If you want to catch up on sleep, don’t plan a vacation to West Virginia. People there are more sleep-deprived than anywhere else in the US. You’d be better off going to, say, Hawaii, where the scent of plumeria must lull citizens into REM, since more people there report sleeping through the night compared to every other state.

According to a poll of more than 400,000 people just completed by the Centers for Disease Control, the percentage of people reporting disturbed and inadequate sleep really does vary wildly from one state to the next. In West Virginia, over 19 percent of the respondents reported bad sleep during the previous 30 days. But people in chilly North Dakota had far lower numbers, with only 7.4 percent having lost sleep. In general, the Southern states performed poorly, although none were nearly as sorry as West Virginia. Florida respondents, for instance, reported 13.5 percent poor sleep, and Alabama 13.2.

But while the geography factor certainly sparked interest among researchers, so did the finding that overall, the respondents, regardless of which state they lived in, were overwhelmingly short on sleep. Only three out of every 10 respondents claimed excellent sleep for the previous month, meaning that a full 70 percent hadn’t slept well at least some of the month A full 38 percent hadn’t had adequate sleep for more than seven nights in the previous 30 days, and more than one in ten claimed they hadn’t enjoyed a single good night’s rest.

The study also found that adults now get considerably less sleep than they did a mere decade ago, and that sleep levels continue to decline. Experts say that adults need between seven and eight hours of rest every night in order to maintain health. But in this latest poll, 20 percent of the respondents reported sleeping less than six hours a night, far short of the minimum, compared to only 13 percent in 2001. And remember, quality of sleep counts even more than quantity — six restless hours adds up to nowhere near enough restorative rest.

The statistics skew not only by geography, but also by gender, economic status, and educational level. Having a college degree, for instance, may open the door to employment, but apparently, it shuts the door on good shut-eye. In fact, high school dropouts fare much better in the sleep department (38 percent report excellent sleep) than do college graduates (28 percent). The data show that men sleep better than women, the elderly sleep better than young adults, and Caucasians sleep better than Blacks or Hispanics.

The sleeplessness epidemic has an impact beyond making people dull at work or school. In fact, the researchers say that not sleeping the minimum seven hours night after night adds up to a chronic sleep disorder, and that’s what between 50 million to 70 million Americans suffer from. Lack of sleep correlates with psychological problems such as anxiety and depression, as well as with physical issues including increased risk for obesity, hypertension, diabetes, and high cholesterol — not mention, higher mortality rates. Plus, poor sleep links to higher levels of smoking, substance abuse, and drinking, more risk of car accidents, compromised attention span and greater likelihood of obesity.

On the other hand, some evidence indicates that oversleeping (more than eight hours a night) also correlates to major health issues and increased risk of early death. You can’t sleep too much or too little. But many experts argue that the factors that lead people to oversleep — typically depression or preexisting heath issues — cause the spike in morbidity and mortality, not sleeping in. In any event, nobody is arguing with the reality that sleep deprivation causes an array of serious psychological and physical health problems.

So what is causing all the restless nights? And why do rates of sleeplessness just keep increasing?

The CDC report says, "The major causes of sleep loss are overlapping and include lifestyle and occupational factors that reflect broad societal factors (e.g., work hours and access to technology), and specific sleep disorders." In other words, people work into the night or work so many hours that their schedule cuts into sleep. Or, they stay up at night enjoying "technology," including the Internet and television.

According to researcher Lela McKnight Eily, who led a previous CDC sleep study, "At night, we’re doing everything except for sleeping — we’re on the Internet, we may be watching TV. With these new lifestyles, we have kind of taken sleep for granted as something that we can do when we have time or we can catch up on it on the weekends. We don’t realize that sleep is a vital part of overall health and that chronic sleep loss is related to both physical and mental health issues. It’s getting worse."

The researchers don’t mention a few other factors that might cause tossing and turning. First, diet contributes to insomnia. Drinking caffeine-laden sodas and coffees, eating sweets, and eating a poorly balanced diet all create sleeplessness. So do many pharmaceuticals. Not getting enough exercise also throws the metabolism off and makes sleep difficult. Compared to a few decades ago, we eat more, we eat worse, and we exercise less and then to compensate for the toll on our bodies, we take more pharmaceuticals. No wonder we have disturbed sleep. And, of course, we haven’t even mentioned the epidemic of obesity, which can be a major contributing factor to sleep apnea. Add to that the factors the CDC named — the late night internet cruising and work schedules that spill over into the night, and you have the perfect recipe for insomnia.

The CDC recommends that health care providers address the problem by "evaluating patients who report chronic insufficient rest or sleep and advise them of effective behavioral strategies including keeping a regular sleep schedule; avoiding stimulating activities within 2 hours of bedtime; avoiding caffeine, nicotine, and alcohol in the evening; sleeping in a dark, quiet, well-ventilated space; and avoiding going to bed hungry." I was with them until that last recommendation, the "avoid going to bed hungry" They don’t mention that the pre-bedtime snack should not be milk and cookies, nor should it be a large meal, which surely will wake you in a few hours as your body tries to digest. Instead, the report says, "pharmacologic intervention might be warranted."

If you can’t sleep, you might take a good look at your lifestyle and physical condition, and if there’s no way to get it under control in the short run, at least try some natural solutions before resorting to Ambien.

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At the turn of the last century, a popular cure for most major ailments was a stay in the country. The fresh air, it was believed, could strengthen a weak constitution and restore health. Now, new evidence shows that proximity to things green and alive in fact does exert a curative, or at least a protective health benefit.

Researchers from the EMGO Institute VU University Medical Centre in the Netherlands studied the medical records of 345,143 adults. Sorting the records by postal code, the researchers determined the percentage of green spaces such as parks or forests within two miles of each patient’s home. They then reviewed the records for prevalence of 24 different health conditions and found that those subjects living closest to green areas had a lower incidence of 15 of the 24 diseases on the list.

Apparently, the closer to the green, the more powerful the healing effect experienced. Head researcher Jolanda Maas, PhD, says, "The strongest associations we saw between green space and health occurred within a one kilometer [0.6 mile] radius of the home."  Also, the association was strongest for children, for low-income people, and for those who lived in slightly urban areas rather than in the inner city.

Of the conditions studied, mental health problems were the most affected by the presence of green. Those who lived close to parks or other natural areas had a 30 percent reduced risk of anxiety disorders requiring treatment and a 20 percent reduced risk of needing treatment for depression. It’s no secret that anxiety and depression can lead to a host of other health problems over time. In fact, both anxiety and depression negatively affect longevity, and so if green deprivation compromises mental heath, that surely has some spillover to physical health.

Among the physical ailments, respiratory conditions responded most dramatically to proximity to green. The data showed a sharp reduction of asthma rates, COPD, and upper respiratory infections among people who lived close to nature. An association also was found between green and lowered rates of cardiovascular disease, diabetes, cancer, and even back problems.

Earlier studies also underlined the palliative effect of green. Last year, researchers at the University of Glasgow found that the sizeable disparity in mortality rates between rich and poor families narrowed in residential areas closest to nature. In fact, the gap between rich and poor living in the greenest areas was half that in the most urban. In densely urban areas devoid of green, the mortality rate among poor people exceeded that of rich people by 1.93 times, but in the greenest areas, that gap shrunk to 1.43. When considering only death rates by cardiovascular complications, the figures become even more dramatic, with low-income people living in the least green areas having 2.19 times the incidence of death compared to their rich neighbors. But in the greenest places, the cardiovascular death gap between rich and poor ratcheted down to 1.54. Then again, we already knew that the closer people lived to heavily trafficked roads, the higher the incidence of cardiovascular disease.

But what causes the "green effect"? Researchers believe that those living nearest parks and outdoor recreational areas get more exercise, taking advantage of the opportunities such areas provide. This is particularly true of children. Parks also lead to social encounters, which improve mental health. And, people use parks and green areas simply to relax, so they can be major stress reducers. The researchers think that the reason the effect of green diminished in the heart of the city is because urban parks are considered unsafe so people use them less.

"The role of green space in the living environment for health should not be underestimated," the study authors wrote in the Journal of Epidemiology and Community Health. "Most of the diseases which were found to be related to the percentage of green space in the living environment are highly prevalent in society and in many countries, and they are the subject of large-scale prevention programs." The authors say that opening more green space might be an effective use of disease-prevention funds.

Interestingly, the authors did not mention several factors that might be key. First, where green dominates, the golden arches don’t. In other words, neighborhoods with plenty of natural areas probably don’t have fast food joints on every corner, and that means less access to junk food. Studies have shown that the closer people live to fast food restaurants, the more likely that they’ll have major health problems. Also, more green usually means fewer roads and buildings, which translates to fewer emissions from automobiles and places of business. Again, studies have repeatedly shown that the more pollution in the air, the greater the risk of numerous diseases and death. And finally, of course, plants actually remove pollutants from the air.

In fact, an analysis in Australia determined that if roofs in that country’s major cities were replaced with "green roofs" consisting of live plants, the carbon dioxide emissions could be reduced by half a million tons each year. While green roofs cost a bit more than regular roofs to construct, they increase roof life by two times and experts say costs can be recouped in a few years. Although not so common in the US, sales of green roofs in Europe are, so to speak, "through the roof," with 700 million Deutsch Mark in sales in 1997 in Germany alone. Of course, it might be far more satisfying to walk through a field filled with flowers or to bike through the woods than to climb up to your urban roof for a green fix, but at least the roof is close to home.

When you think about, real estate agents may have been onto something all these many years when they said, "The three most important things to consider when buying a home are: location, location, and location." But who knew they were talking about your health?

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In at least five states, parents have had their children taken away by the government and placed into foster care, or they have completely lost custody, because the kids weighed too much. Ditto in Canada and in the United Kingdom. With two-thirds of all adults in the US now overweight and one third so overweight that they qualify as obese, it’s surprising to hear about obese children being removed from their homes because they are too fat. You’ve got to wonder if the welfare authorities and attorneys and judges and foster parents involved all fall into that minority of adults still at healthy weight, or if they themselves hypocritically tip the scales.

You would think the preponderance of obese individuals would usher in a climate of leniency toward those grappling with weight problems, but apparently not. In fact, according to Dr. Matt Capehorn of the U.K.’s National Obesity Forum, "It’s happening more than the public is aware of, but because these cases are usually kept quiet [as a result of child-privacy laws], we have no record."

The publicized cases have thus far been extreme. In South Carolina, mother Jerri Gray lost custody of her 555-pound 14-year-old son after failing to show up for an appointment with social services. In New York, a 261-pound teenage girl was ordered by the court to follow a prescribed diet and a fitness regimen, although she was allowed to remain at home.  And in Scotland, parents just had a newborn temporarily removed because the whole family is fat. The other six children in the family range in age from three to 13 and weigh between 56 and 220 pounds.  The three- and four-year-old children already have been placed in foster care. The authorities have warned the parents that all the kids will be taken if their weight doesn’t go down.

All of these cases went to court on the grounds that allowing kids to get fat represents a form of abuse. In fact, courts in Texas, Pennsylvania, New York, New Mexico, and Indiana already have ruled that medical neglect includes morbid obesity. Although criminal charges against the parents have been filed in several cases, no parent yet has served jail time because junior is fat. But an expert from the British National Obesity Board, Tam Fry, says, "My point will be that we regard malnourished children as being abused and so with those children who are so overweight, either consciously or by neglect because their parents allow it, there should be a case for them being removed from their parents to a pediatric ward and put under weight management by doctors."

And Ron Jones, an Atlanta-based wellness expert, has spearheaded a campaign declaring that child obesity is child abuse. "If you gave your child a drug, you’d be held in the court. But if you kill them with food, that seems to be acceptable," he says.

The thinking is that kids who remain obese will likely develop weight-related diseases like type 2 diabetes, hypertension, sleep apnea, and so on unless they get out of the environment where they gained excess weight. They need to go somewhere that will enforce dietary restrictions and teach them healthier eating habits. Meanwhile, their parents need to pay the price for allowing their kids to balloon up.

But some experts decry this type of thinking. Grant Varner, who is the attorney for Ms. Gray, the South Carolina mother mentioned above, says, "If she’s found guilty on those criminal charges, you have set a precedent that opens Pandora’s box. Where do you go next?" In other words, just how fat do kids need to get before they get taken away from their parents, and who makes that determination? Twenty states now have laws that allow schools to screen kids for body mass index. Can the law be interpreted so that kids who "fail" their BMI become wards of the state? These are the questions that critics of the recent actions against parents are asking.

Meanwhile, the welfare authorities universally argue that they wouldn’t remove children from their homes just on the basis of weight, that they only act when there’s an imminent medical threat to children. But let’s get real. The fact is that 30 percent of all kids between the ages of 10 and 17 are now overweight or obese. In Mississippi, that rate is 44 percent. The obesity rates keep climbing — not going down. Studies show that one out of four overweight children already shows early signs of type II diabetes and 60% already have one risk factor for heart disease. And according to the CDC, one in three U.S. children born in 2000 will become diabetic — and if you’re black or Hispanic, that percentage is half. That means that if we are to believe the authorities, one third of all children will be subject to court ordered removal from their homes — and again, half if they’re black or Hispanic. Perhaps it’s just me, but that seems a bit Orwellian!

And maybe all the parents of all those kids are indeed endangering the health of their children, and they need to be stopped. But clearly, the problem is so out of control that something needs to be done beyond pressing criminal charges against parents. For instance, consider the fact that food companies are allowed to produce and market foods that make kids fat, no holds barred. And while it’s true that cigarette companies can’t bombard kids with ads during cartoon hour trying to get them to crave tobacco, the makers of candy and chips and greasy prepared foods sure can — and do. They also seduce the parents with promises of no-fuss meals and surefire ways to keep the kids happy, and load the shelves with these products.

As obesity expert Dr. Marc Jacobson of The American Academy of Pediatrics says, "There’s clear evidence that the food industry — fast food restaurants, vending machines, sweetened cereals — influences childhood obesity. I can’t say which is relatively greater in influence [parents or the food industry], but [the food industry] certainly is important. The more fast food restaurants in a community, the more likely the kids are to be obese." If we want to point fingers, the FDA and AMA both endorse high fructose corn syrup, one of the primary culprits in the obesity epidemic, and the US government subsidizes its production and sale. Isn’t it a bit Hansel and Gretelish for the government to subsidize the fattening of our children and then be in charge of removing them from their homes once they get fat?

Meanwhile, the economic realities demand that most parents work during the hours when kids snack and nobody is home to monitor. Parents who don’t have health insurance can’t afford to enroll kids in weight-control programs after the damage is done, and many can’t afford to live in neighborhoods where parks and recreational options abound. And let’s not forget the fact that fast food outlets are concentrated in poor neighborhoods — by design.

David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital in Boston sums up this side of the argument in Time Magazine, "Parents have a responsibility, but it’s also society’s responsibility — the national government spending billions of dollars on farm subsidies for poor-quality foods, communities placing their priorities on development revenue rather than parks, cutbacks to school nutrition. All this is unfair to the kids." In short, holding a few parents criminally responsible won’t end the epidemic of fat kids. Sweeping changes are needed in industry and society. Or perhaps as (dare I say it) Hillary Clinton once said, "It takes a village to raise a child."

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If it wasn’t for bratty kids and their exasperated parents, television shows like SuperNanny and Nanny 911 wouldn’t be so incredibly popular. The child-rearing experts on those shows make it look like an effortless deal to turn kids who curse, bite, and throw spinach at the wall into civilized beings. But unlike those calm, in-charge TV nannies, the typical parent still flounders through the discipline quagmire — pleading, cajoling, yelling, screaming, punishing, and finally spanking or hitting the errant child in desperate hope of effecting some change.

And spanking — that last-resort tactic–does indeed effect changes in kids, but those changes tend to be for the worse. That’s what numerous studies have confirmed, including a new study out of the University of New Hampshire. The study followed 806 children aged two to four, and 704 children ages five to nine. The children took IQ tests at the start of the study and then four years later. Those children who had been spanked during those years tested lower on the IQ tests than the children who weren’t spanked — five points lower in the case of the younger group and 2.8 points for the five to nine year olds. The researchers had controlled for socioeconomic status, level of parental education, amount of cognitive stimulation the children received, and so on. They also noted how often the child was spanked and found that the more spanking the child received, the greater the negative impact on intelligence. "But even small amounts of spanking made a difference," said study director Murray Straus.

So how does a bop on the butt translate into lost IQ points? According to Dr. Straus, "Contrary to what everyone believes, being hit by parents is a traumatic experience. We know from lots of research that traumatic stresses affect the brain adversely." He says that most children who receive spankings get hit at least three times a week, which over the years creates post-traumatic stress symptoms (PTSD). PTSD is associated with lower IQ. This especially holds true for children who get hit into adolescence, as he found in a separate study that confirmed a link between spanking prevalence in countries around the world and the national IQ, using data on over 17,000 university students worldwide. That study found that in places where spanking flourished, the national IQ tended to be lower.

Another expert, Elizabeth Gershoff of the University of Texas, Austin, says, "With spanking, a parent is delivering a punishment to get the child’s attention and to get them to behave in a certain way. It’s not fostering children’s independent thinking."

Some fed up parents may not care about knocking a few IQ points out of their kids, but even the most diehard spanking-enthusiasts might decide to spare the rod if they review the results of other studies on the subject. Earlier studies almost universally have found that spanking makes kids meaner and more aggressive. A recent study found that spanking tends to lead to sexual dysfunction in adulthood. (Maybe spanking would be more effective if you could actually communicate that down-the-road effect to the child being punished.) And yet another study that just came out, involving 2,500 toddlers from low-income families, found that spanking at age one led to increased aggressive behavior by age two and poorer performance on mental ability tests by age three. In other words, spanking may provoke the very behavior that it’s intended stop. In this study, one-third of the one-year-olds, and about half of the two to three year olds had received spankings in the week prior according to reports filled out by the parents. And those are just the parents who admitted hitting their kids! If one-year-olds commonly get hit, no wonder so many people grow up ornery!

Interestingly, verbal punishment, including screaming, yelling, and so on, didn’t have the same negative effect on the kids, according to the study results. This is good news, if an article in the New York Times is to be believed. The article quotes Amy McCready, a parenting skills expert who founded Positive Parenting Solutions, who says, "I’ve worked with thousands of parents and I can tell you, without question, that screaming is the new spanking. This is so the issue right now."  In other words, at least in New York, spanking is popularly considered taboo, so parents scream instead. (But truly, isn’t that so New York?)

The article refers to one study that asked 1300 parents what created the most guilt for them, and over two-thirds named yelling at their kids as the single biggest source of guilt, though other choices included hitting the kids or failing them in some other way. Another study found that of 991 parents interviewed, 88 percent admitted screaming at their children within the past year.

The article ends with plenty of ammunition to convince parents that yelling is bad, and that it undermines kids (despite the findings of the Straus study). But an editorial in The Last Psychiatrist makes an interesting point. It says that the problem isn’t so much the disciplinary tactic used, it’s the fact that so many parents discipline kids willy nilly for shaming or burdening the parents rather than for doing something intrinsically wrong. For instance, a kid who spills milk on a clean floor may get punished as harshly as a kid who lies, leaving the kid confused about the difference between right and wrong and about what really counts.

And perhaps that’s true. Perhaps many parents do spout off because of their own frustrations and stresses rather than responding wisely and reasonably. But clearly, if almost 90 percent of all parents scream at their kids and a large percentage spank, it won’t work to simply say, "It’s bad for your kids — don’t do it." So what should parents do when kids act out? For one thing, they should care for themselves. They should get enough exercise, meditate, eat well, and if necessary, take some herbal or nutraceutical relaxants so that they react to exasperating kid behavior from a place of poise rather than a place of frenzy. They also might find that the kids behave better if they follow a similar regimen — eating well, avoiding sugar, getting enough exercise, and yes — meditating. But if de-stressing the adult and dealing with the child’s excess physical energy doesn’t help, you can always get in line for a spot on the Nanny 911 show.

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Back in September of 1968, 100 women became famous for protesting outside a Miss America pageant — throwing their girdles, bras, hair curlers, high heels, and other "instruments of torture" into a huge trashcan. The media picked up the action, and women nationwide discussed whether they really needed to keep wearing the restrictive and oft-times painful garments. In the case of high heels, the answer at that time, at least among the feminists, was a resounding "no."

The gist of the argument against heels was political — high heels make it impossible for women to run, so women in heels become easy prey for predatory men. Also, as author William Rossi explains in The Sex Life of the Foot and Shoe, men get erotic pleasure from watching the "sashaying buttocks and undulating hips of the high-heel walk" — a fact that infuriated feminists who believed that the constricting discomfort of heels was too high a price to pay for stimulating male fantasies.

But beyond politics, even back then, it was clear that there were plenty of reasons to avoid high heels. In heels, women got blisters and bunions, twisted their ankles, and hurt their backs. Now, a new problem with heels has come to light: they can cause damage to feet and ankles that shows up years after the shoes have been put to rest.

A study by Boston University and The Institute for Aging Research of Hebrew Senior Life reviewed medical data on the feet of over 3,300 men and women. The researchers found that when older women suffered pain in the back of their feet and in their ankles, there was a strong association to having worn high heels for long periods of time earlier in life. And those who wore pumps or sandals didn’t fare much better, according to the data.

Given that foot pain ranks as one of the top 20 reasons people over the age of 65 go to the doctor, and that more than 43 million Americans have foot problems, these results are significant. In the study, 29 percent of the women reported generalized foot pain on most days, as did 19 percent of the men. Those women who had worn "good" supportive shoes for most of their lives were 67 per cent less likely to experience ankle or heel pain than women who wore less supportive shoes. But in fact, most women had not opted for a life in sneakers. The study found that 64 percent of the women surveyed had worn heels, sandals, or pumps for most of their lives — shoes categorized by the researchers as "poor choices." In contrast, less than two percent of the men wore shoes in the poor choice category. Good choices, according to the researchers, include sneakers and athletic shoes. Work boots and rubber-soled shoes fall somewhere in the middle.

Research conducted by the American Podiatric Association found that 39 percent of women wear high heels every day.  Of those daily wearers, 75 percent have shoe-related foot pain and related problems such as hammer toes, calluses, corns, tendonitis, lower back pain, and plantar warts. The Association warns women that heels higher than three inches put seven times the pressure on the ball of the foot, which can damage bones. In fact, one study published last year in Clinical Biomechanics found that standing in high heels for long periods can result in a deformity of the big toe where it angles in toward the other toes. Even worse, perhaps, is a finding out of the Harvard Medical School that links wearing high heels to the development of osteoarthritis in the knees.

"High heel shoes may alter foot structure and alignment…while sandals and slippers are considered to lack the support of a conventional shoe," said Dr. Howard Hillstrom of the Hospital for Special Surgery in New York. And Dr. Marian Hannan of the Harvard Medical School adds, "Wearing shoes with poor arch support or shoes that negatively affect any aspect of foot biomechanics could lead to a breakdown in the health and operation of the foot’s musculoskeletal system."

The researchers say that with every step we walk, the foot absorbs shock from contact with the ground. Most of the stress goes to the heel area (in non high heel shoes). Better shoes offer both cushioning and support so that the heel isn’t subjected to constant pounding , while the worst shoes offer neither. 

So back to the political argument. If high heels and women’s shoes in general consign women to foot deformities, arthritis, and extreme foot and ankle pain that make it difficult to walk later in life, just how far have we come from the practice of foot binding in China? The obvious similarity is that just as in China, women today suffer a high price for high fashion, but the difference is that women now do have a choice: they can opt to wear sneakers instead of spikes. At the least, they can wear heels only when absolutely necessary.

If the thought of wearing sneakers horrifies you, don’t despair. It may in fact be possible to wear sandals and pumps of a certain type without suffering damage.

Dr. Hannan points out, "The issue is not simply whether one is wearing a good shoe, but if one is wearing a good shoe for one’s foot type." Some sandals do, in fact, offer excellent support, and some foot types actually respond better to certain types of sandals than to other shoes. Just make sure that whatever shoes you wear offer good support, plenty of cushioning, minimal lift, and that they fit really well. And if you do wear heels, stretch your heel and calf muscles afterwards, give your feet and legs a soak and massage, take smaller steps, and opt for shoes that at least have straps in the back.

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When the economy tanks, not everything goes into the toilet. Though it seems as counterintuitive as Magnetic Hill, where cars in neutral roll up the mountain, history shows that during economic recessions, longevity increases and health improves. In fact, according to a new study out of the Institute for Social Research at the University of Michigan, Ann Arbor, the Great Depression ushered in a considerable leap in life expectancy, but as soon as the economy looked sunny again, life expectancy took a nosedive.

The study focused on the two decades between 1920 and 1940, a period of extreme economic volatility. During the years of the Depression, from 1929 to 1933, the gross domestic product dropped five percent while the population experienced a 6.2-year gain in life expectancy. The pattern held true for both genders and across ethnic groups. While life expectancy has consistency climbed since the 1920s (it was 57.1 years in 1929, and currently is 77 years), the gains were greatest and fastest during the years of the worst economic conditions. In the case of this study, life expectancy rose by 8.8 years during the entire 20-year span, with, as mentioned above, the majority of the increase — 6.2 years — occurring during the four years of the Depression. Of course, one needs to read life expectancy numbers with a skeptical eye since they don’t always mean what you think they mean.

Nevertheless, throughout the 20 years studied: whenever the economy improved, mortality rates went up. Whenever the economy suffered, mortality rates went down. Translated another way, according to Dr. Christopher Ruhm of the University of North Carolina, for every increase of one percent in unemployment, mortality rates drop by half a percent. And according to research director Dr. A. Tapia Granados, the same thing happened during the recession in the early 1980s and 1990s. Recessions abroad have seen the same pattern. On virtually every health parameter studied — heart disease, kidney disease, cancer, pulmonary disease, tuberculosis, infant mortality — recession ushered in improvements. The only exception was death by suicide, which did increase during the Great Depression.

"This is a pattern that is found again and again," Dr. Granados confirmed. "The basic finding … is that mortality rates tend to evolve in parallel to the economy. When the economy goes up, mortality tends to go up. When the economy goes down, mortality rates tend to go down, too."

The scientists have no definitive explanation for the unexpected phenomenon, but they do have some theories. First, they cite the fact that fewer people drive automobiles when the economy is bad. This means that fewer die in automobile accidents, which helps mortality statistics. It also means that air pollution from vehicular emissions decreases, reducing deaths triggered by particulate matter. Along a similar line of reasoning, when companies shut down, they add less pollution to the air, and so in times of low productivity air quality improves. Then again, wouldn’t the health benefits of better air quality be reflected several decades down the line after long term non-exposure?

An article in US News and World Report suggests that recession cuts into people’s cigarette and alcohol budget, and the less people drink and smoke, the healthier they stay. It’s a good theory, but there’s a credibility gap given the fact that recent data indicates that cigarette sales have gone up for the first time in years ever since the recession hit. Recent tax increases on cigarette sales may be impacting that trend, but overall, alcohol, tobacco, and chocolate are among the few items still selling well in spite (or possibly because of) the economy. And again, as with air quality, wouldn’t the mortality benefits show up several decades down the line? I mean, it’s not like you get cancer one month after smoking your first cigarette.

Dr. Granados postulates that the debilitating impact of working too hard explains higher mortality in boom times. "During expansions, firms are very busy, and they typically demand a lot of effort from employees, who are required to work a lot of overtime, and to work at a fast pace. Also, new workers may be hired who are inexperienced, so injuries are likely to be more common," he says. He suggests that the stress may drive people to smoke, drink, and eat unhealthy foods — but again, data shows that smoking and drinking rates stay relatively stable as the economy fluctuates. But he’s probably on target in suggesting that work demands may cause people to sleep less, and of course, there’s the general impact of stress on the body to consider — and that’s a huge factor. Then again, you might think that being out of work would be incredibly stressful, but as it turns out, it’s not that simple.

Along those lines, another study perhaps offers some clues. The University of Michigan research compared two groups of subjects, one surveyed between 1986 and 1989 and another between 1995 and 2005. The study found that those who "feared" losing their jobs suffered far more health-wise than those who had actually been laid off or fired. "In fact, chronic job insecurity was a stronger predictor of poor health than either smoking or hypertension in one of the groups we studied," the director of that study, Sarah Burgard, said.

The other viable theory that Dr. Granados puts forth is that economic distress causes people to band together. People have more time to spend socializing, and they tend to support each other more than when everyone has money. "This would improve the level of social cohesion and social support and could have a protective effect on health," he says.

One possibility that none of the experts put forth is that when people can’t afford medical treatment, they fare better simply by avoiding doctors. They aren’t subject to harmful pharmaceuticals, hospital disasters, and dangerous diagnostic and surgical procedures. While public health officials fret and sigh that people aren’t getting the care they need, in fact, doing nothing may oftentimes be healthier than going to the doctor. Given the 98,000 deaths annually from medical error in the US, less exposure to medical practitioners may have a bigger impact on declining mortality rate than those other factors named. The bottom line is that it is not a coincidence that time after time, when doctors go on strike, mortality rates drop dramatically in those cities or countries affected by the strikes.

I’m certainly not saying there’s no place for health care and that we should all just ride out whatever ailments assail us without any intervention. But if illness does come, a natural health regimen may be the safest first choice, reserving pharmaceuticals and surgeries for the most dire cases and for illnesses that won’t respond to less invasive approaches. Hopefully, this is a lesson the public can learn without having the economy completely bottom out.

:hc

One of the great advantages of HMOs, at least according to advocates, is that they typically offer patient education, a key preventative health measure. But recent evidence indicates that merely providing health information and medical advice doesn’t guarantee that patients will heed it.

A new study just published in the journal Circulation: Cardiovascular Quality and Outcomes, followed 3522 people with an average age of 67, who had a history of heart problems. Half of the subjects received intensive counseling about how to recognize heart attack symptoms and when to seek help. The study found that the patients who received the counseling were not one bit more likely to seek help at the appropriate time than patients who had received no such coaching. During the duration of the study, 565 of the subjects made use of emergency medical services due to cardiovascular symptoms.

The subjects who had received counseling waited 2.2 hours between experiencing symptoms and getting to the hospital, the un-counseled group waited 2.25 hours. Given the fact that patients need to receive treatment within 90 minutes of the onset of symptoms in order to prevent the worst outcomes, and given that the counseled group had been warned about the 90-minute window, the education clearly failed to make a dent. Also, the patients who hadn’t received counseling actually made better use of the emergency medical system, employing it 66.9 percent of the time, versus only 63.6 percent for the "educated" patients. Again, this points to the failure of the counseling, which focused on the urgency of getting to the hospital immediately and using the emergency medical system to expedite delivery of services.

In the case of cardiac problems, not heeding medical advice can mean big trouble — trouble, of course, best avoided by implementing natural health practices that prevent heart disease in the first place. But this blog entry isn’t about people following the advice of natural health practitioners; it’s about people following the advice of their doctors. And, as it turns out, advice issued after medical problems have developed often comes too late and patients don’t listen anyway, as other studies attest. It seems that the impulse to ignore what the doctor says may come with the human psyche. Patients consult doctors, but they don’t always like what they’re told and in the end, do what they please.

One study found, for example, that two-thirds of patients with gum disease ignore advice given by their dentist about how to brush their teeth. And if you think the results of such noncompliance would not equate to the dire consequences of failing to act in the case of cardiac warning signs, you would be wrong. Serious medical conditions associated with periodontal disease include, rheumatoid arthritis, diabetes, and heart disease. As it was, the dentists in the study advised patients to brush for two minutes twice a day. The patients used special toothbrushes that recorded brush time, and the vast majority fell short, though half believed that they had complied.

One of the lead researchers, Professor Peter Heasman of Newcastle University, said: "I think that many dentists and dental hygienists are fully aware that their patients do not always follow their professional advice. Nevertheless, we were surprised to find so many of our patients who were unable to follow instructions accurately, even in the short term."

Dr. Heasman’s comment allows that patients might not understand that non-compliance can really lead to loss of teeth [and death], rather than assuming deliberate non-compliance. But deliberate non-compliance seems to be the reason that college students ignore advice to wash hands regularly as a flu-busting measure, a recent study found. The schools involved in the study placed sanitizer gel dispensers at the entrances to public buildings, with signs urging students to make use of the gel, but only 17 percent of students did so. At New York University, students received flyers and emails urging them to wash hands and stay out of classes if they became ill, but again, most simply paid no attention.

NYU freshman Daniel Lee explains, "I think most people just toss the fliers out without giving them a second thought."

Perhaps of greater concern is the fact that young people also ignore advice about taking pharmaceuticals, according to a 2001 study by the Royal Pharmaceutical Society in Great Britain. The study followed 200 people aged 18-39, and found that only a small minority followed the instructions they were given with their prescription medicine. One-third ignored advice to avoid alcohol when on their pills, many drove when on medication that could make them drowsy, and 50 percent stopped taking their medications before completing the recommended course.

What’s going on here? Are people unable to pay attention long enough to grasp the advice? Are they simply cantankerous, rebellious, pig-headed? Or is ignoring medical advice sometimes actually called for?

In fact, while doctors fret and moan about patients who fail to complete the course of their medications, given the side effects of so many medications, stopping may be "just what the doctor [should have] ordered." For instance, the recommended course for antibiotics keeps shrinking. Whereas a 10-day course of treatment once was standard for upper respiratory infections, doctors in Europe now typically prescribe only five days. Recent research indicates that three days of treatment for non-acute pneumonia works as well as five days. So patients who use their own intuition and stop after a few days may simply be in advance of the medical establishment. When patients stop taking medications that make them feel awful, they may be making the wise choice — or they be helping to breed resistant strains of viruses and bacteria that threaten all of humanity. The problem is that they don’t necessarily know what alternatives are available to them (no thanks to the medical professionals), and doing nothing may be dangerous.

There’s also the fact that a very recent study found that the percentage of patients leaving the hospital against medical advice has increased 40 percent in recent years. Still, only 1.2 percent of all hospital patients self-discharge, and many of those leave for financial reasons; but patients who leave because they fear getting worse in the hospital are on to something real, given the fact that hospital-induced infections are legion, and medical errors account for 98,000 wrongful deaths a year in the US alone.  

In short, it often makes sense to heed advice intended to prevent problems in the first place. If you ignore heart-attack symptoms, you can end up dead within a few hours. If you fail to brush your teeth thoroughly, you can end up toothless, diabetic, or dead from a heart attack. If you drink while on prescription meds, you’re asking for trouble. But sometimes it makes sense to ignore advice that would hurl you into the pill-popping, hospital frequenting medical mainstream, as long as you know what alternatives might work more safely and effectively.

:hc

If the smell of beets makes you gag but you simply can’t get enough sour crème and chive potato chips, your Mom may be to blame — and not because of what she fed you growing up. Several studies show that food preferences may be set even before you’re born, as early as 13 weeks after gestation. And those preferences derive from what your Mom ate while you were in the womb.

The process is called "food imprinting," and it works because the scent and flavor of what a pregnant woman eats passes into the amniotic fluid. The fetus ingests that amniotic fluid starting at 12 weeks, and apparently, develops taste preferences based on that experience.

To verify that particular foods eaten by mothers affect later preferences of the baby, researchers at the Monel Chemical Senses Center in Philadelphia had pregnant women in their final trimester drink carrot juice four days a week for three consecutive weeks. Six months later, the babies of these women preferred carrot-flavored cereal to other varieties and made fewer unhappy faces when exposed to carrot cereal than babies who had not had prenatal carrot juice. They also consumed 20 percent more carrot-flavored cereal than babies who didn’t have exposure to carrot juice in utero.

A series of similar studies have found parallel results. When mothers consumed lots of peaches during pregnancy, their babies preferred peaches after birth. When nursing mothers ate green beans in large quantities, their babies developed a lasting love of green beans. Similar studies in Europe found that women who consumed plenty of garlic during their pregnancies had babies who enjoyed garlic, and a French study found anise-consumption by pregnant moms imparted a love of anise to their offspring.

"So what that tells you is that there’s some type of memory that’s being formed," said Dr. Julie Menella, director of the carrot-juice study. That’s also the premise of a new book called Feeding Baby Green by pediatrician Dr. Allen Greene. Dr. Greene contends that babies remember the tastes they experienced in the womb and seek them out after birth. He cites a study published in 2008 in the Journal of Physiology in which pregnant animals were divided into two groups: one that ate healthy foods and another that ate fatty, sugary, salty foods including donuts and chips. After giving birth, the offspring that had been exposed to healthy diets in utero wanted healthy foods, while the junk food fetuses turned into junk-food junkies with far more health problems than the animals that came from parents with healthier diets.

(Thank goodness no major food company has yet undertaken a study to discover if brand preferences can be set before birth — if one can cultivate "Kelloggs babies," for instance, as opposed to "Post babies.") Anyway, if a mother can’t get past pickles and ice-cream while pregnant, there’s still hope of salvaging the baby’s food tastes as long as the mother acts quickly after giving birth. Dr. Menella says that what mothers eat while nursing their babies impacts the child’s food tastes, too. In fact, what a child eats in the first seven months of life, combined with the mother’s food intake in the last few months of pregnancy, sets that child’s food preferences for life. Or to put it another way, regular meals of Hamburger Helper, Diet Pepsi, and Ding Dongs while pregnant are probably not in your baby’s best interest.

And as I was saying, this advice also extends to nursing mothers as babies who nurse will probably have more diverse food preferences than babies fed formula. This is because breast milk contains traces of whatever mom has eaten and the baby imprints those various flavors. Formula, on the other hand, has a fixed blend of flavors, exposing the child to limited tastes. The experts suggest that pregnant and nursing moms should eat plenty of diverse fruits and vegetables if they want their children to grow up making wise choices.

They should also avoid drinking, as most pregnant women and nursing mothers know — but now for another reason. Studies have found that rodents exposed to alcohol in utero prefer alcohol-flavored water after birth. Other studies have found a connection between prenatal alcohol exposure and alcoholism later in life. And as described above, a yearning for junk food can be passed on, so pregnant and nursing moms would do well to avoid sugar and unhealthy fats as assiduously as they avoid beer and margueritas. It’s also something to think about when choosing a formula for your baby if you’re bottle feeding. In many formulas, sugar or corn syrup is either the first or second listed ingredient.

That’s especially true because babies naturally prefer sweet tastes, and given limited exposure to other tastes they can easily evolve into sugar junkies. According to Dr. Leann Birch, chair of Pennsylvania State University Department of Health and Human Development, fetuses increase the rate at which they ingest amniotic fluid when a sweet taste is present. Vegetables tend to taste bitter to babies, and so they naturally prefer fruits, but exposing the children to vegetables from before birth can ameliorate that tendency.

The trick is to be consistent. If mom eats a carrot every other week it isn’t going to turn junior into a vegan after birth. By the same token, an ice-cream cone enjoyed by Mom every other month probably won’t lead to baby’s first words being "Cherry Garcia."  As Dr. Birch says, "[F]or an infant to interpret a food as same and acceptable, there has to be repeated exposure — particularly when you get to fruits and vegetables that aren’t naturally sweet"

The side benefit to eating well during pregnancy and lactation, of course, is that mom also gets healthy. But if mom herself was exposed to too many cookies and cakes and convenience foods before her own birth, she may have a difficult time giving up the foods she craves for the duration of her pregnancy — the foods she’s been imprinted to — even though she knows the potential benefits to her offspring and herself. And so the cycle continues, with each generation getting fatter and unhealthier than the previous.

:hc

To drink, or not to drink: that is the question that the experts keep batting around, and the jury still is out. One week the news announces that red wine keeps the doctor away; the next it announces that drinking alcohol leads to cancer. For those on the love-to-drink side of the fence, a new study gives you something to toast.

The study, led by the Norwegian University of Science and Technology and the University of Bergen, analyzed data collected on 38,000 Norwegians. The researchers looked at drinking habits and mental health of the subjects, considering how much alcohol they had consumed in the two previous weeks and reviewing results of standardized tests that measure anxiety and depression levels. While it was indeed those who drank the most who turned up the most anxious, the surprise was that those who didn’t drink at all had an elevated incidence of anxiety compared to moderate drinkers. Even more surprising, though, was the fact that those who drank the least registered as most depressed. Those who hadn’t had a drink in the past two weeks were more depressed (and more anxious) than the moderate drinkers; those who abstained from alcohol completely were the most depressed of all.

It seems counter-intuitive that abstinence would bring on the blues since alcohol is a depressant, but in fact, the data showed that the happiest people consumed a few glasses of wine a week, or a bottle of beer, or a shot of hard liquor. To repeat, too much alcohol correlated with increasing depression, but again, not as much as complete abstinence. As the abstract for the study, published in the journal Addiction, concludes, "The risk of case-level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk."

But teetotalers need not despair. There is a silver lining in this study for them — sort of.

The reason for the increased depression, say the experts, probably has nothing to do with the effects of alcohol on the system, and everything to do with the context in which drinking occurs. According to study director Dr. Eystein Stordal, non-drinkers tend to be social misfits. "We see that this group is less socially well-adjusted than other groups. Generally when people are with friends, it is more acceptable in Western societies to drink than not to drink. While the questionnaire recorded non-drinkers’ subjective perception of the situation, a number of other studies also confirm that teetotalers experience some level of social exclusion."

For those who don’t cop to the "if you can’t beat them, join them" mentality at cocktail hour, here’s some more unsettling analysis from the pros. Time Magazine says non-drinkers "have fewer close friends than drinkers, even though they tend to participate more often in organized social activities," and "have a harder time making strong friendship bonds." And a UPI article says, "…abstinence may be associated with being socially marginalized, or with particular personality traits that may also be associated with mental illness."

The experts do also note that non-drinkers may have made the choice to abstain not because they’re lunatics, but because they have health issues that prevent them from drinking, and those health issues may have an independent effect on mood. And in fact, according to Dr. Stordal, "We found on average that there were more people with physical complaints among the non-drinkers than in the other groups. These individuals are more likely to use medicines that mean they shouldn’t drink. But it may also be true that having such an illness increases a person’s tendency to be anxious or depressed."

In other words, if you don’t drink because you have cancer, it may be the cancer that makes you depressed and not the lack of merlot. Or, it could be the medications you take to battle the disease are triggering your depression. On the other hand, if you had a drinking problem in the past, as did 14 percent of the subjects now on the wagon, you might still be facing the internal and external issues that led you to drink in the first place, and now you have no substance with which to soothe yourself, which would lead, of course, to depression.

If you do choose to risk being a pariah and refuse to drink, you can take comfort in knowing that a study several years ago found that after seven days of abstinence from alcohol, brain cell proliferation doubled, and after four to five weeks, new neurons formed in the hippocampus. You can interpret those findings several ways. Perhaps they indicate that ignorance really is bliss — the more brain cells you have, the more miserable you get. On the other hand, maybe the analysts need to go on the wagon for a month or two themselves so they might notice that many non-drinkers don’t have a personality flaw, a physical ailment, a mental illness, or a history of substance abuse — they simply want to be conscious, clear, and happily depressed without the use of intoxicants.

:hc

Most dogs love to drive with their heads hanging out the window, the wind whipping the saliva out of their open mouths. Likewise, many humans believe that every dog should have his day and that driving a convertible is one of life’s drool inducing pleasures. But the open-air fun and glamour that convertibles evoke may come at a cost beyond the price-tag, because new research shows that convertible riders have an elevated risk of losing their hearing.

The study, funded by Worcestershire Royal Hospital in the UK, found that the typical noise generated by a moving convertible registers considerably higher than the threshold usually associated with hearing loss. Dr. Philip Michael, the study director, said, "If you are exposed for long periods above 85 decibels [of sound], you have the potential for hearing loss. The maximum noise [of cars tested] was at 70 miles per hour and that was 89 decibels. It has the potential for causing long-term hearing loss.”

The researchers tried out a variety of vehicles just to make sure the noise level stayed loud from one car to the next. In the name of medicine, they drove a Toyota MR2, a Mazda Miata MX5, the Audi A4 Cabriolet, a Morgan plus 4 Roadster, a Porsche 997 Carrera, an Aston Martin V-8 Vantage, and a Bentley convertible — all at 50, 60, and 70 miles per hour.

Dr. Michael found that paying a lot for a car doesn’t mean it becomes exempt from wind resistance. The expensive cars were as noisy as the cheapest once the tops went down. Also, going slower made only a minimal difference in noise level when driving on the highway. Oh, and cranking up your car’s stereo to override the wind noise doesn’t actually help.

But in the world of ear-popping noise, all is relative. While normal conversation registers at about 60 decibels, you could drive with the top down to a Rolling Stones concert and back again and get a whole lot less noise exposure than if you actually went into the concert, where the noise-level would be at about 115 decibels.

And that brings up a simultaneous study of 5,000 people in the US, which found that men have three times the risk of hearing loss related to noise compared to women. While driving a convertible may up the ante for potential deafness, so do many other activities — and apparently, men indulge in more of those activities. For instance, operating heavy equipment or machinery like chain saws or lawnmowers without ear protection can damage hearing. Men are more likely to shoot guns, to drive motorcycles, and to listen to head-banging music — in other words, to have jobs or hobbies that require noise exposure.

It’s something that most people don’t think about in the course of normal life — that turning the stereo up too high can degrade hearing over time, even if it’s Mozart on the sound waves. In fact, a significant percentage of adults do suffer from noise-induced hearing loss, including 13 percent of the subjects in the sample. According to Dr. Douglas Mattox, professor of otolaryngology at Emory University School of Medicine, "Noise-induced hearing loss is the number one preventable kind of hearing loss. We’re all born with 20,000 inner hair cells on each side of the head, and those are a non-renewable resource, and they never come back every time one is lost."

How can you lessen your chances of damaging your hearing while still having fun? First, wear earplugs or noise-canceling headphones when operating noisy machinery, playing the drums, taking off in the airplane, and when driving your convertible (assuming it’s legal to do so in your state). Next, lower your frequency of exposure. As Allison Grimes, head of the audiology department at the UCLA Medical Center says, "…if you drive eight hours a day, seven days a week you have a much greater concern than if you drive two hours on a Sunday afternoon." If you have a convertible, roll up the windows to slash the noise level, and use a wind guard. Also, eat your vegetables and fruits: another simultaneous study found that men over the age of 60 can decrease their risk of hearing loss by a full 20 percent just by consuming plenty of folates, which are found in leafy green vegetables, fruits, and beans.

Oh, I almost forgot to mention: men can also possibly preserve their hearing by remaining single. The data shows that married men suffer far more noise-induced hearing loss than single men, a fact that puzzles the researchers. Some media sources have been having fun with this fact, blaming nagging wives for the phenomenon. A more politically correct analysis might theorize that with a wife’s second income, men can afford to buy more of the toys and tools they crave — the power saws, CDs, and motorbikes. If so, perhaps they can begin diverting some of the excess funds to a folate supplement and a pair of good noise-cancelling headphones.

:hc