March 12, 2002 [Volume 3, Issue 6]
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In this issue of To Your Health:
Cartilage: Going, Going... Gone
Osteoarthritis,
the most common form of arthritis, involves the degeneration of cartilage
within the joints. It is essentially due to "wear and tear" and may eventually
eliminate the cartilage buffer between bones, causing them to rub together.
Patients with osteoarthritis of the hip or knee are often instructed to
perform regular exercise to reduce the pain and disability of the condition.
The long-term effects of an exercise program on reducing arthritis symptoms
are unclear, however.
A recent study in the Annals of the Rheumatic Diseases evaluated the effects of an exercise program on hip- and knee-osteoarthritis patients after three months of ongoing exercise therapy, and three and six months after conclusion of therapy. The 200 patients were divided into two groups. Both groups were administered education and drug treatment, but only one group completed 12 weeks of therapist-supervised strength, mobility, and coordination exercises, one-to-three times per week. Patients in both groups rated their pain weekly.
The exercise group showed decreased pain compared to the nonexercise group during the training period, as expected. However, the maximum beneficial reduction in pain in the exercise group occurred at the end of the exercise program, and declined steadily over the remaining six months of the study. Three months after discontinuing exercise, the exercise group still showed only a "small to moderate" reduction in pain; six months later, both groups showed similar pain levels.
These results are similar to those of other studies on the residual effects of exercise on osteoarthritis. If you have osteoarthritis of the hip or knees, maintaining a consistent exercise pattern can reduce your pain. A half-hour of aerobic exercise, three days per week, appears to generate the largest decreases in pain. Go to https://www.chiroweb.com/tyh/sports.html for more information about the benefits of sports and fitness.
Reference: Van Baar ME, Dekker J, Oostendorp RAB, et al. Effectiveness of exercise in patients with osteoarthritis of hip or knee: Nine months' follow up. Annals of the Rheumatic Diseases 2001:60, pp. 1123-1130.
Breaking the Bad News
Hip fracture is a serious problem. It leads to death in 20% of patients in the year after occurrence, and approximately $14 billion was spent on fractures in 1995 alone in the U.S. Although the best predictor for fracture risk in postmenopausal women is low bone mineral density (BMD), or thinning bones, a recent study in the Journal of the American Medical Association shows that not enough women are aware of their low BMD levels.
The National Osteoporosis Risk Assessment, a long-term osteoporosis study of postmenopausal women, was utilized in the study to determine BMD levels, risk factors for thinning bones, and relation of BMD to fractures. Two-hundred thousand women at least 50 years old were recruited from over 4,000 medical practices and examined for bone density at the forearm, finger, or heel using dual-energy x-ray absorptiometry (DXA) scanning - the best method for calculating BMD.
Almost half of the women in the study had thinning bones that they were previously unaware of, subjecting them to an increased risk for hip fracture. Women who were older; had a family history of low BMD; were of Asian/Hispanic background; used cortisone; and smoked were most likely to have lower BMD. Risk of fracture was four times greater in women with osteoporosis in the year following the examination. Osteopenia, a more mild form of bone thinning, doubled the odds of fracture.
Based on current U.S. Census Bureau estimates, this study shows that nearly 20 million women in the U.S. may have low bone density and are unaware of it. If you are a woman age 50 or older, have your doctor measure your BMD, and if it is lower than normal, ask about effective treatment. Also, be sure to eat calcium rich foods, such as milk and cheese, and exercise regularly.
Reference: Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: Results from the National Osteoporosis Risk Assessment. Journal of the American Medical Association 2001:286(22), pp. 2815-2822.
To find out more about women's health, go to https://www.chiroweb.com/tyh/women.html.
Eat Less, More Often
Most people normally don't eat five or more small meals per day, but instead eat two-to-three larger meals for the sake of convenience and tradition. Yet studies have shown that a common American "gorging" diet - in which a person obtains total daily calories in only a few meals per day - may lead to higher levels of LDL, or "bad" cholesterol than a diet in which calories are divided among multiple meals throughout the day.
A recent study published in the British Medical Journal determined self-reported eating frequency; amount and types of nutrients eaten; and fat concentrations in the blood for nearly 15,000 people 45-75 years of age. Eating frequency per day was classified into five groups: one-to-two meals; three meals; four meals; five meals; or six-or-more meals.
Blood concentrations of "bad" and total cholesterol decreased steadily with an increasing number of meals eaten per day. Cholesterol levels were significantly lower in those eating six-or-more meals per day than in those eating only one or two meals. Despite lower cholesterol levels, eating more often was also linked to higher calorie, fat, carbohydrate, and protein consumption, however.
This study is one of many that show the benefits of eating numerous small meals per day, as opposed to only a few large ones. By consuming five or six daily meals, your body will also convert less off the food you eat into fat and maintain a constant blood-sugar level, making you less likely to experience periods of low energy. Be careful not to simply eat the same sized meals you eat now, but more often - or you might actually gain weight and raise your cholesterol.
Reference: Titan SMO, Bingham S, Welch A, et al. Frequency of eating and concentrations of serum cholesterol in the Norfolk population of the European prospective investigation into cancer (EPIC-Norfolk): Cross sectional study. British Medical Journal 2001:323, pp. 1286-1288.
To find out more about the benefits of good nutrition, check out https://www.chiroweb.com/find/archives/nutrition.
Can the Pill Kill?
Up to 45% of American women of reproductive age use oral contraception - otherwise known as birth control pills or "the pill" - to prevent unwanted pregnancy. New oral contraceptives have recently been developed to be safer than their predecessors, which were linked to heart attacks. These third-generation contraceptives have been suggested to actually protect against heart attacks, yet a recent study in The New England Journal of Medicine provided different results.
The study examined the association between first-, second- and third-generation oral contraceptives and heart attacks in the Netherlands. Approximately 250 women who had suffered a heart attack and nearly 1,000 other women who had not were selected for the study. The 18- to 49-year-old women provided information on oral contraceptive use and other heart-attack risk factors.
Using any type of oral contraceptive doubled heart-attack risk. In particular, first-generation oral contraceptives increased heart-attack risk by 2.7 times; second-generation contraceptives increased risk 2.5 times; and third-generation contraceptives increased risk 1.3 times. Risks were highest among women who smoked, had diabetes, or had high levels of "bad" (LDL) cholesterol.
The data for third-generation oral contraceptives are inconclusive. Yet it appears that although they may provide a decreased risk for heart attacks compared to first- and second-generation pills, they may still slightly increase your risk for a heart attack.
Reference: Tanis BC, van den Bosch M, Kemmeren JM, et al. Oral contraceptives and the risk of myocardial infarction. The New England Journal of Medicine 2001:345(25), pp. 1787-1793.
For more information on the adverse effects of drugs, go to https://www.chiroweb.com/find/archives/general/drugs/index.html.
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