Health Tip: Heart Palpitations

(HealthDay News) -- Heart palpitations feel like the heart is pounding or racing. The sensation may also feel like a skipped or abnormal beat, often felt in the chest, neck or throat.
Heart palpitations may or may not indicate a serious condition, says the U.S. National Library of Medicine. Here are a few common causes of heart palpitations:

• Exercise.


• Emotions such as fear, stress or anxiety.


• Fever.


• Substances including caffeine, nicotine, cocaine or diet pills.


• Conditions such as overactive thyroid, low oxygen levels in the blood, hyperventilation, heart disease or mitral valve prolapse.


• Medications to treat thyroid conditions, asthma, blood pressure or irregular heartbeat.

The NLM says you should seek emergency medical help if you also feel faint, dizzy or lightheaded with chest pain or shortness of breath.

Hangover Helpers

(HealthDay News) -- Don't look to Khursheed Navder for sympathy if you drink too much on New Year's Eve and wake up with a wicked hangover.

Navder, a registered dietitian and associate professor in the nutrition and food science program at Hunter College in New York City, is willing to offer you some advice on how to deal with the party-fueled problem, however.

But first, it may help to understand the science behind that throbbing, queasy, mouth-full-of-cotton malaise. According to Dr. Christine Lay, a neurologist at The Headache Institute at St. Luke's-Roosevelt Hospital Center in New York City and co-author of an upcoming article on hangovers in the journal Headache, the culprits are:

• Dilation of blood vessels. This may contribute to the throbbing headache.
• Low blood sugar. Alcohol can interfere with the liver's ability to produce glucose, which leaves you feeling weak and tired, clouds your thinking and makes you moody.
• Poor sleep. While alcohol is sedating and promotes sleep initially, the sleep is often of poor quality with frequent awakenings due to factors such as decreased rapid eye movement (REM) sleep.
• The accumulation of toxins. The main byproduct of metabolized alcohol, acetaldehyde, is a toxin that can make your heart race and lead to headache, sweatiness, flushed skin, nausea and vomiting.
• Dehydration and electrolyte imbalance. Alcohol promotes urination by inhibiting the release of the brain hormone that normally protects against dehydration. When dehydration is accompanied by sweating, vomiting or diarrhea, there is additional fluid and mineral loss leading to electrolyte imbalances The result? Excessive thirst, lethargy, dizziness and light-headedness.

So, if you do consume too much alcohol, drinking plenty of water is essential because dehydration is perhaps the most common cause of hangover symptoms.

"Those pounding headaches and everything else are related to the shriveling of the cells because they lose so much water," Navder said. "Before sleeping, force yourself to drink water. If you throw up, very good, because you're going to get some of the alcohol out that way."

If you forget to drink water before going to bed, then do it first thing in the morning. The sooner you replenish your fluid loss, the quicker you'll bounce back, Navder said.

If you don't feel like drinking water, then sports drinks are a good option because they replace essential salts and minerals that were flushed out of your body during frequent urination. Non-acidic fruit juices are another good choice because the sugar in them helps prevent hypoglycemia and feeling weak and lightheaded.

Also, avoid coffee and other caffeinated beverages. Caffeine does not speed up the body's metabolism of alcohol. All it does is irritate the stomach lining and prevent you from falling asleep, which is one of the best ways to escape a hangover, she said.

Navder's next bit of advice involves a bit of tough-love: exercise. While being active is the last thing you may want to do when you have a pounding head, it increases blood flow to the brain and the rest of the body and induces sweating, which helps the body purge alcohol, she said.
Other tips, courtesy of Navder and the U.S. National Institutes of Health:

• Try to eat because food will reduce the irritation to your stomach lining. Soups are good for replacing salt and potassium depleted by alcohol, and fruits and vegetables can help replenish lost nutrients.
• You can take pain relief medications such as ibuprofen and naproxen sodium to reduce your headache and muscle aches as long as your stomach isn't upset and you have no history of ulcers or bleeding problems. Antacids can help ease nausea and gastritis.
• Drink a glass of water in between drinks containing alcohol. This will help you drink less alcohol, and will also decrease the dehydration associated with drinking alcohol.

Navder also has some hangover-prevention advice. Drinking lighter-colored alcohol and higher brands of alcohol may reduce the severity of a hangover. That's because lighter-colored drinks, such as vodka, gin and white wine, have fewer congeners -- a toxic byproduct of fermentation and aging -- than darker-colored drinks such as whisky, brandy and red wine.

And more expensive alcohol generally contains fewer congeners because it goes through a more rigorous distillation process that filters out more congeners.

She also suggests that you eat while you drink, because food in your stomach slows the absorption of alcohol. But don't munch on salty snacks because they'll just make you thirsty and likely to drink more.

Or, Navder said, you could just avoid booze altogether. "With a hangover, I think prevention is definitely better than the cure," she said.

More information
The U.S. National Library of Medicine has more about hangover prevention and treatment.

Resolve to Keep Those New Year's Resolutions

(HealthDay News) -- Keeping a New Year's resolution may depend on following three simple steps, says Dr. Bernard Davidson, a family psychologist at the Medical College of Georgia Health System.

Here are the steps:

• Be committed. You must think through what you want to change and commit yourself to the long-term process it usually takes to achieve change. You then need to come up with a realistic plan to help you reach your goals, Davidson said in a statement. For example, if you want to shed some pounds, create a weight-loss schedule and an achievable diet and exercise plan. If your family and friends are supportive, tell them about your goals. They can provide encouragement and reinforce your commitment to change. If necessary, seek professional help to assist you.
• Be prepared for setbacks. Don't think of them as complete failures, don't dwell on them, and don't let them make you give up your goals. After a setback, try to get back on track to reach your objective. Plan ahead on how you'll deal with setbacks. For example, if you do have a cigarette when you're trying to quit, your plan may include calling a supportive friend to talk about it. Or you may want to review all the reasons you listed for wanting to stop smoking and why reaching that goal will make you happy.
• Track your progress. Motivate yourself by celebrating your successes and by getting positive feedback from supportive family and friends. A good approach is to evaluate yourself every week or two weeks. However, don't over-monitor yourself by doing a self-assessment every day. That's just likely to end in frustration. Don't compare yourself to others. Accomplish your goal in a way that's best suited to you.

More information
The American Psychiatric Association has more about New Year's resolutions.

What you should know about FATS?

By Grace Wei Ern Quek, RDExcellence Healthcare Pte Ltd

For many who are managing their weight, fats seems like a taboo word. Yes, we always hear "Too much fat can kill". But what do you know? Certain fats are actually good for our body!

Besides cushioning our vital organs, giving us extra padding for shock and impact from falls/injuries, and keeping us warm during the cold weather, some fats known as essential fatty acids are vital for brain development, skin integrity and also for reduction of heart disease and stroke risks.

Types and sources

There are mainly two distinct types of fat: Saturated fats and Unsaturated fats.

Saturated fats mainly come from animal and animal products, such as meat, milk, eggs etc. There are however, a few exceptions. Saturated fats can also be found in coconut milk and palm oil. Besides cholesterol, saturated fat is notoriously known for the fat that clogs up arteries.

Additionally, it has also been shown that excessive consumption of saturated fats can also increase risk of certain cancers, especially colon, rectum, endometrial, breast and prostate cancers. Many nutrition experts and authorities recommend keeping saturated fat consumption to less than 10% of daily calories.

Unsaturated fats mainly come from fish and plant sources. Unsaturated fats are divided into: polyunsaturated fats (PUFAs) and monounsaturated fats (MUFAs). PUFAs are further categorized into Omega-3 and Omega-6 fatty acids. Omega-3 and Omega-6 fatty acids are known as "Essential fatty acids" (EFAs) as they are critical for good health and the body does not have the ability to manufacture such fats on its own.

Omega-6 fatty acids can be converted into arachidonic acids (ARA), one type of fat used to build the brain. Other benefits from consuming Omega-6 fatty acids include: lowering of blood pressure, reduction of inflammation and joint pains, regulation of nerve functions and skin support. Omega-6 fatty acids sources include seeds and oils, such as pumpkin, sunflower, safflower, sesame, corn, walnut and soybean.

Omega-3 fatty acids can manufacture other important fats for the brain as well, EPA (Eicosapentanoic acid) and DHA (Docohexanoic acid). Studies have shown that increased consumption of EPA and DHA sources can boost a few more IQ points! Omega-3 fatty acids have also been found to have a cholesterol-lowering effect, particularly on LDL (low-density lipoprotein) cholesterol, also known as "bad cholesterol". Unfortunately, it lowers the HDL (high-density lipoprotein) or "good cholesterol" as well.

Omega-3 fatty acids are also needed for the formation of new tissues, and hence play an important role in growth and development. Such fats also improve immune function, decrease inflammation and help maintain water balance. Sources of Omega-3 fatty acids include fish (e.g. salmon, tuna, mackerel, herring, and cod), walnuts, flaxseeds and pumpkin seeds.

Monounsaturated fats (MUFAs) are known to lower LDL cholesterol, without affecting HDL cholesterol. Some studies even indicate that increased consumption of MUFAs can help improve HDL cholesterol. In fact, researchers have found that the Mediterranean diet, a diet rich in monounsaturated fats, gives lower incidences of coronary heart disease. It is also believed that MUFAs can offer protection against certain cancers, such as breast and colon cancers. MUFAs are also abundant in Vitamin E, an antioxidant that protects against free radical damage. Free radicals are often associated with aging, development of cancers and heart disease. Rich sources of MUFAs include: avocado, olive oil, canola oil, hazelnuts, brazil nuts, almonds, walnuts, cashews, sesame seeds and pumpkin seeds.

Trans-fat

What is trans-fat? Trans-fat actually originates from healthier oils like vegetable oils (e.g. olive or canola) and fish oils, but through a process called hydrogenation where hydrogen bonds are added, the fat's configuration is altered to a "trans" state. Trans-fat is generally added to foods to extend shelf life and enhance flavor.

Besides saturated fat and cholesterol, there is scientific evidence to show that trans-fat also raises LDL cholesterol, thus increasing the risk of coronary heart disease. Essentially, it is best to avoid food products that are labeled with ingredients containing "partially hydrogenated or hydrogenated vegetable oils". Where can trans-fat be found? Virtually almost all processed foods, such as margarine, shortening, french fries, snack foods such as potato chips, and cookies contain high amounts of trans-fat.

Food preparation

Frying should be avoided as much as possible as it damages healthier oils like PUFAs and MUFAs. The high heat oxidizes the oil and generates free radicals that are harmful to the body. But if you do fry, which types of cooking oils on the market are then best suited for the job? Polyunsaturated fat sources, e.g. corn, sunflower, safflower and soybean oils, are not recommended for frying as they are chemically unstable, especially when exposed to heat.

Never fry at high heats with corn oil for it has a high tendency to produce foam and smoke.
But the use of tropical oils is the preferred choice when frying, e.g. palm oil, which is a major component in common vegetable oils. Even though palm oil is high in saturated fat, it has a good oxidative stability during frying, owing to its fat composition and vitamin E content. In terms of daily sautéing or stir-frying, canola and olive oils top the list.

Thus, it is recommended to have at least two different oils at home for different cooking methods. However, the answer does not lie in choosing the best oil among cooking oils that offer health benefits, but in using them sparingly. All cooking oils are still 100% fat and pack approximately 126 calories per tablespoon.

Natural fats or supplements?

Having listed the many benefits of certain fats such as Omega-3 fatty acids, some consumers may choose to obtain such fats in the form of supplements. However, studies indicate that extracted and artificially isolated nutrients may not exert the same benefits as wholesome foods. In fact, most nutrients work in synergy with other nutrients. By consuming a single nutrient, you may be missing out on other beneficial nutrients that are included in wholesome foods as well. Whole foods also offer lower risk of toxicity than supplements.

References:
"The intake of fried virgin olive or sunflower oils differentially induces oxidative stress in rat liver microsomes". British Journal of Nutrition. February 2002.
Holford, P. "New Optimum Nutrition Bible". Piatkus Books Ltd. 2004.
Mackay, S. "Techniques and Types of Fat used in Deep-Fat Frying - A policy statement and background paper prepared by the Heart Foundation of New Zealand". July 2000. http://www.nhf.org.nz/files/Food_Industry/deep_fat_frying_exec_summary.pdf

FDA Panel Hits Antibiotic For Bronchitis, Sinusitis

(HealthDay News) -- A U.S. Food and Drug Administration advisory committee recommended late Friday that a "black-box" warning be added to the controversial antibiotic Ketek for its use in fighting pneumonia.

It's also possible that the drug will lose its approval for two lesser indications, sinusitis and bronchitis.

The FDA panel voted 17-to-2 that Ketek's benefits for patients with those milder conditions do not outweigh risks associated with the drug, which include liver damage and other events.

"For community-acquired pneumonia, we got a general sense from the committee that the majority of members felt there should be a black-box warning added to the labeling to address some of the risks associated with the drug," said Dr. John Jenkins, director of the office of new drugs at the FDA's Center for Drug Evaluation and Research. "We also got the sense -- and the company is in agreement -- that there should be a medication guide required to be handed out with each prescription."

Jenkins spoke at a news conference Friday night, capping two days of meetings during which an outside panel of experts heard testimony about Ketek's safety and efficacy.

At the end of the second day, the committees voted 16-to-3 that the benefits of Ketek (telithromycin) outweighed the risks for community-acquired pneumonia, a potentially life-threatening condition.

Asked whether the FDA would rescind the drug's indications for bronchitis and sinusitis, Jenkins responded, "We will be assessing the advice we heard from the committee and will be discussing that internally. We can't announce what the regulatory action will be, but we will take the committee's advice very seriously."

Finally, committee members voted 13-to-5 in favor of a black-box warning for the pneumonia indication (one committee member had left by the time that vote was taken).

"This is a decision that places safety first," said Dr. Klaus-Dieter Lessnau, a board-certified lung and critical-care medicine specialist at Lenox Hill Hospital in New York City. "Similar things have been said about other medications including Tylenol, which is over-the-counter. This doesn't mean Ketek shouldn't be used. It's a balance of risks and benefits. The main thing is that patients who get yellow eyes or pain in the belly should see a doctor."

Ketek is used to treat certain types of bronchitis, sinusitis and pneumonia. But since its approval in 2004, hundreds of cases of liver damage, loss of consciousness and other side effects have been reported. According to the Wall Street Journal, U.S. doctors wrote more than 3.35 million prescriptions for the antibiotic in 2005, bringing in $193 million in revenues.

The drug and the related approval process have been haunted by criticism, however.
In June, the drug's maker, Sanofi-Aventis, agreed to update Ketek's labeling to reflect the possibility of severe liver damage.

Last month, a European Medicines Agency panel recommended that Ketek not be given to patients with a history of such liver conditions as hepatitis or jaundice.

And during the first day of hearings Thursday, the FDA was forced to defend its use of post-marketing data from Europe to approve the drug.

The U.S. Senate Finance Committee is also investigating allegations of fraud involving clinical trials of Ketek and is looking into how the FDA handled Ketek-related safety issues, Bloomberg News reported.

Sen. Charles Grassley, an Iowa Republican, accused the FDA of withholding relevant information at the time of the drug's approval and has asked FDA Commissioner Dr. Andrew von Eschenback to respond by Jan. 17 to allegations that the agency had knowingly used fraudulent safety data to approve Ketek.

Committee members themselves spoke of an arduous session that involved 13 pounds of reading material mailed to them before the briefing even began.

"It was a particularly challenging meeting for the two committees within the context of continued critical concerns for diminished interest in the development of anti-infective agents pharmaceutical agents in general and an increased concern for safety considerations for drugs in general," said Dr. John Edwards, acting chair of the Anti-Infective Drugs Advisory Committee.

"Antibiotics and all drugs have a certain amount of risk associated with them, and those of us who use drugs and prescribe drugs have a great concern for the possibility that the risks may occur in any given individual patient," Edwards added. "So, yes, we are cautious about the use of the drugs both specifically and in general. And much of the discussion today was around caution in using anti-infectives."

More information
For more on the briefings, visit the FDA.

FDA OKs Celebrex for Kids With Arthritis

(HealthDay News) -- The U.S. Food and Drug Administration Friday gave the green light to Celebrex for use in kids older than two as a treatment for juvenile rheumatoid arthritis.
The agency's action followed an advisory panel recommendation just over two weeks ago, which found that the benefits of the painkiller for children outweighed the shortage of proof on its safety

The panel, a committee of doctors and other specialists, voted 15-1 to approve the expanded use. But it also voted 8-7, with one abstention, that available data doesn't demonstrate that Celebrex is safe in treating JRA and that a registry should be established to track these young patients for 10 to 20 years.

As part of the approval process, the FDA said Friday, the drug's manufacturer, Pfizer, has agreed to conduct two Phase 4 post-marketing studies: a short-term controlled trial to evaluate high blood pressure, and a several-year registry study to further evaluate long-term safety issues, including renal toxicity, high blood pressure, and cardiovascular events.

"JRA is often a devastating disease," Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a prepared statement. "While there are other medicines approved for the treatment of this disorder, for some children they may have limited effectiveness or cause intolerable side effects. Celebrex will be a needed additional treatment option for children."

His sentiment had been echoed by other experts after the advisory panel sent in its recommendation on Nov. 29.

The painkiller will quietly become one more option in the array already available, doctors said at the time.

"There will not be a mad rush to switch kids over to Celebrex," said Dr. Stephen Lindsey, section head of rheumatology at Ochsner Health System in Baton Rouge, La.

"I don't think there's going to be a huge move to this drug," added Dr. Norman Ilowite, chief of the division of rheumatology at Montefiore Children's Hospital in New York City. "Doctors will try this on patients with gastrointestinal problems who are on conventional NSAIDs (nonsteroidal anti-inflammatory drugs)."

"We're not sure exactly what the role of this drug is going to be in the treatment of juvenile rheumatoid arthritis," Ilowite continued. "The biggest issue is that there will be more choices. There's not really good evidence that Celebrex spares side effects or is particularly effective more than other choices, but for individualized patients it might be."

It's estimated that as many as 60,000 children in the United States have JRA, which causes painful joint swelling and can affect growth and development.

Up until now, Celebrex (celecoxib) was approved to treat adults with osteoarthritis and rheumatoid arthritis. In its application to expand that approval to include treatment of JRA, Pfizer included a six-month study that concluded that Celebrex works as well as naproxen in treating young patients.

Celebrex is a member of the controversial group of painkillers called cox-2 inhibitors, which have been linked to an increased risk of heart attack and stroke.

Two other cox-2s, Vioxx and Bextra, have been withdrawn from the market because of heart risk concerns. Celebrex remains available to consumers, but in 2005, the FDA required that the drug carry a "black box" warning on the possible risk of heart attack or stroke.

More information
For more on with juvenile rheumatoid arthritis, visit the U.S. National Library of Medicine.

Helping Grieving Children Through the Holidays

(HealthDay News) -- The holiday season can be especially difficult for children who've experienced the death of a loved one or suffered some other traumatic event during the past year.

To help deal with these kinds of situations, New York University's Child Study Center offers a free guide with practical solutions for parents and mental health and school professionals who work with children.

The publication, Caring for Kids After Death, Trauma and Disaster: A Guide for Parents and Professionals, outlines what to expect from children experiencing grief or trauma. It provides practical advice on how to talk to children about their feelings, how to help children cope, and how to build a child's resilience to adversity.

"Holidays highlight that a loved one is missed," said Dr. Michelle Pearlman, director of clinical services at the center's Institute for Trauma and Stress.

"After the loss, children usually feel different about these special days and may experience new emotions like anger and sadness. Establishing new traditions, anticipating children's reactions and initiating discussions are all significant ways to help children cope with the loss," Pearlman added in a prepared statement.

More information
The guide is available for download at the Child Study Center's Web site.

Make the Holiday Buffet Your Friend This Season

(HealthDay News) -- Dieting got you playing Scrooge with all those holiday treats?

One expert nutritionist says you don't have to deprive yourself of favorite yuletide goodies -- just enjoy them in moderation.

Connie Diekman, director of university nutrition at Washington University in St. Louis, offered up some tricks to avoid overindulging.

"The first rule of thumb for eating at holiday gatherings is never go to the party hungry," said Diekman in a prepared statement. "Have a little something healthy before you go -- a piece of fruit, half a sandwich or a glass of milk. Be sure when you arrive that you aren't overly hungry."
When you get to the party, survey the buffet table and think about how you're going to approach it.

"Plan on getting your food off the buffet table and then moving away from the table to eat. Use a plate, and don't stand at the table and pick at the food. Seeing what is on the plate begins the process of realizing how much food is enough for you," Diekman said.

Two-thirds of your plate should be filed with fruits, vegetables and whole-grains. The remaining third can be meats, sauces, and high-fat, high-calorie foods.

If you find it hard to resist everything on the table, try to limit yourself to just small portions of each item.

"It's perfectly fine to do that, as long as you don't gorge yourself. Try some of everything if you have to, but do it in moderation," Diekman said.

"In truth, the [holiday] period is not all that long when taken in the context of an entire year. What people shouldn't do is worry too much and start limiting lots of foods, especially if it's a once-a-year food. If you cut out those things entirely, you'll just end up eating more. Don't cut out those foods, just shift to smaller portions," she said.

It's also important to limit alcohol intake and get exercise, she added.

"Exercise is a great way to combat holiday stress, and it gives you some balance if the eating is a little out of hand. After you've eaten a big meal, let your food digest, and then get out and move around. Take a walk. Try not to sit on the couch all day long," Diekman said.

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about portions.

Frequent Weight Change Raises Men's Gallstone Risk

(HealthDay News) -- "Weight cycling" -- intentionally losing weight then gaining it all back -- may increase men's risk for gallstones, a University of Kentucky Medical Center study finds.

Researchers analyzed data from nearly 25,000 men who took part in the Health Professionals Follow-up Study. The men provided information about any weight fluctuations occurring between 1988 and 1992, and whether they developed gallstones between 1992 and 2002.

The men were grouped as: weight maintainers (those who remained within five pounds of their initial weight between 1988 and 1992); light weight cyclers (a maximum weight loss of between five and nine pounds); moderate cyclers (weight loss between 10 and 19 pounds); and severe cyclers (weight loss of 20 pounds or more).

Overall, there were over 1,200 cases of symptomatic gallstones between 1992 and 2002.
Compared to weight maintainers, light cyclers had a 21 percent increased risk of gallstones, moderate cyclers had a 38 percent increased risk, and severe cyclers had a 76 percent increased risk.

The study was published in the Nov. 27 issue of the journal Archives of Internal Medicine.
There are a number of likely factors contributing to the association between weight cycling and gallstones, the study authors said. They noted that when a person loses and then regains weight, much of the regained weight is made up of body fat.

"Studies have shown that large swings of body weight, especially the phase of weight recovery, are particularly sensitive to the accumulation of body fat and to the development of metabolic abnormalities, including insulin resistance, and thereby may facilitate gallstone formation," the researchers wrote.

More information
The American Academy of Family Physicians has more about gallstones.

Workouts Help Ward Off Cancer's Return

(HealthDay News) -- For cancer survivors, exercising and maintaining a healthy weight are important factors in preventing malignancy's return, at least for some forms of the disease.

That's the conclusion of an American Cancer Society report that updates nutrition and physical activity recommendations for cancer survivors during and after treatment.

Among the points contained in the report:

For some kinds of cancer, just 1 to 3 hours a week of exercise can lower the risk of cancer recurrence and death, as well as death from all causes. Exercise has also been shown to improve fitness, fatigue, and several other quality of life aspects in cancer survivors.
While a vegetarian diet can help health in some ways, there's no direct evidence that this kind of diet can prevent cancer recurrence. Survivors who eat a vegetarian diet should ensure that they're getting an adequate intake of nutrients.
A standard multivitamin and mineral supplement in amounts equivalent to 100 percent of the Daily Value can help cancer survivors meet their nutrient needs when it's difficult for them to eat a healthy diet. However, some supplements -- such as those with high levels of folic acid or antioxidants -- may be harmful during cancer treatment.
Food safety is especially important for cancer survivors, particularly during treatment that involves immunosuppression.
Alcohol can affect the risk for new primary cancers in certain areas of the body.
The report is published in the November/December issue of CA: A Cancer Journal for Clinicians.

Currently, nearly two out of three cancer patients in the United States live more than five years after their diagnosis. There are more than 10 million Americans who have been diagnosed with cancer at some point in their lives.

More information

The U.S. National Cancer Institute has more about life after cancer treatment.

Underweight Women More Likely to Miscarry

(HealthDay News) -- Women who are underweight before they become pregnant are 72 percent more likely to suffer a miscarriage in the first three months of pregnancy, according to a study from the London School of Hygiene & Tropical Medicine.

The study of more than 6,600 women, aged 18-55, also found that underweight women can significantly reduce their risk of miscarriage in the first trimester by about 50 percent by taking supplements with folate or iron and by eating fresh fruits and vegetables every day.

Chocolate was also associated with reduced risk of miscarriage in this group of women.

The study is published in the current online edition of BJOG: An International Journal of Obstetrics and Gynecology.

Among the study's other findings:

• Women who weren't married or living with a partner had an increased risk of miscarriage.
• Women who had changed partners (for example, after having been pregnant before by a previous partner) had a 60 percent increased risk.
• Previous pregnancy termination increased the risk of subsequent miscarriage by 60 percent.
• Fertility problems were associated with a 41 percent increased risk.
• All types of assisted reproduction were associated with increased risk, particularly intrauterine insemination or artificial insemination.
• Women who said their pregnancies were "planned" had a 40 percent reduced risk of miscarriage.
• Women who had nausea and sickness in the first 12 weeks of pregnancy had about a 70 percent reduced risk.

"Our study confirms the findings of previous studies which suggest that following a healthy diet, reducing stress and looking after your emotional well-being may all play a role in helping women in early pregnancy, or planning a pregnancy, to reduce their risk of miscarriage," study author Noreen Maconochie, a senior lecturer in epidemiology and medical statistics, said in a prepared statement.

"The findings related to low pre-pregnancy weight, previous termination, stress and change of partner are noteworthy, and we suggest further work be initiated to confirm these findings in other study populations," Maconochie said.

More information
The American Pregnancy Association has more about pregnancy loss.

New Diabetes Drug Improves Blood Sugar, Weight Loss

(HealthDay News) -- The new drug called rimonabant (brand name Acomplia) helped improve blood sugar control and promote weight loss in people with type 2 diabetes, according to study results released Tuesday by drug maker Sanofi-Aventis.

The study of 278 patients at 56 centers in the United States and six other countries found that the drug also had an effect on other risk factors such as levels of good and bad cholesterol, blood pressure and triglycerides.

The patients in this study, called SERENADE (Study Evaluating Rimonabant Efficacy in Drug-Naive Diabetic Patients), were not taking any other medications for their diabetes. The findings were presented at the World Diabetes Congress in Cape Town, South Africa.

"The management of type 2 diabetes should not only focus on controlling blood sugar levels but also improve other risk factors such as weight, good and bad cholesterol, triglycerides and blood pressure," Dr. Julio Rosenstock, director of the Dallas Diabetes and Endocrine Center at Medical City and clinical professor of medicine at the University of Texas Southwestern Medical School at Dallas, said in a prepared statement.

"This study suggests that rimonabant can achieve improvement in blood glucose with the added benefit of significant weight loss and improvement in other risk factors," said Rosenstock, who was an investigator in the SERENADE study.

"Some current medications for type 2 diabetes are often associated with weight gain. The fact that blood sugar levels were reduced along with weight loss and improvements in HDL ("good") cholesterol and triglycerides may further support the novel mechanism of action of rimonabant, which is different from the mode of action of current oral anti-diabetic medications," Rosenstock said.

This is the second study to find that rimonabant improves blood sugar levels in people with type 2 diabetes. The previous study, funded by Sanofi-Aventis, was published online Oct. 27 in the journal The Lancet.

Rimonabant is approved in Europe but has not been approved in the United States.

More information
The U.S. Centers for Disease Control and Prevention has more about diabetes.

Sleep Problems Can Strike Preschoolers, Too

(HealthDay News) -- Sleep problems don't just plague teenagers who burn the candle at both ends or adults anxious about paying their bills.

Even preschoolers can have trouble sleeping, and experts suspect the main difficulty for kids ages 1 to 5 is simply a lack of restful slumber.

"Twelve to 15 hours a night is recommended based on best guesses," said Christine Acebo, an assistant professor of psychiatry and human behavior at Brown University Medical School. Part of the problem, she explained, is that no rigorous studies have been done to test the effects of various amounts of sleep on young children. "We don't really know how much sleep they need."
However, in a recent study published in the journal Sleep, Acebo found that few young children get the recommended 12 to 15 hours of sleep. When she tracked 169 children, ages 1 to 5, she found that the older kids got less than 9.5 hours of sleep in a 24-hour period, including naps. And the 1- and 2-year-olds got 10.5 to 11 hours in each 24-hour period.

Acebo, who's also assistant director of the Bradley Hospital Sleep and Chronobiology Research Laboratory in Providence, R.I., also found that children in lower-income families spent more time in bed at night, but woke up more frequently during the night than children from higher-income families. The children from low-income families also tended to have variable bedtimes, which can trigger sleep problems, the researchers found. She suspects the variable bedtimes could be due to the parents' changing work schedules. They may have to work alternating shifts, for instance.

Besides a lack of sleep, young children often struggle with other conditions, Acebo said, such as restless leg syndrome, a neurological disorder that typically affects older adults. Restless legs syndrome is characterized by unpleasant sensations in the legs. Or, children, like adults, can suffer from sleep apnea, in which they have episodes of upper airway obstruction, interrupting breathing and compromising sleep.

"There are a fair number of kids who have sleep problems such as sleep apnea from enlarged tonsils and adenoids," Acebo said.

Some sleep problems may be traced to feelings of insecurity in a child, said another sleep expert, Dr. Rafael Pelayo, a pediatric neurologist and assistant professor at the Stanford University Sleep Disorders Clinic. "We want children to go to bed feeling safe, comfortable and loved," he said. If they don't feel that way, it's understandable they may have trouble falling or staying asleep.

Sufficient sleep is crucial not only for proper growth and development, but for a child's behavior, too, as any parent of a crabby preschooler already knows. On a more scientific level, researchers from Northwestern University Medical School studied the link between adequate sleep and behavior. They evaluated 510 children, ages 2 to 5, asking parents to report the amount of sleep their child got and then to describe the youngster's behavior the next day. The result: A lack of sleep during the night or naps translated into next-day behavior problems.

So, what's the experts' advice for parents of preschoolers?

"Keep regularly scheduled bedtimes and have good routines for bedtime," Acebo said. Those routines might include a bedtime story or anything else that is relaxing, she said. The point is to ease them to sleep in a relaxed manner.

Pelayo prefered to give a broader recommendation to parents. "I don't get caught up in details [such as have your child go to bed at the same time very night] on purpose," he said. Instead, he emphasizes that parents should make a child feel safe and comfortable and that the household shouldn't be too chaotic. A child will fall asleep more easily if the environment is conducive, he said.

Pelayo does caution parents not to tell a child she can stay up later and use a later bedtime as a reward for good behavior. That sends the wrong message, he said -- that sleep or having to go to bed is punishment. Another habit that some parents get into is to establish too early a bedtime for the age of the child. "Sometimes the kids have inappropriate [too early] bedtimes because the parent wants a break, they want earlier bedtimes," Pelayo said.

Occasional lack or sleep or sleep problems are probably nothing to worry about, Acebo said. However, if a child aged one to five seems sleepy during the day, outside of his or her regular nap time, then that is "something to tend to," she said. In these cases, a call or a visit to your pediatrician may be in order, the expert said.

More information
To learn more about children and sleep, visit the National Sleep Foundation.

Diabetes Drug Halts Weight Gain in Kids Taking Antipsychotics

(HealthDay News) -- While increasing numbers of children and teens are being treated for psychiatric illness with medications called atypical antipsychotics, many experience significant weight gain while on these drugs -- as much as a pound or more a week.

However, a new study suggests that the diabetes drug metformin may be able to put the brakes on that weight gain.

During the 16-week study period, children taking metformin along with atypical antipsychotics lost a slight amount of weight, while those given a placebo along with their psychiatric medications gained nearly 9 pounds.

"For someone with a major psychiatric diagnosis, there's a stigma attached to that to begin with, then if you add obesity on top of that, there's an additional stigma," noted the study's lead author, Dr. David Klein, an endocrinologist at Cincinnati Children's Hospital Medical Center.

"Now, if people do gain weight, there's an effective treatment to control weight gain."
Results of the study are in the December 2006 issue of the American Journal of Psychiatry.

Atypical antipsychotic medications include risperidone (brand name Risperidal), olanzapine (brand name Zyprexa) and quetiapine (brand name Seroquel). These medications are used to treat a variety of psychiatric illnesses, such as bipolar disorder disorder and schizophrenia.

Increased appetite and accompanying weight gain are common side effects attributed to the drugs.

"We know that appetite increases, but the mechanism behind that isn't fully clear," said Dr. Glenn Hirsch, medical director of the New York University Child Study Center.

Klein said his interest was piqued when he saw a patient with type 2 diabetes who was "eating voraciously." Once he took her off the antipsychotic medications, her diabetes went away.

Unfortunately, her psychiatric symptoms quickly returned. Once back on the atypical antipsychotics, her diabetes came back.

That suggested, said Klein, "that there was some 'diabeticogenic' effect of these agents," and that insulin resistance might play some role in the excess weight gain.

So, for the current study, the researchers wanted to learn if medication that can improve the body's use of insulin might also halt the weight gain these children experienced.

For the study, the researchers randomly assigned a group 39 children between the ages of 10 and 17 to receive either 850 milligrams of metformin daily or a placebo. All of the children were taking atypical antipsychotic medications, and all had experienced at least a 10 percent gain in body weight in less than a year.

The study lasted four months. During that time, those taking the placebo gained an average of 8.8 pounds while those on metformin lost 0.2 pounds.

Additionally, there was a significant reduction in insulin resistance in the group taking metformin.

Klein said there were no serious side effects in the treatment group, and the drug was generally well-tolerated.

"For people who need these medicines and start to gain weight, this study suggests we can stop the weight gain," said Hirsch.

However, both Klein and Hirsch said that larger studies of longer duration should be conducted to confirm these findings.
In the meantime, Klein said he expects that physicians will try using metformin if they have patients who are gaining weight while taking atypical antipsychotics.

Hirsch said that if you or your child is taking these drugs, and you've done everything you can to prevent weight gain, including consulting a nutritionist and exercising, but weight gain continues, you should talk to your doctor about possibly trying metformin.

"We have a critical issue here. Certain kids need this type of medication and are helped by it, but we don't want to cause any additional problems. If you have a child who's gaining weight on this medicine, there may be a treatment that can stop the weight gain. It's certainly worth talking with your physician about it," said Hirsch.

More information
To learn more about antipsychotic medications, visit the National Institute of Mental Health.

Statins Cut Risk of Heart Attack, Stroke in Those Without Heart Disease

(HealthDay News) -- There are clear medical benefits for prescribing cholesterol-reducing statin drugs for people who don't have cardiovascular disease but are at moderate risk of heart attack, stroke or other events, new research indicates.

An analysis of studies that included more than 48,000 people supports current guidelines about who should get statins, said study lead author Dr. Niteesh K. Choudhry, an associate physician at Brigham and Women's Hospital, in Boston.

Those guidelines state that "those at highest risk even without known cardiovascular disease should get statins," Choudhry said. "They suggest that people at moderate risk, they may also benefit."

There are clear benefits for people at moderate risk due to such conditions as diabetes or high blood pressure, in addition to high blood cholesterol, the analysis found. The incidence of major cardiovascular events such as heart attack was 29 percent lower for those who took a statin rather than a placebo, an inactive substance, and a 14 percent reduction in strokes over an average of 4.3 years.

Statin therapy did not reduce the death rate in the trials, "likely because of the relatively low risk of mortality in this patient population and insufficient length of follow-up," the report said.
The study was published in the Nov. 27 issue of the Archives of Internal Medicine.

The cost of statin treatment must also be considered against the benefits, Choudhry said. If the 23 million Americans at moderate risk of cardiovascular disease were treated for 4.3 years, an estimated 85,800 strokes and 383,000 major coronary events would be prevented -- but the cost would be at least $40 billion.

"Whether those at moderate risk should be getting statins is a matter of cost-benefit analysis, whether the bang for the buck is worth it," he said.

Dr. Christopher P. Cannon, a cardiologist at Brigham and Women's who was not involved with the study, has no doubts that the benefits of statin therapy outweigh the costs.

"The study is very important news for tens of millions of people here in the United States," Cannon said. "It provides very important evidence supporting the use of statins to lower cholesterol in people at moderate risk."

The study shows that a person would have to be treated with a statin for 4.3 years to prevent one major coronary event, Cannon noted. "That cost is well within the realm of standard medical practice," he said.

Alternative cholesterol-lowering measures, such as better diet, do not offer the same clear benefits as statin treatment, Cannon said. "People take a look at the box of oatmeal in the morning and say, 'Not today,' " he said.

And the price of statin therapy is coming down, Cannon said. "Fortunately, statins are available as generics," he said. "That dramatically reduces the cost of implementing the strategy. Three statins are now available generically."

The analysis also showed statistically significant benefits of statin therapy even for people at relatively low risk, Choudhry added. "But the amount of benefit is small," he said. "The question is, is it worth it?"

More information
For more on statins and how they work, visit the U.S. National Heart, Lung, and Blood Institute.

Combination Therapy Eases Pulmonary Arterial Hypertension

(HealthDay News) -- A combination therapy of two drugs -- inhaled iloprost and bosentan -- appears to improve the condition of patients with pulmonary arterial hypertension (PAH), a debilitating and potentially fatal disease characterized by a progressive narrowing of blood vessels in the lungs.

Dr. Vallerie V. McLaughlin, of the University of Michigan Medical Center, and nine colleagues studied 65 PAH patients who were being treated with bosentan, an endothelin receptor antagonist that helps boost blood flow in the lungs.

Of those patients, 32 were selected to receive inhaled iloprost (a prostacyclin analog) along with bosentan, while the remainder took a placebo and bosentan.

By the end of the 12-week study, all the patients who received the bosentan-iloprost therapy were able to walk 98 feet further during a six-minute walk test, and 11 of them showed improvement in a measurement of how severely they were affected by PAH.

In addition, none of the patients who received the bosentan-iloprost therapy experienced clinical deterioration over the course of the study.

The findings are published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine.

Symptoms of PAH, which has no known cause, include shortness of breath following exercise, excessive fatigue, weakness, dizziness and fainting. The symptoms tend to grow worse over time.

More information
The U.S. National Heart, Lung, and Blood Institute has more about PAH.

Prescription Painkillers Top Heroin as Drugs of Abuse in Canada

(HealthDay News) -- Heroin use in Canada has declined, and prescription opioids such as morphine, OxyContin or Dilaudid now make up the biggest share of illicit opioid use, note researchers in the current Canadian Medical Association Journal.

A team led by Benedikt Fischer, of the University of Victoria, in British Columbia, analyzed data from the OPICAN study, a multi-site examination of drug use patterns among opioid users across Canada.

The researchers said their findings have several implications.

They noted that people who use prescription opioids illegally usually obtain the drugs directly or indirectly (i.e., through partners or friends) from sources within the medical system. Changes may be needed in the way that opioid addiction treatment programs are managed, the researchers suggested.

The study was prompted by reports of substantial increases in prescription opioid abuse in Canada.

More information
The American Academy of Family Physicians has more about opioid addiction.

Health Tip: Keep Food Longer During a Blackout

(HealthDay News) -- In the event of a power outage, how do you know how long the food in your fridge will remain safe to eat?

The answer depends on the food. But when in doubt, throw it out, says the City of Kingston in Ontario.

Here are some steps to keep your food safe for as long as possible:

• Plan what you need from the fridge and remove items quickly.
• Open the fridge as little as possible.
• Leave your freezer closed.

Shop-Till-You-Drop Season Scary for Some

(HealthDay News) -- Nearly everyone gets into the spirit of shopping during the holiday season, and folks will be grabbing their credit cards and checkbooks Friday as the mad rush to the stores begins.

For most, spending a bit beyond your means sometimes doesn't land you in serious trouble. But for one in 20 American adults, shopping is no laughing matter, and the holiday season can be pure torture. That's the number of people affected, experts say, by a compulsive need to shop and buy.

"It is difficult all year long [for compulsive shoppers]," said Dr. Lorrin M. Koran, an emeritus professor of psychiatry and behavioral sciences at Stanford University who has studied the topic intensively. "[But] some compulsive shoppers find the holiday, with the emphasis on advertising, buying things, and the supposed joys of material possessions, more trying than the rest of the year."

Some experts, including Koran, believe that compulsive buying should be classified as a mental disorder and officially included in a guidebook for psychological and psychiatric treatment used worldwide, called the Diagnostic and Statistical Manual of Mental Disorders.
In his study of more than 2,500 adults, he found that 6 percent of women and 5.5 percent of men were compulsive buyers.

If you frequently buy things you don't need and can't afford, go on buying binges and bring home things you then have no interest in, or your shopping behavior is causing problems with family, work or finances, you may have a problem, Koran said.

During the holidays, those urges are even harder to ignore. "People can feel obliged to give," Koran said.

Added April Lane Benson, a psychologist in private practice in New York City: "People believe that how much they spend correlates with how much they care." She is founder of a Web site devoted to "stopping over-shopping."

A materialistic attitude, plus poor self-image, can also fuel the tendency to buy too much, Benson said. Other common triggers, according to Koran: depression, anxiety, boredom and anger.

However, you can curb your compulsive buying, even in this "shop-till-you-drop" season, Koran and Benson agreed. Here are some of their suggestions:

Plan well in advance -- that would mean right now -- how you will avoid compulsive shopping over the holidays, Benson said. That can involve an attitude adjustment. "Research shows that experiences lead to more satisfaction than material goods," she said. Instead of buying your loved ones something, give your expertise, she suggested. Give a friend or relative a coupon good for five hours of computer counseling, a photography session at their child's next birthday party, or help with yard work.

If you get the urge to shop, think about why you are having it. "What is it you are needing?" Benson asked. For instance, if you're feeling inadequate and think you'll go to the mall and buy yourself a great new outfit -- plus buy two or three more gifts than you had planned to get for each person on your list -- figure out another way to feel better about yourself. "Is there something nice you can do for someone?" she asked.

Keep track of the triggers that lead you to shop compulsively, Koran suggested. For instance, if you head to the stores when you are feeling low, think about developing an alternative plan, something that will make you feel better without shopping. That might mean a workout, reading a book, or taking a bubble bath.

When you go shopping for holiday gifts, Koran said, "Only go shopping with a trusted friend or relative who is instructed to prevent impulsive purchases." Take a list and stick to it.
"Recognize that it truly is the thought that counts, not the size of the gift," Koran said.

More information
To learn more about compulsive shopping, head to the Illinois Institute for Addiction Recovery.

Certain Fatty Acid May Cut Dementia Risk

(HealthDay News) -- Adding further weight to the theory that fish may be brain food, new research found that people with diets rich in fish have a significantly lower risk of dementia and Alzheimer's disease.

The key appears to be docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid that appears to affect dementia risk and to be important for the proper functioning of the central nervous system.

"If you have a high level of DHA, a fatty acid found in fish, it reduced your risk of dementia by about half," said study lead researcher Dr. Ernst J. Schaefer, senior scientist and director of the Lipid Metabolism Laboratory at the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.

It's known that omega-3 fatty acids protect the heart and the circulatory system. "Just as fish is good for your heart, it's probably good for your brain as well," Schaefer said.

Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in DHA.

The study findings are published in the November issue of the Archives of Neurology.

In the study, Schaefer and his colleagues collected data on DHA levels and dementia in 899 men and women who were part of the Framingham Heart Study. Over nine years of follow-up, 99 people developed dementia, including 71 with Alzheimer's disease.

The researchers found that people with the highest blood levels of DHA had a 47 percent lower risk of developing dementia and a 39 percent lower risk of developing Alzheimer's, compared with those with lower DHA levels.

Levels of DHA in the blood vary by how much the liver converts alpha-linolenic acid, an essential fatty acid, to DHA and also by the amount of DHA in the diet, the researchers noted.
People with the highest blood levels of DHA said they ate an average of two to three servings of fish a week. People with lower DHA levels ate substantially less fish, the researchers reported.

Schaefer thinks the same benefit can be realized by taking fish-oil supplements. "Everything that we know suggests that supplements would be as effective as eating fish," he said. "Since low fish intake appears to be a risk factor for developing dementia, either eat more fish or use one or two fish oil capsules a day."

However, Schaefer added that a randomized clinical trial is still needed to see if DHA really protects the brain from dementia.

Martha Clare Morris is an epidemiologist at Rush University Medical Center in Chicago and author of an accompanying editorial in the journal. "This is the first study to link blood levels of DHA to protection against Alzheimer's disease," she said, adding that recent animal studies have shown that DHA reduces amyloid plaques -- a hallmark of Alzheimer's -- in the brain and also improves memory.

"There is a lot of animal and biochemical evidence to support what this new study shows," Morris said.

But, she said, she's not sure there is enough data to suggest the value of fish oil supplements. "It looks like the protective benefits from omega-3 fatty acids are at a very low level. There is very little evidence that you get better protection from higher intake," she said. "Whether fish oil supplements are protective is yet to be seen."

Another expert thinks clinical trials are needed to see if DHA really protects against Alzheimer's.
"This shows in a prospective study that DHA is the only plasma lipid to cut the risk for developing dementia a decade or more later," said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System and associate director of the Alzheimer's Disease Research Center at UCLA's David Geffen School of Medicine.

This apparent protection is associated with eating fish, Cole said. "Other studies have pointed to fish intake as protective but have been far less clear that the omega-3 fatty acids in fish were the factor associated with risk reduction," he said. "This matters because if it is the fat, you could take fish oil supplements and avoid mercury contamination issues."

More information
The Alzheimer's Association can tell you more about Alzheimer's disease.

Newly Released Data Stirs Naproxen Debate

(HealthDay News) -- Just-released data from a trial that was stopped early in 2004 for safety reasons is re-igniting debate on the safety of two popular painkillers.

The trial suggested the over-the-counter painkiller Aleve boosted heart risks, while another controversial prescription painkiller known as Celebrex did not.

Now, the data from that trial has finally been made available. But that has not silenced one critic, who says this early data is unreliable and questions the reasons the trial was stopped prematurely.

"The trial was improperly stopped by what appears to be political considerations. When you do that, you generate data which we know is unreliable," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic Foundation.

Nissen is author of an accompanying commentary in the Nov. 17 online edition of PLoS Clinical Trials, which has published the data from the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT).

Specifically, Nissen charges that ADAPT was cut short not on the advice of its safety-review board but by nervous officials at the U.S. National Institutes of Health, which had funded the trial. Those officials were worried about the media furor over the safety of now-withdrawn painkiller Vioxx, Nissen claims.

The medications in question all fall into the class of nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, naproxen, ibuprofen and cox-2 inhibitor medications such as Celebrex and the now-withdrawn Bextra and Vioxx.

Beginning in late 2004, major studies began to show that heart risks to users rose with long-term use of cox-2s. This led to the eventual withdrawal from the market of Vioxx and Bextra, and the U.S. Food and Drug Administration slapping a "black box" cardiovascular warning on the remaining cox-2, Celebrex.

In December of 2004, officials at the NIH announced the premature termination of the ADAPT trial, which had been set up to look at the possible usefulness of NSAIDs in preventing Alzheimer's disease.

Early results from that trial came as a surprise to many, because they suggested that long-term use of Celebrex did not significantly boost heart risks, while the use of an over-the-counter rival, naproxen (Aleve), did.

"We ended up stopping the trial early, when another trial brought up some safety concerns about these drugs," said study author Barbara Martin, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

"We found a small but not statistically significant risk with celecoxib, and a larger and statistically significant increased risk with naproxen," Martin said.

But the actual data from the trial was not released at the time, adding to the confusion. It has now been published.

The 2,500 elderly participants in the ADAPT trial took either celecoxib, naproxen or placebo for up to 3.5 years.

Compared to those taking placebo, people taking celecoxib had a 10 percent increased risk of heart attack and stroke, while those taking naproxen had a 63 percent increase risk, the researchers found.

Martin said she wasn't sure why these drugs might have different risk profiles. Other trials have suggested that naproxen was actually cardioprotective, but these results indicated that it is not, she said.

Martin believes that the ADAPT results would also apply to people who take the painkillers over the long-term to help relieve arthritis.

"As yet, the specifics of the risks aren't really well-defined, but the clinical benefits of the drug are established," Martin said. "What is most clear is that when you take NSAIDs for a long period of time, there is a risk associated with them. What exactly it is, how big it is, is still not clear, but there is no completely safe NSAID."

There did not seem to be any protective effect from the drugs in terms of warding off Alzheimer's, she added. "Part of the reason we stopped was that there was some evidence of risk, and there wasn't any overwhelming evidence of benefit to counter that," Martin said.
But Nissen strongly disagreed with the findings, noting that they run counter to the results of other large trials.

"The published results of the ADAPT trial with regard to cardiovascular risk are completely unreliable," said Nissen. In his editorial, he explained that because the trial was stopped early, the data lacks the statistical power to deliver any clear verdict on either Celebrex or naproxen.
"These results cannot be used in any way to assess the relative risks of naproxen," Nissen said.

He added that he is not surprised that the premature termination of the trial in late 2004 -- coming at the height of the Vioxx debacle -- caused such a media uproar. Newspapers at the time trumpeted headlines such as "Heart Risk Seen in Naproxen" (Wall Street Journal) and "Patients, Doctors Agonize Over Risks of Painkillers", (Los Angeles Times).

"A warning was issued to the public that we now know was wrong," he said.

But Martin said she blames the media for creating a false impression of why the trial was stopped. "All of the publicity when the trial was stopped -- it was not what we intended," she said. "It's difficult in a political maelstrom of events to have the true rationale come through."

According to Martin, the trial was stopped because of data from another major trial was raising questions about the safety of Celebrex, triggering the premature closure of that arm of the ADAPT trial. When that happened, the researchers decided against continuing with the naproxen arm alone.

"We weren't seeing a risk with celecoxib (Celebrex), so it put us in a very uncomfortable position. We were imagining three years later if the adverse effects with naproxen were really real getting roundly criticized for not having stopped it earlier," she said.

Martin agreed, then, that there were political as well as safety concerns in stopping the trial.
"There was this domino effect and we felt that even though the results in and of themselves would not have led us to stop the trial, this domino effect made it necessary," she said.

Despite all the controversy, Martin feels that the trial data remains valid. She also believes it was right to have stopped the trial early. As to the safety of naproxen, Martin said there's not yet enough data to answer that question.

But Nissen said the accumulated evidence on NSAIDS supports the notion that the drug is, on the whole, safe.

"There is overwhelming evidence that of all the drugs in the class, the safest drug is naproxen," he said. "Analyses involving millions of patients have shown, consistently, that it is probably the safest drug."

Nissen doesn't believe naproxen actually protects against heart attack, however. "It's neutral," he said.

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

Eye Tests Predict Later Vision Trouble for Preemies

(HealthDay News) -- Having youngsters undergo eye tests at two-and-a-half years of age can help predict vision problems when they're 10 years old, Swedish researchers report.

Previous studies have found that refractive errors (problems with the degree of light that reaches the back of the eye) are more common in children born preterm (before 35 weeks of gestation) than in full-term children.

In this new study, researchers at Uppsala University Hospital checked for refractive errors in 198 preterm children at 6 months, 2.5 years, and 10 years of age. The researchers assessed the development of astigmatism (an unequal curve in one of the eye's refractive surfaces) and for anisometropia (a difference in refractive power between the two eyes that can lead to partial vision loss).

Reporting in the November issue of Archives of Ophthalmology, they found that 108 children had astigmatism at 6 months, 54 at 2.5 years, and 41 at 10 years. They also found that 15 children had anisometropia at 6 months, 17 at 2.5 years, and 16 at age 10.

"The presence of astigmatism and anisometropia at 2.5 years of age were the strongest risk factors for having astigmatism and anisometropia at 10 years of age," the study authors wrote.
"In this population-based study, we found that a refractive error at 2.5 years of age predicts that refractive error will also be present at 10 years of age," the team concluded.

"Recommendations for follow-up examinations must include all aspects of visual function, i.e., visual acuity, contrast sensitivity and visual fields, as well as the refraction, strabismus and perceptual problems. All preterm children should be included in such follow-up examination for refractive error, irrespective of the retinopathy of prematurity stage," the researchers wrote.

Retinopathy of prematurity (ROP) is a condition where there is abnormal development of blood vessels in the retina. The smaller the baby is at birth, the greater the risk of ROP.

More information
The Nemours Foundation has more about premature babies.

Higher IQs Protect Kids From Traumatic Events

(HealthDay News) -- Intelligence could help shield children from traumatic events, U.S. researchers report.

A new study found that children who are more intelligent than their peers at age 6 were less likely to experience traumatic events by age 17 and, if they did, were less likely to develop post-traumatic stress disorder (PTSD).

Michigan State University researchers studied 336 boys and 377 girls born between 1983 and 1985 at two Michigan hospitals. One hospital was located in a middle-class suburban community, while the other was in a disadvantaged urban community.

The children were given intelligence tests when they were 6 years old. Their parents and teachers provided information about the children's behavior at school and about any symptoms of anxiety disorders, such as phobias, separation anxiety and generalized anxiety disorder.
At age 17, the youngsters were interviewed again as to the number and type of traumatic events they'd experienced in their lives. They were also asked how seriously those events affected them, including whether they'd ever suffered symptoms of PTSD.

The researchers found that 541 (75.9 percent) of the youngsters had experienced a traumatic event and 45 (6.3 percent overall and 8.3 percent of those who experienced trauma) met criteria for PTSD.

Youngsters who had an IQ greater than 115 at age 6 were less likely to have experienced any kind of trauma (especially violent assaults) and, if they did, were less likely to develop PTSD by age 17.

Participants who had more conduct problems at school at age 6 were more likely to have been exposed to violent crime, such as mugging, beating or rape, by age 17, the study found.
These children, and those who had anxiety disorders at age 6, were about twice as likely to develop PTSD by age 17 if they were exposed to trauma, compared to children who had no anxiety disorders or conduct problems at age 6.

The researchers also found that boys were more likely to be exposed to trauma, while girls were more likely to develop PTSD after exposure to trauma.

"The ways in which high IQ might protect from the PTSD effects of traumatic exposure are unclear," the study authors wrote. "The findings underscore the importance of investigating cognitive processes in a person's responses to challenging and potentially traumatic experiences and the involvement of general intelligence in shaping them."

The study was published in the November issue of the journal Archives of General Psychiatry.

More information
The U.S. National Institute of Mental Health offers advice on how to help children cope with violence and disasters.

3 Million Worldwide Die From High Blood Sugar

(HealthDay News) -- High blood sugar is linked to diabetes, heart disease and stroke, and kills 3 million people around the world each year, a new study finds.

This risk begins far below blood levels used to define diabetes, experts add.

"Blood glucose at all levels, even those below the threshold we call diabetes, is responsible for a very large number of cardiovascular deaths in the world, in fact, substantially larger than the number that directly die of diabetes," said lead researcher Majid Ezzati, an associate professor of international health at the Harvard School of Public Health.

His team published its report in the Nov. 11 issue of The Lancet.

In the study, Ezzati's group looked at the effects of higher-than-optimum concentrations of blood sugar on death from heart disease and stroke worldwide. They gathered data on blood sugar from 52 countries in different parts of the world.

The researchers found that 959,000 deaths in 2001 were directly attributed to diabetes, 1,490,000 to heart disease and 709,000 to stroke, and all were linked to high blood sugar. This means that 21 percent of all deaths from heart disease and 13 percent of all deaths from stroke are associated with high blood sugar.

Higher-than-optimum blood sugar accounts for 3.16 million deaths a year. This is substantially higher than the deaths attributed to diabetes alone. Deaths from high blood sugar are comparable to the 4.8 million deaths from smoking, the 3.9 million deaths from high cholesterol and the 2.4 millions deaths from overweight and obesity each year, the researchers note.
Ezzati thinks that these findings indicate that blood sugar should be considered a risk factor beyond the risk for diabetes. Like blood pressure control, lowering blood sugar reduces the risk for heart disease.

"At all levels of blood glucose, it seems that higher is worse," Ezzati said. "Most people can benefit from having lower blood glucose, in the same way we think about blood pressure," he said.

Ezzati believes that people need to know about the risks of high blood sugar. Public health programs that highlight the risks of high blood sugar are needed, in the same way that there are programs about the risks of high blood pressure and high cholesterol, he said.

One expert agrees that lowered blood sugar reduces the risk for heart disease and stroke as well as diabetes.

"This is not news to me," said Dr. Larry Deeb, the president for Medicine and Science at the American Diabetes Association. "We have been dealing with this in the diabetes community for a while."

Blood sugar is a variable, like blood pressure and cholesterol, that is associated with deaths from heart disease and stroke, Deeb said. "All of those variables -- the lower the better," he said.
The key to keeping blood sugar low is lifestyle, especially diet and exercise, Deed said.
In a related study in the same journal issue, Finnish researchers found that diet and exercise counseling can change lifestyle and reduce the incidence of diabetes among people at high risk for type 2 diabetes.

"From a public health point of view, there is an important message: An intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," researcher Jaakko Tuomilehto, from the Diabetes Unit in the Department of Health Promotion and Chronic Disease Prevention at the National Public Health Institute, Mannerheimintie, said in a prepared statement.

"Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease," Tuomilehto said. "Even delaying the onset of diabetes can have a substantial effect on subsequent morbidity, and therefore on the cost-effectiveness of diabetes prevention."

More information
There's advice on controlling blood sugar at the American Diabetes Association.

Health Tip: Understanding Pulmonary Hypertension

(HealthDay News) -- Pulmonary hypertension occurs when the arteries of the lungs become narrow and restrict the flow of blood from the heart.

Blood pressure increases in these arteries and ultimately causes the right ventricle of the heart to become weaker and possibly fail.

The Cleveland Clinic Health Information Center says that by the time symptoms of pulmonary hypertension appear, the condition probably has progressed considerably. The most common symptoms include shortness of breath during regular activities like climbing stairs, as well as dizziness, fainting, and chest pain.

Treatment for pulmonary hypertension depends on its cause, the clinic says. These may include medication, lifestyle changes like diet and exercise, or surgery.

Blood Pressure Drugs Ward Off Kidney Disease

(HealthDay News) -- ACE inhibitor blood pressure drugs can cut kidney disease risk in diabetes patients with high blood pressure, researchers report.

The Italian study included more than 1,200 patients with type 2 diabetes and high blood pressure. They were randomly assigned to receive either an ACE inhibitor drug; another type of blood pressure drug called a calcium channel blocker; a combination of ACE inhibitor and calcium; or a placebo.

Reporting in the December issue of the Journal of the American Society of Nephrology, the researchers checked the study participants for rates of microalbuminuria -- small amounts of the protein albumin in urine that are among the first signs of kidney disease.

After an average of 3.5 years, patients with good blood pressure control had lower rates of microalbuminuria, regardless of which treatment they received. Patients who took the combination treatment showed the greatest decreases in blood pressure and were less likely to need additional drugs to control their blood pressure, the study said.

The researchers also found that taking an ACE inhibitor, either alone or as part of the combination treatment, provided further protection against kidney disease, even if a patient's blood pressure remained high.

"Treatment with an ACE inhibitor was particularly important when the blood pressure was poorly controlled -- as may happen in most diabetic patients with hypertension, despite the use of two, three, or even more drugs," study lead author Dr. Piero Ruggenenti, of Mario Negri Institute for Pharmacological Research in Bergamo, said in a prepared statement.

About 80 percent to 90 percent of people with type 2 diabetes also have high blood pressure, a major risk factor for diabetic kidney disease. Typically, about 30 percent of diabetics develop kidney failure, and an even larger percentage of them may be at risk of premature death from heart failure. Controlling blood pressure in these patients may be critical in reducing or preventing the risk of kidney failure or death for these patients, Ruggenenti said.

"Our results clearly show that an ACE inhibitor should always be used in patients with high blood pressure and diabetes, even when they have no evidence of renal or cardiovascular disease," he said.

More information
The National Kidney Foundation has more about diabetes and kidney disease.

Flu's Misery May Lie in the Genes

(HealthDay News) -- If the flu hits you especially hard this season, blame it on your DNA.

A new study of flu-infected mice found that certain genes spurred a strong immune response in the lungs that led to much more severe illness. Mice that didn't exhibit such an immune response were more likely to recover, the researchers found.

The findings may help humans not only survive the annual flu season but also an avian flu pandemic, should it ever arise.

"The long-term implications would fit into the idea of genetically based preventive medicine," explained co-researcher Dr. Linda Toth, associate dean of research at Southern Illinois University School of Medicine in Springfield. "To know that some people are predisposed to any kind of disease, we would be able to better advise or monitor those people so as to limit their health risk."

This knowledge might also help public health officials allocate precious resources.

"In the case of influenza, viral treatments and vaccine are in limited availability and if we had this kind of information, it could potentially be used to target the resources to those most at risk," Toth said.

She and co-researcher Rita Trammell, an assistant professor of internal medicine at Southern Illinois University School of Medicine, were expected to present the findings Friday at a meeting of the American Physiological Society, in Fort Lauderdale, Fla.

Another expert said the research has implications for the treatment of flu.

"It brings up the question of whether anti-inflammatories have a role in treating a flu with a lot of inflammation," said Dr. Marc Siegel, author of Bird Flu: Everything You Need to Know About the Next Pandemic and clinical associate professor of medicine at New York University School of Medicine in New York City. "It also brings up the question of 'Does genetics allow you to anticipate which group is going to have a more deleterious inflammatory response?' That would be very helpful epidemiologically."

The question of who dies of influenza has been a hot topic since at least the 1918 pandemic, which killed millions of people around the world. At the time, doctors noted that the immune systems of young, robust adults often "overreacted," resulting in a severe and often deadly inflammation of the lungs.

"This has been a long-time concern of scientists since 1918, when the theory was that people drowned in their own secretions," Siegel explained. "The body sees influenza and responds with a strong immunological response, and that response can lead to a lot of secretions."

The 1918 pandemic and the current avian flu -- which has so far killed only a small number of humans -- have some similarities: Both cause an intense inflammatory and immune response in the lungs of mice and people.

"With the current avian influenza as well as the influenza from the 1918 pandemic, the influenza caused a really enhanced and intense inflammatory and immune response in the lungs which killed the mice," Trammell said. "This was really important in determining why they died. We wanted to look at the background genetics of mice, how they reacted differently."

In their research, Trammell and Toth infected two strains of laboratory mice -- called Types "B" and "C" -- with an influenza A virus. Past work had shown that about half of the Type B mice would die, compared to about 10 percent of the Type C mice.

When lung tissue from the mice was examined about 30 hours after infection, the authors found that levels of all the pro-inflammatory cytokines (with one exception) were elevated and were much higher in the sensitive mice. This indicates a more severe inflammatory response, the researchers said. Cytokines are proteins that can cause inflammation when an immune response is mounted.

Despite the variation in inflammation, the level of the virus in the rodents' lungs was about the same in both groups.

A second, related study found that levels of immune-related messenger RNA (mRNA) in Type B mice were on average 24 times higher (and sometimes 100 times higher) than in uninfected mice. The mRNA levels in Type C mice increased less than three-fold after infection.

The next step?

"We want to try to identify specific genes or the array of genes that contribute to either the resistance or the severe response to the virus," Toth said. "Right now, we have some ideas, but we haven't nailed that down definitively."

Trammell said that this type of information, "would have enormous implications for understanding and avoiding the fatality associated with influenza virus."

More information

For more on avian influenza, visit the World Health Organization.

Pleasant Surroundings Boost Walking Habits

(HealthDay News) -- The availability of pleasant, shopping-friendly locales is more likely to influence whether or not people walk regularly than factors such as traffic or crime, a new study finds.

Researchers at the University of Victoria in British Columbia, Canada, analyzed questionnaires filled out by 351 people. They were asked about their attitudes toward walking; how much they walked; whether there were paths, trails, parks or recreational facilities near their homes; and their thoughts about local neighborhoods and walking areas.

The team found that neighborhood aesthetics and the mix of retail stores were more important that local crime levels or traffic in terms of motivating people to walk.

The most surprising finding was the strong link between a person's intention to walk and actually doing it, if they had a good place to walk. In other words, if a person wanted to walk, having a good place to walk made it more likely to happen. However, a good place to walk had no impact if the person had no intention to walk in the first place.

The study is published in the November/December issue of the American Journal of Health Promotion.

"These findings are not going to translate into getting people to walk more," John Librett, an adjunct professor at Utah College of Health in Salt Lake City, said in a prepared statement. He was not involved in the study.

However, he said the findings should prompt community planners to consider how the design of neighborhoods and urban areas affects people's walking behavior. Redesigning old neighborhoods and creating new ones that promote walking is good for public health, Librett noted.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about the benefits of walking.

Chronic Fatigue Syndrome Campaign Launched

(HealthDay News) -- U.S. health officials on Friday launched a major campaign to increase awareness of chronic fatigue syndrome, an illness that has labored under an intense level of controversy.

"This disease has been shrouded in a lot of mystery. Sometimes people question if it's real or not real," Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said at a news conference. "We hope to help patients know they have an illness that requires medical attention and help physicians be able to diagnose the illness, and be able to validate and understand the incredible suffering that many people and their families experience in this context."

The campaign will consist of public service announcements, brochures, a "tool kit" for health-care professionals and a photo exhibit called "The Faces of Chronic Fatigue Syndrome," which will travel to cities across the country throughout 2007.

"We hope this will be a turning point in the public's awareness of the disease as well as in health-care professionals' ability to diagnose and treat it," Kim McCleary, president and CEO of the CFIDS Association of America, said at the news conference.

"This launch is so important to increasing understanding of this illness," added Dr. Nancy Klimas, of the University of Miami Miller School of Medicine. "Historically, lack of credibility of this illness has been a major stumbling block."

According to Dr. William Reeves, of the CDC's National Center for Infectious Diseases, the level of impairment experienced by people with chronic fatigue syndrome is comparable to that of multiple sclerosis, AIDS, end-stage renal failure and chronic obstructive pulmonary disease.

One CFS patient, Adrianne Ryan, said that sometimes taking a walk or a shower was too much, and resulted in her collapsing for weeks afterwards. Ryan is a former marathoner.

Doctors still don't know what causes CFS or how to treat it successfully, but more than 4,000 studies over the past two decades show definite underlying biological abnormalities, said Dr. Anthony Komaroff, of Harvard Medical School.

"This is not an illness that people can imagine they have. It's not a psychological illness," he said. "That debate, which has raged for 20 years, should now be over."

Among other things, Komaroff pointed out, the brain hormone systems of people with CFS are different than those without the disease. Brain functioning is also impaired and cells' energy metabolism seems to be compromised.

Analyses of the activity levels of 20,000 genes in people with CFS have found abnormalities in genes related to the part of brain activity mediating the stress response, Reeves said.

Some 1 million Americans suffer from the disease. Women are affected at about four times the rate as men and non-white women are affected more than white women. The disease can affect any age and demographic but is most likely to strike when a person is 40 to 59 years of age.

According to a large study conducted in Wichita, Kans., only half of people with CFS have consulted a physician and only 16 percent have been diagnosed and treated, although studies have shown that those who get appropriate care early in the illness have better long-term results. A quarter of people with the disease were unemployed or receiving disability, with the average affected family foregoing $20,000 annually in income. That amounts to $9.1 billion in lost income and wages for the U.S. economy as a whole, the study found.

While there's reason to be happy with advances in the basic scientific knowledge of the disease, Klimas said she was less happy with advances in care. Over the past 20 years, she said, she has treated more than 2,000 people with CFS who were "angry and defiant, frustrated, trying to convince physicians, friends and families that this was a real illness."

"We need much more work to understand the biological underpinnings and translate this into clinical practice," she said. "At the same time, there are effective strategies we can use right now, treatments that do help and help significantly."

More information

Visit the U.S. Centers for Disease Control and Prevention for more on chronic fatigue syndrome.

Simple Steps Safeguard Diabetics' Feet

(HealthDay News) -- The estimated 20 million Americans with diabetes need to remember that simple foot care can reduce their risk of toe, foot or leg amputations, say experts at the American College of Foot and Ankle Surgeons (ACFAS).

People with diabetes are 10 times more likely to have a lower limb amputated than people who don't have the illness, which can cause poor blood circulation and nerve damage in the feet. This makes feet more vulnerable to ulcers, infections, deformities and brittle bones.

The ACFAS offers the following foot care tips for people with diabetes:

Inspect feet daily for injuries that could lead to dangerous ulcers.
Gently wash feet in lukewarm -- not hot -- water.
Moisturize feet but avoid the areas between the toes.
Never trim corns or calluses. Doing so can lead to serious infections.
Inspect the inside of shoes before you put them on.
At the first sign of trouble, see a doctor. Early treatment can prevent foot problems from worsening and reduce the risk of amputations.

November is National Diabetes Awareness Month in the United States.

More information

The American Academy of Family Physicians has more about diabetes and foot care.

Better Treatment for HIV/AIDS?

Q: Better Treatment for HIV/AIDS?
Is there any new information with regard to diet or herbal treatments for those with HIV/AIDS that might allow discontinuation of the "cocktail" medication?

A: First of all, let me assure you that no herbal or dietary approach exists to replace treatment of HIV/AIDS with the highly effective "cocktail" of protease inhibitors and antiviral drugs. These medications reduce the amount of the HIV virus in the body, preventing development of full-blown AIDS and extending life expectancy.

I would never advise a person with HIV/AIDS against using the "cocktail." The major disadvantage of this treatment is the number of pills involved, but this inconvenience is a small price to pay for a treatment that protects against a deadly disease. Unfortunately, the expense of the treatment means that millions of people in third-world countries where HIV/AIDS is rampant don't have access to these life-saving drugs.

We urgently need programs to make the cocktail more widely available and affordable. Beyond that, we need an effective vaccine to stem the still-escalating AIDS epidemic. Some 40 million people worldwide are living with HIV/AIDS, nearly one million of them in the United States. More than 40,000 people become infected with HIV in this country every year, and the spread of the disease continues unabated elsewhere. Reportedly, the disease is out of control in Russia with one out of every 100 adults infected. In India, 4.5 million people are infected - so many that World Health Organization authorities say that India may have overtaken South Africa as the most infected country.

Unfortunately, we don't yet have a vaccine, but that's not for lack of trying: a total of 30 vaccines are in human trials in 19 countries. The biggest obstacle investigators face is the ability of HIV to change its shape, frustrating efforts to find a vaccine that stops it from replicating.
To complement treatment with the HIV/AIDS cocktail of drugs, I recommend using a mixture of medicinal mushrooms with antiviral, immune-enhancing effects, as in the product called Host Defense from New Chapter.

If you're taking the HIV/AIDS cocktail, be cautious about the use of two herbal remedies. Studies at the National Institute of Allergy and Infectious Diseases found that taking garlic supplements twice a day for three weeks reduced blood levels of the anti-HIV drug saquinavir by approximately 50 percent. The same team found that St. John's wort can reduce concentrations in the blood of the protease inhibitor indinavir.

Andrew Weil, M.D.

Yohimbe: Restoring Sexual Potency?

Q: Yohimbe: Restoring Sexual Potency?
What do you think of yohimbe or other natural supplements for Erectile dysfunction as an alternative to Viagra?

A: Yohimbe is an herbal remedy that comes from the bark of an African tree, Pausinystalia yohimbe. Before Viagra, drugs containing yohimbine hydrochloride, the active ingredient in yohimbe bark extract, were used to treat erectile dysfunction (ED). However, levels of yohimbine in yohimbe bark extract vary considerably and are often very low.

Yohimbe bark extract, by itself, never has been shown to work as effectively as drugs containing yohimbine hydrochloride. What's more, yohimbe can have serious side effects including paralysis, fatigue, stomach disorders, even death. I don't recommend it, and harvesting of its bark is driving the yohimbe species to extinction.

Viagra and related drugs are the most effective treatments for ED by far, but you can try the following non-drug approaches if you wish:

Stop smoking. Nicotine can reduce genital blood flow and impair potency.
Check your meds. ED is an unfortunate side effect of many drugs. Ask your physician or pharmacist about alternatives.

See your physician. A general medical examination should be done to rule out physical causes as well as any signs of vascular, hormonal or neurological disorder.
Limit alcohol consumption. Alcohol's depressive effects can have a negative impact on sexual functioning.

Shape up. ED is often linked with restricted blood flow to the penis. Keep your heart and arteries in good condition by maintaining a healthy weight, and following a diet high in fruits, vegetables and whole grains. Avoid saturated fats and trans-fats. Regular aerobic exercise can improve blood flow to the genitals and reduce the stress that can contribute to ED.

Deal with anxiety, depression and stress that may undermine desire and potency. Try breath work, meditation or yoga to reduce stress. Be open and honest with your partner about your mutual needs to help ease any tension or misunderstandings.
Don't worry about your age. Discard the myth that sexual activity ends with age.

In addition to the measures above, the following supplements may help:
Arginine, an amino acid used by the body to make nitric oxide, a substance that relaxes blood vessels to help increase blood flow to the penis. Arginine appears to be safe at lower doses however, there is some concern about its increasing stomach acid and potassium levels when taken at higher doses, and recent evidence suggests it may have negative effects in people with existing heart problems. Individuals with a history of stomach problems, cardiac problems or who are on medicines for high blood pressure should use this with caution.
Ginkgo biloba, which may help by increasing blood flow to the genitals. The usual dose is 120 milligrams a day, in divided doses with food.

Ashwaganda, an Ayurvedic herbal remedy reputed to act as a mild aphrodisiac, or Asian ginseng (Panax ginseng), a good stimulant and sexual energizer. For either, follow the dosage on the package, and give it six or eight weeks to have an effect. Both ashwaganda and Asian ginseng are generally safe (but Asian ginseng can raise blood pressure and cause irritability and insomnia in some people).

Andrew Weil, M.D.