Drop and pull up 20 weeds to stay in shape

In the fitness world there’s an ongoing debate about whether gardening constitutes moderate physical activity. Yes, say some; the walking, bending, digging and pruning that go on are strenuous enough to gain fitness benefits. No, say others; more vigorous movement is needed to make a difference.

A recent study may put this discussion to rest, at least when it comes to older people. Researchers from Kansas State University studied the gardening habits of 14 older men and women and determined that their time spent among the foliage does count as moderate physical activity — important to note, since many people become sedentary as they age. They observed how much time the participants, ages 63 to 86, spent on tasks such as watering, walking, cleaning tools, weeding and harvesting. During these tasks their heart rates and oxygen uptake were measured to determine how hard they worked. Standard metabolic equivalent measures were used to rate the intensity.

Activities such as digging, raking and mulching used upper and lower body muscles and were considered moderate intensity, while lower intensity work like mixing soil and hand weeding engaged only the upper body.

Overall, researchers concluded the gardeners’ activity was of moderate intensity, changing with the seasons and plant growth cycles. In logs that the gardeners kept to track their activity, they reported spending on average 33 hours a week gardening in May and 15 hours a week in June and July.

The study noted that since boredom is a familiar reason many give for abandoning exercise, the dynamic qualities of gardening could help people stay active. The study was published recently in the journal HortTechnology.

-- Jeannine Stein

Photo: Carol J. Williams / Los Angeles Times

Vitamin supplements fail to reduce cancer risk in women

This has been a dismal year for vitamin supplements. People continue to buy them but data from numerous controlled clinical trials published this year have failed to show that vitamin supplements decrease the risk of various diseases, such as cancer. An overview of the findings was published in the Los Angeles Times earlier this month by reporter Karen Kaplan.

Adding to the tally of failed vitamin trials is a study published yesterday in the Journal of the National Cancer Institute that found women who took beta carotene or vitamin C or E or a combination of supplements had a similar risk of cancer as women who did not take the supplements. The study by researchers at Brigham and Women's Hospital and Harvard Medical School tested the supplements on 7,627 women. After more than nine years of follow-up, there was no difference in cancer risk.

Studies following the health habits of large groups of people have shown that eating lots of fruits and vegetables is linked to a lower risk of cancer and other diseases, and the advice to eat multiple servings of fruits and vegetables each day has not changed. It will take more research to understand why a healthy diet seems to have disease-prevention powers that are lacking in use of supplements.

In an editorial accompanying the study, Dr. Demetrius Albanes of the National Cancer Institute points out that the new study still contributes to a better understanding of cancer processes. For example, the study found some evidence that vitamin E may reduce colon cancer risk and beta carotene was linked to a modest rise in lung cancer risk. These findings have also been shown in previous trials.

-- Shari Roan

Photo: Vitamin E. Credit: Robert Gauthier / Los Angeles Times 

Pediatrician slams vaccine book

A report published Monday in the journal Pediatrics charges the author of a popular book for parents on childhood vaccines with stoking fears about vaccine safety and misrepresenting the science behind the nation's immunization policy. "The Vaccine Book: Making the Right Decision for Your Child" was published last year by Dr. Robert Sears, son of the well-known Capistrano Beach pediatrician and author William Sears.

In a scathing critique not often seen in a pediatric journal, vaccine expert Paul A. Offit and coauthor Charlotte A. Moser say the book misrepresents science; supports delaying, withholding or spacing out vaccines; endorses the concept of natural immunity through such methods as chickenpox parties; does not distinguish between solid science and poorly conducted studies; and commits several errors of fact. "In an effort to protect children from harm, Sears' book will likely put more in harm's way," Offit and Moser write.

"He [Sears] believes that parents' fears should be indulged by offering alternative schedules, not countered by scientific studies, and he fails to explain that good science is the only way to determine whether a vaccine causes a particular adverse event. Instead, Sears alludes to evidence on both sides of any issue, failing to distinguish studies on the basis of their quality, internal consistency, or reproducibility and failing to distinguish those that are accepted by the scientific community from those that are not."

Sears issued a response in which he expresses surprise at the vitriol and says his position on childhood vaccination does not differ significantly from the American Academy of Pediatrics. Sears says he erred in the book by not distinguishing between good vaccine studies and poor ones but calls the Pediatrics paper "riddled with selective, misleading, and inaccurate quotes."

The biggest point of contention between the two papers, which can be found on their respective websites, Pediatrics and TheVaccineBook, is whether it's reasonable for parents who are worried about their individual child's safety to postpone or skip some vaccines. Offit and Moser call this strategy an invitation to more community outbreaks of measles, pertussis and mumps. But Sears defends the idea.

"Where my alternative schedule comes into play is for those parents who are still unsure about vaccines but they do want to fully vaccinate. I offer them an optional schedule that gets their child full vaccinated, but at a slower pace. It doesn't delay any of the most important shots."

Some of the arguments between the two papers are trivial, but the fundamental disagreement is not. The nation's public health policy depends on widespread support for childhood vaccination. However, a growing number of parents are apparently uncomfortable with having their children receive so many vaccines in a short amount of time. Their reticence to adhere to the recommended schedule may launch a return to the days when children were left immobile from polio or brain-damaged or dead from meningitis. Hopefully, the value of the nation's childhood vaccine program will come into full focus for everyone before then.

-- Shari Roan

Photo credit: Irfan Khan / Los Angeles Times

Blood sugar linked to 'senior moments'

The decline in mental sharpness is among the most distressing aspects of aging. But a new study suggests that good blood sugar control, even in people without any evidence of diseases such as diabetes, may be an important strategy to maintain healthy brain function in later life.

The study, published today in the Annals of Neurology, focuses on changes in the hippocampus part of the brain. Even in people without Alzheimer's disease, the hippocampus is vulnerable to aging. As this part of the brain declines, so do functions like memory. Researchers from Columbia University Medical Center, however, have shown that rising levels of blood glucose, which occurs normally during aging, may be a contributing factor to a lackluster function in the hippocampus. Ways to reduce blood sugar levels, such as through exercise, could be a way for people to postpone some of that normal cognitive decline in old age.

"Whether through physical exercise, diet or drugs, our research suggests that improving glucose metabolism could help some of us avert the cognitive slide that occurs in many of us as we age," said the lead author of the study, Dr. Scott A. Small, in a news release.

To arrive at their findings, Small and his colleagues mapped out specific areas of the hippocampus impacted by diseases such as diabetes and stroke. They found that blood glucose selectively targets the dentate gyrus area of the brain. Decreasing activity in the dentate gyrus correlated with rising blood sugar levels. Other studies have also shown that exercise causes an improvement in the dentate gyrus function.

--Shari Roan

Photo: Cerebral blood flow is mapped in the brain of someone with diabetes. Warmer colors indicate greater activity. Credit: Columbia University Medical Center.

Overweight and obese kids: Are enough being diagnosed?

Parents aren’t always aware (or acknowledge) that their children and teens are overweight or obese. It often falls to doctors to correctly diagnose those children, and, in the best-case scenario, give them guidance for a weight-loss program.

But are physicians doing a good enough job at identifying which kids are too heavy? Maybe not, says a new study that reveals diagnoses may be falling short.

Researchers examined medical records from 60,711 patients age 2 to 18 who had at least one well-child visit between 1999 and 2007. Going by body mass index scores, 19% were considered overweight, 23% obese, and 8% (or 33% of the obese patients) severely obese.

However, among all overweight and obese patients, only 34% were diagnosed as such. Breaking it down, among the overweight children, only 10% received that diagnosis, while 54% of obese kids and 76% of severely obese kids were identified that way. Also, girls were more likely to be diagnosed than boys, while Latino and African American children were more likely than whites to be diagnosed. Results were published in the January 2009 issue of the journal Pediatrics.

Researchers make the point that diagnosing and helping children before they become obese may be the best plan, but study results show that few overweight children may be identified as having a problem.

"As with any chronic disease," the study authors wrote, "early diagnosis of overweight and obesity is likely to be an important step toward reducing morbidity, mortality, and health care."

-Jeannine Stein

Gastric bypass surgery resolves diabetes in teens

Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal Pediatrics.

Studies on adults with Type 2 diabetes show that gastric bypass can result in disease remission or better disease control. However, this study is the first to explore the effects of the surgery in children. The study examined adolescents with Type 2 diabetes, which is usually related to obesity and is being diagnosed with alarming frequency in American children and teenagers.

Dr. Thomas Inge, director of the Cincinnati Children's Surgical Weight Loss Program for Teens, studied 11 extremely obese teens with Type 2 diabetes who had gastric bypass surgery and 67 obese teens who were receiving medical management for Type 2 diabetes. Among the 11 teens who underwent surgery, all but one had a remission in diabetes. The response was so rapid, the patients often discontinued medication for diabetes control before leaving the hospital after surgery. These teens lost an average of 34% of their body weight one year after surgery. In contrast, the teens who were medically managed did not have any weight change after one year and were all still taking medication for diabetes. The adolescents who had surgery also had improvements in blood pressure, cholesterol and triglyceride levels.

"The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery," Inge said in a news release.

Inge and his co-authors noted that future studies will be needed to track the long-term health of teenagers who participated in the study. Cincinnati Children's Hospital is home to a study funded by the National Institutes of Health that will collect and report outcomes on 200 teens undergoing weight-loss surgery nationwide.

-- Shari Roan

Photo: Amanda Munson is among the participants in Cincinnati Children's study on gastric bypass surgery. Credit: Ernest Coleman / Cincinnati Enquirer

FDA approves product to plump eyelashes

A glaucoma drug that has been on the market for years has been approved by the Food and Drug Administration for a new use: making eyelashes longer and fuller.

Allergan Inc. of Irvine announced Friday that the company had received the government's blessing to market Latisse for a condition called hypotrichosis of the eyelashes. Eyelash hypotrichosis is defined as not having enough eyelashes. While mascara has served mankind well for many years, Latisse is the first science-based product to enhance eyelashes and it stands to earn Allergan an estimated $500 million a year, according to the company. The drug is a once-daily prescription treatment applied to the upper eyelashes with a disposable applicator. Studies show lashes grow darker, fuller and longer in  eight to 16 weeks, however, continued use is necessary to maintain the benefits. Available by prescription only, Latisse will sell for about $120 for a one-month supply.

How Latisse works is a bit of a mystery. The active ingredient, bimatoprost, is a lipid that binds to prostaglandin receptors. These receptors are found in hair follicles. The phase-three study of Latisse revealed no serious side effects but darkening of the eyelid skin may occur as well as skin sensitivity and eye redness. During the FDA hearings on Latisse earlier this month, some doctors expressed worry that teen-agers might over-use the product and suffer unknown side effects. The safety of Latisse in pediatric patients has not been established.

Allergan will announce a time line for distribution of the product in January.

-- Shari Roan

Photo: Before and after photos of a patient using Latisse. Credit: Allergan Inc.

Gay and bisexual black men lag behind others in prostate cancer screening

Many doctors recommend that once men reach 50, they should be screened for prostate and colorectal cancer. However, not all men get those tests, and a recent study has found that discrepancies exist among some groups.

Among all racial and ethnic groups and regardless of sexual orientation, African American men are least likely to get tested for prostate cancer. Prostate-specific antigen tests among gay and bisexual African American men were done 12% to 14% less than among heterosexual African Americans and 15% to 28% less than gay and bisexual white men. This is especially important considering African American men have significantly higher prostate cancer rates than white men.

It was a different story in the Latino community, however: Gay and bisexual Latinos’ use of up-to-date PSA testing was 11% higher than heterosexual Latino men and about the same as rates among gay and bisexual white men.

"Gay and bisexual black men had the lowest use of the PSA test, compared with every other group of men in the study," said the study’s lead author, Kevin Heslin, in a news release. Heslin, assistant professor at Charles Drew University in Los Angeles, added, "For blacks, being a member of both racial and sexual minority groups represents a kind of double jeopardy when it comes to getting PSA testing."

Data were examined from 19,410 men who participated in the California Health Interview Survey. Results were published in the December issue of the journal Medical Care.

Researchers also discovered that among all groups, more gay and bisexual men have received colorectal cancer tests than heterosexual men. That may be chalked up to the fact that gays and bisexuals may have greater access to tests, and that they also may be diagnosed as part of testing for sexual health issues.

-- Jeannine Stein

Missing a little sleep hurts a lot

Researchers already know that not getting enough sleep is bad for you. It can increase your risk of high blood pressure, diabetes and gaining weight. Now it appears that it can also increase hardening of your arteries.

Dr. Diane Lauderdale of the University of Chicago Medical Center and her colleagues studied 495 people in their 30s and 40s, fitting them with sophisticated sensors to determine how much sleep they got over a three-night period at the beginning of the study and five years later. They also used electron-beam CT scans at the beginning and end of the study to measure the thickness of the walls of the coronary arteries that deliver blood to the heart.

Over the five years the subjects were monitored, about 12% of those in the study suffered a thickening in the walls of their coronary arteries, an early warning of heart disease, the team reported Tuesday in the Journal of the American Medical Assn. Among those who slept fewer than five hours per night, however, 27% had artery thickening. For those who slept five to seven hours, only 11% developed thickening. And among those who slept more than seven hours a night, only 6% had thickening.

The size of the effect "came as a surprise," Lauderdale said. "It is also something of a mystery" because researchers have no good idea of the biological mechanism. It is possible there is some yet-to-be-identified factor that decreases sleep duration and increases artery hardening. Or the reduced sleep may mean that average blood pressure levels are higher. Finally, stress or a stress hormone like cortisol, which has been tied to decreased sleep and increased hardening, may play a role.

Or there may be some other reason they have not considered, she added.

Lauderdale conceded that the study was relatively small and said she would like to see it replicated. But considering what is already known about the effects of sleep deprivation, this work simply provides one more reason to try to get a good night's sleep.

-- Thomas H. Maugh II

Living close to where alcohol is sold could affect teen drinking

Peer pressure may be a key cause of teen drinking, but it might not be the only factor.

A new study reveals that the closer teens live to where alcohol is sold, the greater the risk may be of binge drinking and driving under the influence.

Researchers from the Pardee RAND Graduate School in Santa Monica looked at the number and location of alcohol retailers in zones around homes in California to see what relationship existed between proximity to those stores and drinking in children ages 12 to 17. They found a significant association among homes within walking distance of places selling alcohol (about half a mile) and evidence of binge drinking and driving after drinking, and predict that moving those stores and restaurants farther away could reduce those numbers.

The study also noted that alcohol is more readily available in minority and lower-income areas. In predominantly white neighborhoods, within a half-mile there are an average 5.5 locations with active alcohol licenses. In predominantly African American neighborhoods it’s 6.4 locations; in predominantly Latino, 8.6; and in predominantly Asian, 9.5. Researchers point out that living in areas with higher alcohol sales could also mean more exposure to violent crime and drunk driving.

"Our study suggests that living in close proximity to alcohol outlets is a risk factor for youth," write the authors, whose study appears online this month in the American Journal of Public Health. "In California, retail licenses are not typically approved within 100 feet of a residence or within 600 feet of schools, public playgrounds and nonprofit youth facilities, but proximity by itself is not sufficient to deny a license. Our study suggests that more attention on the proximity rule is needed and environmental interventions need to curb opportunities for youth to get alcohol from commercial sources, whether being through tightening licensure or enforcing minimum age drinking laws."

-- Jeannine Stein

Photo credit: Charlie Litchfield / AP