Bacteria In House Dust May Help Prevent Allergies

Bacteria in house dust may actually protect babies against developing allergies. Numerous reports suggest that hygiene measures in modernized societies may be partly responsible for the increased occurrence of (asthma-related) diseases in these populations. Read more

Allergies Can Dig Into Gardening's Fun

(HealthDay News) -- For gardeners with allergies, it can be difficult to enjoy their passion for plants when they have to cope with the misery of sneezing, itchy eyes, congestion and, in some cases, an asthma attack.

"Gardening outside during times of high pollen counts puts patients at risk for severe allergic symptoms," Dr. Warren Filley, an allergist/immunologist in Oklahoma City, said in a prepared statement.

"Avoidance measures, as well as the use of medications and allergy immunotherapy, can make the difference between having fun in the garden and being miserable," said Filley, a long-time gardener who suffers from allergies.

An allergist/immunologist can help determine which plant species are causing allergies and offer advice on the best time of day or season to work in the garden, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). For example, pollen levels are typically lower on rainy, cloudy and windless days.

Gardeners can also control their allergies by careful selection of plants. Certain flowers, trees and grasses are less likely to produce pollen. These include: cacti, cherry, dahlia, daisy, geranium, iris, magnolia, rose, snapdragon and tulip.

Plants that are highly allergenic include: ash, cedar, cottonwood, oak, maple, pine, saltgrass and timothy.

Skin testing is the best way to determine which plants will trigger allergic reactions in individuals, said the AAAAI, which offered some additional allergy prevention tips for gardeners:

• Whenever working around plants likely to cause an allergic reaction, avoid touching your eyes or face.


• Consider wearing a mask to reduce the amount of pollen spores that you inhale.


• Wear gloves, long-sleeved shirts and long pants to minimize skin contact with allergens.


• Leave gardening tools and clothing, such as gloves and shoes, outside to avoid bringing allergens indoors.


• Shower immediately after gardening or doing other yard work.

More information

The American Academy of Family Physicians has more about allergies.

My Immune System Confronts a Virus

After a stem cell transplant, it's a little scary to run into a familiar old enemy
by Jason Carpenter

As I reached Day 21 of my stem cell transplant, my recovery hit a very scary wall. I woke up with a fever of 102 and could barely lift my head off my pillow. I felt that little tingle in the back of my throat and knew right away what it was: the common cold.

For a stem-cell-transplant patient, though, a cold is anything but common. Quoth the International Myeloma Foundation: “Even a minor infection...can lead to serious problems because the body’s immune system is so weakened by the effects of the high-dose chemotherapy and the loss of blood cells.”

Translation: I could die. Continue reading »

A Bone Marrow Disease With a Brighter Prognosis

(HealthDay News) -- Blood is life. And the rare disease known as aplastic anemia robs the body of life by robbing the body of blood.

The aplastic anemia patient's blood thins as the bone marrow slows its production of blood cells. The results can range from chronic fatigue to heart disease or from endless infections to cuts that won't clot, depending on the type of blood cells that are lacking.

But there's hope: Considered fatal as recently as two decades ago, aplastic anemia is becoming a far more manageable disease. Advances in drug therapies and improvements in the field of transplantation have slashed the death toll, allowing patients to live longer, fuller lives.

"We are getting better at treating aplastic anemia, either in getting rid of it or treating its symptoms," said Dr. Jaroslaw P. Maciejewski, with the Cleveland Clinic's Department of Hematologic Oncology and Blood Disorders.

And those advances are helping doctors gain greater insights into other, more prevalent, health conditions, such as heart disease and leukemia.

An estimated 50,000 people develop aplastic anemia in the United States each year, according to the U.S. National Institutes of Health. (A related blood disorder, myelodysplastic syndrome, or MDS, occurs when the bone marrow begins to produce poorly functioning or immature blood cells. About 20,000 to 30,000 new cases of MDS occur each year.)

It's important to note that many symptoms of aplastic anemia, such as fatigue and infection, can also be caused by other diseases, said Dr. Ronald Paquette, a blood disease researcher with the University of California, Los Angeles' Jonsson Comprehensive Cancer Center.

"If everyone who was fatigued thought they had aplastic anemia, we'd be swamped," Paquette said.

Bone marrow -- the spongy material inside bones -- produces stem cells that normally develop into the three main types of blood cells -- red blood cells, white blood cells, and platelets.

"Essentially, the bone marrow is a factory of blood," Maciejewski said.

In patients with aplastic anemia, the stem cells have been damaged, slowing or stopping the production of all blood cells.

The cause of the damage to stem cells remains unknown in more than half of people with aplastic anemia. Some research has suggested that stem cell damage occurs when the immune system attacks the body's own cells by mistake, according to the National Institutes of Health.

Aplastic anemia has also been linked to exposure to toxins such as pesticides, arsenic and benzene. Some infectious diseases also can cause the disorder, including hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV, as well as autoimmune diseases like lupus and rheumatoid arthritis. Finally, some genetic disorders have been linked to it.

Symptoms vary depending on the type of blood cells in shortage:

• Too few red blood cells can mean not enough oxygen is carried to the body, according to the NIH. People who have a low red blood cell count often feel tired. Because the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues, heart disease can develop over time.
• Too few white blood cells weaken the body's defense against infection. The patient may become ill more often, and the illness can be severe.
• Too few platelets hamper the blood's ability to clot. Patients with a low platelet count may bruise or bleed easily, and their bleeding may be hard to stop.
• Once aplastic anemia is detected, swift treatment is essential, Paquette said. "Because it's a rare disease, it's important to be treated at a specialized center," he said. "The most important thing is to be seen by someone with a lot of experience treating the disease early on."

For patients younger than 30, stem cell transplantation is often the preferred treatment. For those with a matched sibling donor, stem cell transplantation replaces the defective bone marrow with healthy cells, and as many as 80 percent of patients enjoy a complete recovery, according to the Aplastic Anemia & MDS International Foundation Inc.

Advances in stem cell research and anti-rejection drugs have meant that transplantations from unrelated donors also are becoming more successful, Paquette said.

One promising avenue of treatment involves transplantation using stem cells harvested from the umbilical cord of new mothers. "The cells can be cryopreserved [frozen] and saved, then given to unrelated donors," Paquette said. "It's quite encouraging."

For these patients, again, speed is of the essence. "The data show the earlier you do a transplant, the better the outcome," Paquette said.

Patients whose transplants fail, or for whom transplantation is not an option, often receive successful immunosuppressive therapy with agents like anti-thymocyte globulin and cyclosporine. Response rates typically range from 70 percent to 80 percent, according to the Aplastic Anemia & MDS International Foundation Inc.

Blood transfusions from matched donors also are used to keep blood counts high and help relieve symptoms, although they are not an effective long-term treatment.

"Whether we cure the disease or not, patients are getting better across the board," Maciejewski said. "We now can maintain life, keep these patients alive longer."

More information
To learn more, visit the Aplastic Anemia & MDS International Foundation Inc.

Zinc Helps Elderly Ward Off Pneumonia

(HealthDay News) -- Maintaining normal zinc concentrations in the blood may help prevent pneumonia in elderly nursing home residents, a new study shows.

A team at Tufts University looked at 617 people 65 and older in 33 nursing homes in the Boston area.

They found that those with normal blood zinc concentrations were about 50 percent less likely to develop pneumonia than those with low concentrations.

The study, published in the October issue of the American Journal of Clinical Nutrition, also found that people with normal zinc concentrations had a 39 percent lower rate of death from all causes.

"Not only did (people with lower zinc concentrations) have a higher risk of developing pneumonia, when they did become sick, they did not recover as quickly and required a longer course of antibiotics," corresponding author Simin Nikbin Meydani, director of the nutritional immunology laboratory at the U.S. Department of Agriculture's Human Nutrition Research Center on Aging at Tufts, said in a prepared statement.

The Tufts researchers took blood samples from the participants at the start and conclusion of the one-year study. All the participants received daily supplements containing 50 percent of the recommended dietary allowance of several vitamins and minerals, including zinc, for one year.

"Zinc is already known to strengthen the immune system; however, there needs to be further investigation of zinc and its effect on pneumonia development and prevention in nursing homes. The next step would be a clinical trial," Meydani said.

Red meat, poultry, whole grains, beans, dairy products, and oysters are examples of foods that provide zinc.

More information
The American Lung Association has more about pneumonia.
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Food for the Aging Mind

Agricultural Research
08-27-07
Originally Published:20070801.

Scientists know that certain nutrients and other key chemical compounds are essential to human brain function. Serious deficiencies in some of these, such as vitamin B12 and iron, can lead to impaired cognitive function due to neurological, or nerve fiber, complications.

Cognition can be defined as the ability to use simple-to-complex information to meet the challenges of daily living.

So, could careful attention to diet help protect the aging brain from problems with nerve cell signals involved in memory and cognition? A clear-cut answer could greatly affect the 77 million baby boomers who are now facing retirement. Their independence, quality of life, and even economic status will largely be defined by their ability to traffic information signals as they age.

In researching the nutrition-brain connection, new technologies are being used, such as those that take images of the brain or actually count individual brain cells. Behavioral tests that measure motor and cognitive skills-or lack thereof-are also providing insights. Yet the science of nutrition and brain function is relatively new and evolving.

Agricultural Research Service scientists at several locations nationwide are contributing to a growing body of research that explores the effect of diet and nutrition on the brain and its function across the lifespan.

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Boosting Neuronal Function
The brain's billions of neurons "talk" to one another through chemical neurotransmitters that convey signals through neural pathways. These chemical transporters- which include norepinephrine, serotonin, and dopamine-are key to signal movement.

Although people naturally lose brain cells throughout their lives, the process of neuronal death does not necessarily accelerate with aging. "There is a lot of individual difference," says ARS neuroscientist James Joseph. "Loss of mental agility may be less due to loss of brain cells than to the cells' failure to communicate effectively."

Joseph heads the Neuroscience Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston. There, researchers are looking at the beneficial effects of certain dietary plant compounds to learn how they affect brain function.

"Vitamins and minerals in plant foods provide protective antioxidants," says Joseph. "But fruits, vegetables, nuts, seeds, and grains contain thousands of other types of compounds that contribute significantly to the overall dietary intake of antioxidants.

"A partial measure of the antioxidant effect is called 'ORAC,' for Oxygen Radical Absorbance Capacity. ORAC scores are now showing up in charts and on some food and beverage packages. They may be helpful in choosing foods to include in your diet."

Perhaps there is no better place in which to gauge the power of antioxidants than between the minute connections of the nerve cells.

Bucking Long-Held Dogma
Eight years ago, Joseph and colleagues began publishing a series of studies, done in rodents, that shed light on the relationship between various diets and the mechanisms behind cognitive losses in specific neighborhoods of the aging brain.

Many in the series are groundbreaking in that they challenge the long-accepted belief that the central nervous system, which includes the brain, is not capable of regenerating itself. Other published studies in the series echo similar findings based on primate and human brain research at the Salk Institute for Biological Studies, San Diego, California. Scientists there, using new technologies, disputed the notion that the brain does not make new neurons-a process called "neurogenesis"-into old age: It does, but at a much slower rate.

One of the first of Joseph's studies, published in the Journal of Neuroscience, showed a protective effect of consuming antioxidants. Study rats were fed-from adulthood to middle age-vitamin E, strawberry extracts, or spinach extracts, all with similar ORAC values. Animals receiving the high-antioxidant diets did not experience the age-related cognitive performance losses seen in control rats fed standard chow.

A later study, also published in the Journal of Neuroscience, showed a reversal of functional loss among rats on special diets. Each of three groups of rats, equivalent in age to 63-year-old humans, was fed a different high-antioxidant extract. A control group was fed standard chow.

After 8 weeks-equivalent to about 10 years in humans-the rats' performance levels were measured.

The rats fed the spinach, strawberry, or blueberry extracts effectively reversed age-related deficits in neuronal and cognitive function. In addition, the blueberryfed group far outperformed their peers while traversing a rotating rod to test balance and coordination.

"Despite their status as 'senior citizens,' those rats showed remarkable stamina on neuromotor function tests," says psychologist and coauthor Barbara Shukitt-Hale, also with the Neuroscience Laboratory.

Examination of the brain tissue of those blueberry-fed rats showed much higher levels of dopamine than were found in the other groups. Dopamine has many functions within the brain. In particular, it can affect the way the brain controls movements.

"We suspected that the combined antioxidant potency of compounds in blueberry extract may have reduced inflammatory compounds in the brains of these older animals," says Joseph.

"Inflammation ordinarily contributes to neuronal and behavioral shortfalls during aging."
Tests have since shown that blueberry compounds cross the blood-brain barrier and localize in rodent brain tissue.

Hard News: Brain Plaques
Later, the lab's researchers published an Alzheimer's disease model study in Nutritional Neuroscience. They studied mice that carried a genetic mutation for promoting increased amounts of amyloid beta, a protein fragment found within the telltale neuritic plaque, or "hardening of the brain," seen in Alzheimer's disease.

Although the exact cause of Alzheimer's is not completely understood, experts have recently identified one mechanism involving the insufficient breakdown and recycling of amyloid protein in the brain. That mechanism is both genetic and physiological. In those individuals, normally harmless amyloid protein turns into fragments of amyloid beta, which build up as plaque in the brain rather than being escorted into cellular recycling. That action leads to cell death and weakened neuronal communication.

In the mouse study, beginning at age 4 months-early adulthood-half the brainplaqued group was fed a diet that included blueberry extract for 8 months. The other half was fed standard rat chow and so was a control group of mice that didn't carry the amyloid-plaque mutation.

At 12 months-early middle age-all groups were tested for their performance in a maze.

The brain-plaqued mice that were fed the blueberry extract performed as well as the healthy control mice and performed much better than their brain-plaqued peers fed standard chow.

A look at the plaqued brains of both the blueberry-fed and chow-fed mice after death revealed no difference in the number of brain plaques in either group. "Amyloid-beta-induced plaques are only one aspect of Alzheimer's disease," says Joseph. "But the fact that we saw a dietinduced behavioral difference, despite a similarity in plaque density in both these animal groups, is significant."

The team found increased activity of a family of enzymes called "kinases" in the brains of the amyloid-plaqued mice that were fed blueberry extract. Two kinases found in particular, ERK and PKC, are important in mediating cognitive function, such as converting short-term memory to long-term.

"These kinase molecules are involved in signaling pathways for learning and memory," says Joseph. "It could be that the increased kinase activity within the plaque-ridden brains of the blueberry-fed mice enhanced the signaling in certain receptors."

Brain Cells Are Born
Another HNRCA rat study looked at the aged brain's ability to change physiologically- a condition scientists refer to as "neuronal plasticity." In addition to cell division and differentiation, or "mission assignment," brain tissue undergoes many other changes throughout aging.

For example, a newborn sprouts billions of nerve cells while soaking up information from the environment. But lower levels of synapse growth continue in waves throughout the lifespan.

Littleused synapses are eliminated, while others are strengthened in a neuronal pruning process, of sorts.

Repair mechanisms involve neural immune cells, called "microglia," that seek to heal and protect injured brain tissue; enzymes that regulate safe chemical levels; and genes that are expressed in response to inflammation.

The neuronal-plasticity study investigated the physiological link between nutrition and the memory-control hippocampal area of the aged brain. That region, in the center of the brain, is essential for what's called "working" or "short-term" memory. It receives and processes data, and then, if needed, passes it on for storage.

Neurogenesis also plays a role in the formation of new memories. The capacity of the hippocampus to produce new neurons is thought to be greatly diminished during aging. But this study suggested that old rats fed blueberry extracts for a short time had increased neurogenesis in the dentate gyrus area of their brain's hippocampus. The dentate gyrus is one of the few regions of the brain where neurogenesis occurs.

"We found changes in the proliferation of neurons in blueberry-fed rats," said Gemma Casadesus, formerly a graduate student with the Neuroscience Laboratory and now with Case Western Reserve University. In maze tests, blueberry-fed aged lab rats showed improvement in cognition over chow-fed peers. "There was an association between the proliferation of neuronal precursor cells and better performance of spatial memory," she says.

The researchers don't yet know whether the cognitive improvements seen in the aged blueberry-fed rats translate to humans. "But it's an important step in learning about the brain's ability to rescue itself from age-associated declines in physiological function," Casadesus says.

Can You Hear Me Now?
Neurons that can't get their messages through signaling pathways are like cell phones that can't get their signals through to other cell phones. Why does this happen?

As the brain matures, cell division becomes largely restricted to specific regions of the brain, and brain cells tend to become more vulnerable to two partners in crime: oxidative stress and inflammation.

In the body, free radicals-weakened atoms formed during activities of daily living-are missing an electron and want to bond with neighboring biomolecules to stabilize. The problem is that unless neutralized, free radicals cause cellular damage known as "oxidative stress."

Cellular antioxidant defense systems counterbalance these rogue molecules, but they're not 100 percent effective-particularly as the body and brain mature. And the brain is thought to be especially vulnerable to oxidative stress.

"Weighing just 3 pounds, the brain accounts for only 2 percent of the body's total mass, yet it uses up to half of the body's total oxygen consumed during mental activity," says Joseph.

"Phytochemicals, together with essential nutrients in foods, provide a health-benefits cocktail of sorts. It is feasible that continued research in this area will point to dietary regimens that are effective in boosting neuronal function."

Inflammation is thought to be stoked by the overactivation of microglia-the neural immune cells mentioned earlier.

Microglia are usually dormant, but they migrate to the site of any brain injury. These sentries make up about 20 percent of the cell population in certain regions of the brain.

While seeking to protect and repair tissue, microglia cells produce and send out molecular stress signals, some by way of defensive cytokines, as a bugle call to other cells. Those signals begin a cascade of reactions, including the activation of genes that express proteins and other stress chemicals to help clear away cellular debris.

Microglial activation by amyloid beta is thought to be a key event in the progression of Alzheimer's disease. "When microglia are stuck in an always-on loop in response to plaque buildup in the brain, they become problematic in and of themselves," says Joseph.

This year, Francis Lau, a molecular biologist in the Neuroscience Laboratory, published a study that investigated whether blueberry extracts could have a preventive effect on inflammatory signals coming from activated microglia cells.

Microglial activation is considered the hallmark of inflammation in the central nervous system. For this study, Lau used a rodent microglial cell line that has previously served as a model to study plaqueinduced microglial activation.

Lau exposed groups of those test cells to various levels of blueberry extracts. He then challenged the cells with oxidative stress by exposing them to a toxin-lipopolysaccharide- that triggers secretion of inflammatory chemicals.

Neuroinflammation has been linked to the expression of genes that spew two inflammatory enzymes, iNOS and COX-2, and two cytokines, IL-1b and TNF-a.

Lau used real-time PCR (polymerase chain reaction) to find and measure expression of genes that produce iNOS and COX-2 in the stress-induced cell cultures. He found that the blueberry treatment significantly reduced that expression.

The blueberry extract also markedly lessened secretion of the two inflammatory cytokines. In fact, says Lau, "In cells exposed to the highest blueberry extract concentration, the amount of TNF-a cytokine found was next to nothing- essentially identical to that found in the control cells."

Looking to the Future
The food industry is now using a range of new and existing product ingredients to gain entrance into the emerging brainhealth market. Some are producing food labels that list ORAC values-for example, for use on containers of polyphenol-rich fruit juices and teas. So far, however, there has been no review conducted by the U.S. Food and Drug Administration on health benefits from eating berries.

Future studies at HNRCA will ideally include use of new diagnostic tools as well as human clinical trials. Neuroimaging equipment, for example, could be used to monitor the influence of various dietary factors on development of plaque within the human brain. Such studies aim to find the best dietary regimens to help adults preserve their mental capabilities while aging.-By Rosalie Marion Bliss, ARS.

This research is part of Human Nutrition, an ARS national program (#107) described on the World Wide Web at www. nps.ars.usda.gov.

James A. Joseph is with the USDA-ARS Human Nutrition Research Center on Aging at Tufts University, 711 Washington St., Boston, MA 02111; phone (617) 556-3178, fax (617) 556-3222, e-mail jim.joseph@ ars.usda.gov.

Cervical Cancer Vaccines Won't Fight Existing HPV Infection

(HealthDay News) -- Cervical cancer vaccines that prevent infection with the human papillomavirus (HPV) do not reduce or eliminate preexisting infections, a new study suggests.

That means that shots such as Gardasil, or a similar, yet-to-be-FDA-approved vaccine, Cervarix, should not be viewed as a treatment for women who've most likely contracted the highly common, sexually transmitted virus through their partners.

"From a public health perspective, a population-wide perspective, the best approach is to vaccinate girls and women before they initiate sexual activity," said study researcher Allan Hildesheim, senior investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute.

"You can then protect individuals prior to their being exposed, since the vaccine doesn't have any effect after infection has happened," he said.

The findings, reported in the Aug. 15 issue of the Journal of the American Medical Association, support a recommendation in June from the U.S. Centers for Disease Control and Prevention that vaccination focus on girls 11 and 12 years of age, most of whom would not have already become sexually active.

Gardasil, which targets four cancer-causing strains of the virus -- 6, 11, 16 and 18 -- should be added to the list of routine school vaccinations, experts say.

On the other hand, "for women who have initiated sexual activity, cervical cancer screening is probably a better preventive measure than vaccination," Hildesheim said.

His team's NCI-funded study, which focused on the Cervarix vaccine, was conducted in Costa Rica and included almost 2,200 women aged 18 to 25. Cervarix has not yet been approved by the U.S. Food and Drug Administration, but its maker, GlaxoSmithKline, has said it believes the shot will gain approval sometime in 2008.

According to Hildesheim, prior studies had already strongly suggested that both Gardasil and Cervarix would be ineffective against preexisting viral infections.

"However, we noticed shortly after the initial licensure of the [Gardasil] vaccine that there was tremendous confusion -- both in the clinical and the lay community, regarding the use of this vaccine among women who were already infected," he said.

Other specialists have noticed similar confusion among their peers.

"Each of us has received anecdotal reports of doctors thinking that you can benefit [an infected] woman by vaccinating her," said Dr. Howard Strickler, professor of epidemiology and population health at the Albert Einstein College of Medicine, in New York City. "There are misconceptions in the field," he said.

Even though HPV occurs in a wide variety of strains, Cervarix targets the two strains thought to cause 70 percent of cervical malignancies -- strains 16 and 18.

In the study, the researchers gave the vaccine to about 1,100 young women, all of whom had tested positive for genetic traces of HPV at the beginning of the study. Another group of infected young women received a hepatitis A shot as a "control."

By the end of 12 months, rates of HPV 16 and/or 18 "clearance" -- or absence -- from the body was 48.8 percent in the HPV vaccine group and 49.8 percent among the controls -- a statistical dead heat.

As the experience of the control group showed, the human immune system naturally clears many HPV infections over time. Giving women the vaccine appeared to provide no added benefit, the researchers said.

The investigators also observed no differences between the two groups in terms of the extent of HPV-linked disease, viral antibody load or the results of cervical cell tests conducted in the lab.

"Our results reinforce the notion that this vaccine is meant to protect against infections when they occur, but it isn't effective at helping clear the infection once it has established itself," Hildesheim said.

Still, given the array of HPV viral strains, wouldn't vaccination help protect against viral types a woman had perhaps not yet encountered? Theoretically, that's true, the experts said, and it is for exactly that reason that the CDC recommends the vaccine for women up to age 26.

However, there's currently no test that can determine a woman's HPV history.

"If you are sexually active, there is no way for you to know for sure whether or not you have been exposed to these particular [carcinogenic] strains," explained Hildesheim. They "are very common, and, typically, exposure happens fairly shortly after the initiation of sexual activity," he said. "That's why the best policy is to try and get the vaccine administered prior to sexual debut."

So, for both girls and women, vaccinated or not, the expert advice on avoiding cervical cancer remains the same: Get regular Pap smears.

"Remember, even [Gardasil] is just working against four strains," noted Dr. Stephanie Blank, a gynecologic oncologist and assistant professor of gynecologic oncology at New York University School of Medicine. "There are many more strains than that. So, the Pap smear recommendations have remained unchanged."

More information
There's more on cervical cancer at the American Cancer Society.

Farms Shield Kids From Bowel Disease

(HealthDay News) -- Children regularly exposed to farm life as babies are about half as likely as other kids to develop Inflammatory bowel disease such as ulcerative colitis or Crohn disease, German researchers report.

The findings, published in the August issue of Pediatrics, fall into line with what experts in inflammatory bowel diseases (IBDs), allergy and asthma call the "hygiene hypothesis."

That theory "refers to the observation that children living in environments with lower levels of microbial exposure seem to be at higher risk for the development of allergies," explained the study's lead researcher, Katja Radon, of Ludwig-Maximilians-University in Munich.

Crohn's and ulcerative colitis are autoimmune illnesses, where the body's immune system mistakenly attacks its own tissues. It is possible that this dysfunction may originate, at least in part, in how immune responses develop very early in life, said Dr. Joel Rosh, director of pediatric gastroenterology at Goryeb Children's Hospital, part of the Atlantic Health System in Morristown, N.J.

He pointed out that while rates of IBDs are holding steady in the developing world, they are rising sharply in more affluent nations.

"It's something that we are doing to ourselves," Rosh said.

"The thinking is that if your immune system isn't appropriately challenged at the appropriate time in life, then it might do some wacky things," Rosh added. In other words, a too-clean environment -- while healthy in some ways -- might be less than ideal when it comes to immune-linked illness, experts say.

The German study is one of the first to compare inflammatory bowel disease rates against infant exposures to farm animals and farm life. The German team questioned the parents of more than 2,200 6- to-18-year-old children. More than 300 of the children had ulcerative colitis, another 444 had Crohn's, and almost 1,500 were free of either illness.

Kids with either Crohn's or ulcerative colitis "were less likely to have lived in rural environments and were less likely to have farm contact in the first year of life, before the disease had developed," Radon noted.

In contrast, children who had spent regular amounts of time visiting or living on farms during their first year of life were 50 percent less likely to develop Crohn's as they got older and 60 percent less prone to ulcerative colitis, compared to youngsters who had not had that experience.

Early exposure to cattle, especially, appeared to help keep the diseases at bay, cutting the odds of Crohn's by 60 percent and colitis by 70 percent, the study authors said.

Cattle appeared to have a more potent effect on IBD risk than exposure to household pets, the study found. Household cat and dog exposure has been the focus of much study and debate among allergists and immunologists.

In this study, regular exposure in infancy to cats reduced Crohn's risk by just 20 percent, a statistic the researchers described as only of "borderline significance." Cat exposure was somewhat more useful against colitis, with rates dropping by 50 percent compared to unexposed children.

The cat-cattle discrepancy didn't come as a big surprise to Rosh.

"It seems that it's not so much animals, per se, as it is which animals," he said. "So, the domesticated cat that stays in the corner cleaning himself all day may not be 'dirty enough' to save you."

Radon agreed. "It has also been shown for allergies that farm animal contact is more efficient [in reducing risk] than pet contact. Therefore, it is not surprising that we see the same for inflammatory bowel disease," she said. "The reason might be that the level of exposure to bacteria and fungi in the farm environment is much higher than if you have a cat or dog at home."

Rosh has his own theories as to where the protective element might lie. "They sanitize it in the article, but they do say it can't be a clean animal -- it's got to be livestock. It's got to be something in that environment, and I would say, it's not in the air so much, as in the poop," he said.

So, does all this mean that modern-day babies need to get "back to the land"?

Perhaps not, according to the experts.

"You can't make the leap to say that to protect our children against autoimmune disease, we need to take them to farms, because we don't know yet what the [protective] exposure is," said Dr. Peter Mannon, head of the Clinical Inflammatory Bowel Diseases Research Unit at the U.S. National Institute of Allergy and Infectious Diseases.

"Are you supposed to be exposed to hay? To a particular type of vermin? The rats in barns? It's very hard to know," he said. While there's no reason not to bring infants to more pastoral settings, "I would not guarantee that it is going to add any protection," Mannon said.

Radon agreed that "at the moment, we cannot give direct advice to parents" since the study showed no cause-and-effect relationship, only an association.

And she pointed out that society's obsession with cleanliness does have its rewards. "We should not forget that an improved level of hygiene has relevantly contributed to today's health in industrialized countries," she said.

For his part, Rosh said there might be some virtue in letting kids get a little dirty -- a prescription most youngsters should have no problem with.

"I don't mean that we all have to eat dirt, but if we could isolate what is in it that is good, maybe we'd have a good [IBD] treatment," he said. "These various areas of research are going to unlock the secrets that we need to cure these diseases."

More information
There's more on the hygiene hypothesis at the American Academy of Allergy, Asthma & Immunology.

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Scientists Probe How HIV Infection Turns Into AIDS

(HealthDay News) -- The common scientific wisdom on how HIV infection proceeds to full-blown AIDS might be wrong, two U.S. researchers say.

They hope that their new insights, if proven, will lead to exciting new treatment targets down the line.

Working from a complex mathematical model of viral replication and immune cell death, the researchers now suspect that AIDS begins when one especially fast-killing strain of HIV gains the upper hand over a less-lethal, but more prolific, strain.

"This throws into question a lot of the notions that have been accepted about the evolution of the virus" within a typical infected human, explained study co-author Dominik Wodarz, associate professor of biology at the University of California, Irvine.

He and another researcher, David Levy, of New York University, published their findings in the July 31 issue of the Proceedings of the Royal Society B.

Since its first recorded appearance nearly three decades ago, HIV infection has followed the same deadly path: a short, weeks-long period of acute flu-like symptoms followed by years of asymptomatic dormancy, and then symptoms of immune system breakdown that herald the emergence of AIDS.

But what is it that tips asymptomatic, low-level infection into AIDS?

The common dogma among scientists has long been that various strains of HIV battle a silent war within the body over time until the fittest -- defined as the strain that reproduces itself the most -- wins. That strain then goes on to overwhelm the body's immune cells and destroy the host's defenses against disease.

To test that theory, Wodarz and Levy constructed a complex mathematical model that took into account two factors about HIV: how fast the various strains replicate and how fast they kill cells (not always the same thing, the researchers noted). They also factored in human immune system responses to HIV.

What the two scientists found surprised them. According to the new model, AIDS actually begins when a less fit variety of HIV wins the day. This strain kills immune system cells extremely widely and quickly, but, in doing so, also limits the number of copies of itself it can produce. "It basically kills its own habitat, its house," Wodarz explained.

However, because this form of HIV is very good at quickly killing large numbers of immune cells, "once these less-fit strains emerge, they can plunge the patient into AIDS," Wodarz said.

In many cases, two or more strains of the virus can co-infect the same immune system cell, he added. If a fast-killing variety is one of those strains, it kills the cell before slower -- but better-replicating -- versions can go to work making millions of new viral particles.

"But without this ganging up on the same cell, the killer virus [that leads to AIDS] would go extinct, because evolution would select against it -- because it is less fit and replicates less," Wodarz explained.

That means that -- according to the model -- one way of keeping AIDS at bay might be to make sure that only one type of HIV invades a cell at any given time.

Specific cellular mechanisms do allow a second or third viral particle to enter a cell, and a medicine that thwarted these "party crashers" might keep the deadliest form of HIV from ever emerging, Wodarz speculated.

He pointed to wild monkeys that are infected throughout their lives with HIV-like simian immunodeficiency virus (SIV) but never get sick.

"Some of them have a lot of the virus, and it evolves a lot, but it does not cause AIDS, ever," Wodarz said. He suspects the monkey's immune cells may have evolved to block secondary viral entry and thereby keep the most dangerous strain of SIV at bay.

Not everyone is convinced by the new model, however.

Dr. Benigno Rodriguez is assistant professor of medicine at Case Western Reserve University in Cleveland, and a specialist in the evolution of HIV disease. He called Wodarz and Levy's paper "an interesting concept," but said it contained a few significant flaws.

First of all, he said, most of the available data suggests that HIV does get better at forming copies of itself as AIDS progresses. And Rodriguez believes the two scientists have left another important factor out of their model -- the fact that most AIDS patients' immune cells are not killed off by the virus directly but are destroyed by so-called "bystander" mechanisms that accompany AIDS.

"In an individual with advanced disease, if you look at the number of cells that are actually infected [with HIV], we are talking less than 1 percent," he said. "But, in reality, that individual may have lost 20, 30, 50 percent of his immune cells."

Rodriguez also questioned the importance of multiple strains of HIV infecting the same immune cell. "The data that we already have in hand shows that multiple infection is relatively infrequent," he said.

The bottom line, according to the Cleveland expert: As with any mathematical model, this one needs to be tested out in the laboratory.

Wodarz agreed that experimental verification is necessary, but he said mathematical disease models more often than not prove to be right.

In fact, he said, it was just such a model that led scientists to discover that HIV never stops evolving in the body -- even during infection's years-long asymptomatic phase.

"In HIV, mathematical models have led to great progress before," Wodarz said.

More information
To find out more about HIV/AIDS, head to the U.S. National Institute of Allergy and Infectious Disease.

New Crohn's Disease Drug Shows Promise

(HealthDay News) -- A new drug against Crohn's disease may be of real help to people who don't respond well to existing medications, two new studies show.

Certolizumab pegol, which works in a similar fashion to standard medicines, isn't on the market yet and hasn't been approved by the U.S. Food and Drug Administration. Still, "it may at some time offer another option for patients," said University of Louisville associate professor of medicine Dr. Gerald W. Dryden Jr., who studies Crohn's disease and is familiar with the new research.

Crohn's disease causes inflammation in the intestines and other parts of the body. It typically causes cramps and diarrhea, and other symptoms are possible.

In the United States, young people in their 20s and 30s seem to be most susceptible, but scientists appear to be far from fully understanding the disease.

Prednisone, a steroid that dampens the immune system, is often the first line of treatment, Dryden said. In moderate-to-severe cases, doctors often turn to two drugs that appear to tinker with a protein called tumor necrosis factor (TNF) alpha, which has also been linked to the inflammation caused by the disease.

The introduction of the first anti-TNF drug, infliximab (Remicade), revolutionized the treatment of Crohn's disease, wrote Dr. James Lewis, an associate professor of medicine and epidemiology at the University of Pennsylvania, in a commentary accompanying the two studies. Another drug, adalimumab (Humira), is now available.

The problem? They can both cause side effects. Also, "none of the currently available medications are effective at inducing remission in all patients," Lewis said in an interview. "Even the most effective medications typically induce a sustained remission in well less than 50 percent of patients."

That forces many patients to turn to surgery.

Enter the new drug, certolizumab pegol, which is being developed by the pharmaceutical company UCB Pharma. The company helped pay for the two new studies, which are published in the July 19 issue of the New England Journal of Medicine.

In one of the studies, 668 patients with moderate-to-severe Crohn's disease received 400 milligrams of the injectable drug three times over four weeks. Those who responded were assigned to more of the drug or a placebo.

According to the team led by Dr. Stefan Schreiber of Christian Albrechts University in Kiel, Germany, 48 percent of patients who showed an early response to the drug were still in remission in the 26th week after staying on the drug. In comparison, just 29 percent of patients who responded to the drug early but were then assigned to a placebo later went into remission.

In the other study, this time led by Dr. William Sandborn of the Mayo Clinic in Rochester, Minn., 662 patients took the drug or a placebo three times over a four-week period and then once every four weeks. Patients had a better short-term result if they took the drug, but the long-term remission rates were nearly identical between the two groups.

In other words, the two studies of the same drug produced somewhat different results. Still, commentary author Lewis wrote that they suggest that the drug is an "effective therapy."

If approved, the drug would offer an alternative to the two existing similar drugs, he said. "It appears that patients who lose response to or become intolerant of one anti-TNF medication may respond to another anti-TNF medication. Thus, we may ultimately see patients switching between the different anti-TNF medications."

Dryden, the University of Louisville professor, said that the new drug's convenience may appeal to patients. It may need to be injected only once every month, a procedure that could be done at home, compared to other drugs that must be administered more often, he said.

According to Lewis, it's unlikely that studies will measure the new drug and the two old ones against each other, meaning they may end up being prescribed based on their perceived effectiveness, cost, and ease of use.

More information
Learn more about Crohn's disease from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Zinc Supplements Save Poor Children's Lives

(HealthDay News) -- In the developing world, daily zinc supplements can reduce the risk of death in children aged 1 to 4, but they do not provide any significant benefit for babies under 1, U.S. researchers report.

Zinc, which is one of the most plentiful trace elements in the body, is believed to play an important role in healthy immune system function.

The study, by a team from the Johns Hopkins Bloomberg School of Public Health in Baltimore, included more than 42,500 children in the East African nation of Zanzibar. Half the children received daily zinc supplements (5 milligrams for infants, 10 milligrams for children 12 months and older), while the other half received a placebo pill.

Overall, children who took the zinc supplements were 7 percent less likely to die than those who took the placebo. In children aged 12 to 48 months, those taking zinc supplements were 18 percent less likely to die.

"This large trial demonstrates that the benefits of zinc supplementation include mortality reduction in addition to the reduction in cases of pneumonia, diarrhea and malaria that we found in previous trials," study senior author Dr. Robert Black, professor and chairman of the Bloomberg School's department of international health, said in a prepared statement.

The study appears in the March 17 issue of The Lancet.

"While further work is needed to evaluate higher dose effects, recommendations for use of zinc as a preventive strategy needs to consider the collective evidence of the effect on growth, morbidity and mortality, which would suggest benefit in children age 6 months and up," lead author Sunil Sazawal, an associate professor in the department of international health, said in a prepared statement.

More information
The Medlineplus Medical Encyclopedia has more about zinc.

Researching Alternatives: A Talk With Donald Abrams

By Bob Huff
June 2003
You have a reputation as being a rigorous clinical researcher and tough advocate for making evidence-based treatment decisions.

Yet you've also been very open to studying a number of alternative and complementary therapies that have been used in the HIV patient community. How did all these concerns come together and what are you involved with these days?

I was training in oncology at UC San Francisco just as the first AIDS cases were reported. I helped found the AIDS program there and I've been participating in academic clinical research for over 20 years. More recently I've become an associate fellow of the Program in Integrative Medicine at the University of Arizona that was founded by Andrew Weil.

This is a two-year program, mostly online, that is increasing my training and background in integrative medicine, including things like botanical medicine, manual medicine, and spirituality. It's been a stimulating experience so far and I'm really enjoying it.

I've been interested in complementary medicine since the very beginning of my career, so one of the reasons I'm doing the fellowship is to learn more that I can integrate into my own healthcare discussions with my patients. Of course another impetus is to see what other things we might want to do clinical research on.

My intention is to continue to investigate the complementary and alternative approaches that our patients are using. We want to determine whether or not they may be beneficial, but also determine whether or not they may be harmful, particularly in how they interact with the conventional medications that patients are taking.

In the earliest days of AIDS we didn't have any treatment for this new disease; people were dying and everybody was frightened. Being here in San Francisco, we were near the Linus Pauling Research Institute in Palo Alto, so there were a number of people in the city who were proponents of high doses of Vitamin C.

One of the first responses we saw in the early '80s were storefront clinics opening up where people went to receive intravenous injections of very high doses of Vitamin C.

At that point in time we didn't even know that it was a virus causing the disease. So I used to go around on the lecture circuit with someone who would talk to audiences of concerned people who listened to him while hooked up to intravenous infusions of Vitamin C.

Then I would speak as the academician who cautioned people that we really don't know if this is beneficial and there may be some dangers to being hooked up to intravenous vitamin C, and so on. Ultimately, this led to me to write a grant proposal in collaboration with the Linus Pauling Institute.

It was right about the time we learned that HIV was the cause of AIDS so we wrote a proposal to the NIH to study the in vitro effects of Vitamin C on HIV. That grant didn't get funded.

In San Francisco at that time there were also a number of DNCB proponents. DNCB, dinitroclorobenzene, is actually a photographic chemical used for developing pictures, but it is also a skin sensitizer that had been used to test for delayed hypersensitivity reactions.

There were people who believed that somehow it might be useful in restoring some of the T-cell immunity that patients with this new disease were lacking. So there were people who would paint themselves weekly or so with DNCB until they developed these skin reactions, thinking that the skin reaction was some sort of improved T-cell immune response that would help combat the virus.

And again, seeing that people were using this and seeing that we really didn't have much else happening, I worked with some of the DNCB proponents, as well as some experts from the University of California -- I remember Jay Levy was involved, as was Marcus Conant and others -- and we wrote a protocol that we submitted to the FDA for funding. That also was rejected.

Around the time that AZT first became available in 1986, I went to a conference in Japan where I was introduced to some investigators from the Ueno Fine Chemicals company who told me that they had the cure for this disease. They said it was something that was very commonly used in Japan but they couldn't tell me about it until I signed a confidentiality agreement.

That turned out to be dextran sulfate. Not long after I was going through the process of filing the paperwork to get approval from the FDA to do a phase I study of dextran sulfate in the United States when evidently some people heard about it.

They realized that it was a product that was widely available in Japan -- I believe it was used for lowering cholesterol -- so they started an importation scheme similar to what had happened in earlier days with isoprinosine and ribavirin, which were brought across the Mexican border.

But people had now become more sophisticated in their methods and began to import dextran sulfate from Japan to sell in the underground AIDS therapy market.

I remember that activists stormed the offices of a Japanese drug distributor in New York for refusing to make dextran sulfate more widely available. Ultimately it became such a political issue that, even though my clinical trial here in San Francisco didn't show much benefit, Congress got involved and the AIDS Clinical Trial Group (ACTG) was asked to do a study of dextran sulfate through the NIH-funded mechanism. It turned out the drug was not even absorbed into the blood.

Another Japanese product I worked with was lentinin, which was an intravenously administered extract of shiitake mushroom. In Japan it was felt to be an immune booster for patients with cancer. Although it was being used by mainstream doctors in Japan, it was an alternative therapy here because it was not something that we had ever learned about or used in hospitals in the U.S. That's David Eisenberg's description of what an alternative therapy is -- that it's not taught about in medical schools or widely available in U.S. hospitals -- and certainly shiitake mushroom extracts qualified. Again, that's another study we did that had negative findings;

there was no benefit to the intravenous infusions of lentinin. Since I've learned more about botanicals, it would seem to me that if there were immune enhancing benefits to shiitake mushrooms then they are more likely to be obtained by eating them rather than by injecting an extract intravenously.

During that time I was also involved with studies of conventional therapies. Even in the days of early AZT monotherapy, which I was not a big supporter of, I was involved in trying to put some evidence behind the claims of the proponents for these various agents. And since that time, I've had a constant history of investigating conventional therapies through the federally-funded CPCRA (Community Programs for Clinical Research on AIDS), and more recently through the ESPRIT study of interleukin 2, as well as in other, sometimes pharmaceutical industry-sponsored trials. But always ongoing with those studies, I've been involved with clinical trials of complementary and alternative interventions.

When we first became aware of immune thrombocytopenic purpora (ITP) in AIDS, I worked with a nurse who was very interested in therapeutic touch and we studied men with low platelet counts to see if therapeutic touch could decrease their stress and increase their platelet counts. That was another study that turned out to be fairly negative.

I then became interested in traditional Chinese medicine (TCM) and, in fact, one of the colleges of TCM here in San Francisco sent me to China in 1989 just to learn about Qigong (Chi Kung) -- that exercise that's felt to improve the immune system -- to see if it was something that I wanted to study here. Although I never studied Qigong I collaborated with Misha Cohen from the Quan Yin Healing Arts Center here in San Francisco. We did three studies of traditional Chinese herbal interventions for, first, symptomatic HIV, then for patients with diarrhea without a pathogenic source, and then another study for patients with anemia.

The last two were hindered by the fact of being initiated about the time that HAART became available, so patients with diarrhea as well as anemia became scarce. There were also a lot of pills that needed to be taken in these Chinese herbal investigations and patients at that time were taking huge amounts of pills with their antiretroviral regimens, so the studies weren't very attractive. None of these studies had spectacular results and the anemia study was terminated for poor enrollment.

Have "soft endpoints" such as life satisfaction created a problem for designing and conducting credible studies?

The TCM herbal study that we published in 1996 investigated herbs versus placebo in symptomatic HIV infection. At the time of the study in 1993, we had patients with about 14 symptoms on average and we found that there was a significant decrease of symptoms in the herb-treated group -- they decreased from 14 to 12 -- whereas the other group still had 14 symptoms. We also found that they had improved "life satisfaction" which improved by a factor of +0.86 or thereabouts.

Yet, if you look at the rest of the results, the Chinese herbal patients actually lost weight over 12 weeks compared to the placebo group, and their CD4 counts also dropped -- not statistically significant, but it was a trend. So that was an example of where their symptoms improved and their life satisfaction increased, but the parameters that we would normally look at to see if a patient is doing well (i.e., weight and CD4 count) went in the wrong direction. So, although I was also first author on a study that showed that epoetin alfa improves quality of life in HIV patients who are anemic, I'd have to say that a study whose main endpoint is quality of life is something I would find difficult to interpret.

The CPCRA actually did a large study of acupuncture for patients with HIV-related peripheral neuropathy that was published in JAMA. That was a landmark, having the NIH support an acupuncture study, although, again, it turned out to have negative results; acupuncture didn't appear to be effective in treating peripheral neuropathy.

About this time I began trying to study another botanical, which has consumed my efforts for the past decade, and that would be cannabis, or marijuana. Starting in 1992 I began proposing and developing clinical trials to investigate first the effectiveness -- but then I realized that that wasn't going to happen -- so subsequently, the safety of smoked marijuana in patients with HIV.

We finally completed a study in the year 2000, that we hope will soon be published, that looked at the safety of marijuana in patients taking protease inhibitor regimens. And since that time we have obtained funding from the State of California that allows us now to conduct clinical trials to look at the potential effectiveness of smoked marijuana in patients with various syndromes. We have also just completed a pilot study in patients with HIV peripheral neuropathy, which allowed us to ascertain that there was some effectiveness of marijuana. But an open-label pilot study is not going to prove that, so we're now in the process of continuing on with a randomized, placebo controlled, double-blind trial in patients with HIV-related peripheral neuropathy. We're also doing marijuana studies in patients with cancer who have pain who are on opioid analgesics, and another study to look at the effect of smoked marijuana in patients who have delayed nausea and vomiting from breast cancer chemotherapy.

It was working with marijuana and all the problems that are inherent in studying a plant as a therapy that has led me to a broader interest in botanicals and the use of substances that come from nature as medicinal agents. Certainly, for thousands of years, people have depended primarily on these things. Whether or not they worked is unclear, but as an oncologist I know that many of my most potent chemotherapeutic agents were derived from plants. So right now we are waiting to hear if a protocol we submitted to the National Center for Complementary and Alternative Medicine (NCCAM) to investigate the lipid lowering effects of oyster mushrooms in patients on Kaletra is being funded. There's good evidence that mushrooms, including oyster mushrooms in particular, have some activity for lowering blood lipids and cholesterol.

We're also just finishing a three-year NCCAM grant studying the effects of DHEA, dehydroepiandrosterone, which is an over-the-counter adrenal steroid that people are taking for many reasons. We received a grant to investigate it as an antiviral and to see what impact it has on the immune system. Hopefully that data will be available by the end of the year and we will know if DHEA had any impact, positively or negatively, in our patients.

The goal, ultimately, would be to submit a center grant to the NCCAM, to allow us to establish a center here for the study of botanicals in HIV because there are still a number of herbal preparations and mushroom extracts that warrant further investigation for their potential benefit -- and to make sure that they're not harmful in our patients.

Safety keeps coming up again and again as one of the inarguable justifications for doing this research.

There's not a huge amount that we know about some of these botanical products and how they're metabolized, but there's probably more than people think. There are a number of textbooks available that talk about herb-drug interactions. That was the question in our marijuana study: is there an interaction between cannabinoids and protease inhibitors, which are both metabolized by cytochrome P450 enzymes in the liver, that may alter the activity of the protease inhibitors such that patients lose their viral suppression when they mix cannabis with their treatments?

And in fact, in our article that was already published in AIDS, we saw no such effect. We've all heard about garlic and St. John's Wort and their interactions, and I think there are many other agents that we would like to study to make sure that they are not having significant interactions with protease inhibitors. We don't want people to either lose control of their viremia (through underdosing) or experience toxicity (through overdosing) because of antiretroviral concentrations that have been affected by herb-drug interactions.

You had to be enormously persistent to accomplish your marijuana study. In the current political climate, is it going to be more difficult to do marijuana studies?

I think we're blessed to live in the State of California, which is somewhat of a freestanding republic in and of itself. In 1996, the people of California voted to allow physicians to talk to their patients about the medicinal use of cannabis. Then, through the work of Senator John Vasconcellos, one of our state senators, appropriations were made to the University of California that established the Center for Medicinal Cannabis Research (http://www.cmcr.ucsd.edu/). And that Center has had funds for the past three years that allows it to support clinical trials to investigate the use of marijuana for medicinal purposes.

Whereas the NIH and NIDA, via their congressional mandate, could only give marijuana to clinical trials that show that it was harmful (they are the National Institute on Drug Abuse, not for Drug Abuse, as NIDA's director Alan Leshner always reminded me), they were not really able to provide us with marijuana to study the benefits. But now, they have modified their system so they can provide marijuana for peer reviewed clinical trials that will look at its effectiveness as a therapeutic agent -- as long as they are not funding it. So they have now created this ability for us to obtain government marijuana.

Is there a need to increase provider knowledge about these issues?

I think a part of the problem is a lack of communication from both sides. Patients don't really perceive that these substances are something that they need to tell their doctor about -- in fact many studies show they don't want to tell their doctor because they're afraid they're going to be reprimanded or told that they're wasting their money. And many physicians never even think about asking about these things as potential confounders or as things that are causing clinical symptoms.

There also may be a variable of where in the country you are. I know many surveys show that we in the West have the highest percentage of people in the population who are using complementary and alternative interventions. So many of my colleagues here might be more familiar with how to ask the question and what to be looking for.

I remember once seeing a patient at our drop-in clinic who clearly had a drug rash. I looked through his chart -- this was when we had paper charts -- and he had a high CD4 count and a low viral load but he wasn't taking any medications.

So I said to the guy, "You're not taking any medications, huh?" And he said, "No."
"Are you taking any vitamins?" And he said, "Yeah."

So I asked him what he took and he listed about four or five vitamin preparations. Then I asked, "Do you take any herbs?" And he said, "Sure."

And so I listed the three or four herbal substances th
at he took.
"Do you take any minerals?" And he said, "Yeah."
By the time I finished I had a list of 12 different things he was taking.
So I asked, "Well, how come everybody else wrote down that you don't take anything?" And he said, "Well, nobody ever asked me before."


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Mistletoe Injection Linked to Tumor-Like Growth

(HealthDay News) -- Adding a new twist to the debate over the value of mistletoe as an alternative cancer treatment, British doctors are reporting the case of a patient whose consumption of an extract from the Christmas decoration led to a tumor-like growth.

An accompanying commentary suggests the case provides yet another reason to avoid using mistletoe as anything other than a holiday decoration. But an alternative medicine specialist points out that risks are inherent in conventional medicine, too.

While the plant itself is poisonous, mistletoe extracts have long been touted as an alternative cancer cure, especially in Europe and Germany. Extracts are typically given by injection and said to boost the immune system to fight tumors.

According to the National Institutes of Health (NIH), some mistletoe studies have suggested that it has value as a cancer treatment. However, the NIH -- which has launched its own study -- said the previous research has been flawed.

In the Dec. 23-30 issue of the British Medical Journal, doctors report about the case of a 61-year-old woman who reported a tumor-like mass in her abdomen after undergoing breast cancer treatment. She had previously suffered from lymphoma.

Doctors were mystified by the mass, until the patient revealed that she had been taking under-the-skin injections of a mistletoe extract as a treatment for lymphoma.

The doctors wrote that the mass appeared to be an inflammation caused by the mistletoe treatment. The report didn't say if the woman had any further problems.

In the commentary, Dr. Edzard Ernst, of the Universities of Exeter and Plymouth and a professor of complementary medicine, wrote that mistletoe produces many other side effects, including joint pain and kidney failure.

The claim that mistletoe injections have no serious risks "is therefore misleading," wrote Ernst, who added that "the costs of regular mistletoe injections are high."

Still, it's important to put the risks into context, said Dr. Adam Perlman, executive director of the Institute for Complementary and Alternative Medicine at the University of Medicine and Dentistry of New Jersey.

"I don't think the significance of this case report should be exaggerated," he said. "There is much that we do in conventional medicine that has limited evidence and potential for harm.

The main issue here is less the risk of mistletoe and more the idea that the public needs to understand that 'alternative' medicine, in general, can have both potentially positive and negative consequences."

He added that the case points out that it's important for patients to be up front with doctors about alternative medications that they're taking.

More information
Learn more about mistletoe from the National Institutes of Health.

Earlier HIV Therapy Helps Beat Back Hepatitis C

(HealthDay News) -- Starting HIV antiretroviral therapy earlier than generally recommended may lead to better control of the hepatitis C virus in people also infected with HIV, a new study finds.

Infection with both hepatitis C and HIV is a growing problem, say researchers at the Partners AIDS Research Center at Massachusetts General Hospital, Boston.

While the immune systems of many people infected with the hepatitis C virus (HCV) are able to naturally control levels of that virus, this natural control may be lost in people who are also infected with HIV, the virus that causes AIDS.

"The global burden on health of chronic viral infections is immense, and HCV and HIV are chief among culprit viruses," study co-author Dr. Arthur Kim said in a prepared statement.
"Due to shared routes of transmission, infection with both viruses is common. Unfortunately, HCV behaves as an opportunistic infection in the presence of HIV and is becoming a leading cause of illness and death in persons with HIV," Kim said.

This study included 60 people infected with both HIV and HCV, and 17 infected only with HCV. The findings suggest that, in people infected with both viruses, it may be beneficial to start antiretroviral therapy before levels of immune system CD4 helper T-cell levels drop too low to maintain control of HCV.

The findings appear in the December issue of PLoS Medicine.
"Currently, a nationwide trial is recruiting people for a study examining whether earlier treatment of HIV will improve hepatitis C treatment outcomes," Kim said. "Part of this study will investigate how earlier treatment may affect immune responses."

More information
The U.S. Centers for Disease Control and Prevention has more about HIV/HCV co-infection.

Smokers May Be More Likely to Contract HIV

(HealthDay News) -- Smokers may be at higher risk of contracting HIV infection than nonsmokers, new research finds.
Cigarette smoking has already been linked to an increased risk of infection in general, including sexually transmitted infections.
For their analysis, researchers identified six studies that investigated the association between smoking and becoming HIV positive.

Five of the studies found smokers were at increased risk of contracting HIV. The increased risk ranged from 60 percent higher in smokers to a more than tripling of the risk.

The researchers looked at another 10 studies that assessed the association between smoking and progression to AIDS. Nine of these studies concluded that smokers were not at increased risk.

Smokers may be more vulnerable to infection due to changes in the lungs and the immune system, said the authors.

This study was published online ahead of print in Sexually Transmitted Infections.

More information
The Centers for Disease Control and Prevention have more about HIV and AIDS prevention.

Spleen Cells May Prove Effective Target for Lupus Treatment

(HealthDay News) -- Research done on mice specially bred to develop lupus has uncovered an area of the spleen that may give rise to the disease.
The area is called the marginal zone of the spleen and it appears that this is where B cells from the immune system go awry and turn into cells that attack the body's own tissues and organs, researchers say.
"This current work gives rise to new possibilities for targeted therapies that are perhaps much milder and more effective than current therapies," said the study's lead author, Thomas Enzler, a visiting scholar, internist and immunologist at the University of California, San Diego. However, he was quick to add that it would be a long time before any such potential therapy could be available for humans.
Results of the study were published Thursday in the online edition of the journal Immunity.
Lupus is an autoimmune disease in which the immune system mistakenly attacks the body's tissues and organs. The disease can affect the joints, kidneys, lungs, brain, blood or skin. As many as 1.5 million Americans have lupus, and the disease is far more common in women than in men, according to the Lupus Foundation of America (LFA).
Previously, researchers had developed a mouse version of lupus. These mice are bred to overproduce an immune system hormone (cytokine) known as B-cell activating factor (BAFF). In humans with lupus, the BAFF cytokine is often present in much higher-than-normal levels. B cells produce antibodies. Normally, antibodies are produced to protect against viruses and bacteria. In the case of someone with lupus, however, the B cells produce autoreactive antibodies. This means the antibodies attack normal, rather than diseased, tissue.
When the mice overproduce BAFF, they develop lupus, though the mouse version isn't exactly the same as the human version.
The UCSD researchers transplanted some of the cells from the spleens of the marginal zone of the lupus mice into mice that didn't have their own B cells. Lupus-like antibodies began to develop in these mice immediately.
The researchers also removed the spleens of some of the lupus mice when they were in the early stages of developing the disease, or the scientists interrupted the production of the B cells. When they did this, lupus was diminished or prevented.
"It seems to be that the marginal zone is really important for developing autoimmune disease in transgenic mice," Enzler explained.
Dr. Joan Merrill, medical director of the Lupus Foundation of America and head of the clinical pharmacology research program at Oklahoma Medical Research Foundation, said, "This is an exciting scientific paper."
But, Merrill said, people with lupus shouldn't rush to their doctors to remove their spleens. "If a lupus patient has a splenectomy, the disease doesn't go away," she said, explaining that sometimes lupus patients have to have their spleens removed due to complications of the disease, and it doesn't cure lupus.
She also pointed out that this study was done in mice and the human immune system doesn't work in exactly the same way as the mouse immune system does.
Still, Merrill added that with this study and other research, "We're beginning to unravel some of the mysteries surrounding lupus, and I'm cautiously optimistic about the future. We're trying to find better targets and develop better and safer medicines."

More information
To learn more about lupus, visit the Lupus Foundation of America.

Children's Health

Children's Health
In this section many common questions related to children’s health are explored.

Contrary to popular belief, children are not "little adults," and the approaches to their health conditions are often markedly different than those used for grown-ups.

The rapid changes that occur during growth and development require special consideration in choosing both treatments and medications.

In some cases, specific treatments have not been well studied in children, but the majority of childhood health concerns are those that parents have been asking about for many generations, and the solutions are tried and true. Information on other childhood conditions can be found in the QA archives.

• Acupuncture
• Attention Deficit Disorder
• Asthma from Exercise
• Bedwetting
• Broken Bones
• Carsickness
• Colicky Babies
• Constipation
• Ear Infections
• Early Puberty
• Fluoride
• Food Coloring
• Head Lice
• Overweight Kids
• Sore Throat
• Teething
• Toy Safety
• Vitamins

Acupuncture
In the United States, acupuncture hasn’t often been used to treat children, mainly because youngsters tend to be afraid of needles.

But several recent studies have suggested that this fear can be overcome and that children can benefit from acupuncture treatment for certain conditions.

The latest study on this subject was conducted at the Harvard-affiliated Children’s Hospital in Boston by Yuan-Chi Lin, MD, an anesthesiologist who specializes in pain management in children. Dr. Lin’s study included 243 youngsters ranging in age from six months to 18 years who were being treated for headaches, stomachaches, back pain and other chronic complaints that often caused them to miss school.

When the study began, the young patients rated their pain as an "8" on a scale of 1 to 10. (One of Dr. Lin’s methods of demonstrating to the kids that the needles won’t hurt is by inserting them first in the children’s parents.)

When the year-long study was over, the average pain rating among the youngsters was a "3." The kids also reported missing less school, sleeping better, and being more able to participate in extracurricular activities as a result of treatment.

In an earlier study at the same hospital, 70 percent of the 47 youngsters participating reported that acupuncture helped relieve their pain and 59 percent of their parents agreed.

The conditions for which these patients were treated included migraines, endometriosis in teenage girls, and reflex sympathetic dystrophy (a syndrome in which pain becomes chronic after an injury).

In this study, 15 children were age 12 or under while 32 were between 13 and 20 years old. Other studies have looked at acupuncture as a treatment for attention deficit hyperactivity disorder and cerebral palsy in children.

While not many acupuncturists specialize in treating children, Dr. Lin estimates that about a third of pediatric pain centers nationwide now offer acupuncture to their young patients.

Acupuncture is best used for pain reduction as part of comprehensive treatment that includes relaxation techniques, clinical hypnosis and various forms of bodywork.

Attention Deficit Disorder
Ritalin, a stimulant, remains the most common treatment for Attention Deficit Disorder (ADD), also called Attention Deficit Hyperactivity Disorder (ADHD). Paradoxically, with ADHD the drug has a calming effect, apparently because it stimulates parts of the brain that regulate activity and attention.

While it can have excellent results in some cases, it is greatly over-prescribed.
There currently is no herbal treatment for ADHD, except possibly coffee, which may work like Ritalin for some patients.

Pediatrician Sandy Newmark, M.D., of Tucson, Ariz., confirms that no herbs have been found effective for treating the main or "core" symptoms of ADHD — that is, lack of focused attention that often leads to poor school performance. And he doesn’t think coffee is a good long-term solution. However, Dr. Newmark notes that herbs can help with some of the associated symptoms. For example, valerian tea can help youngsters with sleeping problems and St. John's wort can help relieve depression. For children under 12, use half the adult dosage.

Dr. Newmark does recommend a dietary supplement, omega-3 fatty acids, for all children with ADHD because levels of omega-3s in the plasma and red blood cells of children with ADHD are lower than in normal children. He also recommends that youngsters with ADHD take a quality multivitamin as well as a good probiotic, a product that contains "friendly" bacteria that can stabilize the digestive tract. You can find milk-free brands in health-food stores.

Make certain that the underlying cause of your child’s disruptive behavior really is ADHD, and that he or she isn’t acting out difficulties at home or expressing frustration with a learning disability. Be sure to rule out hearing or vision problems, allergies, depression or even boredom in a gifted child.

As far as foods are concerned, while there’s no evidence that a dietary approach helps in all cases, a 1993 Cornell University study found that eliminating dairy products, wheat, corn, yeast, soy, citrus, eggs, chocolate, peanuts, artificial colors and preservatives seemed to decrease ADHD symptoms. An even earlier study showed that a low-allergen diet supplemented with calcium, magnesium, zinc and vitamins produced favorable results.

Asthma from Exercise
Exercise can trigger asthma symptoms in children and adults – even those who don't otherwise suffer from the condition - and can aggravate the problem in up to 80 percent of those who do have asthma.

The symptoms – coughing, wheezing, shortness of breath or tightness in the chest – usually come on after exercise, although they can occur soon after exercise has begun. It can be treated with medication and by taking precautions to prevent or minimize symptoms. Here’s a rundown of medication options, provided by pediatrician John Mark, MD, an assistant professor of pediatrics at the University of Arizona who treats asthma in both adults and children.

Albuterol – A short-acting bronchodilator that’s inhaled 15 to 20 minutes prior to exercise and that protects against symptoms for about four to six hours.

Salmeterol – A long-acting bronchodilator that’s inhaled twice a day which offers protection for up to 12 hours. You can also use salmeterol as a preventive before you work out.

Montelukast (Singulair) – A drug that blocks the action of leukotrienes in the lungs, resulting in less constriction of bronchial tissue and less inflammation. Leukotrienes are one of several classes of chemical messengers produced in the body that can trigger bronchial constriction and inflammation. Montelukast is available in pill form and is taken the night before you exercise.

Cromolyn (Intal) – An anti-inflammatory drug inhaled 15 to 20 minutes before exercising that prevents the release of histamines and leukotrienes. It’s most useful in asthma when an allergic component is present.

In addition to medication, the following approaches can help prevent or minimize symptoms:
A very slow warmup. Even to the point that your child reports the beginning feelings of the "tightness" associated with exercise-induced asthma.

Then your child should stop and stretch, or slow down if exercising vigorously. By taking this break, the development of asthmatic symptoms can often be blocked and a normal pace can be resumed. This may take some getting used to, but can sometimes eliminate the need for medication.

Try breath work. The most effective approaches are pranayama techniques – breath control exercises taught in some yoga classes for adults. You can have your child do these after the initial warm-up, again, when the symptoms are almost felt. For most children, you can start with Dr. Weil’s technique for "The Relaxing Breath."

Find a form of physical activity that minimizes exercise-induced symptoms. Sports or activities that have intermittent rest periods (such as tennis, softball and golf) can allow your child to regain control of his or her breathing. Swimming may be better than running outdoors in cold weather, but no type of exercise is off-limits with proper treatment. In fact, some of the world’s top athletes have exercise-induced asthma, and they’re still able to compete successfully in Olympic-level events.

Bedwetting
Although by age 8 most youngsters have outgrown bedwetting, a sizeable minority still haven’t. As a matter of fact, 5 to 10 percent of boys still have enuresis (the medical term for bedwetting) by age 10. Enuresis tends to run in families and, when this is the case, children usually outgrow it at the same age as the parent, sibling or other relative who had the problem did.

No one knows what causes bedwetting, although it is sometimes associated with constipation. If so, simple dietary changes such as eating more fruits and vegetables and drinking more water early in the day can help resolve matters. Pediatrician Sandy Newmark, MD, of Tucson, Ariz., suggests making sure that children aren’t drinking any beverages that contain caffeine (such as some sodas) and trying to limit (within reason) the amount of fluids they drink in the evening.

Dr. Newmark explains that an "enuresis alarm" is the most simple and effective intervention for youngsters. This device is a wristwatch with a sensor that is attached to pajamas so that the alarm sounds at the first sign of wetness.

This system eventually conditions a child to wake when the bladder is full. Dr. Newmark says that the alarms work in about 70 to 80 percent of children. They are available at most drugstores and cost about $50. Be patient with this system since it can take weeks, and sometimes months, to see results.

If the alarm doesn’t help, Dr. Newmark suggests trying hypnosis as a safe and effective treatment. While some pediatricians prescribe drugs for children who wet the bed, using medication is controversial and should be viewed as a last resort. Homeopathic remedies also may be effective; consult a homeopathic practitioner if you want to try this approach.

Broken Bones
Results of a recent study at the Mayo Clinic in Rochester, Minn., suggest that the rate of wrist and forearm fractures among young girls has increased dramatically in the last 30 years. The study results, published in the Sept. 17, 2003, issue of the Journal of the American Medical Association showed that the fracture rate for young girls increased 56 percent from 1969-1971 and 1999-2001.

Boys still suffer more fractures, but the rate of increase among young boys was only 32 percent. Overall, the Mayo Clinic researchers found that the fracture rate among young people had increased 42 percent over three decades.

The researchers had no answers for why this is happening. It is unlikely that youngsters are breaking more bones because they’ve become more physically active. One possibility is that kids may not be getting enough calcium during a period when their bones are growing rapidly.

If so, their bones may never become as dense as they should, which raises the possibility that affected youngsters may be more vulnerable later in life to osteoporosis and hip and vertebral fractures.

The researchers noted that government surveys have shown a decrease in milk consumption among older girls and an increase in consumption of carbonated drinks. The phosphates in carbonated beverages interfere with calcium absorption.

The RDA for calcium is 1,300 mg for young people age 9 to 18. This translates to 4-5 servings of dairy per day, but kids don’t have to drink milk to get their calcium. Other good sources include yogurt, cheese, sea vegetables, collard and mustard greens, kale, bok choy, broccoli, canned salmon and sardines, tofu that has been coagulated with a calcium compound, calcium-fortified soy milk, fruit juice and blackstrap molasses.

Other experts have noted instances of vitamin D deficiency that could contribute to weakened bones. Our bodies make vitamin D with exposure to sunlight, and youngsters who spend too much time indoors may not produce optimal amounts of vitamin D. Spending 10 minutes in the sun without sunscreen a few days each week will do the trick, but it is not a bad idea for kids 12 and older to take a multivitamin supplement that includes 400 IU of vitamin D.

Carsickness
Carsickness, like all types of motion sickness, occurs when the brain receives conflicting signals from the inner ears, eyes, and other parts of the body that sense motion. A child sitting in the back seat of a car may sense movement – her inner ear perceives the motion – but she may not be able to see out the window to see that she is moving. At the same time, her perception is that her body isn’t moving at all. In some children, these conflicting messages can result in very distressing nausea.

One effective remedy for motion sickness comes from an old Chinese fisherman’s remedy of stimulating the acupressure points that control nausea. The updated version of this treatment is done with wristbands equipped with a plastic peg that presses on acupressure points on the inner surfaces of the wrists. The wristbands are available at most drug and health-food stores. Follow package directions carefully – proper placement of the wristbands is critical.

Motion sickness can also be prevented (and treated) with ginger. Mix a half teaspoon of ginger powder in a glass of water and give it to your child 20 minutes before you get in the car. Or give your child two capsules of powdered ginger.

This remedy has proved more effective than Dramamine – with none of the drowsiness that can occur as a side effect of the drug. Ginger snaps, ginger ale and candied ginger can all help with mild nausea, so keep some in the car should someone develop symptoms during the trip. You also could explore homeopathic remedies – and possibly hypnosis – as a long-term solution.

The American Academy of Pediatrics suggests trying to deal with carsickness in children by focusing youngsters’ attention away from their queasiness. Listen to the radio or tapes, sing or talk. Also, direct their attention at things outside the car, not at books or games. Make sure that they look out the front windows, where apparent motion of objects is less.

Colicky Babies
First, exclude other reasons for the baby’s crying. Make sure the infant isn’t running a fever, isn’t lethargic, is eating normally and isn’t having any trouble breathing. Your pediatrician will also want to exclude GERD (gastroesophageal reflux disease), which can occur among babies (although it is much more common among adults).

The good news about colic is that what you see is what you get – a fussy, crying but otherwise perfectly healthy baby. Some doctors think that this irritating phase may be part of normal development. Between 5 and 28 percent of infants develop colic between when they are two to six weeks old, and usually outgrow it by the time they’re three to four months old.

Here are Dr. Russell Greenfield’s suggestions for dealing with colic – and with the frustration it can breed among parents:

• Try massage therapy, a great way to enhance bonding between parent and child at a time when colic may be interfering with the bonding process.
• Rock your baby rhythmically.
• Turn on music or try the clothes dryer or vacuum cleaner. Sometimes the white noise they produce helps.
• Try cranial osteopathy or homeopathy; both may help and are safe forms of treatment.
• Try herbal remedies such as cooled chamomile or fennel tea. You can get tea bags at the health food store and give the baby one to two ounces at a time, no more than three to four ounces per day.
• Switch to a cow’s milk-free formula, or, if breast feeding, change the mother’s diet to affect what is entering her breast milk (in some cases, a food sensitivity may play a role).
  Swaddle your baby – it provides a nice snug feeling.
• Chill – find a way to relax; try breathing exercises or other relaxation techniques to lower your frustration level.

By the way, the latest international report on colic comes from a Canadian study that found that mothers don’t appear to sustain any lasting psychological effects as a result of dealing with a colicky infant.

Constipation
Constipation is a common problem for children and usually is temporary. Strictly speaking, a child is constipated if he or she has fewer than three bowel movements per week or if the stools are hard, dry, and unusually large or difficult to pass. Because constipation can make bowel movements painful, youngsters may try to avoid having them. (In addition, about 60 percent of constipated children experience recurrent abdominal pain, a common stress-related condition in youngsters.)

The causes of constipation in kids usually are simple and relatively easy to correct: not enough fiber in their diets, not drinking enough liquids or not getting enough exercise. Then, too, constipation can occur when youngsters ignore the urge to have a bowel movement, which they can do for reasons ranging from not wanting to take a break from playing to embarrassment at using a public bathroom or because a parent isn’t around to help when the urge occurs.

Medication can also be a factor. Those that can cause constipation include aspirin and codeine, vitamins with high doses of iron, the bismuth in Pepto-Bismol, as well as some chemotherapy agents (vincristine) and some psychiatric drugs (imipramine).

Sandy Newmark, MD, a pediatrician at the University of Arizona Program in Integrative Medicine, recommends the best ways to deal with constipation in young children, listed here:
Decrease dairy products: They can be constipating. Provide your child with an alternative source of calcium such as soy milk fortified with calcium or a calcium-fortified breakfast cereal.
Increase fluids: Encourage your child to drink lots of water.

Increase fiber: Give your child lots of high-fiber fruits and vegetables as well as high-fiber cereals, whole-grain breads and beans.

Although these measures probably will do the trick, if a child’s episodes of constipation last longer than three weeks and prevent him or her from participating in normal activities, you might want to consult a pediatrician. Don’t be tempted to administer the over-the-counter laxatives designed for children. They can be dangerous to youngsters and should be given only under the direction of a pediatrician.

Ear Infections
Recurrent ear infections can be troublesome during early childhood. Here are two strategies:
Eliminate milk and milk products from your child’s diet for at least two months. This means avoiding all dairy products as well as other foods containing milk in any form. Soy, rice, and nut milks such as almond milk are all right. The protein in milk, casein, is often associated with recurrent ear infections in early life as well as with sinus conditions, eczema, chronic bronchitis, and asthma.

Try cranial osteopathy. It is another good treatment for recurrent ear infections. When performed by a skilled practitioner, this technique can often end cycles of ear infections, sometimes with a single treatment.

The late Bob Fulford, D.O., a leading practitioner of cranial osteopathy, had great success curing recurring infections in young children. He believed that fluid stagnation in the middle ear – caused by restricted breathing – was at the root of the trouble.

Gentle manual manipulation (and sometimes application of a vibrating instrument known as a percussion hammer) opens up breathing, which in turn helps fluid drain from the middle ear. To find a practitioner of cranial osteopathy, send a self-addressed stamped envelope to the Cranial Academy, 8202 Clearvista Parkway, #9D, Indianapolis IN 46256. At the University of Arizona, researchers are now concluding a study funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine on the use of both cranial therapy and Echinacea to break cycles of recurrent childhood ear infections.

Early Puberty
In the United States, there's a virtual epidemic of precocious puberty these days – the onset of puberty at very young ages in both boys and girls. Among Caucasian girls today, 1 in 7 starts to develop breasts or pubic hair before she is 8 years old. Among African-American girls, the number is 1 out of 2! Unfortunately, no one knows why this is happening, although there's plenty of speculation. Precocious puberty can be triggered by tumors in the pituitary gland, hypothalamus, ovaries, or testicles, but these cases are rare. Environmental factors are more likely to blame for the upsurge in cases today. The theory with the most scientific support is that obesity is responsible. I think this may be true, since we've long known that overweight girls mature physically earlier than thin ones.

Research also has suggested that environmental pollution may play a small role. In the spring of 2000, results of a study reported in the Journal of Pediatrics showed that boys exposed to DDE (a breakdown product of DDT) were heavier than their peers, while girls exposed to PCBs were heavier than their peers and tended to reach puberty a bit sooner, even though the actual numbers involved in the study were not deemed statistically significant. (Both DDT and PCBs are chemicals that appear to interfere with the body's own hormones.) Researchers are also looking at other environmental chemicals – among them Bisphenol A (BPA), used in manufacturing plastic – but so far haven't found a definitive link.

Unfortunately, there's not a lot to offer in terms of treatment and no natural remedy that I can suggest. Since it's occurring so often these days, some physicians believe that precocious puberty in girls between the ages of 6 and 8 should be seen as normal and not treated at all. (We do know that the risk of breast cancer later in life increases with an earlier onset of puberty.) The only approved allopathic treatments are two drugs: Gonadotropin-Releasing Hormone, GnRH, and Luteinizing Hormone-Releasing Hormone, LHRH, both given by daily injections or at intervals of every three to four weeks. These drugs interfere with the hormonal changes responsible for precocious puberty, in effect putting them on "hold" until the child reaches a more appropriate age (typically between the ages of 11 and 13 in girls). The drugs may also reverse the changes that already have taken place.

The physical changes are only one aspect of what girls must contend with as a result of precocious puberty. Because they look like young women, they're often treated as if they were much older than they are by boys (or men who should know better) and may also be teased by friends and at school. If you are a parent with a child in the midst of precocious puberty, you must keep the parent-child lines of communication open. Make sure that your child understands that despite the change in her appearance, he or she is still a child.

Fluoride
The only children who need fluoride supplements of any type are those who live in communities without fluoridated water supplies or in homes with water purifiers that remove minerals. The easiest, most efficient and most cost-effective means of making sure that children have adequate fluoride to protect against tooth decay is to support fluoridation of your area's water supply.

If your community's water is not fluoridated, your child will need dietary fluoride supplements which are available only by prescription from your dentist or physician. To protect against tooth decay, children need fluoride on a daily basis from the age of 6 months to 16 years. (Pregnant women take fluoride supplements beginning in the sixth month of gestation to ensure strong tooth development in the fetus – check with your obstetrician about this.) The correct dosage for your child must be calculated on the basis of the natural fluoride concentration of your local drinking water as well as your child's age, and the extent of his or her exposure (if any) to other sources of fluoride, such as toothpaste or commercial products.

Some fluoride is present in all water sources, but according to the American Dental Association, most bottled waters don't contain enough to prevent tooth decay. Fluoridation of community water supplies involves adjusting the fluoride content to the optimal level for dental health, 0.7 to 1.2 parts fluoride per million parts water. Too much fluoride can be bad for children's teeth, just as too little is bad. An excess of fluoride can lead to mottled, chalky, white spots on the teeth. Other health risks include weight loss, brittle bones, anemia and weakness. Be aware that there are conflicting reports that continue to fuel the controversy over fluoridation. Yet at proper levels, fluoride is of immeasurable benefit to the teeth – during childhood and throughout life.

Food Coloring
We are seeing more and more strangely colored foods and snacks, but as a precaution, keep children – and adults – away from foods with artificial colorings. The danger is that the chemicals used to create color are energetic molecules, many of which are capable of interacting with and damaging DNA. Anything that damages DNA can injure the immune system, accelerate aging, and increase the risk of cancer. Indeed, many synthetic food dyes once considered safe have turned out to be carcinogenic. Some approved for use in Europe are considered unsafe in the United States, and vice versa.

Dyes are added to foods for the convenience of the manufacturer, not for the health of the consumer. Luckily, these are among the easiest types of food additives to avoid. Try to convey to your children that garishly colored snack foods are weird and unhealthy – rather than attractive – and make it a rule not to buy them. Watch out for labels that list any of the following terms: "color added," "artificial color added," "U.S.-certified color added," or "FD&C red No. 3" (or green or blue or yellow followed by any number; these are FDA-approved food drug and cosmetic dyes).

There is nothing wrong with foods dyed with natural colors obtained from plants. The most common, annatto, is from the reddish seed of a tropical tree. It is widely used in Latin American cooking to make yellow rice and breads, and is also commonly added to butter and cheese to make them yellow or orange. Other safe food colorings are a red pigment obtained from beets, a green one from chlorella (freshwater algae), caramel, and carotene from carrots.
Definitely keep your kids away from bright green ketchup, a product designed specifically to appeal to youngsters.

Head Lice
Head lice are a common nuisance of childhood. Kids pick them up from someone who already has them by wearing each other’s hats, scarves, hair ribbons and other clothes; sharing combs, brushes or towels; or lying on a bed, couch, pillow or even cuddling a stuffed animal that belongs to a child who has lice. Try to discourage this kind of sharing, particularly if you hear that there’s an infestation at school, at a day care center, or wherever your children spend time.

The conventional treatment is one-percent lindane, sold as Kwell lotion. Yet lindane is a cousin of DDT and can harm the nervous system. Natural and safer alternatives include one-percent permethrin cream rinse, sold as Nix and Neem, which is derived from a tree in India. Lice can develop resistance to permethrin products, and they can aggravate asthma in some children, but both are relatively nontoxic. (Neem is sold in garden shops.)

Some California school systems are using a new product called Lice B Gone, a non-toxic, multi-enzyme shampoo made from plant sources that seems to get rid of lice in a single application. It works by softening the glue that holds the nits (lice eggs) to the hair shaft and also dissolves the exoskeletons of adult lice. Since it contains no pesticides, Lice B Gone is considered safe for pregnant women, nursing mothers, young children and people with asthma.

Overweight Kids
You'll probably be happy to hear that not all children who are heavy grow up to be overweight adults. However, we do have an epidemic of childhood obesity in the U.S., and all parents should be aware that for every year that a child remains overweight, his or her chances of growing into an overweight adult increase.

Aside from eliminating sodas or junk food at home, look to physical activity as a way to help your child lose weight. Try for at least half an hour of physical activity each day. Unfortunately, only 25 percent of school-aged children now take physical education classes. If your child doesn't get any exercise at school, it's up to you to make sure he or she does some type of physical activity at home.

Here are some approaches to add exercise to your child's life as well as foods that will help control his or her weight:
Curb screen time. Limit the time your child spends watching television, sitting at the computer or playing video games.
Set a good example. Studies have found that children are more likely to be physically active if their parents and siblings are active, and if they're encouraged to take part in physical activities. Take family walks, hikes or bike rides on a daily basis, if possible.
Emphasize nutritious foods. Don't limit the amount your child eats, but make sure the foods he does eat are low in fat and high in fiber. When making these changes, say that you're doing it for the entire family to avoid drawing attention to your child's need to lose weight.
Eat meals together. Family breakfasts and dinners give you more control over what your child eats and allow you to make sure that everyone gets at least two nutritious meals per day.
Think about drinks. Cut back on fruit juices, sodas and whole milk. Drinks can provide a surprisingly large number of calories per day.
Teach a relaxation technique. If your child eats in response to stress, you might show him how a relaxation technique such as deep breathing can help to calm him.

Sore Throat
The most important thing parents can do when children develop sore throats is to make sure that the problem isn’t strep, a bacterial infection that requires antibiotic treatment. Strep is diagnosed via a throat culture. (Or a rapid strep test, which takes only 10 minutes but is not as accurate.) While the results may not be available for a few days, a doctor often can tell on the basis of observation whether strep is the likely problem and begin immediate treatment with penicillin. The sore throat usually eases in 24 to 48 hours.
Besides a very sore throat, symptoms of strep often include fever, swollen and tender lymph glands under the jaw, and a swollen and marked redness at the back of the throat that may have white dots. Those symptoms don’t always mean strep, but they often do. (Another clue: suspect strep when there are none of the typical symptoms of a viral infection such as a cough, runny nose, hoarseness and eye irritation.)
It is very important to treat strep throat with antibiotics as soon as possible, because in rare cases it can lead to an autoimmune reaction – rheumatic fever – that can affect the joints, heart and kidneys.
To reduce your child’s susceptibility to sore throat, try to build up his or her immune system by administering a course of the Chinese herb astragalus (Astragalus membranaceous) during cold and flu season. You can get astragalus in tincture form or in capsules at the health-food store. Administer one half the adult dose. This herb is safe for regular use.
If your child can gargle, give her a mixture of half hot water and half hydrogen peroxide to use several times a day. Gargling with warm salt water (one-quarter teaspoon salt to one cup of warm water) is also soothing.

Teething
In many infants, the process of teething is painless, causing only some increased drooling and a desire to chew. However, some infants develop tender, swollen gums, may not sleep or eat well, and may run a low fever (under 100 degrees). A fever above 100 degrees or diarrhea suggests problems unrelated to teething.
Here are some recommendations to keep a teething baby comfortable:
Wipe the drool off your baby’s face with a soft cloth (to prevent rashes).
Rub the baby’s gums with a clean finger.
Let your baby chew on a wet washcloth that has been placed in the freezer for 30 minutes (wash it after each use). Alternatively, use a cool spoon or rubber teething ring (take it out of the freezer before it gets so hard that it bruises the tender gums).
Never tie a teething ring around a baby’s neck – it could get caught on something and strangle the child.
Homeopathic teething tablets are a good option. Many parents tell me they have used them successfully to relieve the minor discomforts of teething in their babies.

Toy Safety
Look over the toys you have at home to see if they are age-appropriate for your children. In general, this means making sure they aren't too advanced for the youngest child, but sufficiently sophisticated for the older ones. Homes with infants or toddlers should make sure all toys (and their removable parts) are large enough so they can't be put into a child's mouth and become a choking hazard. (An easy test: A child can choke on any object that fits inside the tube from a roll of toilet paper.)
Parents or grandparents should also be aware that over the last two years toy manufacturers have recalled teethers, rattles, and other products that contain a cancer-causing chemical called diisononyl phthalate (DINP) from the market. Phthalates are used to soften plastics, but high doses have been linked to cancer in mice and rats. The U.S. Consumer Product Safety Commission has said the amounts that might have been ingested by small children are not high enough to pose a risk, but it does make sense to toss any soft plastic rattles and teethers that you’ve had more than a year – that's when most toy manufacturers agreed to phase out use of the additive.
The following guidelines for toy safety are from the American Academy of Pediatrics and the Consumer Products Safety Commission:
Check the surface and edges of wooden toys. Sandpaper sharp corners and splinters.
Don't give hobby kits, such as chemistry sets, to children younger than 12.
Don't permit children to play with adult darts or other hobby or sporting equipment that have sharp points.
Examine all outdoor toys regularly for rust or weak parts that could become hazardous.
Discard all plastic wrappings on toys before they become deadly playthings.
New toys intended for children under age 8 should be free of glass and metal edges.
Toys with long strings or cords may be dangerous around infants and very young children. Never hang toys with long strings, cords, loops, or ribbons in cribs or playpens where children can become entangled.
Keep toys designed for older children out of the hands of little ones.

Vitamins
Yes, children should take vitamins, mostly because so many kids don’t eat enough fruits and vegetables, and because their diets are often full of processed and refined foods. However, vitamin supplements shouldn’t be substitutes for whole foods, especially fruits and vegetables.
Teach children of any age to enjoy healthy food by involving them in its preparation, even if they’re only in the kitchen to observe. In "The Healthy Kitchen," Rosie Daley and I give a number of ideas for recipes and snacks that kids will like. Also, try to discourage your children from eating too much fast food, processed food, sugar and caffeine (in cola and other soft drinks). There’s no harm in the occasional ice cream, pizza or candy bar in the context of a well-balanced diet, but try to encourage snacking on healthier foods – fresh or dried fruit; a small handful of raw, unsalted nuts such as cashews and walnuts; a piece of flavorful, natural cheese; or a piece of dark chocolate.
As far as supplements are concerned, give children a complete antioxidant formula as well as multiminerals. Be sure to keep the vitamins out of the reach of young children – some supplements for kids taste and look like candy and there is a danger of overdosing, especially when supplements contain iron.

Andrew Weil, M.D.–Author of:
Eight Weeks to Optimum Health
Spontaneous Healing
The Natural Mind
The Marriage of the Sun and Moon
Health and Healing
Natural Health, Natural Medicine
From Chocolate to Morphine (with Winifred Rosen)