Why Religious Fasting Could Be Good for Your Brain

By Andrea Useem

Ramadan is in its third week now, and the required dawn-to-dusk fasting often feels like a daily mini–marathon. By late afternoon, hunger and thirst have sucked me dry, leaving me sleepy, slow-minded, and sometimes short-tempered.

I know that the purpose of fasting is spiritual—God will reward us in the next life—but in this lifetime, fasting sometimes makes me an ineffective, irritable person. So I was excited to learn that Harvard psychiatrist John Ratey, MD, had spoken at a recent Renaissance Weekend event about how caloric restriction can improve brain function. Read More

Compound in Red Wine Fights Ravages of Age

(HealthDay News) -- A key compound in red wine known as resveratrol appears to protect against many of the health ravages associated with growing old, new animal research reveals.

"It's very hard to extrapolate from this finding to comment on the benefits of red wine directly, because red wine has many other compounds besides resveratrol, including ethanol, which have very active biological effects," noted study author Rafael de Cabo, unit chief of the laboratory of experimental gerontology at the National Institute on Aging in Baltimore.

"But red wine is a good source of resveratrol," he added. "And, in this mouse study, we have shown that this particular compound has very strong positive effects on preventing cardiovascular disease, reducing heart inflammation, keeping bone health in terms of structure and function, and maintaining loco-motor and balance activity. So, if these effects translate into humans, it will have a very good impact on the standard of human health."

De Cabo conducted the research with David A. Sinclair, of Harvard Medical School. Their team is publishing its findings in the July 3 online issue of Cell Metabolism.

Daily consumption of the compound -- also found in the skin of grapes and the crust of peanuts and walnuts -- broadly improved the long-term quality of life of middle-aged mice, although most mice did not end up living longer.

Nevertheless, the age-defying health benefits of resveratrol closely mimicked those previously associated with rigorous calorie-restricted diets -- raising hopes for simpler and easier means by which to help fight off age-related decline.

The authors noted that prior research has touted the healthy benefits associated with daily caloric restriction of between 30 percent and 50 percent below average, as well as with fasting every other day. Such diets have been linked to a reduction in the risk for age-associated diseases and stress, alongside a slowing of age-related functional decline.

"But we can't have half of America going permanently on a diet," said de Cabo. "We just can't do it. It's not practical, and it's not going to happen."

Alternatively, he and his colleagues began to explore the potential of resveratrol -- a compound that has already been shown to extend the lives of yeast, worms, flies and fish.

In initial studies, the team found that consuming the compound did improve the health and survival of obese mice -- despite consuming a high-calorie diet.

To follow up, the researchers now compared the health and life spans of middle-age mice given either a standard diet or a calorie-restricted diet, with or without high or low daily dosages of resveratrol.

De Cabo and his colleagues found that resveratrol had the same positive impact on mouse livers, muscles, hearts and bones as calorie restriction alone.

Regardless of dietary protocol, the general health and vigor of mice on a long-term regimen (approximately one year) of resveratrol improved overall, without apparent side effects. However, only mice consuming resveratrol alongside a high-calorie diet were found to actually live longer.

"This certainly is consistent with previous studies," noted Dr. Edward A. Fisher, a professor of cardiovascular medicine and cell biology at the New York University School of Medicine in New York City. "So, I'm not surprised by the finding."

"But by looking at specific outcomes in specific tissues, this work is certainly more detailed and rigorous," he added. "And it further supports the hypothesis that this compound staves off the effects of aging."

On another food front, researchers out of Athens Medical School in Greece have published a new study in the current issue of the European Journal of Cardiovascular Prevention and Rehabilitation suggesting that drinking green tea is good for the heart.

Consuming green tea, the authors noted, appeared to quickly improve the function of cells that line the circulatory system, known as endothelial cells. Because endothelial cell damage is a key contributor to the onset of atherosclerosis, boosting the performance of such cells could help stave off heart disease.

America's Healthiest Fast-Food Chains

Health magazine's choices for the healthy places to eat when you’re on the go
by Ross Weale

Frances Largeman-Roth discusses America’s healthiest fast-food chains on the Today show on March 25.




FRANCES LARGEMAN-ROTH

Frances Largeman-Roth, RD, is the senior food and nutrition editor at Health magazine, where she works on healthy recipes, food trends, weight-loss issues, and the latest nutrition research. She also writes a monthly food and health trend column called Hot Dish. Frances was previously part of the editorial team at the Discovery Health Channel and also held the post of managing editor at FoodFit.com. She has had the opportunity to work with top chefs and food personalities, putting a healthier spin on recipes from Jamie Oliver, Mark Bittman, Emily Luchetti, Gayle Gand, Rick Bayless, and Stephen Raichlen, among others. Frances is a member of the American Dietetic Association and the International Association of Culinary Professionals.

Frances earned her undergraduate degree from Cornell University and completed her dietetic internship at Columbia University in New York. She’s done several local and national radio and TV appearances, including the Today show, CBS's Early Show, and iVillage Live, and she has two satellite media tours under her belt. Frances has also used her food background to judge the AllRecipes.com annual recipe contest as well as two Food Network Challenges.

Terriers Join Fight Against a Killer Disease in Humans

(HealthDay News) -- A feisty breed of terrier could stop scientists from barking up the wrong tree as they research a deadly lung disease in humans.

The illness, called idiopathic pulmonary fibrosis (IPF), affects 128,000 Americans, is typically fatal within three years of diagnosis, and kills more than 40,000 people in the United States annually -- a death toll equivalent to that of breast cancer.

A fatal condition that looks remarkably like IPF also strikes the diminutive West Highland White terrier ("Westie"), however. And recently, medical scientists from the human and veterinarian worlds met for the first time to share information and pool resources against a mysterious killer.

"People may be a little startled at first to learn about this idea -- 'You're kidding me, you actually think there's promise in studying this dog to help my Dad with this disease?' And the answer is -- 'Yes'," said Mark Shreve, chief operating officer of the patient advocacy group Coalition for Pulmonary Fibrosis, based in San Jose, Calif.

Because the Westie is so tightly bred, and because the illness progresses faster in dogs than humans, it is conceivable that dog-based research might yield valuable clues to the genetics or environmental factors that trigger pulmonary fibrosis in both species, experts explained.

"And if it transpires that it is the same disease, then obviously the options are limitless as to how we can look at information from dogs and use it to understand the disease in humans and vice versa," said Dr. Brendan Corcoran, director of the Hospital for Small Animals at the University of Edinburgh, Scotland, and a pioneer in researching pulmonary fibrosis in Westies.

According to Shreve, most people find it hard to believe that a disease like IPF even exists amid the wonders of modern medicine.

"We are dealing here with one of the few diseases left on the planet for which there are no proven causes and no treatments," he said.

Idiopathic pulmonary fibrosis occurs spontaneously, although certain factors -- such as smoking or exposure to airborne toxins -- do raise risks for the illness. "IPF is a progressive scarring process in the lungs that gradually robs a person of the ability to breathe," Shreve explained.

Some sort of signaling seems to go awry at the cellular level, he said, converting normal, expansive lung tissue into stiff, fibrotic scar tissue.

"Once it starts in patients with IPF, your body just never sends a signal to stop that scar tissue from being produced," Shreve said. "This scar tissue is obviously not lung tissue that is able to process oxygen."

There have so far been very few promising leads in discovering the root causes of IPF, said Dr. Jesse Roman, one of the country's leading researchers in the disease and a professor of medicine at Emory University in Atlanta.

"Studies do suggest very specific [cellular] pathways, and there's a number of molecules that everybody is tuned into," he said. "But how you block them and how they relate to what happens in humans, that's less clear."

So, scientists are turning to creative new ways of looking at IPF.

Cross-talk between scientists worldwide led to the first-ever summit on the disease that included both veterinary and human medical researchers. The meeting was held in October on the campus of Purdue University in West Lafayette, Ind., and was attended by Corcoran, Roman and others. It was sponsored by the Westie Foundation of America and the American Kennel Club (AKC) Canine Health Foundation.

Westies, which grow to just under a foot in length, are described by the AKC as "courageous and self-reliant, but friendly."

"They're a very popular pet because of their size and their nature," Corcoran said.

However, pulmonary fibrosis does pop up in the breed with regularity, first revealing itself as excessive panting and shortness of breath. The illness also tends to develop in the terriers' late middle-age (about eight or nine years), mimicking its typical onset in humans at about age 50 to 60.

Westies inevitably succumb to the lung fibrosis about a year and a half after their diagnosis, Corcoran said.

Still, "there's still the contentious issue of whether this is the same disease as occurs in humans," he said. The exact prevalence of the disease among Westies is also unclear, he added. That means the first aim of Westies-centered research will be epidemiological -- studying disease prevalence and gathering a core of dogs and their owners that researchers might follow going forward.

Getting postmortem samples of canine lung tissue will also be crucial to a better understanding of the causes of the disease, Corcoran said. But that has its own challenges, he added.

"Getting owners to volunteer their dogs for necropsy is always problematic," he said. In fact, it's often "harder in many instances to get lung pathology samples from dogs than it is from humans," Corcoran said.

"However, one of our plans is to try and build up a group of concerned owners who will volunteer to donate their dog when that day arrives. We've been having some discussions on that already with our colleagues in America," Corcoran said. "Hopefully, the more publicity that we get with this condition, the more we may get owners coming forward and volunteering their dogs for research."

Corcoran and the other experts said that a cure for IPF is definitely not around the corner -- the disease has been as tenacious in keeping its secrets as, well, a terrier.

But Westies may be just the foe in the fight against IPF requires. Corcoran pointed out that the dogs' tight breeding means genetic research could yield important clues. And their shorter lifespan -- a seventh of that of humans -- means scientists can watch the disease in "fast-forward," which might also speed research.

Westies are also free of certain confounding factors, such as smoking, that often muddle human research. "The dogs might turn out to have a very pure form of the disease that allows you to investigate the disease itself and not worry about other factors," Corcoran noted.

Given all of this, "why wouldn't you look at a Westie and research how the disease progresses?" said patient-advocate Shreve.

"We think it's a very creative approach to trying to help out humans," he said, "and our patients don't really have the patience to hang around waiting for a miracle.

More information
To learn much more about IPF, visit the Coalition for Pulmonary Fibrosis.

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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.

PSA Test Still Important to Detect Prostate Cancer, Studies Find

(HealthDay News) -- Despite questions as to whether early screening for prostate cancer is accurate, new research suggests it continues to be important.

And even more encouraging news indicates that statins, drugs designed to lower cholesterol, might also reduce the risk of developing prostate cancer. Both sets of findings were presented Sunday at the American Urological Association's annual meeting, in Anaheim, Calif.

Screening for prostate cancer has become controversial, particularly the issue of whether a prostate-specific antigen (PSA) blood test is useful as an early detector of malignancy. Two studies presented at the conference indicate it is still worthwhile to have such a test.

In one study, Dr. Hans Lilja, from Memorial Sloan-Kettering Cancer Center in New York City, and colleagues found that PSA testing of men in their 40s was predictive of developing prostate cancer later. In fact, the higher the initial PSA, the greater was the probability that the cancer would be aggressive, the research showed.

As recently as last month, a study published in the Journal of the National Cancer Institute found that PSA tests "perform poorly in distinguishing between those who develop a lethal prostate cancer from those at low or no risk of disease progression."

But among the patients in the Sloan-Kettering study, risk for prostate cancer was concentrated, with 89 percent of advanced cancers occurring in men with the top 10 percent of PSA levels, the researchers found.

Lilij thinks that men should have an initial PSA test when they are in their 40s rather than waiting. "It is surprising that this marker can predict cancer 20 years later," he said. "We should focus our efforts on those men who are on the highest risk for cancer."

Another study found that among patients who had a radical prostatectomy (removal of the prostate and some of the tissue surrounding it), those who had been screened for prostate cancer were more likely to have malignancy confined to the prostate, compared with men who had not been screened.

"Patients should be screened," said lead researcher Dr. Alexandre E. Pelzer, from the Medical University Innsbruck, Austria. "Screening reduces mortality from prostate cancer by 50 percent in our part of Austria, where screening is done, compared with other parts of the country where it isn't," he said.

Another debate in prostate cancer care is whether patients diagnosed with the disease should be treated immediately or whether watchful waiting is best.

In one study, Dr. Marc A. Dall'Era, and colleagues from the University of California, San Francisco, found that it was not possible to predict how fast the cancer would progress among the study subjects who had what was termed low-risk prostate cancer.

In the study, more than 400 men had their cancer watched monthly. "Among the men on active surveillance, about 28 percent progressed," Dall'Era said. "Over five years, none of the men died from prostate cancer," he added.

Men who opted for treatment were those who had the highest grade tumors, Dall'Era added.
In another study, Dr. Bradley A. Erickson, from Northwestern University, and colleagues collected data on 347 older men who selected watchful waiting. Among these men, 36 percent showed progression and/or underwent secondary treatment. Overall mortality was 30 percent, with 8 percent dying from prostate cancer.

"Men who were more likely to die were those with higher PSA and those whose cancer progressed," Erickson said. "This is the first study to that gives us a natural history of PSA screening."

In a second group of studies, researchers presented evidence that statins might reduce prostate cancer risk.

In the first report, Dr. Janet Colli, and colleagues from the University of Alabama, Birmingham, were able to make an association between declining prostate cancer rates in the United States and statin use.

The researchers said they found the declining death rates were most noticeable among white men who used statins. "There was a very strong correlation between declining prostate cancer mortality rates and declining high cholesterol levels in white males," Colli said.

Colli thinks statin use may be one reason for this decline in prostate cancer mortality. "Future studies are needed to determine the effect of statins on prostate cancer," she said.

In a second study, a research team led by Dr. Robert J. Hamilton, from Duke University Medical Center, found statins lower PSA levels. "In 1,200 men, we found an average 4.1 percent decline in PSA after starting their statin," Hamilton said. "The PSA dropped more if the patient was on a higher dose of a statin."

Moreover, men whose PSA was highest saw the greatest drop in PSA levels after starting statins, Hamilton said. "These men had an average of a 15 percent drop in their PSA," he noted.
Hamilton said studies need to be done to see if statins actually protect against prostate cancer.

He added the concern that statins may not prevent cancer, but rather mask the malignancy through the decline in PSA levels, so some prostate cancers may go undiagnosed.

In a third study, a group headed by Dr. Teemu J. Murtola from the University of Tampere, Finland, collected data on 78,484 Finnish men between the ages of 55 and 67.

They found that there were fewer cases of prostate cancer among men who used statins. "There was a dose-dependent reduction in prostate cancer among users of statins, but not among users of other cholesterol drugs," Murtola said. "The overall risk of prostate cancer was around half of that of non-statin users."

In addition, Murtola's team found that PSA levels were also lower among study subjects without cancer who used statins.

"The association of statins with the reduced risk of prostate cancer should be made known to men taking statins," Murtola said.

More information
For more information on prostate cancer, visit the U.S. National Cancer Institute.

New Cholesterol Check Gauges Kids' Heart Risk

(HealthDay News) -- Whether America's fast-food-and-video-game culture, or some other confluence of factors is to blame, there's no denying that adolescents' health is at risk.

Little wonder, then, that one group of researchers has begun to take a serious look at the long-term health consequences of kids' inactivity. And they are using cholesterol levels as a window into these youngsters' futures.

Obesity, inactivity and cholesterol are closely linked, and data from the latest U.S. National Health and Nutrition Examination Survey (NHANES) finds that 17 percent of U.S. teens are overweight. Just one in four high school students packs enough physical activity into their day, and 12 percent get little or no daily exercise, reports the U.S. Centers for Disease Control and Prevention.

So, measuring kids' cholesterol in a really detailed way may make sense.
"There is growing scientific evidence indicating that cholesterol levels in childhood and adolescence have an effect on the development of plaque in the arteries, which is a clear indication of cardiovascular disease risk," explained study leader Ian Janssen, an assistant professor in the School of Kinesiology and Health Studies at Queens University in Ontario, Canada.

"There is also strong evidence indicating that children and youth with high cholesterol will continue to have high cholesterol in adulthood," he added. "Thus, it is important to start treatment and prevention efforts early."

Using data from the NHANES on more than 6,000 kids aged 12 to 20, Janssen and his colleagues developed age- and gender-specific reference points for total cholesterol, LDL ("bad") cholesterol, HDL ("good) cholesterol and triglyceride fat levels. The new tables, published last year in the journal Circulation, take into account fluctuations in cholesterol and fat that occur as a child matures.

The new reference data are meant to improve upon current guidelines, published by the U.S. National Cholesterol Education Program, which do not account for age-related fluctuations.
Still, Janssen admits that the guidelines have not yet been routinely adapted into clinical care settings in the United States. "These sorts of changes to clinical practice typically take years to manifest," he said.

Dr. Marc S. Jacobson, director of the Center for AtherosclerosisAtherosclerosis Prevention at Schneider Children's Hospital in New Hyde Park, N.Y., said it's unclear how the new tables will be received in the United States.

"It complicates lives of people like me who treat adolescents with lipid problems because instead of just having one number, you have to have four graphs and plot them out by age," he said.
"Instead of having one cut point," he continued, "you have a graph that you have to plot out a percentile. With each lipid profile, you have to decide which percentile this is for that individual's age. And when it goes up and when it goes down, did it go down because of treatment? Or did it go down because of advancing puberty?"

The challenge, then, is to make sense of that information, he explained. "It argues that you almost have to take it into account because you could say if the LDL changes, is it the treatment or is it a change in puberty?"

Currently, the federal government recommends cholesterol screening for children and teens with at least one parent with high cholesterol or a family history of early heart disease.
"Typically high-risk adolescents should be screened, and probably every year or two," Janssen said. "A high-risk adolescent would be one who's had a parent or grandparent with premature cardiovascular disease or high cholesterol, or a teen with other risk factors, such as obesity and high blood pressure."

Other risk factors, such as high blood pressure, obesity, diabetes or smoking, also would trigger cholesterol testing in doctors' offices, "and that covers a lot of kids now," Jacobson noted.
The issue is destined to garner greater attention when a U.S. National Heart, Lung, and Blood Institute (NHLBI) panel updates guidelines on cholesterol screening in children and teens. The new guidance is scheduled for release in April 2008, said Dr. Rae-Ellen Kavey, senior medical officer with the Pediatric Cardiovascular Risk Reduction Program in NHLBI's Office of Prevention, Education, and Control.

"Stay tuned," Kavey said, "because there really is going to be new information."

More information
Find out more about cholesterol at the U.S. National Heart, Lung, and Blood Institute.

Diabetes Epidemic Spreading Worldwide: Experts

(HealthDay News) -- More than two-thirds of the world's estimated 246 million diabetics come from less-affluent developing nations, and more must be done to curb a disease that now rivals HIV/AIDS in terms of suffering and death around the globe.

That sobering assessment was offered by experts gathered at this week's Global Changing Diabetes Leadership Forum in New York City, which included keynote speaker former President Bill Clinton. The conference is one of the largest such gatherings ever of scientists, health-care advocates and government leaders focused on the issue.

"This truly is an epidemic," warned Dr. Martin Silink, president of the International Diabetes Federation (IDF), which represents more than 200 diabetes associations across 158 countries. "Seventy percent of the global burden of diabetes is now in developing countries, even though that seems paradoxical. People think that it should be in the developed world where there is access to fast food and lots of obesity."

But rapid lifestyle changes are affecting the health of people in China, India, South America, and elsewhere, he said. "As their economies develop, diabetes is now subverting the gains of economic development," Silink said.

The issue has gained such urgency that the United Nations' General Assembly in December passed a global resolution to encourage the prevention, treatment and care of diabetes. The U.N. has only passed one such disease-targeted resolution before, when it vowed to fight HIV/AIDS.

Some statistics from the IDF:
By 2025, the number of people with diabetes is expected to rise to 380 million worldwide, with 80 percent living in the developing world.

Each year, another 7 million people develop diabetes, while 3.8 million die of diabetes-linked causes.

In many countries in Asia, the Middle East and the Caribbean, diabetes already affects 15 percent to 20 percent of the adult population.

India now has the largest number of diabetics (almost 41 million) in the world, followed by China (nearly 40 million), the United States (19.2 million) and Russia (9.6 million).

Diabetes increasingly affects the young or middle-aged, with more than half of diabetics in developing countries between the ages of 40 and 59.

According to the experts, a "perfect storm" of genetics and social change is driving the spread of obesity-linked type 2 diabetes in poorer countries. Visitors to today's China quickly notice McDonald's, KFC and other fast-food outlets springing up in major cities. At the same time, the foot and bicycle are making way for the car on urban streets.

Scientists have also long understood that Asians, Hispanics and blacks are more vulnerable, genetically, to develop type 2 disease compared with those of European descent.

"They simply don't have to get as obese as a European to get diabetes," Silink explained. Among non-Europeans, even a relatively modest increase in abdominal fat -- the so-called "spare tire" -- can trigger changes that lead to insulin insensitivity and diabetes.

"The risk of diabetes in a European starts rising after a body mass index (BMI, a ratio of weight to height) of about 25 or 26," the normal threshold for overweight, Silink said. "But for a person coming from Bangladesh or India, that risk curve starts after a BMI of just 22," he said.

A person who is 5-feet, 8-inches tall and weighs 145 pounds has a BMI of 22.

Too often, expensive, pay-as-you-go health-care systems in developing countries mean diabetes isn't even detected until it reaches crisis levels, Silink added. The results -- prolonged disability, amputation, even death -- can destroy a family's income.

Urban stress is another factor driving the epidemic, as the world's poor seek employment in cities, Silink said. For reasons that remain unclear, "we know that simply moving from a rural environment to a city doubles your risk of diabetes without any change in body mass," he said. "And if you have to go to a 'mega-city' -- a population of over 10 million -- the risk probably rises fourfold."

Another expert said it's not too late to put the brakes on this developing crisis, however.
Dr. Alan Moses was the former chief medical officer of Harvard's Joslin Diabetes Center and is now associate vice president of medical affairs at pharmaceutical giant Novo Nordisk, which sponsored the conference.

"We tend to think of the costs associated with diabetes and worry that putting appropriate resources into diabetes is going to cost more," he said. "But diabetes is one of the few conditions where when you improve health, you actually reduce the cost burden on society. It should be viewed as an investment with a real return."

Certain steps taken by governments in the developed world are already helping. For example, Sen. Guy Barnett of Australia, himself a type 1 diabetic, said his government is moving to change what he labeled an "obesinogenic" environment Down Under.

Along with the United States, "we are one of the fattest countries on Earth," Barnett told reporters at a press conference held Wednesday. "But for governments everywhere, (diabetes) is a monster that is getting bigger and bigger."

With one in 10 Australian children now obese, the Australian government has mandated healthy school lunches, boosted funding for after-school physical activity programs and negotiated with fast-food giant McDonald's to make menus healthier. Former U.S. President Clinton helped broker similar deals with food companies last year to keep unhealthy sodas and snacks out of American schools.

Those and other initiatives can and should be tested in countries worldwide, Silink said. In one sense, he said, developing countries have a real edge on the West, since "they are still in the process of developing their new towns, their urban centers.

"So, in terms of town planning, societal engineering, they have a chance to engineer it for health and not for conditions that are detrimental to human health," Silink said. "It's up to the diabetes world to work with the various organizations to make this happen."

More information
Find out more about diabetes at the American Diabetes Association.

Penicilliosis and HIV

HIV InSite Knowledge Base ChapterMarch 2006
Woraphot Tantisiriwat, MD, Srinakharinwirot University, Bangkok, Thailand Judith A. Aberg, MD, New York University, New York

Introduction

Penicilliosis is an infection caused by Penicillium marneffei, a dimorphic fungus endemic to Southeast Asia and the southern part of China.(1) Rarely noted before the AIDS epidemic, P marneffei infections have become more prevalent in the endemic areas in conjunction with the AIDS epidemic.(2,3)

Persons affected by penicilliosis usually have AIDS with low CD4 lymphocyte counts, typically <100 href="javascript:openWindow(" page="kb-05-02-07&rf=2,4','References')">2,4) Patients with penicilliosis occasionally are seen outside endemic areas, but most have a history of travel to an endemic area.(5-8)

The most common presentation is a disseminated infection manifested by fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.(2) Localized infection such as pneumonia also has been reported.(7)

Patients with penicilliosis have a poor prognosis without treatment.(2) P marneffei demonstrates in vitro susceptibility to multiple antifungal agents including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9)

Response rates of up to 97% have been reported with amphotericin B therapy for the first 2 weeks followed by 10 weeks of itraconazole.(4) Relapse occurs in the absence of prophylaxis in approximately 50% of patients after discontinuation of successful therapy.(10,11) Maintenance therapy with itraconazole is effective for prevention of relapse.(11)

Microbiology and Epidemiology

P marneffei appears in tissue as a unicellular yeastlike organism that reproduces by planate division.(12) The fungus is a mold at room temperature and it coverts to the yeast form if incubated at 37° C. This dimorphism is not found in other known members of the genus Penicillium.

In the mycelial form on culture, the mold grows relatively fast, producing a grayish-white and downy or woolly colony in 2-3 days. The underside of the fungus appears either pink or red due to the production of a characteristic soluble red pigment that diffuses into the agar. Over time, the colony becomes more rugose while the aerial mycelia become pink.

The color of the colony changes from white to light brown to light green after 10 days. The yeastlike cells are oval or cylindrical and are about 3-6 microns in length. Unlike the mold, the colonies of yeast do not produce a red pigment. The organism can be cultured from various clinical specimens including blood, bone marrow, skin, sputum, bronchoalveolar lavage fluid, and lymph nodes.

P marneffei is endemic to Southeast Asia and the southern part of China, where it has been isolated from 4 species of bamboo rats and from soil.(1,13,14)

Infection seems to be more frequent in the rainy season.(15) Recent history of occupational or other exposure to a potential environmental reservoir of organisms in the soil has been shown to be the predominant risk factor for infection in susceptible persons.(16)

Infection rarely was documented before the AIDS epidemic. The first report of natural infection with P marneffei was in a person with Hodgkin lymphoma who had lived in Southeast Asia.(17) Only 8 cases of infection with P marneffei were reported between 1964 and 1983.(18)

The prevalence of infection has increased substantially, especially in persons who are infected with HIV.(2) There were 92 cases diagnosed from 1987 to 1992 in Chiang Mai University Hospital, involving 86 patients who also were infected with HIV.

Currently, this infection is the third most common opportunistic pathogen in patients with AIDS in Thailand, after tuberculosis and cryptococcosis, despite the fact that it is endemic only to the northern part of Thailand.(3)

Infections with P marneffei occasionally are seen outside the endemic area. Sporadic cases have been reported, all of which involved patients with a history connected to the endemic area.(5-8) The diagnosis should be considered in HIV-infected patients with fever, compatible clinical manifestations, and a history of travel to an endemic area.

Clinical Presentation
The clinical features of infection with P marneffei are shown in Table 1.(2) The most common presentation is fever and weight loss, occurring in more than 75% of patients. The average duration of symptoms prior to presentation is 4 weeks.(1,2)

Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. Skin lesions are present in approximately two thirds of cases and can be varied in appearance. Generalized papular eruptions, central umbilicated papules resembling those of molluscum contagiosum, acnelike lesions and folliculitis all may occur. Skin lesions commonly occur on the face, trunk, and extremities.

Pharyngeal and palatal lesions also can be seen.(19) Subcutaneous nodules occasionally can be seen.(2) Pulmonary symptoms (such as cough and dyspnea) occur in about 50% of cases. Chest radiographic abnormalities typically manifest as diffuse reticulonodular infiltrates, though 50% of cases have normal chest radiographs.

Cavitary lesions also have been reported, particularly in patients with hemoptysis.(20) Laboratory findings include anemia, elevated transaminases (alanine and aspartate aminotransferase), and elevated alkaline phosphatase levels. Fungemia is observed in >50% of cases.

Diagnosis
Diagnosis usually is made by identification of fungi from clinical specimens. Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.(2) The fungi are spherical or oval in shape with basophilic intracellular or extracellular yeastlike appearance on Wright stain, often with clear central septation.

The organism also can be identified on peripheral blood smear or bone marrow aspirate.(21) Blood cultures are positive frequently, while bone marrow culture is positive in nearly all cases.(2) The lysis centrifugation culture system may improve the yield of blood cultures.

Histopathologic features include granulomatous, suppurative, or necrotizing inflammation.(22) Immunologic techniques to identify organisms on tissue samples are under evaluation with promising results.(23-30)

A specific polymerase chain reaction (PCR) assay is under evaluation and might be useful as an alternative test for rapid diagnosis of P marneffei infection.(31-32)

Therapy and Prevention

Patients with penicilliosis have poor prognosis without treatment.(2) Even with treatment, mortality is approximately 20%. Treatment with amphotericin B with or without flucytosine, or itraconazole, is the treatment of choice.(10,33)

P marneffei demonstrates in vitro susceptibility to many of the currently available antifungal agents, including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9,34) Fluconazole appears to be less active in vitro.(9)

Clinical failure is more common in treatment with fluconazole (63.8%) compared with amphotericin B (22.8%) or itraconazole (25%).(9) Newer azoles (posaconazole, ravuconazole, and voriconazole) have demonstrated good in vitro activity against P marneffei.(35)
There are no randomized, controlled trials of the treatment of penicilliosis.

One open-label study of amphotericin B 0.6 mg/kg/day intravenously for 2 weeks followed by 10 weeks of itraconazole 400 mg/day showed excellent results.(4) This regimen was effective in 97% of 74 HIV-infected patients treated. All patients had cleared fungemia by the end of their second week of treatment. Patients tolerated the regimen without any major adverse reactions.

After completing initial treatment, patients with P marneffei infection should receive secondary prophylaxis to prevent relapse of infection. A randomized controlled trial demonstrated that secondary prophylaxis with itraconazole 200 mg daily is effective.(11)

None of the patients receiving itraconazole had a relapse, whereas 57% of those in the placebo group had a relapse within 1 year after completing initial treatment. Although this study was not powered to detect a survival difference, 15% of the patients who had a relapse died.

Primary prophylaxis can prevent the occurrence of penicilliosis. A randomized placebo-controlled study from Chiang Mai University suggests that primary prophylaxis with itraconazole 200 mg daily can prevent the occurrence of penicilliosis among patients with AIDS and CD4 counts <200>36)

Of 129 patients enrolled, penicilliosis occurred in only 1 case in the itraconazole arm compared with 11 cases in the placebo arm, a statistically significant difference (p = .008 in those who had CD4 counts <100 name="S6X">References
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Desakorn V, Smith MD, Walsh AL, Simpson AJ, Sahassananda D, Rajanuwong A, Wuthiekanun V, Howe P, Angus BJ, Suntharasamai P, White NJ. Diagnosis of Penicillium marneffei infection by quantitation of urinary antigen by using an enzyme immunoassay. J Clin Microbiol 1999; 37:117-21.
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Chaiyaroj SC, Chawengkirttikul R, Sirisinha S, Watkins P, Srinoulprasert Y. Antigen detection assay for identification of Penicillium marneffei infection. J Clin Microbiol 2003; 41:432-4.
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Panichakul T, Chawengkirttikul R, Chaiyaroj SC, Sirisinha S. Development of a monoclonal antibody-based enzyme-linked immunosorbent assay for the diagnosis of Penicillium marneffei infection. Am J Trop Med Hyg 2002; 67:443-7.
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Prariyachatigul C, Chaiprasert A, Geenkajorn K, Kappe R, Chuchottaworn C, Termsetjaroen S, Srimuang S. Development and evaluation of a one-tube seminested PCR assay for the detection and identification of Penicillium marneffei. Mycoses 2003; 46:447-54.
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Tsunemi Y, Takahashi T, Tamaki T. Penicillium marneffei infection diagnosed by polymerase chain reaction from the skin specimen. J Am Acad Dermatol 2003; 49:344-6.
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Drouhet E. Penicilliosis due to Penicillium marneffei: A new emerging systemic mycosis in AIDS patients traveling or living in Southeast Asia. Review of 44 cases reported in HIV infected patients during the last 5 years compared to 44 cases of non AIDS patients reported over 20 years. J Mycol Med. 1993;4:195-224.
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Imwidthaya P, Thipsuvan K, Chaiprasert A, Danchaivijitra S, Sutthent R, Jearanaisilavong J. Penicillium marneffei: types and drug susceptibility. Mycopathologia 2001; 149:109-15.
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Pfaller MA, Messer SA, Hollis RJ, Jones RN. Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY Antimicrobial Surveillance Program, 2000. Antimicrob Agents Chemother 2002; 46:1032-7.
36.

Chariyalertsak S, Supparatpinyo K, Sirisanthana T, Nelson KE. A controlled trial of itraconazole as primary prophylaxis for systemic fungal infections in patients with advanced human immunodeficiency virus infection in Thailand. Clin Infect Dis 2002; 34:277-84.

Do You Need These Tests?

Q: Do You Need These Tests?
Can you tell me what tests we all should have as we get older? Which ones do you recommend?

A: As we get older, a variety of medical tests can warn of impending problems, with hearts, bones and other chronic disorders. As long as you're in good health and have no unusual symptoms, I don't necessarily recommend an annual physical exam. But here's a list of the tests I do think everyone should have periodically as they age:

Cholesterol: This simple blood test can give you an idea of your heart disease risk. Have your cholesterol tested every five years beginning at age 20 and have your HDL ("good") cholesterol and LDL ("bad" cholesterol) checked if your total cholesterol is over 200. You should also request measurement of serum homocysteine and C-reactive protein, other indicators of heart disease risk.

Bone density: Any woman at high risk of osteoporosis (because her mother had it or because she is light boned and fair-skinned) should have this DEXA scan to determine her bone mineral density and keep track of how it is declining over time.

All women age 65 and older should have at least one DEXA scan to gauge the condition of their bones. We have good drugs to halt and reverse osteoporosis and reduce risk of hip fractures in old age. You should know, however, that DEXA tests also identify bone weakness (osteopenia) that is nowhere near the range of osteoporosis.

As a result of these findings, women may be put on the same strong drugs used to treat osteoporosis - not a wise move, in my judgment.

PSA: This test for prostate specific antigen, a protein produced by prostate cells, can warn men of prostate cancer.

However, false positives are common, and even when the test does detect cancer, it provides no information about how aggressive it is or how likely it is to spread. Until we have a reliable follow-up test to show whether or not a tumor is aggressive, I doubt the wisdom of using PSA as a screening tool, except for men at high risk of prostate cancer on the basis of family history or lifestyle. A newer test, the pro-PSA, may do better.

Discuss prostate screening with your physician.

Mammogram: Every one to two years for all women over 40 to detect early (and curable) breast cancer. Women with a positive family history of breast cancer may want to start screening earlier.

Colonoscopy: A test for early signs of colon cancer; every 10 years starting at age 50, earlier if there is a positive family history.

Blood pressure: Every two years after the age of 18 as long as your blood pressure is normal.
Eye exams: Every two to four years between ages 40 and 65; every one to two years after age 65. If you wear glasses or contacts, you should have your eyes checked annually, regardless of age.

Dental exams: Everyone, regardless of age, should have a dental check-up once or twice a year.
Full body skin exams: Check yourself monthly for moles; an annual skin exam by a physician regardless of age; follow your doctor's recommendations for more frequent exams if you've had any type of skin cancer.

Thyroid tests: All adults, particularly women, should be screened for thyroid disorders at the age of 35 and every five years thereafter.

Pap smears: Women need Pap smears to detect abnormalities that may precede cervical cancer every one to three years.

Diabetes screening: Fasting blood sugar and insulin levels should be checked if you are overweight or have a positive family history.


Weil, M.D.

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)