Mixed evidence on acupuncture for irritable bowels

NEW YORK (Reuters Health) - The research on whether acupuncture helps ease irritable bowel syndrome has so far been a mixed bag, according to a new review of past clinical trials. The review, published in the American Journal of Gastroenterology, found that in some trials, acupuncture seemed to work better than certain medications for irritable bowel syndrome, or IBS. Yet in others, acupuncture was no better than a "sham" version of acupuncture used for comparison. "It's difficult to interpret the results of the review," said lead researcher Eric Manheimer, of the Center for Integrative Medicine at the University of Maryland School of Medicine. For now, he told Reuters Health, "I think the evidence is equivocal." IBS is a digestive disorder that causes repeated bouts of abdominal cramps, bloating, and either diarrhea or constipation. It's different from the similar-sounding inflammatory bowel disease -- an umbrella term for ulcerative colitis and Crohn's disease, two more-serious digestive disorders that damage the lining of the colon. In many cases, IBS can be managed with diet changes, along with anti-diarrheal medication or, for constipation, laxatives or fiber supplements. But people with tougher-to-treat IBS may need more. There are a few drugs for the condition -- including alosetron (Lotronex), which works on nerves to relax the colon, and lubiprostone (Amitiza), which helps with constipation. Doctors sometimes also prescribe low-dose antidepressants, anti-anxiety medications or drugs called antispasmodics, which may help with abdominal pain. But those drugs are often limited in their effectiveness, and can have side effects. PLACEBO EFFECT? So researchers are looking at different non-drug options. Two -- namely, cognitive behavioral therapy and hypnosis -- have proven effective for some people in clinical trials. A fairly small number of studies have begun looking at acupuncture. And so far, Manheimer's team found, those trials have yielded mixed results. In their review, the researchers found five clinical trials that tested "true" acupuncture against a sham version of the procedure. Some studies use sham procedures to try to account for the "placebo effect" -- where people feel better simply because they expect a treatment to work. Overall, Manheimer's team found, none of the five trials showed that real acupuncture was any better than the fake version when it came to improving patients' ratings of their symptoms or quality of life. On the other hand, five trials done in China did find that patients reported bigger gains from acupuncture when it was tested against certain medications -- which included certain anti-diarrheal, antispasmodic and anti-inflammatory drugs. But there are limitations to both types of studies, Manheimer said. With the trials that pitted acupuncture against drugs, the patients were recruited at hospitals for traditional Chinese medicine. "So it's possible that patients' expectations played a role" in acupuncture's higher success odds, Manheimer explained. That is, many may have believed acupuncture to be effective, or had a preference for it over medication. With the sham-acupuncture trials, the study groups tended to be small, which may have limited their ability to pick up small benefits of true acupuncture, the researchers say. There's also debate over what makes for a good sham version of acupuncture. In some studies, it may involve inserting needles in the skin at sites that are not considered acupuncture points according to traditional Chinese medicine. In others, it means using a dull needle that doesn't penetrate the skin. "It's not clear that they (shams) are all inert," Manheimer said. That means some sham acupuncture tactics may have biological effects that are close to the real thing. No one is sure how acupuncture works, but some research suggests the needle stimulation triggers the release of pain- and inflammation-fighting chemicals in the body -- even if the acupuncture doesn't strictly follow traditional principles. Of the five trials in this review, two were judged as having sham acupuncture that might have had real biological effects. But that doesn't explain why the other three studies showed no benefit, the researchers say. NOT A 'GO-TO' TREATMENT In the future, Manheimer said it might be helpful to do trials that compare acupuncture against other treatments, but do it with a more general population of IBS sufferers than the Chinese studies used. It would also be a good idea, he said, to measure patients' expectations going into the study. That way, researchers can look at whether people who expected to improve were more likely to report benefits from acupuncture. "This is an interesting study," said Jeffrey M. Lackner, an associate professor at the University at Buffalo School of Medicine in New York, who was not involved in the work. In the U.S., he noted, acupuncture would not be considered a "go-to" IBS treatment right now anyway. As far as non-drug options, cognitive behavioral therapy (CBT) seems to have the best research evidence to back it up, according to Lackner. CBT is a form of "talk therapy" that helps people recognize the unhealthy thought patterns and behaviors that feed their symptoms, and gives them practical ways to manage them. The problem with CBT, though, is availability. "There are not a lot of therapists out there who can do it," Lackner told Reuters Health. "We really need to start developing IBS treatments that are more easily disseminated," he said. That could mean "self-help materials," like books or CDs, that teach people CBT principles. As for acupuncture, Manheimer said that if people did want to give it a shot, safety and cost would be the other considerations. Acupuncture is generally considered safe, with side effects like bruising at the needle site. The cost can vary widely, but a session would typically start at around $100. And many patients, Manheimer noted, may have to pay out of pocket. SOURCE: http://bit.ly/ioaqna American Journal of Gastroenterology, online April 10, 2012.

How to Beat Resistant Hypertension

Can’t get a handle on high blood pressure? You could have “resistant hypertension.” Here’s what will help get your numbers back to heart-healthy levels… Many people start each day by taking three pills for high blood pressure. Still, their hypertension defies treatment. The condition, called resistant hypertension, is dangerous, multiplying your risk for heart disease, stroke, kidney disease and other health issues, says Addison A. Taylor, M.D., Ph.D., chief of the division of hypertension and clinical pharmacology at Baylor College of Medicine in Houston. It’s common too. As many as one-third of the 43 million people diagnosed with high blood pressure have resistant hypertension, according to the American Heart Association (AHA). Because it’s on the rise, the AHA recently outlined specific guidelines on how to treat the condition. “Evaluating and treating resistant hypertension requires special consideration,” says David A. Calhoun, M.D., chair of the AHA’s guideline-writing committee. Defining Resistant Hypertension Blood pressure measures the force of blood flowing through the body. The top number, or systolic reading, is the pressure when your heart beats. The bottom, or diastolic, measures pressure between beats. With resistant hypertension, systolic readings surge to 145 or higher, and diastolic pressure hovers at 90 or higher. A resistant-hypertension patient’s blood pressure can’t be lowered, even when taking three drugs or more, explains Taylor. But there’s good news: Resistant hypertension can be treated effectively, says Jerome E. Granato, M.D., author of Living With Coronary Heart Disease: A Guide for Patients and Families (Johns Hopkins Press). But first, doctors look for its cause, which can vary by patient. Hypertension’s Causes Age, obesity and heavy alcohol or sodium intake can trigger resistant hypertension, according to the AHA report. But patients are their own worst enemies, too, Granato says. “Most resistant-hypertension cases result because patients don’t follow their treatment plan,” he says. Whether to avoid side effects or from forgetfulness, “some patients skip doses or stop taking their medication altogether." Others follow dosing precisely, but fail to exercise or cut salt out of their diet. Another problem: Patients’ white lies in the exam room. “They won’t tell their doctor they’ve skipped doses or aren’t exercising as recommended,” Granato says. “And those fibs make it hard [for a physician] to get resistant hypertension under control.” Medical Triggers But other factors also contribute, including common over-the-counter pain relievers, decongestants, stimulants and some herbal supplements (for example, yohimbe bark taken for sexual dysfunction). These block the effectiveness of blood pressure medications, Granato says. Medical conditions, such as adrenal tumors or sleep apnea, can also cause resistant hypertension. One of the most common triggers is primary aldosteronism, often caused by benign adrenal tumors (called adenomas) or an increase in normal adrenal gland cells. "In either case, primary aldosteronism elevates levels of the adrenal hormone aldosterone, leading to excessive water and salt retention, and hypertension," Granato says. It affects 10%-20% of patients diagnosed with hypertension and is so common that many physicians routinely screen hypertensive patients with a simple blood test. It’s also very treatable by using drugs to regulate adrenal function and blood pressure, Granato adds. Obstructive sleep apnea (OSA) is also prevalent among resistant-hypertension patients. “Those with OSA are often obese, and losing weight improves their symptoms and responsiveness to antihypertensive medications,” says Kameswari Maganti, M.D., director of cardiac rehabilitation at Chicago’s Northwestern Memorial Hospital. Using a continuous positive airway pressure (CPAP) device also lowers blood pressure among patients with OSA-related hypertension, according to 2010 Spanish study. CPAP helps regulate breathing via a face mask connected to a pump. The White-Coat Effect Some persistently high readings mimic resistant hypertension, but actually may be skewed by “white-coat syndrome,” which causes patients’ numbers to soar as soon as they walk into the exam room. “The fear of receiving bad news or overall anxiety over being in the doctor’s office causes blood pressure to [temporarily] rise higher than normal,” Granato says. Although several studies have recognized white-coat syndrome, a 2010 Israeli study published in the medical journal Hypertension focused on the effect that exam rooms have on blood pressure. Researchers found that women are more susceptible to higher-than-normal readings in a doctor’s office than men; their systolic readings increased an average 8.8%, and diastolic were an average of 8.3% higher than numbers recorded at home. Men’s numbers increased an average 6.1% systolic and 6.95% diastolic in doctors’ offices. If your pressure is always high at your doctor’s office, you have options: 1. Monitor blood pressure at home. “Talk to your doctor about ambulatory home monitoring for 24 hours,” which records readings during your normal daily routine, Taylor says. A device measures your blood pressure about every 20 minutes during the day and every 30-45 minutes at night, giving doctors a “clearer picture of blood pressure than one or two office readings,” Taylor says. You can also buy a monitor to record your blood pressure at home. Just remember to bring the device to checkups so your physician can compare office readings against yours at home. 2. Avoid coffee and cigarettes. To get more accurate numbers at home or doctor’s office, avoid coffee an hour preceding readings and don’t smoke for at least 30 minutes beforehand. Both can increase readings 10-15 points, Maganti says. 3. Change positions. Your body position influences the reading. “Posture and position of arms and legs can increase systolic numbers by 12.5%-14.2% and diastolic by 4.4%-7.6%,” Maganati says. If your blood pressure is high at doctor’s visits, change the way you sit. For the most accurate reading, sit upright in a chair with back support, not slouched over an exam room table, Maganti says. Hold arms at heart level, not hanging down, so your heart doesn’t have to pump hard to maintain adequate blood flow to your fingers. The blood pressure cuff should also be at the same level. 4. Take more than one reading. Ask for another reading once you’ve relaxed, or at the end of your doctor’s visit, after you’ve discussed questions or concerns with your doctor. Ways to Lower Blood Pressure The AHA has guidelines to help patients tackle resistant hypertension. Besides using drugs prescribed by your doctor, take these steps: Lose weight: Obese people often have more severe high blood pressure. Dropping pounds can not only treat resistant hypertension, but also reduce the number of drugs you take for it. Reduce salt: Cutting sodium intake from 1,200-1,500 mg a day can shave 5-10 systolic points and 2-6 diastolic points from blood-pressure levels. Limit alcohol: Cutting back on wine, beer and other alcoholic drinks can reduce systolic pressure by 7.2 points and diastolic by 6.6 points, while cutting the prevalence of hypertension by 30%, according to a 2009 study in the journal Hypertension. Time medications: Taking at least one of your hypertension medicines at bedtime leads to better blood pressure control, particularly during the night. “Taking prescribed blood pressure – controlling medicine, reducing alcohol and salt consumption, maintaining clear communication with your doctor, losing weight and getting exercise are the most effective ways to treat and prevent resistant hypertension,” Granato says.

What's the Best Diabetes Food Plan? Choosing Between Low-Carb, Vegan, Paleo and Mediterranean-Style Diets

If you’re at risk for type 2 diabetes, what you eat can make a big difference to your health. But experts don’t all agree on the best diabetes food plan. Before you decide, learn the benefits of low-carb, vegan, “caveman” and Mediterranean-style eating… If you’re overweight or obese, your doctor has probably warned you that excess pounds can make you a target for type 2 diabetes. Losing weight can reduce that risk significantly. Shedding just 7%-10% of your weight can help reduce your diabetes risk by 60%, according to the Harvard School of Public Health. And if you already have type 2 diabetes, dropping 10-15 pounds can help lower your blood sugar levels and blood pressure and improve your cholesterol, says the American Diabetes Association (ADA). But with thousands of weight-loss programs to choose from, what’s the best diet for managing diabetes? It’s tough to say, because even experts don’t agree on a perfect diabetes food plan, says Judith Wylie-Rosett, R.D., Ed.D., professor and division head for health promotion and nutrition research at Albert Einstein College of Medicine in New York City. “There’s no one official diabetes diet to lose weight and manage blood glucose levels,” adds Sheri Colberg-Ochs, Ph.D., a diabetes management expert and professor of exercise science at Old Dominion University in Norfolk, Va. “Different diets work for different women,” she says. Some experts recommend a Mediterranean-style diet with moderate amounts of healthy carbs. Others swear by a low-carb diet (with as few as 30 grams of carbs daily). Still, others suggest you eat a moderate-carb vegan diet, or a “caveman” diet with meat and vegetables but no grains. Even the nation’s biggest diabetes advocacy group, the ADA, has changed its perspective on the healthiest way to eat. Historically, the organization backed a moderate-carb Mediterranean-style diet centered on whole grains, lean protein and healthy fats, and eschewed low-carb diets. That was because “women with type 2 diabetes already have a higher risk for heart disease, and many low-carb diets are high in saturated fats and have been linked with cardiovascular disease,” Wylie says. But in 2008, after several large studies found that low-carb diets were as good as moderate-carb diets for managing diabetes, the ADA endorsed low-carb eating for weight loss. Whether your aim is to lose weight, or prevent or manage diabetes, choose a diet you can stick with, whether it’s a moderate-carb, low-carb, vegan or cavemen diet, advises Hope Warshaw, R.D., C.D.E., a nationally recognized diabetes educator and author of Guide to Healthy Restaurant Eating (ADA). Also, ask your doctor how many carbs you need to control blood sugar levels, Warshaw says. So which kind of diet works best for people with diabetes? Read on for the latest research on each one. Diabetes Food Plan #1: Moderate-Carb, Mediterranean-Style Diet Women with type 2 diabetes who ate healthy carbs as part of a Mediterranean-style diet lost more weight, saw more improvements in cholesterol and reduced their blood pressure and risk of heart disease more than women following a low-fat diet, according to a 2009 study conducted in Naples, Italy. “The Mediterranean diet also gives you built-in protection against diseases that come with diabetes, such as obesity, high blood pressure, high blood sugar and high cholesterol,” says Michael Nussbaum, M.D., a bariatric physician and medical director of the Obesity Treatment Center outside Philadelphia. “The diet also helps you reduce or get off your diabetes medications,” says Timothy Harlan, M.D., a chef and associate chief of general internal medicine at Tulane University School of Medicine in New Orleans. “In the [Naples] study, 56% of people following the Mediterranean diet were able to stop taking insulin, compared to just 30% of people following the low-fat diet,” says Harlan, who’s also the editor of DrGourmet.com, a diet, health and lifestyle website. Mediterranean-style diets focus on fresh vegetables and fruits, moderate amounts of fish, lean poultry and nuts, healthy fats such as olive oil, and whole grains. Whole grains help protect against diabetes, whereas diets rich in refined carbohydrates lead to increased risk, according to the Harvard School of Public Health. “If you have type 2 diabetes, you need a steady source of healthy carbs (found in whole grains, fruits, beans and vegetables) to keep your blood sugar levels stable,” says Lisa Moskovitz, R.D., a New York-based registered dietitian who specializes in diabetes. “That’s about 45-60 grams of carbs per meal, or 135-180 grams daily [adding up to 540-720 calories], based on a 2,000-calorie diet,” she adds. “It’s not healthy to skimp on healthy carbs, because they provide fiber, vitamins and disease-fighting antioxidants and phytochemicals not available in other foods,” says Connie Guttersen, Ph.D., R.D., creator of The New Sonoma Diet and author of The New Sonoma Cookbook: Simple Recipes for a Healthy, More Delicious Way to Live, which features a Mediterranean-style eating plan. This diabetes food plan may also be easier to stick with over the long term. “Unlike other diets, the Mediterranean diet doesn’t exclude food groups or force you to give up foods you love,” says Jessica Bartfield, M.D., an internist who specializes in weight loss at Loyola University Health System outside Chicago. “Women with diabetes may lose weight faster on a low-carb diet than on a moderate-carb one, but they tend to regain lost weight on a low-carb diet because they just can’t live without bread, pasta and other healthy carbs,” she says. Diabetes Food Plan #2: Low-Carb Diet Despite the advantages of a Mediterranean-style diet, more physicians and scientists believe diabetes control needs a more drastic carb-cutting approach. “Type 2 diabetes is fundamentally a disease of carbohydrate intolerance,” says diabetes researcher Richard Feinman, Ph.D., professor of biochemistry at the SUNY Downstate Medical Center in Brooklyn. “Eating 180 grams of carbs a day is like eating poison if you have the disease – your body just can’t tolerate it,” he says. “The more carbs you eat, the more insulin you need to [metabolize them], which becomes a vicious cycle that ensures you’ll always have diabetes.” People with diabetes who went on low-carb diets were better able to control blood glucose levels, lose weight and avoid cardiovascular disease than those who followed moderate-carb diets, according to a 2008 study led by Feinman. Another study, conducted in 2009 at Duke University, found that diabetics who followed low-carb diets under medical supervision lost more weight and had lower levels of A1C, a measure of long-term blood sugar levels, than people following a reduced-calorie diet that included some slow-burning carbs. Richard K. Bernstein, M.D., uses his own experience to promote the benefits of this diabetes food plan. Widely regarded as the father of low-carb diets, he says he suffered from uncontrolled type 1 diabetes, heart disease and kidney disease until he put himself on a plan that allows just 30 grams of carbs per day. “When I cut the carbs, I became healthy,” he says. Today, Bernstein treats patients with a low-carb eating plan. They have no trouble sticking with the diet because it tastes good, they lose weight without feeling hungry and can reduce or even eliminate their diabetes medications, he says. Critics claim low-carb diets increase the risk of heart disease because they contain more fat and saturated fat, in foods such as red meat, than moderate-carb diets. But you can eat lean meats and dairy if you want to lower your intake of saturated fat, and use your limited carb allowance for fruits and vegetables, Feinman notes. Red meat is rich in iron, which can reduce the effectiveness of insulin or damage cells that produce the hormone, according to a 2007 review of studies by the Harvard School of Public Health. Eating a 3-ounce serving of red meat every day increases the risk of type 2 diabetes by 20%, while smaller amounts of processed red meat, such as a few strips of bacon or hot dog, increases the risk of diabetes risk by 51%, according to a 2011 Harvard study. Substituting nuts, low-fat dairy, poultry, fish or whole grains for red meat lowers diabetes risk by up to 35%, the study found. Here’s another reason to limit red meat: “Eating a high-fat meal is rapidly followed by an increase in blood endotoxins, which are bacterial fragments that can provoke inflammation,” says Alison Harte, Ph.D., senior research fellow and lead author of a 2012 study on high-fat diets conducted at the University of Warwick in the United Kingdom. Inflammation provoked by immune cells can lead to insulin resistance and type 2 diabetes, according to a 2007 study conducted at the University of California, San Francisco. “Patients with type 2 diabetes show this response more than twice that of controls,” Harte says. But even that long-held truth is being questioned. “There’s some misunderstanding about saturated fats,” notes Frank Nuttall, M.D., Ph.D., chief of the Endocrinology, Metabolism & Nutrition Section at the Minneapolis VA Health Care System and professor of medicine at the University of Minnesota, in the ADA’s Diabetes Forecast magazine. “We really don’t have good evidence that saturated fat causes coronary heart disease. It can raise cholesterol levels, but whether that’s sufficient to raise the risk for coronary heart disease is not conclusive,” he says. Nuttall’s theory has been proven in research by Kerry Stewart, Ed.D, professor of medicine at Johns Hopkins School of Medicine in Baltimore and lead author on a 2012 study that compared higher-fat, low-carb diets with higher-carb, low-fat diets. In the study, people on a low-carb diet with 40% calories from fat lost more weight and belly fat than people on diet with 30% fat calories, Stewart says. (Fat in the belly is more metabolically active and more likely to increase diabetes risk.) “Cardiovascular improvement was directly linked to how much belly fat people lost, regardless of which diet they were on,” he says. Diabetes Food Plan #3: Low-Fat, Moderate-Carb Vegan Diet If eating meat is a turn-off, consider a vegan diet. It’s based on fruits, vegetables and grains that have a low glycemic index rating, which means they’re absorbed more slowly, says Ulka Agarwal, M.D., chief medical officer of the Physicians Committee for Responsible Medicine (PCRM), a non-profit organization that promotes healthful vegetarian eating. In 2006, PCRM co-authored a study with George Washington University School of Medicine that compared how people with type 2 diabetes fared on a low-fat vegan diet versus a Mediterranean-style diabetes food program. The vegan group lost more weight and saw more improvements in cholesterol than the Mediterranean group, and 43% were able to reduce their insulin requirements, compared to 26% on the Mediterranean diet. Diabetes Food Plan #4: Caveman (Paleo) Diet These plans are based on the assumption that a healthful human diet evolved to favor plants and meat, before the introduction of grains and processed carbs. “The caveman diet revolves around fruits, vegetables and lean meats – hold the grains, dairy and processed foods,” says Lynda Frassetto, M.D., an internist and nephrologist at the University of California, San Francisco and coauthor of a 2009 study comparing how people with type 2 diabetes did on a caveman plan versus the Mediterranean-style diet. “Women with type 2 diabetes who ate like cavemen saw dramatic reductions in blood pressure, cholesterol, triglycerides and blood sugar and were able to reduce their insulin needs, while those on the Mediterranean diet saw very little improvements,” she adds. “The only downside to the diet is that it eliminates all processed foods, so you have to do a lot of shopping, prep work and cooking,” Frassetto says. Confused about how to track the number of carbs in your meals? Read Carb-Counting Tips for Diabetics. For more on eating with type 2 diabetes, visit our Type 2 Diabetes Health Center and Diabetes Healthy Eating Guide. Myth vs. Fact: How Much Do You Know About Diabetes? In the United States alone, 23.6 million people have diabetes. And 5.6 million of them don’t even know it. Unfortunately, misinformation about diabetes is rampant – and mixing up the facts about this disease can have dire consequences.

Expert Advice on Migraine Triggers and Symptoms How to Avoid and Treat Migraine Pain

It’s not just a headache. When symptoms of a migraine come on, many sufferers want to run for the hills. Or into a dark, quiet room where they can sleep. Our migraine expert shares how to prevent and reduce migraine triggers, and, should you get a headache, how to manage migraine pain... More than 28 million Americans suffer from migraine pain – and women are three times more prone to experience symptoms of a migraine than men, says Janine Good, M.D., associate professor of neurology and medical director of ambulatory services at the University of Maryland Medical Center. Women are more prone to migraines, possibly because symptoms of a migraine can be triggered by hormonal fluctuations. Certain foods, environmental factors, even too little caffeine or too much sleep can also be migraine triggers. In this interview, Good tells us how migraine sufferers – called “migraineurs” – can better understand their condition, lessen the length and number of symptoms of a migraine and, most importantly, manage pain. How is a migraine different from a regular headache? A migraine includes a constellation of symptoms, including a throbbing, intermittent headache usually affecting only one side of the head, as well as nausea and extreme sensitivity to light and noise. A migraine is far more disabling than a typical headache. How do you know it's a migraine and not something more serious, like a brain tumor? Migraines are recurrent, but between episodes you feel perfectly normal. In more serious conditions the pain stays steady or gets worse. If you can sleep off the headache, that’s a good sign it’s a migraine. Are certain foods migraine triggers? Not all patients note dietary migraine triggers, but among those who do, cheese, alcohol, caffeine, MSG, citrus fruit and soy sauce are typical offenders. Chemicals that end in the letters “amine,” such as tyramine, found in aged meats, red wine, and especially cheese, are often problematic, so check labels. Chocolate is controversial. For some time it was considered a trigger, but now the theory is that perhaps chocolate is only a pre-headache craving, and not one of the migraine triggers. Speaking of chocolate and cravings, are women more apt to experience symptoms of a migraine at certain points in their menstrual cycle? Women who keep headache diaries often note they get migraines at a certain time each month. For some, it’s a week before their period; for others, it’s ovulation. There’s also a subcategory called the “menstrual migraine,” which starts anywhere from two days before the flow to two days after. Women in perimenopause sometimes see a spike in migraines, but after menopause is over, many patients report they get fewer migraines and some women stop having migraine pain altogether. You mentioned a headache diary. Should all migraine sufferers keep one and, if so, what should it contain? As soon as I see a new patient, I urge them to start a diary, which can just be notes on a basic calendar, and to keep it for a minimum of three months. When they have a headache, they should note where they are in their menstrual cycle, any food or drink they’ve had, and also things like the weather and where they are. Environmental factors like heat, exposure to certain chemicals, smoke, changes in barometric pressure or even odors can also be migraine triggers. They should rate the pain on a scale of 1 to 10, and note if they took any medication, and whether it worked. What patterns emerge from these diaries? One patient realized she only had migraine pain on Saturdays. We figured out that she drank coffee at work, but not on weekends. So it wasn’t caffeine that was triggering her, but rather caffeine withdrawal. Migraines also are related to sleep patterns. Too little or too much sleep can be migraine triggers, as can any change in your normal cycle. For example, night-shift workers often get headaches on weekends when they try to catch up on sleep. Should you treat migraines with over-the-counter (OTC) medication? If headaches are infrequent and relatively mild, over-the-counter medication may be enough. But some patients get such frequent and intense migraines that OTC medication can’t help. Also, some OTC medicines can damage the stomach or liver over time, while others, like Excedrin, have caffeine, which often makes migraines worse. Finally, OTC drugs can cause rebound headaches. Follow the rule of moderation: If you only use OTC medicines once or twice a week, that’s probably fine. But if you’re using them five or more days a week, that’s too much. What’s a rebound headache? It’s a chronic daily headache resulting from overuse of medication, whether OTC or prescription. Anything you take more than twice a week can put you at risk for a rebound. I tell patients, if you need that much medicine just to function, take a look at your lifestyle. Do stress and anxiety act as migraine triggers? A lot of migraineurs have Type A personalities. They tend to be very organized, classic perfectionists. Along with migraines, you often see depression, anxiety and irritable bowel syndrome. Depression and anxiety don’t cause migraine pain, but the conditions are often seen together. People who get migraines tend to be sensitive to changes in routine, so it’s important they create regular rituals in their daily lives. Can medicines you take for other conditions be migraine triggers? Blood pressure medicine, birth control pills, hormonal treatments and certain antidepressants can be problematic, so talk to your doctor if you take any of these drugs and find your headaches getting more frequent or worse. Even OTC treatments for acid reflux and heartburn can be migraine triggers. Is there a genetic component to migraines? It’s not clear. About 60% of people with migraines say they have a first-degree relative with migraine, which seems too high to be accidental, so there seems to be a genetic piece to the puzzle. But a lot of migraine sufferers don’t have anyone else in the family with the condition. At what age do people start getting migraines? Migraines peak between the ages of 25-55. If boys are going to have them, they usually start in pre-adolescence, while girls usually get them around puberty. After the age of 55, they often begin to fade. What prescription medicines are commonly prescribed for migraine pain? Do they have side effects? The most common class of medicines used to treat migraines are tripans, drugs such as Imitrex, which reduce inflammation of blood vessels in the brain, and thus reduce sensitivity. Side effects are pretty mild – nausea, throat fullness, slight fatigue or flushing of the face. Sometimes there’s a mild escalation of the headache before the drug begins to work. Do natural remedies such as vitamins and herbs help combat migraine triggers? Butterbur and feverfew are sometimes mentioned, but I don’t see evidence they help. St. John’s Wort, which is sometimes used as a natural antidepressant, is currently in studies. So far, the most promising evidence points to supplementing with Vitamin B2 and magnesium. Are all the medicines used to treat existing pain? Is there any way to stop migraine triggers? There are two categories of migraine drugs. Abortive treatments, which are designed to stop the pain once it’s started, are where there’s the most growth. Seven new tripans have come on the market in the last 10 years, along with new ways to administer them. Right now, we have pills, needles and nasal spray, but they’re looking at patches and powders as well. The second category is in preventative drugs, and there’s been less advancement in those. Only four have been approved over the last few years, and no one seems able to find a definitive way to raise the threshold that keeps migraine triggers from breaking through. In other words, there’s no cure so far. We’re getting better ways to manage migraine pain once it happens, but we are lagging behind in finding ways to prevent them altogether. What about Botox? Botox has just been FDA-approved for people with chronic migraines – which is defined as people who have headaches more than 15 times a month, with eight of these headaches intense enough to be categorized as full migraines. The protocol is injections on the forehead, temples, back of the skull and down the neck. The temples and forehead? How can they make sure people aren’t faking headaches to get the Botox for cosmetic reasons? You only get FDA approval to use it for the worst cases, which means people who have been under the care of their doctor for a long time. Since it’s just been approved, it’s too soon to say how successful it will be, but Botox may rise on the list of common treatments once we get more data. When, if ever, should you go to the emergency room with a migraine? Go to the emergency room if you have any of these symptoms of a migraine: alteration of consciousness, disorientation or confusion, fever over 101, weakness or numbness in your arms or legs, nausea that won’t stop, speech changes, or severe vertigo. People who have had migraines over time get familiar with their migraine triggers, what they feel like, how they start, where the pain localizes and how long they last. So if you’re having a new kind of headache or it’s the worst pain of your life, you’re going to know that this isn’t your typical experience and you need to get it checked out immediately. Can lifestyle measures help prevent migraines? Anything that makes you feel good is also good for preventing migraine triggers: a healthy diet, good sleep hygiene, regular exercise, avoiding smoke and alcohol. Find ways to manage stress, unwind and relax. It can be biofeedback or meditation or a hobby — some sort of escape mechanism. But if these commonsense steps don’t stop your migraines, seek help. Treatments are improving all the time, and there’s no need to let migraines control your life. What Do You Know About Migraines? In the U.S. alone, 30 million people suffer from migraine headaches, and the condition is three times more common in women than in men. However, surveys show that fewer than half of sufferers have received a diagnosis from their health-care providers.

THOUGHT FOR THE DAY...

You can close more business in two months by becoming interested in other people than you can in two years by trying to get people interested in you.

FUN FACTS AND A GREAT WAY TO MAKE EXTRA INCOME WITH MJ-HLC, - AND - CHECK OUT " WWW.MELODYSHAPPYWORLD.COM" FOR A FREE WAY TO BRING HAPPINESS TO THE WORLD AND LOTS OF IT TO THE WORLD WE LIVE IN!! - YOU CAN REACH MELODY AT; - 949 -706- 0887 -

*** Donald Duck comics were always banned from Finland because he doesn't wear trousers. *** The Muppet Show was totally banned from Saudi Arabian TV because one if its stars was a pig. *** The most popular sport as a topic for a film is boxing. *** The mask used by Michael Myers in the original 'Halloween' was actually a Captain Kirk mask painted white. *** The very first TV commercial showed a Bulova watch ticking onscreen for exactly 60 seconds. *** The first song played on Virgin Radio was Born to be wild by INXS! *** _____________________________________________________________________________________ WWW.MELODYSHAPPYWORLD.COM - "True happiness is not looking back with regret, but looking forward to the future and creating your own exciting, magnificent destiny and masterpiece, YOUR LIFE!" MELODY JENSEN IS THE MOST WONDERFUL PERSON AND THE GREATEST HUMANITARIAN I KNOW. CHECK OUT MELODY'S HAPPY WORLD, IT'S FREE!! ASSOCIATIONS: WWW.MELODYSSECRET.COM - YOU CAN REACH MELODY AT; 949 -706- 0887 -

Trying to Get Pregnant? 10 Things That May Trigger Fertility Problems

Having trouble getting pregnant? These 10 common obstacles – from vitamin A to personal lubricants – may be to blame. Plus, find out how to boost your fertility. Getting pregnant is a snap, right? You’ve got the partner, it’s the right time of life (and month) – so let the baby-making begin! Not so fast. Experts say fertility problems – such as advancing age, a history of sexually transmitted diseases, weight issues and a low sperm count – can put the brakes on reproduction. So while conception is a slam-dunk for some, many others struggle to get pregnant. “A healthy 20-year-old has only a 20%-25% chance of getting pregnant each cycle,” says John Norian, M.D., a fertility specialist at Loma Linda University’s Center for Fertility in California. In fact, among married women ages 15-44, 2.1 million (or 7.4%) were infertile in 2002, the latest period for which the Centers for Disease Control and Prevention (CDC) has statistics. And an impressive 9% of U.S. women ages 18-44 received fertility services, such as drugs, artificial insemination, embryo freezing and in vitro fertilization, that same year. Here are the top 10 fertility missteps: 1. Waiting too long You’re approaching 40 and still holding off on motherhood, wanting to climb one more rung on the career ladder. Besides, even women at age 55 bear children (with someone else’s eggs, in most cases). So what difference does a few more years make? A lot. Although you may be as fit as a teenager – exercising and eating healthfully – by age 42, your eggs are on life support, fertility experts say. As a woman ages, her number of eggs and their quality drop dramatically, says fertility specialist Mousa Shamonki, M.D., director of in vitro fertilization and assisted reproduction at University of California - Los Angeles' School of Medicine. Conception by the time a woman is in her late 30s and early 40s is difficult, and it becomes nearly impossible after age 45, Shamonki says. “Their bodies aren’t designed evolutionarily to get pregnant as easily later as when they’re in their teens and 20s,” she says. Usually, conception happens when an egg cell is released from a woman’s ovary, travels through a fallopian tube, and is fertilized by a man’s sperm. The fertilized egg undergoes many cell divisions on its way to the uterus, where it implants and grows. Embryo quality, however, diminishes as mothers-to-be age, while the possibility of chromosomal abnormalities increases, says Shari Brasner, M.D., an obstetrician and gynecologist affiliated with Mount Sinai Medical Center in New York. “Biologically, Mother Nature doesn’t care what your reasons are for delaying childbearing,” says Barry Brock, M.D., assistant clinical professor at UCLA’s department of obstetrics and gynecology. His advice: “If you’ve found your life partner and want kids, don’t wait.” 2. Sexually Transmitted Diseases (STDs) Oh, those college liaisons. So spontaneous, so passionate, so unprotected. Many produce an unwelcome outcome: STDs. Genital human papillomavirus, or HPV, is the most common sexually transmitted infection. It can result in cervical dysplasia, an abnormal growth of cells, and cancer, if undetected, says Shamonki. By the end of college, 70% of students have been infected with HPV, adds Shamonki. That can increase the risk of developing dysplasia. Procedures to remove those abnormal cells sometimes make it difficult to get pregnant or carry a baby to term. Chlamydia is another fertility ne’er-do-well. About 2.8 million cases of chlamydia and 718,000 cases of gonorrhea, which can co-exist with chlamydia, occur each year in the U.S., according to the CDC. Untreated, about 10%-15% of women with chlamydia develop pelvic inflammatory disease (PID), which can damage the fallopian tube and tissues in and near the uterus and ovaries, according to the CDC. As many as 93% of women who’ve had a fallopian-tube abscess due to PID cannot become pregnant afterward. Chlamydia also can cause fallopian-tube infections without any symptoms, permanently damaging the tubes, uterus and surrounding tissue. Other women may face a potentially life-threatening ectopic, or tubal, pregnancy. Even more STDs can affect labor and delivery, says Brasner. “Women with active herpes infections at the time of delivery need cesarean sections,” she says, because the mother’s disease can lead to potentially fatal infections in babies. Vaccines are available to protect girls and women against the types of HPV that cause most cervical cancers and genital warts. They are recommended for girls and women up to age 26, according to the CDC. “The HPV vaccine for pre-adolescents and adolescents should be a very high priority,” says David Soper, M.D., director of the Division of Gynecology and General Obstetrics at Medical University of South Carolina in Charleston. 3. Sperm count Fertility doesn’t depend on women alone. Men’s sperm must pass muster too. A low sperm count – fewer than 20 million sperm per milliliter of semen – means that the fluid the man ejaculates during an orgasm has too few sperm. A normal ejaculation should contain at least 39 million sperm, according to the Mayo Clinic. Some causes of a low sperm count: Infection: Chlamydia, gonorrhea and other infections can cause scarring in the testes that prevents passage of sperm. Hormone imbalances: Low testosterone, the result of abnormalities of certain glands, may cause infertility. Medications: Long-term anabolic steroid use, certain antibiotics (such as tetracyclines, erythromycin and neomycin) and some ulcer medicines (such as Tagamet) can impede fertility, according to Harvard Health Publications. Don’t worry, though. A woman can get pregnant even if her partner’s sperm underperform. Conception can occur with a low sperm count, but it often takes longer, says Norian. Treating low sperm count with medication (if the problem is hormonal) often helps boost the odds. 4. You can be too thin You’ve decided to take the pregnancy plunge. Fearing the weight gain that comes with it, you hit the treadmill like a college track star before you conceive, and achieve a weight worthy of a magazine cover. Big mistake. Lack of fat can slow production of the hormones needed for ovulation (which includes estrogen), says Norian. “Estrogen and testosterone [the latter of which stimulates sperm production] come from cholesterol,” he says. So, “a little fat is OK.” Plus, “your body tells you when you have weight trouble,” Brock adds. “If you lose your periods, gain some weight.” Ask your doctor to determine your ideal weight to optimize fertility. 5. Too much weight Don’t start eating for two before conception. Overweight women may also face problems getting pregnant. Why? Extra pounds can throw off normal hormone production, explains Brasner. That’s because too many fat cells lead to estrogen overproduction, resulting in irregular ovulation. Also, obesity may increase the risk of miscarriage. In overweight men, sperm motility (or movement) may be slowed and sperm count may go down because testes become too warm due to the additional weight, says Norian. Try to lose weight before trying to conceive, Shamonki advises. “The sweet spot is a BMI between 19 and 24,” Norian says. To learn your level, use our Body Mass Index calculator. Very obese women should lose 5% of their body weight, he adds. Even that small amount can start ovulation. 6. Over-exercising Yes, exercise is good for you. But running 40 miles a week? That won't help you if you're trying to get pregnant. Women who over-exercise risk losing body fat that helps produce estrogen, which spurs ovulation. They may experience infrequent or light periods, or their periods stop altogether. Exercising 4-5 days per week for 30 minutes, maintaining a heart rate of 120-130 beats per minute, is appropriate, says Norian. Men who exercise too much may also raise the internal temperature of their testicles (which should be 96°), causing sperm to die. Over-exercise can also affect sperm shape, a prime predictor of infertility, doctors say. 7. Dietary supplements Sometimes even a good thing, such as vitamins, turns bad. Too much vitamin A – stored in the body and sometimes taken in excess by women seeking to boost their antioxidant intake – can lead to birth defects, liver abnormalities and other disorders, according to the CDC. Women 19 years and older should take no more than 5,000 IU daily, of which at least 50% comes from beta-carotene, typically the amount in a multivitamin. “Black cohosh, an herb used by some women to treat menopause symptoms or boost fertility, is a definite no-no,” Norian says. The supplement is not regulated and could be harmful. Folic acid, on the other hand, is recommended. This B vitamin helps prevent neural-tube defects, such as spina bifida. Take only the daily recommended dose of any supplement. A daily multivitamin covers most women’s needs. Read supplement labels carefully. Some have hormones that “defeat the purpose of getting pregnant,” Norian says. For example, some women take dehydroepiandrosterone (DHEA) – a hormone produced naturally, and chemically in laboratories – to boost their fertility. It should be taken only under the supervision of a physician. Remember, too, that the Food and Drug Administration (FDA) doesn’t regulate herbs and vitamins. “So you don’t know the actual dosage you’re getting,” Brock says. “The contents in a bottle of vitamins may contain 0%-95% of what they say is in them.” 8. Lubricants What adds to your sexual pleasure may put you on a slippery slope to infertility. “Almost every lubricant can [harm] sperm,” Brock says. Check the label to make sure the liquid doesn’t contain a spermicidal ingredient. Nonoxynol-9, or N-9, for example, often is used by couples thinking they’re killing bacteria responsible for some STDs. In fact, it doesn’t protect against STDs, but it does kill sperm. If you must use a lubricant, choose a water-based – not petroleum-based – gel or cream, says Norian. That’s because petroleum slows down sperm. Put simply: The fewer barriers you put between sperm and egg, the easier it is to conceive. 9. Douching Don’t do it, doctors say. The old yarn about douching to produce the gender you want (acidic environment for girls and alkaline for boys) is unproven, and that tactic may do harm. “Our bodies weren’t designed to have stuff flushed backwards,” Norian says. Since the vagina isn’t sterile, it’s better not to inject contents back into the uterus and fallopian tubes, he explains. 10. Everything else Tobacco: Heavy smoking can damage your cervix and fallopian tubes, age your ovaries and deplete your eggs prematurely. Nicotine may also interfere with estrogen production and predispose your eggs to genetic abnormalities. Plus, smokers start menopause 2 years earlier than non-smokers. Butts out, doctors advise. Alcohol: Heavy drinking – more than 4 fluid ounces of wine or 10 ounces of weak beer at least three times a week may increase the risk of ovulation disorders. Although the American College of Obstetricians and Gynecologists (ACOG) advises women to avoid all alcohol during pregnancy, some doctors believe an occasional glass of wine or beer will not harm the fetus, according to a large University College of London study. Caffeine: Too much may damage fallopian tubes and contribute to endometriosis. A good rule of thumb is to start safe caffeine habits before trying to conceive, researchers say. ACOG recommends that pregnant women consume no more than 12 ounces of coffee (200 mg of caffeine – that means green tea and soda, too!) a day. Keep in mind that some Starbucks 12-ounce cups of coffee contain 320 mg of caffeine. Jacuzzis: All that hot water can put sperm in, well, hot water. Testicles sit outside the body for a reason, to remain cooler. “Anything that increases body temperature can have a negative impact on sperm quality,” Brasner says. When to see a doctor Doctors advise seeing a fertility specialist if: You’re older than 39 and haven’t conceived after three months You’re 35 or older and haven’t conceived after six months You’re under 35 and haven’t conceived after 12 months Also, if you have a history of fibroid tumors or bleeding between cycles, or if you’ve had trouble conceiving previously, get a physical exam before you start trying, Shamonki says. The good news: Following these tips, 85% of women find themselves starting a family after just one year. Women’s Health: How Much Do You Know? As a woman, your health concerns are as unique as your body. How you take care of yourself has a huge impact on your future, affecting everything from your ability to have children to your risk of heart disease. There's no substitute for good health, and when it's gone, it's often gone for good.