Vitamin D

Low levels of vitamin D in the blood may increase risk of cardiovascular events such as a heart attack, according to two recent studies published in the Archives of Internal Medicine.

In addition to its critical role in bone development and maintenance, recent research has shown that vitamin D may be far more important for other aspects of health and disease prevention than was previously realized. In fact, research has linked low levels of vitamin D with chronic diseases such as cancer and multiple sclerosis. Now, new research suggests that inadequate vitamin D may increase the risk of heart attacks and death due to cardiovascular disease and other causes.

Investigating diet’s impact on heart health

In the Health Professionals Follow-up study, a study evaluating the associations between diet and the incidence of chronic disease, 18,225 men ages 40 to 75 were evaluated for their blood levels of vitamin D (measured as 25-hydroxyvitamin D [25(OH)D]) and subsequent risk of heart attack. After ten years of follow-up, 454 men had a heart attack or died from coronary artery disease. Men who had less than 15 nanograms per milliliter of the vitamin D measure had a 50% increased risk of having a heart attack compared with men whose blood levels were 30 nanograms per milliliter or higher.

In another study, 3,258 men and women (average age 62) who were scheduled for angiography because of suspected coronary artery disease were followed for subsequent cardiovascular death or death by another cause. People in the study had blood levels of vitamin D drawn at the time of angiography. After 7.7 years of follow-up, 737 people died and 463 of those people died from cardiovascular disease. People with the lowest levels of vitamin D—less than 13.3 nanograms per milliliter—had a higher risk of death from any cause, and a higher risk of death from cardiovascular disease compared with those people whose levels were greater than 28.3 nanograms per milliliter.

Vitamin D may help prevent heart disease by lowering blood pressure, decreasing calcification in the heart vessels, or by other mechanisms. However, the optimal daily level of vitamin D to prevent chronic disease and maintain health is still not known.

“Vitamin D deficiency has been related to an increasing number of conditions and to total mortality,” said Edward Giovannucci, MD, ScD, and his colleagues from the Harvard School of Public Health, Boston, Massachusetts. Dr. Giovannucci comments that the amount of vitamin D required for optimal health may be much higher than the current daily recommendation of 200 to 600 IU per day. This would be especially true for those with minimal sun exposure, added Dr. Giovannucci.

Getting enough vitamin D

Sources of vitamin D include the sun, food, and dietary supplements. People who live in sunny climates who wear less clothing and therefore allow more daily exposure of their arms and legs usually have higher levels of vitamin D compared with people who live in more northern or more cloudy climates.

Food sources of vitamin D are limited but include some fish such as salmon, mackerel, and tuna; cod liver oil; fortified milk; and fortified cereal products. Eggs, fortified margarine, some cheese, and other foods have small amounts of vitamin D.

Ask your doctor about how to get enough vitamin D from appropriate dietary changes or supplements based on your current health.

Smoking

When your parents were young, people could buy cigarettes and smoke pretty much anywhere — even in hospitals! Ads for cigarettes were all over the place. Today we're more aware about how bad smoking is for our health. Smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines.

Almost everyone knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer, in a word, is addiction.

Once You Start, It's Hard to Stop

Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal.

People start smoking for a variety of different reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all.

How Smoking Affects Your Health

There are no physical reasons to start smoking. The body doesn't need tobacco the way it needs food, water, sleep, and exercise. In fact, many of the chemicals in cigarettes, like nicotine and cyanide, are actually poisons that can kill in high enough doses.

The body is smart. It goes on the defense when it's being poisoned. For this reason, many people find it takes several tries to get started smoking: First-time smokers often feel pain or burning in the throat and lungs, and some people feel sick or even throw up the first few times they try tobacco.

The consequences of this poisoning happen gradually. Over the long term, smoking leads people to develop health problems like cancer, emphysema (breakdown of lung tissue), organ damage, and heart disease. These diseases limit a person's ability to be normally active — and can be fatal. Each time a smoker lights up, that single cigarette takes about 5 to 20 minutes off the person's life.

Smokers not only develop wrinkles and yellow teeth, they also lose bone density, which increases their risk of osteoporosis (pronounced: ahs-tee-o-puh-row-sus), a condition that causes older people to become bent over and their bones to break more easily. Smokers also tend to be less active than nonsmokers because smoking affects lung power.

Smoking can also cause fertility problems and can impact sexual health in both men and women. Girls who are on the pill or other hormone-based methods of birth control (like the patch or the ring) increase their risk of serious health problems, such as heart attacks, if they smoke.

The consequences of smoking may seem very far off, but long-term health problems aren't the only hazard of smoking. Nicotine and the other toxins in cigarettes, cigars, and pipes can affect a person's body quickly, which means that teen smokers experience many of these problems:

• Bad skin. Because smoking restricts blood vessels, it can prevent oxygen and nutrients from getting to the skin — which is why smokers often appear pale and unhealthy. An Italian study also linked smoking to an increased risk of getting a type of skin rash called psoriasis.
• Bad breath. Cigarettes leave smokers with a condition called halitosis, or persistent bad breath.
• Bad-smelling clothes and hair. The smell of stale smoke tends to linger — not just on people's clothing, but on their hair, furniture, and cars. And it's often hard to get the smell of smoke out.
• Reduced athletic performance. People who smoke usually can't compete with nonsmoking peers because the physical effects of smoking (like rapid heartbeat, decreased circulation, and shortness of breath) impair sports performance.
• Greater risk of injury and slower healing time. Smoking affects the body's ability to produce collagen, so common sports injuries, such as damage to tendons and ligaments, will heal more slowly in smokers than nonsmokers.
• Increased risk of illness. Studies show that smokers get more colds, flu, bronchitis, and pneumonia than nonsmokers. And people with certain health conditions, like asthma, become more sick if they smoke (and often if they're just around people who smoke). Because teens who smoke as a way to manage weight often light up instead of eating, their bodies lack the nutrients they need to grow, develop, and fight off illness properly.

Kicking Butts and Staying Smoke Free

All forms of tobacco — cigarettes, pipes, cigars, and smokeless tobacco — are hazardous. It doesn't help to substitute products that seem like they're better for you than regular cigarettes, such as filtered or low-tar cigarettes.

The only thing that really helps a person avoid the problems associated with smoking is staying smoke free. This isn't always easy, especially if everyone around you is smoking and offering you cigarettes. It may help to have your reasons for not smoking ready for times you may feel the pressure, such as "I just don't like it" or "I want to stay in shape for soccer" (or football, basketball, or other sport).

The good news for people who don't smoke or who want to quit is that studies show that the number of teens who smoke has dropped dramatically. Today, about 23% of high school students smoke.

If you do smoke and want to quit, you have lots of information and support available. Different approaches to quitting work for different people. For some, quitting cold turkey is best. Others find that a slower approach is the way to go. Some people find that it helps to go to a support group especially for teens. These are sometimes sponsored by local hospitals or organizations like the American Cancer Society. The Internet offers a number of good resources to help people quit smoking.

When quitting, it can be helpful to realize that the first few days are the hardest. So don’t give up. Some people find they have a few relapses before they manage to quit for good.

Staying smoke free will give you a whole lot more of everything — more energy, better performance, better looks, more money in your pocket, and, in the long run, more life to live!

Tiny carp nibble your toes in fishy pedicure Va. spa uses 'doctor fish' to rid clients of scaly skin —but do they polish?

He said he wanted to come up with something unique while finding a replacement for pedicures that use razors to scrape off dead skin. The razors have fallen out of favor with state regulators because of concerns about whether they're sanitary.

Ho was skeptical at first about the fish, which are called garra rufa but typically known as doctor fish. They were first used in Turkey and have become popular in some Asian countries. But Ho doubted they would thrive in the warm water needed for a comfortable footbath. And he didn't know if customers would like the idea. "I know people were a little intimidated at first," Ho said. "But I just said, 'Let's give it a shot.' "

Customers were quickly hooked.

Tracy Roberts, 33, heard about it on a local radio show. She said it was "the best pedicure I ever had" and has spread the word to friends and co-workers.

"I'd been an athlete all my life, so I've always had calluses on my feet. This was the first time somebody got rid of my calluses completely," she said.

'Feels like your foot's asleep'

First time customer KaNin Reese, 32, described the tingling sensation created by the toothless fish: "It kind of feels like your foot's asleep," she said.

The fish don't do the job alone. After 15 to 30 minutes in the tank, customers get a standard pedicure, made easier by the soft skin the doctor fish leave behind.

Ho believes his is the only salon in the country to offer the treatment, which costs $35 for 15 minutes and $50 for 30 minutes. The spa has more than 1,000 fish, with about 100 in each individual pedicure tank at any given time.

Dennis Arnold, a podiatrist who four years ago established the International Pedicure Association, said he had never heard of the treatment and doubts it will become widespread. "I think most people would be afraid of it," he said.

Customer Patsy Fisher, 42, admitted she was nervous as she prepared for her first fish pedicure. But her apprehension dissolved into laughter after she put her feet in the tank and the fish swarmed to her toes.

"It's a little ticklish, actually," she said.

Ho said the hot water in which the fish thrive doesn't support much plant or aquatic life, so they learned to feed on whatever food sources were available — including dead, flaking skin. They leave live skin alone because, without teeth, they can't bite it off.

Next up: full-body fish treatments?

In addition to offering pedicures, Ho hopes to establish a network of Doctor Fish Massage franchises and is evaluating a full-body fish treatment that, among other things, could treat psoriasis and other skin ailments.

Ho spent a year and about $40,000 getting the pedicures up and running, with a few hiccups along the way.

State regulations make no provision for regulating fish pedicures. But the county health department — which does regulate pools — required the salon to switch from a shallow, tiled communal pool that served as many as eight people to individual tanks in which the water is changed for each customer.

The communal pool also presented its own problem: At times the fish would flock to the feet of an individual with a surplus of dead skin, leaving others with a dearth of fish.

"It would sometimes be embarrassing for them but it was also really hilarious," Ho said.

Osteoporosis

Women over 50 are usually reminded to have their bone density evaluated every couple of years, but many healthcare providers don’t know when to recommend this screening to men. To help pinpoint the right time for testing men’s bone density, a new review has identified the major factors that put men at risk for fracture from osteoporosis. The review, published in the Annals of Internal Medicine, analyzed the findings from 177 studies performed between 1990 and 2007 that assessed risk factors for osteoporosis-related fracture in men, and 20 studies that evaluated various screening tests for osteoporosis. The findings from a previous review were also included in the analysis.

What puts men at risk

It comes as little surprise that the two most important risk factors identified for men were the same as those for women: being over 70 years old and being thin (having a low body mass index). Other risk factors included sedentary lifestyle, having taken prolonged courses of steroid medications, weight loss, and having had a previous fracture due to osteoporosis. Androgen deprivation therapy, a prostate cancer therapy that reduces testosterone levels, was also found to significantly increase fracture risk.

Smoking was found to slightly increase fracture risk, while low dietary calcium from milk was not consistently associated with fracture risk. Drinking alcohol had no apparent effect on fracture risk or bone mineral density.

Although some studies identified rheumatoid arthritis, respiratory diseases such as asthma, and gastrointestinal disorders such as celiac disease as risk factors for low bone density and fracture, the evidence was not strong.

Are you a good candidate for screening?

Dual-energy x-ray absorptiometry (DEXA) is the current gold standard for diagnosing low bone density and osteoporosis in men and women. It is regularly recommended for women but less commonly for men, despite the fact that 25% of men over age 60 will have a fracture due to osteoporosis sometime in their lifetime.

A simple osteoporosis screening questionnaire involving age and weight as the only variables was found to be an accurate predictor of osteoporosis in men, and one study found that the strongest predictor for hip fracture risk was weight under about 150 pounds (70 kilograms).

“Osteoporosis in men is substantially underdiagnosed and undertreated in the United States and worldwide,” said lead study author Dr. Hau Liu of the Santa Clara Valley Medical Center in San Jose, California. “We determined that men of advanced age and low body weight are the best candidates for osteoporosis screening. Identifying other important risk factors, particularly weight loss, physical inactivity, corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy, can help healthcare providers select other men who are good candidates for screening.”

Pregnant : Get Fatty Acids for Baby’s Brain Development

Premature babies are at risk for complications in their mental development, but new evidence shows that their brains may get a boost from fatty acids: A study in Pediatrics reports that breast milk supplemented with omega-3 DHA (docosahexaenoic acid) and omega-6 AA (arachidonic acid) may improve brain development in premature infants.
DHA and AA are two types of fatty acids essential for many bodily functions including brain, eye, and nervous system development. The optimal amounts of these fatty acids for premature infants has not been determined, but researchers suggest that increasing the amounts in early infancy may reduce the risk of developmental problems later in life.
Learning disabilities and school-related problems are more common among premature infants than full-term infants. Prior studies, however, have shown that premature infants who are breast-fed have higher IQs than babies receiving formula milk. This finding was attributed to higher concentrations of DHA found in human milk compared with formula milk. The authors of the new study considered the possibility that increasing the DHA content of human milk and adding AA could further improve preemies’ brain development.
Study results encouraging
In the study, 141 premature infants weighing less than 1,500 grams (about 3 pounds) were randomly assigned to receive human breast milk supplemented with either 32 mg of DHA and 31 mg of AA per 100 ml of milk, or breast milk supplemented with soy oil and medium-chain triglyceride oil. Infants received more than 100 ml of human milk per kilogram of body weight per day beginning on the first or second day of birth and continuing until discharge from the hospital (an average of nine weeks).
At six months of age, infants who received the human milk supplemented with DHA and AA were better at problem-solving and were better able to discriminate between familiar and unfamiliar objects compared with infants in the control group.
“There is growing evidence that DHA and AA have specific functions related to memory and problem-solving,” said Christine Henriksen, PhD, lead author of the study from the Department of Nutrition at the University of Oslo, Norway. Dr. Henriksen and her colleagues point out that these functions are critical for being able to focus, be attentive, learn, and process information. Further research is needed to understand the long-term impact of supplementing with fatty acids on school performance and attention capacity later in life.

Ensure you eat your EFAs
Babies are dependent on breast milk and/or fortified formula milk for DHA and AA, but there are other important sources of essential fatty acids (EFAs) to consider as the child grows older. In addition, recent research has shown that it is important for pregnant women to eat plenty of fatty acids in order to help optimize their baby’s brain function. You can find them in these sources:
• Fatty fish such as salmon, halibut, and tuna are good sources of DHA, which is also found in smaller amounts in eggs. Pregnant women should balance the need for fatty acids from fish with reducing exposure to mercury by limiting the amount of fish they eat and avoiding fish high in mercury content.
• AA is found in meat, chicken, and eggs.
• Some people may benefit from supplements that contain fatty acids. Check with your doctor about the appropriateness of using supplements to further enrich your diet.

10 ways to be kind to your skin in the spring

Your skin resembles your alligator bag

"The two keys are moisturization and things that make the skin glow, such as exfoliation," says Jeffrey Dover, associate clinical professor of dermatology at Yale University School of Medicine. Start with a shower rubdown, using a moisturizing body cleanser on a clean washcloth. Don't bother scrubbing your legs if you already use a razor, since shaving removes dead skin on its own. Tempting though it may be to follow this kind of body exfoliation with a heavy cream, it's an unwise move (except on your freshly shaved legs) because in warm weather, even slight perspiration can leave skin dripping. You can avoid the issue completely by applying a soothing cream at night. Otherwise, any light lotion that contains glycolic, alpha hydroxy, or fruit acid will quickly restore vibrance to dead-looking skin, says Dover. (Alyria Resurfacing Body Care lotion contains time-released glycolic acid to reduce irritation.)

For more intense exfoliation on the arms and chest, the microdermabrasion treatment Vibraderm, available at many dermatology offices, uses a vibrating paddle rather than abrasive particles or suction, and was shown in a company-sponsored study to remove over 75 percent of the skin's outermost layer on those areas in less than 10 minutes.

Your arms deserve a penalty for unnecessary roughness

The likely culprit is keratosis pilaris, a genetic condition that can resemble goose bumps (they tend to be white or red), and appears on the arms, legs, or buttocks of about half of all women. "Extra skin cells build up around individual hair follicles, giving you a bumpy texture and a polka-dotted appearance," says Kunin. Though there's no cure, a daily moisturizer containing urea, glycolic, or lactic acid can soften the bumps; Dover is partial to AmLactin, a lactic acid cream, while Kunin's Dermadoctor KP Duty also has a strong following. A body scrub can wear down the bumps even more, but dermatologists preach moderation, since overscrubbing can cause extra redness and inflammation. "Natural particles — crushed seeds or nut shells — have jagged edges that can injure the skin," says Kunin. Synthetic microbeads, on the other hand, are less likely to tear skin. For an instant improvement, apply a shimmery cream to refract light.

Your knees and elbows have faded to gray

"The skin in these areas is some of the driest on our bodies, and so it can take on a cracked, whitish, or grayish appearance — especially on olive or darker skin," says Jeanine Downie, assistant attending dermatologist at Mountainside Hospital in Montclair, New Jersey, and co-author of "Beautiful Skin of Color" (Regan Books/HarperCollins). The best fix is a potent daily moisturizing cream, such as AmLactin or Salex (by prescription), or even petroleum jelly on the elbows and knees once a week before bed. "Trim the toes off a tube sock, and shimmy it up the arm so the Vaseline stays in contact with your skin instead of wiping off on your sheets," Downie says. Scrubbing, scratching, picking, or even leaning on knees or elbows can exacerbate ashiness. So, too, can sun exposure. "When the background skin gets darker, the ashy skin on top stands out more," says Downie, who recommends "constant" use of SPF 30 (or higher) sunscreen.

Acne pops up in unexpected — and unpleasant — places As if the very presence of pimples on your back and rear weren't disturbing enough, the acne there is also most likely to produce a lasting scar. "The skin is thicker, and there are fewer blood vessels, which means slower healing," says Dover. Wash the areas with a benzoyl-peroxide cleanser, such as Peter Thomas Roth Medicated BPO 10% Acne Wash or PanOxyl. But be sure to let any creams or gels sink in fully before dressing because they can bleach some fabrics. You can also consider treatments with a diode laser (like Smooth Beam), photodynamic therapy, Intense Pulsed Dye laser, or blue light, which often help to rid the skin of acne gradually over a few sessions (usually for $250 to $600 each). Aesthera's Isolaz treatment offers the advantage of instant gratification, says Vic Narurkar, assistant clinical professor of dermatology at the University of California–Davis School of Medicine. Available in physicians' offices for $250 to $400, Isolaz suctions the skin to unclog pores while delivering broadband light to kill acne-causing bacteria immediately, for results "just like a cortisone injection," he says. Narurkar recently co-authored a study on the device in the Journal of Drugs in Dermatology that found that it reduced all types of acne (including whiteheads and cysts) by 50 percent in a single treatment and by 90 percent with two treatments, and results were usually maintained for three to six months. "We still recommend a series of three to four treatments, as patients will see improvements in pore size reduction, discoloration, and brown spots," he says.

Your foot calluses are as tough as leather

High heels and pinched shoes may contribute to calluses by causing friction, but Narurkar says the problem can often be alleviated by slipping in a thin insert. One is Foot Petals Tip Toes, a cushion that supports the ball of the foot and is small enough even for open-toe shoes.

To remove existing calluses, take a shower or bath so that skin is soft and pliable, then buff feet with a foot file, a pumice stone, or a pad premoistened with a cleanser, such as Kerasal Callus Removal Cleansing Pads. Follow with a cream containing urea, which "eats away at and loosens up the dead skin cells, and makes the skin really smooth and hydrated," says Kathy Fields, an assistant clinical professor of dermatology at the University of California–San Francisco. You can try Curél Targeted Therapy Foot Cream (which smells of coconut, since company research revealed that most women dislike peppermint scents at night, when they're most likely to apply cream). For a stronger treatment, ask your doctor for a prescription cream that contains 6 percent salicylic acid or 40 percent urea.

Not just lip service: Gloss can invite skin cancer

“These lip glosses can make more of the light rays penetrate directly through the skin instead of getting reflected off of the skin’s surface,” says Dr. Christine Brown, a dermatologist at Baylor University Medical Center in Dallas. (You're covered, however, if you wear lip gloss with SPF.)

At worst, say some dermatologists, the resulting sun damage can lead to potentially fatal forms of skin cancer. An estimated 3,500 new cases of skin cancer of the lips are diagnosed each year, and 90 percent of those cancers are squamous cell carcinoma. While that form of cancer isn't usually particularly serious, it can be more aggressive on the lips than on other parts of the skin. If left untreated, it can cause disfigurement, and in very few cases, it can spread to other organs and become deadly.

But the less serious effects may grab a lip gloss junkie’s attention more quickly: All that sun exposure could be slowly building gross, non-cancerous disfigurements on your lips. One such effect is actinic keratosis, a small, scaly patch of skin that can morph into a wart-like bump if left untreated. Sun exposure can also cause small brown spots that look like freckles on the lips. The spots are noncancerous but could cause people to whisper, "Hey, you've got food on your lips."

Sun damage can also cause premature aging, making the already thin skin on your lips even thinner, which can lead to rips and tears. Ultraviolet light zaps skin of much of its elasticity, leaving the skin lax. That lack of elasticity can prevent the upper and lower lips from lining up properly, which can cause pools of saliva to collect at the corners of the mouth.

It's the moisture in lip gloss that's to blame, says Dr. Bruce Robinson, a Manhattan dermatologist. Your lips are equipped with a protective outer layer, but the hydration of a lip gloss "kind of smooshes that down," Robinson says. Once that outer layer is effectively squashed, it's easier for UV rays to penetrate deeper into the skin.

"Instead of having to travel through that thicker layer, it's more condensed," Robinson says. "So the UV rays reach are reaching deeper layers of epidermis and dermis because you don't have this forcefield."

Sun's laser focus on lips

Apart from the extra hydration, the “super shine” and “ultra shine” of the glosses could be damaging as well. “Take a magnifying glass and put it over your lips,” Robinson says. When you apply lip gloss and go out in the sun, “that’s essentially what you’re doing.” But no studies have confirmed the lip gloss-skin cancer link, and not all dermatologists agree that it poses a risk.

“The only way I could see it is if you’re thinking you’re protected, and you stay out in the sun longer, that may increase your risk,” says Robin Ashinoff, a dermatologist in Hackensack, N.J.

That's what happened to Sherry Duplar, a fair-skinned, horseback-riding redhead who spends as much time as possible outdoors. She always applied lip balm or gloss, and figured that was enough. “I didn’t realize, back then, that our lips were so susceptible,” says Duplar, who’s 59 and lives in Mesquite, Texas.

But about 12 years ago, Duplar’s lips were cracked and chapped, and constantly peeling, and nothing she did would heal them. She’d developed actinic cheilitis, a precancerous condition that's sometimes known as "farmer's lip" or "sailor's lip." It often leads to squamous cell carcinoma, a form of skin cancer.

Since then, she’s had three laser treatments, to deconstruct the affected skin cells. The treatments which leave her lips raw, swelled up and oozing, for as many as three weeks. “It was nasty,” Duplar says.

Now she slathers on lip balm boasting 50 SPF before she goes out in the sun, which makes her dermatologist, the lip gloss-bashing Brown, much happier. Brown wishes women would abandon their lip glosses for lip balm with an SPF of at least 30. But for those who balk at tossing all their lip gloss, Robinson offers a compromise: find a lip gloss infused with SPF, which also protects the lips from ultraviolet light.