time, especially if you tell yourself that wine is good for your heart. But more than one alcoholic drink can have consequences: Excessive drinking can trigger atrial fibrillation, a form of irregular heartbeat. If it persists, atrial fibrillation ups your odds of suffering a stroke. "There are huge campaigns not to drink and drive during the holidays, but no one talks about the heart dangers," says Dr. Sharma.

Extra money woes coupled with an already stressful holiday season can also be a setup for overindulgence. "People don't have as much money, but they still need to spend," says Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Rochester, Minn. "They're cutting back, but they're worried about the credit card bill on the way. With all this in mind, people might be drinking more than ever."

Normally, a holiday heart arrhythmia isn't fatal, and in fact it usually fades on its own. Some of the symptoms are the same as a hangover—nausea, weakness, and a pale face—and your heart should be back to normal in 24 hours. But if it isn't, you may need to see a doctor for medication or electrical cardioversion, which will stabilize your heart beat.

Statins May Worsen Heart Failure for Some

2012-01-12T14:42:00.000+08:00

WEDNESDAY, Nov. 4, 2009 (Health.com) — It’s widely known that cholesterol-lowering statins can benefit patients with heart disease, but a new study suggests they may actually harm some people with heart failure.

Heart disease can occur when arteries become clogged, but in heart failure, the heart gets progressively weaker and larger.

Still, since the study included a small number of patients and looked at only one point in time, it’s too early to say if the findings have implications for heart failure patients taking statins, according to lead author Lawrence P. Cahalin, PhD, of Northeastern University, in Boston. Cahalin presented his findings on Tuesday at the American College of Chest Physicians annual meeting in San Diego.

Tamara Horwich, MD, an assistant professor of medicine at the University of California, Los Angeles, agrees that the results need to be interpreted with caution. “I just don’t think we can draw any conclusions about statins having benefits versus ill effects in some patients,” says Dr. Horwich, who wasn’t involved with Cahalin’s study.

In heart failure, the enlarged heart struggles to pump a sufficient amount of blood, which can cause fluid to collect in the limbs and lungs, resulting in shortness of breath and fatigue. However, one type of heart failure, systolic, occurs when the lower chambers of the heart can’t contract with enough force to drive blood throughout the body.

In the other type, diastolic heart failure, the heart muscle is so stiff that it can no longer relax enough to fill with blood between beats. About half of people with heart failure have systolic; the other half have diastolic, which becomes more common with age and is more likely to strike women.

About 5 million Americans have heart failure.

Currently, there are no guidelines on whether patients with heart failure should take statins. Some studies have shown that they can be helpful, while others have found no benefit. The decision of whether to prescribe these drugs is typically based on a patient’s cholesterol levels, his age, and whether he also has coronary artery disease, according to Dr. Horwich.

“There’s not a consensus,” she says. “It’s up to the individual physician to make a decision.”

Lower Cholesterol May Lessen Risk of Some Cancers

2012-01-12T10:09:00.000+08:00

THURSDAY, Nov. 5 (Health.com) — Most people know that healthy cholesterol levels can help protect your heart. But new research suggests another potential benefit: a lower risk of developing some types of cancer.

In fact, low total cholesterol is associated with about 60% less risk of the most aggressive form of prostate cancer, and higher levels of good cholesterol (HDL) may protect against lung, liver, and other cancers, according to two studies published this week in the journal Cancer Epidemiology, Biomarkers & Prevention.

That’s quite a reversal of fortune for low cholesterol, which has, in the past, been associated with a higher cancer risk. The new studies suggest that low cholesterol may not deserve its bad reputation, earned from a series of studies in the 1980s that said people with low cholesterol might be at risk of cancer.

In fact, cholesterol may drop in people with undiagnosed cancer, meaning that low cholesterol may be a result—not a cause—of cancer.

In the first study, men with HDL cholesterol above roughly 55 mg/dL had an 11% decrease in overall cancer risk, including lung and liver cancer. (HDL levels between 40 and 50 are average for men.) The study, conducted by National Cancer Institute (NCI) researchers who looked at about 29,000 male smokers in Finland over an 18-year period, is the largest to show a relationship between HDL and cancer.

"Very few studies measured [HDL], and any relationship between HDL and overall cancer risk had therefore not been adequately evaluated," the NCI's Demetrius Albanes, MD, the lead author of the study, said at a press briefing.

While the findings are new and intriguing, more research needs to be conducted to confirm a link between HDL and cancer risk reduction.

“[It’s] a very new, exciting question, but we need to do a great deal more research before we have any clear answers," says Eric Jacobs, PhD, an epidemiologist with the American Cancer Society, who co-wrote an editorial accompanying the studies. For his part, Dr. Albanes stressed that the results need to be confirmed, especially in women and nonsmokers.

Plaque in Your Arteries Can Cause a Heart Attack

2012-01-12T06:33:00.000+08:00

What is a heart attack?

A heart attack happens when a sudden blockage in one of your coronary arteries cuts off the blood supply to your heart muscle. If a tear or rupture develops in a plaque that has built up in your coronary artery as a result of atherosclerosis, a blood clot can form on the torn plaque, just as a blood clot forms when you cut your skin. This clot can completely block the artery and cut off the blood supply to a portion of your heart muscle. Without blood, your heart muscle doesn't get oxygen, and without oxygen, the muscle can die.

The medical term for a heart attack is a myocardial infarction. "Myocardial" refers to your heart muscle, and "infarction" refers to the permanent damage to your heart muscle that results from a heart attack.

Many people live with coronary artery disease (CAD) and never have a heart attack. It's important to understand, however, that a heart attack can occur suddenly even in someone who has never had symptoms of CAD before. If you have plaque in your coronary arteries from atherosclerosis, you can have a heart attack. In fact, some people first learn that they have CAD when they have a heart attack. These people likely had CAD for many years but did not know it because it did not cause any symptoms.

What does a heart attack feel like?

The symptoms of a heart attack are similar to the symptoms of a type of chest pain called angina. Most people who have a heart attack experience some form of chest pain or discomfort that is often described as tightness, heaviness, squeezing, or crushing in the chest. Heart attacks also cause other related symptoms, such as difficulty breathing, nausea, and sweating. If you have had angina before, you will probably find that the symptoms of a heart attack are more intense and last longer than the symptoms of angina. A heart attack can happen during exertion or even while you are resting.

These symptoms can also be from unstable angina, a severe form of angina that means you have a greater risk of having a heart attack. When you go to the hospital, your doctor will have to determine whether you are having a heart attack or an episode of unstable angina.

What should I do if I think I am having a heart attack?

Call 911 or other emergency services immediately if you have any symptoms that suggest unstable angina or a heart attack. If you are having a heart attack, every minute counts. The longer you wait, the greater the chance that your heart will be permanently damaged or that you might die from the heart attack.

Will I die from a heart attack?

Your chances of dying from a heart attack depend on the size of your heart attack, the part of your heart that is affected, and your overall health. The other important factor is how quickly you are able to get medical attention after your heart attack begins. The longer your heart muscle is deprived of oxygen, the more the heart attack will damage your heart.

Your chances of dying from a heart attack also increase if your heart attack causes serious problems with your heart or with other parts of your body, such as heart failure or a stroke. The more problems that your heart attack causes, the worse your chances of survival are.

Cholesterol-Lowering Supplements: What Works, What Doesn’t

2012-01-12T02:58:00.000+08:00

If you’re looking for an all-natural way to lower your cholesterol—in addition to watching what you eat and exercising—there are plenty of dietary supplements on the market that claim to do the trick. Each year seems to bring a new alternative remedy—garlic, ginseng, or red yeast rice, for example—that users tout as the next best thing to get cholesterol under control.

But just because your Uncle Jack says a supplement worked miracles on his cholesterol doesn’t mean it will work for you. In fact, his success may be due to a placebo effect or a diet overhaul he neglected to mention.

Though not always perfect, scientific studies are the best way to determine if nonprescription remedies really work. Below, we break down what the research does—and doesn’t—say about the benefits of the most popular alternative remedies for lowering cholesterol.

To see what these supplements look like, view this slideshow.

Artichoke leaf extract

• What it is: The dried extract of the artichoke leaf is also known as Cynara scolymus.

• The evidence: In 2000, German researchers performed a randomized, double-blind, placebo-controlled trial using nearly 150 adults with total cholesterol over 280—well into what the American Heart Association (AHA) considers “high risk” territory. The participants who took an artichoke supplement for six weeks saw their levels of low-density lipoprotein (LDL), or bad cholesterol, fall by 23%, on average, compared to just 6% in the placebo group.

These are promising numbers, but they haven’t been replicated. A more recent, three-month trial of similar design found that total cholesterol fell by an average of 4% among participants taking artichoke leaf extract, but the researchers found no measurable impact on either LDL or high-density lipoprotein (HDL), also known as good cholesterol. They suggested that differences in the health of the participants and the potency of the supplements—the patients in the second study received a dose about 30% smaller—could explain the discrepancy between the results of the two studies.

• The bottom line: There have been very few quality studies conducted on artichoke leaf extract, and the mixed results suggest that more evidence is needed to confirm its effect on cholesterol. Don’t expect your LDL to plummet if you take artichoke supplements.

Fenugreek

• What it is: Fenugreek is a seed (often ground into a powder) that has been used since the days of ancient Egypt and is available in capsule form.

• The evidence: Several studies from the 1990s have reported that, in high doses, various fenugreek seed preparations can lower total cholesterol and LDL, in some cases dramatically. (One study recorded an LDL drop of 38%.) Almost without exception, however, the studies have been small and of poor quality, which casts some doubt on the validity of the results.

Fenugreek contains a significant amount of dietary fiber (anywhere from 20% to 50%, analyses have shown), and some experts speculate that the purported cholesterol-lowering effect of fenugreek may in fact be attributed largely to its fiber content.

• The bottom line: Despite the studies frequently cited as proof of fenugreek’s ability to lower cholesterol, there is not enough evidence to support its use.

Fiber

• What it is: Soluble fiber is a type of dietary fiber found in oats, barley, bran, peas, and citrus fruits, as well as in dietary supplements. (Though it is good for the heart in other ways, insoluble fiber does not affect blood cholesterol.)

• The evidence: In 1999, a team of Harvard Medical School researchers conducted a meta-analysis of nearly 70 clinical trials that examined the effect of soluble fiber on cholesterol levels. High soluble fiber intake was associated with reductions in both LDL and total cholesterol in 60% to 70% of the studies they examined. For each gram of soluble fiber that the participants of the various studies added to their daily diet, their LDL levels fell by about 2 points. (The average time frame was seven weeks.)

The amount of fiber you’d need to eat to significantly lower your LDL is a bit unwieldy. Most people eat far less than the 25 grams of dietary fiber recommended as a minimum by most health organizations—and only about 20% of your total fiber intake is likely to be soluble. (Eating three bowls of oatmeal a day will only yield about 3 grams of soluble fiber, according to the Harvard researchers.) Taking daily fiber supplements can help, but they can cause some gastrointestinal side effects if taken regularly and can interfere with some prescription medications.

• The bottom line: A diet high in soluble fiber can lower your LDL. The effect is likely to be relatively modest, however, and loading up on soluble fiber may be impractical.

Menopause Causes Cholesterol Jump, Study Shows

2012-01-11T22:48:00.000+08:00

FRIDAY, Dec. 11, 2009 (Health.com) — Doctors have known for years that a woman's risk of developing heart disease rises after menopause, but they weren't exactly sure why. It wasn't clear whether the increased risk is due to the hormonal changes associated with menopause, to aging itself, or to some combination of the two.

Now, we have at least part of the answer: A new study shows beyond a doubt that menopause, not the natural aging process, is responsible for a sharp increase in cholesterol levels.

This seems to be true of all women, regardless of ethnicity, according to the study, which will be published next week in the Journal of the American College of Cardiology.

“As they approach menopause, many, many women show a very striking increase in cholesterol levels, which in turn increases risk for later heart disease,” says the lead author of the study, Karen A. Matthews, PhD, a professor of psychiatry and epidemiology at the University of Pittsburgh.

Over a 10-year period, Matthews and her colleagues followed 1,054 U.S. women as they went through menopause. Each year the researchers tested study participants for cholesterol, blood pressure, and other heart disease risk factors such as blood glucose and insulin.

In nearly every woman, the study found, cholesterol levels jumped around the time of menopause. (Menopause usually occurs around age 50 but can happen naturally as early as 40 and as late as 60.)

In the two-year window surrounding their final menstrual period, the women's average LDL, or bad cholesterol, rose by about 10.5 points, or about 9%. The average total cholesterol level also increased substantially, by about 6.5%.

Other risk factors, such as insulin and systolic blood pressure (the top number in a blood pressure reading), also rose during the study, but they did so at a steady rate, suggesting that the increases—unlike those for cholesterol—were related to aging, not menopause. Of all the risk factors measured in the study, the changes in cholesterol were the most dramatic.

The jumps in cholesterol reported in the study could definitely have an impact on a woman’s health, says Vera Bittner, MD, a professor of medicine at the University of Alabama at Birmingham, who wrote an editorial accompanying Matthews’s study.

“The changes don't look large, but given that the typical woman lives several decades after menopause, any adverse change becomes cumulative over time,” says Dr. Bittner. “If somebody had cholesterol levels at the lower ranges of normal, the small change may not make a difference. But if somebody's risk factors were already borderline in several categories, this increase may tip them over the edge and put them in a risk category where treatment may be beneficial.”

In a first, the study did not find any measurable differences in the impact of menopause on cholesterol across ethnic groups.

Experts have been unsure how ethnicity may affect the link between menopause and cardiovascular risk, because most research to date has been conducted in Caucasian women. Matthews and her colleagues were able to explore the role of ethnicity because their research is part of the larger Study of Women’s Health Across the Nation (SWAN), which includes substantial numbers of African-American, Hispanic, and Asian-American women.

The Top 5 Cholesterol Myths

2012-01-11T18:44:00.000+08:00

American men rank 83rd in the world in average total cholesterol.Even if you think you know everything there is to know about cholesterol, there may be a few more surprises in store. Check out these common myths about high cholesterol; find out who’s most likely to have it, what types of food can cause it, and why—sometimes—cholesterol isn’t a bad word.

Myth 1: Americans have the highest cholesterol in the world
One of the world's enduring stereotypes is the fat American with cholesterol-clogged arteries who is a Big Mac or two away from a heart attack. As a nation, we could certainly use some slimming down, but when it comes to cholesterol levels we are solidly middle-of-the-road.

The Cholesterol-Inflammation Connection Inflammation is cholesterol's partner in crime Read moreAccording to 2005 World Health Organization statistics, American men rank 83rd in the world in average total cholesterol, and American women rank 81st; in both cases, the average number is 197 mg/dL, just below the Borderline-High Risk category. That is very respectable compared to the top-ranked countries: In Colombia the average cholesterol among men is a dangerous 244, while the women in Israel, Libya, Norway, and Uruguay are locked in a four-way tie at 232.

Myth 2: Eggs are evil
It's true that eggs have a lot of dietary cholesterol—upwards of 200 mg, which is more than two-thirds of the American Heart Association's recommended limit of 300 mg a day. But dietary cholesterol isn't nearly as dangerous as was once thought. Only some of the cholesterol in food ends up as cholesterol in your bloodstream, and if your dietary cholesterol intake rises, your body compensates by producing less cholesterol of its own.

While you don't want to overdo it, eating an egg or two a few times a week isn't dangerous. In fact, eggs are an excellent source of protein and contain unsaturated fat, a so-called good fat.

Can Twitter and Facebook Help Fight Breast Cancer?

2012-01-11T14:19:00.000+08:00

Twitter and other social media sites are often perceived as the ultimate navel-gazing tools. Seemingly a narcissist’s dream, many think that Facebook status updates and the 140-character Twitter messages (known as “tweets”) are really just boring play-by-plays of daily life—I had granola for breakfast! I’m stuck in traffic!

But Laurie Brosius, 31, isn’t buying it. Brosius, a business analyst in Dallas, used Twitter to raise $6,000 for a walk for breast cancer research in 2008. “Fifty percent of that came from online strangers,” she says. She was able to reach those people in part because her Twitter followers re-tweeted her messages.

In 2004, Brosius started blogging about her upcoming wedding. But after she married, she felt a key person was missing from the happy picture—her husband’s mother, who had died of breast cancer at age 48 when her husband was 20 years old. “I felt like I missed out on having her in my life,” says Brosius. “I felt cheated.”

She wanted to raise money for breast cancer research, so she participated in a three-day walk and fund-raiser, but felt she could do more. She had used Twitter to raise a small sum for that first walk, but for the second walk she relied mainly on tweets to direct people to the donation website.

(Anyone can see breast cancer–related tweets by typing #breastcancer into Twitter’s search field.)

Brosius still blogs and says that breast cancer organizations’ websites are great places to donate. However, Brosius says, they only reach a specific crowd—those already interested in the topic.

“[Social media sites] are reaching people who might not be specifically looking for that kind of information,” she explains. “They’re reaching everyone.”

Panel Says Women Should Start Mammograms at 50, Not 40

2012-01-11T09:47:00.000+08:00

Women should have a mammogram every two years starting at age 50—not 40, according to an expert panel’s new breast cancer screening guidelines, which are sure to cause confusion among women, particularly those in their 40s who routinely schedule a mammogram each year.

However, a number of prominent groups say they strongly disagree with the new advice, which was issued by the U.S. Preventive Services Task Force (USPSTF) on Monday.

The USPSTF panel has backed off a 2002 statement advising women to have a routine mammogram every year or two beginning at age 40. The panel now recommends that women undergo mammography screening every two years starting at age 50 and continue being screened through age 74.

The USPSTF concluded that the benefit gained by starting screening at 40 versus 50 is “small” and that the decision to start screening before 50 should be an individual one.

The new guidelines would seem to reopen a debate that raged in the 1990s, but seemed to have been settled years ago. The American Cancer Society (ACS) now recommends that women get an annual mammogram and have a clinical breast examination beginning at age 40.

Otis W. Brawley, MD, the chief medical officer of the ACS, said in a statement that the ACS would stick to its current guidelines.

Mammograms are the “one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member,” Dr. Brawley said. The USPSTF is an independent panel, sponsored by the federal Agency for Healthcare Research and Quality, whose members make recommendations about preventive-care services and published the new recommendations in the Annals of Internal Medicine.

The panel’s recommendations are based, in part, on a review of the latest scientific evidence on the benefits and harms of breast cancer screening. The pooled data show that mammography screening does reduce breast cancer death—by 15% for women ages 39 to 49. To prevent one cancer death in this group, 1,904 women would have to be screened. Among women 50 to 59, one death is avoided per 1,339 screenings.

Because breast cancer risk increases with age, younger women are at a somewhat lower risk of developing the disease, explains George W. Sledge Jr., MD, a professor of oncology at Indiana University’s Melvin and Bren Simon Cancer Center, in Indianapolis, and president-elect of the American Society of Clinical Oncology.

They’re also somewhat more likely to have a false-positive mammogram—a test result that triggers a biopsy or other tests, but turns out not to be cancer—because they tend to have denser breasts, he says.

“No one is saying, or no one should say, that screening mammography has no value for younger women,” he says.

What the task force is saying is that the absolute reduction in breast cancer deaths is much greater in an older population.

But the American Cancer Society’s Dr. Brawley reasoned that “the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

Study: Moderate Drinking Ups Risk of Breast Cancer Return

2012-01-11T06:46:00.000+08:00

THURSDAY, Dec. 10, 2009 (Health.com) — Breast cancer survivors who have just a few alcoholic drinks per week are more likely than women who drink little or no alcohol to see their breast cancer return, according to research presented today at an annual meeting of breast cancer specialists.

The study, which followed about 1,900 early-stage breast cancer survivors for eight years, found that women who consumed an average of at least three to four alcoholic drinks in a week had a 34% higher risk of breast cancer recurrence. (One drink equals a 5-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of liquor.)

The increased risk was more pronounced among breast cancer survivors who had gone through menopause and those who were overweight or obese, the study found.

Wine was by far the most common drink among women in the study, followed by liquor and beer, but no one type of alcohol was found to be significantly more or less associated with the risk of recurrence.

In all, there were 349 breast cancer recurrences and 332 deaths during the follow-up period. Alcohol use was not linked to the risk of death from breast cancer, however.

“More research should be done, but there is a growing body of evidence which suggests that women previously diagnosed with breast cancer should speak with their doctor about possibly limiting their consumption of alcohol,” says the lead researcher on the study, Marilyn L. Kwan, PhD, a staff scientist at Kaiser Permanente in Oakland.

Previous research has suggested that alcohol consumption may increase the risk of developing breast cancer in the first place. Kwan's research extends these findings to include the risk of recurrence among women who have already been diagnosed and treated for breast cancer, a population that numbers about 2.5 million in the United States, according to the American Cancer Society.

“Cutting back on alcohol represents a real step that a breast cancer survivor can take to reduce her risk of recurrence,” says Marisa Weiss, MD, the president and founder of the advocacy group Breastcancer.org. “You don’t have to give up alcohol, but use it more carefully and in moderation,” she says.

Limiting alcohol intake can improve the overall health of breast cancer survivors, according to Dr. Weiss, the author of the forthcoming book Living Beyond Breast Cancer. “Alcohol is liquid calories, and being overweight is a risk factor for breast cancer,” she says. “If you consume a lot of alcohol, you tend to be less physically active and/or smoke. So, for a number of reasons, that one step of cutting back on alcohol does have a number of health benefits."

Exactly how alcohol consumption affects breast cancer risk is not fully understood, says Kwan, although estrogen, which fuels the growth of most types of breast cancer, is likely involved.

“It has been suggested that alcohol could increase the risk of breast cancer by increasing estrogen metabolism and circulating levels of estrogen, thus promoting growth of the tumor,” she says. “A similar mechanism might be responsible for increasing the risk of breast cancer recurrence.”

Drinking-related weight gain could also play a role, Kwan adds. “Obesity may…promote estrogen production and breast cell proliferation, in addition to the direct effect alcohol can have on estrogen metabolism and levels in the body,” she explains.

The study, which was funded by the National Cancer Institute, was presented at the San Antonio Breast Cancer Symposium, an annual meeting for oncologists, surgeons, and other breast cancer specialists. The symposium is co-hosted by the American Association for Cancer Research and the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio.

Estrogen and Your Breast Cancer Risk

2012-01-11T02:13:00.000+08:00

Taking estrogen may increase a woman's risk of getting breast cancer.Estrogen is probably the hardest-working hormone in a woman’s body, but it also has a dark side: Research has determined that estrogen often plays a key role in the development of breast cancer, especially after a woman reaches menopause. How? The estrogen in a woman’s body seems to raise breast cancer risk by encouraging the growth of breast tissue, which can speed up an existing tumor’s growth. Here's what you need to know.

• Combination hormone therapy (HT): If you’re considering taking estrogen and progestin (a synthetic form of the hormone progesterone) to give you relief from annoying menopause symptoms like hot flashes and night sweats, be sure to limit the time you’re on the drugs. That’s because over time your breast cancer risk climbs, says JoAnn Manson, MD, professor of medicine at Harvard Medical School and author of Hot Flashes, Hormones & Your Health.

"In the Women’s Health Initiative (WHI) trial, when women got seven years of estrogen alone, there was no increased risk of breast cancer, but after four to five years on combined hormone therapy, the risk emerges," she says. In fact, over time, estrogen plus progestin can raise a woman’s risk for breast cancer by 24%; even if you take estrogen on its own for more than 10 to 15 years, your risk may still go up.

Dr. Manson was a coauthor on a March 2008 study in the Journal of the American Medical Association that followed up on the WHI trial. It showed that even after the women stopped taking combination HT, their breast cancer risk remained elevated. "The risk of breast cancer does decline after stopping hormone therapy," she stresses, "but if a tumor has formed while a woman is on hormones it’s very likely to come to light even after she stops hormones, so there is some residual risk. Stopping drug therapy doesn’t mean a tumor evaporates, but the risk gradually declines."

• HT and early diagnosis of breast cancer: If you have no family history of the disease, you’ve probably been encouraged to get your first mammogram by age 40 and every one to two years after that to help ensure that any tumor is caught early, when it’s most treatable. That’s good advice, but taking HT may complicate things. "Estrogen-and-progestin HT can lead to increased mammographic density"—denser breast tissue—"that can obscure breast tumors and delay diagnosis," says Dr. Manson. Denser breasts are believed to be an independent risk factor for breast cancer, but they also make it harder to accurately read a mammogram and that "can lead to abnormal mammograms that may require extensive follow-up and anxiety about repeat testing and even unnecessary biopsies," Dr. Manson adds.

• HT and risk for benign breast disease: In April 2008, the Journal of the National Cancer Institute found that postmenopausal women who’d taken estrogen on its own doubled their risk of a noncancerous type of breast disease, but one that’s associated with a higher risk of breast cancer. A September 2008 study led by the same author, Thomas E. Rohan, MD, PhD, an epidemiologist at the Albert Einstein College of Medicine, in New York City, found similarly disturbing evidence in a study of women taking estrogen and progestin: Combined HT raised a woman’s risk of benign breast disease by 74%.

Drugs Help Prevent Breast Cancer but Pose Risks Too

2012-01-10T22:37:00.000+08:00

THURSDAY, Sept. 17, 2009 (Health.com) — Women at high risk of breast cancer can often lower that risk by taking medication, including drugs like tamoxifen or the osteoporosis drug raloxifene (Evista).

Now, a new analysis suggests that women and their doctors need to weigh the dangers of the drugs’ side effects—which can include blood clots, cataracts, and cancer of the uterine lining—against the benefits of breast cancer prevention.

More about metastatic breast cancerThe analysis, funded by the U.S. Department of Health and Human Service’s Agency for Healthcare Research and Quality, was published in the September 15 issue of Annals of Internal Medicine.

However, the bigger problem may be that not enough women who are candidates for the drugs are actually taking them. About 2% of U.S. women are at high risk for breast cancer, but many don’t take tamoxifen or raloxifene, according to Christy Russell, MD, an American Cancer Society spokesperson who chairs the organization’s breast cancer advisory committee.

“That’s extremely unfortunate, because we have 200,000 new cases of invasive breast cancer every year and we could potentially reduce that number by half using drugs that are already approved by the [Food and Drug Administration] for this specific purpose,” she says. Dr. Russell says the drugs are underused due to a lack of education among both patients and physicians as to their safety and effectiveness.

“As a culture, it’s a very hard sell to convince us to take drugs for a disease we don’t already have,” she adds.

Study: Soy May Benefit Breast Cancer Survivors

2012-01-10T19:02:00.000+08:00

TUESDAY, December 8, 2009 (Health.com) — Women with breast cancer who eat more soy are less likely to die or have a recurrence of cancer than women who eat few or no soy products, according to a new study.

In the past, physicians have often warned breast cancer patients not to eat soy. The new research represents "a complete turnaround" from the previous understanding about the link between soy consumption and breast cancer, says Sally Scroggs, a registered dietician and senior health education specialist at M.D. Anderson's Cancer Prevention Center in Houston.

"We have gone from saying, 'No soy for breast cancer survivors' to, 'It's not going to hurt,'" Scroggs says. "Now it looks like we can say, 'It may help.'"

The study followed more than 5,000 women in China who had undergone a mastectomy for about four years. The women who consumed the most soy protein (about 15 grams or more a day) had a 29% lower risk of dying and a 32% decreased risk of breast cancer recurrence compared to the women who consumed less than about 5 grams of soy protein a day, according to the study, which appears in the December 9 issue of the Journal of the American Medical Association. The National Cancer Institute and the U.S. Department of Defense's Breast Cancer Research Program funded the study.

Women who ate between 9.5 and 15 grams of soy protein saw nearly the same decrease in risk as the women who ate more than 15 grams. In fact, the researchers found no additional benefits to eating more than 11 grams of soy protein a day. (An 8-ounce glass of soy milk and a cup of shelled edamame contain about 7 and 14 grams of soy protein, respectively.)

In all, 534 women had a breast cancer recurrence or died from breast cancer during the study period.

Soy foods—such as milk, tofu, and edamame—are rich in naturally occurring estrogens (especially isoflavones) that can mimic the effects of estrogen in the female body. Because the most common types of breast cancer depend on estrogen to grow, experts once feared that soy isoflavones could stimulate the estrogen receptors in breast-cancer cells, even though the estrogens in soy are much weaker than those produced by the body.

The current study suggests the exact opposite: Soy may actually reduce the amount of estrogen that's available to the body.

"Soy isoflavones may compete with estrogens produced by the body. Soy isoflavones may also reduce the body's production of estrogen, and increase clearance of these hormones from the circulation—all of which together reduce the overall amount of estrogen in the body," says the lead author of the study, Xiao Ou Shu, MD, PhD, a cancer epidemiologist at the Vanderbilt-Ingram Cancer Center of Vanderbilt University Medical Center in Nashville, Tenn.

Dr. Shu says, however, that factors beyond estrogen may be at work. Other components of soy foods, such as folate, protein, calcium, or fiber (or some combination thereof) may also be responsible for the health benefits reported in the study, she says.

Breast Cancer Risk and Estrogen Alternatives

2012-01-10T14:52:00.000+08:00

Taking estrogen may increase a woman's risk of getting breast cancer.Getting relief from menopause symptoms doesn’t need to mean estrogen-only treatments or combined hormone therapy (HT), which may increase your risk of breast cancer. If you can, consider nondrug remedies first, says JoAnn Manson, MD, a professor of medicine at Harvard Medical School and the author of Hot Flashes, Hormones & Your Health.

Dr. Manson has several suggestions for managing hot flashes and night sweats:

Wear layered clothing.Lower the thermostat.Use portable fans.Avoid dietary triggers such as caffeine, spicy foods, and alcohol.Avoid tobacco.Increase your intake of soy-based foods.Consider trying the herb black cohosh.A low dose of a selective serotonin-reuptake inhibitor (SSRI) or the antiseizure medication gabapentin may also be useful, according to Kala Visvanathan, MBBS, assistant professor of epidemiology and oncology at Johns Hopkins Bloomberg School of Public Health, in Baltimore. Alternative Therapy for Side Effects More than 80% of breast cancer patients have tried complementary therapies. Read more"If a woman has only vaginal dryness and discomfort with intercourse and no other symptoms, she can use a topical estrogen or a vaginal estrogen ring, which have a much lower absorption of estrogen," adds Dr. Manson, who notes that relaxation and breathing techniques have worked for some women as well. "I would encourage women to try lifestyle modifications before going with estrogen, especially if they have mild symptoms," she says.

Dr. Visvanathan agrees: "You definitely want to try simple things first, then go to [HT] if you need to. It used to be that hormones were the first thing you tried, but the paradigm is changing because we’ve determined the long-term breast cancer and cardiovascular risk associated with HT, and because the benefits of HT have been shown to be less effective than previously thought. Women with modest menopausal symptoms can often treat their symptoms effectively with nonmedical therapies."

Have you tried estrogen alternatives for hot flashes?If you end up needing estrogen or combination HT, though, and you want to keep your breast cancer risk low while still keeping menopause symptoms in check, ask your doctor about transdermal patches, gels, and sprays, which deliver low doses of estrogen through the skin and may have fewer risks than pills. "Transdermal estrogen may be less likely to cause blood clots and gallbladder disease," Dr. Manson explains. "And lower doses may be less likely to increase the risk of breast cancer or other cancers."

The bottom line: Consider alternative approaches to see if one or several together can control your menopause symptoms before turning to oral estrogen or combination HT.

Study: Soy May Benefit Breast Cancer Survivors

2012-01-10T10:48:00.001+08:00

"We have gone from saying, 'No soy for breast cancer survivors' to, 'It's not going to hurt,'" Scroggs says. "Now it looks like we can say, 'It may help.'"

In all, 534 women had a breast cancer recurrence or died from breast cancer during the study period.

The current study suggests the exact opposite: Soy may actually reduce the amount of estrogen that's available to the body.

What Could My Strange Obsessive Symptoms Mean?

2012-01-08T04:43:00.001+08:00

When personality quirks start to get in the way of a person's productivity and quality of life, they may be the sign of a serious mental health disorder.

Behaviors such as attention problems, repetitive actions, and obsessive thoughts may signal several different conditions whose symptoms often overlap. While only a doctor can diagnose the actual root of these issues, here are a few of the most common causes.

Obsessive compulsive disorder (OCD)
For people with full-blown OCD, this chronic anxiety disorder can be downright disabling: They become plagued by persistent, unwelcome thoughts—such a something bad happening to a loved one—and feel that the only way to prevent these thoughts is to engage in rituals such as repetitive hand washing or checking door locks, for example.

Body dysmorphic disorder
Sufferers of this condition obsess about a perceived flaw in their physical appearance, like moles, freckles, scars, acne, or body hair. People with the disorder frequently check themselves in the mirror, avoid having their pictures taken, and repeatedly check, touch, or measure the imagined flaw.

Hypochondria
This intense preoccupation with physical health can cause sufferers to worry that minor and imagined physical symptoms are signs of a serious illness. They aren't reassured when tests or doctors' diagnoses come back negative. Read one writer's experience with hypochondria.

Trichotillomania
People with trichotillomania have an irresistible urge to pull their hair from their head, eyebrows, or body. Pathological skin picking (also called neurotic excoriation, psychogenic excoriation, and dermatotillomania) is similar.

Tic disorders
This group of disorders includes Tourette syndrome, in which sufferers make impulsive sounds or movements—like blinking their eyes or shrugging their shoulders—over which they have little control. Although Tourette syndrome may be best known for the uncontrollable tendency to blurt out curse words or other inappropriate words or phrases, this symptom (called coprolalia) actually occurs in only a small number of patients.

Attention deficit hyperactivity disorder (ADHD)
This condition is often misdiagnosed, especially in adults, because patients do not in fact have to exhibit symptoms of hyperactivity. Some adult ADHD sufferers can appear quite laid back, even lazy or lethargic, and without the ability to stay focused on important tasks. Instead, people with ADHD often "hyperfocus" on, or become obsessed with, trivial project details or hobbies.

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