Water, Water, Everywhere, but Is It Safe to Swim?

by Elizabeth Peterson, MFA

It’s a favorite summertime activity for all ages. In fact, swimming or relaxing in recreational water, such as swimming pools, water parks, hot tubs, lakes, rivers, or the ocean is one of the most popular activities in the country. However, in the past decade, more than 15,000 swimmers have become ill from recreational water illnesses. As more and more of us take to the water every year, recreational water illnesses are becoming a very real concern.

In swimming pools, germs, such as Cryptosporidium, E coli,Giardia, Shigella, and Hepatitis A are the most common causes of recreational water illnesses. These germs enter the water primarily through fecal contamination. Exposure to these contaminants usually manifests as diarrhea. However, contaminated water may also cause skin rashes, ear infections, or respiratory infections.

And while it’s true that chlorine does kill these germs, insufficient maintenance of chlorine levels and filtering systems may impact the effectiveness of chlorination. In addition, chlorine takes time to work, even in the most stringently maintained swimming facilities. While E coli is destroyed in less than a minute, Hepatitis A and Giardia take 16 minutes and 45 minutes respectively. Cryptosporidium, which is highly resistant to chlorine, may take as long as seven days to be killed by chlorine.

In lakes, rivers, and oceans, pollution by raw sewage is the largest culprit for water contamination with disease-causing organisms, such as bacteria, viruses, protozoa, and worms. And of course, open water isn’t chlorinated. This means that your best defense is a good offense, and you should check with your local pollution control authorities regarding water quality at your favorite beach before you go. You can also check the US Environmental Protection Agency’s (EPA) beach watch website at http://www.epa.gov/OST/beaches.

In addition to fecal contamination, swimming pools, hot tubs, and water parks may also be contaminated by vomit or blood in the water. The US Centers for Disease Control and Prevention (CDC) publishes guidelines for the maintenance and care of these facilities and recommends procedures to deal with any of the above mentioned types of contamination.

If your favorite spot to relax happens to be a swimming pool, water park, or hot tub, check with the pool’s management and staff to make sure they are aware of these recommendations and have a clear plan for responding to any type of water contamination.

If your favorite water spot is a public beach, here are some questions the EPA suggests you ask your local beach-monitoring official so you can stay safe:

• Which beaches do you monitor and how often?
• Where can I see the test results and who can explain them to me?
• What are the primary sources of pollution that affect this beach?

If your favorite beach is not monitored regularly, here are some things you can do to protect yourself and your family:

• Avoid swimming after a heavy rain.
• Look for storm drains along the beach. Don’t swim near them.
• If the waters of your beach have been designated as a no-discharge zone for vessel sewage, check to see if boat pump out facilities are available and working.
• Look for trash and other signs of pollution, such as oil slicks in the water.
• If you think your local beach is contaminated, contact your local health or environmental protection officials.
•    Work with your local authorities to create a monitoring program.

The CDC has published “PLEAs” for healthy swimming to help you protect yourself against recreational water illnesses. Following these six recommendations will go a long way in ensuring everyone has fun in the water this summer!

1. Please don’t swim, or allow your child to swim, if either of you has diarrhea. Contrary to popular belief, diapers—even those designed for swimming—do not prevent fecal matter from leaking into the water. Allowing your kids to swim with diarrhea, or doing so yourself, may easily spread germs that could make you, your children, or others sick.
2. Please don’t drink the water, and if possible, try to avoid getting it in your mouth. Children should be instructed that this water is not for drinking.
3. Please wash your hands after using the toilet or after changing a baby’s diapers.
4. Please take your children to the bathroom often. “Mommy, I have to . . .” may come too late to prevent an accident.
5. Please change your children’s diapers in the bathroom or in a designated changing area, not by the side of the pool.
6. Please bathe your children thoroughly before they get in the water. The cleaner your children, the cleaner the water.

RESOURCES:

United States Centers for Disease Control and Prevention
http://www.cdc.gov/

United States Environmental Protection Agency
http://www.epa.gov/

World Health Organization
http://www.who.int/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/index-eng.php

References:

Before you go to the beach. United States Environmental Protection Agency website. Available at: http://www.epa.gov/ . Accessed May 19, 2008.

Healthy swimming 2003. Division of Parasitic Diseases. United States Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/healthyswimming . Accessed May 19, 2008.

Last reviewed May 2008 by Marcin Chwistek, MD
Last Updated: 6/10/2008

Sun Exposure: Finding a Balance

by Krisha McCoy, MS

Skin cancer is the most common type of cancer diagnosed in the United States. Since the main cause of skin cancer is ultraviolet (UV) rays from the sun, people are becoming more conscious of the harmful effects of sun exposure.

Since the 1980s, Americans have transitioned from slathering on baby oil and baking in the sun to covering themselves with high SPF (sun protection factor) sunscreens and avoiding midday sun. While there are still many sun worshipers out there, most people are now aware of the risks of sun exposure.

The National Cancer Institute recommends avoiding the sun between 11 am and 3 pm whenever possible, wearing protective clothing (e.g., sun hats, long sleeves), and using sunscreen with an SPF of at least 15 or 30. Similarly, the American Academy of Dermatology recommends staying out of the sun between 10 am and 4 pm, wearing protective clothing, and applying broad-spectrum sunscreen (the kind that protects against both UVA and UVB rays) with an SPF of 15 or higher.

The sun, however, does have certain health benefits. It can enhance your mood, protect against certain diseases, and boost your level of vitamin D. And recent studies have suggested that sun exposure may help prevent certain types of cancer. So should sun protection guidelines change? Should people work to balance their level of sun exposure—finding a common ground between getting enough, but not too much, rather than avoiding the sun altogether?

Each year, about a million Americans are diagnosed with skin cancer. Of these, an estimated 54,000 (5%) have melanoma, the most deadly form of skin cancer. While non-melanoma skin cancers (basal and squamous cell carcinomas) rarely spread, melanoma can spread to other parts of the body.

Ultraviolet rays from the sun are the main cause of skin cancer. Scientists have discovered that people who live in climates closer to the sun are more likely to get skin cancer. To demonstrate, skin cancer is more common in people living in Texas than in Minnesota, and the highest rates of skin cancer are found in South Africa and Australia.

Fortunately, for the most part, skin cancer can be prevented with safe and consistent sun protection. But since the damaging effects of the sun start early in life, it is important to begin practicing sun protection in childhood.

The warmth and light generated by the sun can enhance your feeling of well-being and stimulate blood circulation. Sun exposure can also help prevent Seasonal Affective Disorder (SAD), a condition that results in bouts of depression in the late fall and winter, when exposure to sunlight is reduced.

Furthermore, the sun triggers your skin to synthesize vitamin D. While vitamin D is found in foods, including fortified milk and cereals, cod liver oil, and certain fish, many people don’t get enough of it from foods, so the sun provides most people with their vitamin D requirement. The catch is that sunscreen blocks the production of vitamin D.

With 10-15 minutes of sun exposure to the face, arms, hands, or back without sunscreen at least two times per week, most people can get an adequate level of vitamin D. However, people who live in northern or cloudy climates during certain times of the year may not be able to synthesize enough vitamin D from the sun.

Adequate levels of vitamin D prevent rickets in children and osteomalacia in adults (both are diseases that weaken bones). In addition, vitamin D may help maintain a healthy immune system, promote normal cell growth, and prevent osteoporosis.

Interestingly, a number of studies have linked sun exposure to a reduced risk of cancer.

An article published in Preventive Medicine in November 1990 found that the risk of fatal breast cancer in the United States was higher in the northeast and lower in the south and southwest, indicating that sunlight exposure may protect against death from breast cancer. And in 1999, the National Institutes of Health published a report that showed that people living in northern states are more likely to die from a number of cancers, compared to those living in southern states.

More recently, two studies in the February 2, 2005 issue of the Journal of the National Cancer Institute provided striking evidence of the protective effect of sunlight against cancer. The first study looked at the level of sun damage to the skin, and history of sunscreen use, severe sunburn, and intermittent sun exposure in 528 people diagnosed with early-stage melanoma, a type of skin cancer. Other than sunscreen use, all measures of sun exposure were associated with a decreased risk of death from melanoma.

The second study compared 3,700 people with malignant lymphomas to 3,200 people without cancer. The researchers found that high frequencies of sunbathing and sunburns before age 21 were associated with a significant 30% to 40% reduction in the risk of developing non-Hodgkin’s lymphoma.

Two more studies, one in the June 15, 2005 issue of Cancer Research and one in the April 2005 issue of Mutation Research, indicated that increased levels of sun exposure may be associated with a lower risk of advanced prostate cancer.

Why might sun exposure be protective against cancer? Researchers don’t yet know for sure, but some propose that increased levels of vitamin D associated with sun exposure may have anti-cancer effects. In laboratory studies, vitamin D has been shown to inhibit cancer cell growth and induce death of cancer cells.

While the evidence continues to build that sun exposure may be protective against cancer, these studies are far from conclusive. They cannot say why people who are exposed to more sun are less likely to develop or die from cancer, so it is too early to go back to the days of baking in the sun.

Until there is enough evidence to make solid recommendations, the best advice is to use your own good judgment. Weigh your own personal risks versus benefits of moderate sun exposure and decide on a safe amount of sun for you.

While anyone can get skin cancer, people with fair skin, light-colored eyes, blonde or red hair, a tendency to burn or freckle, and a family or personal history of skin cancer are at higher risk. For most people, spending 10-15 minutes in the sun two or three times per week before applying sunscreen is a safe, healthful way to get an adequate amount of vitamin D.

RESOURCES:

American Academy of Dermatology
http://www.aad.org/

Skin Cancer Home Page
National Cancer Institute
http://www.nci.nih.gov/cancertopics/types/skin

References:

Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberie C, Barnhill R. Sun exposure and mortality from melanoma. Journal of the National Cancer Institute . 2005;97:195-199.

Blot WJ, McLaughlin JK. Geographic patterns of breast cancer among American Women. Journal of the National Cancer Institute . 1995;87:1819-1820.

Devesa SS, Grauman MA, Blot WJ, Pennello GA, Hoover RN, Fraumeni JF. Atlas of cancer mortality in the United States: 1950 to 1994. NIH Publication No. 99—4564, 1999.

Dietary supplement fact sheet: vitamin D. Office of Dietary Supplements website. Available at: http://ods.od.nih.gov/factsheets/vitamind.asp . Accessed July 4, 2005.

Emedby KE, Hjalgrim H, Melbye M, et al. Ultraviolet radiation exposure and risk of malignant melanomas. Journal of the National Cancer Institute . 2005;97:199-209.

Facts and statistics about skin cancer. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/chooseyourcover/skin.htm . Accessed July 4, 2005.

Moon SJ, Fryer AA, Strange RC. Ultraviolet radiation: effects on risks of prostate cancer and other internal cancers. Mutation Research . 2005;571:207-219.

Seasonal affective disorder. National Alliance for the Mentally Ill website. Available at: http://www.nami.or… . Accessed July 4, 2005.

The known health effects of UV. World Health Organization website. Available at: http://www.who.int/uv/faq/uvhealtfac/en/ . Accessed July 4, 2005.

What is skin cancer? American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/skincancernet/whatis.html . Accessed July 4, 2005.

What you need to know about skin cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/skin/page1 . Accessed July 4, 2005.

Last reviewed July 2005 by Larry Frisch, MD, MPH

Bras and gravity

By Maggie Roberge (The Bra Lady)

When I was a pre-teen of 13, I secretly envied my friends that had developed breasts early.  They were the ones that got to wear bras.  Regardless if it was only an AA or a D, it meant the same.  They had crossed the line to womanhood. It wasn’t the boys that first noticed this rite of passage; it was we, less endowed, girls ogling on the sidelines wondering when we would be next. While these gals may have been the ones envied back then, now, years later, having an ample bosom or any bosom for that matter, can be a different story. The muscles that were supple in youth lose their elasticity and gravity does take its course.  Those funny cartoons you see of Madeline, the frumpy old lady that has the boobs hanging to her knees? This picture isn’t far off for a lot of ladies.

I recently met up with a friend from high school. Donna was always one of the popular ones. She was cute with a curvy figure, and as we put it back then “well stacked”.  Today, she still has the great personality, but things have shifted somewhat. Those perky ladies that used to jut proudly out, well, for want of a better expression, took a nose dive. I found myself again ogling, not out of envy, but out of concern. When Donna walks, she looks as if she is striding downhill. Her body is being pulled forward by the weight of her breasts.    She moans and groans and talks about needing a breast reduction and suffers multiple issues. She has backaches, neck aches and indented lines where the bra strap is digging into her shoulders.  These are also signs that the bras she once wore are simply not right for her changing body.  Donna needed to take a serious look and toss the outdated bra that was allowing her breasts to dangle freestyle

Throughout the years it’s fairly common that women’s breasts grow and shrink.  When the body changes we need to adjust and wear undergarments that ‘serve’ us with correct support.  .Regardless of the size of bust one has, it is so important to pick a bra that fits right. This is especially true because as you get older the breasts begin to droop, lending not only to a matronly appearance, but also resulting in muscle discomfort and headaches.  The natural spine alignment is thrown off as the extra weight of the breast causes pressure on the back.   Naturally the first thing that comes to mind is, if I lose weight, I’ll lose breast weight and that will resolve the aches and pains. Right and wrong.  You may be healthier when you lose weight, but when the fat leaves the tissue, the breast is still left drooping and falling to the bottom of the bra cup.  The sagging breast tissues role off the chest wall and under the arm, and continues to pull on the neck which reduces the blood flow to the head.  The result?  Headache 101.  Having the right bra is one way to combat this for the tissue will be lifted up and supported.     

Now, my friend Donna really may need a breast reduction to help with her issues, but, without the correct bra afterwards she realizes that she could still be facing the same problems she is having now. As Oprah’s been saying on her show over the past few years, 85% of women are wearing the wrong bra.  Are you one of them? Think about it. Does your flesh squeeze over the top of your bra?  Does the back of your bra ride up? Does the shoulder strap leave deep gauges in your shoulder? Do you just look a bit frumpy and sagging? 

Do yourself a favor.  Have a fitting by a professional bra fitter.  The right bra will not only enhance your appearance, but it could be a contributing factor for helping to alleviate the back and neck problems you find yourself plagued with. 

Ladies, with the right bra, and the right fitting, the results can be simply ‘uplifting’. 

Maggie Roberge, “The Bra Lady” www.myessentialbodywear.com/beautyblooms 408-319-7612

Breast Cancer

by Laurie LaRusso, MS, ELS

Breast cancer is a disease in which cancer cells grow in the breast tissue.

Cancer occurs when cells in the body divide without control or order. If cells keep dividing uncontrollably, a mass of tissue forms. This is called a growth or tumor. The term cancer refers to malignant tumors. They can invade nearby tissue and spread to other parts of the body.

Although most people think of breast cancer as affecting women, men can develop breast cancer as well. Breast cancer in men can be more aggressive.

The cause of breast cancer is unknown. Research shows that certain risk factors are associated with the disease.

Factors that increase your risk for breast cancer include:

• Sex: female, although men can also get breast cancer
• Age: 50 or older
• Personal history of breast cancer
• Family members with breast cancer
• Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and lobular carcinoma in situ (LCIS)
• Changes in certain genes (BRCA1, BRCA2, and others)
• Race: Caucasian
•  Increased exposure to estrogen over a lifetime through:
• Early onset of menstruation
• Late onset of menopause
• No childbearing or late childbearing
• Absence of breast-feeding
• Taking hormone replacement therapy for long periods of time (Prempro for more than four years)
• Tobacco use
• Increased breast density (more lobular and ductal tissue and less fatty tissue)
• Radiation therapy before the age of 30 years old
• Overuse of alcohol

Note: Studies show that most women with known risk factors do not get breast cancer. Many women who get breast cancer have none of the risk factors listed above except age.

When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause the following changes:

• A lump or thickening in or near the breast or in the underarm area or in the neck
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
• Ridges or pitting of the breast skin (like the skin of an orange)
• A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these should see a doctor.

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Clinical breast exam—the size and texture of the lump is manually examined to determines whether the lump moves easily
• Mammography —x-rays of the breast used to see lumps or other changes in breast tissue
• Ultrasonography—the use of high-frequency sound waves to see whether a lump is a fluid-filled cyst or a solid mass
• Biopsy —removal of tumor tissue to be tested for cancer cells, types of biopsies for breast cancer include:
• Fine-needle aspiration—removal of fluid and/or cells from a breast lump using a thin needle
• Needle biopsy —removal of tissue with a needle from an area that looks suspicious on a mammogram but cannot be felt
• Surgical biopsy:
• Incisional biopsy—cutting out a sample of a lump or suspicious area
• Excisional biopsy—cutting out all of a lump or suspicious area and an area of healthy tissue around the edges
• Tissue evaluation—breast cancer tissue is tested for the presence of estrogen and progesterone receptors, as well as the presence of HER2/neu; these are used to help plan therapy
• Genetic testing—blood is evaluated for the presence of specific gene mutations in certain patients

Treatment   

Once breast cancer is found, staging tests are done. This will help to find out if the cancer has spread and, if so, to what extent.

Treatments include:

• Lumpectomy —removal of the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are also removed.
•  May also be called tylectomy or quadrantectomy
• Segmentectomy—removal of the cancer and a larger area of normal breast tissue around it.
• Simple mastectomy —removal of the breast, or as much of the breast as possible. The surgeon will try not to remove lymph nodes.
• Radical mastectomy—removal of the breast, both chest muscles, the lymph nodes under the arm, and some additional fat and skin. This procedure is only considered in rare cases. It is done if the cancer has spread to the chest muscles. This procedure is rarely done in the US at this time.
•  Modified radical mastectomy—removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles.
• Axillary lymph node dissection—removal of the lymph nodes under the arm. This is done to help determine whether cancer cells have entered the lymphatic system.
• Sentinel lymph node biopsy —a small amount of blue dye and/or a radioactive tracer is placed in the area where the tumor was located. The dye or tracer is then followed into the armpit. The lymph nodes that pick up the substance are removed. The accuracy rate for this procedure exceeds 95% in experienced hands. It reliably identifies those lymph nodes that may contain cancer. Presently, those remaining lymph nodes should be removed if any sentinel nodes contain cancer. This method is usually done in women who do not have lymph nodes that can be felt in the armpit. The potential side effects are far less than seen after a standard lymph node dissection.

Radiation Therapy

This is the use of radiation to kill cancer cells and shrink tumors. Two main types of radiation may be used:

• External radiation therapy—radiation directed at the breast from a source outside the body
•  Internal radiation therapy—radioactive materials placed into the breast in or near the cancer cells

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream. They travel through the body killing mostly cancer cells. Some healthy cells are killed as well.

The use of medications or substances made by the body. They can increase or restore the body’s natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.

Finding breast cancer early and treating it is the best way to prevent death from the disease. Breast cancer does not cause symptoms in the early stages. It is important to have screening exams and tests. These steps can help to find the cancer before symptoms appear.

• Women age 20 or older should perform a breast self-exam (BSE) every month
• Women between the ages of 20-39 should have a clinical breast exam by a health professional every three years
• A breast exam should be performed more regularly if there is a family history or there have been previous breast biopsies
• Women age 40 and older should have a screening mammogram every year
• Some advocate that a mammogram should be performed sooner for patients with a strong family history or whom have had previous breast biopsies performed
• After age 40, women should have a breast exam by a healthcare professional every year

Researchers are still studying the effectiveness of these measures. According to a study, getting regular mammograms starting at age 50 does appear to decrease deaths related to breast cancer.

RESOURCES:

American Cancer Society
http://www.cancer.org

CancerCare
http://www.cancercare.org/

CANADIAN RESOURCES:

Canadian Breast Cancer Foundation
http://www.cbcf.org/

Canadian Cancer Society
http://www.cancer.ca

References:

Cancer of the female breast. National Cancer Institute website. Available at: http://seer.cancer.gov/publications/survival/surv_breast.pdf . Accessed July 11, 2008.

Learn about brest cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/LRN/LRN_0.asp?dt=5 . Accessed July 11, 2008.

*¹12/21/2006 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomised controlled trial. Lancet . 2006;368:2053-2060.

Last reviewed February 2009 by Igor Puzanov, MD
Last Updated: 3/10/2009

A Healthy Dose of Optimism

by Elissa Sonnenberg, MSEd

Take a close look at that glass of water. Half empty? Half full? What you see could make a difference, not only in your daily health, but in how long you live.

So say the results of a new Mayo Clinic study that tracked 839 people over 30 years. In the 1960s, study participants took a standardized test to determine whether they were optimistic, pessimistic or somewhere in between. Those who scored high on the pessimism scale turned out to have a 19% greater chance of premature death than those who scored more optimistically.

“I believe we have compelling evidence that optimists and pessimists differ markedly in how long they will live,” says psychologist Martin Seligman of the University of Pennsylvania in his editorial accompanying the study. “It is not clear if pessimism shortens life, optimism prolongs life, or both.”

Seligman says there are at least four ways that optimism can affect longevity:

•  Optimists tend to be less passive than pessimists and less likely to develop learned helplessness or negative and debilitating responses to things that happen to them.
• Optimists tend to be more likely to practice preventive health measures because they believe their actions make a difference.
• Optimists suffer depression at a markedly lower rate than pessimists; depression is associated with mortality.
• Optimists’ immune systems have been shown to function more effectively than those of pessimists.

Learning to See the Bright Side

For decades, psychologists have studied the link between positive thinking and physical and mental health. According to Seligman, author of Learned Optimism: How to Change Your Mind and Your Life, it’s more important to change negative thought patterns into positive ones than to worry about being optimistic. The picture of optimism he paints is not one of Pollyanna-like blindness to reality, but of a learned optimism grounded in accuracy and non-negative thinking.

Based on the results of several large-scale, long-term, carefully controlled experiments, Seligman discovered that optimists are more successful than pessimists. Optimistic politicians win more elections, optimistic students get better grades, optimistic athletes win more contests, and optimistic salespeople make more money.

Why would this be so? In his book Self-help Stuff That Works, Adam Kahn says it is “Because optimism and pessimism both tend to be self-fulfilling prophecies. If you think a setback is permanent, why would you try to change it? Pessimistic explanations tend to make you feel defeated, making you less likely to take constructive action. Optimistic explanations, on the other hand, make you more likely to act. If you think the setback is only temporary, you’re apt to try to do something about it.”

How can you determine whether you think more optimistically or pessimistically?

“I don’t like to use the word pessimistic because most people would never consider themselves pessimistic,” says Khan, “but many people are willing to admit they aren’t optimistic.”

Khan, like Seligman and other experts on motivation, defines optimists and non-optimists by how they explain events in their lives. Optimists see setbacks as specific, temporary and changeable, and are therefore motivated to take action. Non-optimists tend to look at setbacks as general, permanent and hopeless, symptoms of widespread failure that cannot be changed.

For example, an optimist who didn’t follow through on an exercise routine for a week might say, “I had a lot going on this week. I didn’t plan my time too well. I’ll have to do better next week.” A pessimist in the same situation might say, “I have no self-discipline. I obviously won’t be able to meet my goals. Exercise just isn’t for me.”

Dr. Pierce Howard, author of The Owner’s Manual for the Brain, contends that the line between optimism and pessimism is far from clear-cut.

“You’re not just an optimist or a pessimist, it’s a matter of degree,” Dr. Howard says. “You can be successful in life anywhere along the continuum.” He points out that pessimistic thinkers make great tax accountants, while optimists are more suited for careers in sales.

Mood also has an influence on whether optimistic or pessimistic thoughts dominate your brain, according to Dr. Susan Vaughan, psychiatrist, psychoanalyst and researcher whose latest book, Half Empty, Half Full, explores how working to gain control over moods can result in more positive thinking.

“Mood is a powerful filter on how we see things,” maintains Vaughan, who sees most people as a blend of optimism and pessimism, depending on the situation with which they are faced.

She points to three methods optimistic people tend to use to lift their moods:

•  Alternative thinking—When bad things happen, optimists tend to take them less personally and come up with multiple alternatives for why they might have happened, then work actively to fix the situation.
• Downward comparison—Though it sounds unkind, optimists compare themselves to others who are in worse situations as a way to brighten their own spirits.
• Relaxation—Optimists tend to use exercise, yoga, and even “putting on a happy face” as ways to relax and thereby improve their moods.

Optimism Not Always the Answer    

“The idea that optimists are healthier than pessimists is overly simplistic,” says Dr. Howard Friedman, a psychology professor at the University of California, Riverside. “Many times, excessive optimism can be harmful to one’s health. This is especially evident among teenagers, who take many risks.”

Friedman contends it can be damaging to think optimistically when it comes to difficult health choices like quitting cigarettes, using condoms, or wearing seatbelts.

“I do not agree that in general we could try to make everyone more optimistic. There is absolutely no evidence that trying to do so will improve the general health of the population,” Friedman says.

Seligman concurs that there are times when it pays not to be optimistic, such as when planning for a risky future, when advising those with poor chances for the future and when trying to be sympathetic to others’ problems. When the cost of failure is high, he advises, optimism is the wrong strategy.

Still, there are times when optimism can be a powerful ally. When achievement is the goal, use optimism. If you’re fighting off depression, optimistic thoughts can boost your morale.

Seligman argues that optimism, like other interpersonal skills, can be learned.

“The way you explain setbacks to yourself is as much a habit as the way you tie your shoes,” agrees Khan. “It is no harder or easier to change a thought habit than it is to change a physical habit.” He recommends writing about setbacks and practicing arguing with your less optimistic thoughts until a more realistic vision of what has happened and what is likely to happen in the future emerges.

“It takes work, discipline, and focus,” Khan says. “But if you don’t think you have these things, those are the first non-optimistic thoughts to tear apart.”

RESOURCES:

American Counseling Association
http://www.counseling.org/

Positive psychology
http://psych.upenn.edu/seligman/pospsy.htm .

CANADIAN RESOURCES:

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp

Healthy Canadians
http://www.healthycanadians.gc.ca

REFERENCES

Positive psychology. Martin Seligman Research Alliance at the University of Pennsylvania website. Available at: http://psych.upenn.edu/seligman/pospsy.htm .

Segerstrom SC, Taylor SE, Kemeny ME, et al. Optimism is associated with mood, coping, and immune change in response to stress. J Pers Soc Psychol . 1998;74(6).

Last reviewed May 2009 by Rosalyn Carson-DeWitt, MD
Last Updated: 5/20/2009

Tobacco Use Disorder

(Nicotine Addiction; Smoking Addiction)

by Krisha McCoy, MS

Definition

Tobacco use disorder occurs when the use of tobacco harms a person’s health or social functioning, or when a person becomes dependent on tobacco. Tobacco may be consumed in the form of cigarettes, smokeless tobacco products (eg, snuff, chewing tobacco), cigars, or pipes.

This condition can be treated. Talk to your doctor if you think you have tobacco use disorder.

Causes

Tobacco products contain nicotine, which is transported to the brain and causes pleasurable sensations. The effects of nicotine dissipate within a few minutes, however. This cause tobacco users to continue using tobacco to maintain the pleasurable effects and prevent withdrawal. Other chemicals in tobacco products may also contribute to tobacco use disorder.

Risk Factors    

The following factors increase your chance of developing tobacco use disorder. If you have any of these risk factors, tell your doctor:

• Schizophrenia
• Post-traumatic stress disorder
• Bipolar disorder
• Major depression
• Other mental illness

Symptoms    

If you experience any of these symptoms, do not assume it is due to tobacco use disorder. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

• Nicotine “highs”
  • Increase in blood pressure, respiration, and heart rate
  • Hyperglycemia (abnormally high blood sugar level)
• Nicotine withdrawal
  • Irritability
  • Craving
  • Thinking and attention problems
  • Sleep disturbances
  • Increased appetite
  • Nervousness
  • Headache
• Tobacco-related health problems:
  • Smoker’s cough
  • Hot flashes in women * 6
  • Cancer, including cancers of the larynx (voice box), oral cavity, throat, esophagus, lung, and colon.
  • Chronic bronchitis
  • Emphysema
  • Chronic obstructive pulmonary disease
  • Heart disease
  • Stroke
  • Miscarriage, premature delivery, stillbirth, infant death, low birth weight, or sudden infant death syndrome (SIDS)
• Tobacco-related social problems

A study involving over 100,000 women found that smoking is associated with a shorter life span. After five years of quitting smoking, though, women had a reduced chance of dying compared to those who continued smoking.

Diagnosis    

Your doctor will ask about your symptoms and medical history, and perform a physical exam. He or she will ask you specific questions about your tobacco use, such as how long you have been using tobacco and how often you use it.

Your doctor can test your lung function and compare the results to those of a non-smoking person. The results can be given to you as your “lung age.” Knowing your “lung age” right after having the test done may help you to stop smoking. * 3

Treatment    

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT), including nicotine gum, nasal sprays, patches, and inhalers, are used to relieve nicotine withdrawal symptoms. They do not produce the pleasurable effects of tobacco products, so there is little chance NRT will be abused. Combining behaviorial therapy with NRT may be even more helpful. *¹

According to studies, NRT may help you to:

• Reduce the amount of tobacco you usually consume and quit altogether even if you are unable or unwilling to stop smoking *²
• Quit and stay smoke-free if you use the product before your actual “quit day” * 4
• Abstain from smoking * 5

Talk to you doctor about how to best use this therapy.

Behavioral Therapy

Behavioral therapies to help people quit using tobacco include:

• Step-by-step manuals
• Telephone quit lines
• Self-help classes
• Group behavior therapy—This may be more helpful than self-help programs. * 7
• Counseling
• Cognitive behavioral therapy —This teaches people to recognize high-risk tobacco use situations, develop alternate coping strategies, manage stress, improve problem-solving skills, and increase social support.

Other Medications

Research has shown that certain medications, including the antidepressant bupropion (Zyban) and varenicline tartrate (Chantix) may help people quit smoking. Varenicline tartrate helps ease symptoms of nicotine withdrawal and may block the effects of nicotine if people resume smoking.

A Note About the Effects of Secondhand Smoke Exposure  

Even if you’re not a smoker, exposure to smoke from tobacco products on a regular basis is dangerous, sometimes even life-threatening.

Here are the US Surgeon General’s conclusions about effects from inhaling secondhand smoke:

• Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.
• Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
• Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
• The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
• Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to secondhand smoke. But eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke.

Prevention    

The best way to prevent tobacco use disorder is to never use tobacco products. Tobacco products are highly addictive. Also, avoid regular exposure to secondhand smoke.

RESOURCES:

American Cancer Society
http://www.cancer.org

Smokefree.gov
Telephone: 1-800-QUITNOW
http://www.smokefree.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer….

The Lung Association
http://www.lung.ca/home-accueil_e.php

References:

Diagnostic codes (ICD9-CM). Surgeon General website. Available at: http://www.surgeongeneral.gov/tobacco/codes.htm . Accessed September 25, 2006.

Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA. 2008;299:2037-2047. In: Tobacco use disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 22, 2008.

Questions about smoking, tobacco, and health. American Cancer Society website. Available at: http://www.cancer.org/ . Accessed September 25, 2006.

Research report series: tobacco addiction. National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/ResearchReports/Nicotine/Nicotine.html . Accessed September 25, 2006.

* 1 2/27/2007 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob Control. 2006;280-285.

* 2 9/24/2007 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use [review]. Cochrane Database of Systematic Reviews. 2007;3.

* 3 3/25/2008 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336:598-600.

* 4 10/14/2008 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008;103:557-563.

* 5 12/16/2008 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008;179:135-144.

* 6 2/5/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Cochran CJ, Gallicchio L, Miller SR, Zacur H, Flaws JA. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstet Gynecol. 2008;112:1037-1044.

* 7 2/17/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2009;(1):CD001007.

Last reviewed January 2009 by Theodor B. Rais, MD
Last Updated: 2/23/2009

Osteoarthritis

(Degenerative Joint Disease; Arthritis, Osteo-)

by Editorial Staff and Contributors

Osteoarthritis is the breakdown of cartilage in the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.

Osteoarthritis is associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity.

These factors increase your chance of developing osteoarthritis. Tell your doctor if you have any of these risk factors:

·         Obesity

·         Genetic factors

·         Injury to the joint surface

·         Occupations and physical activities that put stress on joints

·         Neuromuscular disorders, like diabetes

Symptoms include:

·         Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time

·         Creaking or grating sound in the joint

·         Swelling, stiffness, limited movement of the joint, especially in the morning

·         Weakness in muscles around the sore joint

·         Deformity of the joint

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

·         X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones

·         Blood tests

·         Arthrocentesis —a procedure that involves withdrawing fluid from a joint

There is no treatment that stops cartilage loss or repairs cartilage that is damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.

Treatments may include:

• Over-the-counter pain medication
  • Acetaminophen (eg, Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg, Advil) and naproxen (eg, Aleve)
• Prescription Pain Relief Medication

o        Arthrotec —NSAID that may reduce the risk for gastrointestinal bleeding

o        Opiates and opiate-like medications

• Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps lubricate the joint
• Pain relief creams— capsaicin, methyl salicylate, and menthol

There is some evidence that glucosamine and chondroitin may relieve pain and/or decrease osteoarthritis progression. Talk with your doctor before taking any herbs and supplements.

Some doctors report that acupuncture has been successful in reducing the pain of osteoarthritis, although the evidence is not consistent.

While more studies are needed, balneotherapy (hot water therapy), relaxation therapy, exercise, yoga, and tai chi may be helpful.

Shoes with shock-absorbing soles may provide some relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain. Also, a firm mattress may help chronic back pain. Canes, crutches, walkers, and orthopedic shoes also can help those with advanced osteoarthritis in the lower body.

Losing weight can lessen the stress on joints affected by osteoarthritis. Losing five pounds can eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the greater the benefit.

Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis in the knee, exercise, including strength training, can also help improve knee function. * 1,

Swimming and water aerobics are good options because they don’t put stress on the joint.

If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you’re having difficulty rising after sitting.

Applying heat (with hot water bottles or heating pads) helps joints and muscles move more easily. It can also lessen pain. Using ice packs after activity can also help.

Corticosteroid injections to the inflamed joint may be given if other pain medicines do not work. Because repeated cortisone injections can be harmful to the cartilage, they are reserved for those with severe symptoms.

Surgery can:

·         Reposition bones to redistribute stress on the joint

·         Replace joints

·         Remove loose pieces of bone or cartilage from joints

To reduce your chance of getting osteoarthritis:

·         Maintain a healthy weight.

·         Do regular, gentle exercise (eg, walking, stretching, swimming, yoga).

·         Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.

·         With advancing age, certain activities may have to be dropped or modified. But, continue to be active.

RESOURCES:

American College of Rheumatology
http://www.rheumatology.org

The Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca

Seniors Canada On-line
http://www.seniors.gc.ca/

References:

American College of Rheumatology Subcommittee on Osteoarthritis. Recommendations for the medical management of osteoarthritis of the hip and knee. 2000 update. Arthritis Rheum . 2000;43:1905-1915.

Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp . Published July 2002. Updated May 2006. Accessed June 9, 2008.

Jordan K, Arden N, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis . 2003;62:1145-1155.

Osteoarthritis. EBSCO Natural and Alternative Treatment website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114 . Accessed March 4, 2008.

van den Berg WB. Pathophysiology of osteoarthritis. Joint Bone Spine . 2000;67:555-556.

*¹10/21/2008 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;CD004376.

Last reviewed February 2009 by Jill D. Landis, MD
Last Updated: 3/11/2009

Tips for Getting a Good Night Sleep

by Mary Calvagna, MS

Have you been tossing and turning and wondering if you will ever fall asleep? You are not alone–more than half of adults have trouble falling asleep. Learn why sleep is so important and what you can do to get some.

Here’s Why:

During sleep, the body repairs itself and revitalizes organs and muscles. In addition, sleep is important for proper functioning of the immune system and the nervous system. Lack of sleep can result in:

• Increased feelings of stress
• Impaired memory
• Shortened temper
• Lower motivation
• Slower reflexes
• More mistakes

But a good night sleep can be elusive. A survey conducted by the National Sleep Foundation found that 60% of adults have problems falling asleep at least a few nights a week.

Here’s How:

• Keep regular hours —Try to go to bed at the same time each night and wake up at the same time each morning, even on weekends.
• Develop a sleep ritual —Whether it is taking a hot bath, drinking a cup of herbal tea, or reading a book, doing the same things each night just before bed cues your body to settle down for the night.
• Exercise regularly —Exercise can help relieve tension. But be careful not to exercise too close to bedtime or you may have a hard time falling asleep.
• Cut down on stimulants —Consuming stimulants, such as caffeine, in the evening interferes with falling asleep and prevents deep sleep. Instead, have a cup of herbal tea, which is noncaffeinated, before bed.
• Don’t smoke —Smokers tend to take longer to fall asleep, awaken more often, and experience disrupted, fragmented sleep.
• Drink alcohol in moderation —You may fall asleep faster, but drinking alcohol shortly before bedtime interrupts and fragments sleep, leading to poor quality sleep.
• Unwind early in the evening —Deal with worries and distractions several hours before going to bed. Make a list of things you need to do tomorrow, so you won’t think about them all night. Try relaxation exercises, like slow rhythmic breathing.
• Sleep on a comfortable, supportive mattress and foundation —It’s difficult to get deep, restful sleep on a bed that’s too small, too soft, or too hard.
• Create a restful sleep environment —A dark, quiet room is more conducive to sleep. Sudden, loud noises or bright lights can disrupt sleep. A room that is too hot or too cold can disturb sleep as well. The ideal bedroom temperature is between 60-65°F.
• Use the bedroom only for sleep and sex —Don’t use the bedroom for things like paying bills, watching television, or discussing the problems of the day.
• Make sleep a priority —Say “yes” to sleep even when you’re tempted to stay up late. You’ll feel healthier, refreshed, and ready to take on the day!
• Light and cognitive behavioral therapy —For those who want better sleep without the use of drugs, “light therapy” and cognitive behavioral therapy have both been shown to have some benefit.
• Take prescribed sleep medications as directed —Sleep medications should only be used temporarily and as a last resort. If you do use them, follow your doctor’s recommendations.
• Generally, it is best to take sleeping pills one hour before bedtime, or 10 hours before you plan on getting up to avoid daytime drowsiness. Always talk with your doctor before taking sleeping pills, including over-the-counter brands. Some contain diphenhydramine, an anti-allergy substance, which may help you fall asleep quicker, but may not provide a more restful sleep. There also may be side effects.
• Melatonin, a natural hormone, is thought to help insomnia, but study results are inconsistent. Ramelteon (Rozerem), which works like melatonin, may be more effective. Tolerance to some sleep medications can happen quickly, and some may be addictive.

Remember that, in some cases, restless leg syndrome and sleep apnea can cause poor sleep quality. If you have questions about either of these conditions ask your doctor.

RESOURCES:

National Institute on Aging
http://www.nia.nih.gov/

National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca/

The Canadian Sleep Society (CSS)
http://www.css.to/

References:

Healthy sleep tips. National Sleep Foundation website. Available at: http://www.sleepfoundation.org . Accessed February 27, 2006.

Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114 Updated March 2008. Accessed June 16, 2008.

What is insomnia? National Institutes of Health website. Available at: http://www.nih.gov . Updated Accessed November 2006. Accessed June 16, 2008.

Last reviewed May 2008 by Ryan Estévez, MD, PhD, MPH
Last Updated: 6/17/2008

Progress in Stroke Prevention

by Elizabeth Smoots, MD

Medical experts are quietly but determinedly advancing the field of stroke prevention. Although the total number of deaths from stroke continues to rise, its death rate (deaths per 100,000 people) has dropped by approximately 12.3%. This partial success may be attributed to healthier lifestyles and improved medical care. Here is a summary of recent developments that are helping to prevent strokes in those most at risk.

A stroke occurs when an artery in the brain becomes blocked. This may occur from a blood clot or a burst blood vessel. Either way, the brain does not receive enough blood and oxygen and brain cells begin to die.

Many of the risk factors for stroke, such as high blood pressure, heart and blood vessel disease, high cholesterol, physical inactivity, obesity, diabetes, smoking and alcohol or drug abuse can be lowered or treated. Others, such as increasing age, family history of stroke, African American race, or prior stroke cannot be.

       High blood pressure: The most common and most preventable risk factor for stroke is high blood pressure. According to a review published in the September 18, 2002 issue of the Journal of the American Medical Association (JAMA), lowering blood pressure reduces the risk of stroke an average of 42%. The American Heart Association (AHA) recommends all adults have their blood pressure checked at least once every two years. A healthy blood pressure is less than 140/90. People with other conditions, such as diabetes, heart failure, or kidney failure should aim for a blood pressure of less than 130/85. There is evidence that reduction of blood pressure below these levels may provide further benefit in decreasing stroke.

       High cholesterol: Lowering cholesterol levels with diet or medication may help reduce the buildup of fatty arterial plaque that can trigger a stroke. The JAMA review found that people taking statins (an effective class of cholesterol-lowering drugs) reduced their risk of stroke by as much as 25%. In a separate recent clinical trial of daily atorvastatin (one type of statin) after recent stroke or “mini-stroke” (and no known coronary heart disease), atorvastatin reduced the risk of repeat stroke or heart attack. *¹ There is benefit in decreasing repeat strokes by treating with “statins” even in individuals with normal cholesterol levels. The AHA recommends adults have a fasting cholesterol check at least every five years. A desirable cholesterol is less than 200 mg/dl (5.2 mmol/L); 180 mg/dl (4.7 mmol/L) or lower in patients with known cardiovascular disease (CVD) or multiple CVD risk factors.

       Heart arrhythmias: Patients who have an irregular heart rhythm called atrial fibrillation and take warfarin (a blood thinner) may lower their risk for stroke by as much as two thirds. However, your doctor should monitor your condition carefully if you are taking warfarin therapy to watch for possible bleeding.

       Diabetes: If you have diabetes, keeping your blood pressure below 130/85 can reduce your risk of stroke by as much as 44%, according to the JAMA review. Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors are especially helpful for this purpose. Control of blood sugar is important as well in decreasing stroke risk.

       Smoking: Cigarette smokers have twice the risk of suffering a stroke as nonsmokers. However, if you stop smoking, your risk of stroke will fall to the same level as someone who never smoked within about five years. There are many smoking cessation aids available today, including working with your physician, taking support classes, or using nicotine patches, sprays, gum, or certain antidepressant drugs.

       Aspirin and aspirin derivatives: These drugs make blood platelets less sticky and therefore less likely to form clots that can lead to strokes. Some people who have already suffered a stroke or a warning stroke (called a transient ischemic attack (TIA) , or a “mini-stroke”) may benefit by taking an anti-platelet agent. Aspirin, clopidogrel (Plavix), ticlopidine(Ticlid), or the combination of aspirin plus dipridamole (Aggrenox) are usually reserved for patients at high risk for stroke because they may have adverse effects such as bleeding.

       Carotid artery surgery: Patients who have fatty arterial deposits in their neck, which can lead to stroke, may find benefit in a surgical procedure called carotid endarterectomy. In patients with severe arterial blockage and a history of previous stroke or warning stroke, this procedure may reduce their risk of a second stroke by as much as 44%.

       Exercise: Exercising regularly can reduce your risk of stroke. Researchers found that people who participate regularly in sports had a lower incidence of having a stroke. *² Work with your doctor to create an exercise routine that is safe for you.

Today we are much better prepared than in the past to prevent strokes. If you are at increased risk for stroke discuss your options with your health care provider. If you do experience symptoms of a stroke, it is important to immediately undergo medical evaluation. For acute strokes the time to diagnosis and treatment is extremely important.

RESOURCES:

American Stroke Association
http://www.strokeassociation.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

National Stroke Association
http://www.stroke.org/

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

References:

About stroke: Impact of stroke. American Stroke Association website. Available at: http://216.185.112.7/presenter . Accessed Sept. 22, 2003.

About stroke: What are the risk factors of stroke? American Stroke Association website. Available at: http://216.185.112.7/presenter . Accessed Sept. 22, 2003.

Chalmer J, Todd A, Chapman N, et al. International society of hypertension (ISH): statement of blood pressure lowering and stroke prevention. J Hypertension. 2003;21:651-63.

Chatfield J. American Heart Association scientific statement on the primary prevention of ischemic stroke. American Family Physician . 2001; 64: 513-514.

Llinas FH, Aldrich E, Wityk R. Update on stroke prevention and treatment. Advanced Studies in Medicine . 2003;3:93-101.

Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline of the American Heart Association/American Stroke Association Stroke Council: co-sponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity and Metabolism Council; and the Quality of Care and Outcomes research Interdisciplinary Working Group. Circulation 2006;113:e873-923.

Preventing stroke with evidence-based care. Patient Care . 2002; June:48-57.

Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: Scientific review. Journal of the American Medical Association . 2002;288:1388-1395.

*¹9/19/2006 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med . 2006;355(6):549-59.

*²2/24/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Grau AJ, Barth C, Geletneky B, et al. Association between recent sports activity, sports activity in young adulthood, and stroke. Stroke. 2009;40:426-431. Epub 2008 Dec 24.

Last reviewed May 2008 by Rimas Lukas, MD
Last Updated: 2/24/2009

Black Tea

Camellia sinensis

Alternate Names/Related terms

Theanine

Principal Proposed Uses

Heart Disease Prevention

Other Proposed Uses

Cancer Prevention; Diabetes; High Blood Pressure; High Cholesterol; Osteoporosis Prevention; Sports and Fitness Support: Enhancing Performance; Stress

Black and green tea are made from the same plant, but black tea has been allowed to oxidize, altering its constituents. While green tea is high in catechins (especially epigallocatechin gallate, or EGCG), black tea contains relatively high levels of theaflavins, theanine, and thearubigens. Although green tea is more commonly presented as a healthful beverage, traditional black tea too might have health-promoting properties. However, there is no reliable evidence as yet for any of its proposed health benefits.

According to some but not all observational studies, high consumption of black tea is associated with reduced risk of heart disease and heart disease death.1-3

Unfortunately, observational studies are notoriously unreliable for proving the efficacy of a treatment. Some additional support comes from animal studies that hint black tea may help prevent atherosclerosis, the primary cause of heart disease.4 However, only double-blind, placebo-controlled studies can actually prove a treatment effective, and few have been conducted on black tea. (For information about why such studies are essential, see Why Does This Database Rely on Double-blind Studies?) One double-blind, placebo-controlled study found that black tea modestly improves cholesterol profile, but it enrolled too few participants (a total of 15) to provide trustworthy results.5 Another study, about twice as large, failed to find benefit.18

A much larger study (more than 200 participants) evaluated a form of green tea enriched with black tea theaflavin.6 In this substantial 3-month study, use of the tea product resulted in significant reductions in LDL (”bad”) cholesterol as compared to placebo. However, these results might not apply to black tea itself.

Theanine, a component of black tea, has been advocated as a sports supplement. Physical activity causes elevation of the stress hormone cortisol, which could, in theory, interfere with the benefits of exercise by slowing muscle growth. One study widely reported by tea advocates tested a mixture of theanine and several other herbs and supplements ( Magnolia officinalis, Epimedium koreanum, beta-sitosterol, and phosphatidylserine).7 The results appeared to indicate that use of this combination could decrease the cortisol response to exercise, and on this basis, theanine and the combination supplement are widely marketed as an aid to body building. However, this study suffers from a number of limitations. Perhaps the most important of these limitations is that presumably the body releases cortisol during exercise for a reason, and preventing this response may not, in fact, produce health benefits. In addition, the study was not designed to look for particular benefits, such as improved muscle development.

Other preliminary evidence from small trials suggests that the consumption of theanine in black tea may reduce the body’s response to stress in general (physical or psychological),15,16 lead to a more relaxed mental state,21 and help reduce blood pressure.19

Black tea might also help prevent cancer, though evidence from observational studies is thoroughly inconsistent.8-12 Weak observational study evidence additionally hints at benefits for osteoporosis.13

Though black tea has shown blood-sugar-lowering effects in healthy people,20 one study failed to find that a combined extract of black and green tea could help control blood sugar levels in people with type 2 diabetes.17

Optimal doses of black tea or its constituents are not known.

As an extraordinarily widely consumed beverage, black tea is presumed to have a high safety factor. Its side effects would be expected to be similar to those of coffee—heartburn, gastritis, insomnia, anxiety, and heart arrhythmias (benign palpitations or more serious disturbances of heart rhythm).14 All drug interactions that can occur with caffeine would be expected to occur with black tea.

If you are taking:

•  MAO inhibitors: The caffeine in black tea could cause dangerous drug interactions.
•  Stimulant drugs such as Ritalin: The stimulant effects of black tea might be amplified.
•  Drugs to prevent heart arrhythmias or to treat insomnia, heartburn, ulcers, or anxiety: Black tea might interfere with their action.
•  Folic acid: Black tea may decrease the absorption of folic acid into the blood stream.22

References[ + ]

1. Hakim IA, Alsaif MA, Alduwaihy M, et al. Tea consumption and the prevalence of coronary heart disease in Saudi adults: results from a Saudi national study. Prev Med. 2002;36:64-70.

2. Vinson JA. Black and green tea and heart disease: a review. Biofactors. 2001;13:127-132.

3. Sesso HD, Paffenbarger RS Jr, Oguma Y, et al. Lack of association between tea and cardiovascular disease in college alumni. Int J Epidemiol. 2003;32:527-533.

4. Vinson JA, Teufel K, Wu N, et al. Green and black teas inhibit atherosclerosis by lipid, antioxidant, and fibrinolytic mechanisms. J Agric Food Chem. 2004;52:3661-3665.

5. Davies MJ, Judd JT, Baer DJ, et al. Black tea consumption reduces total and LDL cholesterol in mildly hypercholesterolemic adults. J Nutr. 2003;133:3298S-3302S.

6. Maron DJ, Lu GP, Cai NS, et al. Cholesterol-lowering effect of a theaflavin-enriched green tea extract: a randomized controlled trial. Arch Intern Med. 2003;163:1448-1453.

7. Kraemer WJ, French DN, Spiering BA, et al. Cortitrol supplementation reduces serum cortisol responses to physical stress. Metabolism. 2005;54:657-668.

8. Blot WJ, McLaughlin JK, Chow WH, et al. Cancer rates among drinkers of black tea. Crit Rev Food Sci Nutr. 1998;37:739-760.

9. Hartman TJ, Tangrea JA, Pietinen P, et al. Tea and coffee consumption and risk of colon and rectal cancer in middle-aged Finnish men. Nutr Cancer. 1998;31:41-48.

10. Mukhtar H, Ahmad N. Tea polyphenols: prevention of cancer and optimizing health. Am J Clin Nutr. 2000;71:1698S-1702S; discussion 1703S-4S.

11. Wu AH, Yu MC, Tseng CC, et al. Green tea and risk of breast cancer in Asian Americans. Int J Cancer. 2003;106:574-579.

12. Arab L, Il’yasova D. The epidemiology of tea consumption and colorectal cancer incidence. J Nutr. 2003;133:3310S-3318S.

13. Hegarty VM, May HM, Khaw KT. Tea drinking and bone mineral density in older women. Am J Clin Nutr. 2000;71:1003-1007.

14. Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac arrhythmia: an unrecognised danger of healthfood products. Med J Aust. 2001;174:520-521.

15. Kimura K, Ozeki M, Juneja LR, et al. l-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2006 Aug 21. [Epub ahead of print]

16. Kraemer WJ, French DN, Spiering BA, et al. Cortitrol supplementation reduces serum cortisol responses to physical stress. Metabolism. 2005;54:657-668.

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Last reviewed April 2009 by EBSCO CAM Review Board
Last Updated: 04/01/2009