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.