Sep
01
2004

Second Hand Cigarette Smoke Kills

By | Cancer, Heart Disease, Men's Health, Women’s Diseases

A recent publication in the British Medical Journal was reviewed in the Aug.10 issue of The Medical Post. The study was concerning detailed census data from New Zealand where two cohorts of the population were compared in 1981 and 1996.

The 1981 study involved 286,796 people, the 1996 study involved 382,462 people. Both cohorts were further classified into exposure to second hand smoke and non-exposure meaning that they lived in a smoke-free home (controls). I have elected to show the results in a graph below for ease of reference. The authors Dr. Tony Blakely and others from the University of Otago had followed each cohort for 3 years and recorded death rates (mortality rates) for each of the subgroups.

They pointed out that there was a 15% increase in premature death for those exposed to second hand smoke when compared to the controls who were not exposed.

Comments: 1. The mortality in the 1996 study (in blue bars in the graph below) for males is what the authors quoted (15.1%). However, for females, the death rate was even higher with regard to exposure to second hand smoke: mortality was 26.7% higher when the exposed group is compared to the controls.

Second Hand Cigarette Smoke Kills

Second Hand Cigarette Smoke Kills

2. The 1981 study (green bars in the graph below) had a much higher overall mortality than the overall mortality in the 1996 study (blue bars). This likely is due to the 15 year interval between the two study groups and the fact that during that time in New Zealand as in many other industrialized countries the death rate from cigarette smoke exposure has declined significantly.

One such study indicates a reduction between 1981 and 1997 of 38% in all preventable deaths, which includes death as a result of exposure to cigarette smoke. The average death rate reduction in the New Zealand study over the 15 years was 31.7% for men and 29.35% for women when the exposed groups and control groups were pooled.

3. The controls and the relationship of the subgroups within the 1996 study (the blue bars in the graph below) were very consistent , but were not consistent within the 1981 study (green bars).

For instance, the controls of death rates should always be smaller in both males and females when compared to the groups that were exposed to second hand cigarette smoke. In the 1996 study this was the case, but in the 1981 study this was not the case. This may indicate that there were other negative factors included in the 1981 study leading to premature death or that the controls were simply also exposed to cigarette smoke in the past.

Mortalitiy Rates (%) Resulting From Exposure to Second Hand Smoke in New Zealand Study
 Second Hand Cigarette Smoke Kills1

Conclusion: This is an important study as it is based on large numbers and it shows that even relatively small concentrations of cigarette smoke in the environment make a measurable difference in terms of death rates among the population. It also confirms the fact that the death toll has been reduced by about 30% in the population within 15 years (between 1981 and 1996), because many people have quit smoking during that time period and this is measurable as indicated above (green bars higher on average than blue bars).

More info on:

Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Lung cancer: http://nethealthbook.com/cancer-overview/lung-cancer/

Reference: The Medical Post, Aug. 10, 2004, page 48

Last edited October 27, 2014

Aug
01
2004

Birth Control Pill Increases Strokes And Heart Attacks

By | Heart Disease, Hormones, Stroke, Women’s Diseases

At the recent 86th Annual Meeting of the Endocrine Society in New Orleans/Louisiana a Canadian delegation presented data from a meta-analysis of 14 trials regarding side effects of the birth control pill (BCP) when taken on a prolonged basis. The researchers were interested to know the risk of heart attacks or strokes that would be associated with the prolonged use of the low dose estrogen BCP. All of the studies between 1980 and October of 2002 were examined and 14 independent studies qualified for the meta-analysis. The strength of such a meta-analysis lies in the pooling of data and the fact that the data is derived from a much larger patient population, which generally makes the results more reliable. Dr. J. Baillargeon from the Centre Hospitalier Universitaire in Sherbrooke, Quebec/Canada, stated that they found a 1.85-fold risk for developing heart attacks with longterm use of the BCP and at the same time there was a risk of 2.54-fold of hemorrhagic strokes with longterm use of the low-dose BCP.

I have depicted these findings below in graph form where the risk is readily seen when compared to women who did not use any birth control pills. In discussions following this presentation the authors explained that with short-term use of the BCP using the modern low dose formulations heart attacks and strokes would likely not be noticeable.

Birth Control Pill Increases Strokes And Heart Attacks

Birth Control Pill Increases Strokes And Heart Attacks

But women should know that long-term use does have this risk. These decisions of whether to take the BCP and for how long needs to be discussed with the treating physician also in the view that other risks such as high blood pressure, diabetes or the metabolic syndrome would be added risks where heart attacks and strokes can occur more frequently. In these conditions the BCP likely should be avoided.

Risk of Developing Heart Attack or Stroke after Longterm Use of The Birth Control Pill
 Birth Control Pill Increases Strokes And Heart Attacks1

 

 

 

 

 

 

 

 

 

Dr. Ricardo Azziz, chairman of obstetrics and gynecology at the Cedars-Sinai Medical Centre in Los Angeles, California, stated that these findings from this meta-analysis would be very important because it was based on such a large data base and was measuring the effect of the BCP over a long period of time. He stressed that the benefits of any medication must always be weighed against the risks by the treating physician. In diabetic patients on the BCP, for instance, the benefits likely outweigh the risks as the metabolism is stabilized through an improved insulin sensitivity, improved managability of the diabetes and avoidance of the high risk pregnancies in diabetics.

More info on:

Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/

Reference: The Medical Post, Vol.40, July 20, 2004, page 20

Comments on Nov. 6, 2012: What was not discussed by these experts is the fact that the BCP contains a mix of two artificial hormones (estrogen and progesterone equivalents) that the body’s estrogen and progesterone hormone receptors cannot recognize. Bio-identical estrogen and progesterone creams on the other hand would be recognized by these receptors, but nobody has researched their use for BCP purposes, only for post-menopausal hormone replacement.

Last edited Oct. 26, 2014

Jul
01
2004

Insomnia Sufferers Will Get Help

By | Health, Men's Health, Women’s Diseases

People with chronic insomnia not only have difficulties to get a good rest at night. If they reach for the currently available sleeping medications, their days start with a drug-induced mild “hangover”: they feel drowsy for a few hours, and once they discontinue the medication, withdrawal can be a problem.

A new medication by the name of indiplon to treat chronic insomnia will be a safer, more effective form of medicine for patients with sleep disorders, reports Dr. James Walsh (PhD). He is an executive director and senior scientist at St. Luke’s Hospital and the Unity Sleep Medicine Center in St. Louis. Dr. Walsh reports that the new medication has a very short half-life, meaning, that it is out of the body, by the time the patient wakes up in the morning. A 35-day trial showed that it is not only safe and effective, but also suitable to treat patients who have trouble falling asleep and those who have trouble sleeping through the night.
More studies are needed, before the medication will be available in the U.S. (conditional approved in 2007 in the US, see link above) and in Canada. Here is a more extensive review regarding this complex new sleeping pill.

Reference: The Medical Post, May 25, 2004, pg. 16

Insomnia Sufferers Will Get Help

Insomnia Sufferers Will Get Help

Comment on Nov. 5, 2012: It appears that there are problems with long-term safety studies that were never completed. I would suggest to stick to over-the-counter melatonine proparations in the 1 mg to 3 mg range. Melatonine is safe as it is a body hormone. Prescription hypnotics (as sleeping pills are called) are problematic as they do not fit into the body chemistry receptor-wise. No problems there with melatonine.

Last edited December 8, 2012

Apr
01
2004

Breast Cancer And Miscarriages; Fear-Mongering Debunked

By | Cancer, Women’s Diseases

For many years there were conflicting reports about the emotionally charged topic of whether miscarriages (=spontaneous abortions) or induced abortions (also simply known as abortions) would lead to an increased risk for these women later in life. The problem was that the studies could not be directly compared because they differed in size, in age group and whether the women had one or more children or none.

The studies also differed in respect to whether they were prospective or restrospective. In this context a prospective study is one where it was known at the outset before the women developed breast cancer whether or not there was a history of a spontaneous or induced abortion in the past. A retrospective study would be one where a group of women with established breast cancer would be asked retrospectively whether or not they had a history of abortions (spontaneous or induced).

It turns out that the discrepancies between these studies in the past were largely because of the significant difference between the data of the unreliable retrospective studies and the very reliable prospective studies.

On March 27, 2004 the Lancet reported about a study that had been undertaken by the Collaborative Group on Hormonal Factors in Breast Cancer (seat of the Secretariat in Oxford, England). This study involved hundreds of scientists and clinicians from the major Cancer Clinics around the world who gathered the world-wide epidemiological evidence about breast cancer and pooled the data regarding 53 studies from 16 countries.

Breast Cancer And Miscarriages; Fear-Mongering Debunked

Breast Cancer And Miscarriages; Fear-Mongering Debunked

A total of 83,000 women with breast cancer around the world had been included in this study. The data was separated into sub-categories. For instance, 44,000 women were included in the prospective branch of the study and 33,000 in the retrospective branch. The data was carefully controlled for the factors mentioned above and many other differences to ensure that the data could be compared (rules of evidence-based medicine).

The surprise finding was that there was no statistical difference regarding the risk for developing breast cancer in the prospective branch of the study between the group of women who never were pregnant, those who had one or more children and those who had miscarriages or abortions in the past. However, the retrospective studies reported a higher incidence of breast cancer because of an observer bias. The researchers and clinicians concluded that the data of the restrospective studies were unreliable because they were not carefully controlled and there likely was more reliable reporting of the women who had developed breast cancer than the control groups who likely underreported their histories thus resulting in misleading conclusions.

Summary: Women do not have a higher risk of developing breast cancer following spontaneous or induced abortions. Forget all of the fear-mongering that you may have heard in the past in the popular press.

More information about causes of breast  cancer: http://nethealthbook.com/cancer-overview/breast-cancer/causes-breast-cancer/

Lancet 2004; 363: 1007-16.

Last edited October 26, 2014

Jan
03
2004

Poverty Still A Threat To Mothers’ Lives

By | Health, Prevention, Women’s Diseases

Adrienne Germain from the International Women’s Health Coalition, New York, wrote a review in the Lancet (Lancet 363: 65-66, 2004) about the state of health and mortality of pregnant women (maternal death rate) around the world. 500,000 pregnant girls and women die around the globe every year from conditions that are preventable or treatable. 99% of these live in developing countries. At the same time 3.9 million newborns die every year in their first 4 weeks of life!

2004 is the 10-year anniversary of the recommendation for reproductive health from the 1994 International Conference on Population and Development (ICPD). The maternal death rate in Europe is about 1 in 4000 pregnancies; in many African countries (sub-Saharan Africa) it is 1 in 16! Despite some progress that has occurred, still 70% of all deaths associated with pregnancy occur in only 13 countries. In another article in the Lancet (Lancet 2004; 363: 23-27) Prof. Wendy Graham and co-workers used a new familial technique to determine whether there is a statistical association between poverty and the maternal death rate. The answer is not only a clear “yes” for the maternal death rate within one country, but there is a clear association between poverty and maternal death rate in countries all around the world!
A high mortality rate in babies and children in addition to the maternal death rate has traditionally been a grave concern in poor countries. Research in development countries has shown that 70% of the poorest 1.3 billion people in the world are women. The study also shows that these mothers have a high mortality rate. Maternal death can occur during pregnancy or birth, and the poorer the population group, the higher the maternal death rates will be. The reasons are varied: for the poorest of the poor, medical treatment is often unaffordable.

Poverty Still A Threat To Mothers' Lives

Poverty Still A Threat To Mothers’ Lives

Also seemingly simple measures such as clean drinking water, toilets and whether floors are present in dwellings do have an impact on health. At the same time the level of education determines whether death rates are higher or lower. These results are not only true for one specific country. Even though most of the alarming numbers come from the African countries such as Burkina Faso, Chad, Ethiopia, Kenya, Mali, and Tanzania, other countries like Indonesia and the Philippines show the same troubling picture.
The main causes of maternal deaths were due to the following conditions: bleeding after delivery, early pregnancy bleeding; infections that would lead to sepsis and death; complications surrounding abortions; blood pressure problems such as eclampsia with seizures and kidney damage; and prolonged labor when the baby’s head is too large. This latter condition requires an Cesarean section on an emergency basis, which is not always readily available in rural areas.

As we know from other studies, even closer to home, poverty and rural isolation remain a risk to health and life.
Adrienne Germain in her editorial review pointed out that some poor countries such as Bangladesh have taken the recommendations for reproductive health from the 1994 ICPD-conference seriously and have instituted a nationally sponsored program.

The result has been that between 1988 and 2002 the percentage of women receiving antenatal care has improved from 26% to 47% while the maternal death rates have declined from 410 to 320 per 100,000 women during and after the pregnancy. Childhood mortality also improved significantly as did the mothers life expectancy (from 58 to 60 years). There are success stories in other countries as well.
What is needed is political will around the globe, co-operation between the appropriate agencies such as the WHO, the UNICEF, the International Women’s Health Coalition, and others. Locally in every country it is vital to have an interdisciplinary co-operation to fight poverty and to provide shelter with a certain minimum living standard.

Link to UNICEF. Link to WHO. Link to International Women’s Health Coalition.

Last edited December 8, 2012

Sep
01
2003

Stillbirth Associated With High Coffee Consumption In Pregnancy

By | Nutrition, Women’s Diseases

A study entitled “Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life” by Dr. K. Wisborg et al. was published recently in the British Medical Journal (BMJ 2003; 326: 420-423).

The pregnancy outcome of 18,478 women who completed a questionnaire at their first prenatal visit was studied. They were asked about coffee consumption and the following 4 groups were identified: group 1 consisted of the 43% of women who drank no coffee. Group 2 (34%) drank 1-3 cups per day, group 3 drank 4-7 cups per day (18%). Group 4 drank 8 or more cups per day (5%).

Below are the results in tabular form.

The surprising result was that a small amount of coffee (1-3 cups per day) was actually reducing the risk of stillbirth by 30% when compared to women who drank no coffee at all. However, from 4 cups of coffee per day or more there was a sharp increase of stillbirths within the first year (=sum of stillbirths and deaths within the first year of life).

Stillbith Associated with High Coffee Consumption in Pregnancy

Stillbith Associated with High Coffee Consumption in Pregnancy

The authors suggest that physicians should advise their pregnant patients to limit coffee consumption in pregnancy to 1 or 2 cups of coffee or the equivalent of caffeinated drinks per day as a precautionary measure.

Stillbirth coffee study
Groups with varying amounts of coffee consumption: Risk increase of stillbirth compared to group 1 as control:
group 2  (1- 3 cups per day) -30%
group 3 (4 – 7 cups per day) 80%
group 4 (8 or more cups per day) 300%

Last edited December 9, 2012

Aug
01
2003

HRT; Findings From The British Million Women Study

By | Cancer, Hormones, Women’s Diseases

 

In the latest issue of the Lancet (Lancet 2003;362:414-415,419-427) a study from Great Britain was published regarding the risk of breast cancer. Over 1 million women were followed from 1996 to 2001. They were in the age group of 50 to 64. Of these 80% were postmenopausal, and these formed the basis of the study. Dr. Valerie Beral (from the Cancer Research group UK in Oxford) was the lead investigator. About half of the women were on various forms of hormone replacement therapy (HRT), the others were not and served as a control. Risks were always expressed in comparison to the controls without any hormone replacements. Here is a tabular summary of the various hormone replacement therapies and their risks of leading to breast cancer.

The relative risk of developing breast cancer did not significantly change whether HRT was taken orally, transdermally or through implanted formulations. Tibolone is a synthetic steroid used for postmenopausal symptoms and treatment of endometriosis.

Dr. Beral’s group has estimated that in Great Britain in the past 10 years about 20,000 additional cases of breast cancer were caused by HRT for menopause among women aged 50 to 64. Out of these about 75% were due to the use of the combination of estrogen/progestin.

HRT; Findings From The British Million Women Study

HRT; Findings From The British Million Women Study

An accompanying editorial by Dr. Chris van Weel stated that “general practitioners should discourage HRT for their patients” and, if used, should last “no longer than 3-6 months”. The investigators of this study suggested that “discontinuing HRT should be suggested in as supportive a way as possible, because no one will benefit from panic or over-reaction”.

Findings from the British Million Women Study on HRT
Detail of hormone replacement: Breast cancer risk compared to control:
overall risk of HRT for all groups of HRT 1.66-fold
women who stopped HRT the previous year 1.14-fold
estrogen only use currently 1.30-fold
estrogen-progestagen combination
 1.88-fold
tibolone users
 1.45-fold
combination HRT user less than 5 years 1.7-fold
combination HRT user more than 5 years 2.21-fold
equine estrogen combined with medroxyprogesterone acetate and taken at least 5 years 2.42-fold
death rates from breast cancer associated with current use of HRT 1.22-fold

Discussion: Please keep in mind that the British authors of this study were using the drug manufactured synthetic hormone-like substances and NOT bio-identical hormones. The outcome with bio-identical hormones would have shown the opposite, namely that women would not have developed heart attacks, strokes or cancer and they would not have died prematurely. Read more about bio-identical hormone replacement in the links below.

Here is a link to a chapter on menopause from Dr. Schilling’s Net Health Book.

This link deals with bioidentical hormone replacement (see lower half of that page).

Last edited October 26, 2014

Jul
01
2003

New In Vitro Fertilization (IVF) Gold Standard Declared

By | Women’s Diseases

At a recent conference in Montreal/Canada about “Measuring Human Embryo Quality” several IVF research groups exchanged the latest on single embryo transfer, which has become the standard for in vitro fertilization. These techniques are important for treating infertile couples.

In the past an in vitro fertilized egg was implanted into the woman’s uterus, but the success rate of a normal pregnancy was extremely low (in the order of 15% to 20%).

Subsequently more than one fertilized egg was implanted to improve the success rate, but this led to twins, triplets and multiple pregnancies with a high complication rate and death due to premature deliveries. Subsequently it was found that the success rate was much higher after a few cell divisions, which were allowed to take place outside the uterus in vitro cultures. Dr. William Schoolcraft (director of the Colorado Centre for Reproductive Medicine at a private clinic in Englewood, Col.) reported that embryos that were cultured for 5 days until the blastocyst stage in vitro are much more stable for implantation.

New In Vitro Fertilization (IVF) Gold Standard Declared

New In Vitro Fertilization (IVF) Gold Standard Declared

For the past 5 to 6 years they and other groups have only employed this technique, which according to him is now the gold standard. Although they were largely still using two embryos for transfer into the uterus for IVF. It has become increasingly clear that the risk of twin pregnancies in these already high risk situations is ranging from 4- to 10-times the risk of a single embryo transferred (singleton) into the uterus. Because of this his group has decided to only do singleton transfers. The other new finding is that it matters tremendously what culture medium is used for incubating the fertilized egg for the 5 day period in culture and what the exact conditions are. They found that for optimal results they have to use two different growth media, the first 3 days a low glucose or glucose free medium that mimics the environment of the fallopian tube. On day 4 and 5 the medium must mimic the environment inside the uterus, which requires it to be rich in amino acids and contain glucose.

An embryologist, Dr. Barry Behr from the Stanford University Medical Centre in California, reported that the same culture medium is not necessarily suitable for all patients, but individualization and close observation of the wellbeing of the embryo and the mother is necessary. To optimize maximum quality of the embryos growth factors may also have to be introduced into the culture medium and further research is going on in this direction.

This report is based on a summary in The Medical Post , June 24, 2003, page 8.

Here is a useful link regarding the topic of infertility: http://www.nethealthbook.com/articles/infertility.php

Last edited December 9, 2012

Jul
01
2003

Beware Of Binges

By | Gastrointestinal Disease, Health, Men's Health, Women’s Diseases

In the June 16, 2003 issue of Time (page 73) an article appeared under the heading “Summertime booze”. A study from the Buffalo University showed that women, in particular, have to be conscious that drinking 3 or 4 drinks at one time on the weekend is not the same as drinking the same 3 to 4 drinks over the course of one week.

A study looking at the frequency of breast cancer in relation to drinking patterns found that the binge drinking women had a 80% higher breast cancer risk than the controls who drank 3 to 4 drinks at a time (but only one drink per day). Jo Freudenheim, the epidemiologist involved in this study, suggested that perhaps with the binge drinking alcohol’s toxic potential for breast cancer cells had been reached whereas with one drink at a time over one week this level was never encountered.

In another study from the Buffalo University liver toxicity as a result of alcohol exposure was examined. These researchers used blood tests to measure liver enzymes, which were leaking from the liver cells as a result of the toxic effect of alcohol. Both men and women were tested and various drinking patterns were also studied. Men who drink several drinks daily had the highest liver enzyme counts (reflecting the toxic effect of alcohol on the liver). However, women who drink only on weekends had even higher counts of the liver enzymes than men! Women who drank on an empty stomach had much higher liver enzymes in these studies than men where this effect did not show (with men it did not matter whether they drank with food or on an empty stomach).

Beware Of Binges

Beware Of Binges

The researchers concluded that binge drinking appears to affect women more than men. Generally speaking the higher the amount of alcohol consumed, the more toxic the effects on body cells and on the liver. Moderation may be in order.

Comments: These type of studies are particularly important in view of the fact of marketing techniques of the wine industry. Wine and alcoholic beverages are being portrayed as being a good source of bioflavonoids that are lowering cholesterol and would prevent or postpone heart attacks. Some of the data on cancer indicates that for ovarian cancer and colorectal cancer there may not be a safe low dose as even one drink per day can have a measurable effect on cancer risk. On the other hand, bioflavonoids are abundantly present in raw vegetables and fruit, so there is no panic about not getting enough heart attack preventing foods. Finally, a bit of common sense does not harm: alcohol is a cell toxin, so it should be diluted (nothing stronger than wine) and if you desire a drink, use it in moderation.

Link to chapter on alcoholism in Net Health Book:

http://nethealthbook.com/drug-addiction/alcoholism/

Last edited October 26, 2014

 

Jun
01
2003

Genetic Link Found For Bipolar Disorder

By | Diabetes, Mental Health, Prevention, Women’s Diseases

A staff psychiatrist at the Dalhousie Medical School in Halifax (Novia Scotia, Canada) has gathered 1100 DNA samples and psychiatric histories from patients with bipolar disorder and family members who do not have this psychiatric disease. Dr. Martin Alda, The Medical Post reports on page 46 of the May 20, 2003 edition, and his medical team were able to identify 4 areas of interest on chromosomes 15, 7, 6 and 21 where molecular markers for bipolar disease were located.

Two additional tools, namely responders to lithium (common bipolar disease stabilizer) and certain ethnic group differences, are being utilized as well. Dr. Alda has already found that unstable genes can be stabilized in the presence of lithium. By studying the genes involved in the expression of bipolar disorder and defining what triggers a depressive response and what triggers a manic episode, the researchers hope to unravel the mysteries that still surround this intriguing disease. Dr. Alda is also studying the connection of diabetes and biploar disease. Patients with biploar disease are 3 times more prone to diabetes than the general population. As these patients (bipolar patients with diabetes) are poor responders to lithium, there is a suggestion that perhaps the newly defined genetic loci are blocked in some way by the hormone changes in diabetics. Further investigations in this direction are planned by the research group.

Genetic Link Found For Bipolar Disorder

Genetic Link Found For Bipolar Disorder

Link to bipolar disorder: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/bipolar-disorder/

Link to diabetes:

http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited October 26, 2014