Five Ways to Lower Your Stress

Feeling frazzled? Here are five ways to help you lower your stress. These come from MSNBC and biochemist Shawn Talbott, author of The Cortisol Connection.

1.The first stress-buster: Music. Mellow tunes can have a calming effect on your brain, especially if you’re highly stressed. In one study, patients who got colonoscopies while listening to music had 66% less of the stress hormone cortisol in their bloodstream than those who were scoped in a quiet room. Another study found that listening to music helped people wind down faster at bedtime, and fall asleep quicker than watching TV.

2.Hit the sack early – or take a nap. When you get six hours of sleep instead of the recommended eight hours, your body pumps out 50% more stress hormones all day. Getting a full night’s sleep – or taking a catnap – can bring your cortisol levels right back to normal.

3.Also, drink black tea. The polyphenols and flavonoids in black tea help your body shake off stress more quickly. In a study in England, when volunteers were exposed to stress, the stress hormones of black tea drinkers returned to normal within an hour. However, those who drank fake tea took four hours to get back to normal.

4.Another way to de-stress: Chew gum. Just moving the muscles in your jaw instantly defuses tension. Studies show that gum-chewers are more alert and pump out 15% fewer stress hormones than their gum-deprived counterparts. Why? The act of chewing increases blood flow to your brain, and boosts neural activity in the areas tied to energy and focus.

5.One final way to de-stress: Hang out with a funny friend. According to researchers at Loma Linda University, simply anticipating laughter is enough to cut your stress hormone levels nearly in half. If your favorite Tina Fey clone can’t meet you for coffee, you can get almost the same stress-melting effect by popping in a DVD of a funny movie, or your favorite stand-up comic.

Why Your Vitamins Aren't Working

With promises to boost health and prevent chronic diseases, supplements can seem like an over the counter cure-all. Consumers more than buy into that notion: Vitamins accounted for roughly one-third of the $23.7 billion spent on supplements in 2007, according to the Nutrition Business Journal.

While a handful of studies have demonstrated a strong link between certain supplements and positive health outcomes, there's still limited clinical evidence to support the notion that they are critical to excellent health. In fact, much of that $23.7 billion could have been a waste of money, according to recent research.

In a study released last week in the Archives of Internal Medicine, researchers found that multivitamin use in post-menopausal women neither increased nor decreased risk of cardiovascular diseases or common cancers. And last fall, a major study of almost 35,000 men found no link between vitamin E and selenium supplements and prostate cancer prevention.

Dr. Marian L. Neuhouser, the lead author of the multivitamin study and an associate member of the Fred Hutchinson Cancer Research Center in Seattle, says that while fruits, vegetables and whole grains have been linked to good health and prevention of cancer and cardiovascular disease, that doesn't mean vitamins extracted from those food groups will have the same effect.

Scientists still aren't sure why studies of supplement use don't always mirror what we know to be true about dietary vitamin intake--that it's essential to good health. One reason is that it's very difficult to separate cause from effect. Healthier people tend to take vitamins, but that's not enough proof to establish a definitive link between supplements and optimal health.

"Each consumer needs to decide their own health practices," says Neuhouser. But "they're missing a lot if they think [vitamin] substitution will do the trick."

What the Body Needs
The body requires 13 vitamins and 15 minerals to function properly. Among the necessary vitamins are B6, which maintains brain function; biotin, which is essential for metabolism; and A, which is critical to the maintenance of healthy teeth and bones.

A deficiency in any of these 13 vitamins--which is rare in the U.S.--can cause a range of health problems, including depression, anemia and diminished immunity. An average eater who fills his or her plate mostly with fruits, vegetables and whole grains should meet the daily recommended intake of vitamins, says Dr. John W. Erdman Jr., a professor of food science and human nutrition at the University of Illinois at Urbana-Champaign.

Even skipping leafy greens one day or apples and bananas the next won't adversely affect your health--provided this doesn't become a chronic habit. (Children, pregnant or lactating women and the elderly, however, can be more vulnerable to vitamin deficiencies.)

Despite the fact that a balanced diet provides the right amount of vitamins and minerals, millions of Americans consider supplements as an insurance policy against poor eating choices, chronic disease and chance. At least half of all Americans purchase supplements, according to the Council for Responsible Nutrition, a trade association that represents industry suppliers and manufacturers.

Do Vitamins Work at All?
Unfortunately, there isn't a clear-cut answer as to whether vitamins help one's health. Dr. Andrew Shao, the association's vice president of scientific and regulatory affairs, admits that the science of vitamin use can be confusing at times.

"No one study is the final word," he says, referring to Dr. Neuhouser's results. "It's always evolving, and the results in one trial don't erase the evidence." Some research has demonstrated benefits, according to Shao, including a 2003 study that linked multivitamins to reduced heart attack risk and a 1998 study that linked multivitamins to reduced colon-cancer risk.

Still, several academic reviews, including a major National Institutes of Health conference in 2006, have yet to identify convincing evidence for widespread supplement use--except for in a few cases. Vitamin K, which is essential for coagulation, is routinely given to newborn infants to avoid bleeding problems. Pregnant women receive doses of folic acid and other important vitamins for fetal development.

Dr. Neuhouser also suspects that missing bioactives--compounds like anti-oxidants and isoflavonoids that are thought to act synergistically with vitamins and minerals in food--might be the culprit. Researchers are currently trying to understand what role these compounds play in making naturally occurring vitamins powerfully effective.

The bottom line, says Dr. Patsy Brannon, a professor of nutritional sciences at Cornell University, is that consumers should add vitamins and minerals to their diet with fruits, vegetables and whole grains. She doesn't oppose supplement use, but says consumers should avoid self-prescribing and familiarize themselves with when a dose becomes toxic.

Vitamin use, Brannon says, shouldn't exceed 100% of the recommended daily intake, which is determined by the Department of Agriculture.

"It's always an interesting issue," Brannon says of counseling people on whether to take supplements. "You can choose a multivitamin with just 100% of the daily allowance, but you'll be getting those nutrients anyway."

How to get money for not smoking

When trying to quit smoking, it can help to keep your eyes on the prize — especially if that prize is $750.

A new study shows that smokers who earn financial incentives are three times more likely than others to kick the habit. In an experiment with nearly 900 smokers employed by General Electric, 15% of those given incentives were smoke-free after a year, compared with 5% of those who weren't eligible for cash rewards.

The study rewarded employees for incremental milestones — $100 for completing a smoking-cessation class, another $250 for being smoke-free after six months and $400 more for being smoke-free after a year.

"People are drawn to tangible things," says author Kevin Volpp, a doctor at the Philadelphia VA Medical Center and director of the Center for Health Incentives at the University of Pennsylvania. "It makes it easier for you to do in the short term what you know is in your long-term best interest."

The incentives paid for themselves in about three years, says co-author Robert Galvin, GE's chief medical officer. GE plans to offer a version of the smoking-cessation program next year, although officials haven't yet decided the amount of the incentives.

Tobacco taxes also provide strong incentives to quit, says the American Cancer Society's Tom Glynn, who wasn't involved in the study. Research shows that each 10% increase in the cost of cigarettes reduces the teen smoking rate by 7% and the adult rate by 4%.

He says he understands that some people may question the wisdom of paying people to do something that's in their own best interest. But he notes that we already pay for health problems caused by smoking and obesity, through private insurance premiums and taxes for Medicare.

In the study in today's New England Journal of Medicine, researchers gave everyone information about local smoking-cessation classes and the company's coverage of drugs designed to help them quit. Half were also offered incentives. Each group had about the same number of heavily addicted smokers.

Quitters need all the help they can get, Volpp says, noting that 70% of smokers want to quit but only 3% succeed each year. And the relatively low quit rates in his study — in spite of incentives — underscore how difficult it is to quit, even with help.

Glynn hopes the study will inspire other businesses to help employees quit. "In the long run," he says, "stopping smoking pays off for everyone."

For help with quitting, call 800-QUIT-NOW

Vigorous exercise may prevent vision loss

There’s another reason to dust off those running shoes. Vigorous exercise may help prevent vision loss, according to a pair of studies from the U.S. Department of Energy’s Lawrence Berkeley National Laboratory.

The studies tracked approximately 31,000 runners for more than seven years, and found that running reduced the risk of both cataracts and age-related macular degeneration.

The research, which is among the first to suggest that vigorous exercise may help prevent vision loss, offers hope for people seeking to fend off the onset of eye disease.

“In addition to obtaining regular eye exams, people can take a more active role in preserving their vision,” says Paul Williams, an epidemiologist in Berkeley Lab’s Life Sciences Division who conducted the research. “The studies suggest that people can perhaps lessen their risk for these diseases by taking part in a fitness regimen that includes vigorous exercise.”

A cataract, which is a cloudy opacity of the eye lens, is the leading cause of blindness. More than one-half of people in the U.S. over the age of 65 suffer from some form of cataracts. Age-related macular degeneration, which is damage to the retina, is the leading cause of irreversible vision loss in older white Americans, affecting 28 percent of people aged 75 and older.

The diseases have several known risk factors, such as sunlight exposure and diabetes in the case of cataracts, but few interventions. Now, it appears that vigorous cardiovascular exercise may be one way to derail the diseases.

To conduct the research, Williams analyzed data collected in the National Runners’ Health Study, which he established in 1991 to determine the health benefits of running.

In this case, he followed approximately 29,000 male runners and 12,000 female runners for more than seven years. Of these people, 733 men reported being diagnosed with cataracts on a questionnaire filled out at the end of the study. Too few women reported cataracts to track.

Men who ran more than 5.7 miles per day had a 35 percent lower risk of developing cataracts than men who ran less than 1.4 miles per day. The study also analyzed men’s 10-kilometer race performances, which is a good indicator of overall fitness. The fittest men boasted one-half the risk of developing cataracts compared to the least-fit men.

A second study found that running appeared to reduce the risk of age-related macular degeneration. In the study, 152 men and women reported being diagnosed with the disease. Compared to people who ran less than 1.2 miles per day, people who averaged between 1.2 and 2.4 miles per day had a 19 percent lower risk for the disease, and people who ran more than 2.4 miles per day had between 42 percent and 54 percent lower risk of the disease.

“These findings are compelling because of the large size of the study, and the fact that we are looking at something that is fairly well defined: vigorous exercise, as opposed to more moderate exercise,” says Williams.

Most of the runners in the study exceeded the current public health recommendations for physical activity, which is at least 30 minutes of moderate-intensity activities such as brisk walking five days a week, or smaller doses of more vigorous exercise such as running. It is unclear whether people might also lower their risk for cataracts and age-related macular degeneration by walking.

“We know there are important health benefits to walking, including lowering heart disease risk,” says Williams. “It is quite likely that the studies’ results might apply to a lesser extent to smaller doses of more moderate exercise.”

Williams also adds that further research is needed to explore why there is a link between vigorous exercise and a decreased risk for eye disease.

“We know some of the physiological benefits of exercise, and we know about the physiological background of these diseases, so we need to better understand where there’s an overlap,” says Williams.

The studies are published in the January 2009 issue of Investigative Ophthalmology and Visual Science. They were supported in part by grants from the National Heart Lung and Blood Institute.

Berkeley Lab is a U.S. Department of Energy national laboratory located in Berkeley, California. It conducts unclassified scientific research and is managed by the University of California. Visit our website at http://www.lbl.gov.
Additional information:

* More information on Williams’ research can be found at http://healthresearch.lbl.gov.

U. of C. emergency room to get more selective

The emergency room of the University of Chicago Medical Center may no longer be for every illness or injury.

Have a severe injury from a car accident? Head to the ER. Have pneumonia that can be treated with antibiotics? You may be led elsewhere.

That's because the hospital is changing the way it admits emergency room patients as part of its effort to deal with the worsening economy, a move underscored by Monday's announcement of 450 layoffs, or 5 percent of its workforce.

The U. of C.'s decision to introduce what amounts to a new version of patient triage represents an aggressive and unusual move by one of the city's premier hospitals to cope with spiraling costs and the long waits for emergency treatment.

Some don't like the plan, but the U. of C. says it has no choice.

The academic medical center in the Hyde Park neighborhood said 40 percent of the 80,000 patients who go to its emergency room each year do not need to be there. These visits cost the hospital tens of millions of dollars a year in time spent by staff and specialists whose attention is redirected to cuts, bruises and other less severe conditions that can be treated at community hospitals or through prescriptions.

In addition, the hospital has been dealing with the rising numbers of uninsured, as well as patients covered by Medicaid, which pays low rates and has been months behind on payments to doctors and hospitals in Illinois.

So the hospital is escalating steps to direct these consumers elsewhere, which it says will allow it to focus on treating the sickest of patients, as well as conduct research and train doctors. The U. of C. says its costs are 30 percent to 40 percent higher than community hospitals, which are better positioned to treat a variety of patients.

"We are trying to get the right patients to the right doctor at the right time for their disease and disorder," medical center Chief Executive Dr. James Madara said.

The hospital's effort to manage patient care began as the Urban Health Initiative with a group of executives that included First Lady Michelle Obama, who was involved in early efforts to educate patients on the best use of the emergency room.

Under the escalated program, the emergency department will be reorganized to provide more evaluations from doctors and nurses before care is provided. In the past, the U. of C. treated the patients and then educated them about health clinics, setting appointments at doctor's offices and community centers for follow-up care.

The medical center found in a poll that 60 percent of its patients did not know these community health centers were an option, said Dr. Eric Whitaker, who took over Obama's duties as executive vice president for strategic affiliations and external affairs in January.

Some analysts say the shift in strategy could be risky, particularly if a patient who had a condition that needed the medical center's attention were to be turned away.

"This is tricky," said Jim Unland, president of The Health Capital Group, a consulting firm based in Chicago. "If patients really need to be in an ER and the U. of C. is turning them away, I have a problem with that.

"But if patients can be better served at a primary care clinic or urgent care center, it is a good idea as long as they can get there."

Whitaker said the U. of C. has criteria that nurses and doctors use to make their best judgment—evaluations that routinely are done in emergency departments nationwide. There are times, he said, in any emergency situation where a person is treated and advised to go home only to find out they need to return for more care.

"At the end of the day, we want to have quality care and be sure the people are treated in the right place," Whitaker said.

In some cases, patients will be referred to any of about two dozen health centers throughout the South Side or to either of two community hospitals, Mercy Hospital and Medical Center and Holy Cross Hospital, which have agreed to be partners in the initiative. For some patients, The U. of C. will provide transportation or schedule appointments.

"We are trying to streamline the process so that patients get seen at our nearby partners in a much shorter time frame," Whitaker said.

But it can be confusing for patients who feel they should be able to come to the hospital and get the care they need, particularly from a place like U. of C., which is known for state-of-the-art care.

Take Mary Darden, who was rushed to the medical center by ambulance around 8 a.m. Monday and diagnosed with pneumonia. By mid-afternoon, U. of C. doctors recommended that she be transferred to Mercy Hospital, her family said.

"Why would you keep moving a 92-year-old woman with pneumonia?" said her daughter, Carol Thomas.

Joshua Darden questioned the hospital's judgment in not admitting his grandmother.

"That's what a hospital is for," he said.

The medical center would not comment on the case, but said pneumonia is a common condition that has resulted in many patients being referred elsewhere.

Critics have been looking at the role of non-profit hospitals in communities and how they balance business decisions against their missions to provide care.

Sen. Charles Grassley (R- Iowa) has been looking into the U. of C.'s Urban Health Initiative and said through a spokeswoman Monday that the announcement "raises questions that should be asked as part of the review."

Grassley has a say in how federal dollars are spent in health care as the ranking Republican on the powerful Senate finance committee.

The U. of C. was also criticized for Monday's layoff announcement. The hospital did not specify where cuts will be made, but said patient care will not be affected.

Representatives for the workers say the cuts will have an impact.

"Of course, sizable cuts are going to impact everything the university does, including patient care," said Joe Sexauer, union representative for Teamsters Local 743, which represents clerical, service and maintenance workers and licensed practical nurses. "It is important to have an adequate staff to provide accurate medical information, and it's important to have adequate environmental service workers [janitors] so you can kill enough germs."

Cigarettes' Cost in Dollars and Lives

At least one of every 10 patients arrive at Jeffrey D. Forman's medical office with an oxygen tank.

They lug them like carry-on bags. They wheel them on devices that resemble golf caddies, careful not to tangle the plastic tubing that fills their nostrils with life-giving oxygen.

Once, it was cigarettes they carried. Now, battling lung cancer, emphysema or a wasting disease called chronic pulmonary obstructive disorder, they bear the costs of a lifetime of smoking. They illustrate the price that all Americans pay for tobacco and the reason why Virginia Gov. Timothy M. Kaine (D) has brought his tobacco-producing state closer than ever to a ban on smoking in bars and restaurants.

After five decades of smoking, Pattie Tatem, 67, sits in a wheelchair with an oxygen tank at her feet, a victim of severe chronic obstructive pulmonary disease. The disease takes her breath away and makes her feel as if she's drowning. It wiped out her retirement savings. Now it's slowly killing her.

"It catches up with you, and when it hits you, it hits you hard," said Tatem, whose treatment costs are footed mostly by taxpayers through Medicare.

To recover some of Virginia's health-care costs caused by tobacco, Kaine proposed doubling the state tax on cigarettes to 60 cents a pack. The governor and the General Assembly took aim at tobacco in other ways, too, by moving to ban smoking in restaurants and bars and prohibiting people from lighting up in a vehicle when a child is present.

Last week, Kaine announced a compromise with House Speaker William J. Howell (R-Stafford) on a smoking ban that some anti-smoking advocates criticized as too timid. But in years past, even that would have been dead on arrival in the House. The governor's tobacco tax, in contrast, never made it to the floor of the Republican-controlled House or the Democratic-controlled Senate.

In a state whose fortunes have been interwoven with tobacco since Colonial times, opponents warned against damaging an industry that contributes healthy paychecks and tax revenue to the commonwealth.

"These are jobs in my community you're talking about," said Sen. John C. Watkins (R-Chesterfield), whose district is near Philip Morris USA.

But doctors, health advocates and patients tally the costs differently: More than 9,000 Virginians die every year because of tobacco use, and more than 9,000 Virginia youths get hooked every year. More than 1,000 people die from secondhand smoke.

Laurens Sartoris, president of the Virginia Hospital & Healthcare Association, said Virginians pay financially, too, because they pay for smokers' medical bills.

Consider Medicaid, the government-run health insurance for the poor. The program, whose costs are split by states and the federal government, reimburses doctors, hospitals and other providers at a rate substantially below the cost of medical care.

When a smoker goes into the hospital for cancer treatment -- smokers are statistically more likely to need medical care earlier and longer than nonsmokers -- Medicaid covers 75 cents of every dollar in expenses. Taxpayers and patients with private insurance make up the difference.

"That is a hidden, extraordinary, regressive tax on everybody's insurance premiums," Sartoris said.

That's why anti-smoking advocates had pushed for a bigger tobacco tax: to narrow a $148 million gap in Virginia's Medicaid funds that is expected to grow. Along with the smoking ban, the tax would pay further dividends by inhibiting people from starting to smoke and forcing others to cut down, advocates said.

Research shows that for every 10 percent increase in the price of cigarettes, tobacco use drops 7 percent among youths and 2 percent among adults.

Forman, who grew up in Howard County, sees the human consequences of smoking every day. At least half of his patients are smokers or former smokers.

Forman can easily spot the signs of blocked airways: Patients purse their lips, puffing and hyper-inflating their chests in an effort to empty their damaged lungs. After a few minutes with a CT scan, he finds a spidery white speck that means a cluster of cancer cells has taken root in a person's lung.

Then he must break the news to people such as Don Eason.

"I said, 'What you're telling me is, I'm going to die,' " recalled Eason, who underwent surgery about three years ago to remove his right lung and a chunk of his left.

Like many smokers, Eason, 70, an easygoing man with white hair, a Southern accent and a persistent cough, knows what led to this. He was 15 years old and stocking shelves at the A&P in Franklin, Va., when he first smoked. It was a Pall Mall then, and later Salem menthols.

Eason enlisted in the Air Force, became a traveling salesman, ran a barbershop, married, had children and divorced. But cigarettes were a constant. He smoked a pack, maybe a pack and a half, every day.

"Back then, a cigarette and a radio were your buddies," Eason said, remembering the days on the road peddling farm equipment.

After doctors told Eason that he had a year to live, he put his affairs in order. He did not want to leave debts for his daughters to pay. He gave away belongings. He picked out a coffin.

Tatem, a wisecracking former dental hygienist, also started smoking young. As a teenager in Norfolk, she and some girlfriends pilfered Lucky Strikes from her mother's purse. Soon, she became a pack-a-day smoker. Her favorite ritual centered on a morning cigarette, a freshly brewed pot of coffee and a chocolate cookie.

These days, Tatem must be connected to the oxygen supply at all times, a nuisance when the tubes irritate her nostrils or get tangled underfoot in her living room. Her skin, gray and fragile, rips as easily as wet paper, one of the effects of a medication that helps her breathe. Another makes her bones brittle, causing painful fractures.

Two years ago, Tatem was rushed to the hospital. Doctors put her in the hospice unit.

"They said there wasn't anything they could do for me," Tatem said. She rallied, but she said she knows that her prognosis is grim. And she, too, wishes she had never smoked.

"I feel angry at myself for doing it, because no one made me do it," she said.