FDA finds more traces of toxics in formula

Several samples of infant formula have tested positive for trace amounts of the toxic contaminant melamine or a related compound, the Food and Drug Administration said Thursday. full story

Tooth Replacement Options

A: Tooth replacement options are now more accessible than ever. By "permanent tooth replacement," I assume you mean a non-removable restoration. Some of your choices include dental implants, permanent fixed bridges, acid-etched bridges (Maryland splints), and chairside bonded bridges.... Read more

Texting Food Diaries Helps Kids Stick With Diets

(HealthDay News) -- Experts hope that letting kids have their fingers do the texting will increase compliance with the food diaries that are such a critical part of successful dieting.

As a first proof that such a method might work, a new University of North Carolina study shows that kids aged 5 to 13 are almost twice as likely to text daily records of their food intake, exercise and screen time as those using the old-fashioned kinds of diaries. The research was published in the November/December issue of the Journal of Nutrition Education and Behavior.

Previous studies have shown that dieters who keep these types of records are more likely to lose weight and to keep it off, according to study author Jennifer Shapiro, an assistant professor in the department of psychiatry.

"What we're looking for is a fun way for people, particularly children," to keep these diaries, Shapiro said. "If people enjoy doing it, they're more likely to do it and more likely to lose weight."



The eight-week study following 31 families with children aged 5 to 13 showed that those kids who used text messaging were almost twice as likely to comply with the program than kids who used paper and pencil.

The popularity of this approach was demonstrated by the fact 100 percent of the participating children and parents initially said they hoped they would be selected for the text-messaging group.

In the study, an immediate text message responded to the children's report on how well they met their goals. Children who used the paper-and-pencil diaries had to wait a week to report to their nutritionist for a response to their progress.

"Feedback is very important," Shapiro explained. "It makes them feel like there is someone on the other line paying attention, and they need to be more accountable."

The study's goal was to measure adherence to the dieting diary process and did not measure weight loss, Shapiro said. Because it was such a small study, the results did not reach statistical significance, but the researchers hope to repeat the study with a larger population and for a longer time.

"The idea of text messaging is really interesting, particularly to communicate with a new generation," added Dorothy Teegarden, a professor in the department of foods and nutrition at Purdue University.

But Teegarden agreed further research needs to be done on the effectiveness of this approach, given the wide gap in the age range and the fact that parents also were involved. She explained that some research shows that it's easier to modify behavior within the context of a family environment. "So, just that part of the study might have contributed to better compliance," she added.

The fact that all of the kids wanted to be part of the text-messaging group also may have biased the study, said Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. The children who were assigned the paper-and-pencil diary might not have been as compliant, because they didn't get the tool they wanted, she explained.

Research has shown that 19 percent of kids aged 6 to 11 are overweight, and 80 percent of those kids become obese adults, according to the study.

More information
For more on children and obesity, go to the U.S. National Institutes of Health.

Alternative Medicine - Videos

From yoga techniques to acupuncture to herbal supplements, learn all about alternative therapies, medicines and nutrition.... Read more

Peppermint Oil, Fiber Can Fight Irritable Bowel

(HealthDay News) -- For some patients, the best therapy for irritable bowel syndrome (IBS) may be older, cheaper drugs such as fiber, antispasmodics and peppermint oil, a new study finds.
According to researchers, these simple treatments have fallen out of favor because of the availability of newer (and more expensive) drugs, some of which have been taken off the market due to safety concerns.

But more traditional therapies should become first-line treatments in guidelines for the treatment of IBS, the experts say.

"IBS can be difficult for physicians to treat," noted lead researcher Dr. Alex Ford, from McMaster University, Health Sciences Centre in Ontario, Canada.

"New drugs are always being developed, but recent ones such as alosetron and tegaserod have been withdrawn, and are now only available on a restricted basis, and renzapride has not been shown to be effective," he said. On the other hand "older drugs, which are cheap, safe, and in some cases available over the counter, appear to be effective in IBS."

The report is published in the Nov. 14 online edition of the BMJ.

As many as 45 million Americans may have IBS, the International Foundation for Functional Gastrointestinal Disorders reports. Between 60 percent and 65 percent of IBS sufferers are women.

In addition to pain and discomfort, people with IBS experience chronic or recurrent constipation or diarrhea -- or bouts of both. While the exact cause of the condition isn't known, symptoms seem to result from a disturbance in the interaction of the gut, brain and nervous system, according to the foundation.

For the study, Ford's team reviewed trials that compared IBS treatment with fiber antispasmodics and peppermint oil to a placebo or no treatment. The trials included more than 2,500 IBS patients.

The researchers found that fiber, antispasmodics and peppermint oil were effective treatments for IBS. Specifically, that meant that to prevent IBS symptoms in one patient, 11 needed to be treated with fiber, five with antispasmodics, and 2.5 with peppermint oil.

There were no serious side effects associated with any of these treatments, the researchers note.

Peppermint oil appeared to be the most effective therapy of those reviewed, the researchers found.

In trials comparing fiber with placebo, insoluble fiber such as bran was not effective. Instead, only soluble fiber, such as ispaghula husk, reduced symptoms. For antispasmodics, the most effective was hyoscine. This should be used first among antispasmodics, Ford's group advised.

"Physicians, particularly those in primary care, who are being asked to take increasing responsibility for the management of IBS, should consider the use of these agents as first-line therapies for IBS," Ford said.

Dr. Roger Jones, from Kings College London and author of an accompanying journal editorial, welcomed the study.

"These treatments might be slightly more effective than recently thought and they are worth trying," Jones said.

For some patients with pain and diarrhea the antispasmodics may be useful. Patients with constipation should try fiber and for other patients, peppermint oil may be helpful, Jones said.

"If you have IBS which is not under reasonably good control or you are not happy with your symptom profile, you should see your primary-care doc or gastroenterologist for review and perhaps remind them that there is new evidence about the effectiveness of these traditional medicines and you would like to give it a go," Jones said.

"Alternatively, if you feel sufficiently well-informed and confident, you can go do it yourself and get these treatments at the pharmacy," Jones added.

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

Beta Blocker Use Questioned in Non-Heart Surgery

(HealthDay News) -- An analysis of 33 studies on drugs known as beta blockers has concluded that they are not useful in any surgical procedure other than heart surgery. In fact, using beta blockers for non-coronary surgery may actually increase the risk of stroke, the scientists say.

The researchers who conducted the study -- known as a meta-analysis -- recommend that the guidelines committees of both the American College of Cardiology and the American Heart Association "soften" their recommendations that beta blockers be used to prevent surgical complications in non-coronary operations.

"Our study says that if you look at the overall picture, do a meta-analysis, studies that are not particularly well-done come to the conclusion that they are useful," said Dr. Franz Messerli, professor of medicine at Columbia University and an author of a report published online by The Lancet to coincide with the annual heart meeting now underway. "But if you look at the high-quality studies, there are distinctly more strokes with beta blockers." Beta blockers are drugs that inhibit adrenaline and slow the nerve impulses to the heart. They can also be used to treat irregular heartbeat, known as arrhythmia.

The meta-analysis did show a 35 percent reduced risk of heart attacks and a 64 percent reduction in less serious heart artery blockages among the more than 12,000 participants in all the studies where beta blockers were prescribed before surgery. But there was no overall reduction in total deaths, heart failure or deaths due to heart disease, and a doubled risk of nonfatal stroke.

Beta blocker usage was also associated with a high risk of bradycardia, low heart rate requiring medical treatment, which occurred in 1 of every 22 people getting beta blockers, and of lower blood pressure dangerous enough to require treatment.

In September 2008, researchers writing in the Journal of the American College of Cardiology concluded that beta blocker drugs don't prevent development of heart failure in people with high blood pressure and should not be used as first-line treatment for hypertension.

The increased risk of stroke, occurring in 1 of every 293 beta blocker recipients, is especially important, Messerli said. "Stroke is one of the most devastating complications of cardiovascular disease," he said. "For that reason, we would be very reluctant to use beta blockers in noncomplicated patients."

There is a presurgical role for beta blockers in many cases, Messerli said. "If a patient has coronary artery disease, he or she should certainly be on beta blockers," he said. "If they are on beta blockers already, they should remain on beta blockers. But if there is no particular cardiovascular risk, beta blockers should not be prescribed for noncardiac procedures."

Existing recommendations that call for routine use of beta blockers before surgery should be revised, Messerli said. "This is regarded as a quality measure for physicians," he said. "If they don't prescribe a beta blocker, it is considered to be falling short of a quality measure. Since the data are relatively soft, it certainly should not be a quality measure."

But an argument for use of beta blockers before surgery was made in an accompanying comment to the study by Dr. Don Poldermans, professor of medicine at Erasmus Medical Center in Rotterdam, the Netherlands. One major problem with studies showing difficulties when beta blockers were prescribed was that the doses were too high, Poldermans said.

"A low dose is safe, so why not use it?" Poldermans said, citing a study that he presented to the American Heart Association's annual scientific sessions, in New Orleans.

The study of 1,066 people who underwent surgery and were classified as being of intermediate risk of cardiovascular complications found that 2.1 percent of those getting a moderate daily dose of bisoprolol, a widely used beta blocker, suffered heart attacks or died of heart disease, compared to 6 percent of those not getting the beta blocker, Poldermans reported.

What might help decide the issue would be "a study to clarify dose and regimen" of beta blockers before surgery, he said. But such a study might be difficult to do, because the dangers of high-dose beta blockers are clear, Poldermans said.

"I would be very careful with high doses of beta blockers," he said. "There could be an increased risk of stroke. But a low dose is safe, so why take a high dose?"

More information
Learn why and how beta blockers are used from the Texas Heart Institute.

Statin Might Help More People Fight Heart Disease Than Thought

(HealthDay News) -- A widely used cholesterol-lowering drug appears to protect against heart attacks, stroke and other adverse outcomes in people who do not have high cholesterol.

The patients receiving the drug, Crestor (rosuvastatin), did have high levels of C-reactive protein (CRP), a marker for the inflammation process which is implicated in hardening of the arteries.

The study, sponsored by drug maker AstraZeneca and conducted by researchers at Brigham and Women's Hospital in Boston and colleagues, was presented Sunday at the American Heart Association's annual scientific sessions, in New Orleans. It will also be published in the Nov. 20 issue of the New England Journal of Medicine.

Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at New York University's Langone Medical Center, believes these results will change practice and will expand the universe of people who can benefit from the drug.

"This article conveys clearly that if all you do is use LDL cholesterol as a discriminator for cardiovascular risk, you are going to underestimate cardiovascular risk substantially," he said. "Individuals even with modest LDL can have considerable cardiovascular risk when other factors are present."

One of the study authors agreed. "This shifts the paradigm for evaluating risk and treatment," said Dr. Antonio M. Gotto Jr., dean of Weill Cornell Medical College in New York City.

In a statement, Dr. Elizabeth G. Nabel, director of the U.S. National Heart, Lung, and Blood Institute (NHLBI), acknowledged this study and two others concerning CRP.

"New results from three studies being presented at the American Heart Association (AHA) Scientific Sessions in New Orleans and published in scientific journals today provide the strongest evidence to date that a simple blood test for high-sensitivity C-reactive protein (hsCRP) is a useful marker for cardiovascular disease," she said.

But other experts urged caution.

"We have to really not lose sight of traditional guidelines," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. "This is very interesting, but I think we have to wait and see."

According to the NHLBI, about 450,000 Americans will die of coronary heart disease, which is the leading cause of death for both men and women.

People with increased levels of CRP, a marker of inflammation, have a higher risk for cardiovascular events. And about half of all heart attacks and strokes occur in apparently healthy people with lower LDL levels.

Statins are known to lower CRP levels, in addition to cholesterol levels.

The JUPITER trial randomized almost 18,000 men and women with LDL cholesterol levels less than 130 milligrams per deciliter (130 is considered "borderline high") and CRP levels of 2 milligrams per liter or higher (considered average risk) to take 20 milligrams of Crestor daily or a placebo.

Men were 50 years or older, while women were 60 or older, with no history of cardiovascular disease, no diabetes and no uncontrolled hypertension.

"These people would not have been candidates for statins," Weintraub said. "The use of statins right now is entirely related to LDL cholesterol."

The trial was halted after only two of four planned years of follow-up, when researchers noted a significant reduction (44 percent) in the primary endpoint -- a composite of cardiovascular events including heart attack, stroke and death.

Crestor reduced LDL levels by 50 percent and CRP levels by 37 percent.

"We estimate that the application of this simple screening and treatment strategy, when used over a five-year period, would prevent more than 250,000 heart attacks, strokes, revascularizations and cardiovascular deaths in the U.S. alone," said study author Dr. Paul Ridker.

However, one expert was more cautious.

"We cannot say cannot say CRP is a risk factor nor a causal mediator," said Dr. Andrew Tonkin, head of the cardiovascular research unit at Monash University in Melbourne, Australia. "I don't think we would screen everyone, not at all at this time. We need to know the absolute risk reductions."

The findings do indicate that women could be taking statins for primary prevention, Gotto said. But the specific age group these findings relate to needs to be kept in mind.

Weintraub doubted that the benefit would be seen with all drugs in the class of statins. "There are features in each of the drugs that makes it better or not as good an anti-inflammatory agent," he said.

More information
The American Heart Association has more on C-reactive protein.

Five steps to getting a second opinion online

Not sure your doctor's got it right? Get a second opinion without ever leaving your living room. In this week's Empowered Patient, CNN Medical Correspondent Elizabeth Cohen tells you how to get a second opinion from one of the nation's top doctors. full story

6 Simple Ways a Woman Can Be Healthy Every Day

6 Simple Ways a Woman Can Be Healthy Every Day - By cutting down on the number of calories taken in and being physically active , women can reduce their chances of becoming overweight or overweight or obese.... Read more