Health Tip: Severe Food Allergy?

(HealthDay News) - If you or a loved one has a serious allergy to one or more foods, it's important to have an action plan in case of accidental ingestion.

Here are some guidelines, courtesy of the American Academy of Family Physicians:

• Work with your doctor and family members to create a clear, detailed emergency action plan. Always carry it with you.
• Designate a trusted third party as an emergency contact.
• At all times, carry emergency medications recommended by your doctor, which may include an epinephrine pen and an antihistamine.

Diet Drug Rimonabant Tied to Depression, Anxiety

(HealthDay News) -- People who take the weight-loss drug rimonabant may face heightened risks for severe depression and anxiety, Danish researchers report.

The finding follows a recommendation by a U.S. Food and Drug Administration panel in June that the agency not approve the diet drug because of continuing concerns about increased risks for suicidal thoughts among some users. Previously, the FDA rejected the drug as an aid to help people quit smoking.

"Up to this point in time, there has been controversy over the rates and severity of psychiatric adverse effects with rimonabant," noted Dr. Philip Mitchell, head of the School of Psychiatry at the University of New South Wales in Sydney, Australia, and co-author of an editorial that accompanies the study.

This is the first review to examine rates of severe psychiatric symptoms with rimonabant (Acomplia), symptoms severe enough that patients discontinue treatment, Mitchell said.
The report is published in the Nov. 17 edition of The Lancet.

In the meta-analysis, Dr. Arne Astrup, from the department of human nutrition at the University of Copenhagen, collected data on more than 4,100 patients enrolled in four clinical trials. Those trials compared taking rimonabant (20 milligrams a day) against a placebo.

The researchers found that people taking rimonabant did lose weight -- about 15 pounds in a year -- compared to those receiving a placebo.

However, those taking rimonabant were also 40 percent more likely to have an adverse reaction than people not taking it. In fact, those taking rimonabant were 2.5 times more likely to stop taking the drug because of depression and three times more likely to stop the drug because of anxiety, compared to people on placebo.

"Our findings suggest that 20 milligrams per day of rimonabant increases the risk of psychiatric events -- i.e., depressed mood disorders and anxiety -- despite depressed mood being an exclusion criterion in these trials," Astrup's team said. "Taken together with the recent U.S. Food and Drug Administration finding of increased risk of suicide during treatment with rimonabant, we recommend increased alertness by physicians to these potentially severe psychiatric adverse reactions."

Mitchell noted that depression is common in overweight and obese people, and is something that doctors need to take into account when prescribing weight-loss drugs.

"This increased risk of depression and anxiety is a major safety issue in the treatment of obesity, as obese patients already have an increased risk of depression even prior to treatment," Mitchell said.

As far as rimonabant is concerned, Mitchell believes doctors should consider alternate weight-loss drugs for people who are depressed. "If one is using rimonabant, patients should be monitored carefully for the emergence of depressive symptoms and/or suicidal thoughts," he added.

In June, rimonabant's maker, French pharmaceutical giant Sanofi-Aventis, said in a statement that despite the FDA's decision, the company "is confident in the positive benefit-risk ratio of rimonabant 20 milligrams when used in the appropriate population."

Another expert said more data on the safety of rimonabant is needed.

"Rimonabant is potentially beneficial in some patients, but we really need long-term data demonstrating reductions in major obesity-related comorbidities such as heart attack, stroke and sleep apnea and/or mortality, to be completely certain," said Dr. Raj Padwal, an assistant professor of general internal medicine at the University of Alberta in Edmonton, Canada.

The drug needs to be avoided in anyone who has a mood disorder, Padwal added. "Since many patients with weight issues have depression, this means that the drug cannot be used in a large number of people. In the remaining individuals in whom the drug is used, the patient and physician must be cognizant of the risk of a mood disorder and monitor accordingly," he said.

In a related study in the Nov. 16 issue of the British Medical Journal, Padwal's team found that long-term users of weight-loss drugs such as orlistat (Xenical), sibutramine (Meridia) and rimonabant experienced only modest weight loss -- less than 11 pounds, which was less than 5 percent of their total body weight.

Padwal's team also noted that the U.S. National Institute for Clinical Excellence recommends stopping the use of weight-loss drugs if 5 percent of total body weight is not lost after three months.

Commenting on Padwal's study, Dr. Gareth Williams, dean of the Faculty of Medicine & Dentistry at the University of Bristol in the U.K., wrote in an accompanying editorial: "Selling anti-obesity drugs over the counter will perpetuate the myth that obesity can be fixed simply by popping a pill and could further undermine the efforts to promote healthy living, which is the only long-term escape from obesity."

More information
For more information on obesity, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Make Thanksgiving a Feast of Health

(HealthDay News) -- If the pilgrims could do without marshmallows atop their sweet potatoes, so can you.

Especially if your sweet potato casserole is topped instead with a pecan streusel that's just as tasty as marshmallow but healthier and lower in fat, nutritionists say.

By tweaking traditional Thanksgiving dinner recipes, you can avoid as much as 60 grams of fat, ensuring a healthier meal and a good beginning to the diet-busting holiday season.

"Thanksgiving dinner provides one of the healthiest food options of any holiday, because turkey is a low-fat meat, and sweet potatoes, pumpkin pie and cranberries are healthy foods and excellent sources of antioxidants," said Kathy Goldberg, a dietitian and cooking teacher at the University of Michigan Health System's health promotion program, called MFit.

But many traditional recipes -- think creamed onions, sausage stuffing, potato casseroles -- rely on lots of fat, cream, butter and sugar, both white and brown, resulting in a dinner that can range from 2,000 to 3,000 calories, an amount that should suffice an average person for a whole day, she said.

"By cleaning it up a bit," Goldberg said, which means making some simple recipe substitutions, you can provide equally delicious dishes that are nutritious as well.

"Nobody will feel like they're being cheated. Your guests won't even know, as long as you don't talk about it," she added.

Alice Lichtenstein, the Gershoff Professor of Nutrition Science and Policy at Tufts University in Boston, agreed. "No one wants to take the fun out of Thanksgiving. You just want to provide good choices that will set the stage for the next month as people face the holidays, which I call 'the license-to-eat season,'" she said.

Lichtenstein said people tend to eat more when they are sitting at a table for long stretches of time, and when there's a wide variety of foods to choose from -- both of which occur at Thanksgiving.

"You want to create an environment at the Thanksgiving table that makes it easier for people not to overdo it," she said.

The more you can replace calorie-dense foods such as buttery mashed potatoes with lower-calorie dishes like salads and vegetables that are well-prepared and tasty, the better your guests will feel, Lichtenstein said.

Goldberg, who teaches a healthy holiday cooking class at MFit, offers the following suggestions to "lighten up" your Thanksgiving dinner without sacrificing taste:

• Instead of buying a self-basting turkey, baste your own bird with low-fat, low-sodium chicken stock. Rubbing herbs and olive oil under the skin of the meat will give it more flavor.
• When the turkey is done, use the drippings -- "de-fatted" -- to make gravy. "De-fat" by pouring the drippings into a baggie that you've set in a large measuring cup. The fat will rise to the top of the baggie. Then lift the bag out of the measuring cup, prick the bottom and pour the de-fatted drippings back into a pan before thickening with flour or cornstarch.
• Whole wheat English muffins cut up into cubes are a great base for stuffing, Goldberg said, increasing nutrients, adding more fiber to the stuffing and tasting good. And don't be shy about adding vegetables and fruits like chopped apples or cranberries to the traditional celery and onions in your recipe.
• Steam or roast vegetables, and serve lots of them. Instead of butter and cream sauces, try low-fat products and/or flavor the dishes with shallots, carmelized onions, lemon zest, herbs and spices.
• Make it easy on yourself by using frozen vegetables and the bags of prewashed and cut-up vegetables now available in most supermarkets. For only a slight extra cost, you can save time and provide healthful choices.
• Vary rich pie desserts with an apple crisp or crumble.

"Your food will taste like the traditional recipes. Only the cook has to know the secrets," Goldberg said.

Looking for other nutritious treats? How about kiwis?

"In a recent study, kiwi was found to be one of the most nutritionally dense fruits out of 27 fruits," Stephanie Dean, a dietitian with Baylor University Medical Center at Dallas, said in a prepared statement.

Kiwis are full of antioxidants, vitamin E and lutein, and they ward off vision problems, blood clots and even lower cholesterol, Dean said.

Dean's also high on cranberries. "The crimson color of cranberries signal that they are full of flavonoids," she explained, adding that flavonoids are high in antioxidants and help prevent everything from infections to strokes and cancer.

And, for a final recommendation, Dean likes broccoli sprouts, which, she said, are sold by the package and can be thrown on top of salads or be an addition to sandwiches.

"Broccoli sprouts have been shown to actually contain 20 percent more anti-cancer agents than regular broccoli," Dean said.

More information
For a selection of tasty and nutritious Thanksgiving recipes, including Goldberg's sweet potato casserole, visit the University of Michigan.

Hispanics Receive Fewer Surgeries for Vascular Disease

(HealthDay News) -- Compared to the general population, Hispanics in the United States have fewer vascular surgeries, less favorable outcomes for treatment of vascular disease, and often have advanced vascular disease by the time they seek treatment, according to a new study.

While the reasons for these disparities aren't understood, they may be due to a number of socioeconomic and genetic factors, said the study authors, led by a vascular surgery team from New York-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College.

Their findings were published in the November issue of the Journal of Vascular Surgery.

The research focused on three common vascular surgery procedures -- lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic aneurysm (AAA) repair -- performed at hospitals in New York and in Florida between 2000 and 2004.

Compared to whites, Hispanic patients had a higher rate of amputation (6.2 percent vs. 3.4 percent) following LER -- meant to restore blood supply to a body part or organ -- and higher death rates following elective AAA repair (5.0 percent vs. 3.4 percent). The study also found that Hispanic patients were as much as two times more likely than whites to seek treatment only after developing advanced vascular disease, and they had longer hospital recovery times.

"These are significant disparities, and the reasons for them must be determined in order to make improvements," principal investigator Dr. Nicholas J. Morrissey, director of clinical trials and a vascular surgeon at New York-Presbyterian Hospital/Columbia University Medical Center, said in a prepared statement.

"One explanation may be socioeconomic factors, particularly insurance status, which could impede Hispanic patients' access to proper preventive and diagnostic care," said Morrissey, who is also an assistant professor of surgery at Columbia University College of Physicians and Surgeons and Weill Cornell Medical College.

More information
The Society of Interventional Radiology has more about vascular diseases.

A Full and Long Life, Despite Diabetes

(HealthDay News) -- Bob Cleveland may be 87 years old, but he still remembers the day he was first diagnosed with type 1 diabetes -- in 1925.

"I went to the hospital at five years of age, and I thought to myself, 'OK, I'm going to die.' Because never having been to the hospital before, I just thought that's where you went to die," said Cleveland, of Syracuse, N.Y.

He didn't die. The hospital personnel just tested and confirmed that he had type 1 diabetes. But Cleveland has gone on to enjoy life to the fullest, pursuing mountain climbing and other outdoor adventures, having a rewarding career as an accountant at General Motors, and raising a family -- with his wife, Ruth, 86 -- all the while monitoring his blood sugar and taking insulin as needed each day.

"He amazes me," Ruth Cleveland said. "He's still able to take care of the yard, even drive a 32-foot motor home to Florida -- and he does it well."

People like Cleveland -- and his older brother Gerald, who is 91, and also has type 1 diabetes-- serve as a reminder on Nov. 14 , World Diabetes Day, that amid the grim statistics lies the notion that a life with diabetes can be active, healthy and without limits.

According to the World Health Organization, 3.2 million people worldwide die from diabetes each year and, if improperly managed, the illness can shorten lifespans by an average of 12 years. More than 18 million Americans have diabetes, with 95 percent developing the obesity-linked type 2 disease.

Type 1 disease usually begins in childhood and is linked to an inability of the insulin-producing cells to do their job. It typically means a lifetime of blood glucose monitoring and insulin supplementation.

Most type 1 diabetics don't let it overwhelm them, however.

"Yes, diabetes is something that you have to deal with, but it's just another part of your life," said 73-year-old Alan Lewis, professor emeritus of oceanography at the University of British Columbia, Vancouver.

Lewis was first diagnosed with type 1 diabetes 69 years ago but has also spent most of his adult life as a competitive swimmer. He only eased up on the competition at age 71, after a back injury got in the way of his breaststroke.

That setback is only temporary, he said. "The old juices are still flowing, so I have a feeling that I will get back into competitive swimming in about a year," Lewis said.

Experts say that type of can-do attitude, coupled with steadfast attention to blood sugar monitoring, diet and exercise, are the keys that allow diabetics to live well into their 70s, 80s, and even beyond.

Diabetes care has certainly improved since the Clevelands and Lewis were diagnosed as children. Today, high-tech pocket-sized glucose monitors mean quick, easy blood-sugar monitoring is literally at your fingertips. Insulin delivery is also easier than ever.

In the 1930s and 1940s, however, blood sugar could only be tested at home via urine sampling, which provided patients with only a much-delayed look at blood glucose levels. Medical crises -- moments when sugar levels dipped so low a coma might result -- were common.

"When you talk to the elderly with diabetes who have gotten to live to today, they have lived through a time and place when we really couldn't take care of diabetes very well," said Dr. Larry Deeb, immediate past president for medicine and science at the American Diabetes Association.
"However, even then, they made the commitment to take care of themselves," he added. "They reviewed their urine glucose, they took their insulin every day, they watched their diet and were active."

"It takes a huge commitment to take care of yourself with diabetes, to mind it every day," he said. "There's never a day off."

And yet, most elderly diabetics say that managing their diabetes quickly became routine.
"I think I was so focused on what was of interest to me in my life that diabetes was simply something I got used to," Lewis said. "It became just a hurdle I needed to go through to get someplace."

Indeed, many older diabetics may have lived so long, because "they have turned their diabetes into an asset," explained Dr. Sheri Colberg, a Virginia Beach, Va., exercise physiologist who has done much research on diabetes, longevity and lifestyle.

Colberg -- a type 1 diabetic herself -- interviewed dozens of diabetic seniors for her book, 50 Secrets of the Longest Living People With Diabetes. "I actually had some people who told me, 'Diabetes saved my life,' " she said. "They said to themselves, 'If I don't do this, I am going to die sooner.' They used diabetes as an incentive to adopt a healthier lifestyle, better eating patterns. And to stay physically active -- every one of them was physically active."

That's something Cleveland and Lewis agreed with.

"I've always been more of an outdoor person and more interested in exercise, games, swimming, thing like that," Cleveland said. "They were definitely advantageous for a diabetic."
Lewis added that the discipline and energy expenditure demanded by competitive swimming forced him early on to closely track his blood sugar highs and lows.

"I would advise people to test frequently, to get to know what your own [blood sugar] profile is, and then to set up a game plan to deal with those effects," he said.

Exercise also helps people stay slim, which is always a good thing when it comes to either type 1 or adult-onset type 2 diabetes, Deeb said. Indeed, all of the advice for people with type 1 disease would apply to the greater population of people with type 2 illness, he said.

Another key to a long, healthy life with diabetes: the support of loved ones.

Lewis said his wife, Carolyn, has helped him manage his diabetes for more than 50 years.

Cleveland credits Ruth with helping him get him through the tough times.

"I got married at age 27, and my wife has done the most wonderful job of helping me that anyone ever could," Cleveland said.

Ruth Cleveland said her husband initially kept his diabetes a secret from her when they were first courting more than 60 years ago, due to the stigma then attached to the disease.

"He claims he was afraid to tell me, afraid that I wouldn't want to continue seeing him," she said.
Those fears were unfounded.

"If anything, it made me appreciate him more and want to be a part of his life," Ruth said. "Which has turned out to be wonderful."

More information
Find out more on managing diabetes at the American Diabetes Association.

Arthritis-related disability can have a major impact on a person's employment, forcing them to change work hours, the type and na

(HealthDay News) -- Living farther away from transplant centers doesn't explain why black Americans with end-stage renal (kidney) disease are less apt than whites to be placed on the kidney transplant waiting list, researchers say.

A team that analyzed data on end-stage renal (kidney) disease patients in Georgia and the Carolinas from 1998 to 2002 found that black patients in poorer neighborhoods were 56 percent less likely to than whites to be placed on the transplant waiting list.

"This finding warrants further exploration but suggests that racial disparity in the wait-listing process may indeed be a reflection of differential access to health care," study co-author Dr. Sandra Amaral, of Emory University in Atlanta, said in a prepared statement.

Of the almost 12,600 patients (62 percent of them black) included in the study, 17 percent were placed on the kidney transplant waiting list during the study period. Black patients were more likely than whites (27 percent versus 9 percent) to live in areas where more than 25 percent of the population lived below the poverty line.

The researchers had hypothesized that patients who lived farther from transplant centers would be less likely to be placed on the kidney transplant waiting list. But they found that distance to the transplant center didn't have a major impact on the likelihood of being placed on the list. They did find that black patients living in poorer neighborhoods were 56 percent less likely than whites to make it on the list.

"Racial disparities persist in the U.S. transplantation process," Amaral said. "The reasons for this are poorly understood, but multiple factors are likely involved."

"To our knowledge, this is the first study to examine the impact of community poverty on racial disparity in transplant wait-listing. It also introduces a potential new approach to addressing the disparities: reaching out to poorer communities with advocacy and education," she said.

The study was scheduled to be presented at the American Society of Nephrology annual meeting, in San Francisco.

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

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New Heart Pump Helps Women Awaiting Transplants

(HealthDay News) -- An implantable device that helps the heart pump blood -- and is about the size of a "D" battery, one-quarter the weight of the traditional device -- benefits women as well as men who are waiting for heart transplants.

That's the conclusion of new research that's expected to be presented Sunday at the American Heart Association annual meeting in Orlando, Fla.

"In the past, they were not as beneficial in women as in men, partly because of size," said Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City. "It didn't match up anatomically."

The new device in question, the HeartMate II, is an implantable left ventricular assist device that helps heart function in people with severe congestive heart failure. The U.S. Food and Drug Administration is currently reviewing an application to approve the pump-like device.

According to background information for the study, women with advanced heart failure tended to be underrepresented in studies of left ventricular assist devices (LVADs). Only 9 percent to 16 percent of participants in trials of the first generation of the device were women.

The new trial included 231 patients with heart failure, 23 percent of whom were women being treated at one of 40 different U.S. heart transplant centers and were awaiting heart transplants.

The device serves as a "bridge" to transplantation.

The average age of the women was 56 (the range was 20 to 69 years). Men in the study averaged 54 years old, with an age range of 17 to 68.

Coronary artery disease was more likely to be the cause of heart failure in men -- 43 percent, compared with 31 percent in women.

The women may have suffered a weakened heart because of pregnancy, cancer chemotherapy, a viral infection or some other unknown cause, the researchers said.

Several study participants regained enough pumping power in the heart to have the device removed and no longer needed a transplant. And they've resumed normal physical activities, said the study authors, who are affiliated with such research centers as the Texas Heart Institute in Houston; the University of Rochester in New York; Johns Hopkins Hospital in Baltimore; Duke University, in Durham, N.C.; and Massachusetts General Hospital, in Boston.
Among the study's other findings:

• Six-month survival was about the same for men and women -- 80.6 percent versus 79.5 percent.
• The study found that 3.3 percent of women and 2.2 percent of men experienced strokes within two days of surgery; 13.6 percent of women and 4 percent of men experienced strokes after that.
• After three months with the device, 76 percent of women and 57 percent of men had increased the distance they could walk in six minutes by more than 200 meters.
• Functionally, it helped women more than men," Steinbaum said.
  At the beginning of the study, all patients had Class IV heart failure, meaning they couldn't engage in any physical activity without discomfort. After three months with the device, 84 percent of women and men had only Class I and Class II heart failure symptoms -- no or slight limitations on physical activity. "Eighty-four percent of men and women went from Class IV heart failure -- they couldn't even move without being short of breath -- to Class I and II," Steinbaum said. "It's very exciting."

The trial was funded by Thoratec Corp. of Pleasanton, Calif., which manufactures the device.

One of the study authors is the company's vice president for research and scientific affairs. The other study authors are consultants and serve on a Thoratec advisory board.

More information
The American Heart Association has more on left ventricular assist devices.

Radiation Seed Treatment Helps Younger Men Fight Prostate Cancer

(HealthDay News) -- Radiation seed implants, known as brachytherapy, are just as effective for treating prostate cancer in men 60 and younger as they are for older men, a new study finds.
Brachytherapy is a minimally invasive procedure in which small radioactive seeds are placed in the prostate to kill cancer cells. Recovery time after seed implantation is much shorter than surgery, and studies have found brachytherapy to be as effective as surgery.

However, men 60 and younger are often advised to have surgery to remove part or all of the prostate, because many surgeons believe it's more effective long-term, according to background information in a news release about the study.

In this study, researchers analyzed the outcomes of more than 1,700 men with localized prostate cancer treated with brachytherapy at Mount Sinai Medical Center in New York between 1990 and 2005.

They found that men 60 and younger had the same outcomes as older men.

"These results suggest that brachytherapy is extremely effective in curing localized prostate cancer for men aged 60 and younger," lead author Dr. Alice Ho, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York, said in a prepared statement.

"When younger men are diagnosed with localized prostate cancer, they should be presented with all viable treatment options, including brachytherapy. Every man with prostate cancer, regardless of his age, should have access to the treatment that is best for his cancer and lifestyle," Ho said.

The findings were expected to be presented Wednesday at the American Society for Therapeutic Radiology and Oncology annual meeting, in Los Angeles.

More information
The American Academy of Family Physicians outlines prostate cancer treatment options.