A Failure to Communicate

Patients who exaggerate their pain or set unreasonable expectations of their chiropractors are known to be at a higher risk for long-term disability. For the most effective treatment from your doctor of chiropractic, he or she must have a clear knowledge of your symptoms and concerns.

A recent survey of 30 chiropractors and 336 patients in Sweden showed that both groups had many similar goals and expectations for treatment. For example, both doctors and patients expected the practitioner to identify and explain a problem, and both expected treatment to reduce symptoms and make patients feel better overall.

There were several differences in treatment expectations, however. Patients had significantly lower expectations of treatment success than their doctors, yet higher expectations for advice and exercise. Patients also disagreed with their doctors of chiropractic on how many treatments were necessary. Out of options ranging from 1-2, 3-5, 6-10, or more than 10 treatments (or no opinion), most chiropractors felt that 3-5 treatments are necessary for "substantial" improvement. Patients expected improvement after 1-2 treatments, or had no opinion on what to expect.

Poor communication between the patient and doctor can negatively affect treatment outcomes. With any health practitioner you seek, be sure to understand one another and have similar treatment expectations for the best results possible.

Reference: Sigrell H. Expectations of chiropractic treatment: What are the expectations of new patients consulting a chiropractor, and do chiropractors and patients have similar expectations? Journal of Manipulative and Physiological Therapeutics 2002:25(5), pp. 300-305.

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Heart Failure Risk Doubled in Obese

Very obese people have been shown to face a much higher risk for heart failure than people of normal weight. With more and more Americans considered overweight or obese, the authors of a recent study in The New England Journal of Medicine wanted to determine if being overweight to a lesser degree also puts a person at a greater risk for heart failure.

Using body-mass index (BMI) to classify a person's weight, almost 6,000 people were divided into one of three categories: normal weight, overweight, or obese. Incidence of heart failure was compared among the groups, who averaged 55 years old.

Overweight women were 50% more likely to experience heart failure than women of normal weight, based on an average of 14 years of follow-up. Obese women and men were approximately twice as likely to have heart failure. The risk for heart failure rose consistently for both genders as BMI increased, regardless of other factors like smoking, alcohol consumption, or age.

To figure out your BMI, multiply your weight (in lbs.) by 703, then divide twice by your height (in inches). Normal weight is considered a BMI of 18.5 to 25; "overweight," 25 to 30; and over 30 is considered "obese."

This measure of "healthy" weight has been criticized, however, as some people who work out regularly and are dense with muscle may be healthy despite a high BMI.

Reference: Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. The New England Journal of Medicine 2002:347(5), pp. 305-313.

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Which Vitamins Prevent Chronic Disease?

Inadequate levels of some vitamins can lead to chronic diseases, including cancer and heart disease. Many Americans get most of the vitamins they need from the foods they eat, but deficiencies involving even one vitamin can lead to problems.

The authors of this report in the Journal of the American Medical Association reviewed nine vitamins key to preventative care in adults (vitamins A, B6, B12, C, D, E, and K; folate; and provitamin A carotenoids) based on studies published from 1966-2002. The following is a list of health conditions and vitamins that may alter their progression:

Osteoporosis: Vitamin D, along with calcium, has been shown to reduce bone loss and fracture risk in the elderly.

Heart Disease: Folic acid, B6, and B12 may decrease risk for heart disease; results from studies on vitamin E preventing heart disease are less conclusive. Beta-carotene (vitamin A) may raise risk in smokers.

Cancer: Lycopene, although technically a non-vitamin antioxidant, may be superior to vitamin E in helping prevent prostate cancer. It is found in tomatoes and tomato products. Folic acid has been shown to decrease risk for colon cancer in both genders, and breast cancer in women who drink alcohol. Beta-carotene may increase risk for lung cancer in smokers.

Birth Defects: Folic acid appears to reduce risk for spinal birth defects in infants whose mothers take these supplements. Excessive vitamin A during pregnancy may cause negative side effects.

The elderly, vegans, and alcoholics are especially at risk for inadequate intake of some vitamins. The best natural sources for these vitamins include: Leafy greens, whole grains, and fortified grain products for folate; fish, poultry, and legumes for vitamin B6; fish, eggs, and milk for vitamin B12; citrus fruits for vitamin C; and margarine, nuts, and salad oils for vitamin E.

Reference: Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: Scientific review. Journal of the American Medical Association 2002:287(23), pp. 3116-3126.

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Preemptive Strike

Did you know you can actually protect your baby before she's even born? By taking folic acid supplements before and during pregnancy, you can prevent birth defects, based on a recent study in the Canadian Medical Association Journal.

Birth defects in an infant's developing central nervous system are called "neural tube defects" (NTDs). These defects result when the spine and brain, or the bones that protect the two, don't form correctly during pregnancy. In 1994, Canada recommended that prior to and during pregnancy, all women should include folic acid supplementation in their diets because it has been shown to help prevent NTDs. The authors of this study tracked the success of Canada's recommendation by looking at all births in Nova Scotia from 1991-2000, and comparing the incidence of NTDs:

before the 1994 recommendations;

after the recommendations; and

after November 1998, when Canada began fortifying grain products with folic acid because of little response from mothers to follow recommendations.

The study revealed that following government recommendations to take folic acid supplements, the incidence of NTDs remained the same as before. However, following government fortification of grain products, the risk for these defects dropped by over 50%.

Folic acid is vital for a healthy baby. Women who could become pregnant should take folic acid daily, in addition to a healthy diet, for at least two months prior to a planned pregnancy until at least the end of the first trimester of pregnancy. Everybody should include folic acid in their diet for its many health benefits; simply taking a multivitamin provides enough for most people.

Reference: Persad VL, Van den Hof MC, Dubé JM, et al. Incidence of open neural tube defects in Nova Scotia after folic acid fortification. Canadian Medical Association Journal 2002:167(3), pp. 241-245.

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Veterans Salute Alternative Medicine

American civilians clearly love complementary and alternative medicine (CAM): Visits to CAM practitioners exceeded the number of visits to primary care physicians from 1990-1997. Do military veterans, who may be exposed to more injuries and ailments than the general public, similarly seek alternative health to heal themselves?

To determine the prevalence of CAM usage by military veterans in the southwestern U.S., over 500 veterans from the Southern Arizona Veterans Administration Health Care System were randomly selected to complete a phone interview. "CAM" included chiropractic, acupuncture, herbal remedies and homeopathy in this study published in the Archives of Internal Medicine.

Half (50%) of the veterans indicated previous or current CAM use, which is at the high end of the estimated 30-50% of other Americans using CAM. Back pain was the most common ailment in CAM users (50% of users), followed by hay fever (43%) and medication allergies (39%).

Why the interest in alternative medicine? Because in many cases, it's been proven more effective than traditional medicine. Talk to your doctor of chiropractic about the many alternatives to conventional medical care, and the variety of conditions chiropractic is proven to treat.

Reference: Baldwin CM, Long K, et al. A profile of military veterans in the southwestern United States who use complementary and alternative medicine: Implications for integrated care. Archives of Internal Medicine 2002:162, pp. 1697-1704.

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Exercise: Is Quality or Quantity Better?

There is a long-standing debate as to whether the intensity or the duration of exercise is more important for good health. It's been shown that men who exercise at high intensity cut their risk for heart disease nearly in half, compared to sedentary men, yet similar risk reduction also applies to low-intensity exercise, and varying levels of energy expenditure.

Almost 50,000 men ages 40-75 completed multiple questionnaires from 1986-1998 assessing diet, lifestyle, medical history and exercise. In this study in the Journal of the American Medical Association, walking/hiking; jogging; bicycling; tennis; swimming; rowing; calisthenics; outdoor work; weight training; and racquetball were all considered as types of exercise.

Higher amounts of physical activity did translate into corresponding reductions in risk for coronary heart disease (CHD); men with the greatest amount of activity reduced their risk 30%, compared to sedentary men. But wait - high exercise intensity also independently lowered risk for CHD - 17% more than low-intensity exercises. Activities that offered the most significant reductions in CHD risk included running, weight training and rowing. A faster walking pace was found to reduce heart-disease risk more than a slower pace, regardless of the total time spent walking.

So, which is better: intense exercise for a couple of hours per week, or low-intensity exercise for several hours per week? There is no definite answer. It appears, though, that regular aerobic exercise each week, combined with some high-intensity training, may be optimal. Your chiropractor can help you determine the exercise-intensity level that is safe for you, and help you focus on maintaining that level of fitness.

Reference: Tanasescu M, Leitzmann MF, et al. Exercise type and intensity in relation to coronary heart disease in men. Journal of the American Medical Association 2002:288(16), pp. 1994-2000.

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How Sweet It Isn't

Although they lack many necessary nutrients and accelerate tooth decay, soft drinks have been shown to provide up to one-quarter of all the calories eaten by children and adolescents. Another problem with these beverages is that the more of them kids drink, the less milk and juice they drink. Is soft-drink consumption also associated with eating fewer fruits and vegetables?

More than 500 students in grades four through six in Houston, Texas, provided diet records in their classrooms for 3-7 days. The results of this study, published in the American Journal of Public Health, showed that sweetened beverages accounted for 51% of the volume of beverages drank by students each day (soft drinks and fruit-flavored drinks were both considered sweetened beverages).

The study also showed that students who drank the most sweetened beverages ate 62% less fruit than students who drank the least. Additionally, those who drank the most sweetened beverages consumed about 330 more calories per day (and consumed more high-fat vegetables) than those who did not consume any sweetened drinks.

Fruits and true fruit juices provide nutrients that reduce risks for sickness and chronic diseases, and not drinking enough of them as a child may lead to bad habits lasting into adulthood. Obviously, if a child is filling up on sugary drinks, he or she won't have room for other, healthier foods and drinks, and may be consuming too many calories in the process.

Reference: Cullen KW, Ash DM, et al. Intake of soft drinks, fruit-flavored beverages, and fruits and vegetables by children in grades 4 through 6. American Journal of Public Health 2002:92(9), pp. 1475-1478.

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Bad Company

Nearly 10% of women of reproductive age suffer from endometriosis, a painful disease in which the tissue that normally lines the uterus, the endometrium, forms outside the uterus and develops into small growths. Besides pain and inflammation, this disorder may cause infertility, and based on a recent study in Human Reproduction, it may also be associated with other disorders.

The study compared immune-system-disorder, chronic-pain, and allergy prevalence in over 3,500 women with endometriosis to women in the general population. It seems this condition keeps bad company. Women with endometriosis were found to be significantly more likely to suffer from multiple disorders, including:

• chronic fatigue syndrome (CFS) - more than 150 times more likely;
• fibromyalgia - almost twice as likely;
• hypothyroidism - seven times;
• rheumatoid arthritis - 1.5 times;
• allergies - over three times;
• asthma - more than double the risk;
• multiple sclerosis - seven times; and
• lupus - over 20 times more likely.

Despite pelvic pain and other symptoms of endometriosis, many women are not diagnosed with the disorder for many years. Women should be aware of the symptoms, such as extreme pain during periods, heavy or irregular bleeding and fatigue, and discuss any concerns with their doctors. Also, if you suffer from any of these conditions, it may not be a coincidence that you also suffer from different disorders.

Reference: Sinaii N, Cleary SD, et al. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: A survey analysis. Human Reproduction 2002:17(10), pp. 2715-2724.

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One-Third of Americans Suffer Joint Pain

The leading causes of disability in the U.S. are arthritis and related rheumatic conditions, which cause joint pain and inflammation in sufferers. Arthritis results from immune system disorders or wearing down of the cartilage and tissues of the joints. According to the Centers for Disease Control, the prevalence of arthritis and chronic joint pain and stiffness may be higher than previously thought.

Questionnaires administered to randomly chosen adults in all 50 states, the District of Columbia, and Puerto Rico provided data on arthritis incidence. Arthritis prevalence was defined as doctor diagnosis; prevalence of chronic joint symptoms, or CJS, was determined when patients responded "yes" to "pain, aching, stiffness, or swelling in or around a joint" in the previous year during "most days for at least a month."

The overall prevalence of CJS/arthritis was 33%, or approximately 70 million adults. By categories, the percentages of American adults estimated to suffer from specific conditions were: arthritis (11%), CJS (10%) and both CJS and physician-diagnosed arthritis (12%).

Arthritis symptoms can affect anyone, particularly the elderly, women and those who are overweight and lead sedentary lives. The best way to avoid developing arthritis is to maintain a healthy diet and weight and get adequate sleep. Conservative treatments for arthritis include low-impact regular aerobic exercise, massage, acupuncture and heat and cold therapy.

Reference: Bolen J, Helmick CG, et al. Prevalence of self-reported arthritis or chronic joint symptoms among adults - United States, 2001. Morbidity and Mortality Weekly Report (CDC) 2002:51(42), pp. 948-950.

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Meat in the Middle

Let's face it - a lot of middle-aged guys have a little bit of a "beer gut." While body mass index (BMI) is commonly used for the classification of obese or overweight individuals, it does not account for this type of body fat distribution, which has been shown to be a strong predictor of disease risk factors.

A study in the American Journal of Clinical Nutrition compared the relative values of BMI and waist circumference for predicting cardiovascular disease and diabetes in almost 10,000 people, to determine which was more accurate. Results of the study showed that in both men and women, waist circumference was a better predictor than BMI when determining the health impacts of excess body fat in overweight or obese patients. Waist circumference accurately predicted odds for obesity-related risk factors like poor cholesterol levels, high blood sugar and high blood pressure.

You already know that being overweight is unhealthy. Now you also know that being large around the middle, as opposed to carrying extra weight in the hip region or elsewhere, may be even more unhealthy. If you have a weight problem, go to your doctor of chiropractic and ask for help. In addition to maximizing your health, you'll probably enhance your current quality of life.

Reference: Zhu S, Wang Z, et al. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: Clinical action thresholds. American Journal of Clinical Nutrition 2002:76, pp. 743-749.

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Bad Breath Acceptable

Vampires and cancer, beware! Garlic, onions and the other allium vegetables are known to help ward off many forms of cancer, including those of the stomach, esophagus and colon. The Chinese include a high amount of these vegetables in their diets, and also have the lowest rates of prostate cancer in the world.

A recent study conducted in Shanghai, China, and appearing in the Journal of the National Cancer Institute examined the diets of 238 men with prostate cancer and 471 cancer-free men of similar ages randomly selected from the general population. Specifically, amounts of allium vegetables (garlic, onions, scallions, shallots, chives and leeks) eaten were compared between the two groups.

Men who ate the most allium vegetables (a mere one-third of an ounce per day or more) were 50% less likely to have prostate cancer than those who ate the least. Scallions and garlic appeared to reduce cancer risk the most; men who ate the most scallions reduced their risk for prostate cancer by 70%.

Try to include about two cloves of garlic per day in your diet, and enjoy an assortment of scallions and onions. Besides adding flavor to foods, they offer multiple health benefits and boost your immune system. Men should also consume tomato products as another weapon in the fight to ward off prostate cancer, as they provide a powerful antioxidant called lycopene.

Reference: Hsing AW, Chokkalingam AP, et al. Allium vegetables and risk of prostate cancer: A population-based study. Journal of the National Cancer Institute 2002:94(21), pp. 1648-1651.

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Never Too Old to Care

"Malnutrition" refers to undernutrition or overnutrition, either of which creates significant health risks in the elderly. A recent review of nutritional studies in Topics in Clinical Chiropractic covered the incidence and causes of malnourishment in seniors, and brought up the dangers of not eating right.

The review noted that a quarter of all men and half of all women over age 65 in America are considered overweight. Obesity is associated with adult-onset diabetes, high blood pressure, coronary artery disease and several forms of cancer (breast, colon, uterine). Body shape may be more important than a simple weight-height ratio when assessing overnutrition: fat concentrated around or above the waistline (e.g., a potbelly) is more closely associated with cardiovascular diseases, stroke, and diabetes than fat centralized around the hips.

Undernutrition, either from being too thin or lacking certain nutrients, occurs in 5-20% of seniors and is related to increased risk of death, infection, osteoporosis and degenerative diseases. Medical causes may be seen in 93% of undernutrition cases (due to medications seniors are taking); other causes include anorexia, cancer, depression and hypothyroidism. Protein and vitamin/mineral deficiencies are common in undernourished individuals. Although people require fewer calories as they age, they should not reduce nutrient intake.

Nutritional supplements containing vitamin C, B vitamins and zinc may lessen the effects of undernutrition. A diet packed with fruits, vegetables and adequate amounts of protein can provide the best form of absorbable nutrients. If you are overweight, try to shed some extra pounds by eating fewer calories and staying physically active.

Reference: Thomas DR, Morley JE. Nutritional considerations in older people. Topics in Clinical Chiropractic 2002:9(2), pp. 7-24.

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