Daily Archives: January 21, 2008

Testosterone levels fall in men… are we becoming women?


back_hairy-1.jpg My boyhood baseball hero Rich “Goose” Gossage made it into the baseball Hall of Fame last week. His 98-mph fastball and 22-year career as a fearsome relief pitcher were achieved without the use of steroids. His best years were back in the ’70s and early ’80s when men were men and made their own testosterone naturally. But even the most macho among us face a decline in the quintessential male hormone as we age. Recent evidence points to a decline in testosterone levels in the general population of men, regardless of age.

A 20-year study of testosterone levels in men found that testosterone concentrations dropped about 1.2% per year, or about 17% overall, from 1987 to 2004. The downward trend was seen in both the population and in individuals over time….Read more here

Caffeine raises risk of miscarriage.


Caffeine increases risk for miscarriage  By Serena Gordon
HealthDay Reporter

MONDAY, Jan. 21 (HealthDay News) — Caffeine consumption by pregnant women can increase the risk of miscarriage, a new study reports.

And, it doesn’t matter if the caffeine comes from coffee, tea, soda or hot chocolate. What does matter is the amount — the study found that when women drink more than 200 milligrams of caffeine daily, the risk of miscarriage increases twofold.”What we found was that if women have heavy caffeine intake — greater than 200 milligrams a day — they have double the risk of miscarriage than women that don’t have any caffeine,” said one of the study’s authors, Dr. De-Kun Li, a reproductive and perinatal epidemiologist in the division of research at Kaiser Permanente in Oakland, Calif.

Results of the study were published online in the January issue of the American Journal of Obstetrics and Gynecology.

Caffeine, the most frequently consumed drug in the world, crosses the placental barrier and reaches the developing fetus, according to the study. While previous studies have found an association between caffeine intake and miscarriage, it hadn’t been clear whether the problem was due to the caffeine or another substance in coffee, or if it had something to do with non-coffee drinkers’ lifestyles — perhaps people who didn’t drink coffee ate more fruits and vegetables, for example.

For the new study, the researchers looked at 1,063 women from the Kaiser Permanente Medical Care Program in San Francisco; they were interviewed at an average of 10 weeks’ gestation. During the study period, 16 percent of the women — 172 — had miscarriages.

The researchers found that 25 percent of the women who miscarried reported consuming no caffeine during their pregnancy. Another 60 percent said they had up to 200 milligrams of caffeine daily, and 15 percent regularly consumed more than 200 milligrams of caffeine each day.

In addition to asking about caffeine intake, the researchers also assessed the other known risk factors for miscarriage, such as smoking, a history of previous miscarriage, alcohol use and more. The researchers also compensated for nausea and vomiting during pregnancy.

“If you have a low risk of miscarriage, the effect of caffeine tends to show more,” said Li.

Li said that even among women who drank less than 200 milligrams of caffeine a day, the study found a 40 percent increased risk of miscarriage, but this finding didn’t reach the level of statistical significance.

“Women shouldn’t drink more than two regular cups of coffee a day, and hopefully they stop drinking totally for at least the first three months. It’s not a permanent stop. If they really have to drink, limit the amount to one or two cups — a regular cup is about seven and half ounces,” Li said.

But, not every doctor is convinced that there’s a direct cause-and-effect relationship between caffeine and miscarriage.

“The problem with this study is that when people miscarry, a large percentage of those miscarriages are due to genetic abnormalities, and the researchers didn’t say whether these were normal or abnormal fetuses,” said Dr. Laura Corio, an obstetrician and gynecologist at Mount Sinai Medical Center in New York City.

“Women are always worrying and wondering, ‘What did I do?’ Before we say a woman drank too much caffeine and that’s why she had a miscarriage, let’s see if it was an abnormal or normal pregnancy, said Corio.

“I think about 60 to 80 percent of miscarriages are due to genetic abnormalities,” she added.

That said, however, Corio does advise her pregnant patients to limit caffeine consumption. “Women have a responsibility to the fetus — no cigarettes, no alcohol and just one cup of coffee a day,” she said, noting that many store-bought cups of coffee contain far too much caffeine, so a woman has to be aware of how much caffeine is in her favorite coffee.

“Have less than 200 milligrams a day,” no matter what the source — coffee, tea, cola, chocolate, etcetera, Corio advised. She said caffeine has also been linked to low birth weights and smaller head circumferences.

Li also advised limiting caffeine to less than 200 milligrams a day, especially in the early months of pregnancy and in the preconception period.

More information

To learn more about caffeine and pregnancy, visit the American Pregnancy Association.

Obesity a choice or a disease?


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by Karin Zeitvogel Thu Jan 10

WASHINGTON (AFP) – As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.

“Obesity is a natural extension of an advancing economy. As you become a First World economy and you get all these labor-saving devices and low-cost, easily accessible foods, people are going to eat more and exercise less,” health economist Eric Finkelstein told AFP. In “The Fattening of America”, published this month, Finkelstein says that adult obesity more than doubled in the United States between 1960 and 2004, rising from 13 percent to around 33 percent.

Globally, only Saudi Arabia fares worse than the United States in terms of the percentage of adults with a severe weight problem — 35 percent of people in the oil-rich desert kingdom are classified as obese, the book says, citing data from the World Health Organization and Organization for Economic Cooperation and Development.

With the rising tide of obesity come health problems and an increased burden on the healthcare system and industry.

“But the nasty side-effects of obesity aren’t as nasty as they used to be,” Finkelstein said.

“When you have a first-rate medical system that can cure the diseases that obesity promotes, you no longer need to worry so much about being obese,” he told AFP.

“With our ever-advancing modern medicine there helping to save the day (at least for many people), are government and the media blowing the magnitude of the ‘obesity crisis’ out of proportion?” his book says.

A study in which Finkelstein and colleagues at the RTI International, an independent research institute in North Carolina that works on social and scientific problems, asked overweight, obese and normal weight people to predict their life expectancy came up with a total difference of four years.

Normal weight respondents predicted they would live to 78, the obese to 74, and the overweight 75.5.

Other studies that looked at death data back the conclusion that people who carry excess weight tend to die slightly earlier, the book says, and draws the conclusion that “many individuals are making a conscious decision to engage in a lifestyle that is obesity-promoting.”

“People make choices, and some people will choose a weight that the public health community might be unhappy about. Why should we try to make them thinner?” Finkelstein said.

Linda Gotthelf, a doctor who heads research at Health Management Resources, a private, nationwide firm that specializes in weight loss and management, agreed that Americans now live longer but stressed that quality of life declines with age.

“People are living longer but with more chronic diseases,” Gotthelf told AFP.

“That brings a diminished quality of life, especially for the obese who have more functional limitations as they age and tend to be on multiple medications.”

Obesity is not a choice for Alley English, a 28-year-old mother from Missouri who has struggled with a weight problem all her life.

“If you knew that you could be what society considers normal, why would you not choose to do that?” English told AFP.

“As we get older, life does get more rushed and we do tend to make the easier choices sometimes,” English, who currently weighs 392 pounds (178 kilograms), told AFP.

“But you can’t say if you quit going to the drive-through, exercise more and eat more vegetables, you’ll lose weight. There are so many more factors involved.”

Gotthelf also disagreed that people choose to be obese.

“There are studies in which people have said they would rather lose a limb or be blind than obese. Being obese is not a desire,” she said.

“For many, this is a problem they have struggled with for many years… it gets discouraging after a while,” she said.

“I would not doubt that if you asked obese people if they could push a button and not be obese, close to 100 percent would say they would push the button.”

Finkelstein says he wrote “The Fattening of America” to “encourage discussion of what I understand is probably an uncomfortable position for a lot of people.”

Even if private industry and government take steps to protect society against the costs of obesity, many Americans “will likely continue to choose a diet and exercise regimen that leads to excess weight,” because losing weight requires too many lifestyle sacrifices, his book warns.

Meanwhile, frustrated by years of unsuccessful dieting and weight loss programs, English has opted to join a growing number of Americans who have gastric bypass surgery — hailed in Finkelstein’s book as “the best-known treatment for severe obesity.”

“I have a higher risk of developing diabetes or hypertension if I don’t have the surgery,” English said.

“I don’t care if I end up with a body like whoever-in-the-media thinks I should look like; I just want to be healthy and able to participate in my daughter’s life,” she said.

Tekturna-HCTZ combo approved for high blood pressure


Tekturna is a new blood pressure medication on the market. While the studies have shown it to be beneficial, the fact that it is branded (non generic) makes it difficult to have it covered by insurance.   Drugstore.com shows the price of Tekturna  (30 tablets/ 1 month  for 93.27).  Whether the patient pays cash or with insurance, this is a lot of money and there are only so many healthcare dollars. Ultimately, the patient pays on either directly or indirectly. Patients should discuss with their physicians whether any of the below medications would be beneficial for their blood pressure as recommended by the JNC VII.

The  medications recommended first line by the JNC VII include HCTZ (100 tablets or 3 mos for $15.99),   Atenolol (50 mg/ 6 week supply, $12.99),  Lisinopril (30 tabs for  $12.99),   Amlodipine (30 tablets, $52).

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WASHINGTON – Tablets containing a combination of the blood pressure medication aliskiren and water pill hydrochlorothiazide have been approved by the Food and Drug Administration, the product’s manufacturer, Novartis AG, said Monday.

Sold under the name Tekturna in the United States, the hypertension compound aliskiren was approved last March. It acts by targeting renin, an enzyme responsible for high blood pressure. The newly approved version also includes hydrochlorothiazide, a compound that inhibits the kidney’s ability to retain water. This water pill is commonly used to treat high blood pressure.

Tekturna HCT tablets are intended for patients whose blood pressure has not been controlled by a single drug. They will be available in early February the company said.

Side effects associated with the new combination tablets include dizziness, flu-like symptoms, diarrhea, cough, tiredness and skin rashes.

Attempts to reach FDA officials to confirm the approval were not immediately successful.

Tekturna is known as Rasilez outside of the United States.

The company’s U.S. affiliate Novartis Pharmaceuticals Corp. is based in East Hanover, N.J.

Speed and Cocaine increase risk of strokes in young adults.


Amphetamine, Cocaine Usage Increase Risk Of Stroke Among Young Adults

ScienceDaily (2007-04-03) — Increasing rates of amphetamine and cocaine usage by young adults significantly boost their risk of stroke, with amphetamine abuse associated with the greatest risk, researchers recently report. In the study, available online in the Archives of General Psychiatry, UT Southwestern physicians examined more than 8,300 stroke patients — ranging in age from 18 to 44 — at more than 500 Texas hospitals in the years 2000 through 2003.

An analysis of risk factors and trends among stroke victims in this age group pointed to an increase in substance abuse as a major danger, particularly in the abuse of methamphetamines, which are produced in illegal drug labs or illegally imported into the country … > read full article