Marion County Medical Center

Health Shorts

November 2006

Depression–Cause or Effect
Of Sleep Problems?
Insomnia has long been considered one of the major symptoms of depression, but two recent studies suggest that, at least in some cases, insomnia may be the cause rather than an effect of depression.

In one study, older adults with insomnia but no history of mood disorders were six times more likely to develop depression than similar subjects who slept well. Another study found that symptoms of depression were more likely to linger for a year or longer in depressed patients with insomnia compared to those who were sleeping well.
[SOURCE: Salynn Boyles, “Insomnia May Trigger Depression, Study Shows,” WebMD Medical News, June 24, 2005; 19th Annual Meeting of the Associated Professional Sleep Societies, Denver, June 18-23, 2005]

Keep Eyes Wide Open When
Trying Alternative Sleep Therapies
If you’re having trouble sleeping at night, you may be tempted by the claims of numerous alternative treatments. Among supplements with sleep-inducing claims are valerian root, chamomile, passionflower, hops, ginseng, lemon balm, skullcap and melatonin. Most of these remedies have not been thoroughly studied for safety and efficacy, and they may interact negatively with prescription medications.

Always tell your doctor about any supplements you are taking.
Promptly report side effects such as nausea, vomiting, rapid heartbeat, anxiety, diarrhea or skin rashes. And stop taking the supplement.
Avoid any product made with more than one herb.
Purchase only reputable brands that provide clearly on the label the name and address of the manufacturer, the herb’s common and scientific names, expiration date, dosage guidelines and possible side effects.

[SOURCE: The Cleveland Clinic, “Sleep Disorders: Alternative Treatments for Insomnia,’ ed. Cynthia Haines, M.D., February, 2006]

Hot Flashes Cool Sleep Urges
More than 80 percent of menopausal and post-menopausal women with severe hot flashes had chronic insomnia, according to a study published in the Archives of Internal Medicine [September, 2006]. The more severe the hot flashes, the greater the prevalence of sleep problems.

[SOURCE: “Women with Insomnia Should Be Asked about Hot Flushes,” Nursing Standard, September 6, 2006; M.M. Ohayon, “Severe Hot Flushes Are Associated with Chronic Insomnia,” Archives of Internal Medicine, 166, 12, 1262-1268]

Alcohol–Good and Bad for the Heart
One or two alcoholic drinks a day may help protect against heart disease, but heavy consumption of alcohol can weaken the heart and affect its structure, contributing to congestive heart failure.

In some individuals, this change in the structure and size of the heart brought on by heavy drinking can also promote irregular heart rhythms. In one Danish study, men consuming 35 or more drinks a week had a 45 to 63 percent increased risk of atrial fibrillation compared to moderate drinkers.
[SOURCE: “The Risks of Heavy Drinking,” Johns Hopkins White Papers, Coronary Heart Disease, 2006; Circuluation, September 20, 2005]

Runners’ Knee Plagues Marathoners
If you’re training for a marathon, you may encounter chondromalacia patella, or “runner’s knee”–probably at about the time you worked your training mileage up to 40 miles a week or more.

Chondromalacia is a softening of the cartilage just behind the kneecap that manifests itself as a dull pain around the knee cap that may get worse when you go down stairs or run down hill. The cause is usually overuse combined with poor alignment–relatively weak thigh muscles, lack of support from the feet or both. Treatment involves icing the knee, cutting back on hills and speed work, strengthening the appropriate thigh muscles and beefing up stability for the feet with shoes and inserts.

[SOURCE: Matthew Donohoe, Helen Aslanian and Kenneth Solomon, “Types of Knee Injuries and How They Occur,” The Forensic Examiner, Spring, 2005]

CHF May Increase Risk of Alzheimer’s
A five-year study of adults age 75 and over found that those with heart failure had a more than 80 percent increased risk of developing Alzheimer’s disease or another dementia. Subjects with diastolic blood pressure lower than 70 mm Hg also had an increased risk of dementia.
The study found that use of diuretics and other blood pressure drugs tended to counteract the higher risk for dementia.

[SOURCE: “Heart Failure Patients More at Risk of Dementia, Alzheimer’s Disease,” Men’s Health Advisor, July, 2006; Archives of Internal Medicine]

Diuretics Improve Exercise Capacity
Diuretics have always been a standard part of treatment for congestive heart failure, and a recent study found that these drugs improved exercise capacity of heart failure patients by as much as 30 percent. The study concluded that patients may be at increased risk of hospitalization or even death if diuretics are withdrawn.
[SOURCE: William E. Cayley, Jr., “Diuretics for Treatment of Patients with Heart Failure?” American Family Physician, August 1, 2006]

Bone Stress Often Causes Knee Pain
A study of Finnish military recruits found that nearly 10 percent suffered bone stress injuries that caused pain in the knee as a result of increased physical activity during basic training. Stress injuries or fractures can occur in any bone, but in this study subjects with bone stress injuries near the knee reported their pain about two weeks earlier than those with stress injuries in other areas of the body.

Military recruits with a running background were less likely to develop stress fractures, probably because of their training history.
[SOURCE: Maria H. Niva, Martti J. Kluru, Riina Haataja and Harri K. Pihlajamaki, “Bone Stress Injuries Causing Exercise-Induced Knee Pain,” The American Journal of Sports Medicine, January, 2006]

Take Your Meds, Follow Your Diet
Heart failure is the most common reason that an older American is admitted to the hospital...and the most common reason for re-admission. The re-admission rate within the first six months after discharge is close to 50 percent. Two important preventable reasons for re-admission are non-compliance with medication and failure to follow dietary instructions.
[SOURCE: Kathleen L. Grady, “Management of Heart Failure in Older Adults,” Journal of Cardiovascular Nursing, September-October, 2006]

Female Knees Are More Vulnerable
A young female athlete is three to four times more likely than a male the same age to suffer an injury to the anterior cruciate ligament of the knee, according to the National College Athletic Association.

One reason may be the wider quadriceps or Q angle–the angle between the hips and the knees–in broader-hipped females. In addition, studies have shown that women basketball players tend to land from a jump on flat feet while men tend to land on their toes with bent knees. Compared to males, women also rely more heavily on their quadriceps as opposed to their hamstring muscles. These differences can be easily corrected through adjustments in training.
[SOURCE: “Female Basketball Players at Greater Risk for Knee Injury: August 13,” Physical Therapy, October, 2004; Marc Darrow, “The Functioning Knee” from The Knee Sourcebook, Contemporary Books, 2002]

Folate from Food Cuts Cancer Risk
An observational study of about 82,000 males and females in Sweden found a lower risk of pancreatic cancer in subjects with a high intake of folate-rich foods–green, leafy vegetables; cruciferous vegetables (such as broccoli, cauliflower and cabbage); oranges; legumes, and whole grains.

No lower risk was found, however, for subjects taking folic acid supplements. Cereals in Sweden are not fortified with folate, as they are in the United States.
[SOURCE: Miranda Hitti, “Folate May Cut Pancreatic Cancer Risk,” WebMD Medical News, March 14, 2006]

Cereal and Milk Good for Teens
Adolescents with a high intake of whole grains, refined grains and dairy products were less likely than other youth to have high blood concentrations of homocysteine, according to data from the Child and Adolescent Trial for Cardiovascular Health. A high homocysteine level during childhood and adolescence is believed to be a risk factor for cardiovascular disease in later life.

No association was found between homocysteine concentrations and intake of fruits, vegetables or red or processed meats. A high intake of poultry was associated with higher homocysteine levels.
[SOURCE: Pamela L. Lutsey, et al, “Serum Homocysteine Is Related to Food Intake in Adolescents: The Child and Adolescent Trial for Cardiovascular Health,” American Journal of Clinical Nutrition, June, 2006]

Folate May Help Keep Mind Strong
Popeye was known for being able to “fight to the finish” because he ate his spinach. And there are many other benefits from eating green, leafy vegetables and other foods rich in folate. Older male subjects in the Veterans Affairs Normative Study on Aging who obtained more folate through their diets showed significantly less decline in verbal fluency and spatial copying skills over a three-year period than those with lower folate intake.

Another study published in the same issue of the American Journal of Clinical Nutrition found low folate associated with a higher risk of Alzheimer’s disease.
[SOURCE: “Folate and Other B Vitamins May fight Mental Decline with Aging,” Tufts University Health & Nutrition Letter, December, 2005]

Men’s Testosterone Levels Plummet
Average levels of the male hormone testosterone have been dropping an average of one percent a year since the early 1980s, according to data from 1,700 Boston men in the Massachusetts Male Aging Study. In other words, a 65-year-old male in 2002 would have had 15 percent lower testosterone than a comparable male in 1987.
[SOURCE: Anne Harding, “Men’s Testosterone Levels Declined in Last 20 Years,” Reuters Health, October 31, 2006; Journal of Clinical Endocrinology and Metabolism, January, 2007]