Saturday, September 1, 2012

Tired all the time? Figuring Out the Cause of Fatigue

Tired all of the time? Most often, fatigue is a result of lifestyle factors such as poor sleep, stress or a schedule that's too full.

The February issue of Mayo Clinic Health Letter offers suggestions to fight fatigue:

Manage stress -- Learn to say no. Set priorities. Pace yourself. Take time each day to simply relax.

Be active -- Try to get at least 30 minutes of moderate physical activity each day.

Eat well -- A low-fat, high-fiber breakfast prepares your body for the day's demands. Limit high-fat and high-sugar foods, which tend to make you feel sluggish later.

Avoid alcohol -- Alcohol depresses your central nervous system and acts as a sedative, making you tired for hours after consuming even minimal amounts.

Practice good sleep habits -- Avoid eating, reading or watching TV in bed. Keep your bedroom cool, dark and quiet. Set your alarm for the same time each day -- a routine will help establish a regular schedule. Naps are OK, but keep them short and early in the day.

Dramatic or prolonged fatigue may be the sign of an underlying medical problem. If lifestyle changes don't seem to help, see your doctor. Some common medical causes of fatigue are anemia, cancer, depression or other mood disorders, diabetes, infections, restless legs syndrome, sleep apnea, thyroid problems and even heart attack. A recent study found that the most common early warning sign that women experience before a heart attack is unusual fatigue.

This is a highlight from the February issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Also, you may reprint up to four articles annually without cost. More frequent reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Call toll free for subscription information, 800-333-9037, extension 9PR1.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call toll free 800-333-9037, extension 9PR1.
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Chronic sinus infection thought to be tissue issue, Mayo Clinic scientists show it's snot

Findings call for radical change in treatment for the disease, researchers say -

Mayo Clinic researchers have found that the cause of chronic sinus infections lies in the nasal mucus -- the snot -- not in the nasal and sinus tissue targeted by standard treatment. The findings will be published in the August issue of Journal of Allergy and Clinical Immunology and are available online at

"This strikingly teaches against what has been thought worldwide about the origin of chronic sinus infection: that inflammatory cells break down, releasing toxic proteins into the diseased airway tissue," says lead researcher and Mayo Clinic ear, nose and throat specialist Jens Ponikau, M.D. "Instead we found that these toxic proteins are released into the mucus, and not in the tissue. Therefore, scientists might need to take not only the tissue but also the mucus into account when trying to understand what causes chronic sinus infections and probably other airway diseases."

The findings could significantly change the way chronic sinus infection is treated, according to Dr. Ponikau.

"This has far-reaching implications," says Dr. Ponikau. "This suggests a beneficial effect in treatments that target primarily the underlying and presumably damage-inflicting nasal and sinus membrane inflammation, instead of the secondary bacterial infection that has been the primary target of treatments for the disease. Also, some surgeons have already started to change the way they do surgery for patients with chronic sinus infections, focusing now on removing the mucus, which is loaded with toxins from the inflammatory cells, rather than the tissue during surgery. Leaving the mucus behind might predispose patients for early recurrence of the chronic sinus infection."

Dr. Ponikau conducted this research along with Hirohito Kita, M.D., and Gail Kephart, Mayo Clinic allergic diseases researchers. David Sherris, M.D., and Eugene Kern, M.D., both former Mayo Clinic ear, nose and throat specialists who now work at the University at Buffalo, also participated in the project.

The team found that in chronic sinus infection patients, activated white blood cells (eosinophils) cluster in the nasal and sinus mucus and scatter a toxic protein (major basic protein) onto the nasal and sinus membrane. While major basic protein was not distributed in the nasal and sinus tissue, the level of this protein in the mucus of chronic sinus infection patients far exceeded that needed to damage the nasal and sinus membranes and make them more susceptible to infections such as chronic sinus infection.

To conduct this investigation, Dr. Ponikau and fellow researchers collected specimens from 22 consecutive Mayo Clinic chronic sinus infection patients undergoing endoscopic sinus surgery. The surgeons extracted the maximum possible tissue and mucus during the sinus surgery. The surgeons also extracted tissue and mucus from healthy patients undergoing septoplasty, surgery to fix a deviated septum, for comparison with the specimens from the chronic sinus infection patients. Through various forms of laboratory examination of the tissue and attached mucus, the investigators observed an abundance of major basic protein throughout the nasal and sinus mucus in all 22 specimens, but not in the tissue.

Chronic sinus infection is one of the most common chronic diseases in the United States, affecting 32 million adults, according to the National Center of Health Statistics. Chronic sinus infection produces nose and sinus problems characterized by stuffy nose, loss of sense of smell, postnasal drip, nasal discharge, and head and face pain lasting three months or longer. It notably decreases the quality of patients' lives, impairing physical and social functioning, vitality and general health, according to the Mayo Clinic researchers.

To obtain the latest news releases from Mayo Clinic, go to ( is available as a resource for your health stories.

Mayo Clinic is now using Pathfire's Digital Media Gateway (DMG) for video news release distribution, to streamline our services and provide content that is easily accessible as needed. On the DMG main page, look for the Mayo Clinic branded page in the left navbar, or click on the VNF Master Locator and search for MayoClinic0030. If you have questions or problems in locating the story, contact Pathfire Customer Support at 888-345-0489 or
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Restless Leg Syndrome drug, REQUIP, approved by FDA

The US FDA has approved Requip (ropinirole HCl) Tablets for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults, GlaxoSmithKline announced today. Requip is the first and only FDA-approved treatment for those patients with moderate-to-severe primary RLS, a chronic and disruptive neurological condition.

RLS, which encompasses a range of severity that includes mild, moderate and severe symptoms, affects approximately one in ten adults in the U.S. Identified in the early 1940's by neurologist Dr. Karl Ekbom, RLS is characterized by a compelling urge to move the legs and by uncomfortable or sometimes painful sensations in the legs often described as creeping-crawling, tingling, pulling or tightening.

Symptoms of RLS generally occur at rest, such as when sitting, lying or sleeping, and are temporarily relieved by movement. These symptoms can significantly disrupt a patient's sleep and daily activities.

People with RLS often have difficulty falling and staying asleep and can feel less alert during the day. Requip is a second-generation dopamine agonist that directly stimulates dopamine receptors in the brain. Although its exact cause is unknown, researchers believe that the underlying cause of RLS may be related to dopamine, a chemical that carries the signals between nerve cells that control body movement. When the dopamine system does not function properly, it may upset the normal communication of these signals.

"Throughout our clinical research program for Restless Legs Syndrome, we've had the opportunity to speak with many people who suffer from this condition, and we've heard first-hand about how difficult life can be for them," said Chris Viehbacher, President, U.S. Pharmaceuticals, GlaxoSmithKline. "With the approval of Requip for moderate-to-severe primary RLS, we're proud to be able to offer effective relief to millions of people who live with this condition, many of whom have suffered for years without treatment."

"For me, the most difficult aspect of living with RLS has been the urge to move my legs during times when I just want to relax or when I am trying to fall asleep," said Mary Ellen Onufrow. "Several times a week I feel very unpleasant sensations in my legs that are difficult to describe, and the only way to get rid of them is to get up and move around. These symptoms had a significant impact on many aspects of my life including my sleep and my daily activities. Thanks to Requip, my symptoms are under control, and I am able to turn my attention back to my family, friends and work, instead of on my RLS."

Requip Proven Effective in Treating Moderate-to-Severe Primary RLS

The approval of Requip for moderate-to-severe primary Restless Legs Syndrome is supported by data from four double-blind, randomized, placebo-controlled clinical trials in adults diagnosed with RLS. Patients with RLS secondary to other conditions (e.g. iron deficiency, pregnancy and renal failure) were excluded from the study groups. "One of the principal benefits of treatment with Requip is relief of the urge to move the legs," said Dr. William Ondo, Associate Professor of Neurology at Baylor College of Medicine, Houston, Texas. "Requip targets what doctors believe may be an underlying cause of the disorder, which is dysfunction of a system involving the brain chemical dopamine. Now there is an approved treatment specifically for moderate-to-severe primary RLS which should help to validate this under-recognized and misunderstood condition."

In the most recently completed U.S. trial, Requip significantly improved symptoms of moderate-to-severe primary RLS in patients from baseline to week 12, according to two validated measurement tools: the International RLS Rating Scale (IRLS Scale) and Clinical Global Impression-Global Improvement (CGI-I) scale. Patients taking Requip achieved a significantly greater mean improvement in IRLS Rating Scale total score compared to the placebo group (-13.5 points versus -9.8 points, respectively; p<0.0001) and significantly more patients taking Requip showed a "much improved" or "very much improved" score on the CGI-I scale compared with the placebo group (73.3 percent versus 56.5 percent, respectively; p=0.0006). In two other similarly designed trials that took place in centers largely outside of the U.S., Requip also significantly improved IRLS Rating Scale and CGI-I scale scores from baseline to week 12. Long-term maintenance of efficacy in the treatment of RLS was demonstrated in a 36-week relapse prevention study.

In this trial, patients taking Requip demonstrated a significantly lower relapse rate compared with patients randomized to placebo (32.6 percent vs. 57.8 percent, p=0.0156). In clinical trials in the treatment of moderate-to-severe primary RLS, the most commonly observed adverse events for Requip (n=496) versus placebo (n=500) were nausea (40 percent versus 8 percent), somnolence (12 percent versus 6 percent), vomiting (11 percent versus 2 percent) ,dizziness (11 percent versus 5 percent) and fatigue (8 percent versus 4 percent). Occurrences of nausea in clinical trials were generally mild to moderate in intensity. About RLS In general, many people with RLS report a significant impact on their daily activities. In addition to feeling less alert during the day, RLS sufferers may also have difficulty with activities that require prolonged sitting such as movies, long car rides or airline flights. Difficulty falling asleep may frequently be associated with moderate-to-severe primary RLS.

Women account for approximately two-thirds of RLS sufferers, although RLS occurs in both men and women. RLS is generally a chronic condition, and the frequency of RLS symptoms tends to increase with age. In addition, a genetic component has been suggested for patients with primary RLS. Clinical data demonstrate a positive family history of the disorder in as many as 50 percent of affected individuals. When evaluating patients' symptoms of RLS, it is important for health care providers to rule out other underlying conditions that are associated with secondary RLS symptoms, such as iron deficiency, pregnancy and renal failure. Despite the prevalence of RLS, it frequently remains under-diagnosed. A wide range of other diagnoses, including back pain, depression, arthritis, nocturnal cramps, insomnia and neuropathy have been given to patients who present with symptoms of RLS.

Important Safety Information About Requip

Requip may cause patients to fall asleep or feel very sleepy while doing normal activities such as driving; or to feel faint or dizzy, nauseated or sweaty, when they stand up from sitting or lying down. If patients experience these problems, they should talk to their doctor.

About GlaxoSmithKline

GlaxoSmithKline is one of the world's leading research-based pharmaceutical and healthcare companies.

Holly Russell
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Low Calorie, Low Fat, Low Carb ice Cream, Breyers

Breyers ice cream has introduced the first light ice cream products for use as part of a low-carbohydrate diet. Breyers(R) CarbSmart(TM) Light Vanilla Fudge Sundae and Breyers(R) CarbSmart(TM) Light Chocolate Peanut Butter have half the fat, 40 percent fewer calories than regular ice cream* and 4g net carbs (per half-cup serving).

The new light flavors join Breyers(R) line of CarbSmart(TM) ice cream products first introduced in late 2003 and expanded last year. Although low- carb diets may have peaked, carbohydrate awareness is here to stay. Since their introduction, Breyers(R) CarbSmart(TM) ice cream products quickly became best-sellers throughout 2004 with four flavors among the top 10 new packaged ice cream.

"The new light products meet the needs of the many consumers who are customizing their low-carb diets by cutting back on fat as well as carbs," says Dan Hammer, Vice President of Marketing and Development, Good Humor- Breyers. "According to our own research, sixty-six percent of carb-conscious consumers are seeking products lower in fat. These new CarbSmart products are lower in fat than regular ice cream and indulgent-tasting, which makes them an ideal choice for carb-conscious dieters."

New Breyers(R) CarbSmart(TM) Light Vanilla Fudge Sundae pairs vanilla ice cream with crunchy chocolate-covered peanuts and a satisfying fudge swirl. Chocoholics can enjoy Breyers(R) CarbSmart(TM) Light Chocolate Peanut Butter, which combines chocolate ice cream with a thick peanut butter swirl.

New Breyers(R) CarbSmart(TM) Light products will be sold in supermarkets beginning in early February. A 1.75 quart container has a suggested retail price of $5.09.

* CarbSmart Light Vanilla Fudge Sundae: 5g fat and 90 calories per serving vs. CarbSmart Regular Vanilla Fudge Sundae: 13g fat, 150 calories per serving. CarbSmart Light Chocolate Peanut Butter: 5g fat and 100 calories per serving vs. CarbSmart Regular Chocolate Peanut Butter: 10g fat, 170 calories per serving.

Good Humor-Breyers Ice Cream, headquartered in Green Bay, Wis., is among the largest manufacturers and marketers of branded packaged ice cream and frozen novelties in the U.S. In the U.S., the company operates six manufacturing facilities and employs 2,400 people. Its well-known brands include Breyers(R) Ice Cream, Popsicle(R), Good Humor(R) and Klondike(R). Good Humor-Breyers is an operating unit of Unilever.

Unilever (NYSE: UL, UN), one of the world's largest consumer products companies, aims to add vitality to life by meeting everyday needs for nutrition, hygiene and personal care. Each day, around the world, consumers make 150 million decisions to purchase Unilever products. The company has a portfolio of brands that make people feel good, look good and get more out of life.

In the United States these brands include recognized names such as: Axe, "all," Ben & Jerry's, Bertolli, Breyers, Caress, Country Crock, Degree, Dove personal care products, Eternity by Calvin Klein, Hellmann's, Lipton, Knorr, Popsicle, Promise, Q-tips, Skippy, Slim-Fast, Snuggle, Suave and Vaseline.

All of the preceding brand names are registered trademarks of Unilever. Dedicated to serving consumers and the communities where we live, work and play, Unilever in the United States employs more than 15,000 people in 74 office and manufacturing sites in 24 states and Puerto Rico - generating approximately $11 billion in sales.

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New Height Predictor to Estimate Children's Adult Height

Olympic gymnast or NBA basketball star? BabyCenter, the leading online resource for pregnancy and parenting information, has upgraded the most popular interactive tool on to give curious parents a clearer vision of their child's future. With an expanded age range, now parents of children as young as 2 can use the Height Predictor to determine if planning for a basketball scholarship is a reasonable college funding scheme.

For children under age 4, the improved tool uses the new "Multiplier Method," outlined in the October 2004 issue of The Journal of Pediatric Orthopedics, in which height forecasts are based on average height multipliers calculated from Centers for Disease Control data. For children ages 4 and older, the Height Predictor uses the widely accepted Khamis and Roche method that relies on height measurements of each parent for its predictions. is the first Web site to integrate the two leading methods into one easy-to-use tool.

"Parents often hope that they have passed along favorite traits to their child," said Katie Motta, the BabyCenter Associate Editor who oversaw development of the improved tool. "Even when their child's still a newborn, they usually can identify that 'he has his dad's eyes, and mom's chin.' But one thing parents want to know is how tall their child will be. The Height Predictor is based on the latest science, but it's really just a fun way to help parents imagine their child as an adult."

In addition to the expanded Height Predictor, offers an array of useful interactive tools including the Family Entertainment Finder, Behavior Problem Solver, Learning Styles Calculator, and Activity Planner designed to help parents raise great kids. The site also offers more than a thousand original articles, covering children's health and nutrition, fun and activities, learning and development, along with other topics for families with young children. Information is organized by age so parents easily can find the most relevant expert advice, along with ideas and tips from thousands of other moms and dads who've shared their experiences.

About BabyCenter(R)

Founded in 1997, BabyCenter operates, the most visited online resource for new and expectant parents,, the leading online resource for parents of children ages 2 to 8, and , the leading U.K. resource for new and expectant parents. Offering extensive, medical advisory board-approved content, BabyCenter's Web sites attract over 3.5 million visitors each month, as measured by comScore Media Metrix, and have been honored with numerous awards, including the 2005 People's Voice Webby Award for Best Family/Parenting Web site. In addition, the BabyCenter sites offer an array of interactive tools, a supportive online community, a premium subscription service, and an online store featuring thousands of products for parents and children.

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How Vitamin D can Benefit Men's Health

How can we get American men interested in vitamin D? Most men could care less. Say vitamin D did something men find really important, like improve athletic performance or induce hair growth? Or, say it improved sexual performance or increased virility? Nothing would get men treating their vitamin D deficiency like a study that showed vitamin D increased organ size!

Sixteen years ago, Professor Walter Stumpf (who taught me at UNC School of Medicine) first made the case that vitamin D is intimately involved with sex and reproduction. Male genital tissue contains lots of vitamin D receptors but their significance and function remain unknown. One researcher actually gave a vitamin D-like-drug to see if it improved sexual performance in patients with renal failure! To bad for the instant popularity of vitamin D, the results showed no improvement.
Am J Obstet Gynecol. 1989 Nov;161(5):1375-84
Clin Nephrol. 1980 May;13(5):208-14

Vitamin D does appear to improve virility. Conception peaks in the summer, when vitamin D levels are highest, and ebbs in the winter, when vitamin D stores are low. Vitamin D deficiency has profound effects on rat testicles, including dramatically reducing spermatogenesis. Vitamin D deficient male rats were 73% less likely to successfully father pups than vitamin D sufficient males. Vitamin D restored virility to vitamin D deficient male rats and should do the same for vitamin D deficient male humans.
Hum Reprod. 1992 Jul;7(6):735-45
Ann Nutr Metab. 1992;36(4):203-8
Ann Nutr Metab. 1995;39(2):95-8
J Nutr. 1989 May;119(5):741-4

What else are men interested in besides sex? Hair growth! In fact, hair follicles have large numbers of vitamin D receptors but their function is unknown. Although there are no human studies showing vitamin D will grow men a new head of hair, vitamin D like drugs do grow hair in mice. (By the way, both my wife and my barber have told me my head has stopped balding and I've kept my 25(OH)-vitamin D level around 50 ng/ml for several years.) One relevant animal study should get the attention of men; the title contains two of their favorite words: "nude" and "hair growth."
Endocrinology. 2002 Nov;143(11):4389-96

What about weight? Can you see the headlines in the men's' fitness magazines: "Vitamin D Reduces Weight." Although dozens of studies have found that those with the highest 25(OH)-vitamin D blood levels weigh the least, most vitamin D scientists explain this by pointing out that vitamin D is stored in fat tissue, thus lowering blood levels. Of course that does not preclude vitamin D from also having either a direct or indirect effect on weight.
J Clin Endocrinol Metab. 2003 Jan;88(1):157-61
J Clin Endocrinol Metab. 2004 Mar;89(3):1196-9
J Clin Endocrinol Metab. 2005 Feb;90(2):635-40
Am J Clin Nutr. 2000 Sep;72(3):690-3

One study tried to answer that question by looking directly at vitamin D intake and body weight. The authors found an inverse correlation. That is, the more vitamin D in your diet, the less you weighed! If you have a few minutes, test your knowledge by taking our quiz on obesity and vitamin D.
J Nutr. 2003 Jan;133(1):102-6
Obesity and Vitamin D Quiz.

Finally, we turn to athletic performance. After sex, hair growth, and obesity, improving athletic performance would certainly make American men pay attention to vitamin D. Actually, what we are asking is: "Does the most potent steroid hormone system in the human body have any effects on balance, muscle strength, muscle mass, reaction time, etc?" When asked that way, it would be surprising if it had none. In fact, dozens of studies suggest vitamin D will improve athletic performance.

If vitamin D improves athletic performance, then we'd predict physical fitness should peak in the late summer when 25(OH)-vitamin D levels peak. The only two studies that looked at season of the year and athletic performance of trained athletes found physical fitness peaked exactly then.
Acta Physiol Pol. 1981 Nov-Dec;32(6):629-36
Rom J Physiol. 2000 Jan-Dec;37(1-4):51-8

Genetic ablation of vitamin D receptors caused profound impairment in the motor functions of mice. Furthermore, mice without the vitamin D receptor gene showed increased anxiety; performance anxiety is something all men want to avoid. Babies born to vitamin D deficient rats are permanently and irreversibly brain damaged, proving that vitamin D has profound effects on developing neural tissue. (We will have more on this important, and tragic, research coming out of Australia in a future newsletter.)
Brain Res Bull. 2004 Jul 30;64(1):25-9

Muscle strength is important to athletes and it correlated with 25(OH)-vitamin D levels in older men. A vitamin D like drug improved muscle strength in vitamin D deficient older women. In fact, it did the same thing to a group of vitamin D deficient younger women. Furthermore, improved lower extremity function was directly associated with higher 25(OH)-vitamin D levels.
Arch Phys Med Rehabil. 1999 Jan;80(1):54-8

Athletes need to be quick. A single injection of 600,000-units of vitamin D significantly improved reaction times in older adults. Furthermore, higher 25(OH)-vitamin D levels were also independently associated with better reaction time and better performance time.
Age Ageing. 2004 Nov;33(6):589-95

Athletes need good balance. The beneficial effect vitamin D has on balance (reduced falls) is not limited to profoundly vitamin D deficient populations; a vitamin D-like-drug improved balance in the general elder population, even those with "normal" 25(OH)-vitamin D levels. A more recent study showed higher 25(OH)-vitamin D levels correlated with better gait speed, balance and muscle strength.
J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):497-501.

Vitamin D also appears to maintain muscle mass in older people but, no one has reported similar studies of young adults. A recent review concluded that vitamin D is an authentic strength preserving hormone, at least in the elderly. There is no reason to think it has any less effect on vitamin D deficient younger persons.
J Clin Endocrinol Metab. 2003 Dec;88(12):5766-72

Finally, debilitating chronic pain sidelines many athletes. One Mayo clinic study found that virtually all patients treated for chronic pain have low 25(OH)-vitamin D levels. Furthermore, in what must be one of the largest open studies ever reported, 360 patients with low back pain in Saudi Arabia responded exceptionally well to treatment with physiological doses of vitamin D. Like virtually all areas of vitamin D research, we are still awaiting definitive research.
Mayo Clin Proc. 2003 Dec;78(12):1463-70

An impressive scientific literature suggests that vitamin D may improve athletic performance. This should surprise no one as other steroid hormone systems improve athletic performance. One difference is that the U.S. government is going to find it hard to regulate the vitamin D steroid hormone system; the sun is both a free and robust source of vitamin D. Of course, oral vitamin D is toxic in overdose and vitamin D toxicity would greatly impair athletic performance. Smart athletes would get enough sun, or take enough cholecalciferol, to keep their 25(OH)-vitamin D levels around 50 ng/ml, year around. But then, smart non-athletes would do the same.

What would happen if researchers gave physiological doses of cholecalciferol to men for a year or two and studied their sex life, hair growth, weight and athletic performance? Would vitamin D improve men's sex life? Would it make them more virile? Would they stop going bald? Would they lose weight? Would they become better athletes?

We don't know. However, a rapidly expanding scientific literature indicates vitamin D lowers their risk of heart disease, diabetes, hypertension, multiple sclerosis, autoimmune illness, depression and seventeen different types of cancer. It now appears likely that vitamin D has an important role in treating those killer diseases as well.

But that doesn't really interest most American men. Men want to know about the important stuff. Why not start taking 2,000 units of cholecalciferol every day and see if your sex life improves, your hair grows back, you lose weight, and you become a better athlete? (And, don't forget to measure down there; after all, you never know).
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Are saunas good or bad for you?

A saunas' dry heat (which can get as high as 185� F) has profound effects on the body. Skin temperature soars to about 104� F within minutes. The average person will pour out a pint of sweat during a short stint in a sauna. The pulse rate jumps by 30% or more, allowing the heart to nearly double the amount of blood it pumps each minute. Most of the extra blood flow is directed to the skin; in fact, the circulation actually shunts blood away from the internal organs. Blood pressure is unpredictable, rising in some people but falling in others.

The November issue of Harvard Men's Health Watch explains how these changes may influence a man's health.

"All in all, saunas appear safe for the body, but there is little evidence that they have health benefits above and beyond relaxation and a feeling of well-being," says Dr. Harvey Simon, editor-in-chief of Harvard Men's Health Watch. However, heart patients should check with their doctors before taking a sauna. Studies show them to be safe for people with stable coronary artery disease. "But patients with poorly controlled blood pressure, abnormal heart rhythms, unstable angina, and advanced heart failure or heart valve disease will probably be advised to stay cool," says Dr. Simon.

He suggests that sauna users follow these simple precautions:
� Avoid alcohol and medications that may impair sweating and produce overheating before and after your sauna.
� Stay in no more than 15-20 minutes.
� Cool down gradually afterward.
� Drink two to four glasses of cool water after each sauna.
� Don't take a sauna when you are ill, and if you feel unwell during your sauna, head for the door.

Also in this issue:
� Screening for testicular and prostate cancers
� Interactions between grapefruit juice and medications
� A doctor answers: Do I need a blood-thinning medication after hip replacement?

Harvard Men's Health Watch is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $24 per year. Subscribe at or by calling 1-877-649-9457 (toll free).
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Dangerous visceral fat builds up if you don't exercise, can go down if you do

If you lead a sedentary life you risk building up large amounts of visceral fat in your body.


Visceral fat surrounds your vital organs, the fat is located in the abdominal cavity (stomach area).

According to researchers from Duke University Medical Center, exercise can significantly reduce the amount of visceral fat you carry around. The more exercise you do, the more of this type of dangerous fat you will lose. Researchers in this study said that extra exercise can reverse the amount you have, while some moderate exercise can stop your visceral fat mounting up.

If, on the other hand, you remain inactive, more likely than not you will pile on the weight at a rate of four pounds per year, say researchers.

The more visceral fat you carry around the higher your chances of developing insulin resistance (leading to type two diabetes), heart disease and other metabolic syndromes.

Visceral fat is not the fat that lies just under your skin, that type is called subcutaneous fat. Visceral fat is deep inside.

Journal of Applied Physiology. Lead author, Dr Cris Slentz, said, "In our study, the control group that did not exercise saw a sizable and significant 8.6 percent increase in visceral fat in only six months. We also found that a modest exercise program equivalent to a brisk 30-minute walk six times a week can prevent accumulation of visceral fat, while even more exercise can actually reverse the amount of visceral fat.Until we are able to prevent the weight many dieters regain following short-term dieting success, we should place a greater national emphasis toward prevention. It will be a challenge to change the message from 'exercise now to lose weight' to 'exercise now so in five years you won't be 20 pounds heavier.'"

The team studied 175 men and women, they were all overweight and led sedentary lives - they were all beginning to show signs of lipid problems. Four groups were created and the 175 people were placed into them at random. Each group carried out different levels of activity/inactivity:

a. No exercise at all.
b. Low dose moderate intensity activity (walking 12 miles per week
c. Low dose vigorous intensity activity (12 miles jogging per week)
d. High dose vigorous intensity activity (20 miles jogging each week)

All 175 people were told not to alter their diets. The aim of the study was to see what impact exercise alone might have.

The whole trial lasted six months for the couch potatoes (inactive ones) and eight months for the other three groups (the active group were given a two-month start to get them fit enough to do the trial).

All activity was supervised.

Computed Tomography (CT) was used at the beginning and end of the trial (to determine the extent and distribution of fat change).

Slentz found there was no significant difference in visceral fat levels among the low exercise groups. He concluded that mild exercise helps stop the increase, but does not reduce. The inactive group experienced increases in visceral fat levels.

He found that the more people exercised, and the higher their intensity, the faster they lost their excess visceral fat. He also added that jogging 17 to 20 miles a week may seem like a lot. However, all the participants were soon able to run those amounts each week quite comfortably.

The most active group saw visceral fat levels drop by 6.9% in six months, subcutaneous fat levels dropped by 7%.
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How Good Are Energy Drinks?

When pop princess Britney Spears needs a pick-me-up, she turns to a popular energy drink for a quick boost. Red Bull mixed with apple juice, she has said, "really pumps me up."

And that's the idea. Highly caffeinated energy drinks - such as Red Bull, Go-Fast! and Monster - market themselves as sources of increased energy and concentration. Their websites feature high-flying motorcyclists and upside-down skateboarders as dynamic embodiments of all that concentrated energy.

But are these drinks good for you? Maher Karam-Hage, M.D., an addiction specialist at the University of Michigan Health System, raises some concerns about the beverages, particularly when they are mixed with alcohol, ingested before intensive exercise or used by children.

"In the United States, these energy drinks have not had any warnings. In Europe, it's been more cautionary," says Karam-Hage, medical director of the Chelsea-Arbor Treatment Center, a joint program of the U-M Health System and Chelsea Community Hospital. He notes that France has banned some of the drinks and other countries have placed restrictions on them. "In this country, our advertisements for these drinks and the marketing are ahead of the science."

The energy drinks typically contain sugar, caffeine (often 80 mg per can, about the same as a cup of coffee), and taurine, a sulfur-containing amino acid. Some countries have raised concerns about the amount of caffeine in the drinks and the uncertain health effects of taurine. Energy drinks are different from sports drinks, which tend not to have caffeine or taurine and are lower in carbohydrates.

While Karam-Hage stops short of saying people never should consume energy drinks, he says that mixing them with alcohol is dangerous and should be avoided.

"The best analogy I can come up with is it's the same as driving a car, putting one foot on the gas and one foot on the brakes," he says of combining the stimulants in caffeine and the intoxicating effects of alcohol.

Mixing alcohol and caffeine is nothing new - think of the people who try to sober up by drinking coffee after a night at the bar - but Karam-Hage says the belief that caffeine makes someone alert after drinking alcohol is a myth.

"You feel a little bit more alert and a little more awake, but in reality, your reflexes are not changed whatsoever. You're still intoxicated," he says. "And that's exactly the same problem that happens with energy drinks: people drink more and feel like, 'oh, I can handle a bit more alcohol then.' "

When people consume these beverages before intensive exercise, he says, they should be aware of the effects the drinks have on people's bodies. They can put a strain on the body due to the caffeine and, in some of the beverages, other diuretics. These can cause dehydration or even collapse, particularly if people drink more than one can before exercising, Karam-Hage says.

He is particularly concerned about the popularity of the drinks among young people. The beverages can cause children to be hyperactive, fidgety or even rageful, he says. And because the drinks are so small in size, people may be inclined to drink more than one at a time, he says.

"Most of us wouldn't really let our children drink two or three or even four cups of coffee, but children go to the store around the corner and find energy drinks," he says. "That can be dangerous."

Facts about energy drinks:

  • Most energy drinks contain caffeine, often about 80 mg per can (about the same as one cup of brewed coffee and more than the amount in two cans of Coca-Cola)

  • Taurine, which the body produces on its own, is a sulfur-containing amino acid often marketed as an antioxidant, anti-anxiety treatment and a heartbeat regulator, but some scientists and health care providers say it is unclear what effect it has

  • Caffeine will not reduce the effects of alcohol
A Brazilian study found that those who mix Red Bull with alcohol may be drunker than they think they are - the energy drink may mask the alcohol effect.
  • The Perils Of Mixing Energy Drinks With Alcohol
  • French ban on Red Bull (drink) upheld by European Court
  • Scientists Close In On Taurine's Activity In The Brain
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How computers affect student performance, the good and the bad

Regular use of computers can have an effect on student performance on standardized tests, according to a new study by researchers at Boston College and the University of Massachusetts at Lowell.

Analyzing test performance and computer uses of 986 fourth grade students from 55 classrooms in nine Massachusetts school districts, the study found that the more regularly students use computers to write papers for school, the better they performed on the Massachusetts Comprehensive Assessment Systems (MCAS) English/Language Arts exam. This positive effect occurred despite the fact that students were not allowed to use computers for the test.

Conversely, the study found that students' recreational use of computers to play games, explore the Internet for fun, or chat with friends at home had a negative effect on students' MCAS reading scores. Similarly, students' use of computers to create PowerPoint presentations was also negatively associated with MCAS writing scores.

This study of students' MCAS performance is part of the "Use, Support and Effect of Instructional Technology" (USEIT) study conducted by the Technology and Assessment Study Collaborative of the Lynch School of Education at Boston College. Funded by the US Department of Education, USEIT is a three-year assessment of educational technology that occurred across 22 Massachusetts districts.

The MCAS achievement component of USEIT is the most sophisticated analysis of the relationships between students' computer use and test performance conducted to date. Building on several shortcomings of past research on this topic, this study collected detailed measures of a variety of student uses of computers in and out of school, controlled for differences in home learning environments, separated effects of teachers' instructional practices, and controlled for differences in prior achievement by using third grade MCAS scores.

In addition to analyzing the effect of a variety of uses of computers on students' total MCAS scores, this study also examined the sub-scores provided by the MCAS test.

At a time when standardized testing is playing an increasingly important role in shaping the learning experiences of students and instructional practices of teachers, the researchers believe this study provides evidence that students' computer use does have an impact on student achievement as measured by tests like MCAS. More importantly, they say, the study demonstrates that different uses of computers have different effects on student learning.

"Specifically, this study finds that students' use of computers throughout the writing process had a statistically significant positive effect on MCAS writing scores," said the study's director, Michael Russell of BC's Lynch School of Education. "Using computers simply to type in final drafts of essays, however, had no effect on students' test performance. These findings are consistent with past research and demonstrate the importance of allowing students to use computers to produce rough drafts, edit their papers, and to produce final drafts."

This study also indicates that using computers for recreational purposes had a negative effect on test performance, particularly for reading scores. The authors speculate that this occurs because students who spend more time using computers for recreational purposes at home may spend less time reading at home.

Similarly, the study found that use of computers in school to create presentations was negatively associated with writing test scores. According to the researchers, this negative relationship may result from students spending less time writing during class time and more time creating and revising multimedia projects that contain relatively small amounts of written work. In essence, time spent creating presentations may detract from time available during class to develop students' writing skills.

"These findings are important for two reasons," said Russell. "First, at a time when schools are under increased pressure to raise test scores, yet are also facing budget shortfalls, this study provides evidence that investments in computers can have positive effects on student achievement. Second, it shows that teachers and students must be thoughtful about how computers are used and what types of learning they expect to impact."

"When examining the effect of computer use on student learning, it is important to consider how well a specific use is aligned with the measure of learning," added the study's lead author, Laura O'Dwyer of the Graduate School of Education at UMass Lowell, formerly a researcher at Boston College. "While this study found that use of computers to create presentations was negatively associated with writing scores, it does not mean that students should not be creating presentations with computers. Creating presentations may be a positive learning experience, but such effects are not captured by a test like MCAS that measures reading and writing skills."

Adds BC researcher Damian Bebell, the study's third author, "Although this study finds some interesting effects of students' use of computers, teachers in this study generally did not use technology to teach. As more and more schools, districts, and states provide teachers and students with their own laptops, it will be interesting to see if teachers are able to use technology more in the classroom and if these uses add to the effects of student technology use."


Study Director Michael Russell, Boston College: 617-552-0889
Study Lead Author Laura O'Dwyer, UMass Lowell: 978-934-4633
Study Third Author, Damian Bebell, Boston College: 207-326-8328

Michael Russell -
Boston College
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Millions Suffer From Addiction to OTC Nasal Sprays

One of the most common complaints by patients suffering from chronic sinus problems is nasal obstruction and over all congestion. Aside from making it uncomfortable to breathe, this condition can also cause headaches, lack of sleep, and a lowered resistance to general sinus infections.

Due to the severity of their symptoms, chronic sinus sufferers eventually turn to chemical nasal sprays in an attempt to combat their chronic congestion. In turn, a growing percentage of these patients are reporting an addiction to Over The Counter (OTC) nasal sprays, and many physicians are concerned about the connection between these OTC products and a worsening of chronic sick sinus symptoms.

The product names are well known and each helps support a Billion dollar company, but these companies have made clear the fact that if their products are mentioned by name in this article, lawsuits will most definitely follow.

The most popular OTC nasal sprays use many of the same chemically active ingredients such as Phenylephrine, Xylometazoline and the most popular Oxymetazoline. Not only are these chemicals bad for your body, but they can also lead to addiction and recurring symptoms that worsen over time. Worse yet, repeated use of these sprays is also known to damage the sensitive membranes inside the nasal passages which can lead to chronic nose bleeds.

"The whole thing becomes a revolving door of addiction," says Wayne Perry, president and founder of SiCap Industries, the company made famous for introducing the world's first commercially available hot pepper nasal spray.

Known as "Sinus Buster," Perry's spicy concoction has been thoroughly embraced by thousands of physicians and nearly 50 thousand dedicated users. Officially launched in 2004, Sinus Buster has become one of the most talked about Nutraceutical products of the past year. Not only does it have a solid reputation as the most effective natural remedy for chronic headaches and sinus conditions, but it's also recommended by hundreds of doctors as an alternative to addictive OTC nasal sprays.

"I've been addicted to various nasal sprays all my life. They start working at first, but then I start needing more and more to keep it working. Finally I started getting nosebleeds and my doctor told me to get off the nasal sprays. He suggested saline spray and that did help stop my nosebleeds, but it didn't do anything to stop my sinus problems. I almost went back to the drug store nasal sprays. Then I read an article about Sinus Buster and how it could help with nasal spray addiction and my congestion. Since the first day I started using that stuff my sinus problems have been under control and I never felt better," says Robin Burgensen, a loyal Sinus Buster user from central Ohio.

"We have hundreds of doctors who say they use Sinus Buster to help get their patients out from under OTC nasal spray addiction. Not only is Sinus Buster safe to use as needed, but within a few days, most nasal spray addicts are completely clean from the chemical sprays. They do continue to use Buster regularly for relieving chronic congestion and related symptoms, but after a few months they end up only using it when they need it. For most people, the more they use intranasal capsaicin, the less they need it. On the other hand, the more you use a chemical nasal spray, the more you end up needing it. Eventually it causes the same problems most users are looking to relieve in the first place. Basically Sinus Buster can wean anyone off of chemical sprays while also relieving their sick sinus symptoms and it's as safe to use as saline. It's completely natural and even pregnant women can use it," adds Perry.

It may sound as though patients are trading one addiction for another, but unlike natural pepper spray, chemical OTC nasal sprays are in a dangerous category all their own. While the natural (Capsaicin) in Sinus Buster fights the root causes of congestion, inflammation and pain, chemical sprays artificially mask symptoms. The active medications in these sprays cause the tiny blood vessels within the mucous membranes to constrict which appears to provide temporary relief at first, but once the chemicals wear off the symptoms return with a vengeance. The more often a person uses chemicals such as phenylephrine, xylometazoline and oxymetazoline, the worse their chronic symptoms become over time. This is the cycle that leads to classic nasal spray addiction.

Unlike "All Natural" nasal sprays, chemical sprays cause a variety of problems when used for more than two or three days at a time. Chemical sprays eventually cause rebound congestion and headaches which is what leads to addiction in the first place. Chemical ingredients also damage the sensitive lining inside the nose. Moreover, long term use of these chemical sprays can also damage the liver and other vital organs.

Although it's a well regarded fact that chemical nasal sprays can be as addictive as Morphine, there have not been any large studies focusing on the number of people actually addicted. Many researchers estimate numbers approaching the 10 million mark in the United States alone -- based on reports from independent physicians.

"We know there are at least 50 million Americans suffering from long term chronic sinus problems, and according to the experiences of ENTs and MDs, as many as one out of four of these people are addicted to popular over the counter nasal sprays," Perry explains.

According to Perry, the companies that produce the most popular nasal sprays are well aware of the complications. In fact, Perry believes these companies rely on the addictive nature of their products to keep sales booming - similar to cigarette manufacturers.

And Perry isn't alone in criticizing the OTC nasal spray industry. Physicians around the world generally recommend against using chemically based over the counter nasal sprays of any kind. In turn, those same physicians recommend using an "All Natural" solution to help wean patients off the chemicals. Now it seems, all natural hot pepper nasal spray is proving to be the most effective tool for breaking the nasal spray addiction cycle.

To find out more about Sinus Buster hot pepper nasal spray, visit the company website at ( Samples and information kits are also available for verified medical and media personnel upon request.

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Premature ejaculation drug helps control, satisfaction and time

Data presented today demonstrates that men taking dapoxetine hydrochloride for the treatment of premature ejaculation (PE) experienced significant improvements in sexual function, including ejaculatory control, satisfaction with sexual intercourse for men and their partners, and increases in intravaginal ejaculatory latency time (IELT)*. The U.S. Food and Drug Administration is currently reviewing a New Drug Application for dapoxetine, which if approved, would be the first prescription product indicated for the treatment of PE. These data were presented at the 100th Annual Scientific Meeting of the American Urological Association.

According to the American Urological Association, premature ejaculation may be the most common male sexual disorder. It is estimated that PE may affect 27 percent to 34 percent of men across all age ranges**, in contrast to erectile dysfunction, which is estimated to affect 10 percent to 12 percent of all men, who are usually older in age. PE can be a lifelong condition experienced from the beginning of sexual activity or can develop after years of satisfactory sexual activity.

"The impact premature ejaculation can have on men and their partners can be devastating for a relationship and, currently, there are no truly optimal therapies for PE," says Jon L. Pryor, M.D., chairman and program director of the Department of Urologic Surgery at the University of Minnesota and lead investigator of the dapoxetine phase III clinical trials. "The results with dapoxetine are compelling. They demonstrate that, for the first time, a medicine can be taken by men on an on-demand basis and provide significant improvement in their PE condition. The unique profile of dapoxetine translated into targeted treatment of PE compared to existing therapies. There are meaningful improvements in this study across all primary and secondary endpoints, including a three-to-four fold increase in IELT."

Phase III Trial Design and Results

The phase III clinical trials studied 2,614 men with PE aged 18-77 in monogamous sexual relationships of greater than six months. PE was defined as persistent or recurrent ejaculation sooner than desired either before or shortly after penetration, typically reflecting an IELT of two minutes or less, over which the sufferer has minimal or no control.

Men in the studies were randomized to receive 30 mg or 60 mg of dapoxetine over 12 weeks in two identical, double-blind, placebo-controlled, multicenter trials. Patients were asked to take study medication one-to-three hours before intercourse. Participants had IELT of two minutes or less in at least 75 percent of intercourse episodes occurring during the two-week baseline run-in period prior to treatment.

The studies examined changes from baseline for mean IELT as monitored by a stopwatch; measured the subject's ejaculatory control and sexual satisfaction on a five-point scale from "very poor to very good" and measured the partner's satisfaction with sexual intercourse from "very poor to very good." The results showed:

-- Men taking dapoxetine 30 mg and 60 mg experienced more than a three-to-four fold increase in mean IELT compared with placebo (P-value <0.0001 at 30 mg and 60 mg). IELT increased significantly with the first dose of dapoxetine, and increases in IELT were maintained over the 12-week study period.

-- The percentage of men rating control over ejaculation as "fair to very good" increased dramatically for dapoxetine 30 mg (2.5 percent to 51.8 percent) and 60 mg (3.3 percent to 58.4 percent) compared to placebo (3.5 percent to 26.4 percent).

-- The percentage of men rating sexual satisfaction as "good to very good" almost doubled with dapoxetine 30 mg (20.2 percent to 38.7 percent) and 60 mg (22.3 percent to 46.5 percent), respectively, in comparison to placebo (21.6 percent to 24.6 percent).

-- The percentage of partners rating sexual satisfaction as "good to very good" almost doubled with dapoxetine 30 mg (20.4 percent to 39 percent) and 60 mg (24.8 percent to 47.4 percent), respectively, compared to placebo (20.1 percent to 25.2 percent).

The study also found that dapoxetine was generally well tolerated, with most side effects of mild-to-moderate severity. The most common adverse events reported with both 30 mg and 60 mg doses of dapoxetine were nausea, followed by headache.

About Premature Ejaculation (PE)

Although PE is one of the most common male sexual disorders, it remains widely under-diagnosed and under-treated. Most physicians do not screen for PE and patients are extremely reluctant to talk about the condition with their partners or health care professionals. PE can have a significant impact on many aspects of a man's life. It can affect his and his partner's sexual satisfaction and their ability to build and maintain relationships - both sexual and non-sexual - and can impact a man's general sense of self-confidence.

An observational study published in the May 2005 issue of The Journal of Sexual Medicine found that patient-reported outcome measures (PROs), such as control over ejaculation, satisfaction with sexual intercourse and distress are important factors in assessing the benefit of treatments for PE in clinical studies. The study found that men with PE and their partners reported higher ratings for interpersonal difficulty, lack of control over ejaculation and dissatisfaction with sexual intercourse.

About Ortho Urology

Ortho Urology, a unit of Ortho-McNeil Pharmaceutical, Inc., has a proven track record of leadership in the field of urology and is committed to providing patients with products that help them live healthier lives and improve their quality of life. Ortho Urology has a history of clinical expertise and is committed to bringing patients the most advanced options in urology with products such as ELMIRON� (pentosan polysulfate sodium) and DITROPAN XL� (oxybutynin chloride).

* Intravaginal Ejaculatory Latency Time (IELT) - IELT was first introduced in 1994. It is used in clinical setting involving the study of premature ejaculation. A stopwatch may be operated by either partner and is activated when the male enters the female and stopped when a man ejaculates. The amount of time this process takes is known as intravaginal ejaculatory latency time or IELT.

** Represents Hispanic, Caucasian and African American men.
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What's best for sore muscles, heat or cold? Apparently both, cold and then later heat

If sore muscles have you yearning for relief, what's the best strategy to soothe inflamed muscles, heat or cold?

Cold first, advises the August issue of Mayo Clinic Health Letter. Later, heat can help. Wearable heat patches, available in retail and drugstores, allow you to apply heat and keep moving.

Cold first: To relieve pain associated with sprains and strains, it's usually best to first apply a cold compress for about 20 minutes at a time every four to six hours over the first few days. Cold reduces swelling and inflammation and relieves pain. For a cold compress, you can use a cold pack, a plastic bag filled with ice or a bag of frozen vegetables; wrap it in a dry cloth or towel to help prevent frostbite.

Then heat: Start using heat after pain and swelling have decreased, usually two to three days after the injury. Heat relaxes tightened and sore muscles and reduces pain. Heat is usually better than cold for chronic pain -- such as from arthritis -- or for muscle relaxation.

Apply heat to the injured areas for 20 minutes up to three times a day. Traditional methods include using a heat lamp, hot water bottle, warm compress or taking a warm bath or hot shower.

A new option for heat therapy involves single-use wraps or patches that adhere to your skin or clothing near the sore spots. Chemicals in these wraps or patches warm up as they're exposed to air when you open the package. Because they provide a lower level of therapeutic heat, they are safe for extended use -- eight hours or more. (But always follow the manufacturer's instructions.)

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call toll free 800-333-9037, extension 9PR1.
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Is Yogurt Good For You?

A yogurt a day may not mean fewer doctor visits, but there are plenty of health reasons to make this dairy food a regular in your diet.

The May issue of Mayo Clinic Women's HealthSource covers the benefits:

- One 8-ounce cup of plain low-fat yogurt provides around 400 milligrams (mg) of calcium, more than the 300 mg in an 8-ounce glass of milk.

- Yogurt also has as much potassium as a banana and as much protein as an egg or ounce of meat.

- The live bacteria in yogurt help in digestion and protect you against other harmful bacteria.

In fact, some of yogurt's health reputation relies on presence of live bacteria. To make yogurt, warm milk is fermented or cultured with two types of bacteria -- Lactobacillus bulgaricus and Streptococcus thermophilus. Although many bacteria can make you sick, these bacteria are beneficial. They can help break down the lactose (sugar naturally occurring in milk), making yogurt more digestible than milk for people with lactose intolerance.

Some yogurt makers heat the yogurt after it's cultured to increase the shelf life or reduce tartness, but kill the bacteria in the process. When shopping, look for the official National Yogurt Association's seal on the container that says "Live and Active Cultures." Another shopping tip: choose a brand that's low in calories and fat with as few additives as possible.

Yogurt, in its many forms, is great for snacks, lunch boxes and on the go. Whether you take your yogurt with a spoon, a straw or squeeze it from a tube, enjoy. It's good for you.

Mayo Clinic Women's HealthSource is published monthly to help women enjoy healthier, more productive lives. Revenue from subscriptions is used to support medical research at Mayo Clinic.
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Frequent Urination - Causes And Treatments

Frequent urination, where you feel an urge to pass urine more often than usual, is not just a a nuisance and a cause of poor sleep, it can be a symptom of an underlying medical condition. Polyuria is a medical term that refers to the excessive passing of urine (frequent urination).

Unfortunately many people soldier on, perhaps accepting it as something they have to put up with, or they don't think it is worth bothering the doctor about, or maybe they are scared it might signify something serious.

But often, when they seek diagnosis and treatment, patients find the cause is not serious or harmful, and it is possible to return to normal urinary habits.

For instance, frequent urination can result from drinking too many fluids, particularly those containing caffeine or alcohol. Pregnant women often have the condition, due to the enlarged uterus pressing on the bladder.

However, should it be the case that frequent urination is a symptom of something more serious, then there is even more reason to seek medical attention, because the sooner it is diagnosed and treated, the greater the chance of successful treatment.

This article first considers the nature of urination, and then some of the symptoms, causes, and treatments of frequent urination.

Urine and Urination

Urinary system
Urinary System Diagram

1. Urinary system:
2. Kidney,
3. Renal pelvis,
4. Ureter,
5. Urinary bladder,
6. Urethra.
7. Adrenal gland
8. Renal artery & vein,
9. Inferior vena cava,
10. Abdominal aorta,
11. Common iliac artery & vein
With transparency:
12. Liver,
13. Large intestine,
14. Pelvis
Urine is a waste product made in the kidneys. The kidneys spurt urine into the ureters which then pass it into the bladder, where it collects ready to be expelled from the body via the urethra.

Normal urine is a clear, transparent, amber-colored fluid made of urea, uric acid, and water. Some diseases cause other substances to appear in urine, such as sugar (diabetes), albumin (kidney disease), and bile pigments (jaundice).

The average person probably excretes about 5 to 8 cups or 1 to 1.8 litres of urine every 24 hours.

Urination or micturition is the process of expelling urine from the body. The process is complex and involves muscles of the bladder and sphincter mechanism, controlled by various nerve centers in the central and peripheral nervous systems.

For example, the bladder itself is mostly an intricate mesh of interlaced bundles of smooth muscle, known as the detrusor, that relaxes to fill the bladder, while the sphincter mechanism keeps the exit tightly shut and comprises slow twitch muscle fibers in the walls of the urethra, and some muscles that are also part of the pelvic floor.

During urination, the detrusor contracts to squeeze urine out of the bladder, and the sphincter mechanism relaxes, allowing smooth outflow of urine.

In infants and very young children, the process of urination is involuntary, and then gradually, by around 3 to 5 years of age, they have learned to control it and make it voluntary.

The nerve circuitry that controls urination is highly distributed and far from simple, involving far-reaching pathways on several levels. These are in the brain, the spinal cord, and the peripheral nervous system, and interact with many chemical messengers or neurotransmitters.

Research using brain imaging has revealed that in humans, parts of the brain normally associated with thinking and planning of complex behaviours and expression of personality, have strong and direct connections with circuits involved in urination, such as those that relax the sphincter and empty the bladder.

Frequent Urination and Associated Symptoms

Frequent urination is where you pass urine more often than usual. This can sometimes occur with urgent urination: a sudden, compelling urge to urinate, along with discomfort in the bladder.

Most people can sleep for 6 to 8 hours without having to urinate, but many have to get up in the night to relieve themselves. This frequent need to urinate at night is called nocturia, and is common in both men and women. By disturbing sleep, nocturia can significantly affect quality of life.

It is important to assess the underlying cause of nocturia, because chronic conditions, such as diabetes, can present in this way.

Frequent urination is not the same as urinary incontinence, which is where there is no voluntary control of bladder function, reminiscent of the infant's involuntary reflex. However, urinary incontinence can be a cause of frequent urination, and/or the two can occur together.

When doctors assess urinary symptoms, they try to distinguish among several possibilities, such as nocturia, daytime frequent urination, urinary incontinence, obstructive symptom (such as poor, intermittent stream or terminal dribble), and irritative symptoms (such as urgency, burning sensation).

There are also other considerations, such as when is the symptom not something to worry about? For instance, in men it is so common to have a little "leakage" at the end of the stream (the post-micturition dribble), that it does not count as an abnormality. Also, many women leak a little urine on coughing.

So one of the ways to decide if a seemingly harmless urinary symptom is an issue, is to establish the extent to which it impacts quality of life.

If urinary frequency is affecting your quality of life, or you also have other unexplained symptoms such as back or side pain, vomiting, fever, chills, fatigue, bloody or cloudy urine, or discharge from the vagina or penis, or an increase in appetite or thirst, then it is important to seek medical attention promptly.

For instance, one cause of frequent urination is kidney infection, and this requires prompt attention. If not treated, a kidney infection can permanently damage the kidneys, or the bacteria can infect the bloodstream and become life-threatening.

Causes of Frequent Urination

Doctor explains possible causes of frequent urination
Urination is a complex process involving different muscle groups and types, and an intricate nerve network located in the brain and spine, and in and around the bladder. It is no wonder therefore that frequent urination can be a symptom of so many different diseases, conditions and disorders, both physiological and psychological.

The main thing to bear in mind is that if frequent urination is unexplained and persistent, then it could be a symptom of something serious. Some drugs, such as diuretics, can also produce this symptom.

Drinking too much fluid before bedtime, especially if it contains caffeine or alcohol, can cause frequent urination at nighttime.

Or frequent urination could simply be a habit, in which case it may still be advisable to eliminate other potential concerns.

The most common causes of frequent urination are diabetes, pregnancy and prostate problems.

Other causes of frequent urination include:
  • Anxiety,
  • Medication, for example diuretics,
  • Stroke, or other brain or nervous system condition,
  • Infection of the prostate gland (prostatitis),
  • Enlarged prostate,
  • Kidney infection,
  • Tumor or mass in the pelvic area,
  • Interstitial cystitis (inflammation of the bladder wall),
  • Overactive bladder syndrome (unexplained, uncontrolled bladder contractions),
  • Cancer of the bladder,
  • Dysfunction of the bladder,
  • Bladder stones,
  • Urinary incontinence,
  • Abnormal opening (fistula) in the urinary tract,
  • Radiation of the pelvis, eg to treat cancer, and
  • Diverticulitis (inflammation of diverticulosis, small, bulging sacs or pouches that can develop on the inner lining of the large intestine).

Seeing the Doctor

Because of the complexity of the process of urination, the cause of frequent urination can be neurological, physical, or, even psychological, so your doctor will need to perform a thorough diagnosis. To do this, he or she will carry out a physical exam, and ask questions to establish your medical history and gather information about the symptoms you are experiencing.

They may ask about:
  • The pattern of frequent urination (when did it start, how does it compare with what you consider to be normal, is it happening during the day only, or night time only, or both?)
  • Current medications.
  • Any other symptoms.
  • How much fluid you drink: is it more or less than usual?
  • Whether you have noticed any changes in your urine (eg color, smell).
  • How much caffeine and alcohol you consume and whether this has changed recently.
After considering your medical history, and depending on what he or she discovers in the physical exam, your doctor may ask you to undergo some tests, such as:
    Urine sample
    Your Doctor may ask you for a sample of urine
  • Urine analysis: to determine whether any abnormal compounds are present.

  • Imaging tests: to look inside the body.

  • Neurological tests: to see if a nerve disorder is present.

  • Urodynamic tests: to examine how well the bladder, sphincters, and urethra are storing and releasing urine.
Urodynamic tests range from simple observation to precise measurements using sophisticated equipment. Simple observations include for example recording the time it takes to produce a urinary stream, noting the amount of urine produced, and the ability to stop mid-stream.

Precise measurements include, for example, using imaging equipment to observe the bladder filling and emptying, using monitors to measure pressure inside the bladder, and using sensors to record muscle and nerve activity.

Most urodynamic tests do not need special preparation, though some may require you to make a change in fluid intake, or stop taking certain medications. You may also be asked to arrive at the clinic with a full bladder.

Treating Frequent Urination

The importance of seeing your doctor and getting a diagnosis is to establish the underlying cause of frequent urination. That will then decide the treatment.

For example, if the cause is diabetes, then the treatment will be for diabetes, the aim of which is to keep blood sugar under control. If the cause is a kidney infection, then the treatment usually comprises a course of antibiotics and possibly painkillers too.

If the cause is an overactive bladder, then there are several recommended medications, which in conjunction with behavioral techniques, can increase the chances of successful treatment. The most common medications are anticholinergics, which target the overactivity of the detrusor muscle. They should only be used under the direction of the prescribing physician and they can have side effects, such as dry mouth, constipation, blurred vision and confusion (in the elderly).

Other treatments include:
  • Kegel exercises: these regular daily exercises strengthen the muscles of the pelvis and urethra and support the bladder. It is important to learn the correct technique and practise at the recommended frequency (at least 30 to 80 times a day for at least 8 weeks).

  • Biofeedback: Used with with Kegel exercises, this helps improve awareness and control of pelvic muscles.

  • Bladder training: the aim is to train the bladder to hold urine longer and thus urinate less often. It involves increasing the period between visits to the toilet to empty the bladder and is done gradually over two to three months.

  • Monitoring fluid intake: for instance, it could be that drinking before bedtime is the main cause of frequent urination.

  • Changing diet: to avoid foods that irritate the bladder or act as a diuretic, for instance caffeine, alcohol, chocolate, spicy foods, artificial sweeteners. Eating high-fiber foods can help reduce the constipation that worsens an overactive bladder.
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Noise From Earphones Can Damage Your Ears

Although many people like to turn their headphones up as loud as they can after having a bad day or to get their mind off things bothering them, experts from the University of Leicester have shown evidence for the first time that turning the volume on your headphones up too high can damage the coating of nerve cells, eventually causing temporary deafness.

According to the researchers, the noise levels similar to those of jet levels can be heard on earphones or headphones on personal music players if they are turned up loud enough.

Scientists have known that temporary deafness and tinnitus (a condition that presents itself as a noise such as ringing or buzzing in the ears) can be caused by noises louder than 110 decibels. This study, published in the Proceedings of the National Academy of Sciences, is the first to examine how those noises cause underlying cell damage.

Dr. Martine Hamann, of the Department of Cell Physiologu and Pharmacology, lead author and researcher at the University of Leicester, explained:

"The research allows us to understand the pathway from exposure to loud noises to hearing loss. Dissecting the cellular mechanisms underlying this condition is likely to bring a very significant healthcare benefit to a wide population. The work will help prevention as well as progression into finding appropriate cures for hearing loss."

The myelin sheath is a coating found on nerve cells that carry electrical signals from the ears to the brain, which helps the electrical signals travel along the cell.

The cells become stripped of this coating with exposure to loud noises (noise over 100 decibels), which stops the electrical signals and no longer allows information to be successfully transmitted from the ears to the brain.

Fortunately, full hearing can return when the coating surrounding the nerve cells reform and allows the cells to function normally again. This means that hearing loss is sometimes only temporary.

The study is important, according to Dr. Hamann, because it explains why in certain cases, hearing loss can be reversible. He continued:

"We showed that the sheath around the auditory nerve is lost in about half of the cells we looked at, a bit like stripping the electrical cable linking an amplifier to the loudspeaker. The effect is reversible and after three months, hearing has recovered and so has the sheath around the auditory nerve."

Research is still being conducted on the effects of loud noises on a part of the brain referred to as the dorsal cochlear nucleus, the relay that carries signals from nerve cells in the ear to the parts of the brain that decode and make sense of sounds.
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You Can Learn While You Sleep, Says Study

New research from Weizmann Institute, published in Nature Neuroscience has discovered that people can actually learn during sleep, which can unconsciously modify their behavior while awake.

The study suggests that while people sleep, if certain odors are presented after hearing tones, people start sniffing even if there is no odor presented when they hear the same tones. This happens during sleep and even when people wake up.

There have been several past studies explaining the importance of sleep for learning and memory consolidation. However, none of them have been able to show the human brain actually learning new information during sleep.

Professor Noam Sobel, research student Anat Arzi, Sobel's team from the Institute's Neurobiology Department, and experts from Loewenstein Hospital and the Academic College of Tel Aviv- Jaffa, decided to try an experiment with a type of conditioning that exposes participants to a tone followed by an odor, so that they soon experience a similar response to the tone as they would to the odor.

The researchers found many advantages from pairing tones and odors, for example, neither wakes the subject, yet the brain processes them and even reacts during sleep. Certain odors actually even help the participants to have a sound sleep. On the other hand, sleep-learning studies are extremely difficult to conduct, so the experts had to make sure the participants were really asleep during the "lessons."

A man and woman sleeping
Associations made whilst sleeping appear to be retained after waking up.
The sense of smell, or sniffing, holds a unique non-verbal measure that can be examined. Results showed that the brain acts just as it does when it is awake when dealing with smells. When we smell a pleasant aroma we inhale deeply, and when we smell something bad we cut our inhalation short.

It didn't matter if participants were asleep or awake, this variation in sniffing could be recorded either way. This type of conditioning, while appearing so simple, is also associated with some higher brain areas, like the hippocampus (involved in memory formation).

In order to continuously monitor the subjects' sleep state, the subjects slept in a special lab during the experiments. Even if a participant woke up for a second, the results had to be disqualified.

During sleep time, the subjects heard a tone that was followed by either a pleasant or an unpleasant odor. Then another tone was heard, followed by an odor (at the opposite end of the pleasantness scale from what they previously smelt).

The associations were partially reinforced throughout the night, in order to expose the subjects to the tones alone. The volunteers sniffed deeply or took shallow breaths when they heard the tones without the odor, reacting the same way as if the associated odors were still present.

After volunteers awoke the next day, they heard the tones again with no odor following. Since they were asleep the night before, they had no conscious memory of ever listening to them, but their breathing patterns were showing something different. When the tones that were paired with bad smells were played for the subjects, they produced short, shallow sniffs; and when they heard the tones that were associated with nice odors, they sniffed deeply.

The team conducted a second experiment to find out if this type of learning was tied to a particular phase of sleep. In order to do so, they divided the sleep cycles into rapid eye movement (REM) and non-REM sleep where they induced the conditioning in only one phase or the other.

Researchers were surprised to see that the REM phase showed a more pronounced learning response. However, being able to transfer the learned association from sleep to waking was only found when the learning happened in the non-REM phase.

REM sleep may make us more open to stimuli in the environment, according to Sobel and Arzi, but "dream amnesia" (which makes people forget their dreams) may operate on any conditioning during that stage. Non-REM sleep, they explained, is important for consolidating memory, so it could also be playing a role in this form of sleep-learning.

Since Sobel's lab focuses on the sense of smell, Arzi hopes to further investigate brain processing in altered states of consciousness such as sleep and coma.

Arzi said:

"Now that we know that some kind of sleep learning is possible, we want to find where the limits lie- what information can be learned during sleep and what information cannot."
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Why Do Computer Tablets Disrupt Sleeping Patterns?

Communication devices and tablet computers with self-luminous backlit displays can cause melatonin levels to drop, making it much harder to fall asleep, researchers at the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute, Troy, New York, explained. The authors of the report explained that if you have not yet gone to bed when exposed to a luminous screen for long enough, you will probably delay your bedtime.

Their study has been published in Applied Ergonomics and is titled "Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression".

Melatonin, a hormone, is involved in regulating our circadian rhythm, our body clock. Fluctuations in melatonin levels influence on our desire to stay awake or go to sleep. During evolution, sunlight exposure determined what our melatonin levels were. Our bodies still respond to melatonin in the same way we did thousands of years ago. The difference today is that we now have other sources of light, which can upset our body clocks.

Studies have shown that disturbances in our circadian rhythm may lead to brain cell changes, and cause sleep problems in aging. Researchers at the University of Southern California found that circadian rhythm is much more important to life than had previously been suspected.

Research head, associate professor, Mariana Figeuiro and team set out to determine what the effects of self-luminous tablets might be on melatonin suppression. They observed and gathered data on 13 volunteers who used the devices to watch films, play games and read documents.

Prof. Figueiro said:

"Our study shows that a two-hour exposure to light from self-luminous electronic displays can suppress melatonin by about 22 percent. Stimulating the human circadian system to this level may affect sleep in those using the devices prior to bedtime."

Child reading on a tablet computer
Two-hour exposure to tablet computers before bedtime could be making us go to bed later
The melatonin suppression that occurred after exposure to the luminous tablet screen was similar to what one would expect after being exposed to normal sunlight, the researchers explained. In other words, the screen light makes the human's body clock regress from nighttime-sleepy to daytime-alert mode.

Figueiro said "Based on these results, display manufacturers can use our model to determine how their products could affect circadian system regulation."

The team says their findings should be used to encourage gadget, tablet, mobile phone and screen manufacturers to create more circadian-friendly products which could follow our sleep-awake patterns, rather than work against them.

Perhaps manufacturers could design tablets to help people with certain conditions and illnesses linked to lack of sunlight exposure, such as seasonal affective disorder (SAD), and sleep problems commonly experienced by seniors. Users could be receiving therapy for their condition while watching a movie, playing games, writing letters, or reading texts - much more fun that simply sitting in front of a light box. (SAD treatment involves sitting in front of a light box each day for one or two hours).

Melatonin is a "the hormone of darkness"

Melatonin, or N-acetyl-5-methoxytryptamine is a hormone, also an antioxidant, which occurs naturally in all animals, plants and microbes. In animals (this includes humans), levels of melatonin fluctuate during the daily cycle. It is a "timing messenger" which regulates our waking and sleeping cycles. Doctors sometimes prescribe melatonin for people who find it hard to get to sleep.

In humans and other mammals melatonin is secreted by the pineal gland.

Melatonin is secreted when it is dark, that is why it is sometimes called the "hormone of darkness". Our highest melatonin levels usually occur during bedtime.

Technology is robbing us of natural darkness

Prehistoric humans, before they knew how to make fire, would go to sleep as soon as it was dark because their melatonin levels would shoot up after sunset. High melatonin levels make us want to go to sleep. After we knew how to make fire, we no longer lived in total darkness during the night. Then came candles, gaslights, and the electric light bulb.

Technology today means that we can be exposed to intense light at any time of day and night.

Co-author, Brittany Wood, said:

"Technology developments have led to bigger and brighter televisions, computer screens, and cell phones. To produce white light, these electronic devices must emit light at short wavelengths, which makes them potential sources for suppressing or delaying the onset of melatonin in the evening, reducing sleep duration and disrupting sleep. This is particularly worrisome in populations such as young adults and adolescents, who already tend to be night owls."

Wood and team divided the volunteers into three groups:
  • Clear goggles group - they looked at their tablets through a pair of clear goggles. The goggles were fitted with 470-nm (blue) light from LEDs (light emitting diodes). Blue light is known to suppress melatonin. This was the "true positive condition"

  • Orange-tinted glasses group - The tinted glass can filter out short-wavelength radiation which suppresses melatonin. This was the "dark control" condition.

  • No goggles group - they wore no glasses or goggles. Their tablets were set to maximum brightness.
Each participant wore a Dimesimeter near the eye. A Dimesimeter is a device that monitors and records circadian light and levels of activity. It was developed at the Lighting Research Center.

The team found that exposure duration and the distance from their eye to the tablet screen had a significant impact on melatonin levels. The impact on melatonin suppression was insignificant after 60 minute exposure, and considerable after 120 minutes.

Prof Figuiero said:

"We recommended dimming these devices at night as much as possible in order to minimize melatonin suppression, and limiting the amount of time spent using these devices prior to bedtime."
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