Catching on to Chiropractic

Chiropractic is the principal and most-regulated form of complementary and alternative health care. There are about 60,000 chiropractors - a number expected to nearly double by 2010. The percentage of Americans who use chiropractic increased from approximately 3.6% in 1980 to 11% in 1997. The profession may be so successful because it exhibits characteristics of both alternative and mainstream health care.

A recent review of chiropractic in the Annals of Internal Medicine highlighted the necessity of research in furthering the profession, and noted that dozens of well-designed studies on spinal manipulation have shown favorable results of chiropractic care. One of the main reasons chiropractic has done so well is because of studies showing its success. The review presented some very positive figures, which are presented below:

Forty-three clinical studies on the effectiveness of spinal manipulation at treating low back pain have been published; 30 of these showed manipulation to be favorable to other treatments, 13 found no major effects, and none showed manipulation to be less effective than the comparison treatment.

Eleven of the back pain studies included a group receiving placebo (or sham) treatment; of these, eight indicated an advantage of chiropractic manipulation over placebo.

Seven of nine studies on the effectiveness of manipulation for treating headache showed positive results.

Serious complications from chiropractic adjustments are rare: only about one per 100 million lumbar adjustments, and one per 400,000-10 million neck manipulations.

As a chiropractic patient, you have probably known for a long time how effective this form of treatment is at resolving multiple health problems. With more research reaffirming chiropractic's effectiveness, perhaps others will start to catch on as well.

Reference: Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine 2002:136(3), pp. 216-227.

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In the (O)Zone

Asthma, the most common chronic childhood disease, is on the rise due to factors such as a poor diet, infections, allergens, and air pollution. Competitive athletes sometimes have a higher prevalence of asthma than others, possibly because of breathing in more pollutants. Are children involved in outdoor team sports in highly polluted areas at an increased risk for asthma?

Nine- to 16-year-old children in 12 communities in southern California with varying levels of pollution (six with high ozone levels, six with low ozone levels) were selected for a study in a recent issue of The Lancet. The authors assessed asthma risk in approximately 3,500 children who played zero, one, two, or three or more team sports. The children were followed for up to five years to determine the development of asthma.

Children playing three or more team sports in high-ozone communities were over three times more likely to develop asthma than children playing no sports. Playing three or more sports in low-ozone communities had no significant effect on asthma prevalence, however. More time spent outside (unrelated to playing sports) in high-ozone communities also was linked to a higher incidence of asthma.

This study does not imply that your children should avoid outdoor activities or athletics. If you live in an area with higher-than-normal pollution levels, however, be sure to limit your children's outdoor activities and sports participation on high-pollution days. Most cities with high pollution levels provide daily reports of ozone and air quality, often in the local newspaper.

Reference: McConnell R, Berhane K, Gilliland F, et al. Asthma in exercising children exposed to ozone: A cohort study. The Lancet 2002:359, pp. 386-391.

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Skate at Your Own Risk

Over 500,000 men and 70,000 women in Canada regularly play recreational ice hockey, as do many of their American counterparts. Playing hockey on roller skates is another popular recreational sport. These activities subject participants to intense aerobic activity, though, which in older adults has been linked to a higher risk for heart attacks.

The authors of a recent study in the Canadian Medical Association Journal decided to investigate a link between playing recreational hockey and suffering from heart attacks in middle-aged men, after they had treated multiple patients who had suffered a heart attack following play. The authors monitored the heart rates of 113 recreational ice hockey players over 35 years old, using electrocardiographic monitoring devices before, during, and after hockey games. Data were used to determine heart rates and presence of arrhythmias (irregular heart beats).

For every player, maximum heart rate during play was higher than target exercise heart rate; in three-quarters of players, heart rates were in excess of predicted heart rate. In 70% of cases, heart recovery rate was "poor" following play, and arrhythmias were found in two players.

The elevated exercise level during recreational hockey and other vigorous sports may cause a dangerously high cardiac response in middle-aged or older adults. Excessive aerobic activity in the players in this study led to heart rates higher than target and maximum rates, and poor recovery rates. If you are over 35 years old and not in excellent physical condition, hold off on participating in highly demanding sports like ice hockey until you're in better shape.

Reference: Atwal S, Porter J, MacDonald P. Cardiovascular effects of strenuous exercise in adult recreational hockey: The Hockey Heart Study. Canadian Medical Association Journal 2002:166(3), pp. 303-307.

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Can Hormone Therapy Cause Cancer?

For many women going through menopause, the problematic hormonal changes involved can lead them to seek hormone replacement therapy (HRT). HRT involves taking hormones like estrogen and progestin to replenish hormone loss due to aging, for results like improved sleep, hot-flash and night-sweat prevention, and subdued mood swings. A possible association between long-term use of HRT and breast cancer has been shown in numerous studies, however.

The authors of a study in the Journal of the American Medical Association determined the link between HRT use over a five-year period and incidence of breast cancer. Over 700 postmenopausal women 50-74 years old with breast cancer, and nearly as many healthy women, were evaluated for hormone usage.

Overall, breast cancer was 60-85% more likely in women who had used HRT both recently and long-term. HRT use over multiple years and combination therapy of both estrogen and progestin increased risk of one type of breast cancer even more substantially. Continuous long-term and combined-hormone therapy increased lobular breast cancer (a specific type of breast cancer) risk six times.

HRT use also increased risk for nonlobular breast cancer (a more common form). If that isn't enough information to scare you away from hormone therapy, you might be interested to know that other possible side effects include acne; weight gain; increased facial hair; high blood pressure; depression; and heart attacks.

Reference: Chen CL, Weiss NS, Newcomb P, et al. Hormone replacement therapy in relation to breast cancer. Journal of the American Medical Association 2002:287(6), pp. 734-741.

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Smoke Signals

The 25% of adults in the U.S. who smoke cigarettes will live an average of five to 10 years less than those who have never smoked. While smokers are still living, their habit can lead to many ongoing problems as well; studies have shown associations between smoking and low back pain and depression.

To determine the link between smoking and the health, duration of pain, and severity of pain in spinal patients, the authors of a recent study appearing in the journal Spine examined the initial visits of about 25,000 patients at 23 health care locations. Patients answered questions on work status, symptoms, medical history, mental health, and personal statistics. Practitioners provided clinical information and smoking status of their patients.

Smokers were at least 50% more likely to report severe back pain symptoms and symptoms of depression than nonsmokers. Smokers scored significantly lower than nonsmokers on all diagnostic health categories on a health questionnaire. Also, although smokers suffered spinal symptoms for a similar duration to that of nonsmokers, the smokers' symptoms were more severe and occurred more often each day.

Smoking cigarettes, pipes, or cigars can cause many health problems besides well-known, life-threatening illnesses like lung cancer. For example, smokers deal with congestion, coughing, sleeplessness, and weakened immune systems. If you smoke, try to see these more minor symptoms for what they really are: signals of more severe problems down the road.

Reference: Vogt MT, Hanscom B, Lauerman WC, et al. Influence of smoking on the health status of spinal patients: The National Spine Network Database. Spine 2002:27(3), pp. 313-319.

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Intense Exercise Best for Bones

Low bone mineral density increases fracture risk, especially in the larger bones of the hip and upper leg. Older individuals who suffer a hip fracture often lose their independence and face an increased risk of death in the year following their injury. Seniors can strengthen their bones, however, by stimulating bone growth through weight training.

To compare the effectiveness of two exercise regimens focused on increasing bone density, the authors of a study in a recent edition of Medicine and Science in Sports and Exercise examined over 60 seniors (average age: 68 years) for bone mineral density. The individuals were then divided into three groups: no exercise, low-intensity exercise (sets of 13 repetitions using moderate weight), or high-intensity exercise (sets of eight repetitions using heavier weight). Exercise groups performed 12 resistance exercises three times per week for six months. Bone density was re-evaluated at the end of the study using scans of the hip, femur, and spine.

Muscular strength increased significantly in both groups (approximately 17% average for each group) and remained unchanged in the no-exercise group. Yet only the high-intensity exercise group showed significant bone density increases in their upper legs.

One of the best ways elderly individuals can increase their bone strength is by performing high-intensity resistance exercises of eight repetitions, using 80% of their maximum weight potential. Those who are unable to lift a high percentage of their body weight should use lighter weights and add more repetitions.

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Reference: Vincent KR, Braith RW. Resistance exercise and bone turnover in elderly men and women. Medicine and Science in Sports and Exercise 2002:34(1), pp. 17-23.

For Your Own Sake, Don't Fake Bake!

People are increasingly using artificial tanning devices, such as tanning beds and sunlamps, simply to look better. Many people may feel that a tan enhances one's attractiveness. But appearances can be deceptive: Tanning devices emit ultraviolet (UV) radiation, which browns the skin, but may also lead to skin cancer. Researchers recently sought information on the link between tanning devices and two forms of skin cancer - basal cell carcinoma and squamous cell carcinoma.

New Hampshire residents were interviewed about factors related to sun exposure, including sun sensitivity; sunbathing; tanning-device use; and time spent outdoors. Participants were divided into three groups based on presence of skin cancer. Roughly 600 basal cell carcinoma patients, 300 squamous cell carcinoma patients, and 550 healthy individuals were involved in the study, which appeared in the Journal of the National Cancer Institute.

Use of any tanning device was linked to an increased risk for squamous cell carcinoma of two-and-a-half times; tanning-device use was associated with an increased risk for basal cell carcinoma of one-and-a-half times. The odds for skin cancer increased steadily for each decade younger that a person first used a tanning device.

Some sunlight is beneficial for good health, as it increases vitamin D production in the body. Only 15 minutes of sunlight per day on the face and arms is usually enough. But tanning on a bed, in front of a lamp, or under the sun for extended periods just to enhance your appearance simply isn't worth the risks.

Reference: Karagas MR, Stannard VA, Mott LA, et al. Use of tanning devices and risk of basal cell and squamous cell skin cancers. Journal of the National Cancer Institute 2002:94(3), pp. 224-226.

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Super-Sized

The percentage of overweight Americans has increased in recent decades. Despite many possible reasons for the increase in obesity cases, the root cause is essentially a greater overall energy intake than energy expenditure. One reason for obesity prevalence in the U.S. may be larger food portion sizes, especially outside of the home, which encourage individuals to eat more calories.

Portion sizes for popular take-out restaurants, fast-food chains, and family restaurants were measured and compared to U.S. Department of Agriculture (USDA) and Food and Drug Administration (FDA) standards, and to portion sizes in the past. Information was obtained from portion weights, package labels, and manufacturer claims. Below are the findings of the study, which appeared in the American Journal of Public Health:

Excluding white bread, all commonly available food portions exceeded USDA and FDA standards. The largest excesses occurred in cookies (700% over USDA suggestion size), pasta (480%), and muffins (333%).

Portion sizes for foods such as hamburgers, French fries, and soda were two to five times larger in the study than in the past.

Portion sizes started to increase in the 1970s, grew dramatically in the 1980s, and currently continue to rise parallel to increases in average American body weights.

Food manufacturers and restaurants have little incentive to reduce portion sizes: Profits for these companies rise when product size is increased. Also, a recent survey showed that Americans ignore portion sizes when attempting to follow a healthy diet. As portion sizes at restaurants increase, realize that despite what your parents taught you, you don't always have to clean your plate.

Reference: Young LR, Nestle M. The contribution of expanding portion sizes to the U.S. obesity epidemic. American Journal of Public Health 2002:92(2), pp. 246-249.

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