Biofeedback technique eases musicians' anxiety

If you've ever sat down at the piano to play a Mozart sonata and couldn't find middle C, you know the feeling of performance anxiety. The condition, often called stage fright, is anxiety that is so severe it can impede performance. As many as three-quarters of musicians have musical performance anxiety. Thus, for serious students, learning to master this condition may be as important as learning all the scales.

A new study shows that a specific biofeedback technique is highly effective in decreasing stage fright. Researchers studied 14 college-age musicians. The musicians' tendency to have stage fright was estimated in a performance before an audience at the start of the study (with questionnaires and heart rate measurements). Half of the musicians repeated the performance four weeks later. The other half received training in biofeedback that was designed to teach them how to control their heart rate through thoughts and emotions. These students also performed again after four weeks.

The study showed a 71% decrease in performance anxiety in the biofeedback group compared with the control group. The biofeedback group had a 62% improvement in performance. The musicians in the biofeedback group also said they had an overall increased sense of calmness, slept better, were more relaxed and had less anger in their everyday lives.

Biofeedback helps coordinate the brain-heart-body processes, the authors wrote. This synchronicity defeats performance anxiety and gives musicians a feeling of "flow," the authors said, which they defined as "when a person is functioning at peak capacity, including mind, body and energy."

The study appears in the current issue of Biofeedback, published by the Assn. for Applied Psychophysiology and Biofeedback.

-- Shari Roan

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Photo credit: Mel Melcon  /  Los Angeles Times

Job stress can cause heart attacks for women too

Here’s another crack in the glass ceiling: New research shows that high-pressure jobs can raise the risk of heart disease in women as well as in men.

The findings are based on a long-term study of more than 12,000 Danish nurses. Researchers interviewed them in 1993 and asked them how much pressure they felt at work. Over the next 15 years, 580 of them had to check into the hospital to get treatment for ischemic heart disease, including 369 cases of chest pain and 138 heart attacks.

It turned out that nurses who said their work pressure was “much too high” were 50% more likely to be diagnosed with heart disease. After adjusting for factors like smoking habits and lifestyle, the increased risk was revised to 35%.

The researchers, from Glostrup University Hospital in Denmark, also found that the effect was limited to nurses ages 50 and younger.

The study appears in the journal Occupational and Environmental Medicine.

-- Karen Kaplan

Photo: Women (and men) who keep work stress in check could protect their hearts. Credit: Reed Saxon / Associated Press

Get in touch with your stress today!

Perhaps it was the big check you wrote out yesterday. Or the scramble to get to the post office to get said check postmarked in time. Perhaps it's the endless demands of jobs and family. Maybe it's just become a way of life.

If you're stressed, then you've got a reason to have a celebratory cocktail today: April 16 is National Stress Awareness Day.

Oh, wait. National Stress Awareness Day was established in 1982 and has been sponsored yearly by the Health Resource Network, a nonprofit health organization, to encourage healthy ways of dealing with stress.

All right, forget the cocktail. Perhaps a nice walk in the mountains -- or around the parking lot -- instead? Perhaps you should slip into a meditation class between those endless meetings or errands? Or maybe just meditate briefly about the future prospect of learning to meditate. That ought to help. 

In fact, the entire month of April has been designated stress awareness month. But April 16 is a special day on our yearly stress-ometer, the more so this year because everybody's going all tea-party about paying taxes.

Guess who's got ideas on what to do on National Stress Awareness Day? La-Z Boy, maker of the eponymous recliners. They suggest you elevate your feet and get some lumbar support. The Ski Channel also has some ideas that involve elevating your entire body to a higher altitude and coming down -- really fast.

Just so we're clear on this, stress -- in particular chronic stress -- is bad for your health. It's pretty clearly linked to elevated blood pressure and incidence of stroke, it can wreak havoc with your memory and, if you deal with it poorly, can raise your risk of depression -- a new article in Nature Neuroscience recently looked at this link. And then there's the grinding and clenching of teeth. A recent article in BioMedCentral's open access publication Head and Face Medicine found that grinding and clenching of the teeth at night is largely the result of poorly managed stress.

So, be sure to put "celebrate Stress Awareness Day -- healthily" on your to-do list.

--Melissa Healy

  

Book Review: 'The Strong Women's Guide to Total Health' by Miriam E. Nelson and Jennifer Ackerman

Although men may have more heart attacks, more women die as a result of them. Women have stronger immune responses  --  with increased resistance to many infections -- but are much more likely than men to develop autoimmune diseases. Men are more likely to have schizophrenia and alcohol and drug addiction, whereas women have more depression, anxiety and eating disorders. 

Those are just some of the ways women's health differs from men's, according to Miriam E. Nelson and Jennifer Ackerman, authors of "The Strong Women's Guide to Total Health."

"Our gender affects everything from the makeup of our bones and the architecture of our joints, to our skin's response to sunlight and aging, to how we experience pain, react to drugs, and cope with stress," they write.

Until fairly recently, medical researchers considered men's bodies the prototype for both genders. But today women are more than half of participants in health studies, and researchers are looking closely at illnesses affecting mostly them, Nelson and Ackerman write. 

In fact, there is so much health information available to women -- much of it contradictory -- that it can get confusing.

That's where "Strong Women's Guide" comes in. The book aims to summarize the latest thinking on women's health and offer "basic, reliable guidelines for staying well in body, mind and spirit."

And it appears to do so remarkably well considering the range of topics it covers, including reproductive and sexual health; skin, teeth, hair and nails; body weight and metabolism; muscles, bones and joints; the heart and lungs; cancer and disease; vision and hearing; and mental health.

Nelson -- the director of the John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention and an associate professor of nutrition at Tufts University -- has gained a following with earlier "Strong Women" books on topics such as weight control and bone health. Ackerman is a science and health writer and the author of several other books, including "Sex Sleep Eat Drink Dream."

Their new book is not the place you would go for in-depth coverage of a specific health topic, but it offers solid overviews, useful advice and quite a bit of up-to-date detail. 

The section on birth control, for example, looks at the varied oral contraceptives available today, including a spearmint-flavored chewable pill, the three-month combination pill, the mini-pill, the "no more period" pill and other hormonal options such as a skin patch and injections. The chapter on menopause sorts through recent research findings on hormone therapy and summarizes the options for easing symptoms. A discussion of heart disease details the symptoms unique to women and tells what to look for in cholesterol, triglyceride and blood pressure screenings.

The writing is intelligent, accessible and sometimes personal; amid the matter-of-fact health discussions are anecdotes such as one in the sexuality chapter that describes a nervous first-time trip to a sex-toy boutique. A chapter on changing habits includes a story about how a colleague once chastised Nelson for not practicing what she preached about exercise -- a comment that prompted her to start running regularly to train for the Boston Marathon.

"Strong Women's Guide" is as much a how-to health book as it is a medical reference work. It starts with a health self-assessment section that looks at everything from body mass index to joy quotient. Sprinkled throughout the book are checklists of ways to protect or improve health. The book ends with chapters on managing stress and sleeping well, eating and exercising right and getting the proper screenings, tests and vaccines at every age.

-- Anne Colby

Photo: "The Strong Women's Guide to Total Health," Miriam E. Nelson and Jennifer Ackerman, Rodale Books, $27.99 

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Book Review: 'The 6-Week Cure for the Middle-Aged Middle' by Mary Dan Eades and Michael R. Eades

The weight can creep up on you. One day you realize your waistline is not as trim as it once was. You’ve got a little belly going where you once were flat and firm. Or maybe it’s not so little.

If you’re ready to do something about it, you may be tempted by a new book that promises to help you shed those excess abdominal inches and pounds. “The 6-Week Cure for the Middle-Aged Middle” targets people about age 50 and older who have seen their waistlines expand and may be finding it harder to whittle their middles than they once did.

Authors and obesity specialists Dr. Mary Dan Eades and Dr. Michael R. Eades say they designed the diet for themselves when they needed to tighten up their midsections fast to appear more svelte for a TV cooking show. They went on to devise a plan that could be used by others struggling to shed those accumulating abdominal pounds.

This is not unfamiliar ground for the authors, who staked out similar territory in an earlier book, “Protein Power,” which sold more than 4 million copies. But much of the nutritional advice in their latest book is based on new studies and their interpretation of evolving research.

For instance? The Eadeses say saturated fats from red meat, butter, eggs and cream are good, even essential, for abdominal weight loss, as are coconut and palm oils, and they encourage their consumption. Omega-6 vegetable oils such as corn, safflower and sunflower, on the other hand, help pack on the abdominal pounds and should be avoided, they say.

Many nutritional experts advise the opposite, counseling people to strictly limit their intake of saturated fat because of the health risks and to substitute a moderate amount of vegetable oils instead. (But nutritional science does waver: A new analysis, published in the American Journal of Clinical Nutrition, questions the link between saturated fat and heart disease.) This is what the National Institutes of Health says about fats.

Also on the Eadeses’ hit list are carbohydrates, such as those found in breads, rice, pasta, oats and desserts -- whole grain or not. These are allowed only in tiny amounts (an occasional slice of “light” bread) during the six-week diet and in small amounts after that.

They recommend cutting out sugar, particularly fructose, almost entirely. (Low-sugar fruits and low-starch vegetables are allowed in minimal amounts during the diet and can be eaten freely later.) Also severely restricted during the six-week diet are dairy, caffeine and alcohol, as well as any medications not absolutely necessary.

What does one eat on the diet besides saturated fat? Protein, and lots of it. 

Book review: 'The Mayo Clinic Diet'

Some dieters want to drop a few pounds to look better in a bathing suit. Others are trying to undo years of bad eating and exercise habits and are in need of education. Still others seek weight loss on a doctor’s orders to avoid serious illness, such as heart disease or diabetes.
 
All of these people may find things to like about “The Mayo Clinic Diet,” a new book from the respected medical institution. But those in the last two groups could find its program –- the first diet developed by Mayo Clinic -- especially helpful.
 
There are no claims to magic fat-burning ingredients in this book, no nutritional supplements to buy. “The Mayo Clinic Diet” offers sound, health-focused information on how to eat better, move more and change ingrained habits that contribute to overweight and obesity.

The book leads off with "Lose It," a quick-start plan to help dieters drop 6 to 10 pounds in two weeks. In this phase they add five habits (such as eating a healthy breakfast), break five habits (eating in front of the TV) and adopt five bonus habits (keeping food and activity records). The second phase, "Live It," is a lifetime plan designed for weight loss of a pound or 2 a week until the desired weight is reached and can be maintained.
   
The book offers the usual good dieting and exercise advice, but it goes further. 

Mayo Clinic proposes its own healthy weight pyramid, making fruits and vegetables the foundation and putting exercise at the center. (Studies show that people who lose more than 30 pounds and keep it off for five years exercise an hour each day, mostly by walking, according to the book.) 

One chapter gives strategies for getting through weight-loss plateaus and relapses. Another is devoted to sticking to the diet when eating out and includes suggestions on how to eat at ethnic restaurants (avoid the fatty spareribs at Chinese restaurants; go for the hot and sour soup). A photo spread on portion control shows common foods eaten at breakfast, with pictures illustrating typical serving sizes compared with Mayo Clinic-suggested servings (8 ounces of orange juice versus 4).

There's an illustrated guide to reading nutrition labels and a checklist of warning signs for when to stop exercising (pain in an arm or the jaw, an irregular heartbeat). An endocrinology specialist, one of several Mayo Clinic professionals who contribute essays to the book, explains in easy-to-understand language some of the science behind nutrition and weight control. 

"The Mayo Clinic Diet" is written in a conversational, no-nonsense tone. It's colorful and graphically pleasing with lots of photos, sidebars and tips in bite-size chunks. Also available is "The Mayo Clinic Diet Journal," to use for tracking goals and progress.

-- Anne Colby

Photo: “The Mayo Clinic Diet,” Mayo Clinic, Good Books, $25.99 hardcover. Not pictured: “The Mayo Clinic Diet Journal," Mayo Clinic, Good Books, $14.99 plastic comb binding.

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Count to 5--it's the holidays!

Something about the holidays compels people to write lists. Maybe that's why we've been bombarded lately with "five things" pitches that consist of five tips and tricks to get or stay healthy through the holidays--you know, de-stress, avoid the 5-pound weight gain, etc. To say most of these reek of common sense and redundancy is being kind, but maybe there are one or two pointers that will help make your holidays a happier, healthier time (Note: Some tips have been edited, but we retained the key elements):

From ChicagoHealers.com, a site dedicated to natural medicine and a holistic lifestyle, "Tips for Healthy Digestion after Holiday Eating." We’re pretty much down with everything except the one about drinking apple cider vinegar diluted in water first thing in the morning. Not. Going. To happen.

1. Walk it off: Walking helps food move along the digestive tract, improving digestion and absorption. For added benefits, walk while massaging your abdomen with your palms, in a circle around your belly button.

2. Drink herbal tea: Relieve that feeling of fullness with herbal teas that target your digestion. Steep one teaspoon each of mint, rosemary, oregano, cilantro, sage and basil and in a cup of hot water. Drink after each meal to soothe and prevent bloating.

3. The next morning drink apple cider: Apple cider vinegar is traditionally used to remedy digestive distress, support liver detoxification, normalize digestive juices, and reduce intestinal bloating. Mix one tablespoon of organic apple cider vinegar with 12 ounces of warm water, and drink in the morning on empty stomach. Feel free to add a little honey or maple syrup.

4. Eat right: After overdoing it, make sure to eat meals with fiber and protein to help your body recover from the overindulgence.

5. Drink Water: Though this is hardly a secret remedy for combating a hangover, it bears repeating. Alcohol dehydrates your system, so drinking plenty of water will help combat some of your unpleasant hangover symptoms, rehydrate your body and flush out toxins.

If you need to fight stress, take the advice from the online gaming and entertainment website GR88.com. Because no one understands the pressures of the holiday like people who run an online poker and gaming website.

1. Music: According to Forbes, this was the No. 1 way Americans relieved stress in the tumultuous year of 2009. Numerous studies have demonstrated the role of music in relieving stress and it has been discovered that the rhythm or the beat of the music relieves stress.

2. Online gaming: With new online forms of entertainment and gaming emerging, researchers are beginning to find evidence that a wide variety of games can be relaxing.

3. Exercise: The therapeutic benefits of regular exercise are well documented. Study after study has shown that it increases health and general well being. It's been said that if exercise were a drug, it would be the most powerful medication on earth.

4. Mix up your daily routine: Mixing it up, whether by altering your routine or trying something new--like changing your hairstyle--can improve your outlook and mood.

5. Write it out: The physical process of writing, in combination with taking the time to focus on the things that are bothering you, can be very cathartic. What you write is not important; it is the process and the frequency that counts.

The University of Missouridevised some holiday survival strategies based on research studies conducted throughout the year. Not to knock these health and fitness smarties who no doubt have advanced degrees, but we can't get past the clock thing in the first tip. Because once we spot the brie, we're loading up (They also sneaked in a sixth tip which is not cool, Mizzou. You know the rules.):

1. "Try eating around the clock at parties--grab the smallest plate available and look at the plate as though it was a clock face," said Ann Cohen, associate state nutrition specialist for the College of Human Environmental Sciences and MU Extension. "From the noon to 6:00 position, fill it with lots of fruits and vegetables. At the 6 to 7:00 position, fill it with dip or salsa. From the 7 to 8:00 position, add some nuts. From 8 to 10:00, place crackers and cheese. The 10 to midnight position is the space for a sweet treat. Then, have a good time at the party 'eating around the clock,' starting at noon and ending at midnight."

2. "It is helpful to focus on behavioral strategies for exercise during the holiday season," said Vicki Conn, associate dean in the Sinclair School of Nursing. "Effective strategies include setting specific behavioral goals, providing reminders or cues to exercise, rewarding yourself for exercising and self-monitoring your exercise by recording all exercise sessions."

3. "Be realistic--don't focus on losing weight during the holidays. Focus on maintaining your current weight," said Susan Mills-Gray, nutrition specialist with MU extension and HES.

4. "Make sure whatever you're offered is splurge-worthy," Mills-Gray said. "Why waste calories on foods you can have anytime?"

5. "While holiday shopping, the coffee drink you choose many have more calories than you realize," said Tammy Roberts, nutrition specialist for extension and HES.

6. "Relationship conflicts can increase during busy holiday times," said Constance Brooks, nursing professor and instructor in the Master of Public Health Program. "To reduce stress, be clear in explaining to others what you want and need, instead of telling them what you want them to do."

If quitting smoking is on your to-do list for the New Year, the American Lung Assn. has some recommendations for getting through the toughest days (they tried to sneak by seven tips, but we've condensed them to five because this is just getting out of hand now):

1. Talk to your doctor or pharmacist about the different over-the-counter and prescription medications to help you quit smoking.

2. Look into the different options available to help smokers quit. Visit www.lungusa.org or call (800) 548-8252 for suggestions.

3. Take time to plan. Pick your quit date a few weeks ahead of time and mark it on the calendar. If you can, pick a day when life's extra stresses are not at their peak, such as after the holidays. Mark a day on the calendar and stick to it.

4. Get some exercise every day. Walking is a great way to reduce the stress of quitting. Exercise is proven to not only combat weight gain but also to improve mood and energy levels. Eat a balanced diet, drink lots of water and get plenty of sleep.

5. Ask family, friends and co-workers for their help and support. Having someone to take a walk with or just listen can give a needed boost. You don't have to quit alone. Help is available online and in your community. Consider joining a stop-smoking program like Freedom From Smoking from the American Lung Assn.

So there you have it. Count to five and the holidays will be breeze.

-- Jeannine Stein

Photo credit: Anne Cusack / Los Angeles Times

For some with prostate cancer, the danger is knowing you have it

As if prostate cancer were not a grim enough topic, a study released this week by PLoS Medicine found that patients were 8.4 times more likely to attempt suicide within the first week of being diagnosed, and 2.6 times more likely during the first year. Men who received the news were also far more likely to experience a stroke, heart attack or other cardiovascular event than their cancer-free counterparts. Young men seemed most adversely affected.

The link between cancer and the risk of suicide has been well documented, according to a paper in the Journal of Clinical Oncology. Men who are diagnosed are far more liable than women to take their own lives – perhaps reflective of the general population, where men are four times as likely as women to complete a suicide. (Women are three times as likely to make an attempt, though. Why such different suicide- completion rates? Theories point to cognitive differences between men and women, particularly women’s tendencies to process their experiences with friends.)

If you or someone you know is dealing with the burden of cancer, don’t give up on yourself. Know that there is plenty of help and treatment out there, as well as support groups to carry you through difficult times. Here’s a fact sheet from the American Cancer Society on the symptoms of depression, and some information from the National Cancer Institute on how to cope with it.

-- Amina Khan

More evidence that Transcendental Meditation helps the heart

Transcendental Meditation has been around for many years and is perhaps the most scientifically tested of all forms of meditation. Two studies presented this week add to the evidence that this form of stress reduction benefits people with heart disease and those at high risk for it.

One study, presented on Monday at the American Heart Assn.'s annual meeting, found that heart disease patients who practice TM have almost 50% lower rates of heart attacks, stroke and deaths compared to similar patients who don't practice meditation. The study was funded with a $3.8-million grant from the federal government and was conducted at the Medical College of Wisconsin in collaboration with the Institute for Natural Medicine and Prevention at Maharishi University of Management in Fairfield, Iowa, a major center of TM research.

The study followed African American men and women over nine years. The participants were randomly assigned to practice the stress-reducing TM technique or attend traditional health education classes on heart disease prevention.

The results of TM were so striking, it was as if the participants who meditated were taking a new class of medications, the authors said.

"Previous research on Transcendental Meditation has shown reductions in blood pressure, psychological stress, and other risk factors for heart disease, irrespective of ethnicity," the lead author of the study, Dr. Robert Schneider, said in a news release. "But this is the first controlled clinical trial to show that long-term practice of this particular stress reduction program reduces the incidence of clinical cardiovascular events."

In the second study, published today in the American Journal of Hypertension, researchers found that TM was an effective tool to reduce blood pressure, anxiety, depression and anger among college students at risk for high blood pressure.

Scientists at American University in Washington, D.C., and Maharishi University randomly assigned 298 students to either learn TM techniques or remain on a waiting list for the class. After three months, the students practicing TM had reductions of 6.3 millimeters of mercury (mm Hg) in systolic blood pressure and 4.0 mm Hg in diastolic. The reductions translate to a 52% lower risk of developing hypertension in later years. The students also showed improvements in psychological distress and coping.

-- Shari Roan

Photo: The meditation room at UCI Medical Center. Credit: Bob Chamberlin  /  Los Angeles Times

Childhood stress contributes to adult depression, study finds

Growing up in a stressful environment isn’t conducive to becoming a well-adjusted adult. Studies have shown that people who were constantly stressed out during childhood have an increased risk of being depressed.

How exactly are the two related? Stress at a young age permanently alters the expression of a key gene in the brain, resulting in a lifetime of elevated levels of a hormone that contributes to depression, according to a study published this week by the journal Nature Neuroscience.

To figure this out, a team of German researchers stressed out baby mice by separating them from their mothers for three hours a day during their first 10 days of life. Other mice were kept with their mothers continuously, to serve as controls.

All the animals got blood tests when they were six weeks, three months and one year old. The mice that had been removed from their mothers’ nests had higher levels of the stress-related hormone corticosterone circulating in their blood than their counterparts, the researchers found. When the animals were subjected to stressful situations, the traumatized mice also produced more corticosterone than the controls.

The researchers, from the Max Planck Institute of Psychiatry in Munich, found behavioral deficits in the stressed-out mice too. They were more likely to freeze up in forced swim tests, and had memory problems with certain tasks.

The researchers traced these problems to decreased methylation of a key section of the AVP gene, which prompted the mice to make too much of the hormone arginine vasopressin.

To confirm that arginine vasopressin was responsible for the stress, the researchers gave the mice a drug that blocked the hormone’s effects in the brain. When the drug was working, the stressed-out mice produced normal levels of corticosterone.

“Our results suggest that adverse events in early life can leave persistent epigenetic marks on specific genes that may prime susceptibility to neuroendocrine and behavioral dysfunction,” they concluded.

-- Karen Kaplan