Do You Need a Tune-Up?

Smooth and efficient body movements depend on the coordination of multiple "trunk" muscles of the back and stomach. Some of these muscles generate power, while others help your body maintain balance and control. The multifidus in particular appears to be a primary contributor to control and stabilization in the lower back, acting as a "fine-tuning" muscle.

A recent study in the European Spine Journal measured activity in the back muscles of three groups of people: healthy individuals, acute back-pain patients, and chronic back-pain patients (pain for at least one year). Muscle activity was measured during strength, coordination, or stabilization exercises involving kneeling and lifting, in the multifidus muscle and a group of power-generating muscles of the back during maximum exertion.

During coordination exercises, there was a significant decrease in muscle activity of the control/stabilization muscles in the chronic-pain group compared to the healthy group. Testing revealed significantly lower activity in both stabilization and power-generating muscles in the chronic-pain group during strength exercises.

In the long run, low-back-pain patients may have problems with balance and coordination in back movements, due to weakened control muscles. A reduction in activity in the multifidus and other "fine-tuning" muscles during coordination exercises may be one reason behind the origin and recurrence of back pain. If you have low back pain, talk to your doctor of chiropractic about how to safely strengthen your back muscles.

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Reference: Danneels LA, Coorevits PL, Cools AM, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub- acute and chronic low back pain. European Spine Journal 2002:11(1), pp. 13-19.

Assisted Reproduction: Know the Risks

Many couples experiencing difficulty having a child turn to assisted reproductive technology to combat infertility. Methods of assisted reproduction include in vitro fertilization, or assisted fertilization outside of the body, and individual sperm injections into the mother's egg. These are reported as safe, if not completely natural, ways to have a child, but research has not evaluated their risks. Are infants conceived using assisted reproduction more likely to suffer from birth defects than naturally conceived infants?

The prevalence of major birth defects in infants conceived with assisted reproduction was determined in this Western Australian study, published recently in The New England Journal of Medicine. Between 1993 and 1997, the prevalence of major birth defects was calculated for three groups: approximately 300 infants conceived with sperm injection, over 800 conceived with in vitro fertilization, and 4,000 natural births.

Compared to natural births, the odds for a major birth defect were doubled for both groups of assisted-reproductive-technology infants. Also, infants conceived using reproductive technology were at a higher risk for multiple major birth defects, and defects in muscles, bones, and chromosomes. Assisted reproductive births were more likely to involve Cesarean section, pre-term birth, and low birth weight.

If you are contemplating assisted reproduction, consider all of the risks involved to yourself and the child before you elect to use the procedure. Weigh all the alternative options available, including adoption, and ask yourself: Is it worth the risks?

Reference: Hansen M, Kurinczuk JJ, Bower C, et al. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. The New England Journal of Medicine 2002:346(10), pp. 725-730.

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Give Tennis Elbow a Rest

Tennis elbow is a painful condition caused by overuse and injury of the muscles and tissues around the elbow, and lasts from 6-24 months. Tasks involving tools like hammers and screwdrivers are often related to cases, although half of all tennis players also experience the condition -- as the name implies. Corticosteroid injections in the elbow, which suppress the body's natural inflammatory response to injury, have been deemed safe and effective for short-term medical treatment of tennis elbow, but their long-term success rate is unknown.

The authors of a study in The Lancet assigned patients who suffered from tennis elbow into three groups based on treatment to be provided: wait-and-see (no treatment besides ceasing activity), physiotherapy, or corticosteroid injections. Patients underwent six weeks of treatment, and recovery was evaluated over the following year.

In the nearly 200 patients who completed the study, injected corticosteroids proved most effective at the end of six weeks. However, physiotherapy and wait-and-see groups showed the highest recovery success rates in the long run. One year after the start of the study, 91% of the physiotherapy patients and 83% of the wait-and-see patients claimed success, compared to only 69% of the corticosteroid patients.

These results suggest that rest and physiotherapy may be more effective than corticosteroid injections for long-term treatment of tennis elbow. Corticosteroids may provide a short-term solution to pain and disability, but will probably only prolong the condition by masking these symptoms and allowing more damage to be done.

Reference: Smidt N, van der Windt D, Assendelft W, et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomized controlled trial. The Lancet 2002:359, pp. 657-662.

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1 Tomato, 2 Tomatoes, 3 Tomatoes, More!

Italian-food lovers everywhere, rejoice: Tomato sauce is even healthier than previously suspected. Research is showing that tomatoes and tomato-based foods are excellent sources of lycopene, an antioxidant with cancer-fighting abilities; specifically, lycopene is believed to significantly reduce a man's chances of getting prostate cancer. Prostate cancer is serious: It affects one in four men over age 50, who may suffer impotence and incontinence as a result, and is the second leading cause of cancer death in American men.

A six-year study of prostate cancer in 40- to 75-year-old men was recently published in the Journal of the National Cancer Institute as a follow-up to a previous six-year study. Nearly 50,000 men reported on the foods they ate so researchers could evaluate their intakes of lycopene-rich foods, including tomatoes and tomato sauces (e.g., pasta sauce and salsa); pizza; watermelon; and grapefruit.

Consuming tomato sauce (considered the best source of lycopene) more than twice per week reduced the odds for prostate cancer by about 25%, compared to consuming it less than once per month. A high estimated lycopene intake from any foods was also associated with a significant reduction in prostate cancer risk.

These data confirm previous reports of a reduced risk for prostate cancer through consuming tomato products and other sources of lycopene. Cooked tomatoes and tomato products, such as ketchup and various tomato sauces, are the optimal sources of lycopene.

Reference: Giovannucci E, Rimm EB, Liu Y, et al. A prospective study of tomato products, lycopene, and prostate cancer risk. Journal of the National Cancer Institute 2002:94(5), pp. 391-398.

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Is Seafood Good for Expectant Moms?

Premature births, or births before 37 weeks of pregnancy, increase a child's risk for health problems: 60% of serious complications or deaths in newborns are related to preterm births. Greater-than-normal birth weights and longer gestation periods are common in Denmark's remote Faroe Islands, where people eat plenty of fish. A study appearing in a recent issue of the British Medical Journal evaluated a possible link between seafood intake and longer gestation periods.

Nearly 9,000 pregnant women in Denmark completed seafood-intake questionnaires at the 16th and 30th weeks of pregnancy. Seafood consumption included fish and shellfish, and was divided into four intake categories: never, 0-1 times monthly, 1-3 times monthly, or once or more per week.

Women who consumed no fish were three-and-a-half times more likely to have preterm delivery than those consuming fish at least weekly. Incidence of preterm delivery fell progressively from 7% in women eating no fish to 2% in women eating fish at least weekly.

Some of the potential dangers "preemies" face include underdeveloped lungs, bleeding in the brain, kidney problems, and vision and hearing impairment. You might not like fish, but while you're pregnant, you may want to make the sacrifice for your baby. If you refuse to eat seafood, take fish oil supplements, which also contain the omega-3 fatty acids found in fish and may also effectively ward off health problems. Avoid fish that might contain high mercury levels -- larger fish such as shark, mackerel, and swordfish -- which can potentially harm growing infants.

Reference: Olsen SF, Secher NJ. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: Prospective cohort study. British Medical Journal 2002:324, pp. 447-450.

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Try Counting Sheep

As you pass middle age, you will likely have more difficulty experiencing deep, undisturbed sleep. Many elderly people also go to bed and wake up earlier than others, which has been blamed on one of the primary hormones regulating the internal sleep clock: melatonin production in the body. In an attempt to normalize their sleep patterns, many of the elderly take melatonin in its supplement form.

Researchers recently investigated the link between sleep patterns and melatonin secretion in the bodies of young and older individuals. They monitored 15 older men and women (averaging 68 years of age) and 33 men in their twenties. Melatonin levels in each person's body were monitored during three nights of sleep. The results appear in the American Journal of Physiology: Endocrinology and Metabolism.

Average waking times and bedtimes of the seniors were one hour earlier than those of the younger group. Concurrently, the timing of melatonin release occurred at a significantly earlier hour in the elderly than in the young men. However, the relationship between melatonin levels and sleep timing was different in the older people than in their younger counterparts. Thus, the older group woke at a time when melatonin levels were relatively higher than levels in the younger group at waking time.

The study implies that melatonin may not necessarily trigger sleeping and waking time changes associated with aging. Therefore, melatonin supplementation might not be beneficial for seniors seeking "regular" sleep. Consider allowing your body to follow its natural patterns by avoiding melatonin supplements and accepting an earlier bedtime than you had in your youth.

Reference: Duffy JF, Zeitzer JM, Rimmer DW, et al. Peak of circadian melatonin rhythm occurs later within the sleep of older subjects. American Journal of Physiology: Endocrinology and Metabolism 2002:282, pp. e297-e303.

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Diseased Gums Harm Overall Health

Periodontitis, or gum disease, affects 15-30% of all adults. Besides causing tooth loss and bad breath, it has recently been shown to be a possible risk factor for heart disease and stroke. Infected pockets that develop in poorly maintained gums may release inflammatory bacteria, or endotoxins, into the bloodstream. A recent study in the Journal of Periodontology evaluated whether levels of harmful endotoxins are higher in those with poor gum health.

To determine if gentle chewing can cause the release of endotoxins into the bloodstream, the authors of this study examined approximately 70 people with varying levels of periodontal disease: severe, moderate, or none. Blood samples were collected and evaluated for endotoxins before and immediately after chewing gum.

Overall, endotoxin levels in the blood were significantly higher after chewing in all three groups. But levels of these bacteria were much higher in the people with severe gum disease than in the other groups, as were "positive" cases of endotoxemia. Furthermore, patients with severe gum disease were more than three times more likely to have endotoxins in their blood than were those with healthy gums.

Diseased gums may be an underestimated source of chronic bacterial infection and disease. Follow the American Dental Association's recommendations on gum health: Get regular dental check-ups, brush and floss twice per day, and avoid using tobacco. Some signs of unhealthy gums are redness, swelling, bleeding, and persistent bad breath.

Reference: Geerts SO, Nys M, De Mol P, et al. Systemic release of endotoxins induced by gentle mastication: Association with periodontitis severity. Journal of Periodontology 2002:73(1), pp. 73-78.

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Extended Cabs, Extensive Risks

Safety guidelines urge parents to always place children in the back seat of a vehicle. But these recommendations might not be so safe when it comes to some models of pickup trucks. Many trucks provide an extended cab that allows additional passengers to ride inside the vehicle behind the front seats, usually on fold-down "jump" seats. Families may prefer these models because of increased space, yet riding in the rear seats of these trucks may be dangerous for your kids.

Crash injury data were collected from 1998 to 2000 from State Farm Insurance claims involving over 7,000 vehicles and 11,000 children (age 15 or younger). Only 1990 and newer vehicles were included in the study; passenger cars, sport utility vehicles, vans, and pickup trucks (both extended-cab and regular cab) were considered. The results of this study from the Journal of the American Medical Association are disturbing:

Children riding in compact, extended-cab pickup trucks were approximately three times more likely to be injured in a crash than children in all other vehicles.

Children occupying the rear seats of these particular trucks were almost five times as likely to be injured as children in other vehicles.

Even riding in the front seats of these trucks nearly doubled risk for injury in children, compared to riding in the front seats of other vehicles.

Children riding in compact extended-cab trucks may not be as safe as children riding in other vehicles. Researchers concluded that during crashes, collisions of children with the more confined and less padded area, coupled with lap-only seatbelts, might be the reason for more injuries. Parents with a choice of vehicles should not transport children in compact extended-cab trucks; children who must ride in these trucks may be safer in the front seat.

Reference: Winston FK, Kallan MJ, Elliott MR, et al. Risk of injury to child passengers in compact extended-cab pickup trucks. Journal of the American Medical Association 2002:287(9), pp. 1147-1152.

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