Cholesterol - healthy eating tips

Cholesterol is a fatty substance normally produced by the liver and found in our blood. It has many good uses, but can become a problem when there is too much of it in the blood.

Developing healthy eating habits will help reduce your cholesterol levels. Some suggestions include choosing polyunsaturated and mono-unsaturated oils and reducing saturated fats and trans fats in your diet.

If you have high levels of cholesterol, you can reduce them by making changes to your lifestyle (especially changing your eating habits) and, if recommended, by taking medication prescribed by your doctor. Talk to your doctor about what will be the best approach for your situation.

Cholesterol explained
Cholesterol is made in the body by the liver. Cholesterol also comes into the body through some foods – this is called ‘dietary’ cholesterol. Dietary cholesterol is found only in animal products (such as offal, fatty meats, full fat dairy products and egg yolks). Plant foods – such as avocados, nuts, grains, fruit and vegetables – don’t have any dietary cholesterol.

Cholesterol is packaged for transport around the body into small spheres called ‘lipoproteins’. There are two types of lipoproteins:

Low density lipoprotein (LDL) cholesterol – this is known as the ‘bad’ cholesterol because it contributes to heart disease by sticking to and narrowing blood vessels.
High density lipoprotein (HDL) cholesterol – this is known as the ‘good’ cholesterol because it helps protect against heart disease.
High blood cholesterol usually does not give warning signs. You can have high blood cholesterol and feel perfectly well. The only way to find out if your blood cholesterol is high is by having it checked regularly.

Triglycerides
In addition to cholesterol, your blood also contains a type of fat called triglycerides. When you eat, your body converts any calories it doesn’t need to use right away into triglycerides. These triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals. If you regularly eat more calories than you burn, you may have high triglyceride levels (hypertriglyceridaemia).

Causes of high blood cholesterol
Fats in food are a mixture of polyunsaturated, mono-unsaturated, saturated and trans fats. These different types of fats have different effects on your cholesterol level.
Polyunsaturated fats – these help lower blood cholesterol if your meals are low in saturated fat. Some examples of foods that contain polyunsaturated fats are fish, plain nuts (such as walnuts, hazelnuts and brazil nuts) and polyunsaturated margarines and oils.

Mono-unsaturated fats – these can help lower blood cholesterol if your meals are low in saturated fat. Foods that include mono-unsaturated fats include avocado, plain nuts (such as peanuts, cashews and almonds) and mono-unsaturated margarine and oils.

Saturated fats – these raise blood cholesterol. Foods that are high in saturated fats include many takeaway meals, potato chips, commercial cakes, biscuits and pastries, butter and dairy products (full fat milk, cream, cheese and so on).

Trans fats – these raise total and LDL (bad) blood cholesterol and also reduce the HDL (good) component of blood cholesterol. Foods high in trans fats include those that use hydrogenated or partially hydrogenated vegetable fats (for example, baked products like pies, pastries, cakes, biscuits and buns).

Cholesterol in food
Cholesterol in food can also raise blood cholesterol, particularly in people who have a high risk of developing heart disease. However, cholesterol in food does not raise cholesterol in the blood to the same extent as saturated and trans fats. Research shows that limiting the intake of saturated and trans fats is more useful than limiting cholesterol-rich foods when trying to lower blood cholesterol levels. See your doctor or dietitian for further information and advice.

Reducing high blood cholesterol
Replacing foods that contain saturated fats with foods that contain polyunsaturated and mono-unsaturated fats will help lower blood cholesterol levels. Foods high in polyunsaturated fats include margarine spreads and oils (such as sunflower, soybean and safflower), fish, some nuts and seeds. Foods high in mono-unsaturated fats include margarine spreads and oils (such as olive, canola and peanut), avocados and some nuts.

Limiting your intake of foods such as cakes, pastries, pies and biscuits will not only lower your saturated fat intake but also your trans fat intake.

Foods low in refined carbohydrates and high in dietary fibre, particularly soluble fibre, can reduce the level of LDL cholesterol in the blood. Foods containing soluble fibre include fruits, legumes (chickpeas, lentils, soybeans, four bean mix and baked beans) and cereals (oats and barley).

Eating healthy foods as part of a well-balanced diet will help keep your blood cholesterol in check.

Eat vegetables, beans, fruit, wholegrains and nuts
Healthy eating suggestions include:
Base your meals around a variety of vegetables and fruit.
Choose wholegrain foods such as wholegrain rice, pasta, noodles, bread and breakfast cereals.
Include legumes (chickpeas, lentils, soybeans, four bean mix, baked beans or split peas) in two meals a week.
Choose plain, unsalted nuts and seeds.

Eat fish and lean meat
Healthy eating suggestions include:
Eat fish (preferably oily varieties, either fresh or canned) at least twice a week.
Select lean meat (meat trimmed of fat and chicken without skin).
Try to limit fatty meats, including sausages and delicatessen meats such as salami.

Use vegetable oils and choose reduced fat dairy products
Healthy eating suggestions include:
Use margarine spreads instead of butter or dairy blends.

Use a variety of oils for cooking – some suitable choices include canola, sunflower, soybean, olive and peanut oils.

Use salad dressings and mayonnaise made from oils such as canola, sunflower, soybean and olive oils.
Choose low or reduced fat milk and yoghurt or ‘added calcium’ soy beverages.
Try to limit cheese and icecream to twice a week.

Try to limit takeaway and snack food
Healthy eating suggestions include:
Try to limit takeaway foods to once a week. Takeaway foods include pastries, pies, pizza, hamburgers and creamy pasta dishes.
Try to limit snack foods such as potato crisps and corn crisps to once a week.
Try to limit cakes, pastries and biscuits (chocolate or creamy) to once a week.

Cholesterol-rich foods can be included as part of a healthy eating pattern. People with high blood cholesterol should discuss with their doctor or an accredited dietitian (APD) how much cholesterol-rich food they can eat.

Heart Foundation

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14 Foods that Lower Cholesterol

1. Whole grains and oats – a five-year Insulin Resistance Athersclerosis Study showed that people whose diets contain the most whole grains “had the thinnest carotid artery walls and showed the slowest progression in artery wall thickness.”

2. Blueberries – a compound in blueberries (pterostilbene) may help lower cholesterol as effectively as commercial drugs with fewer side effects.

3. Pistachios, 4. Walnuts, and 5. Almonds – a Penn State study showed that eating pistachios significantly lowers LDL (bad) cholesterol levels. Research published in the Journal of the American College of Cardiology showed eating walnuts after a high-fat meal might protect your heart. Omega-3 fats and antioxidants in nuts work to reverse the arterial damage caused by saturated fats.

6. Avocados, 7. Olives, and 8. Olive oil – 26 of the 30 grams of fat in an avocado are heart-healthy, unsaturated fats that can increase your levels of HDL cholesterol. The good fats in avocados, olives, and olive oil protect against heart disease and diabetes. Check out the Mediterranean Diet.

9. Flaxseed oil – flaxseed oil can lower blood pressure in men with high cholesterol. In a three-month study of 59 middle-aged men, those who took daily flaxseed oil supplements (with eight grams of the omega-3 fats, alpha-linoleic acid) experienced significantly lower systolic and diastolic blood pressure.

10. 100% cranberry-grape juice – antioxidants in grape juice slow down LDL cholesterol oxidation, and cranberry juice raises HDL or “good” cholesterol.

11. Fish and Fish oil – a study from the Norwegian University of Science and Technology found that people with type 2 diabetes who consumed high doses of fish oil over nine weeks lowered the size and concentration of several lipoprotein subclasses (cholesterol) in their bodies.

12. Black soybeans – a study from the Journal of the Science of Food and Agriculture shows that black soybeans may help prevent obesity, lower LDL cholesterol, and reduce the risk for type 2 diabetes.

13. Pomegranate juice – a National Academy of Sciences study showed that pomegranate juice reduces cholesterol plaque buildup and increases nitric oxide production (nitric oxide helps reduce arterial plaque).

14. Yogurt with live active cultures (probiotics) – Vicki Koenig, MS, RD, CDN said “several studies have shown that the probiotics Lactobacillus Acidophilus and Lactobacillus Reuteri actually help lower cholesterol. They work by preventing the reabsorption of cholesterol back in to the blood stream.”
You might be a person who is predisposed to high cholesterol, or maybe your diet could use a shape-up. Here are a few key points on cholesterol that I try to focus on:

LDL or “bad” cholesterol deposits itself on the walls of your arteries, forming plaques that make them hard and narrow. HDL or “good” cholesterol removes excess LDL in your blood and brings it to your liver for disposal. The more HDL you consume, the less LDL you’ll have in your blood.
You may need medication to help reduce your cholesterol, but eating a heart-healthy diet and getting exercise are very important.

By Laurel

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A Healthy Inspiration from Tea

Consuming green tea helps to decrease the risk of stroke up to 60%. This has been a routine habit of inhabitants on South China since 2.700 years ago. Thus, it is obvious that South China holds the record as a country with the lowest stroke attack rate within the last 20 years.

Through the years green tea has been combined with other herbs so as to be more perfect in efficacy. PT Mustika Ratu, as an example, combine green tea with the extract of senna leaf, gotu kola, and liquorice. According ot Ani Wahyuningsih of Mustika Ratu, all four ingredients are beneficial to maintain health. Green tea functions as anti-oxidant to battle free radicals; liquorice cleans liver from toxic. Gotu kola may be an aid in promoting collagen synthesis for skin health.

The right time to have a cup of tea is in the afternoon or at night prior to sleep. The reason is herbal tea functions as detoxification by cleaning alimentary canal. (Vina Fitriani)

By trubuson

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5 Natural Ways to Help Your Health (continued)

3. Get Screened and Get Your Shots
This year, with flu in the headlines, no one needs to be reminded that flu shots can dramatically reduce the risk of getting this seasonal bug and its potentially life-threatening complications. Yet only 42% of people 50 to 64 get yearly flu shots. Keeping up to date on all recommended vaccinations can prevent many deadly and debilitating illnesses.

Routine health screens are also lifesavers. Knowing and managing your cholesterol levels and blood pressure is crucial to reducing your risk of heart disease. Cancer screening tests have been shown to catch some forms of the disease early enough to eliminate them.

For the latest recommendations on what tests to get when, check out the U.S. Preventive Services Task Force recommendations at www.ahrq.gov.

4. Don’t Smoke: Quitting Saves Lives
A no-brainer. But lung cancer remains the leading cause of cancer death -- and between 80% and 90% of cases are directly caused by smoking, according to the National Cancer Institute.

The good news: smoking rates are falling in the U.S. And thanks to a variety of new nicotine replacement therapies -- from patches to nasal sprays -- quitting is easier than ever. One recent analysis of studies found that nicotine replacements can almost double the odds that smokers will successfully quit. New medications to help smokers kick the habit are also available. Talk to your doctor about the best strategies for success.

5. Find Joy From Family and Friends
Enjoying life and maintaining a circle of supportive friends is a big part of good health. Indeed, having friendships may be second only to not smoking for preventing heart attacks. People with extensive social networks, according to research at the Uniformed Services University, are less likely to have calcification in their arteries, a sign of heart disease risk.

One way to increase your happiness is to foster cheerful friends. “Happiness turns out to spread through social networks,” says James D. Fowler, PhD, an associate professor of political science at the University of California, San Diego. His research, which tracked the spread of happiness among friends and even friends of friends, found that a person is 15% more likely to be happy if a close contact is happy.

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5 Natural Ways to Help Your Health

By : Peter Jaret
Reviewed By Brunilda Nazario, MD

No matter how the laws change in Washington, D.C., preventive medicine experts say the single best way to improve the nation’s health is simple: Stay healthy.
Preventable illnesses like heart disease, type 2 diabetes, stroke, and several leading forms of cancer make up a big chunk of health care spending, costing billions of dollars. They rob millions of Americans of years of life and blight the final years of others with sickness and disability.

It doesn’t have to be that way. Consider evidence from a 2009 study of 23,153 adults who took part in the European Prospective Investigation into Cancer and Nutrition. Volunteers who followed four tenets of good health -- they didn’t smoke or get fat; they exercised and ate a healthy diet -- were 80% less likely to develop chronic illnesses such as type 2 diabetes, cancer, and heart disease. Their risk of developing type 2 diabetes was 92% lower than the risk of people who shunned the familiar health advice. Their odds of having a heart attack were 81% lower.

“Results like these prove again and again that the most powerful tools we have to improve health are prevention,” says Wes Alles, PhD, director of the Stanford Health Improvement program at Stanford University. “Yet we still have trouble convincing people to make those healthy changes.” To craft your own health care reform program, here’s what Alles and other experts say you should do to get the biggest bang for your efforts:

1. Be More Active and Exercise
Exercise offers so many health benefits, it’s nothing short of a magic bullet. Something as simple as a brisk walk for half an hour a day dramatically reduces the risk of heart disease, diabetes, and several forms of cancer, including colon cancer, one of the leading killers.

“A lifetime of regular exercise improves brain function, allows people to be active and independent in their later years, and adds years to life,” says Steven Blair, PhD, professor of exercise science at the University of South Carolina, who has helped shape federal exercise guidelines. “That addresses most of the leading chronic health threats we face.”

A 2008 study by researchers at Brigham and Women’s Hospital in Boston showed that regular exercise lowered the risk of dying prematurely by 30%.

2. Maintain a Healthy Weight
Easier said than done, according to findings from a new analysis of data from state health departments.

Over the past five years, obesity rates climbed in nearly all states. Indeed, not a single state in the U.S. saw a decline.

Losing weight and keeping it off is difficult. Yet studies show that losing weight just a few pounds if you’re overweight will improve your health. If your weight is normal, work to keep it there by reining in calories and exercising frequently. A healthy diet includes abundant fruits, vegetables, and whole grains. A good diet limits refined sugars and saturated fats. One easy way to shed calories from your diet: drink water instead of sugary beverages. They account for more and more calories in the American diet.

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Coffee and Cholesterol

By Merritt McKinney
Special to msnbc.com
For the millions of people who depend on coffee to jumpstart their day, cholesterol is probably the last thing on their mind as they wait for the morning jolt of caffeine to kick in. In the past few years, though, more and more evidence hints that coffee can increase cholesterol levels.

Experts say that the majority of coffee-drinking Americans do not need to worry about the impact of a cup of joe on cholesterol levels. That's because most Americans drink filtered coffee, which is believed to have much less of an effect on cholesterol than unfiltered coffee. Filters seem to remove most of the cholesterol-boosting substances found in coffee.

But a cholesterol check may be in order for people who use a French press or percolator to make their coffee or who prefer espresso or other varieties of unfiltered coffee, according to Dr. Michael J. Klag, the vice dean for clinical investigation at Johns Hopkins University School of Medicine in Baltimore.

In 2001, Klag and his colleagues reviewed more than a dozen studies that looked at the relationship between coffee consumption and cholesterol levels. They found that drinking an average of six cups of coffee a day was associated with increased total cholesterol and LDL, the harmful type of cholesterol. Nearly all of the rise in cholesterol was linked to unfiltered coffee.

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Anemia

About Anemia
Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health problems because RBCs contain hemoglobin, which carries oxygen to the body's tissues. Anemia can cause a variety of complications, including fatigue and stress on bodily organs.

Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:

excessive destruction of RBCs
blood loss
inadequate production of RBCs
Among many other causes, anemia can result from inherited disorders, nutritional problems (such as an iron or vitamin deficiency), infections, some kinds of cancer, or exposure to a drug or toxin.

Anemia Caused by Destruction of RBCs
Hemolytic anemia occurs when red blood cells are being destroyed prematurely. (The normal lifespan of RBCs is 120 days; in hemolytic anemia, it's much shorter.) And the bone marrow (the soft, spongy tissue inside bones that makes new blood cells) simply can't keep up with the body's demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications — such as antibiotics or antiseizure medicines — are to blame.

In autoimmune hemolytic anemia, the immune system mistakes RBCs for foreign invaders and begins destroying them. Other kids inherit defects in the red blood cells that lead to anemia; common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and hereditary spherocytosis.

Sickle cell anemia is a severe form of anemia found most commonly in people of African heritage, although it can affect those of Caucasian, Saudi Arabian, Indian, and Mediterranean descent. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This leads to premature destruction of RBCs, chronically low levels of hemoglobin, and recurring episodes of pain, as well as problems that can affect virtually every other organ system in the body. About 1 out of every 625 African-American children is born with this form of anemia.
Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived RBCs. Thalassemia major, also called Cooley's anemia, is a severe form of anemia in which RBCs are rapidly destroyed and iron is deposited in the skin and vital organs. Thalassemia minor involves only mild anemia and minimal red blood cell changes.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects males of African heritage, although it has been found in many other groups of people. With this condition the RBCs either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and doesn't work well. When someone born with this deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body's RBCs suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.
Hereditary spherocytosis is a genetic disorder of the RBC's membrane that can cause anemia, jaundice (yellow-tinged skin), and enlargement of the spleen. The RBCs have a smaller surface area than normal red blood cells, which can cause them to break open easily. A family history increases the risk for this disorder, which is most common in people of northern European descent but can affect all races.

By : KidsHealth

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Your cholesterol drug might help you weather the flu

By Nathan Seppa

PHILADELPHIA — Statin drugs, prescribed to keep high cholesterol in check, may also offer partial protection against the ravages of influenza, a study suggests.


A team of researchers reviewed the records of roughly 2,800 patients age 18 or older from 10 states who came down with laboratory-confirmed flu during the 2007–2008 flu season. About 30 percent were taking a statin drug.

During that season, there were 17 deaths in the statin group and 64 deaths in people not using statins. After accounting for differences between the groups in age, race and cardiovascular health, the researchers found that people getting statins were about half as likely to die from the flu, says Meredith Vandermeer,an epidemiologist in Oregon’s Public Health Division in Portland. Vandermeer presented the findings October 29 during a meeting of the Infectious Diseases Society of America.

In addition to their better-known suppression of LDL, the bad cholesterol, statins have been shown to quell inflammation in cardiovascular disease. “But it’s not really been looked at in infectious diseases,” Vandermeer says. In severe cases of the flu, lung inflammation can precipitate pneumonia.
“If you’re on statins for cholesterol, there may be some extra benefits,” says Andrew Pavia, a pediatrician at the University of Utah in Salt Lake City. But he cautions that this study looked only at patients’ ability to survive flu that required hospitalization and offers no evidence that statins played a clear biological role in that survival. Further research is needed to ascertain whether the drugs indeed offer a protective mechanism against flu, he says.

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FDA Approves Influenza A (H1N1) 2009 Monovalent Vaccine

The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus.

Based on preliminary data from adults participating in multiple clinical studies, the 2009 H1N1 vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, as occurs with the seasonal influenza vaccine.

Clinical studies under way will provide additional information about the optimal dose in children. The recommendations for dosing will be updated if indicated by findings from those studies. The findings are expected in the near future.

As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations that contain thimerosal, a mercury-containing preservative, and in formulations that do not contain thimerosal.

People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated.

In the ongoing clinical studies, the vaccines have been well tolerated. Potential side effects of the H1N1 vaccines are expected to be similar to those of seasonal flu vaccines.

For the injected vaccine, the most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation. For the nasal spray vaccine, the most common side effects include runny nose or nasal congestion for all ages, sore throats in adults, and -- in children 2 to 6 years old -- fever.
What is Influenza A (H1N1) 2009 Monovalent Vaccine?

Influenza A (H1N1) 2009 Monovalent Vaccine is an inactivated influenza virus vaccine indicated for active immunization of persons ages 18 years of age and older against influenza disease caused by pandemic (H1N1) 2009 virus.
How will I receive Influenza A (H1N1) 2009 Monovalent Vaccine?

Based on currently available information, the vaccination regimen is as follows:

Adults 18 years of age and older:

* A single 0.5 mL intramuscular injection.

Influenza A (H1N1) 2009 Monovalent Vaccine is an inactivated vaccine that cannot cause influenza but rather stimulates the immune system to produce antibodies.


Dosage Forms and Strengths

Influenza A (H1N1) 2009 Monovalent Vaccine, a sterile suspension for intramuscular injection, is supplied in two presentations:

* 0.5 mL preservative-free, single-dose, pre-filled syringe.
* 5 mL multi-dose vial containing ten doses. Thimerosal, a mercury derivative, is added as a preservative; each 0.5 mL dose contains 24.5 micrograms (mcg) of mercury.

Important information about Influenza A (H1N1) 2009 Monovalent Vaccine

Influenza A (H1N1) 2009 Monovalent Vaccine should not be used in patients who have hypersensitivity to eggs or chicken protein, neomycin, or polymyxin, or life-threatening reaction to previous influenza vaccination.

If Guillain-Barré Syndrome (GBS) has occurred within 6 weeks of previous influenza vaccination, the decision to give Influenza A (H1N1) 2009 Monovalent Vaccine should be based on careful consideration of the potential benefits and risks.

Immunocompromised persons may have a diminished immune response to Influenza A (H1N1) 2009 Monovalent Vaccine.
What other drugs will affect Influenza A (H1N1) 2009 Monovalent Vaccine?

Do not mix Influenza A (H1N1) 2009 Monovalent Vaccine with any other vaccine in the same syringe or vial.

Immunosuppressive therapies may diminish the immune response to Influenza A (H1N1) 2009 Monovalent Vaccine.
Before receiving Influenza A (H1N1) 2009 Monovalent Vaccine

Safety and effectiveness of Influenza A (H1N1) 2009 Monovalent Vaccine have not been established in pregnant women, nursing mothers or in persons less than 18 years of age.
Influenza A (H1N1) 2009 Monovalent Vaccine Side Effects

The most common (= 10%) local (injection-site) adverse reactions were tenderness, pain, redness, and swelling. The most common (= 10%) systemic adverse reactions were headache, malaise, and muscle aches.

Any severe or unusual adverse reactions should be reported to the healthcare provider.

To report SUSPECTED ADVERSE REACTIONS, contact VAERS at 1-800-822-7967 and www.vaers.hhs.gov.

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Diet, Exercise Thwart Diabetes: Study

Diet and exercise can keep diabetes at bay for a decade, cutting the risk for the disease by more than a third in the most susceptible people, a new study finds.

About 11 percent of U.S. adults (24 million) have diabetes, mostly type 2, which is linked to poor diet and sedentary lifestyle. In addition, 57 million overweight adults have higher-than-normal blood sugar levels, which raise the risk of a heart attack or stroke and the likelihood of developing type 2 diabetes, researchers say.

But new research, published in the Oct. 29 online edition of The Lancet, shows that losing weight and exercising can delay or prevent the onset of diabetes more effectively than the prescription drug metformin or a placebo.

Interventions that result in weight loss lower the risk of diabetes, and that lower risk appears to persist for a long period of time," said study author Dr. William C. Knowler of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

For people who are at high risk of getting diabetes, losing weight "is clearly to be recommended," he said. In addition, using a drug like metformin may also benefit people unable to lose weight through exercise and diet alone, he said.

For the diabetes prevention study, 3,234 overweight or obese adults with elevated blood sugar levels were randomly assigned to either lifestyle changes or metformin to control their blood sugar, or a placebo.

After 10 years, 2,766 remained in the trial, and those taking metformin saw an 18 percent reduction in their rate of developing diabetes, compared with those on placebo.

But those who had made lifestyle changes -- reducing caloric and fat intake and exercising at least 150 minutes a week -- reduced their risk of getting diabetes by 34 percent compared with those on placebo, the researchers found.

In the first year of the trial, people in the lifestyle group lost an average of 15 pounds, regaining all but about five pounds over 10 years. People on metformin maintained a five-pound weight loss, and those on placebo lost less than two pounds over 10 years, the researchers note.

Over 10 years, after all the participants made lifestyle changes, the yearly diabetes incidence rates for the drug and placebo groups had dropped to about 5 to 6 percent, the same rate as the lifestyle group.

Lifestyle intervention, even when provided later, also seemed to lower diabetes incidence rate," Knowler said.

But losing weight is difficult, and simply telling someone to slim down won't work, he acknowledges.

To make things like this happen on a large scale, we have to do more than simply tell people to lose weight," he said. People need access to weight loss clinics that can teach them about diet and exercise, he added.

Dr. Anoop Misra, director of the department of diabetes and metabolic diseases at Fortis Hospitals in India, and author of an accompanying journal editorial, said that "prevention of diabetes is important to curb epidemic of diabetes globally. Diet and exercise remain the most important modalities to prevent diabetes, and any drugs are less important.

At-risk groups of diabetes need to be identified, especially certain ethnic groups, and taught proper lifestyle management strategies, Misra said. "Young adults with family history of diabetes should be carefully managed along the same lines," he said.

Diabetes prevention makes economic sense as well, by decreasing costly, lifelong expenditures on management of the disease and its complications, Misra said.

All nations, particularly developing countries, seeing a rapid rise in diabetes should devise or strengthen a national diabetes-control program to help curb the epidemic, he said.

In particular, regulations should apply for advertisement and sale of energy-dense junk food to children, and regular physical activity should be encouraged starting at a young age. Spreading awareness about proper lifestyle and adverse consequences of obesity and diabetes should be at the top of health agenda of all nations," Misra said.

Regarding the study findings, other experts are optimistic. Dr. Ronald Goldberg, a professor of medicine at the Diabetes Research Institute of the University of Miami Miller School of Medicine, whose institution participated in the study, said that "seeing quite significant effects lasting this long really bodes well for the utility of these interventions for diabetes prevention.

Cutting calories and increasing physical activity clearly slow the progression to diabetes, Goldberg said. "Lifestyle works, and every effort needs to be made to begin and maintain a lifestyle program in the long-term.

For more information on diabetes, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

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Hormone Therapy

By: Ruchi Mathur, MD

What is menopause?

Menopause is the stage in a woman's life when menstruation stops and she can no longer bear children. During menopause, the body produces less of the female hormones, estrogen and progesterone. After menopause, the lower hormone levels cause the monthly menstrual periods to stop and gradually eliminate the possibility of becoming pregnant.
These fluctuations in hormone levels can also cause troublesome symptoms, such as hot flashes (a sudden sensation of warmth, sometimes associated with flushing, and often followed by sweating) and sleep disturbance. Sometimes women experience other symptoms, such as vaginal dryness.

While many women encounter little or no trouble during menopause, others endure moderate to severe discomfort.

Does menopause cause bone loss?

The lower estrogen levels of menopause can lead to progressive bone loss that is especially rapid in the first five years after menopause. Some bone loss in both men and women is normal as people age. Lack of estrogen after menopause adds another strain on the bones in addition to the usual age-related bone loss. When bone loss is severe, a condition called osteoporosis weakens bones and renders them susceptible to breaking. For more, please read the osteoporosis article.

What are estrogen therapy and hormone therapy (HT)?

Estrogen, in pill, patch, or gel form, is the single most effective therapy for suppressing hot flashes.

The term estrogen therapy, or ET, refers to estrogen administered alone. Because ET alone can cause uterine cancer (endometrial cancer) (see below), a progestin is administered together with estrogen in women who have a uterus to eliminate the increased risk. Thus, the term estrogen/progestin therapy, or EPT, refers to a combination of estrogen and progestin therapy, as is given to a woman who still has a uterus. This method of prescribing hormones is also known as combination hormone therapy.

The term hormone therapy (HT) is a more general term that is used to refer to either administration of estrogen alone (women who have had a hysterectomy), or combined estrogen/progestin therapy (women with a uterus).

All forms of hormone therapy (HT) that are FDA-approved for therapy of hot flashes are similarly effective in suppressing hot flashes.

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Lowering Your Cholesterol Heart Attack Prevention Series

By : Dennis Lee, M.D., Daniel Kulick, M.D.

What is cholesterol?

Cholesterol is a fatty substance (a lipid) that is an important part of the outer lining (membrane) of cells in the body of animals. Cholesterol is also found in the blood circulation of humans. The cholesterol in a person's blood originates from two major sources; dietary intake and liver production. Dietary cholesterol comes mainly from meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol content, while foods of plant origin contain no cholesterol. After a meal, cholesterol is absorbed by the intestines into the blood circulation and is then packaged inside a protein coat. This cholesterol-protein coat complex is called a chylomicron.

The liver is capable of removing cholesterol from the blood circulation as well as manufacturing cholesterol and secreting cholesterol into the blood circulation. After a meal, the liver removes chylomicrons from the blood circulation. In between meals, the liver manufactures and secretes cholesterol back into the blood circulation.

What are LDL and HDL cholesterol?

LDL cholesterol is called "bad" cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.

HDL cholesterol is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high level of HDL cholesterol (low LDL/HDL ratios) are desirable.

Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.

What determines the level of LDL cholesterol in the blood?

The liver not only manufactures and secretes LDL cholesterol into the blood; it also removes LDL cholesterol from the blood. A high number of active LDL receptors on the liver surfaces is associated with the rapid removal of LDL cholesterol from the blood and low blood LDL cholesterol levels. A deficiency of LDL receptors is associated with high LDL cholesterol blood levels.

Both heredity and diet have a significant influence on a person's LDL, HDL and total cholesterol levels. For example, familial hypercholesterolemia (FH) is a common inherited disorder whose victims have a diminished number or nonexistent LDL receptors on the surface of liver cells. People with this disorder also tend to develop atherosclerosis and heart attacks during early adulthood.

Diets that are high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Fats are classified as saturated or unsaturated (according to their chemical structure). Saturated fats are derived primarily from meat and dairy products and can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.

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Preventive Antibiotics Help Some Kids Fend Off Urinary Infections

Children who are predisposed to recurrent urinary tract infections are commonly treated with preventive antibiotics, and a new Australian study suggests that such prophylactic therapy may have at least a modest effect.

Only 13 percent of youngsters who were given the antibiotic combination of trimethoprim plus sulfamethoxazole (brand names Bactrim and Septra) developed a urinary tract infection while on the medication compared to 19 percent of the children on a placebo, according to the study.

"There was a small benefit across many groups of children, which will be worthwhile in some -- e.g., very young children, those with severe infections and those with recurrent infections," said the study's lead author, Dr. Jonathan C. Craig, a professor of clinical epidemiology at the School of Public Health at the University of Sydney in Australia.

Results of the study are published in the Oct. 29 issue of the New England Journal of Medicine.

Urinary tract infections (UTIs) are very common in children. According to the study, 2 percent of boys and 8 percent of girls will have at least one UTI by the time they're 7 years old. Although often a mild infection, UTIs can be serious, with as many as 5 percent of children with one of these infections developing some type of kidney damage.

And that kidney damage can be long-lasting, according to Dr. Alejandro Hoberman, of the Children's Hospital of Pittsburgh, who authored an accompanying editorial in the journal.

"Some children have a condition known as vesicoureteral reflux, which with a urinary tract infection can lead to renal scarring, which can eventually lead to high blood pressure, the pregnancy complication preeclampsia and even kidney problems," Hoberman explained.

Craig's study included children with varying degrees of vesicoureteral reflux, which means urine backs up from the bladder into the kidney, as well as children without this condition. However, all of the children included in the study had had at least one symptomatic UTI.

The median age of the children at the start of the study was 14 months, and they were recruited from four centers in Australia. Just under two-thirds of the children were girls.

Half of the children (288) were randomly selected to receive the antibiotic combination preventively for 12 months, while the other youngsters received a placebo for 12 months.

The finding that 13 percent of the children receiving antibiotics developed a UTI during the study period versus 19 percent of those on placebo means that 14 children have to be treated with antibiotics to prevent one UTI from occurring, according to the study.

There were no statistically significant differences in the rates of adverse events in either group.

"This study is a welcome addition to the literature. It was a larger sample of children and had a control group with placebo, but there were only modest treatment effects. I think it's probably not a one-size-fits-all approach. There may still be subgroups of children [like those with reflux] who may benefit more," said Hoberman.

But, he added, "I'm not ready to completely discount antimicrobial prophylaxis yet. Let's not throw the baby out with the bathwater."

Craig said he believes the modest reduction in urinary tract infections with preventive antibiotic use outweighs the potential risks, such as the possible development of antibiotic-resistant bacteria.

More Information

To learn more about urinary tract infections in children, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

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