Oct. 10, 2011 -- Some of the supplements that older women take to improve their health may actually raise their risk of death.
In a new study, multivitamins, folic acid, iron, copper, magnesium, zinc, and vitamin B6 supplements all increased an older woman’s risk of dying from any cause. The greatest risk was seen with iron supplements. Calcium supplements, however, seemed to reduce a woman’s risk of dying.
The study, which appears in the Archives of Internal Medicine, was an observational trial, not a cause-and-effect trial. So it can’t say how, or even if, these supplements actually increase a woman’s chance of dying.
By all counts, the dietary supplement industry is booming in the U.S. It grosses billions of dollars per year. A growing number of people are taking one or more vitamin, mineral, or herbal supplements in order to maintain or improve their health. Many also turn to these supplements to treat diseases or conditions.
Women who took part in the Iowa Women’s Health Study were aged an average of 61.6 in 1986. They answered questionnaires about their supplement use through their 80s. A total of 15,594 women died by the end of December 2008. More women took supplements as they aged, with 62.7% saying they took at least one supplement in 1986 and 85.1% saying they did so in 2004.
Women who took multivitamins, folic acid, vitamin B6, iron, copper, magnesium, and zinc supplements were more likely to die than women who did not take supplements even though they had healthier habits and lifestyles than women who did not supplement their diet with extra vitamins and minerals. Supplement use was likely not an indicator for failing health or disease onset.
“It is a big story,” says researcher David R. Jacobs Jr., PhD. He is a Mayo Professor of Public Health in the division of epidemiology and community health at the University of Minnesota School of Public Health in Minneapolis.
Jacobs says the findings may also apply to women -- and men -- of all ages.
His theory is that supplements don’t have the same checks and balances as whole foods. Supplements provide a single nutrient in isolation and may be taken in high, potentially toxic doses. Whole foods are balanced with other nutrients.
Too much vitamin B6, for example, on its own may be harmful, but the foods that contain B6, such as avocados, bananas, dried beans, and whole grains, also bring other nutrients to the table that may all work together.
“People may eat well and take supplements for a guarantee, but this wisdom is not wise,” he says.
“Supplements are regarded as safe as they come from food, but they do have drug-like effects,” Jacobs says. “It would be wise to start treating these as if they are drugs and actually test them.” Supplements are not regulated by the FDA in the same manner as drugs in the U.S.
If you can get your nutrients from food, do that, he says. Elderly people who have issues cooking or eating may need supplements, but this should be done under the guidance of their doctor.
Jaakko Mursu, PhD, of the University of Eastern Finland in Kuopio, Finland, and the University of Minnesota, Minneapolis, is also an author on the study. “We would advise people to reconsider whether they need to use supplements and put more emphasis on a healthy diet,” he says in an email.
March 24, 2011 -- “Mini-strokes” or transient ischemic attacks (TIAs) are known to increase risk for stroke, and now new research shows that they may also double your risk for heart attack.
The findings appear in the journal Stroke.
A TIA occurs when blood flow to an area of the brain is temporarily disrupted. TIA symptoms include: ?numbness or weakness in the face, arm or leg; confusion; double vision or loss of vision; dizziness; and trouble walking or talking. The symptoms come on suddenly and typically resolve within one to two hours without causing any permanent neurologic damage.
In the new study, people who experienced a TIA had about a 1% risk of heart attack per year, which is double that of people in the general population. The increased risk persisted for years, and was most pronounced among people younger than 60. The average time between TIA and heart attack was five years, the study shows.
“Patients who have had a TIA but do not have known [coronary artery disease] have approximately twice the risk for subsequent [heart attack], compared to the general population,” conclude study researchers who were led by Robert D. Brown, Jr., MD, MPH, chair of the neurology department at the Mayo Clinic in Rochester, Minn. “These data support the existing concept that careful attention to the primary prevention of [heart disease] is warranted in all patients who have TIA [and] that screening for asymptomatic [heart disease] may be useful in select TIA patients.”
Close to two-thirds of the people who experienced a TIA had high blood pressure; more than 50% were smokers and three-quarters were being treated with medication to reduce their risk for developing blood clots, the study shows. High blood pressure and smoking are major risk factors for heart attack.
People who were taking statins to lower their cholesterol were also at greater risk for heart attack after a TIA, the new report showed.
Stephen Green, MD, associate director of the Cardiac Catheterization Laboratories at North Shore University Hospital in Manhasset, N.Y., says that TIAs should be viewed as red flags for heart attacks and strokes.
“If you have had a TIA, treat it as a warning sign, and make sure that you see your doctor to make sure you are doing everything you can to minimize your chance for having a heart attack,” he says.
“You need to see a neurologist and a primary care doctor or cardiologist who is going to look at your brain and heart to make sure that your diabetes and/or cholesterol is controlled, you are not smoking and doing all the right things,” he says.
Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City, agrees that TIAs need to be taken seriously.
“The term ‘mini stroke’ trivializes these events,” he says. “We need to take a look at blood vessels to the brain and heart because this symptom means you have a strong possibility of having vascular disease and the next symptom could be in your heart.”
Sophia Sundararajan, MD, PhD, a neurologist at University Hospitals Case Medical Center?in Cleveland, says that people often don’t take TIAs seriously because they get better and don’t have any lasting problems.
But that is a mistake, she says. “It is a warning sign for stroke and also a warning sign for heart attack.” If you experience or think you may have experienced a TIA, seek evaluation ASAP, she says.
Feb. 22, 2011 -- Women at risk of fractures who used the heart medicine nitroglycerin boosted their bone density modestly, according to a new study.
''We found nitroglycerin has a unique ability," says researcher Sophie Jamal, MD, PhD, associate professor of medicine at the University of Toronto. "What it does is both increase bone formation and decrease bone breakdown."
No osteoporosis drug does both to her knowledge, Jamal tells WebMD.
Her study, reported in the Journal of the American Medical Association, did not assess fracture risk with nitroglycerin use, only the effects on bone. She plans to look next at whether taking nitroglycerin for bones will reduce fractures.
While several medicines are on the market to treat osteoporosis, the brittle bone disease that can lead to fractures, Jamal says many are expensive and not all drugs are available worldwide. In the U.S., up to one of every two women and one of four men over age 50 is expected to have an osteoporosis-related fracture at some point, according to the National Institutes of Health.
When used for heart conditions, nitroglycerin causes constricted blood vessels to dilate, relieving the severe chest pains known as angina.
Previous research by others has found that women taking nitroglycerin for heart problems had a lower risk of fractures, and other studies found its use is associated with a reduced fracture risk.
Jamal and colleagues assigned 243 women, average age about 62, to either a nitroglycerin ointment group or a placebo ointment group. The women applied either the nitroglycerin (15 milligrams) or placebo to their upper arm at bedtime, squeezing out about an inch of the medicine.
The researchers, who conducted the study from November 2005 to March 2010, did not accept women who already had osteoporosis or any medical condition that affected bone metabolism.
Bone density was evaluated at the study start and again at the 12-month and 24-month mark.
At the end, they found the women in the nitroglycerin group, compared to those in the placebo group, had a:
The group taking the nitroglycerin also had an increase in a marker of bone formation and a decrease in a marker for bone loss.
Headache was the most common side effect reported by those in the nitroglycerin group, with 35% of participants complaining of it compared to 5.4% in the placebo group in the first month. Over time, the headaches in the treated women declined.
The study was funded by the Canadian Institute of Health Research and the Physicians' Services Incorporated.
Jamal has received support for board membership from Novartis, Amgen, and Warner-Chilcott and has been a consultant for Genzyme, Warner-Chilcott, Novartis, and Shire.
Jan. 25, 2011 -- Baby, it’s cold outside, but keeping warm by cranking up the heat may play a role -- albeit not a very big one -- in the current obesity epidemic, a new study suggests.
"Changes in the way we eat and physical activity levels are the primary factors behind increases in obesity, [but] other aspects of our lifestyle can also make a contribution," says study researcher Fiona Johnson, a research psychologist in the department of epidemiology and public Health at University College London.
Johnson and colleagues reviewed the literature to determine how our desire to stay warm may be affecting our body weight.
The study is published in Obesity Reviews.
Our bodies must work to stay warm when it’s cold, which means we expend more energy or calories. "Our love of warmth may be reducing our expenditure and contributing to the obesity 'epidemic,'" she tells WebMD in an email. "The less time spent in the cold means less time when the body is burning energy to stay warm."
But there is more to it. "It is also likely that a lack of exposure to cold reduces our capacity to generate heat, by diminishing brown fat stores," she says.
Until somewhat recently, researchers thought that only babies had substantial brown fat to help keep warm, and that brown fat went away over time. New research is showing that adults have brown fat, too. Brown fat generates body heat and becomes activated when you're cold. ?
"While white fat acts as an energy storage tissue, brown fat could be viewed as the body's furnace -- burning energy to create heat," she says. “Regular exposure to cold appears to slow down the rate of loss and will and stimulate the development of new brown fat cells."
Going forward, Johnson says, “We would like to see studies that directly measure the effects of cold exposure on brown fat stores, energy balance and body weight by studying the changes that go on in the body when the thermal environment changes."
As far as what someone can do today, Johnson says: “I think it is too early to say exactly what changes to your lifestyle will contribute to increasing energy expenditure, but for now turning down the thermostat at home is unlikely to cause any harm and also contributes to lowering the household energy consumption.”
In the future, she says, “Some form of cold exposure could become an obesity treatment in itself, or that other ways to stimulate the development of brown fat in the body might be established which will boost the capacity for energy expenditure.”
?“When you look at what could be causing the obesity epidemic, there are many possible causes besides eating too much and not exercising enough, and this is clearly one of them,” says Louis Aronne, MD, founder and director of the Comprehensive Weight Control Program at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.
Jan 10, 2011 -- Children born within one year of an older sibling may be three times more likely to be diagnosed with autism, according to a new study in the February issue of Pediatrics.
The study calls attention to interpregnancy interval (IPI), the duration between pregnancies, as a potential risk factor for autism. In the past, much focus has been on environmental triggers of autism such as vaccines as opposed to maternal physiological triggers such as the womb environment.
If the new findings are confirmed and proven to be related to maternal depletion of key nutrients such as folate, it may be possible to prevent autism with nutritional supplements, the study authors and autism experts suggest.
The latest statistics from the CDC show that one in 110 children in the U.S. has an autism spectrum disorder. This is the umbrella term for a group of developmental disorders that can range from mild to severe and that often affect social interaction and communication skills. According to information in the new study, the proportion of births occurring within two years of an earlier birth increased from 11% to 18% between 1995 and 2002.
Researchers analyzed autism risk among more than 660,000 second-born children born in California from 1992 to 2002. Those children who were conceived within one year of an older sibling were more than three times as likely to be diagnosed with autism when compared to peers who were conceived more than three years after the birth of an older sibling.
Children conceived 12 to 23 months after an older sibling were nearly two times more likely to be diagnosed with autism; children conceived two years to 35 months following an older sibling were one and a quarter times more likely to be diagnosed with autism, the study showed.
The findings held even after researchers took into account other factors that may be related to closely timed pregnancies, such as maternal age and maternal education.
“The robustness of the findings was really shocking,” says study author Peter Bearman, PhD, the Jonathan Cole Professor of the Social Sciences at Columbia University in New York City.
Still many questions remain, including exactly how closely spaced pregnancies may affect autism risk, Bearman says.
?“It could be a biological factor, such as maternal depletion of nutrients like folate, or another process that hasn’t been described or discovered yet,” Bearman says. “If the mechanism is depletion of nutrients like folate, then women can make sure to take supplements of it, and if it is something else, it also may be readily modifiable.”
It also could just be that parents with closely spaced kids are more attuned to normal child development, he says. “Parents who have had closely spaced children are more aware of developmental dynamics and more likely to seek help if the child is not developing on the right trajectory,” he says.?
“Watch the science,” he says. “This is the first study, but there is a lot more work to be done.”?????????
Dec. 14, 2010 -- Using inhaled corticosteroids to treat chronic breathing problems may slightly increase a person’s risk of developing type 2 diabetes, a new study finds.
The study’s authors say the increase in risk probably doesn’t outweigh the benefits to people taking daily puffs of inhaled corticosteroids to control asthma.
But researchers are worried about the threat of diabetes when these medications are used to ease breathing in patients with chronic obstructive pulmonary disease, or COPD, a condition for which the benefits of inhaled corticosteroids are less clear.
“For asthma, I’m not as concerned because they are so effective. They keep people out of the emergency room. They save lives,” says lead author Samy Suissa, PhD, director for the center of clinical epidemiology at Jewish General Hospital in Montreal.
“In studies, inhaled corticosteroids don’t work for many people with COPD. If there’s no problem with safety, then that is maybe not such a big deal,” Suissa says, “if there’s a problem with safety, then the equation changes.”
Suissa points out that 70% of people with COPD are prescribed inhaled corticosteroids when clinical guidelines suggest that only 15% to 20% really get any benefit from them.
For the study, which is published in the November issue of The American Journal of Medicine, Suissa and his colleagues analyzed the drug records of more than 388,000 patients who were prescribed inhaled corticosteroids in Montreal from 1990 to 2005.
They found that the risk of needing medication to control high blood sugar increased about 34% in patients taking any dose of daily inhaled corticosteroids. In those on the highest doses, the risk increased by 64%. The study also found that inhaled corticosteroids were associated with an increased risk of needing stronger medications to control blood sugar, an indication that diabetes could be worsening in those who already have it.
While a 34% increase in risk may sound alarming, experts point out that the absolute numbers are still very small. For example, the number of people who were diagnosed with diabetes each year rose from 14 out of 1,000 to 20 out of 1,000 in people taking inhaled corticosteroids.
“This is a modest increase, but it’s not something to sneeze at because type 2 diabetes is such an expensive problem,” says Elizabeth Kern, MD, director of the diabetes program at National Jewish Health in Denver, a hospital that specializes in the treatment of lung disease.
Kern says the findings of this investigation were much anticipated and somewhat controversial among doctors who treat respiratory problems since previous, smaller studies had failed to find an increased risk of diabetes in patients treated with inhaled corticosteroids.
Nov. ?30, 2010 -- New guidelines for vitamin D ?call for increasing the recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone aged 1-70, and raising it to 800 IU for adults older than 70 to optimize bone health.
The guidelines, released by the Institute of Medicine (IOM), also raised daily calcium RDAs.
The new guidelines call for a recommended dietary allowance of 700 milligrams of calcium per day for children aged 1 through 3, 1,000 milligrams daily for almost all children aged 4 through 8, 1,300 milligrams of calcium per day for adolescents aged 9 through 18, and 1,000 milligrams for all adults aged 19 through 50 ?and men until age 71. Women starting at age 51 and men and women aged 71 and older need 1,200 milligrams of calcium per day.
The majority of Americans and Canadians are getting sufficient vitamin D and calcium, the new guidelines state. Some adolescent girls aged 9-18 may fall below the daily recommended level of calcium intake, and some elderly people may have an inadequate intake of calcium and vitamin D.
The older vitamin D guidelines call for a recommended dietary allowance of 200 IU a day for people up to age 50, 400 IU a day for those ages 51 to 70, and 600 IU a day for those older than age 70.
Vitamin D helps the intestines better absorb calcium and plays an important role in bone health. It is often called the "sunshine vitamin" because our bodies make it when exposed to sunlight. It is often added to milk.
Growing numbers of studies link vitamin D deficiency to diseases such as heart disease, certain cancers, and diabetes. The studies show associations that indicate further investigation is needed and do not necessarily prove that vitamin D deficiency has a causative role.? Many scientists were hoping that the new dietary intake levels would go even higher to reflect the findings of these studies.
But “we don’t think more is better,” says committee member Clifford J. Rosen, MD, a senior scientist at the Maine Medical Center Research Institute in Scarborough. “We believe that taking in amounts larger than 600 to 800 IU a day has no extra benefit for bones.”
The new vitamin D recommendations also increased the daily upper level intakes of vitamin D. These levels represent the upper safe boundary.
The upper level intakes for vitamin D are:
Q: I am pregnant and I can’t imagine giving up coffee, but my mother says I risk miscarriage. Is that really true?
A: The answer is FALSE -- with some caveats.
For years, obstetricians thought that even moderate caffeine consumption increased the risk of miscarriage. In fact, one study released in early 2008 found that drinking two cups of coffee a day or five cans of caffeinated soda (both of which contain about 200 milligrams of caffeine) could double a pregnant woman’s risk of miscarriage.
But a review of existing studies on the topic, released by the American College of Obstetricians and Gynecologists in August 2010, found that one cup of caffeinated coffee or one caffeinated soft drink a day won’t raise the risk of miscarriage or preterm birth.
"This is welcome news," says Gene Burkett, MD, professor of obstetrics and gynecology at University of Miami's Miller School of Medicine. "Frankly, there is no credible data that says drinking a cup of coffee a day increases the risk of miscarriage. That effect is only seen after more than two cups per day."
How big can that cup be? Think of it this way: An 8-ounce cup of brewed, drip coffee has about 137 milligrams of caffeine (instant coffee and a single shot of espresso both have about half of that). So a 12-ounce cup has 200 mg of caffeine, which should be your upper limit.
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