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Smoking: the Health Effects

Smoking is a greater cause of death and disability than any single disease, says the World Health Organisation. According to their figures, it is responsible for approximately five million deaths worldwide every year.

Tobacco smoking is a known or probable cause of approximately 25 diseases, and even the WHO says that its impact on world health is not fully assessed.

Smoking damage

The components of cigarette smoke collectively explain its health impacts. Smoke contains over 4,000 chemicals. Nicotine is the predominant addictive chemical and the reason why smokers continue to smoke.

Heart attack and stroke

UK studies show that smokers in their 30s and 40s are five times more likely to have a heart attack than non-smokers.

Tobacco contributes to the hardening of the arteries, which can then become blocked and starve the heart of blood flow, causing the attack.

Often, smokers who develop this will require complex and risky heart bypass surgery.

If you smoke for a lifetime, there is a 50% chance that your eventual death will be smoking-related - half of all these deaths will be in middle age.

Smoking also increases the risk of having a stroke.

Lung problems

Another primary health risk associated with smoking are lung cancer, which kills more than 20,000 people in the UK every year.

US studies have shown that men who smoke increase their chances of dying from the disease by more than 22 times.

Women who smoke increase this risk by nearly 12 times.

Lung cancer is a difficult cancer to treat - long term survival rates are poor.

Smoking also increases the risk of oral, uterine, liver, kidney, bladder, stomach, and cervical cancers, and leukaemia.

Another health problem associated with tobacco is emphysema, which, when combined with chronic bronchitis, produces chronic obstructive pulmonary disease.

The lung damage which causes emphysema is irreversible, and makes it extremely difficult to breathe.

Harm to children

Smoking in pregnancy greatly increases the risk of miscarriage, is associated with lower birthweight babies, and inhibited child development.

Smoking by parents following the birth is linked to sudden infant death syndrome, or cot death, and higher rates of infant respiratory illness, such as bronchitis, colds, and pneumonia.

Nicotine, an ingredient of tobacco, is listed as an addictive substance by the US authorities.

Although the health risks of smoking are cumulative, giving up can yield health benefits regardless of the age of the patient, or the length of time they have been smoking.

Smoking and young people

Smoking is particularly damaging in young people.

Evidence shows people who start smoking in their youth - aged 11 to 15 - are three times more likely to die a premature death than someone who takes up smoking at the age of 20.

They are also more likely to be hooked for life.

Future impact

By 2020, the WHO expects the worldwide death toll to reach 10 million, causing 17.7% of all deaths in developed countries.

There are believed to be 1.1 billion smokers in the world, 800 million of them in developing countries. (BBC News)
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Aura Migraines A Stroke Risk

Young women who have migraines with auras are twice as likely to have a stroke, researchers have confirmed. Auras are notable sensory or visual disturbances that occur before the onset of a migraine headache. Based on available evidence, the risk is greater if the woman is under 45, smokes and is on the contraceptive pill, say international experts.

But a migraine charity said most sufferers did not have auras and the absolute risk of a stroke was small. Migraines affect between 10-20% of people and are four times as common in women compared to men.

The researchers, writing in the British Medical Journal online, say they looked at nine of the most recent studies on the links between migraine and cardiovascular problems.

A previous large study in 2004 did find migraine sufferers had twice the risk of a stroke but the newer studies show that the risk is confined to people who suffer migraines with auras.

The investigators from the US, France and Germany did not find any link between migraines and heart attacks or death due to cardiovascular disease but there was a 30% increase in the risk of angina (heart pain).

Markus Schurks, of the Harvard Medical School and who led the research, said: "Clinicians may not agree but population studies show that up to a third of sufferers experience auras with their headaches.

"And when you consider that as many as 40% of young women suffer from migraines you can see that it really makes an impact on the health of the population."

Sex hormones

The authors recommend that young women who have migraine with aura should be strongly advised to stop smoking and methods of birth control other than oestrogen containing contraceptives should be considered.

They say recent animal studies have shown that high levels of oestrogen can produce auras in animals, so it could be the sex hormones affecting the vascular system, but more research is needed.

The British Heart Foundation recommended the women concerned reduce their risks as much possible - by switching to non-oestrogen based contraceptives, quitting smoking or contact their GP for further guidance.

Lee Tomkins, director of the charity Migraine Action, said: "I think this research will help women to understand that for the majority there is no additional risk, and for women with aura the best policy to help themselves is to have a migraine management plan in place that helps reduce the frequency of attacks, and try to minimise the aura part of the attack."

Susan Haydon of The Migraine Trust stressed: "Although the relative increased risk of stroke associated with migraine with aura is seemingly high, the actual risk is extremely low."

Dr Tony Rudd of The Stroke Association said: "Living a healthy lifestyle, taking regular exercise and having your blood pressure checked regularly are simple ways to reduce your risk of having a stroke." (BBC News)
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Psychiatric Meds Can Bring on Rapid Weight Gain in Kids

Many young children and adolescents taking drugs for severe psychiatric problems gain substantial weight and, in some cases, show increased levels of LDL cholesterol and triglycerides in their blood, researchers report in the Oct. 28 Journal of the American Medical Association.

Although the data from this study need to be replicated over a longer time frame, the findings nonetheless raise worrisome questions about anti-psychotic drugs that often benefit children who have schizophrenia, autism, tics, severe bipolar disorder or aggressive behavior.

“We are between a rock and a hard place here,” says study coauthor Christoph Correll, a psychiatrist at the Zucker Hillside Hospital in Glen Oaks, N.Y. These mental disorders are severe and can lead to suicide or to educational problems and emotional scars, he says. On the other hand, weight gain during youth predisposes an individual to chronic health problems later in life, he says.

Weight gain has been noticed before in children and adolescents taking commonly prescribed drugs for severe psychiatric problems. But studies seeking to link that weight gain to the medications were often muddied because patients had taken one of the drugs beforehand at some point — and may have already put on weight from it or reset their body metabolism to adjust to the drug somehow.

In the new study, Correll and his colleagues monitored 272 children, ages 4 to 19, between 2001 and 2007. Of these, 257 were getting psychotropics for severe problems for the first time, and 15 others refused the drugs but agreed to be seen by a doctor. The drugs were olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) or aripiprazole (Abilify). Restricting the study to first-timers eliminated problems encountered in earlier studies.

After a median follow-up period of nearly 11 weeks, these patients had gained 10 to 19 pounds on average, depending on the drug. Kids on Zyprexa gained the most, on average, while those taking Abilify gained the least. The 15 patients who had refused drug treatment gained less than one pound on average during the monitoring period.

The pace of weight gain seems to level off over time, Correll says, but further study will be needed to clarify that trend.

“This is a really good study of relatively short-term effects,” says Christopher Varley, a child psychiatrist at the University of Washington School of Medicine and Seattle Children’s Hospital. But longer-term data are needed, he says, “because you never really treat a kid with one of these conditions for only 12 weeks — it’s more like six to nine months or a year or two.”

Correll’s team intends to monitor as many of the patients as possible over a longer time period.

Child psychiatrist Linmarie Sikich of the University of North Carolina at Chapel Hill School of Medicine says that she and her colleagues have seen many patients lose weight after coming off these drugs. So far, researchers don’t have enough data to clarify why some patients lose the weight and others don’t, she says.

The biological mechanism underlying the weight gain also remains obscure, Varley says. But some effects are evident, such as carbohydrate cravings. “The appetite of these youngsters dramatically goes up,” he says. At the same time, the drugs have a mild sedative effect. “They’re not out running around, expending calories.”

Sikich says some evidence suggests that the drugs may block the body’s satiety signal.

Meanwhile, patients in this study taking Zyprexa showed increased LDL cholesterol and triglycerides, types of fat in the blood. Patients getting Seroquel also had higher triglycerides. The other drugs showed little change in these metabolic markers.

“This does leave a difficult decision, but I think we’re getting increasing guidance,” Sikich says. Clinicians would prefer to prescribe the drugs with the mildest side effects, she notes.

While all four drugs are cleared for adults, the U.S. Food and Drug Administration has specifically approved only Abilify and Risperdal for pediatric use thus far. Earlier this year, a panel of experts recommended that the FDA approve all four drugs for certain severe psychiatric problems in children. The regulatory body has yet to rule on that. (Nathan Seppa, Science News)
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Four Things You Didn’t Know About Natural Medicine

If natural medicine still sounds too alternative for you, here are four things that may help mainstream the concept for you.

It’s not so “out there”
In addition to the 38 percent of all adults in the United States who have tried natural medicine, nearly 12 percent of children have used complementary and alternative (CAM) therapies. Veterinarians use it on pets, too. “It’s not just the fringe anymore,” says Donald B. Levy, MD, medical director of the Osher Clinical Center for Complementary and Integrative Medical Therapies at Brigham and Women’s Hospital in Boston.

“It’s more widespread.” In fact, CAM is considered standard treatment in many European countries (including Germany, which regulates herbs, and France, where hospitals widely use acupuncture), so sometimes alternative treatments new to the States have already been researched and used for years abroad.

It’s a spa thing
Our strong desire to “heal” ourselves with natural medicine has made alternative therapies hot items at spas and resorts. Some treatments may sound like a wacky mix of the scientific and the spiritual—Crystal Bowl Sound Healing (at Rancho La Puerta Fitness Resort and Spa in Baja California) claims to activate alpha waves in the brain; Spirit Flight treatment (at Miraval in Tucson, Arizona) is touted as a blend of energy medicine, full-body massage, acupuncture, craniosacral therapy, and spinal alignment, along with indigenous ceremonial rituals.

But treatments like these are very popular, and an arm of the National Institutes of Health called the National Center for Complementary and Alternative Medicine (NCCAM) is researching their validity. In fact, you may be able to take part in a clinical trial for an alt med therapy being studied at a university near you.

Lots of MDs use it
More than half of U.S. medical schools now include at least some courses in alternative medicine. And the government is pumping more money than ever into research. The current budget for the NCCAM is $121.5 million—that’s 61 times as much as it was in 1992, the year the department was founded.

Many people turn to alt med when conventional therapy doesn’t do the trick, says Richard Nahin, PhD, senior advisor for scientific coordination and outreach at the NCCAM. The number-one concern: relief for chronic pain (in areas like the neck, joints, and lower back).

But adding complementary therapies like supplements (specifically, omega-3 fatty acids found in fish oils), Tai Chi or yoga, mind-body therapies (such as biofeedback), and even spiritual practices (including forgiveness), to conventional medications for heart disease is getting a lot of attention and can lower risk, says Victor Sierpina, MD, chairman of the Consortium of Academic Health Centers for Integrative Medicine.

Some docs use natural products along with prescription medication, Dr. Levy says. For instance, he may suggest that his patients who can’t tolerate migraine medication try Petasites hybridus (butterbur) root to ease the side effects. “It’s the perfect marriage with modern medicine,” he adds.

Insurance may pay for it
Just over 80 percent of employers’ health insurance plans cover chiropractic care, and more than 33 percent cover acupuncture or acupressure. At least 13 percent will pay for massage and nutrition therapy, and 9 percent cover biofeedback.

Contact your state’s insurance department to find out which companies in your area are most alternative-friendly. You may also be able to deduct some alt med treatments as medical expenses on your tax return if you itemize or as eligible expenses for most flexible-spending and health-savings accounts. (Health.com)

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White Wines 'Bad for the Teeth'

Enjoying a glass of white wine on a frequent basis can damage the teeth, something many wine makers and tasters will know first-hand, experts say. Pale plonk packs an acidic punch that erodes enamel far more than red wine, Nutritional Research reports. It is not the wine's vintage, origin or alcohol that are key but its pH and duration of contact with the teeth. Eating cheese at the same time could counter the effects, because it is rich in calcium, the German authors say. It is the calcium in teeth that the wine attacks.

In the lab, adult teeth soaked in white wine for a day had a loss of both calcium and another mineral called phosphorus to depths of up to 60 micrometers in the enamel surface, which the researchers say is significant. Riesling wines tended to have the greatest impact, having the lowest pH. A "kinder" tooth choice would be a rich red like a Rioja or a Pinot noir, the Johannes Gutenberg University team found.

Power of saliva

Even if people brush their teeth after a night of drinking, over the years repeated exposure could take its toll, say Brita Willershausen and her colleagues.

Indeed, excessive brushing might make matters worse and lead to further loss of enamel.

But they said: "The tradition of enjoying different cheeses for dessert, or in combination with drinking wine, might have a beneficial effect on preventing dental erosion since cheeses contain calcium in a high concentration."

This helps neutralise and boost the remineralising power of saliva to halt the acid attack.

But eating strawberries while supping on your vino or mixing sparkling whites with acid fruit juice to make a bucks fizz may spell trouble because this only adds to the acid attack.

Professor Damien Walmsley, of the British Dental Association, said: "The ability of acidic foods and drinks to erode tooth enamel is well understood, and white wine is recognised as being more erosive than red.

"But it's the way you consume it that's all important. If you're going to have a glass of wine do so with your meal and leave a break of at least 30 minutes afterwards before you brush your teeth and go to bed.

"Consuming wine alongside food, rather than on its own, means the saliva you produce as you chew helps to neutralise its acidity and limits its erosive potential.

"And leaving time before brushing teeth gives the enamel a chance to recover from the acid attack and makes it less susceptible to being brushed away." (BBC News)

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Science to 'stop age clock at 50'

Centenarians with the bodies of 50-year-olds will one day be a realistic possibility, say scientists. Half of babies now born in the UK will reach 100, thanks to higher living standards, but our bodies are wearing out at the same rate. To achieve "50 active years after 50", experts at Leeds University are spending £50m over five years looking at innovative solutions. They plan to provide pensioners with own-grown tissues and durable implants. New hips, knees and heart valves are the starting points, but eventually they envisage most of the body parts that flounder with age could be upgraded.

New lease of life

The university's Institute of Medical and Biological Engineering has already made a hip transplant that should last for life, rather than the 20 years maximum expected from current artificial hips.

The combination of a durable cobalt-chrome metal alloy socket and a ceramic ball or "head" means the joint should easily withstand the 100 million steps that a 50-year-old can be expected to take by their 100th birthday, says investigator Professor John Fisher.

Meanwhile, colleague Professor Eileen Ingham and her team have developed a unique way to allow the body to enhance itself.

The concept is to make transplantable tissues, and eventually organs, that the body can make its own, getting round the problem of rejection.

So far they have managed to make fully functioning heart valves using the technique.

It involves taking a healthy donor heart valve - from a human or a suitable animal, such as a pig - and gently stripping away its cells using a cocktail of enzymes and detergents.

The inert scaffold left can be transplanted into the patient without any fear of rejection - the main reason why normal transplants wear out and fail.

Proof of concept

Once transplanted, the body takes over and repopulates the scaffold with cells.

Trials in animals and on 40 patients in Brazil have shown promising results, says Prof Ingham.

They have licensed the technology to the NHS National Blood and Transplant Tissue Services so it can be used on any UK donated human tissue in the future.

The NHS is already looking into using the method on donor skin for burns patients.

Professor Christina Doyle of Xeno Medical, the medical device company that is developing the technologies, said the holy grail was to remove the heavy reliance on donor organs.

"That's where the technology will lead us eventually."

But she said: "To replace all donor tissue using this technology will take 30 to 50 years. Each single product will need to be designed and tested individually."

Prof Doyle said experts elsewhere were also working on similar regenerative therapies, but grown entirely outside of the body, to ensure that people can continue being as active during their second half-century as they were in their first. (BBC News)

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